Perioperative Medicine最新文献

{"title":"Perioperative real-time information sharing and its impact on family members' anxiety in patients undergoing elective thoracoscopic lobectomy: a single-center randomized controlled trial.","authors":"Yun Linjun, Luo Xi, Ying Yanmei, Luo Wulajing, Fang Linjie, Kang Jingping, He Xiao","doi":"10.1186/s13741-025-00499-8","DOIUrl":"10.1186/s13741-025-00499-8","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the effect of perioperative real-time information sharing on family members' anxiety in patients undergoing elective thoracoscopic lobectomy and to explore the potential role of information sharing in reducing anxiety levels among family members.</p><p><strong>Methods: </strong>This study was a prospective, single-center, well-designed randomized controlled trial (RCT), ensuring methodological rigor, which included family members of patients undergoing elective thoracoscopic lobectomy. Participants were randomly assigned to either the experimental group (real-time information-sharing group) or the control group (routine information communication group). Anxiety levels were assessed at multiple time points, including preoperative (T-1), intraoperative (T1, T2, T3, T4), and postoperative (T5, T6) stages, using widely used anxiety scales: the Self-Rating Anxiety Scale (SAS), the Hospital Anxiety and Depression Scale (HADS), and the Generalized Anxiety Disorder 7 (GAD-7). Statistical analysis was performed using independent sample t-tests, with statistical significance set at P < 0.05 based on a predefined threshold.</p><p><strong>Results: </strong>At several key time points (T0, T1, T2, T3, T4, T5), family members in the experimental group showed significantly lower anxiety scores compared to those in the control group (P < 0.05). Notably, at T1 (when the patient entered the operating room) and T2 (30 min after the surgery began), the GAD-7 scores of the experimental group were significantly lower than those in the control group (T = 2.98, P = 0.003; T = 3.45, P = 0.001). The experimental group also had significantly lower SAS and HADS scores at time points T-1, T0, T1, T2, T3, and T4 compared to the control group.</p><p><strong>Conclusion: </strong>Perioperative real-time information sharing has been shown to significantly reduce anxiety levels in family members of patients undergoing elective thoracoscopic lobectomy, particularly during the early stages of surgery, such as when the patient enters the operating room and 30 min after the surgery begins. Real-time information sharing may serve as an effective intervention to improve the psychological well-being of family members and is worth promoting in clinical practice.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"19"},"PeriodicalIF":2.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11817257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of remimazolam and propofol on sleep rhythm and delirium after spinal surgery in elderly patients.","authors":"Li Yaqiu, Zhou Heng, Wu Ruimin, Wang Xuri","doi":"10.1186/s13741-025-00500-4","DOIUrl":"10.1186/s13741-025-00500-4","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate the effects of remimazolam on postoperative melatonin secretion, sleep rhythm, and postoperative delirium (POD) in elderly patients undergoing spinal surgery.</p><p><strong>Methods: </strong>We selected 120 elderly patients scheduled for elective spinal surgery (lumbar interbody fusion via a posterior approach) under general anaesthesia from November 2023 to January 2024. They were divided into 2 groups according to medication, the remimazolam group (R group) and the propofol group (P group), with 60 patients in each group. The R group received an induction dose of remimazolam 0.2 ~ 0.3 mg/kg, followed by a continuous infusion of remimazolam at 0.1-0.2 mg/kg/h for maintenance. The P group received an induction dose of propofol 1.5 ~ 2.0 mg/kg, followed by a continuous infusion of propofol at 4-6 mg/kg/h for maintenance. Melatonin and cortisol concentrations were measured at 04:00 on the day of surgery and postoperative days 1, 2, and 3. The Pittsburgh Sleep Quality Index (PSQI) and resting visual analog scale (VAS) pain scores were recorded on the day before surgery, and on postoperative days 1 and 2, as well as prior to discharge. Additionally, we documented extubation time, PACU stay duration, total and effective button presses on the analgesia pump, instances of supplemental analgesia, and occurrence of complications.</p><p><strong>Results: </strong>Compared to the P group, the R group exhibited significantly shorter extubation time and PACU stay duration (P < 0.05). On postoperative days 1 and 2 at 04:00, melatonin concentrations were significantly higher, cortisol concentrations were significantly lower, and PSQI scores were significantly reduced in the R group (P < 0.05). The incidence of POD and postoperative sleep disturbance (POSD) was also significantly lower in the R group (P < 0.05). Furthermore, on postoperative day 1, the PSQI and resting VAS pain scores in the R group were significantly lower compared to the P group (P < 0.05). There were no statistically significant differences between the two groups in terms of surgery duration, anaesthesia duration, total and effective analgesia pump button presses, supplemental analgesia rates, intraoperative hypotension, or incidences of postoperative nausea, vomiting, dizziness, and respiratory depression (P > 0.05).</p><p><strong>Conclusion: </strong>The use of remimazolam in elderly patients undergoing spinal surgery has a minimal impact on postoperative melatonin and cortisol secretion rhythms and sleep patterns, and may reduce the incidence of POD and alleviate postoperative sleep disturbances.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"18"},"PeriodicalIF":2.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11817572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative mechanical circulatory support: transitioning from sequential to parallel recovery.","authors":"Jean Deschamps, Andrew D Shaw","doi":"10.1186/s13741-025-00498-9","DOIUrl":"10.1186/s13741-025-00498-9","url":null,"abstract":"","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"17"},"PeriodicalIF":2.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid-free versus opioid-based anesthesia in laparoscopic sleeve gastrectomy: a single-center, randomized, controlled trial.","authors":"Hanane Barakat, Linda Gholmieh, Jessy Abou Nader, Vanda Yazbeck Karam, Obey Albaini, Mohamad El Helou, Rony Al Nawwar","doi":"10.1186/s13741-024-00486-5","DOIUrl":"10.1186/s13741-024-00486-5","url":null,"abstract":"<p><strong>Background: </strong>Opioids are commonly used in general anesthesia for pain management. However, they are linked to significant side effects. Patients undergoing laparoscopic sleeve gastrectomy, particularly those with obesity, are at higher risk of experiencing adverse effects associated with opioids. Therefore, there is a need to explore alternative anesthesia options that do not rely on opioids. This study aims to investigate the efficacy of opioid-free anesthesia (OFA) compared to traditional opioid-based anesthesia (OBA) in patients undergoing laparoscopic sleeve gastrectomy.</p><p><strong>Methods: </strong>This single-center randomized controlled trial included eighty-three patients undergoing laparoscopic sleeve gastrectomy in a tertiary hospital. Patients were randomly assigned to dexmedetomidine and lidocaine infusion (OFA) or remifentanil (OBA). All patients received intra-operative propofol, sevoflurane, a neuromuscular blocking agent, and ketamine. The primary outcome included opioid consumption during the post-anesthesia care unit (PACU). Secondary measures included intraoperative hemodynamic stability, time to extubation, PACU stay duration, opioid consumption during the first 48 h, and anti-emetic requirements. Independent samples t-test or Mann-Whitney U test was used to assess for differences across the two groups.</p><p><strong>Results: </strong>PACU morphine consumption, total postoperative morphine consumption, anti-emetic requirements up to 48 h after surgery, and pain levels after surgery were not statistically significantly different between OFA and OBA groups. Other variables were not statistically different between the two groups, except for intraoperative anti-hypertensives where more patients in the OFA groups required it.</p><p><strong>Conclusions: </strong>Opioid-free anesthesia hasn't shown an opioid-sparing effect in patients with obesity undergoing laparoscopic sleeve gastrectomy. Larger multi-center studies are required to fully establish its effectiveness.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT03507634); first trial registration date: 12/04/2018; first posted date: 25/04/2018.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"16"},"PeriodicalIF":2.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of remote ischemic preconditioning on perioperative neurocognitive disorder in elderly patients undergoing major surgery and associated genetic variant analysis: a randomized clinical trial.","authors":"Feifei Xu, Tingting Liu, Huiqing Liu, Jiao Deng, Shan He, Zhihong Lu, Haopeng Zhang, Hailong Dong","doi":"10.1186/s13741-025-00497-w","DOIUrl":"10.1186/s13741-025-00497-w","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether remote ischemic preconditioning (RIPC) could reduce the incidence of perioperative neurocognitive disorder (PND) in elderly patients undergoing major surgery (> 2 h), to assess the potential of myeloid differentiation factor 2 (MD2) and cystatin C as biomarkers and to identify key genetic variants associated with PND.</p><p><strong>Methods: </strong>From August 2020, 250 patients scheduled for major surgeries under general anesthesia were screened and 120 patients were randomly assigned to the control group or the RIPC group. After anesthesia induction, patients in the RIPC group received a blood pressure cuff around their right upper limb, which was pressurized to 200 mmHg to induce ischemia, whereas the cuff in the control group was pressurized to only 60 mmHg. A total of five cycles were repeated with ischemia for five minutes and reperfusion for five minutes. Six neurological tests were performed before and after the surgery to assess the incidence of PND. Serum levels of myeloid differentiation factor 2 (MD2) and Cystatin C and PND-associated single nucleotide polymorphisms were analyzed by ELISA and whole genome sequencing, respectively. This study adhered to CONSORT research guidelines.</p><p><strong>Results: </strong>In the RIPC group, the incidence of PND (44%) was comparable to that in the control group (44%, P = 0.982). There was no significant difference in the concentrations of MD2 or cystatin C between the NPND and PND groups. A total of 3877 mutated genes were exclusively identified in PND patients. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis revealed that these mutated genes are enriched in synapse function. Notably, a Shank3 variant (SNP rs4824145) was included.</p><p><strong>Conclusions: </strong>RIPC had little effect on the incidence of PND in elderly patients who underwent major surgery (> 2 h). MD2 and cystatin C were unable to predict the occurrence of PND. Patients harboring rs4824145 in the Shank3 gene may be more susceptible to PND.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry (ChiCTR2000035020(07/28/2020)).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"15"},"PeriodicalIF":2.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Length of stay after colorectal surgery in Italy: the gap between \"fit for\" and \"actual\" discharge in a prospective cohort of 4529 cases.","authors":"Lorenzo Pandolfini, Duccio Conti, Piercarlo Ballo, Silvia Rollo, Alessandro Falsetto, Gian Matteo Paroli, Paolo Ciano, Michele Benedetti, Leonardo Antonio Montemurro, Giacomo Ruffo, Massimo Giuseppe Viola, Felice Borghi, Gianandrea Baldazzi, Massimo Basti, Pierluigi Marini, Mariano Fortunato Armellino, Vincenzo Bottino, Giovanni Ciaccio, Alessandro Carrara, Gianluca Guercioni, Marco Scatizzi, Marco Catarci","doi":"10.1186/s13741-025-00492-1","DOIUrl":"10.1186/s13741-025-00492-1","url":null,"abstract":"<p><strong>Background: </strong>It is common to observe a gap between the day on which the discharge criteria are reached and the actual day of discharge after colorectal surgery. The aim of this study is to understand the reasons for this difference and its clinical impact on the overall length of stay (LOS).</p><p><strong>Methods: </strong>All patients enrolled in the prospective iCral3 study were analyzed regarding any difference and reason between the \"fit for discharge\" (FFD) and \"actual discharge\" (AD) dates. The association between the gap and the LOS in the whole population was then assessed through a multivariate regression model including other confounding variables.</p><p><strong>Results: </strong>The analysis included 4529 patients, with a median [IQR] LOS of 6 [4-8] days. The median [IQR] LOS was 6 [4-8] days in the no-gap group (3,910 patients, 86.3%), significantly lower (p < .001) than 7 [6-10] days in the gap group (619 patients, 13.7%). Among the gap reasons, the \"need for postoperative rehabilitation\" compared to \"not willing to return home\" and \"social constraints\" was associated with the longest LOS (9 [6.0-12.5] days, p < 0.001 vs other reasons). The existence of the gap independently determined a 2.3-day lengthening of LOS.</p><p><strong>Conclusions: </strong>Among other factors, the gap between FFD and AD had an independent impact on LOS. The most frequent reasons for this gap were \"not willing to return home\" and \"social constraint\", while the \"need for postoperative rehabilitation\" had the greater clinical impact.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"14"},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construction and application of a stratified nursing intervention program for postoperative delirium after Stanford type A aortic dissection: a quasi-experimental trial.","authors":"Xueping Li, Miaomiao Zheng, Ailin Lin, Chaohong Chen, Yuanbo Wu, Huai Zhang, Zhiqin Yin","doi":"10.1186/s13741-025-00495-y","DOIUrl":"10.1186/s13741-025-00495-y","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium is a common and significant consequence in patients with type A aortic dissection following surgery; however, there is currently no effective postoperative care plan.</p><p><strong>Objective: </strong>The purpose of this study is to develop and evaluate the practical implementation of a stratified nursing intervention program for postoperative delirium in patients undergoing surgery for Stanford type A aortic dissection.</p><p><strong>Methods: </strong>A stratified nursing intervention program for postoperative delirium was created using a literature review, group discussions, and the Delphi method via expert mail inquiry. A quasi-experimental design was used, with patients admitted to the general ward of a tertiary hospital in Wenzhou, China, functioning as subjects. From September to December 2022, 43 patients were included in the control group and given standard treatment. From January to June 2023, 37 patients were recruited in the intervention group, receiving both routine care and the intervention plan. The intervention's effects were compared in the two groups.</p><p><strong>Results: </strong>The intervention group had considerably shorter delirium and hospital stays than the control group (P < 0.05), as well as higher patient satisfaction levels. There were no inadvertent extubations in the intervention group. When the incidence and beginning time of delirium in the general ward were compared, there were no significant differences between the two groups (P > 0.05).</p><p><strong>Conclusion: </strong>Implementing this nurse intervention in the ward context can shorten postoperative delirium and hospital stays, increase patient satisfaction with care, and improve patient prognosis and quality of life. This intervention will also serve as a great resource for future clinical management of postoperative delirium.</p><p><strong>Trial registration: </strong>The National Health Security Information Platform's Medical Research Registration Information System has registered this study under the registration number MR-33-22-022978.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"13"},"PeriodicalIF":2.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global research trends in music therapy for surgery: a bibliometric analysis (2009-2023).","authors":"Xiaoping Xu, Zhenglan Zhong, Yong Yi","doi":"10.1186/s13741-025-00496-x","DOIUrl":"10.1186/s13741-025-00496-x","url":null,"abstract":"<p><p>Music therapy, known for its profound impact on human emotions and physiology, has gained increasing attention for its applications in medical settings, particularly in surgery. This study conducted a bibliometric analysis of publications on the application of music therapy in surgery from 2009 to 2023, utilizing the Web of Science Core Collection (WoSCC) as the primary database. A total of 479 publications were analyzed using VOSviewer, CiteSpace, Microsoft Excel, and online bibliometric tools. Findings indicate a steady increase in annual publications since 2009, peaking in 2021. The USA leads global research efforts with 31.7% of publications, followed by China (17.7%) and Italy (10%). Harvard University was identified as the top contributing institution, while the Journal of Perianesthesia Nursing was the primary publishing journal, and the Cochrane Database of Systematic Reviews was the highest co-cited journal. Cao Hua contributed the most publications, and Nilsson U was identified as the most co-cited author (n = 131). Keyword analysis highlighted anxiety, therapy, music therapy, and pain as primary research trends. This study provides valuable insights into the evolving landscape of music therapy research in surgical contexts. Future efforts should focus on expanding interdisciplinary collaborations, exploring advanced technologies for personalized interventions, and investigating optimal implementation strategies to enhance the integration of music therapy into surgical practice.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"12"},"PeriodicalIF":2.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clients' experiences in their first entry to the operating room: a descriptive phenomenological study.","authors":"Nasim Alipour, Amir Jalali, Rostam Jalali, Alireza Khatony","doi":"10.1186/s13741-025-00494-z","DOIUrl":"10.1186/s13741-025-00494-z","url":null,"abstract":"<p><strong>Background: </strong>The unfamiliar atmosphere of the operating room, waiting for anesthesia, and the process of surgery and anesthesia are some of the factors causing fear and anxiety in patients. It leads to physical and psychological pressure on patients. Better understanding of patients' feelings, beliefs, or fears and recording their experiences for optimal care after surgery is helpful. This study explains the experiences of clients in the first entry to the operating room.</p><p><strong>Methods: </strong>This qualitative study was conducted using a descriptive phenomenological method. In this study, 17 patients who had the experience of entering the operating room for the first time as an elective surgery under general anesthesia over the last 6 months were purposefully selected as participants. Then, they underwent an in-depth and semi-structured interview. After conducting the interview, the participants' statements were qualitatively analyzed using the seven-step Colaizzi method. During the steps of this study, Lincoln and Guba's four reliable criteria were observed.</p><p><strong>Results: </strong>By continuous analysis of interviews about patients' experiences, 308 codes, 10 sub-themes, 6 primary themes, and 3 general themes were obtained. Themes included unpleasant emotions experienced, unpleasant atmosphere factors, and the induction of relaxation and hope.</p><p><strong>Conclusion: </strong>Patients' exposure to an unfamiliar place with new and unknown equipment, personnel with different clothing, stress, worry, psychosomatic reactions following stress, and annoying environmental factors can lead to an unpleasant experience for patients, if they are not managed. Also, the effective communication of the surgical team with the patients leads to reducing or removing the stress and complications caused by it.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"11"},"PeriodicalIF":2.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of continuous positive airway pressure (CPAP) application on airway problems in pediatric patients with subglottic stenosis who undergo balloon dilatation.","authors":"Zeliha Tuncel, Şenay Göksu, Özlem Deligöz, Kemal Tolga Saracoglu, Abdulatif Albasha, Bushra M Abdallah, Ayten Saracoglu","doi":"10.1186/s13741-024-00478-5","DOIUrl":"10.1186/s13741-024-00478-5","url":null,"abstract":"<p><strong>Background: </strong>Subglottic stenosis is a significant clinical challenge in pediatric anesthesia, often necessitating interventions that can lead to various postoperative complications. The aim of this study was to determine the effect of prophylactic continuous positive airway pressure (CPAP) application on recovery time and airway complications in pediatric patients with subglottic stenosis undergoing balloon dilatation.</p><p><strong>Methods: </strong>A prospective, double-blinded, parallel-group, randomized controlled study was conducted at Health Sciences University Ümraniye Training and Research Hospital on pediatric patients with subglottic stenosis, aged from 0 to 12 years and who underwent elective balloon dilatation under general anesthesia. Patients were randomized in a 1:1 ratio into the CPAP or non-CPAP group. The primary outcome was the duration of recovery time. Secondary outcomes included bronchospasm, the number of desaturation episodes, intubation, tracheostomy, and the need for intensive care.</p><p><strong>Results: </strong>A total of 84 patients were enrolled in this randomized controlled trial, 81 of which received the allocated treatment and were analyzed (non-CPAP n = 41, CPAP n = 40). Compared to controls, the proportions of bronchospasm, tracheal secretion, need for intensive care, and tracheostomy were consistently lower in the CPAP group, whereas the requirement of intubation was higher. Further, the mean recovery time was significantly shorter in the CPAP group compared to the non-CPAP group (mean difference - 3.3 min, 95%CI - 5.16 to - 1.44, p = 0.0007). Despite lacking statistical significance, the CPAP group had reduced odds of developing bronchospasm, tracheal secretion, need for intensive care, and tracheostomy, but higher odds of requiring intubation when compared to the controls.</p><p><strong>Conclusion: </strong>Prophylactic CPAP application following therapeutic balloon dilatation in pediatric patients who have developed subglottic stenosis due to acquired or congenital causes appears to effectively shorten recovery time and may have a role in decreasing postoperative pulmonary complications; however, more research is recommended to further confirm these findings.</p><p><strong>Trial registration: </strong>The protocol for this clinical trial was retrospectively registered on clinicaltrials.gov with registration ID NCT06183515 on 30 November 2023.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"10"},"PeriodicalIF":2.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}