Brazilian Journal of Anesthesiology最新文献

{"title":"Relative hematocrit declines at the time of transfusion and postoperative outcomes after coronary artery bypass grafting: a retrospective cohort study","authors":"Fatemeh Sadr,&nbsp;Arash Jalali,&nbsp;Ahmad Vakili-Basir,&nbsp;Mina Pashang,&nbsp;Khosro Barkhordari","doi":"10.1016/j.bjane.2026.844813","DOIUrl":"10.1016/j.bjane.2026.844813","url":null,"abstract":"<div><h3>Background</h3><div>Despite advances in patient blood management, the optimal hemoglobin threshold for Red Blood Cell (RBC) transfusion remains controversial. This observational study evaluated the association between the relative decline in Hematocrit (HCT) at the time of transfusion and postoperative outcomes in patients undergoing Coronary Artery Bypass Graft (CABG) surgery.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 629 patients who underwent CABG and received a transfusion at Tehran Heart Center Hospital, Iran, between March 2018 and December 2021. Based on the relative hematocrit reduction at the time of transfusion, patients were divided into two groups: Group A (≥ 40% change) and Group B (&lt; 40% change). Early postoperative outcomes were compared between groups. Primary outcomes included mortality, hospital length of stay, intensive care unit length of stay, and intubation time. The composite secondary outcome comprised postoperative infection, renal failure, tamponade, and reoperation due to bleeding.</div></div><div><h3>Results</h3><div>There were no significant differences in primary outcomes, except hospital length of stay (p = 0.02). However, after adjustment for potential confounders, this difference was no longer significant (p = 0.32). Composite secondary outcomes were comparable between the two groups, with no significant difference observed (p = 0.85).</div></div><div><h3>Conclusion</h3><div>In patients undergoing CABG surgery, this study did not identify a significant difference in early postoperative outcomes between two transfused patient groups stratified by a 40% change in HCT. Further prospective studies are needed to determine clinical relevance of relative hematocrit decline at the time of transfusion as a potential adjunct to conventional transfusion triggers.</div><div><em>THC institutional review board:</em> IR.TUMS.THC.REC.1402.070.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 5","pages":"Article 844813"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The paradox of mechanical ventilation: life-saving, injurious, and pro-inflammatory – lung protection during general anesthesia with neuromuscular blockade","authors":"Jean-Jacques Rouby,&nbsp;Jean-Michel Constantin","doi":"10.1016/j.bjane.2026.844822","DOIUrl":"10.1016/j.bjane.2026.844822","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 5","pages":"Article 844822"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in cardiopulmonary resuscitation: a systematic review","authors":"Diogenes de Oliveira Silva,&nbsp;Giorgio Pretto,&nbsp;Saul Dominici,&nbsp;Antonio Carlos Aguiar Brandão,&nbsp;Plínio da Cunha Leal","doi":"10.1016/j.bjane.2026.844795","DOIUrl":"10.1016/j.bjane.2026.844795","url":null,"abstract":"<div><div>Cardiac arrest remains a major cause of mortality and neurological disability, and its management depends on rapid recognition, effective resuscitation, and accurate post-arrest prognostication. Artificial intelligence (AI) has been increasingly investigated as a tool to support these stages of care. This narrative review summarizes recent evidence on AI applications in cardiac arrest, including prediction, recognition, intra-arrest support, prognostication, and cardiovascular risk stratification. Searches were conducted in PubMed/MEDLINE, Google Scholar, EMBASE, Scopus, IEEE Xplore, and ScienceDirect for studies published from January 2000 to June 2025. Studies addressing AI, machine learning, or deep learning in cardiac arrest-related contexts were descriptively synthesized according to clinical application, AI methodology, and care setting. Overall, 59 studies were included. Six application categories were identified: early prediction of cardiac arrest or clinical deterioration (n = 16), cardiac arrest recognition and emergency response activation (n = 3), intra-arrest CPR and defibrillation support (n = 6), post-cardiac arrest prognostication (n = 20), risk stratification for sudden cardiac death and malignant arrhythmias (n = 11), and related cardiovascular or perioperative prognostic models (n = 3). Deep learning and neural-network-based approaches were the most frequent methodologies (n = 35), followed by traditional machine learning (n = 18) and natural language processing (n = 6). AI showed particular promise for ECG-based prediction, temporal clinical trajectories, emergency call interpretation, waveform and defibrillation analyses, and neurological or mortality prognostication after cardiac arrest. However, the evidence remains heterogeneous, with many studies relying on retrospective datasets, selected populations, and limited external or prospective validation.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 5","pages":"Article 844795"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced recovery after surgery for cesarean delivery: a systematic review and meta-analysis of randomized trials with trial sequential analysis","authors":"Tauãna Terra Cordeiro de Oliveira,&nbsp;Vanessa Tapioca,&nbsp;Eduardo Pereira,&nbsp;Bruna Ferreira,&nbsp;Tamiris Soares,&nbsp;Sara Amaral,&nbsp;Maria Luisa Assis,&nbsp;Gabriel Carvalho,&nbsp;Julio S. Curi,&nbsp;Kamal Kumar","doi":"10.1016/j.bjane.2026.844817","DOIUrl":"10.1016/j.bjane.2026.844817","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced Recovery After Surgery (ERAS) protocols have improved perioperative care across multiple surgical specialties. In obstetrics, ERAS pathways for cesarean delivery have been increasingly adopted; however, their comparative effectiveness versus standard care remains uncertain. Therefore, we conducted a systematic review and meta-analysis with trial sequential analysis to compare ERAS protocols with standard perioperative care in cesarean delivery.</div></div><div><h3>Methods</h3><div>We systematically searched MEDLINE, Embase, Web of Science, and Cochrane databases for Randomized Clinical Trials (RCTs) comparing ERAS and standard care in parturient undergoing cesarean delivery. Statistical analyses were performed using R software (version 4.2.2). We conducted subgroup analyses based on cesarean category (elective vs. emergency) and national income level. A Trial Sequential Analysis (TSA) was also performed.</div></div><div><h3>Results</h3><div>We included 13 RCTs comprising 1,809 parturient. ERAS was associated with a significant reduction in hospital Length of Stay (LOS) compared with standard care (MD = -17.05-hours, 95% CI -25.08 to -9.02 hours, <em>I</em>² = 98.2%, n = 1,128, p &lt; 0.01), with similar effects across elective and emergency cesarean deliveries. Greater reductions were observed in low- and middle-income countries, whereas no significant difference was identified in upper-middle-income settings, albeit formal subgroup test was not significant. ERAS was associated with lower postoperative pain at 24- and 48 hours, reduced wound infection, and higher maternal satisfaction, with no differences in readmission and postoperative nausea and vomiting. TSA suggested that the accrued sample size was adequate for hospital LOS; however, this should be interpreted cautiously given the substantial clinical and methodological heterogeneity.</div></div><div><h3>Conclusion</h3><div>This systematic review and meta-analysis suggest that ERAS protocols may be associated with reduced hospital stay and improved maternal recovery after cesarean delivery.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 5","pages":"Article 844817"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus recommendations on perioperative mechanical ventilation strategies: an evidence-based guideline by the Brazilian Society of Anesthesiology","authors":"João Manoel Silva-Jr,&nbsp;Talison Silas Pereira,&nbsp;Luiz Fernando dos Reis Falcão,&nbsp;Ricardo Esper Treml,&nbsp;Alexandre Marini Isola,&nbsp;Alexandre Goulart Pustilnik,&nbsp;Anacleto Gabriel de Alcântara,&nbsp;André Prato Schmidt,&nbsp;Antonio Carlos Aguiar Brandão,&nbsp;Arthur Caus de Morais,&nbsp;Bruna Silveira Ferreira Klauck,&nbsp;Bruno Campostrini Sily,&nbsp;Bruno Francisco de Freitas Tonelotto,&nbsp;Carlos Gustavo dos Santos Silva,&nbsp;Carmen Sílvia Valente Barbas,&nbsp;Claudia Marquez Simões,&nbsp;Daniel da Escóssia Melo Sousa,&nbsp;Fábio Barlem Hohmann,&nbsp;Fábio Luis Ferrari Regatieri,&nbsp;Germano Pinheiro Medeiros,&nbsp;Luiz Marcelo Sá Malbouisson","doi":"10.1016/j.bjane.2026.844814","DOIUrl":"10.1016/j.bjane.2026.844814","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative Pulmonary Complications (PPCs) are a leading cause of morbidity, mortality, and prolonged hospitalization in surgical patients. Intraoperative mechanical ventilation plays a critical role in mitigating these risks, yet clinical practices remain heterogeneous and often not guided by evidence-based standards.</div></div><div><h3>Objective</h3><div>To develop evidence-based recommendations on perioperative mechanical ventilation strategies for surgical patients, aiming to optimize respiratory care, reduce PPCs, and standardize practice in Brazil.</div></div><div><h3>Methods</h3><div>This guideline was developed under the coordination of the Brazilian Society of Anesthesiology (SBA) by a panel of anesthesiologists and intensivists from multiple institutions. Seventeen clinical questions were structured in the PICO format (Population, Intervention, Comparison, Outcome). Systematic literature searches were conducted in PubMed, Embase, Cochrane Library, and Scopus up to July 2025. The strength of recommendations and certainty of evidence were assessed using the GRADE methodology. A modified Delphi process was applied to obtain agreement among collaborators, and consensus was discussed only when the predefined threshold of at least 80% agreement was not achieved. All recommendations were standardized in a uniform format.</div></div><div><h3>Results</h3><div>Seventeen thematic chapters were developed, covering topics from respiratory physiology and the definition of PPCs to advanced intraoperative monitoring, special populations (obese, pediatric, thoracic and cardiac surgery), and patients with or without acute lung injury. Key recommendations include the routine use of lung-protective strategies low tidal volumes of 6–8 mL.kg⁻¹ PBW in patients without ARDS and 4–8 mL.kg⁻¹ PBW in patients with ARDS, Positive End-Expiratory Pressure [PEEP] titrated to physiology, driving pressure ΔP ≤ 15 cm H₂O, and Plateau Pressure [Pplat] ≤ 30 cm H₂O), individualized approaches in high-risk patients, avoidance of unnecessary high fraction of inspired oxygen (FiO₂), and selective use of recruitment maneuvers. Standardized definitions of PPCs and structured monitoring were emphasized as essential to improving patient outcomes.</div></div><div><h3>Conclusion</h3><div>These consensus-based recommendations provide clinicians with a practical, evidence-informed framework for perioperative mechanical ventilation. Adoption of protective strategies and standardized definitions is expected to improve respiratory outcomes and reduce variability in perioperative care.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 5","pages":"Article 844814"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of named caps on anesthesia and intensive care team performance: a randomized simulation study","authors":"Sylvain Garnier,&nbsp;Laurent Mattatia,&nbsp;Nicolas Boulet,&nbsp;Gregoire Bosselut,&nbsp;Chris Serrand,&nbsp;Sylvain Benenati,&nbsp;Philippe Cuvillon,&nbsp;Laurent Muller,&nbsp;Lionel Brunel,&nbsp;Claire Roger","doi":"10.1016/j.bjane.2026.844812","DOIUrl":"10.1016/j.bjane.2026.844812","url":null,"abstract":"<div><h3>Background</h3><div>Effective communication and team non-technical skills are key points for patient safety in anesthesia and intensive care. Named caps have been proposed as a strategy to enhance team efficiency. However, evidence regarding their impact on objectively assessed team performance remains limited.</div></div><div><h3>Methods</h3><div>We conducted a prospective, single center, randomized, and experimental study in a high-fidelity simulation setting (SimHU, Nîmes). Anesthesia and intensive care residents, young doctors, and paramedics participated in simulated critical scenarios, alternating between sessions with and without named caps. The primary objective was to compare team performance, assessed by observers using the TEAM score. The secondary objectives were self-reported measures of entitativity, team cohesion and inclusion of self in the group.</div></div><div><h3>Results</h3><div>A total of 112 participants across 32 simulation sessions were included, which were assessed by 19 instructors. TEAM scores were significantly higher in the named cap group compared to the control group: the 44 points TEAM score (37 ± 7 vs. 33 ± 7; p = 0.026) and the total score (45 ± 8 vs. 40 ± 9; p = 0.020). Subjective perceptions of entitativity and team cohesion did not differ significantly.</div></div><div><h3>Conclusions</h3><div>Named caps were associated with higher team performance in a simulated environment. Their impact on perceived team cohesion and entitativity was not statistically significant under simulation conditions. Further research in clinical settings is needed to determine whether named caps improve teamwork and patient safety.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 5","pages":"Article 844812"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of preoperative intranasal dexmedetomidine in adults: a systematic review and meta-analysis of randomized controlled trials","authors":"Vitaliy Voznyy,&nbsp;Mouad Elganga,&nbsp;Leya Tawfik,&nbsp;Tony Tan,&nbsp;Sammie Yu,&nbsp;Ellene Yan,&nbsp;Aparna Saripella,&nbsp;Marina F. Englesakis,&nbsp;Frances Chung","doi":"10.1016/j.bjane.2026.844820","DOIUrl":"10.1016/j.bjane.2026.844820","url":null,"abstract":"<div><div>Background: Airway manipulation during General Anesthesia (GA) can produce sympathetic activation and hemodynamic instability. Intravenous (IV) dexmedetomidine attenuates these responses but may cause bradycardia or hypotension. Intranasal (IN) administration is a noninvasive alternative with uncertain evidence in adults. We evaluated preoperative IN dexmedetomidine in adult patients undergoing GA.</div><div>Methods: We performed a PROSPERO-registered (CRD420251250492) systematic review and meta-analysis of randomized trials. MEDLINE, Embase, CENTRAL, and CDSR were searched from inception to November 26, 2025. IN dexmedetomidine versus control and IN vs. IV dexmedetomidine were assessed separately. Random-effects models pooled continuous outcomes as MDs/SMDs and adverse events as RRs. Risk of bias was assessed using RoB2 and certainty of evidence using GRADE.</div><div>Results: Across 25 trials including 1,968 patients, IN dexmedetomidine was associated with deeper sedation (SMD = 0.76; 95% CI: 0.18–1.34) and reduced heart rate and mean arterial pressure at induction, intubation, and during the early intraoperative period compared with control (MD range: -12.7 to -13.4 bpm and -7.8 to -10.7 mmHg, respectively). Rates of bradycardia and hypotension were similar between IN dexmedetomidine and control groups. Compared with IV dexmedetomidine, IN administration resulted in lighter sedation (SMD = -0.54; 95% CI: -1.08 to -0.01), with similar hemodynamic effects, while bradycardia and hypotension occurred less frequently.</div><div>Conclusion: Preoperative IN dexmedetomidine may improve sedation and blunt peri-induction hemodynamic responses compared with controls, with broadly similar hemodynamic effects and fewer observed cardiovascular adverse events versus IV administration. However, certainty was low or very low for several efficacy outcomes, and larger well-designed trials are needed.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 5","pages":"Article 844820"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social support and partner presence in chronic pain recovery: clarifying the mechanism behind an observed association","authors":"Betul Kozanhan,&nbsp;Mahmut Sami Tutar,&nbsp;Munise Yildiz","doi":"10.1016/j.bjane.2026.844815","DOIUrl":"10.1016/j.bjane.2026.844815","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 5","pages":"Article 844815"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partner presence, social support and chronic pain recovery: reply to a Letter to the Editor","authors":"Camila C. Castro,&nbsp;Sandro Max C. Silva,&nbsp;Martha M.C. Castro,&nbsp;Durval Campos Kraychete,&nbsp;Carla Daltro","doi":"10.1016/j.bjane.2026.844819","DOIUrl":"10.1016/j.bjane.2026.844819","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 5","pages":"Article 844819"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to “Noninvasive intracranial pressure real-time waveform analysis monitor during prostatectomy robotic surgery and Trendelenburg position: case report” [Brazilian Journal of Anesthesiology. Volume 71, Issue 6, November–December 2021, Pages 656–659]","authors":"Gabriela Tognini Saba,&nbsp;Vinicius Caldeira Quintão,&nbsp;Suely Pereira Zeferino,&nbsp;Claudia Marquez Simões,&nbsp;Rafael Ferreira Coelho,&nbsp;Arnaldo Fazoli,&nbsp;William Nahas,&nbsp;Gustavo Henrique Frigieri Vilela,&nbsp;Maria José Carvalho Carmona","doi":"10.1016/j.bjane.2026.844823","DOIUrl":"10.1016/j.bjane.2026.844823","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 5","pages":"Article 844823"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}