Brazilian Journal of Anesthesiology最新文献

{"title":"Hypertonic saline versus mannitol for brain relaxation in supratentorial tumor surgery: a prospective randomized trial","authors":"Eren Fatma Akcil,&nbsp;Ozlem Korkmaz Dilmen,&nbsp;Yusuf Tunali","doi":"10.1016/j.bjane.2025.844684","DOIUrl":"10.1016/j.bjane.2025.844684","url":null,"abstract":"<div><h3>Background</h3><div>Hypertonic saline and mannitol are widely used to improve brain relaxation during supratentorial mass surgeries. Although continuous administration of hypertonic saline is known to reduce intracranial pressure, it has not yet been evaluated in supratentorial mass surgeries.</div></div><div><h3>Methods</h3><div>After institutional ethical committee approval, 92 patients scheduled for supratentorial craniotomy with glioblastoma multiforme, metastasis and/or midline shift (&gt; 0.5 cm) were enrolled into this prospective, randomized, and double-blind study. The patients received hypertonic saline 3 mL.kg^-1 bolus, hypertonic saline infusion 20 mL.h^-1 or 20 % mannitol 0.6 gr.kg^-1 after head positioning. Brain relaxation score (1 = Perfectly relaxed, 2 = Satisfactorily relaxed, 3 = Firm brain and 4 = Bulging brain) was the primary outcome. Sodium and chlorine levels were the secondary outcomes. Postoperative brain edema and midline shift were assessed.</div></div><div><h3>Results</h3><div>After randomization, two patients were excluded from the study. Brain relaxation scores were higher with hypertonic saline bolus compared to mannitol (<em>p</em> = 0.047). The effect size between groups for brain relaxation score was 0.22. Hypertonic saline continuous infusion and mannitol were similar with respect to brain relaxation scores. Sodium and chlorine levels were lower in the mannitol group. Postoperative midline shift and edema were lower with continuous hypertonic saline compared to other groups (<em>p</em> = 0.001, <em>p</em> = 0.006).</div></div><div><h3>Conclusion</h3><div>Continuous infusion of 3 % hypertonic saline was associated with better relaxation scores in the intraoperative period and with lower incidences of edema/midline shift in the postoperative period of supratentorial mass surgeries with glioblastoma multiforme, metastasis and/or midline shift.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 6","pages":"Article 844684"},"PeriodicalIF":1.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088398","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":"Association between family environment and emergence delirium in pediatric patients after tonsillectomy and adenoidectomy: an observational prospective study","authors":"Yubo Gao ,&nbsp;Huihui Pei ,&nbsp;Zhendong Liu,&nbsp;Yunfeng Bai,&nbsp;Jun Liu,&nbsp;Xinli Ni","doi":"10.1016/j.bjane.2025.844676","DOIUrl":"10.1016/j.bjane.2025.844676","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative anxiety in children is a known risk factor for Emergence Delirium (ED). The family environment may indirectly influence ED by modulating anxiety levels, but its direct role in ED remains unclear. The purpose of this study is to explore the associations between the occurrence of ED and family environmental factors in children. Identifying such associations may support the use of preoperative screening and targeted interventions to reduce ED risk.</div></div><div><h3>Methods</h3><div>In this prospective observational study, 334 children (3∼7 years) undergoing elective tonsillectomy/adenoidectomy were assessed. Preoperative visits recorded clinical data and used the Chinese Family Environment Scale (FES-CV) and State/Trait Anxiety Inventories (parental anxiety). Preoperative child anxiety was measured via modified Yale Preoperative Anxiety Scale (m-YPAS). ED was assessed postoperatively in PACU using the Pediatric Anesthesia Emergence Delirium scale (PAED ≥ 10).</div></div><div><h3>Results</h3><div>ED incidence was 21.9%. No significant association existed between overall home environment and ED. However, achievement orientation (FES-CV) negatively correlated with the m-YPAS score (m-YPAS; <em>r</em> = -0.139, p = 0.011). Independent ED risk factors identified: younger age (OR = 0.949, 95% CI 0.912∼0.988), introverted personality (OR = 0.393, 95% CI 0.184∼0.843), and higher postoperative pain (FLACC score; OR = 1.885, 95% CI 1.610∼2.208).</div></div><div><h3>Conclusion</h3><div>While no direct link between home environment and ED was found, the negative correlation between achievement orientation and preoperative anxiety suggests an indirect influence. Identifying high-risk children using factors like age, personality, and pain levels remains important for ED prevention.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 6","pages":"Article 844676"},"PeriodicalIF":1.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006959","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":"Beneath the surface: the emerging concern of covert stroke in surgery","authors":"Adrian W. Gelb ,&nbsp;Bruna Bastiani ,&nbsp;Cristiane Tavares","doi":"10.1016/j.bjane.2025.844669","DOIUrl":"10.1016/j.bjane.2025.844669","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844669"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925075","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":"Thoracic wall blocks in cardiac and thoracic procedures: expanding frontiers for perioperative regional analgesia","authors":"Marcello Fonseca Salgado-Filho ,&nbsp;Luiz Guilherme Villares da Costa ,&nbsp;Eric Benedet Lineburger ,&nbsp;Bruno Francisco de Freitas Tonelotto","doi":"10.1016/j.bjane.2025.844670","DOIUrl":"10.1016/j.bjane.2025.844670","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844670"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859893","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 use of ketamine on emergence agitation in children: a systematic review and meta-analysis","authors":"Ka Ting Ng ,&nbsp;Jun Chuen Hui ,&nbsp;Wan Yi Teoh ,&nbsp;Ina Ismiarti Shariffuddin ,&nbsp;Mohd Fitry Zainal Abidin","doi":"10.1016/j.bjane.2025.844675","DOIUrl":"10.1016/j.bjane.2025.844675","url":null,"abstract":"<div><h3>Background</h3><div>Ketamine is believed to reduce the incidence of emergence agitation in children after surgery. However, recent studies reported contradictory findings. Thus, the primary objective of this review and meta-analysis was to investigate the use of ketamine in the reduction of emergence agitation in children undergoing surgery or procedure.</div></div><div><h3>Methods</h3><div>MEDLINE, EMBASE and CENTRAL were systematically searched from their inception date until March 2024. Randomized controlled trials comparing intravenous ketamine and placebo in children were sought. Observational studies, editorial letters or case reports were excluded.</div></div><div><h3>Results</h3><div>Seventeen studies (1515 patients) were included. Children who received ketamine were reported to have a significantly lower incidence of emergence agitation (OR = 0.27, 95% Confidence Interval: 0.16 to 0.45, <em>p</em> &lt; 0.00001, I² = 61%, certainty of evidence: very low). As compared to placebo, the ketamine group had a significantly lower postoperative pain score (MD = -2.28, 95% Confidence Interval -3.68 to -0.87, <em>p</em> = 0.001, I² = 91%, certainty of evidence: very low). However, no significant differences were observed in the incidence of postoperative nausea and vomiting, desaturation, and laryngospasm.</div></div><div><h3>Conclusion</h3><div>This meta-analysis highlights the potential benefits of ketamine in the reduction of emergence agitation in children undergoing surgery or diagnostic procedures. However, high degrees of heterogeneity and low certainty of evidence limit the recommendations of the routine use of ketamine in the prevention of emergence agitation in children. Further high-quality randomized controlled trials are warranted before routine use can be recommended.</div></div><div><h3>PROSPERO registration</h3><div>CRD42024523680.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 6","pages":"Article 844675"},"PeriodicalIF":1.9,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980641","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":"An anesthetic perspective on transoperative complications in open versus robot-assisted radical cystectomy: a five-year retrospective study","authors":"Sérgio Luiz do Logar Mattos ,&nbsp;Ronaldo Damião ,&nbsp;Fabrício Borges Carrerette ,&nbsp;Aretha Paes de Lima Carneiro ,&nbsp;Ian Maia Fontes","doi":"10.1016/j.bjane.2025.844674","DOIUrl":"10.1016/j.bjane.2025.844674","url":null,"abstract":"<div><h3>Background</h3><div>Radical cystectomy remains the standard treatment for invasive bladder cancer, yet it carries significant anesthetic risks. While robot-assisted surgery has gained popularity, data comparing its anesthetic implications to those of open surgery are limited. This study aimed to compare the incidence of transoperative complications between the two techniques.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 44 patients who underwent open (n = 29) or robot-assisted (n = 15) radical cystectomy in a university hospital between 2019 and 2024. Data were collected on American Society of Anesthesiologists (ASA) physical status, intraoperative hemodynamic parameters, ventilatory complications, additional postoperative opioid requirements, Intensive Care Unit (ICU) stay, and total length of hospital stay. Correlations between blood loss, transfusion requirements, and hemodynamic variables were evaluated.</div></div><div><h3>Results</h3><div>The robotic cystectomy group experienced less intraoperative bleeding (mean of 410 ± 185 mL vs. 662.5 ± 210 mL; p = 0.002), but no significant reduction in transfusion requirements (95% CI not reported; p = 0.110) despite a strong correlation between bleeding volume and need for transfusion (<em>r</em> = 0.78; p &lt; 0.001). Opioid consumption was significantly higher in the open cystectomy group (75.9% vs. 33.3%; p = 0.004). There was no significant difference in intraoperative hypotension, vasoactive drug use, ventilatory complications, in-hospital mortality, ICU stay, or total hospital stay (p &gt; 0.05 for all). However, the small sample size limits the precision of these estimates.</div></div><div><h3>Conclusion</h3><div>While robot-assisted radical cystectomy was associated with reduced blood loss and lower additional postoperative opioid use, our small retrospective sample did not identify significant differences in intraoperative hemodynamic parameters or major complications. The surgical technique had no impact on in-hospital mortality.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 6","pages":"Article 844674"},"PeriodicalIF":1.9,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980556","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 intravenous dexmedetomidine on sensory block duration in spinal anesthesia for lower limb surgery: a randomized controlled trial","authors":"Simran Chahal,&nbsp;Anju R. Bhalotra,&nbsp;Rahil Singh,&nbsp;Shweta Dhiman,&nbsp;Snigdha Singh","doi":"10.1016/j.bjane.2025.844672","DOIUrl":"10.1016/j.bjane.2025.844672","url":null,"abstract":"<div><h3>Study objective</h3><div>To study the effect of Intravenous (IV) dexmedetomidine during spinal anesthesia on duration of sensory block and postoperative analgesia in patients undergoing lower limb orthopedic surgery.</div></div><div><h3>Design</h3><div>Prospective randomized double blind controlled trial.</div></div><div><h3>Intervention</h3><div>Patients in intervention (DX) group received 0.5 mcg.kg^-1 IV dexmedetomidine over 10 min. Spinal anesthesia was administered and an infusion of dexmedetomidine 0.5 mcg.kg^-1.h^-1 was given throughout surgery.</div></div><div><h3>Measurements</h3><div>Onset time of sensory and motor block, maximum height of sensory block and duration of sensory and motor block were assessed. Intraoperative Heart Rate (HR), Blood Pressure (BP), Peripheral Oxygen Saturation (SpO₂), sedation scores, postoperative pain scores, time to requirement of first analgesic and analgesic consumption over first 24h were noted.</div></div><div><h3>Results</h3><div>Data of 58 ASA I/II adults was analyzed. Duration of sensory block, defined as time to two-dermatome regression, was 137.03 ± 25.02 min in DX group and 79.45 ± 11.27 min in the NS group (p = 0.000). Onset of sensory and motor block and maximum height of sensory block were similar. Postoperative VAS scores were lower in the DX group at 4h and 24h (p = 0.001, p 0.0001) and comparable at 0h, 8h and 12h. Time to requirement of postoperative analgesia was longer in the DX group (p &lt; 0.001) and requirement of postoperative analgesics was higher in the NS group. Sedation scores and incidence of bradycardia were higher in the DX group, but hypotension was similar.</div></div><div><h3>Conclusion</h3><div>IV dexmedetomidine (0.5 mcg.kg^-1 followed by 0.5 mcg.kg^-1.h^-1) resulted in extended sensory and motor block, prolonged postoperative analgesia and reduced postoperative analgesic consumption with minimal side effects.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 6","pages":"Article 844672"},"PeriodicalIF":1.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980591","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":"Variable ventilation with two PEEP Levels (BiPEEP) in patients with acute respiratory distress syndrome: a pilot study","authors":"Paula C. Fontela ,&nbsp;Luiz Alberto Forgiarini Junior ,&nbsp;Cristiano Feijó Andrade ,&nbsp;Guillermo Bugedo ,&nbsp;Gilberto Friedman","doi":"10.1016/j.bjane.2025.844673","DOIUrl":"10.1016/j.bjane.2025.844673","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 6","pages":"Article 844673"},"PeriodicalIF":1.9,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980719","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":"Imaging classification in videolaryngoscopy: are we on the right track?","authors":"Daniel Perin,&nbsp;Mauricio Luiz Malito,&nbsp;Maurício do Amaral Neto","doi":"10.1016/j.bjane.2025.844671","DOIUrl":"10.1016/j.bjane.2025.844671","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844671"},"PeriodicalIF":1.9,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859892","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 venous sympathetic block in chronic pain practice: absence of evidence, presence of use?","authors":"Hugo Muscelli Alecrim","doi":"10.1016/j.bjane.2025.844666","DOIUrl":"10.1016/j.bjane.2025.844666","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 6","pages":"Article 844666"},"PeriodicalIF":1.9,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765857","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}