Brazilian Journal of Anesthesiology最新文献

{"title":"Oscillatory ventilation enhances oxygenation and reduces inflammation in an animal model of acute respiratory distress syndrome: an experimental study","authors":"Luiz Alberto Forgiarini Junior ,&nbsp;Luiz Felipe Forgiarini ,&nbsp;Arthur de Oliveira Paludo ,&nbsp;Rodrigo Mariano ,&nbsp;Mikael Marcelo de Moraes ,&nbsp;Elaine Aparecida Felix ,&nbsp;Cristiano Feijó Andrade","doi":"10.1016/j.bjane.2024.844576","DOIUrl":"10.1016/j.bjane.2024.844576","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to compare the use of variable mechanical ventilation with conventional mechanical ventilation in a porcine model of ARDS induced by oleic acid.</div></div><div><h3>Methods</h3><div>The animals were divided into two groups (n = 6), Conventional Ventilation (CO) and variable ventilation with Bi-Oscillatory PEEP (BiPEEP). ARDS was induced using intravenous oleic acid (0.15 mL.kg⁻¹). After, the animals were evaluated during 180 minutes and, measurements were taken every 30 minutes until the end of the observation period. The animals in the CO group were then ventilated under controlled pressure (Tidal Volume target at 6 mL.kg⁻¹) and 5 cm H₂O PEEP. Variable ventilation was characterized by the oscillation of PEEP from 5 to 10 cm H₂O every 4 respiratory cycles. Ventilatory, hemodynamic parameters, oxidative stress, antioxidant enzymes, Interleukin 8 (IL8) and 17-a (IL17a) were evaluated. Histological samples were collected from the upper and the lower portion of the left lungs and analyzed separately.</div></div><div><h3>Results</h3><div>BiPEEP improved lung compliance and PaO₂ in comparison to control (p &lt; 0.05). The levels of oxidative stress and antioxidant enzymes showed no significant difference. There was no difference in IL17a between groups. IL8 was significantly increased in the lung base of CO group in relation to BiPEEP group and it was reduced in the apex of BiPEEP group in comparsion to CO group. The BiPEEP group showed less changes in histopathological patterns.</div></div><div><h3>Conclusion</h3><div>Variable ventilation with bi-oscillatory level of PEEP demonstrated a potential ventilatory strategy for lung protection in an experimental model of ARDS.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844576"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717819","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 hidden cost of hypotension: redefining hemodynamic management to improve patient outcomes","authors":"Eric B. Lineburger ,&nbsp;Deepak K. Tempe ,&nbsp;Luiz Guilherme V. da Costa ,&nbsp;G. Burkhard Mackensen ,&nbsp;Fabio V. Papa ,&nbsp;Carlos Galhardo Jr. ,&nbsp;Mohamed R. El Tahan ,&nbsp;Marcello F. Salgado-Filho ,&nbsp;Rodrigo Diaz ,&nbsp;André P. Schmidt","doi":"10.1016/j.bjane.2024.844581","DOIUrl":"10.1016/j.bjane.2024.844581","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844581"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792746","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":"A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementation","authors":"David Silveira Marinho ,&nbsp;Denise Menezes Brunetta ,&nbsp;Luciana Maria de Barros Carlos ,&nbsp;Luany Elvira Mesquita Carvalho ,&nbsp;Jessica Silva Miranda","doi":"10.1016/j.bjane.2024.844583","DOIUrl":"10.1016/j.bjane.2024.844583","url":null,"abstract":"<div><div>Until the beginning of the century, bleeding management was similar in elective surgeries or exsanguination scenarios: clotting tests were used to guide blood product orders and, while awaiting these results, an aggressive resuscitation with crystalloids was recommended. The high mortality rate in severe hemorrhages managed with this strategy endorsed the need for a special resuscitation plan. As a result, modifications were recommended to develop a new clinical approach to these patients, called “Damage Control Resuscitation”. This strategy includes four principles: damage control surgery, minimization of crystalloids, permissive hypotension and hemostatic resuscitation. The latter involves the use of antifibrinolytics, correction of preconditions of hemostasis (calcium, pH and temperature) and the early and rapid restoration of intravascular volume with blood products. To enable timely availability and transfusion of blood products, specific actions in different hospital areas need to be synchronized, which are usually organized through Massive Transfusion Protocols or, as they have recently been rebranded, Major Hemorrhage Protocols (MHPs). Although these bundles of actions represent a paradigm change, essential aspects such as their historical evolution, theoretical foundations, terminology and operational elements have yet to be well explored. Considering the wide application range of these tools (emergency departments, interventional radiology, operating rooms and military fields), it is essential to integrate all professionals involved with severe hemorrhage scenarios in the implementation of the aforementioned protocols, from conception to execution and management. This review paper addresses MHP aspects relevant to anesthesiologists, transfusion services and other areas involved with the care of patients with severe bleeding.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844583"},"PeriodicalIF":1.7,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900824","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 of Erector Spinae Plane Block (ESPB) in pediatric cardiac surgeries: a systematic review and meta-analysis","authors":"Verônica Pustrelo Damião ,&nbsp;Priscila Pechim Andrade ,&nbsp;Leonardo Saraiva Guimarães de Oliveira ,&nbsp;Angélica de Fátima Assunção Braga ,&nbsp;Vanessa Henriques Carvalho","doi":"10.1016/j.bjane.2024.844579","DOIUrl":"10.1016/j.bjane.2024.844579","url":null,"abstract":"<div><h3>Background</h3><div>Erector Spinae Plane Block (ESPB) effectively reduces pain scores for sternotomy in adults. However, evidence is insufficient to assert that the same result occurs in children. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ESPB in pediatric cardiac surgeries.</div></div><div><h3>Methods</h3><div>Systematic Medline, Embase and Cochrane searches were conducted for studies that compared ESPB versus no block or sham block for pediatric cardiac surgery under sternotomy. The primary outcome was cumulative opioid consumption for up to 48 hours. Statistical analyses were carried out with the use of RStudio version 1.2.1335. Heterogeneity was assessed by Cochran's Q test and I² statistics. Quality assessment and risk of bias assessment complied with Cochrane recommendations.</div></div><div><h3>Results</h3><div>Five studies, involving 328 patients (3 Randomized Controlled Trials [RCT], and 2 cohorts) were included. Of the 328 patients, 160 (48.7%) underwent ESPB. There were significant reductions in cumulative opioid consumption up to 48 hours after ESPB (SMD -0.68; 95% CI -1.13 – -0.23; p &lt; 0.01). In the following outcomes ESPB failed to show superiority: postoperative nausea and vomiting (OR = 0.56; 95% CI 0.25–1.23; p = 0.54), fever (OR = 0.75; 95% CI 0.24–2.31; p = 0.58), length of intensive care unit stay in hours (MD -2.42; 95% CI -5.47–0.64; p &lt; 0.01] and length of hospital stay in days (MD -0.87; 95% CI -2.69–0.96; p = 0.02). Only one cohort study had a high risk of bias.</div></div><div><h3>Conclusion</h3><div>ESPB potentially reduces postoperative pain by significant reductions in cumulative opioid consumption up to 48 hours in pediatric cardiac surgery patients.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844579"},"PeriodicalIF":1.7,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775181","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":"Comparative effects of ciprofol and propofol on perioperative outcomes: a systematic review and meta-analysis of randomized controlled trials","authors":"Jiazheng Qi ,&nbsp;Lingjing Zhang ,&nbsp;Fanhua Meng ,&nbsp;Xiaoyu Yang ,&nbsp;Baoxuan Chen ,&nbsp;Lingqi Gao ,&nbsp;Xu Zhao ,&nbsp;Mengqiang Luo","doi":"10.1016/j.bjane.2024.844578","DOIUrl":"10.1016/j.bjane.2024.844578","url":null,"abstract":"<div><h3>Background</h3><div>The ideal anesthetic agents for sedation, considering their respiratory and cardiovascular benefits and other perioperative or postoperative outcomes, are still unclear. This systematic review and meta-analysis aimed to evaluate whether ciprofol has advantages over propofol for sedation, particularly concerning respiratory and cardiovascular outcomes and other relevant perioperative measures.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive search of PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and two Chinese databases for randomized controlled trials comparing intravenous ciprofol and propofol for sedation. The primary outcome was the incidence of adverse respiratory events. Secondary outcomes included incidences of injection pain, hypotension, hypertension, bradycardia during surgery, perioperative nausea and vomiting, and postoperative awakening time. A random-effects model was used for more than four studies; otherwise, we employed the random-effects model with the Hartung-Knapp-Sidik-Jonkman adjustment.</div></div><div><h3>Results</h3><div>Intravenous ciprofol resulted in fewer adverse respiratory events than propofol (Risk Ratio [RR = 0.44]; 95% Confidence Interval [95% CI 0.35–0.55], p &lt; 0.001, I² = 45%, low quality). It also showed a lower incidence of injection pain (RR = 0.12; 95% CI 0.08‒0.17, p &lt; 0.001, I² = 36%, low quality), intraoperative hypotension (RR = 0.64; 95% CI 0.52–0.77, p &lt; 0.001, I² = 58%, low quality), and nausea and vomiting than propofol (RR = 0.67; 95% CI 0.49–0.92; p = 0.01, I² = 0%, moderate quality). However, no significant differences were observed for hypertension, bradycardia, and awakening time.</div></div><div><h3>Conclusions</h3><div>Ciprofol may be more effective than propofol in minimizing perioperative respiratory adverse events and maintaining hemodynamic stability during sedation without prolonging recovery time.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844578"},"PeriodicalIF":1.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752556","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 of dexamethasone or clonidine as adjuvants in interscalene brachial plexus block for preventing rebound pain after shoulder surgery: a randomized clinical trial","authors":"Layana Vieira Nobre ,&nbsp;Leonardo Henrique Cunha Ferraro ,&nbsp;Juscelino Afonso de Oliveira Júnior ,&nbsp;Vitória Luiza Locatelli Winkeler ,&nbsp;Luis Flávio França Vinhosa Muniz ,&nbsp;Hiago Parreão Braga ,&nbsp;Plínio da Cunha Leal","doi":"10.1016/j.bjane.2024.844575","DOIUrl":"10.1016/j.bjane.2024.844575","url":null,"abstract":"<div><h3>Background</h3><div>Rebound pain is believed to involve both nociceptive pain due to insufficient analgesia and hyperalgesia induced by regional anesthesia. Adjuvant's addition could prevent rebound pain. This study aimed to determine if the addition of dexamethasone or clonidine to local anesthetic when performing interscalene block could prevent rebound pain.</div></div><div><h3>Methods</h3><div>This was a multicenter, prospective, parallel grouping, randomized clinical trial conducted with patients receiving a single injection of bupivacaine 0.375% in interscalene block ultrasound guided and general anesthesia for shoulder surgery were randomly assigned to either no additives (control), clonidine (30 mcg), or dexamethasone (4 mg). The primary outcome was rebound pain, defined as sudden onset of pain, moderate to severe intensity (VAS ≥7) without improvement with oral medication, followed by VAS pain at rest, required rescue analgesia, the occurrence of adverse events or complications, and satisfaction survey assessments between groups. Rebound pain and pain at rest were assessed 2, 4, 6, 12, 24, and 48 hours after the procedure.</div></div><div><h3>Results</h3><div>The incidence of rebound pain was not statistically different between groups (p-value = 0.22), with an observed incidence of 41.2% (95% CI 25.9‒57.9), 28.6% (95% CI 16.7‒43.3), and 23.3% (95% CI 12.6‒37.6) in the control, dexamethasone, and clonidine groups, respectively. Additionally, there were no significant differences between the groups in time, from anesthetic blockade to first complaint of pain or the severity of postoperative pain.</div></div><div><h3>Conclusion</h3><div>The administration of dexamethasone or clonidine as perineural adjuncts to local anesthesia in single-injection interscalene blocks did not significantly reduce the incidence of rebound pain.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844575"},"PeriodicalIF":1.7,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717788","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":"Comparative effectiveness of anterior and posterior approaches for interscalene brachial plexus block: A systematic review and meta-analysis","authors":"Luis Eduardo Ciconini ,&nbsp;Theodoro Beck ,&nbsp;Catreen Abouelsaad ,&nbsp;Karandip Bains ,&nbsp;Mauren F. Carbonar","doi":"10.1016/j.bjane.2024.844574","DOIUrl":"10.1016/j.bjane.2024.844574","url":null,"abstract":"<div><h3>Introduction</h3><div>Interscalene Brachial Plexus Blocks (ISBPB) are highly effective forms of anesthesia for surgeries involving the upper arm, shoulder, and neck. Recently, there has been a growing interest in comparing the advantages and limitations of the anterior and posterior approaches.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis aimed to determine whether the anterior or posterior approach to ISBPB offers a clinical advantage regarding complete block rates and time to block completion. We included randomized controlled trials comparing the anterior and posterior techniques for ISBPB while excluding studies with overlapping populations, comparisons of blocks other than interscalene, and articles written in a non-English language.</div></div><div><h3>Results</h3><div>The search strategy identified 2229 articles, of which six Randomized Controlled Trials (RCTs) met the inclusion criteria for the meta-analysis. A total of 414 patients were included, with 210 patients in the anterior group and 204 in the posterior group. The Odds Ratio (OR) for a complete sensory block between the two techniques did not reach statistical significance (OR = 0.56 [0.20, 1.58], 95% CI, p = 0.27). Similarly, the Standardized Mean Difference (SMD) for the time to complete the block also did not reach statistical significance (SMD: -0.77 [-2.12, 0.59], 95% CI, p = 0.27). Heterogeneity for complete block was not significant (I² = 0%), while procedure time showed high heterogeneity (I² = 97%).</div></div><div><h3>Conclusion</h3><div>Both techniques have shown effectiveness in providing surgical analgesia. The choice of technique should be determined by the provider's comfort and proficiency, as well as ensuring the highest level of safety for the patient.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844574"},"PeriodicalIF":1.7,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649277","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":"Prevalence and predictors of confirmed infection in patients receiving empiric antimicrobials in the intensive care unit: a retrospective cohort study","authors":"Luis Carlos Maia Cardozo Júnior ,&nbsp;Larissa Bianchini ,&nbsp;Jakeline Neves Giovanetti ,&nbsp;Luiz Marcelo Almeida de Araújo ,&nbsp;Yuri de Albuquerque Pessoa dos Santos ,&nbsp;Bruno Adler Maccagnan Pinheiro Besen ,&nbsp;Marcelo Park","doi":"10.1016/j.bjane.2024.844567","DOIUrl":"10.1016/j.bjane.2024.844567","url":null,"abstract":"<div><h3>Background</h3><div>Infection diagnosis in Intensive Care Units (ICUs) is a challenge given the spectrum of conditions that present with systemic inflammation, the illness severity and the delay and imprecision of existing diagnostic methods. We hence sought to analyze the prevalence and predictors of confirmed infection after empirical antimicrobials during ICU stay.</div></div><div><h3>Methods</h3><div>retrospective cohort of prospectively collected ICU data in an academic tertiary hospital in São Paulo, Brazil. We included all adult patients given a new empirical antimicrobial during their ICU stay. We excluded patients using prophylactic or microbiologically guided antimicrobials. Primary outcome was infection status, defined as confirmed, probable, possible, or discarded. In a multivariable analysis, we explored variables associated with confirmed infection.</div></div><div><h3>Results</h3><div>After screening 1721 patients admitted to the ICU from November 2017 to November 2022, we identified 398 new antimicrobial prescriptions in 341 patients. After exclusions, 243 antimicrobial prescriptions for 206 patients were included. Infection was classified as confirmed in 61 (25.1%) prescriptions, probable in 39 (16.0%), possible in 103 (42.4%), and discarded in 40 (16.5%). The only factor associated with infection was deltaSOFA (OR = 1.18, 95% CI 1.02 to 1.36, p = 0.022).</div></div><div><h3>Conclusion</h3><div>Suspected infection in the ICU is frequently not confirmed. Clinicians should be aware of the need to avoid premature closure and revise diagnosis after microbiological results. Development and implementation of new tools for faster infection diagnosis and guiding of antimicrobial prescription should be a research priority.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844567"},"PeriodicalIF":1.7,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514001","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":"Pharmacological and non-pharmacological interventions in patients undergoing nasal surgeries for prevention of emergence agitation: a systematic review and network meta-analysis","authors":"Gustavo R.M. Wegner ,&nbsp;Bruno F.M. Wegner ,&nbsp;Henrik G. Oliveira ,&nbsp;Luis A. Costa ,&nbsp;Luigi W. Spagnol ,&nbsp;Valentine W. Spagnol ,&nbsp;Gilberto T.F. de Oliveira Filho","doi":"10.1016/j.bjane.2024.844565","DOIUrl":"10.1016/j.bjane.2024.844565","url":null,"abstract":"<div><h3>Background</h3><div>Emergence agitation is a common complication after nasal surgeries, marked by increased agitation and a heightened risk of injuries. Factors like urinary catheter, endotracheal tube, postoperative pain, and younger age contribute to its occurrence. Due to the variety of preventive approaches reported in the literature, a network meta-analysis is essential.</div></div><div><h3>Methods</h3><div>This systematic review employs a network meta-analysis design, following Cochrane Handbook and PRISMA-NMA criteria. Inclusion criteria involve randomized controlled studies on pharmacological and non-pharmacological interventions for preventing emergence agitation in nasal surgeries. Electronic searches, including PubMed, Scopus, Embase, Cochrane Library, and Web of Science, without language or date restrictions, were conducted. Two independent reviewers selected studies, and data extraction was performed using standardized tables. Bayesian NMA, MetaInsight web app, and Cochrane Foundation Risk of Bias Assessment Tool were applied for data analysis and bias assessment.</div></div><div><h3>Results</h3><div>After a rigorous selection process, 17 Randomized Controlled Trials (RCTs) encompassing 2,122 patients and 14 interventions were included. The best ranked treatments identified were intraoperative dexmedetomidine (1 μg.kg-¹ for 10 minutes as a bolus, followed by 0.4 μg.kg^-1.h^-1), bilateral nasociliary and maxillary nerve block, ketamine (0.5 mg.kg^-1 administered 20 minutes before the end of surgery), nasal compression for 40 minutes before anesthesia induction, and suction above the cuff of the endotracheal tube.</div></div><div><h3>Conclusions</h3><div>Both pharmacological and non-pharmacological interventions emerged as effective strategies in mitigating emergence agitation after nasal surgeries, offering clinicians valuable options for improving postoperative outcomes in this patient population.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844565"},"PeriodicalIF":1.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482242","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":"Intraoperative hypotension during critical phases of liver transplantation and its impact on acute kidney injury: a retrospective cohort study","authors":"Matthanja Bieze ,&nbsp;Amir Zabida ,&nbsp;Eduarda Schutz Martinelli ,&nbsp;Rebecca Caragata ,&nbsp;Stella Wang ,&nbsp;Jo Carroll ,&nbsp;Markus Selzner ,&nbsp;Stuart A McCluskey","doi":"10.1016/j.bjane.2024.844566","DOIUrl":"10.1016/j.bjane.2024.844566","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute Kidney Injury (AKI) following Liver Transplantation (LT) is associated with prolonged ICU and hospital stay, increased risk of chronic renal disease, and decreased graft survival. Intraoperative hypotension is a modifiable risk factor associated with postoperative AKI. We aimed to determine in which phase of LT hypotension has the strongest association with AKI: the anhepatic or neohepatic phase.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included adult patients undergoing LT between January 2010 and June 2022. Exclusion criteria were re-do or combined transplantations, preoperative dialysis, and early graft failure or death. Primary outcome was AKI as defined by KDIGO. Hypotension was Mean Arterial Pressure (MAP) below predefined thresholds in minutes. Risk adjusted logistic regression analysis considered hypotension in 3 periods: the total procedure, anhepatic phase, and neohepatic phase.</div></div><div><h3>Results</h3><div>Our cohort included 1153 patients. The median MELD-NA score was 19 (IQR 11–28), and 412 (35.9%) were living-related donations. AKI occurred in 544 patients (47.2%). The unadjusted model showed an association with AKI for MAP &lt; 60 mmHg (OR = 1.011 [1.0, 1.022], <em>p</em> = 0.047) and MAP &lt; 55 mmHg (OR = 1.023 [1.002, 1.047], <em>p</em> = 0.040) in the anhepatic phase, and for MAP &lt; 60 mmHg (OR = 1.032 [1.01, 1.056], <em>p</em> = 0.006) in the neohepatic phase. The adjusted model did not reach significance in the subgroups but did in the total procedure: MAP &lt; 60 mmHg (OR = 1.005 [1.002, 1.008], <em>p</em> &lt; 0.001) and MAP &lt; 55 mmHg (OR = 1.008 [1.003–1.013], <em>p</em> = 0.004).</div></div><div><h3>Conclusion</h3><div>Intraoperative hypotension is independently associated with AKI following LT. This association is seen during the anhepatic phase. Maintaining MAP above 60 mmHg may improve kidney function after LT.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 6","pages":"Article 844566"},"PeriodicalIF":1.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482241","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}