Perioperative Medicine最新文献

{"title":"Effect of multimodal home-based prehabilitation on objectively measured physical activity in patients undergoing elective cardiac or non-cardiac major surgery: secondary outcomes from a randomised controlled trial.","authors":"Thomas Vetsch, Simone Wen-Shi Dueblin, Prisca Eser, Christian M Beilstein, Patrick Y Wuethrich, Matthias Wilhelm, Dominque Engel","doi":"10.1186/s13741-025-00554-4","DOIUrl":"10.1186/s13741-025-00554-4","url":null,"abstract":"<p><strong>Objective: </strong>To assess physical activity (PA) measured in steps per day in the preoperative period in high-risk cardiac and non-cardiac surgical patients receiving home-based tele-supervised prehabilitation compared to standard of care and to compare steps per day with raw acceleration metrics.</p><p><strong>Study design: </strong>It is an analysis of secondary outcome data of a prospective, two-arm parallel group, randomised controlled trial.</p><p><strong>Setting: </strong>It is a single university hospital in Switzerland.</p><p><strong>Participants: </strong>These are patients ≥ 65 years awaiting elective cardiac or non-cardiac major surgery with a proven fitness deficit measured by a cardiopulmonary exercise test (CPET). Analysis of PA data after successfully enrolling 200 patients (167 with complete data) in the trial. Average age was 73.8 years (SD 5.3) in cardiac and 76.0 years (SD 6) in non-cardiac patients.</p><p><strong>Intervention: </strong>The intervention arm consists of a multimodal, home-based tele-supervised prehabilitation programme over 2-4 weeks addressing deficits in physical fitness, nutrition, and preoperative anaemia.</p><p><strong>Primary outcome: </strong>Steps per day are assessed by an open-source algorithm from wrist-worn accelerometer data.</p><p><strong>Secondary outcome: </strong>Raw acceleration as overall Euclidean Norm Minus One (ENMO) is expressed in milligravitational units (mg).</p><p><strong>Results: </strong>Non-cardiac (n = 107) patients had more steps per day in the intervention group versus standard of care (4662 [2817; 6807] vs 3378 [1919; 4831], p = 0.042). Overall, ENMO was higher in the intervention group but not statistically significant. No significant differences in PA measures were observed between randomisation groups in cardiac (n = 60) patients. Cardiac patients had overall higher PA levels and were younger than non-cardiac. The difference remained after adjusting for age. Steps per day correlated strongly with overall ENMO.</p><p><strong>Conclusion: </strong>Simple preoperative PA recommendations effectively improve steps per day in high-risk non-cardiac surgery patients. To detect changes in PA in the high-risk surgical patient, steps per day can be used as an intuitive measure. To compare with other populations, overall ENMO is preferable.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov Identifier: NCT04461301.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"69"},"PeriodicalIF":2.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565073","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 of perioperative intravenous lignocaine and intraoperative neuromonitoring in adolescent idiopathic scoliosis surgery: a retrospective study.","authors":"Siti Nadzrah Yunus, Huey Nee Chong, Zheng-Yii Lee, Rosmalinda Osman, Khean Jin Goh, Chee Kidd Chiu, Chris Yin Wei Chan, Mun Keong Kwan, Mohd Shahnaz Hasan","doi":"10.1186/s13741-025-00552-6","DOIUrl":"10.1186/s13741-025-00552-6","url":null,"abstract":"<p><strong>Background: </strong>The use of intravenous (IV) lignocaine as an analgesic adjunct is increasing, but its impact on intraoperative neurophysiological monitoring (IONM) remains unclear. This study aimed to evaluate the association between IV lignocaine and somatosensory evoked potential (SSEP) and motor evoked potential (MEP) during adolescent idiopathic scoliosis (AIS) surgery.</p><p><strong>Methods: </strong>This retrospective study involved AIS patients who underwent single-stage posterior spinal fusion at a tertiary university hospital from 2020 to 2023. In addition to total intravenous anaesthesia (TIVA), patients who received IV lignocaine (1.5 mg/kg bolus at induction followed by 2 mg/kg/h infusion until wound closure) were included (lignocaine group) and matched with those who did not (standard group). Two neurophysiologists independently reviewed SSEP and MEP recordings at five-time points: T1 (10 min post-induction), T2 (during pedicle screw insertion), T3 (during rod insertion or deformity correction), T4 (start of wound closure, 30 min before surgery end), and T5 (post-skin closure). Neurophysiological changes were clinically significant if MEP or SSEP showed > 50% amplitude reduction or > 10% latency increase.</p><p><strong>Results: </strong>A total of 115 AIS patients receiving TIVA were analysed, 59 in the lignocaine group and 56 in the standard group. Demographics and vital signs were comparable. The mean intraoperative propofol dose was significantly lower in the lignocaine group (766.77 ± 315.86 mg vs 928.55 ± 242.93 mg; p = 0.003). MEP amplitudes over the right tibialis anterior and bilateral abductor hallucis were significantly reduced in the lignocaine group (p < 0.05). SSEP analysis revealed significant amplitude reduction and latency prolongation at the left cortical in the lignocaine group at all time points (p < 0.05). Longitudinal changes (T1-T4) in amplitude and latency for both MEP and SSEP were small and not clinically significant.</p><p><strong>Conclusion: </strong>Perioperative IV lignocaine infusion during TIVA for AIS surgery significantly reduced MEP and SSEP amplitudes and prolonged SSEP latency, though lacking clinical significance.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"65"},"PeriodicalIF":2.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565072","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":"Proenkephalin A 119-159 as an early biomarker of acute kidney injury in complex endovascular aortic repair: an explorative single-center cross-sectional study with the utilization of two measurement methods.","authors":"Paulina Walczak-Wieteska, Konrad Zuzda, Jolanta Małyszko, Paweł Andruszkiewicz","doi":"10.1186/s13741-025-00553-5","DOIUrl":"10.1186/s13741-025-00553-5","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) remains a significant complication following endovascular aneurysm repair (EVAR). Current diagnostic methods often detect kidney damage too late for effective intervention. This study evaluated proenkephalin A 119-159 as an early AKI biomarker after EVAR procedures, comparing point-of-care testing with the ELISA method.</p><p><strong>Methods: </strong>Between April 2022 and June 2024, 68 patients undergoing elective EVAR were enrolled. Blood samples were collected preoperatively and for three consecutive postoperative days.</p><p><strong>Results: </strong>AKI was diagnosed according to the KDIGO criteria, with proenkephalin A 119-159 measured via point-of-care (penKid) testing and laboratory ELISA method. AKI occurred in 18 patients (26.5%). penKid showed a superior diagnostic performance to ELISA, demonstrating moderate agreement with KDIGO criteria (Gwet's AC1 = 0.52, p < .001). While penKid exhibited high sensitivity (80% day 1), specificity was moderate (51%). AKI patients had significantly higher median penKid levels (96.47 pmol/L vs 63.01 ng/mL, p = .001), longer hospital stays (12 vs 9 days, p = .028), and lower 6-month survival (50% vs 88.1%, p = .006).</p><p><strong>Conclusions: </strong>penKid testing shows promise as an early AKI biomarker following EVAR procedures, particularly for identifying low-risk AKI patients. However, its moderate specificity suggests it should complement existing clinical assessment tools rather than replace them. These findings support incorporating penKid monitoring into structured AKI care bundles for improved perioperative kidney outcomes.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"66"},"PeriodicalIF":2.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565075","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":"Dexmedetomidine-enhanced chest wall fascial plane blocks in ultra-fast-track minimally invasive heart valve surgery: a randomized controlled trial.","authors":"Shen-Jie Jiang, Tian Jiang, Han-Wei Wei, Xiao-Kan Lou, Yu Wang, Mei-Juan Yan","doi":"10.1186/s13741-025-00547-3","DOIUrl":"10.1186/s13741-025-00547-3","url":null,"abstract":"<p><strong>Background: </strong>Injury to the sternocostal joint during minimally invasive cardiac surgery frequently results in severe pain, yet there is no established standard for perioperative analgesia. This randomized controlled trial evaluated whether adding 1 μg/kg dexmedetomidine to 0.375% ropivacaine for chest wall fascial plane blocks enhances opioid sparing in ultra-fast-track (UFT) minimally invasive heart valve surgery.</p><p><strong>Methods: </strong>Seventy-six elective patients were randomized (1:1) in a double-blind manner. The control group received 60 mL of 0.375% ropivacaine, while the DEX group was administered 60 mL of 1 μg/kg dexmedetomidine plus 0.375% ropivacaine. The primary outcomes were intraoperative remifentanil use and 24-h postoperative sufentanil consumption, which served as co-primary endpoints to evaluate opioid-sparing effects. Secondary outcomes included 24-h postoperative sufentanil consumption, 24-h oxycodone use, patient-controlled analgesia (PCA) activations, episodes of Visual Analog Scale (VAS) scores ≥ 3 within 48 h, time to recovery of consciousness, time to extubation, duration of intensive care unit (ICU), and hospital stays, and complications.</p><p><strong>Results: </strong>The DEX group exhibited significantly reduced intraoperative remifentanil consumption (2.45 ± 0.47 vs. 2.98 ± 0.53 mg, p < 0.001) and 24-h sufentanil use (median with interquartile range (IQR) 57 [54-60] vs. 63 [63-66] μg, p < 0.001). It also demonstrated lower 24-h oxycodone consumption (median [IQR] 5 [0-10] vs. 10 [10-20] mg, p < 0.001), fewer 24-h PCA activations (median [IQR] 3 [2-4] vs. 5 [5-6], p < 0.001), and less frequent VAS ≥ 3 episodes (median [IQR] 3 [2.5-4] vs. 6 [5-6], p < 0.001), alongside shorter lengths of ICU (21.34 ± 3.59 vs. 24.29 ± 4.07 h, p = 0.002) and hospital stays (6.51 ± 1.04 vs. 8.65 ± 1.80 days, p < 0.001). Postoperative complications did not differ significantly between groups, though dexmedetomidine-related hemodynamic effects were not systematically monitored.</p><p><strong>Conclusion: </strong>The administration of 1 μg/kg dexmedetomidine in combination with ropivacaine for chest wall fascial plane blocks reduces opioid requirements and shortens ICU/hospital stays in UFT cardiac surgery, supporting its safety and efficacy, but limitations include the single-center design, fixed dexmedetomidine dosage, and incomplete complication assessment, warranting multicenter validation with standardized safety monitoring.</p><p><strong>Trial registration: </strong>ChiCTR2100051182.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"62"},"PeriodicalIF":2.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476160","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":"In search of a characterisation of frailty: applying exploratory factor analysis to ageing preoperative patients : Cross-sectional study.","authors":"Guillermo Miguel-Ruano, María Aymerich-De-Franceschi, Miguel Ángel García-Aroca, Edgar Benitez, Nicolás Pérez-Fernández, José Manuel Álvarez-Avello","doi":"10.1186/s13741-025-00549-1","DOIUrl":"10.1186/s13741-025-00549-1","url":null,"abstract":"<p><strong>Background: </strong>Frailty is a useful prognostic concept which has spread to many clinical settings, including perioperative medicine. However, there is no consensus on its definition. This situation could impair its screening and the correction of underlying disturbances that have an influence on the clinical course of ageing patients.</p><p><strong>Methods: </strong>In order to achieve a more precise characterisation of frailty, an exploratory factor analysis (EFA) was performed on the variables of eight frailty scales: Clinical Frailty Scale (CFS), FRAIL scale, Edmonton scale, Fried criteria, Robinson scale, Risk Analysis Index, the Frailty Index and the Modified Frailty Index. Later, a concordance study between the factors found in EFA and frailty according to the CFS (≥ 4 points) was conducted. One-hundred nine preoperative patients aged 65 years or older (60% men) were included, and data were collected from medical history and physical and laboratory tests. Our aim was to explain the behaviour of well-known frailty-related variables by identifying the factors that influenced them and to investigate whether these factors were related to frailty.</p><p><strong>Results: </strong>Three factors were found, each relating to a different set of variables: F1 representing comorbidities; F2 being an aggregation of disturbances in physical activity, cognitive status and anaemia; and F3 portraying alterations of the emotional sphere. The concordance study showed a strong association of F2 with frailty: adjusted OR 3.65 (95% CI 1.57 to 8.53). F3 presented a milder relationship: OR 2.54 (95% CI 1.28 to 5.02). No association of F1 with frailty was found: OR 1.15 (95% CI 0.58 to 2.26).</p><p><strong>Conclusions: </strong>In our quest to characterise frailty, we found that this is best described by an aggregate of reductions in physical activity, impairment in cognitive status and anaemia, while comorbidities are not associated with it. This could support a modified version of the phenotypic model against other paradigms.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"63"},"PeriodicalIF":2.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476161","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":"Influence of portal hypertension-associated upper gastrointestinal bleeding and acute kidney injury on liver transplantation prognosis.","authors":"Shifeng Feng, Ou Huiying, Guo Wei, Jingsheng Yuan, Tao Lv, Jian Yang, Yong Zhao, Lingxiang Kong, Jiayin Yang","doi":"10.1186/s13741-025-00545-5","DOIUrl":"10.1186/s13741-025-00545-5","url":null,"abstract":"<p><strong>Background: </strong>Given that prioritization for liver transplantation (LT) is based primarily on the model for end-stage liver disease (MELD) scores, patients with lower MELD scores, who experience chronic anemia and recurrent hypotension due to gastrointestinal bleeding (GIB), tend to be marginalized.</p><p><strong>Methods: </strong>A total of 581 patients with no evidence of acute kidney injury (AKI) or chronic kidney disease 2 months before LT constituted a retrospective cohort. Within this cohort, a nested case-control study was conducted that included 134 patients with preoperative GIB (GIB(+)) and 246 matched patients without preoperative GIB (GIB(-)). A subgroup analysis was conducted based on the occurrence of AKI (AKI(- /+)) within 2 months prior to LT.</p><p><strong>Results: </strong>The incidence of preoperative AKI was significantly higher in patients with GIB(+) compared with patients with GIB(-) (14.9% vs 8.1%, P=0.039), along with higher rates of postoperative complications and prolonged hospital stay; however, long-term survival rates were similar between the two groups. Subgroup analysis also revealed that the postoperative incidence of AKI and mortality rates at 60 days were elevated in patients with preoperative GIB(+) AKI(+) compared with patients with GIB(+) AKI(-). Furthermore, 5-year survival rates were significantly lower for patients with GIB(+) AKI(+) (65.0% vs 82.5%, P = 0.040). However, no significant difference was observed between the two subgroups of AKI(+) (GIB(+) versus GIB(-)) and the two subgroups of AKI(-) in relation to postoperative complications, short-term mortality, and long-term survival rates.</p><p><strong>Conclusions: </strong>Patients who experience preoperative GIB face an elevated risk of developing AKI, which is significantly correlated with a poorer prognosis for LT. A more proactive approach is needed to assess the transplant priority of patients with GIB on the waiting list.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"61"},"PeriodicalIF":2.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216521","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":"A warning model for predicting patient admissions to the intensive care unit (ICU) following surgery.","authors":"Li Li, Hongye He, Linjun Xiang, Yongxiang Wang","doi":"10.1186/s13741-025-00544-6","DOIUrl":"10.1186/s13741-025-00544-6","url":null,"abstract":"<p><strong>Background: </strong>Postoperative admission to the ICU for surgical patients is a significant burden in nursing care, and there is currently a lack of corresponding assessment tools.</p><p><strong>Methods: </strong>Clinical information of patients was extracted from the VitalDB database. LASSO regression and random forest algorithms were used to screen clinical variables related to postoperative ICU admission. Subsequently, the effectiveness of logistic regression, random forest, support vector machine, and multi-layer perceptron algorithms was compared using ROC curves. After selecting the best algorithm, postoperative ICU admission probability prediction nomogram was constructed.</p><p><strong>Results: </strong>This study identified 18 clinical factors that influence postoperative ICU admission. The factors influencing patient outcomes include three physiological characteristics: age, weight, and gender; five preoperative laboratory tests:platelet count, prothrombin time(%),activated partial thromboplastin time, albumin, and blood urea nitrogen; and seven intraoperative anesthesia details: anesthesia duration, propofol dosing during surgery, midazolam dosing during surgery, phenylephrine dosing during surgery, calcium chloride dosing during surgery, American Society of Anesthesiologists (ASA) classification, and anesthesia method. Additionally, three other factors are considered: whether the surgery is classified as an emergency, the department category, and the type of surgery. The logistic regression model developed using these 18 variables was identified as the most effective predictive model for postoperative ICU admission, achieving an ROC AUC of 0.925.</p><p><strong>Conclusion: </strong>The postoperative admission warning model constructed in this study can effectively predict the probability of patients being admitted to the ICU after surgery, providing a corresponding management tool for postoperative care in surgical patients.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"60"},"PeriodicalIF":2.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209109","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 butorphanol nasal spray administration on patient cooperativity during labor epidural placement: a single-center randomized controlled trial.","authors":"Jing Sun, Fan Wu, Mingguang Wu, Guanxiong Wu, Zhao Zheng, Gehui Li, Xiaoguang Wang, Xiaolei Huang, Yuantao Li","doi":"10.1186/s13741-025-00535-7","DOIUrl":"10.1186/s13741-025-00535-7","url":null,"abstract":"<p><strong>Background: </strong>Epidural block stands as the prevailing, secure, and efficient approach to labor analgesia. Inadequate maternal cooperation not only hampers anesthesia effectiveness but also may lead to severe consequences, including nerve damage due to positional changes.</p><p><strong>Methods: </strong>A randomized controlled clinical trial with 200 participants was conducted to compare painless delivery with epidural alone versus a combination of butorphanol nasal spray preceding epidural administration for painless delivery. The objective was to assess the combined approach's efficacy in diminishing maternal pain and enhancing maternal compliance.</p><p><strong>Results: </strong>Within 8-min post-anesthesia, the combined analgesic group (EXP group) exhibited significantly lower maternal pain intensity scores, improved maternal cooperation, reduced visual analogue scale (VAS) pain, and McGill scores compared to the epidural alone group (CTRL group). No statistically significant differences emerged in 24-h postpartum blood loss, labor duration, or lactation period. Neonatal indicators, including umbilical artery blood PCO2, base excess of extracellular fluid (BE-ecf), weight, and Apgar score, showed no significant differences between the EXP and CTRL groups. However, the EXP group demonstrated a higher umbilical artery blood pH than the CTRL group. The EXP group exhibited significantly higher probabilities of pain intensity scores ≤ 6, maternal cooperation scores ≤ 3, VAS scores ≤ 3 at 6-, 8-, and 10-min post-anesthesia, and McGill scores of 0 compared to the CTRL group.</p><p><strong>Conclusion: </strong>Butorphanol nasal spray emerges as an effective means to alleviate pain during epidural puncture in labor analgesia, markedly improving maternal anesthesia adherence. This combined analgesic method proves to be a safe and efficacious approach for maternal pain relief during labor.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"59"},"PeriodicalIF":2.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132589","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 effects of intrathecal fentanyl on postoperative opioid utilization rates in elderly patients undergoing lower extremity orthopedic surgery: a randomized controlled trial.","authors":"Yinghua Gu, Yan Li, Wenxun Liu, Xin Liu, Qingshan Ye","doi":"10.1186/s13741-025-00541-9","DOIUrl":"10.1186/s13741-025-00541-9","url":null,"abstract":"<p><strong>Background: </strong>Various types of lower extremity orthopedic surgeries can cause severe postoperative pain in elderly patients. Achieving adequate pain control while minimizing the use of opioids is advantageous, as it helps reduce postoperative complications and facilitates recovery. In this randomized trial, we compared the opioid utilization rates of elderly patients who received or not receive intrathecal fentanyl as an anesthesia adjuvant.</p><p><strong>Methods: </strong>A total of 180 elderly patients were enrolled in the study. They were randomly assigned to the BF1 group (bupivacaine plus 25 µg of fentanyl), the BF2 group (bupivacaine plus 50 µg of fentanyl), or the B group (bupivacaine), achieving a final between-group ratio of 2:2:1. Our primary outcome was the rate of opioid use, while secondary outcomes included the NRS score and the utilization rate of analgesic drugs on PODS1-3.</p><p><strong>Results: </strong>The usage rate of opioid analgesics within the POD3 was higher in B group compared to BF1 and BF2 groups (100% vs. 79.2% and 80.3%, respectively; P < 0.05). However, there was no significant difference in the usage rate of opioid analgesics among the groups within the PODS1-2 (P > 0.05). The incidence of patients with NRS scores ≥ 4 was significantly lower in BF1 and BF2 groups compared to B group on PODS2-3 (POD2, 62.2% and 68.9% vs. 93.8%, respectively; P < 0.05; POD3, 16.2% and 17.6% vs. 40.6%, respectively; P < 0.05). Additionally, BF1 group had a lower incidence of NRS scores ≥ 4 compared to B group on POD1 (P < 0.05). The rate of analgesic drug use was similar among the three groups on POD1-3 (P > 0.05).</p><p><strong>Conclusion: </strong>In elderly patients undergoing lower extremity surgery, intrathecal fentanyl as an anesthetic adjuvant may correlate with reduced pain scores on PODS1-3 and decreased opioid requirements on POD3.High-dose fentanyl does not provide significant therapeutic advantages.</p><p><strong>Trial registration: </strong>The study registered on the Chinese Clinical Trial Registry ( www.chictr.org.cn ), Clinical Trials identifier ChiCTR2200058362 (2022/04/07).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"58"},"PeriodicalIF":2.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102332","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":"Goal-directed therapy: what is the goal again?","authors":"Amy Yerdon, Ken Taylor, Katie Woodfin, Ryan Richey, Susan McMullan, Desirée Chappell","doi":"10.1186/s13741-025-00533-9","DOIUrl":"10.1186/s13741-025-00533-9","url":null,"abstract":"<p><p>Recent attention has focused on intraoperative hypotension (IOH) and hemodynamic instability. This enhanced awareness to limit IOH, combined with fluid restriction and increased vasopressor use, has been associated with an increase in postoperative acute kidney injury. Recent literature supports improved intraoperative monitoring of mean arterial pressure (MAP), fluid management, and appropriate use of vasopressors and inotropic support for hemodynamic management. Implementing an algorithm to manage the causes of IOH minimizes iatrogenic harm by guiding anesthesia clinicians to select the appropriate interventions at the optimal time. This ensures a comprehensive evaluation of contributing factors such as fluid deficits, myocardial depression, and vasodilation. Shifting attention from the MAP displayed on the physiologic monitor to more individualized care with a goal-directed therapy approach may improve patient outcomes.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"57"},"PeriodicalIF":2.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086379","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}