Brazilian Journal of Anesthesiology最新文献

{"title":"Comparison of automatic versus constant CPAP in elderly patients after major abdominal surgery: a randomized noninferiority trial","authors":"Nguyen Dang Thu ,&nbsp;Nguyen Thi Thuy ,&nbsp;Le Sau Nguyen ,&nbsp;Cong Quyet Thang ,&nbsp;Nguyen Ngoc Thach ,&nbsp;Nguyen Trung Kien","doi":"10.1016/j.bjane.2025.844642","DOIUrl":"10.1016/j.bjane.2025.844642","url":null,"abstract":"<div><h3>Background</h3><div>Geriatric patients undergoing major open abdominal surgery are at high risk for postoperative pulmonary complications and hypoxemia. Continuous Positive Airway Pressure (CPAP) after surgery may improve postoperative lung function. This randomized controlled trial compared two CPAP techniques ‒ automatic via nasal mask and constant via facial mask ‒ regarding pulmonary function and patient tolerance.</div></div><div><h3>Methods</h3><div>Sixty patients (≥ 60 years) were randomized (1:1) to receive either automatic CPAP (2–10 cm H₂O) via a nasal mask (Group A) or constant CPAP (7.5 cm H₂O) via a facial mask (Group C) upon arrival in the post-anesthesia care unit. Oxygenation (PaO₂, PaO₂/FiO₂, SpO₂) and spirometry (FVC, FEV₁, PEF) were assessed preoperatively, postoperatively, and one hour after treatment. Comfort scores (0–10, with 0 indicating the best comfort) and complications were recorded.</div></div><div><h3>Results</h3><div>PaO₂/FiO₂ improvement was lower in Group A (32.6 ± 26.3 mmHg) than in Group C (52.9 ± 40.1 mmHg; p = 0.023). FVC improvement was also lower in Group A (3.7% ± 4.0%) than in Group C (6.7% ± 4.9%; p = 0.012). However, Group A had better tolerance, with lower comfort scores (2 [2–3] vs. 3 [2–4], p = 0.002). Pulmonary function benefits were more pronounced in patients over 70 and those undergoing upper abdominal surgery.</div></div><div><h3>Conclusion</h3><div>Both CPAP techniques prevent pulmonary decline in geriatric patients post-surgery. While automatic CPAP provides better comfort, constant CPAP improves oxygenation. Although our findings are short-term, they suggest that CPAP mode selection should be tailored based on patient-specific needs.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844642"},"PeriodicalIF":1.7,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The expanding role of the erector spinae plane block: from concept to clinical integration","authors":"João Pedro Fernandes Gonçalves ,&nbsp;Anita Perpétua Carvalho Rocha de Castro ,&nbsp;Luiz Gustavo Albuquerque ,&nbsp;Thiago Ramos Grigio ,&nbsp;Durval Campos Kraychete","doi":"10.1016/j.bjane.2025.844644","DOIUrl":"10.1016/j.bjane.2025.844644","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844644"},"PeriodicalIF":1.7,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-measured cutaneous-epiglottic distance for predicting difficult laryngoscopy: an observational study","authors":"Luis Henrique Cangiani ,&nbsp;Rodrigo Leal Alves ,&nbsp;Glenio B. Mizubuti ,&nbsp;Rodrigo Moreira e Lima ,&nbsp;Lais Helena Navarro e Lima","doi":"10.1016/j.bjane.2025.844637","DOIUrl":"10.1016/j.bjane.2025.844637","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasound (US) allows for rapid bedside airway assessment. We aimed to evaluate the US-measured cutaneous-epiglottic distance (CED) in predicting difficult laryngoscopy (Cormack-Lehane grades 3‒4). We also evaluated the potential association between CED, sex, patient’s body mass index (BMI), and the independent associations between CED and increased odds for Cormack-Lehane grades 3‒4 (secondary outcomes).</div></div><div><h3>Methods</h3><div>Patients aged 18‒70 years scheduled for elective surgeries under general anesthesia with tracheal intubation were included. Those with a BMI &gt; 35 kg.m^-2 and/or previous history of difficult intubation were excluded. CED was measured with patients anesthetized before tracheal intubation. Age, sex, BMI, type of surgery, and number of attempts until successful tracheal intubation were recorded. Receiver operator characteristic (ROC) curve analysis was performed to evaluate CED’s clinical relevance. Secondary analyses compared the association between CED and BMI in patients with Cormack-Lehane grades 1‒2 versus those with grades 3‒4. The relationship between CED and BMI was assessed using multiple linear regression. Binary logistic regression was employed for predicting Cormack-Lehane grades 3‒4 as a dichotomous outcome with CED and BMI as a covariate.</div></div><div><h3>Results</h3><div>ROC curve analysis revealed an area under the curve of 0.899 (p &lt; 0.001). The maximum CED cut-off point (by Youden index) was 25.6 mm. CED and BMI were positively correlated, and both were independently associated with an increased odds for difficult laryngoscopy [odds ratio for CED = 1.81, 95% confidence interval (CI) 1.35‒2.41; BMI = 1.30, 95% CI 1.05‒1.59].</div></div><div><h3>Conclusion</h3><div>US-measured CED has a high discriminatory capability for predicting lower (1‒2) and higher (3‒4) Cormack-Lehane grades during direct laryngoscopy. CED was positively correlated with BMI and was independently associated with higher odds for difficult laryngoscopy.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844637"},"PeriodicalIF":1.7,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Propofol-fentanyl versus propofol-dexmedetomidine in outpatient procedures sedation: a triple-blind, randomized controlled clinical trial","authors":"Nicole Morem Pilau Moritz ,&nbsp;Getúlio Rodrigues de Oliveira Filho ,&nbsp;José Eduardo Moritz ,&nbsp;Jefferson Luiz Traebert","doi":"10.1016/j.bjane.2025.844636","DOIUrl":"10.1016/j.bjane.2025.844636","url":null,"abstract":"<div><h3>Introduction</h3><div>The choice of anesthetic agents plays a crucial role in procedural success. This study aimed to compare the effects of propofol-fentanyl and propofol-dexmedetomidine combinations, focusing on patient and surgeon perspectives in outpatient procedures.</div></div><div><h3>Methods</h3><div>A randomized, controlled, triple-blind clinical trial including 128 adult patients undergoing elective outpatient surgical procedures with sedation and local anesthesia. Patients were randomized to receive either propofol-fentanyl (PF, n = 64) or propofol-dexmedetomidine (PDex, n = 64). Primary outcomes were patient satisfaction, assessed using the ISAS-Br score, and the adequacy of sedation, evaluated by the surgeon and measured by a Numerical Rating Scale (NRS) for movement. Respiratory and hemodynamic changes, as well as awakening from anesthesia, adverse events during recovery, and time to hospital discharge were compared.</div></div><div><h3>Results</h3><div>No difference between patient satisfaction scores (median ISAS-Br [IQR]: PF 2.64 [2.45‒3.00] vs. PDex 3.00 [2.45‒3.00], p = 0.252). The PF group had a significantly lower movement score (median NRS [IQR]: 0.5 [0.00‒2.25] vs. 2.0 [0.00‒5.00], p = 0.006). The incidence of intraoperative events related to respiration and hemodynamics, as postoperative pain and postoperative nausea/vomiting were similar. A higher proportion of patients sedated with PF awoke in the operating room (75% vs. 35.9%, p &lt; 0.001), and 98.4% of the PF group vs. 92.2% of the PDex group were ready for hospital discharge in less than thirty minutes, p = 0.208.</div></div><div><h3>Conclusion</h3><div>Single doses of fentanyl or dexmedetomidine combined with propofol resulted in equivalent patient satisfaction, safety, and discharge times. The propofol-fentanyl combination demonstrated superior sedation adequacy from the surgeon’s perspective and facilitated a faster emergence from anesthesia.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844636"},"PeriodicalIF":1.7,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting risk-profiling in pediatric cardiac anesthesia: a commentary on troponin-based outcome measures*","authors":"Rohan Magoon","doi":"10.1016/j.bjane.2025.844634","DOIUrl":"10.1016/j.bjane.2025.844634","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844634"},"PeriodicalIF":1.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and risk factors for acute kidney injury after cardiac surgery in a Brazilian University Hospital: a retrospective cross-sectional study","authors":"Pedro Victor Fernandes Ferreira ,&nbsp;Heitor J.S. Medeiros ,&nbsp;Hugo de Santana Ribeiro Dantas ,&nbsp;Eduardo Venancio Teixeira ,&nbsp;Lucas Pereira Trevisan ,&nbsp;Fernanda de Castro Teixeira ,&nbsp;Fernanda Cunha Soares ,&nbsp;Raphael Klênio Confessor de Souza ,&nbsp;Wallace Andrino da Silva","doi":"10.1016/j.bjane.2025.844635","DOIUrl":"10.1016/j.bjane.2025.844635","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844635"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of PEEP on lung aeration in pediatric patients after cardiac surgery: a CT-Based study","authors":"Solange C. Gimenez ,&nbsp;Milene C. Carrilho ,&nbsp;Isabela M. Malbouisson ,&nbsp;Marcelo Gama de Abreu ,&nbsp;Jean-Jacques Rouby ,&nbsp;Luiz Marcelo Sá Malbouisson","doi":"10.1016/j.bjane.2025.844623","DOIUrl":"10.1016/j.bjane.2025.844623","url":null,"abstract":"<div><h3>Background</h3><div>Loss of lung aeration is frequently observed in adult patients following cardiac surgery with cardiopulmonary bypass. Yet, in children, changes in lung aeration following surgical repair of congenital heart defects, and the effects of Positive End-Expiratory Pressure (PEEP), remain uncertain.</div></div><div><h3>Methods</h3><div>Changes in lung aeration were investigated using volumetric computed tomography in 12 children with congenital acianogenic heart diseases and increased pulmonary flow who underwent total surgical repair under cardiopulmonary bypass. Computed tomography of the lungs was obtained preoperatively during spontaneous breathing and postoperatively during mechanical ventilation with positive end-expiratory pressure of 0, 5 and 10 cm H₂O. Gas and tissue lung volume and mass, as well non-aerated, poorly aerated and normally aerated lung compartments were measured.</div></div><div><h3>Results</h3><div>Median age of patients was 18.3 months, (4 to 24 months), weight was 9.3 ± 2.3 kg. Cardiopulmonary bypass duration was 77 ± 26 minutes. Preoperatively, pulmonary volume was 545 mL (237‒753 mL), whereby tissue and gas volumes were 48.4% (41.7%‒59.6%), and 51.6% (40.4%‒58.3%), respectively. Non-aerated and normally aerated compartments accounted for 15% and 47.9% of lung tissue, respectively. Postoperatively, at zero PEEP, the non-aerated compartment increased to 27%, while normally-aerated compared decreased to 38.5%. Stepwise PEEP application restored normally aerated lung volume to preoperative levels but did not significantly reduce non-aerated parenchyma.</div></div><div><h3>Conclusion</h3><div>Loss of lung aeration was pronounced after surgical correction of congenital heart defects. PEEP up to 10 cm H₂O restored gas volume but failed to recruit the collapsed parenchyma. Ethical Approval CAPPesq n° 854/01.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844623"},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant hyperthermia and surnames: ethical dilemmas and diagnostic pitfalls","authors":"Helga Cristina Almeida da Silva ,&nbsp;Maria Anita Costa Spindola ,&nbsp;José Luiz Gomes do Amaral","doi":"10.1016/j.bjane.2025.844622","DOIUrl":"10.1016/j.bjane.2025.844622","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844622"},"PeriodicalIF":1.7,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative iron supplementation in non-anemic patients undergoing major surgery: a systematic review and meta-analysis","authors":"Fabio Vieira Toledo,&nbsp;Daniel De Carli,&nbsp;Jose Fernando Amaral Meletti,&nbsp;Herman Yuri Almeida Togo,&nbsp;Italo Pires Gomes,&nbsp;Renato Makoto Sakashita,&nbsp;Lucas Felix Montes,&nbsp;Rafael Santos Tiburcio,&nbsp;Cesar de Araujo Miranda","doi":"10.1016/j.bjane.2025.844618","DOIUrl":"10.1016/j.bjane.2025.844618","url":null,"abstract":"<div><h3>Background</h3><div>Blood transfusions are associated with increased morbidity and mortality, and maintaining global blood supplies can be a challenge. This systematic review investigates the impact of preoperative iron supplementation on the risk of blood transfusion among non-anemic patients undergoing major surgeries.</div></div><div><h3>Methods</h3><div>We conducted a systematic search of PubMed, Embase, and Cochrane Central for randomized controlled trials published up to May 2024. Studies involving the use of erythropoietin, or patients already using iron supplementation when trial randomization was conducted were excluded. Outcomes assessed included the number of individuals who received blood transfusions, and mean hemoglobin levels at the first day and by the first postoperative week.</div></div><div><h3>Results</h3><div>A total of 1,162 non-anemic patients from 9 studies were included. Of these, 54% received preoperative iron supplementation. The average age was 71 years, and 44% were women. Preoperative iron supplementation was associated with a significantly lower risk of receiving a blood transfusion (OR = 0.54; 95% CI 0.40 to 0.75; p &lt; 0.001). At the first postoperative day, the iron supplementation group had significantly higher mean hemoglobin levels compared to the no-treatment group (MD = 0.22 g.dL^-1; 95% CI 0.02 to 0.42; p = 0.03). However, the pooled results could not rule out the null hypothesis for the difference in mean hemoglobin levels throughout the first week (MD = 0.12 g.dL^-1; 95% CI -0.12 to 0.35; p = 0.34).</div></div><div><h3>Conclusion</h3><div>Preoperative intravenous iron supplementation in non-anemic patients undergoing major surgeries, particularly cardiac procedures, significantly reduces transfusion requirements. However, the benefits of oral iron remain uncertain, and further research is warranted to establish standardized perioperative supplementation protocols.</div></div><div><h3>PROSPERO identifier</h3><div>CRD42024552559.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844618"},"PeriodicalIF":1.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluid balance dynamics and early postoperative outcomes in orthotopic liver transplantation: a prospective cohort study","authors":"Suzana Margareth Lobo ,&nbsp;Pedro Saggioro Paulucci ,&nbsp;Lucas Martins Tavares ,&nbsp;Graziela Benardin Luckemeyer ,&nbsp;Luana Fernandes Machado ,&nbsp;Neymar Elias de Oliveira ,&nbsp;Silvia Prado Minhoto ,&nbsp;Rita Cassia Alves Silva ,&nbsp;Renato Ferreira da Silva ,&nbsp;Marlon Souza Freitas ,&nbsp;Francisco Ricardo Marques Lobo ,&nbsp;Joana Berger-Estilita","doi":"10.1016/j.bjane.2025.844619","DOIUrl":"10.1016/j.bjane.2025.844619","url":null,"abstract":"<div><h3>Introduction</h3><div>This study evaluates the impact of Fluid Balance (FB) patterns on outcomes after Orthotopic Liver Transplantation (OLT). It hypothesizes that deviations from optimal FB increase morbidity.</div></div><div><h3>Methods</h3><div>In a single-center cohort post hoc analysis of 73 post-OLT patients, FB was categorized into three groups based on cumulative FB at 72 hours: Lowest (negative FB), Intermediate (0-2000 mL), and Highest (&gt; 2000 mL). We analyzed Sequential Organ Failure Assessment (SOFA) scores, mortality rates, and causes of death. Logistic regression identified mortality predictors.</div></div><div><h3>Results</h3><div>The Highest FB group had the highest SOFA scores and mortality (Group “Lo”: 18.2%, Group “In”: 8.6%, Group “Hi”: 40.5%, p = 0.009). A U-shaped relationship between FB and hospital mortality was observed, with extremes of FB associated with higher mortality. Cumulative FB independently predicted all-cause mortality with a 29.5% increase in the risk of death. FB on day 3 also predicted all-cause mortality, increasing the risk by 83.9%. Furthermore, FB on day 1 was linked to a 134.5% increase in the risk of death due to primary non-function of the liver. SOFA_LIVER score strongly predicted all-cause mortality, with a one-point increase associated with a 98.8% to 114.7% increase in mortality risk.</div></div><div><h3>Discussion</h3><div>These findings suggest that both negative and positive extremes of FB are associated with worse outcomes after OLT, reinforcing the U-shaped relationship between FB and mortality. Our results underscore the importance of balanced fluid management, particularly in the early postoperative period. The study highlights the need for individualized FB strategies to optimize organ function and reduce mortality. The use of SOFA_LIVER scores as a predictor of mortality further emphasizes the importance of liver function monitoring in post-OLT patients. However, the single-centre design and convenience sample limit the generalizability of our findings, necessitating validation through multicenter studies.</div></div><div><h3>Conclusion</h3><div>Our study provides valuable insights into the relationship between FB patterns and mortality in OLT patients. Both negative and positive extremes of FB are associated with higher mortality, suggesting the need for a balanced and individualized fluid management approach. The strong predictive value of SOFA_LIVER scores for all-cause mortality highlights the importance of early and continuous monitoring of liver function. Future multicenter randomized controlled trials are needed to validate these findings and develop optimized fluid management protocols for OLT patients.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844619"},"PeriodicalIF":1.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}