Perioperative Medicine最新文献

{"title":"In-hospital coded prevalence and associated factors of postoperative delirium following rotator cuff repair surgery: a retrospective national inpatient sample database study.","authors":"Shengze He, Rui Liu, Nanfeng Huang, Jia Guo, Jie Bai, Hao Xie, Yingbin Wang, Qi Liu","doi":"10.1186/s13741-026-00709-x","DOIUrl":"10.1186/s13741-026-00709-x","url":null,"abstract":"<p><strong>Background: </strong>While postoperative delirium (POD) is a well-known postoperative complication, research on its incidence and risk factors in rotator cuff repair surgeries lacks a robust analysis using a comprehensive national dataset.</p><p><strong>Methods: </strong>Leveraging the National Inpatient Sample (NIS), the most extensive all-payer hospital database in the U.S., we performed a retrospective cohort study analyzing 7,216 patients who underwent rotator cuff repair from 2016 to 2019. Our assessment included patient demographics, hospital-related variables, comorbid conditions, and postoperative adverse events to identify key associations.</p><p><strong>Results: </strong>Among patients undergoing inpatient rotator cuff repair between 2016 and 2019, the in-hospital coded prevalence of POD was 7.5%, with the highest rate (8.8%) recorded in 2019. Patients who developed POD following rotator cuff repair surgery demonstrated several adverse outcomes, including advanced age, increased comorbidity burden, prolonged hospital stays, and higher hospitalization costs (p < 0.001). They were also more prone to experiencing various perioperative medical and surgical complications during their hospitalization. These complications encompassed urinary tract infections, pneumonia, acute renal failure, septicemia, thrombocytopenia, blood transfusions, acute cerebrovascular events, peripheral vascular disease, urinary retention, and other medical concerns. Surgical complications, such as hemorrhage, seroma, or hematoma, were also observed. Multiple factors were associated with POD, including advanced age (65 years or older), Medicaid or private insurance coverage, alcohol or drug abuse, deficiency anemias, neurological disorders, and psychoses. On the other hand, being female and having an elective hospital admission reduced the risk of developing POD.</p><p><strong>Conclusion: </strong>Among patients undergoing inpatient rotator cuff repair, POD had an in-hospital coded prevalence of 7.5%-a non-negligible proportion. Studying its contributing factors remains important, and recognizing these risks may help clinicians refine treatment approaches and enhance patient recovery. These findings are not generalizable to outpatient rotator cuff repair procedures.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239923","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 postoperative esketamine on depression after pancreatoduodenectomy: a randomized controlled trial.","authors":"Bowen Zhang, Zhun Wang, Kaili Yu, Qian Pan, Shan Guan, Mengxue Zhang, Ruoshuang Jia, Yilin Wang, Qingxiang Meng, Ying Ma, Dongliang Mu, Yiqing Yin","doi":"10.1186/s13741-026-00711-3","DOIUrl":"10.1186/s13741-026-00711-3","url":null,"abstract":"<p><strong>Background: </strong>Pancreaticoduodenectomy (PD) can lead to major trauma in terms of patients' mental health, including severe postoperative depression. This study aimed to investigate the effects of supplementing patient-controlled analgesia with low-dose esketamine on postoperative depression among patients undergoing PD.</p><p><strong>Methods: </strong>Eighty patients who were scheduled for PD were randomly assigned to either the control or esketamine groups. The control group received 2 µg/kg of sufentanil for patient-controlled analgesia (PCIA), whereas the esketamine group received a combination of 1.5 mg/kg esketamine and 2 µg/kg sufentanil. The primary outcome was the incidence of depression on the third postoperative day. The secondary outcomes included the Hamilton Depression Scale (HAMD-17) scores on the first, second, third, and fifth postoperative days; the severity of postoperative pain; the analgesic dosage; the incidence of postoperative adverse effects; the concentrations of plasma 5-hydroxytryptamine (5-HT), brain-derived neurotrophic factor (BDNF), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α); and the one-year survival rate.</p><p><strong>Results: </strong>The incidence of depression on the third postoperative day did not differ significantly between the two groups (47.1% vs. 42.9%, P = 0.726). However, the change in the HAMD-17 score between baseline and the fifth postoperative day was significantly lower in the esketamine group (P = 0.029). The number of PCIA button presses was significantly lower in the esketamine group than in the control group (9.32 ± 6.48 vs. 6.54 ± 4.39, P = 0.040), and opioid usage was also significantly lower in the esketamine group (114.9 ± 23.32 vs. 100.9 ± 25.72, P = 0.021). Furthermore, esketamine decreased the plasma concentration of IL-6 on the first postoperative day (P < 0.05) and that of TNF-α on the fifth postoperative day (P < 0.05).</p><p><strong>Conclusion: </strong>The postoperative administration of esketamine may reduce the need for analgesics among patients undergoing PD, alleviate peripheral inflammation, and potentially improve postoperative depressive symptoms.</p><p><strong>Trial registration: </strong>This trial was registered at http://www.chictr.org.cn (ChiCTR2200066303, Principal investigator: Yinqing Yin, Date of registration: 2022-11-30).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239936","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":"Penehyclidine in the prevention of postoperative pulmonary complications in patients after general anesthesia: a systematic review and meta-analysis.","authors":"Songchao Wang, Ying Chen, Suwan Dai, Rong Wang, Qihong Shen","doi":"10.1186/s13741-026-00704-2","DOIUrl":"https://doi.org/10.1186/s13741-026-00704-2","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing general anesthesia are susceptible to postoperative complications, among which postoperative pulmonary complications (PPCs) are highly prevalent. Penehyclidine (PHC) is a novel anticholinergic agent; however, its efficacy in preventing PPCs remains uncertain. Therefore, this systematic review and meta-analysis was conducted to evaluate the efficacy of PHC in preventing PPCs in patients undergoing general anesthesia.</p><p><strong>Methods: </strong>Randomized controlled trials (RCTs) were searched without language restrictions from database inception to December 31, 2023. Published literature was retrieved from Web of Science, The Cochrane Library, PubMed, EMbase, Sinomed, China National Knowledge Infrastructure (CNKI), and Wanfang Database. The references of the included studies were also manually screened. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.</p><p><strong>Results: </strong>A total of 10 randomized controlled trials involving 1,313 patients were included in this study. The forest plot demonstrated that, compared with the control group, PHC was associated with a lower incidence of PPCs (RR = 0.59, 95% CI [0.44, 0.78]; P = 0.0003, I2 = 50%). The subgroup analysis of intravenous administration yielded consistent results. In addition, inflammatory marker levels and airway resistance were significantly reduced in the PHC group. However, no significant differences were observed in length of hospital stay, extubation time, or mortality.</p><p><strong>Conclusion: </strong>The findings of this study suggest that PHC may be associated with a reduced incidence of PPCs. PHC was also associated with lower postoperative inflammatory marker levels and improved respiratory mechanics. However, large-scale randomized clinical trials are still required.</p><p><strong>Trial registration: </strong>The study was registered in PROSPERO under registration number CRD42022327301.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The preventive effect of feedforward control nursing on complications and adverse events during the recovery period of gynecological general anesthesia patients.","authors":"Lan Sun, Yanyue Mu, Jie Liu, Jun Wang","doi":"10.1186/s13741-026-00706-0","DOIUrl":"10.1186/s13741-026-00706-0","url":null,"abstract":"<p><strong>Objective: </strong>To explore the preventive effect of feedforward control nursing on complications and adverse events during the recovery period of gynecological general anesthesia patients.</p><p><strong>Methods: </strong>Total 130 patients who underwent gynecological general anesthesia surgery at our hospital during January 2023 to January 2025 were selected as the research subjects. A retrospective analysis of clinical data was performed. According to different nursing methods, they were divided into a conventional group (n = 64) and a feedforward group (n = 66). The conventional group received routine nursing. The feedforward group received feedforward control nursing interventions on the basis of the conventional group. The complications, adverse nursing events, quality of general anesthesia resuscitation and nursing satisfaction were compared between the two groups. The Aldrete awakening scores at the time of entry and exit were analyzed between the two groups.</p><p><strong>Results: </strong>The feedforward group had fewer various complications and lower overall incidence of complications than the conventional group (P < 0.05). The feedforward group had much lower total incidence of adverse nursing events than the conventional group (P < 0.05). The feedforward group had shorter retention time, spontaneous breathing recovery time, extubation time, and awakening time than the conventional group (P < 0.05). There was no statistically significant difference in the total scores of consciousness, blood oxygen, respiration, activity, blood pressure, and physiological functions between the two groups when entering the room (P > 0.05). However, the scores of various physiological functions in both groups were higher when exiting the room than entering the room, and the feedforward group had much higher scores than the conventional group (P < 0.05). The satisfaction rate of nursing in the feedforward group was 92.42%, markedly higher than 78.13% of the conventional group (P < 0.05).</p><p><strong>Conclusion: </strong>Feedforward control nursing can effectively prevent complications and adverse events during the recovery period of gynecological general anesthesia patients, have positive significance in improving overall recovery quality and nursing satisfaction and promoting patient recovery.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219154","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 impact of preoperative sleep disorders on postoperative pain and recovery in patients undergoing gastrectomy: a prospective cohort study.","authors":"Wenzhi Zhu, Shuxia Li, Yan Huang, Xiaoyi Wang, Hongyu Tan","doi":"10.1186/s13741-026-00699-w","DOIUrl":"10.1186/s13741-026-00699-w","url":null,"abstract":"<p><strong>Background: </strong>Poor sleep quality is a common comorbidity in surgical patients, but its specific impact on postoperative outcomes in gastric cancer surgery remains underexplored. This study investigated the association of preoperative sleep disorders on pain sensitivity, analgesic consumption, and recovery in this population.</p><p><strong>Methods: </strong>One hundred patients undergoing elective gastrectomy were prospectively enrolled and stratified into two groups based on the Pittsburgh Sleep Quality Index (PSQI): a Non-Sleep Disorder group (PSQI < 8, n = 50) and a Sleep Disorder group (PSQI ≥ 8, n = 50). Preoperative assessments included quantitative sensory testing (pressure, cold, heat), anxiety and depression scales, and sleep quality. Postoperative outcomes included pain scores (VAS), sufentanil consumption, rescue analgesia, recovery milestones, and length of hospital stay (LOS).</p><p><strong>Results: </strong>Preoperatively, the Sleep Disorder group demonstrated a significantly lower heat pain threshold (19.63 ± 14.32 s vs. 33.89 ± 16.78 s, p < 0.001) and a higher heat pain score (3.56 ± 1.76 vs. 2.50 ± 0.89, p < 0.001). Postoperatively, this group reported higher VAS scores at extubation (2.60 ± 0.67 vs. 1.88 ± 0.85, p < 0.001), required more rescue analgesia (38.0% vs. 14.0%, p = 0.011), and consumed more sufentanil at 24 h (111.38 ± 39.24 µg vs. 97.71 ± 25.31 µg, p = 0.042) and 48 h (190.46 ± 61.75 µg vs. 169.39 ± 36.83 µg, p = 0.041). Despite a shorter time to first flatus (4.48 ± 1.92 vs. 5.36 ± 2.30 days, p = 0.040), their overall LOS was significantly longer (8.0 vs. 7.0 days, p = 0.005).</p><p><strong>Conclusion: </strong>In patients undergoing gastric cancer surgery, preoperative sleep disorders are associated with heightened pain sensitivity, increased postoperative opioid requirements, and prolonged hospitalization. These findings highlight the importance of preoperative sleep assessment and tailored perioperative management.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212028","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":"Comparison of sacral erector spinae plane block and caudal epidural block for postoperative analgesia in pediatric hypospadias surgery: a prospective observational study.","authors":"Sümeyye Kankal, Mert Bozdana, Engin İhsan Turan, Bahadır Çiftçi, Volkan Özen","doi":"10.1186/s13741-026-00705-1","DOIUrl":"10.1186/s13741-026-00705-1","url":null,"abstract":"<p><strong>Background: </strong>Effective postoperative analgesia is essential in pediatric urogenital surgery to reduce stress responses and opioid exposure. Caudal epidural block is widely used for hypospadias repair; however, its duration may be limited and it is associated with neuraxial-related concerns. Sacral erector spinae plane (ESP) block has recently emerged as a potential alternative regional technique. This study aimed to compare the analgesic efficacy of sacral ESP block and caudal epidural block in children undergoing hypospadias surgery.</p><p><strong>Methods: </strong>This prospective, comparative observational study included 86 pediatric patients (aged 1-7 years, ASA I-II) undergoing elective hypospadias repair. Patients were allocated to receive either ultrasound-guided sacral ESP block or landmark-based caudal epidural block with 0.5 mL·kg⁻¹ of 0.25% bupivacaine. Postoperative pain was assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale at 1, 2, 4, 6, 12, and 24 h postoperatively by a blinded observer. The primary outcome was FLACC score at postoperative 12 h. Secondary outcomes included pain scores at other time points, time to first rescue analgesic, postoperative analgesic consumption, and block-related complications.</p><p><strong>Results: </strong>Eighty-six patients were analyzed (43 per group), with no significant differences in baseline characteristics. Median FLACC scores were significantly lower in the sacral ESP group at all postoperative time points, including the primary endpoint at 12 h (0 [0-0] vs. 1 [0-2], p < 0.001). Time to first rescue analgesic was significantly longer in the sacral ESP group (mean 22.7 h, 95% CI 21.5-23.9) compared with the caudal group (13.7 h, 95% CI 10.9-16.6; p < 0.001). The median number of postoperative analgesic administrations was lower in the sacral ESP group (0 [0-0] vs. 1 [0-1], p < 0.001). No block-related complications were observed in either group.</p><p><strong>Conclusions: </strong>Ultrasound-guided sacral erector spinae plane block was associated with lower postoperative pain scores, prolonged time to rescue analgesia, and reduced analgesic consumption compared with caudal epidural block in pediatric patients undergoing hypospadias surgery. Sacral ESP block may represent a useful alternative to caudal epidural block; however, randomized controlled studies are required to confirm these findings.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT07286786.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212047","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":"Factors associated with persistent postoperative hyperthermia in pediatric craniocerebral injury: a retrospective cohort study and preliminary risk score.","authors":"Na Yan, Xiaoyan Zhou, Fujia Zhuang, Xiaoyan Li","doi":"10.1186/s13741-026-00703-3","DOIUrl":"10.1186/s13741-026-00703-3","url":null,"abstract":"<p><strong>Background: </strong>Fever represents a common postoperative complication in pediatric patients with craniocerebral injury. The present study aimed to investigate the prevalence and factors independently associated with persistent postoperative hyperthermia in children following craniocerebral injury surgery, thereby providing evidence to inform clinical nursing practice.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted involving pediatric patients who underwent craniocerebral injury surgery. Patients were stratified into two groups: the persistent postoperative hyperthermia group and the non-persistent postoperative hyperthermia group, based on the presence of persistent postoperative hyperthermia (defined as a body temperature ≥ 38.5 °C, sustained or recurrent, for a cumulative duration exceeding 36 h within the first 72 h postoperatively).</p><p><strong>Results: </strong>A total of 238 pediatric patients who underwent craniocerebral injury surgery were included. The incidence of persistent postoperative hyperthermia was 28.99%. Multivariate logistic regression analysis revealed that age ≤ 5 years (odds ratio [OR] = 3.516, 95% confidence interval [CI]: 2.108-5.854), severe craniocerebral injury (OR = 6.442, 95%CI: 3.285-12.638), elevated postoperative intracranial pressure (≥ 20 mmHg, OR = 4.598, 95%CI: 2.683-7.895), postoperative drainage tube indwelling time ≥ 72 h (OR = 4.002, 95%CI: 2.356-6.817), pulmonary infection (OR = 5.438, 95%CI: 3.126-9.457), and methicillin-resistant Staphylococcus aureus (MRSA) infection (OR = 3.078, 95%CI: 1.756-5.392) were independently associated with persistent postoperative hyperthermia. A preliminary predictive model constructed based on these factors had a sensitivity of 0.754, specificity of 0.879, and Youden index of 0.633 in the cohort, but these performance estimates are likely optimistic and require external validation.</p><p><strong>Conclusion: </strong>Persistent postoperative hyperthermia is a prevalent complication in children following craniocerebral injury surgery, which is influenced by multiple factors. The identified factors are independently associated with this outcome, although causality cannot be inferred. The exploratory predictive model, while showing favorable discrimination in this sample, must be externally validated before clinical application.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148205648","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":"Comparison of erector spinae plane, paravertebral, and pectoral nerve blocks on postoperative analgesia and Quality of Recovery-15 in patients undergoing mastectomy: a prospective randomized trial.","authors":"Bilal Atilla Bezen, Merve Ay, Ali Kaynak, Murat Akici, Remziye Sivaci","doi":"10.1186/s13741-026-00693-2","DOIUrl":"10.1186/s13741-026-00693-2","url":null,"abstract":"<p><strong>Background: </strong>Modified radical mastectomy (MRM) is frequently associated with moderate to severe postoperative pain, which may negatively affect recovery and quality of life. Regional anesthesia techniques such as the erector spinae plane block (ESPB), thoracic paravertebral block (TPVB), and pectoral nerve block (PECS) have been increasingly used as part of multimodal analgesia strategies for breast surgery. However, their comparative effects on analgesic efficacy and quality of recovery remain unclear.</p><p><strong>Methods: </strong>The study included 90 female patients undergoing unilateral elective MRM. Patients were randomly allocated into three groups (n = 30 each) to receive ESPB, TPVB, or PECS block preoperatively with 0.25% bupivacaine. All patients subsequently underwent standardized general anesthesia. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 0, 1, 3, 6, 12, and 24 h. The primary outcome was total morphine consumption at 24 h. Secondary outcomes included time to first morphine request, incidence of rescue fentanyl use, postoperative nausea and vomiting, patient satisfaction, and scores.</p><p><strong>Results: </strong>Demographic characteristics and operative durations were comparable among the groups (p > 0.05). Total 24-hour morphine consumption was significantly higher in the ESPB group (median 10 mg) compared with TPVB (9 mg, p = 0.009) and PECS (9 mg, p = 0.018) groups. Kaplan-Meier analysis revealed that the time to first morphine request was significantly shorter in the ESPB group (p < 0.001), while TPVB provided the longest analgesic duration. No significant differences were found in postoperative pain scores, rescue opioid requirements, or nausea-vomiting incidence (p > 0.05). QoR-15 scores were significantly lower in the ESPB group compared with TPVB and PECS groups (p < 0.001).</p><p><strong>Conclusion: </strong>Both PECS and TPVB provided superior postoperative analgesia and better quality of recovery scores compared to ESPB in patients undergoing modified radical mastectomy. These findings support the use of PECS or TPVB as effective components of multimodal analgesia strategies for breast cancer surgery.</p><p><strong>Trial registration: </strong>ISRCTN Registry, ISRCTN17247698.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148194798","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":"Neonatal outcome following norepinephrine versus phenylephrine for treatment of spinal-induced hypotension among women undergoing caesarean section: systematic review and meta-analysis of randomised controlled trials.","authors":"Tesfaye Asefa Hordofa, Tajera Tageza Ilala, Kurabachew Mengistu","doi":"10.1186/s13741-026-00701-5","DOIUrl":"10.1186/s13741-026-00701-5","url":null,"abstract":"<p><strong>Background: </strong>There are pharmacological and non-pharmacological approaches to preventing spinal induced hypotension. In obstetrics, norepinephrine may be an alternative to phenylephrine because it better maintains cardiac output and heart rate. We conducted this systematic review and meta-analysis to identify neonatal outcomes and maternal haemodynamic effects.</p><p><strong>Methods: </strong>The systematic review of literature searched was conducted through electronic databases such as PubMed, Cochrane Library, and Google Scholar from February 1 to May 30,2025. All of the articles included in the review and meta-analysis were randomised controlled trials, and the populations of the study were normal pregnancies that underwent caesarean section under spinal anesthesia.</p><p><strong>Results: </strong>A 19 studies of randomised controlled trials involving 2603 participants were included after screening 2446 records. Both prophylactic (MD = 0.17.95%CI: -0.06-0.4, p = 0.15) and therapeutic (MD = 0.03,95%CI: -0.18-0.23, p = 0.79) administration of norepinephrine showed no statistically significant difference in 1 min Apgar scores compared with phenylephrine. However, norepinephrine was associated with slightly higher 5 min Apgar scores during therapeutic administration compared with prophylactic administration (MD = 0.16,95% CI:0.01-0.31, p = 0.04). Norepinephrine revealed that no statistically significant difference in umbilical arterial partial carbon dioxide compared with phenylephrine when administered as bolus, infusion or combined bolus and infusion (MD = -0.98, 95%CI: -3.32-1.35, p = 0.41, MD = 0.43,95%CI: -0.54-1.4, p = 0.38 and MD = 0.25(-0.42-1.92) respectively. In contrast, norepinephrine significantly increased umbilical arterial bicarbonate level during therapeutic adminstration compared with prophylactic or combined prophylactic or therapeutic administration with phenylephrine (MD = 0.74,95%CI:0.15-1.33.p = 0.01). Regarding maternal outcomes,norepinephrine significantly reduced the risk of maternal bradycardia both in prophylactic (RR = 0.52,95%CI:0.34-0.78,p-0.02) and in therapeutic administratuin (RR = 0.46, 95%CI:0.29-0.72, p = 0.0006) compared with phenylephrine. Furthermore, pooled analysis showed that norepinephrine administration during combined of both prophylactic and therapeutic administration (RR = 0.29,95%CI:0.12-0.65, p = 0.003) was associated with lower risk of maternal reflex hypertension than during therapeutic and prophylactic alone compared with phenylephrine.</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis shows women treated with bolus or infusion, prophylactic or therapeutic administration of norepinephrine have comparable neonatal outcome and maternal haemodynamics with phenylephrine. Therefore, Norepinephrine is an alternative vasopressor for management of spinal induced hypotension and for good neonatal outcome.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13483524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043290","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":"Association between VA providers' reported use of care strategies and emergence delirium: a national retrospective cross-sectional survey.","authors":"Monique Y Boudreaux-Kelly, Matthew A Taylor, William M Pileggi, Michael J Boland, David V Julian, Amanda K Beckstead","doi":"10.1186/s13741-026-00700-6","DOIUrl":"10.1186/s13741-026-00700-6","url":null,"abstract":"<p><strong>Background: </strong>Emergence delirium (ED) is a short-term behavioral condition associated with risk of harm that may occur when a patient awakens from anesthesia. A national survey was conducted to evaluate our hypothesis that Veterans Health Administration (VHA) anesthesia providers who reported routinely screening patients for ED risk and selecting medication strategies associated with lower ED risk would be less likely to report estimated ED occurrence.</p><p><strong>Methods: </strong>A retrospective cross-sectional self-report survey was designed by staff at Veterans Affairs' Pittsburgh Healthcare System (PHS) and launched nationally to VHA anesthesia providers. The survey was conducted after an intervention at PHS to increase routine patient screening for ED risk and use of the \"exact medication\" strategy promoted by the intervention regardless of location: administration of propofol, dexmedetomidine, and ketamine and avoidance of midazolam and volatile anesthetics. Comparisons of percentage of PHS and non-PHS anesthesia providers who reported use of the \"exact medication\" strategy and estimated ED occurrence were analyzed using tests of independence and multivariable logistic regression models.</p><p><strong>Results: </strong>Based on survey data from 690 VHA anesthesia providers (PHS n = 34, non-PHS n = 656), both routine screening (PHS: 88.2%, non-PHS: 58.4%, p < 0.001) and the \"exact medication\" strategy (PHS: 44.1%, non-PHS: 1.4%, p < 0.001) were reported by more PHS than non-PHS providers. Survey results indicated 37.3% more providers at PHS (38.2%, n = 13) reported using the \"routine screening plus exact medication\" strategy than non-PHS (0.9%, n = 6, p < 0.001) and providers who used that care strategy were less likely to report estimated ED occurrence (PHS: 46% vs non-PHS: 50%, p < 0.05). Using multivariable modeling analysis, the \"routine screening plus exact medication\" care strategy was associated with lower odds of estimated ED occurrence regardless of location (OR = 0.36, p < 0.05).</p><p><strong>Conclusions: </strong>Bivariate comparisons and multivariable adjusted modeling of survey findings supported our hypothesis that providers who reported routinely screening patients for ED risk and employing the \"exact medication\" strategy were less likely to have estimated ED occurrence. Use of these descriptive analyses to generate hypotheses for future assessments is recommended.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147982987","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}