Brazilian Journal of Anesthesiology最新文献

{"title":"Effects of shoulder rotation and table tilt maneuvers on the lumbar and thoracic paramedian acoustic window in older adults: a quasi-experimental study","authors":"Marcos V. Nunes de Souza,&nbsp;Ana M.M. Caetano,&nbsp;Nádia M.C. Duarte,&nbsp;Camila T. Nunes de Souza,&nbsp;Artur J.L. Bezerra,&nbsp;Emmanuelle T.A.G.B.B. Silva","doi":"10.1016/j.bjane.2026.844769","DOIUrl":"10.1016/j.bjane.2026.844769","url":null,"abstract":"<div><h3>Background</h3><div>Shoulder rotation and table tilt have been reported to increase the acoustic window for spinal ultrasonography. However, evidence in older adults remains scarce. This study evaluated their anatomical effects on lumbar (L3–L4) and thoracic (T10–T11) paramedian acoustic windows, quantified by posterior longitudinal ligament (PLL) length, in older adults (≥ 65 years).</div></div><div><h3>Methods</h3><div>This quasi-experimental study enrolled 45 older adults scheduled for elective surgery at two tertiary hospitals in Brazil. The primary outcome was PLL ultrasonographic length (paramedian sagittal oblique plane) assessed at the L3‒L4 and T10‒T11 interspaces in three positions: F (standard spinal flexion), S (F plus 45° leftward shoulder rotation), and T (F plus 10° dorsal table tilt). Data were analyzed using a Linear Mixed-Effects Model with Bonferroni-adjusted post-hoc contrasts.</div></div><div><h3>Results</h3><div>The model revealed significant effects of position (p = 0.003) and spinal level (p &lt; 0.001) on PLL length, with no Level × Position interaction (p = 0.693). PLL length was significantly greater at L3–L4 than at T10–T11. Table tilt produced a significant increase relative to the flexion position (difference = 2.2 mm; 95% CI 0.9–3.5; p = 0.002), whereas shoulder rotation did not (difference = 1.2 mm; 95% CI 0.0–2.5; p = 0.158), with homogeneous effects across both levels. Fixed effects explained 27% of total variance (R²m = 0.27; R²c = 0.55).</div></div><div><h3>Conclusion</h3><div>Table tilt produced a significant anatomical enlargement of the neuraxial acoustic window at both spinal levels studied, whereas shoulder rotation did not reach statistical significance. These findings establish an anatomical foundation for future trials evaluating their impact on neuraxial procedural outcomes in older adults.</div></div><div><h3>Trial registration</h3><div><span><span>https://ensaiosclinicos.gov.br/rg/RBR-3p6t9pm</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 4","pages":"Article 844769"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152457","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":"Effects of propofol versus sevoflurane induction on echocardiographic parameters in patients with mitral stenosis: a randomized clinical trial","authors":"Mohammed Jaffer Sherif,&nbsp;Saravana Babu MS,&nbsp;Prasanta Kumar Dash,&nbsp;Nagarjuna Panidappu,&nbsp;Subin Sukesan,&nbsp;Thomas Koshy","doi":"10.1016/j.bjane.2026.844772","DOIUrl":"10.1016/j.bjane.2026.844772","url":null,"abstract":"<div><h3>Background</h3><div>The main aim of this study was to compare the effects of propofol and sevoflurane induction on the echocardiographic parameters of Mitral Stenosis (MS) patients.</div></div><div><h3>Methods</h3><div>Prospective, randomized, outcome-assessor-blinded clinical trial in 80 adults with MS undergoing mitral valve replacement. Patients were randomized to receive General Anesthesia (GA) induction with either propofol (Group P) or sevoflurane (Group S). The primary objective was to assess the changes in mean gradient after 3 minutes of GA induction. Secondary objectives were to assess the changes in echocardiographic Doppler parameters and hemodynamic variables.</div></div><div><h3>Results</h3><div>Compared to pre-induction values, there was significant reduction in the peak and mean gradients as well as peak velocity, in both the groups after GA induction. The Mitral Valve Area calculated by continuity equation (MVA-c) and by pressure half time (MVA-p) were increased in Group S after GA induction. On comparison between the two groups, Group S showed lower pressure half time and greater MVA-p (p = 0.0099) and MVA-c (p = 0.0316) than Group P after GA induction. Mean arterial pressure decreased at the 1^st and 3^rd minute following GA induction in both groups. The Heart Rate (HR) increased at the 1^st and 3^rd minute in Group P whereas it reduced at both the time points in group S.</div></div><div><h3>Conclusion</h3><div>Even though both anesthetic agents reduced transvalvular gradients in MS patients, sevoflurane was associated with a greater increase in estimated valve area and a reduction in heart rate compared with propofol. These findings suggest more favorable short-term hemodynamic and echocardiographic changes with sevoflurane at the studied time points.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 4","pages":"Article 844772"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165910","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":"Developing a concise multivariable predictive model for cesarean delivery following neuraxial analgesia during labor: a prospective observational cohort study","authors":"Paula Daniele Lopes da Costa ,&nbsp;Murilo Henrique da Veiga Ferreira ,&nbsp;Joelcio Francisco Abbade ,&nbsp;Claudia Garcia Magalhães ,&nbsp;Norma Sueli Pinheiro Módolo ,&nbsp;Guilherme Antonio Moreira de Barros ,&nbsp;Gabriel Ricardo Correa Turco ,&nbsp;Pedro Henrique Esteves Trindade ,&nbsp;Paulo do Nascimento Junior","doi":"10.1016/j.bjane.2026.844732","DOIUrl":"10.1016/j.bjane.2026.844732","url":null,"abstract":"<div><h3>Background</h3><div>Sometimes, planned vaginal deliveries with neuraxial analgesia may result in unplanned cesareans. We aimed to determine the incidence of cesarean among parturients receiving neuraxial analgesia for vaginal delivery, identify associated factors, and develop a predictive model.</div></div><div><h3>Methods</h3><div>In this prospective observational cohort study, we evaluated parturients receiving neuraxial analgesia for vaginal delivery and analyzed factors associated with progression to cesarean. Multiple logistic regression with a <em>step-up</em> procedure was performed. The dataset was split into training (70%) and testing (30%) databases, with the latter used to assess performance metrics. Bootstrap validation with 5,000 repetitions was performed.</div></div><div><h3>Results</h3><div>We evaluated 331 parturients and 94 (28.4%) underwent cesarean. Variables differing between cesarean and vaginal delivery groups (p &lt; 0.05) included patient age, body mass index, gestational age, cervical dilation at analgesia initiation, time under analgesia, labor conducted/monitored by nurses, and oxytocin use after analgesia initiation. Three variables remained predictive [odds ratio (95% Confidence Interval (95% CI))]: patient age: 1.0436 (1.0091 to 1.0835), p = 0.018; time under analgesia: 1.0043 (1.0008 to 1.0081), p = 0.018; and oxytocin use after analgesia initiation: 0.0921 (0.0400 to 0.1945), p &lt; 0.001. Predictive area under the curve (95% CI) was 71.8% (60.5%‒83.1%). Arrest of descent (35.1%) and fetal distress (34.0%) were the leading indications for cesarean.</div></div><div><h3>Conclusions</h3><div>Among parturients receiving neuraxial labor analgesia, older patients, longer analgesia duration, and no oxytocin use after analgesia initiation increase the probability of cesarean, with moderate predictivity. Arrest of descent and fetal distress were the main causes of cesarean.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 3","pages":"Article 844732"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069211","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 impact of opioid-free labor epidural analgesia maternal and infant outcomes: a retrospective cohort study","authors":"Kush S. Brahmbhatt ,&nbsp;Ankith P. Reddy ,&nbsp;Hiram A. Acevedo Bonilla ,&nbsp;Ibrahim Tahashilder ,&nbsp;Mohamed Ibrahim ,&nbsp;Michelle Simon ,&nbsp;Rakesh B. Vadhera ,&nbsp;Rovnat Babazade","doi":"10.1016/j.bjane.2026.844750","DOIUrl":"10.1016/j.bjane.2026.844750","url":null,"abstract":"<div><h3>Background</h3><div>Opioid Epidural Labor Analgesia (OLEA) is commonly used during labor. However, opioid use has been associated with adverse effects on maternal and fetal outcomes. Medications administered during epidural analgesia are systemically absorbed; therefore, we performed a retrospective cohort study to investigate whether Opioid-Free Labor Epidural Analgesia (OFLEA) is comparable to OLEA regarding maternal and infant outcomes at delivery.</div></div><div><h3>Methods</h3><div>Of 1,423 patients initially identified, we excluded those with twin deliveries, duplicate records, or incomplete data. We then matched 1:1 on the mother’s age, including 618 patients for final data analysis. Our OLFEA group included an epidural solution of 0.2% ropivacaine, while our OLEA group included an epidural solution of 0.1% ropivacaine + 250 mcg fentanyl. Wilcoxon rank-sum tests were performed to assess our primary outcome of time-weighted pain scores before and after epidural placement. Secondary outcomes included duration (minutes) of maternal hypotension, tachycardia, and bradycardia episodes during labor, and incidence of neonatal fever, C-section, and Apgar scores (1 and 5 mins after delivery).</div></div><div><h3>Results</h3><div>There was no significant difference between the OLEA and OFLEA groups in the time-weighted pain scores during labor before epidural placement. However, the time-weighted pain score was significantly lower in the OFLEA group (1.05 ± 1.52) compared to OLEA (1.43 ± 1.77, p = 0.006). Similarly, maximum pain scores after epidural were lower in OFLEA (3.32 ± 3.23) vs. OLEA (3.87 ± 3.33, p = 0.03). There were no significant differences in maternal hemodynamic events, Apgar scores, neonatal fever, or cesarean delivery rates.</div></div><div><h3>Conclusions</h3><div>OFLEA is a safe and feasible alternative to OLEA. Avoidance of opioids may support safer maternal and neonatal care in obstetric anesthesia.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 3","pages":"Article 844750"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678777","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":"Brazilian Journal of Anesthesiology: 75 years consolidating achievements","authors":"Luiz Marciano Cangiani","doi":"10.1016/j.bjane.2026.844764","DOIUrl":"10.1016/j.bjane.2026.844764","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 3","pages":"Article 844764"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935876","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":"Randomized, double-blind trial of preoperative pregabalin versus placebo to improve quality of recovery after breast cancer surgery","authors":"Fabio Vieira Toledo,&nbsp;Jose Fernando Amaral Meletti,&nbsp;Luiza Mansur Cerioni Silva,&nbsp;Nathalia Maria Medeiros Serra,&nbsp;Maria Nathalia Prado Simoes Mendonça,&nbsp;Paulo Henrique Carvalho Guerra,&nbsp;Clóvis Antônio Lopes Pinto","doi":"10.1016/j.bjane.2026.844749","DOIUrl":"10.1016/j.bjane.2026.844749","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgery remains one of the most important treatments for breast cancer. In this context, the quality of postoperative recovery has become a key concern. Adequate control of acute pain is essential to optimize patient comfort and recovery. Pregabalin may contribute to this goal by preventing central sensitization and reducing perioperative anxiety.</div></div><div><h3>Objectives</h3><div>To evaluate the effect of perioperative pregabalin versus placebo on postoperative recovery quality in patients undergoing breast cancer surgery.</div></div><div><h3>Method</h3><div>In this randomized controlled trial, 92 patients received either pregabalin (150 mg orally, 1 hour before surgery) or a matching placebo, both prepared in identical capsules. The primary outcome was the QoR-15 score measured preoperatively, and at 24 and 48 hours postoperatively. The 24- and 48-hour assessments were conducted via telephone. The QoR-15 is a validated instrument that assesses the quality of recovery, with total scores ranging from 0 (very poor recovery) to 150 (excellent recovery). Secondary outcomes included opioid consumption, pain scores, incidence of nausea and vomiting, and lengths of stay in the Post-Anesthesia Care Unit (PACU) and hospital. An exploratory analysis of longitudinal changes in QoR-15 scores within each group was also performed. Analyses were performed per protocol.</div></div><div><h3>Results</h3><div>Eighty-four patients completed the study. There were no differences in overall QoR-15 score between the groups at any of the three assessment time points (preoperative, 24h, and 48h). In the exploratory longitudinal within-group analysis, better maintenance of recovery quality was observed in the pregabalin group compared with baseline, with medians (IQR) of 138 (122.3–145), 132.5 (125.8–135.3), and 134 (131.5–136) [p = 0.006 between 24h and 48h]. In the placebo group, the medians (IQR) were 140 (128–145.3), 129 (126–134.3), and 134 (126.8–136.3) [p = 0.002 between pre and 24h; p = 0.026 between pre and 48h].</div></div><div><h3>Conclusion</h3><div>Although exploratory analysis showed a trend toward improvement within the pregabalin group, there was no significant difference in QoR-15 scores between groups.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 3","pages":"Article 844749"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576751","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":"Airway management and outcomes in surgical drainage of severe odontogenic infections: a retrospective cohort study","authors":"Karam Azem ,&nbsp;Adham Kashkush ,&nbsp;Benjamin Zribi ,&nbsp;Eitan Mangoubi ,&nbsp;Shai Fein ,&nbsp;Roussana Aranbitski ,&nbsp;Sharon Orbach-Zinger ,&nbsp;Esmat Najjar ,&nbsp;Philip Heesen ,&nbsp;Gal Avishai ,&nbsp;Dror Bar Hai ,&nbsp;Gavriel Chaushu ,&nbsp;Daya Masri","doi":"10.1016/j.bjane.2026.844756","DOIUrl":"10.1016/j.bjane.2026.844756","url":null,"abstract":"<div><h3>Background</h3><div>Severe odontogenic infections requiring surgical drainage pose significant airway management challenges. This study aimed to compare perioperative characteristics and clinical outcomes between patients managed with conventional laryngoscopy versus awake fiberoptic intubation, to identify factors associated with the selection of airway management technique, and to determine predictors of hospital length of stay.</div></div><div><h3>Methods</h3><div>This single-center retrospective study included 85 adult patients who underwent surgical drainage of severe odontogenic infections under general anesthesia between 2015 and 2024. The primary objective was to identify factors associated with awake fiberoptic intubation selection. Secondary objectives included comparison of perioperative outcomes and identification of predictors of hospital discharge. Multivariable logistic regression and Cox proportional hazards modeling were used.</div></div><div><h3>Results</h3><div>Of 85 patients, 60% were managed with AFOI. Multivariable analysis identified trismus (OR = 6.67, 95% CI 1.53, 39.53, p = 0.010) and higher BMI (OR = 1.15, 95% CI 1.03, 1.33, p = 0.013) as independent predictors of AFOI selection. AFOI patients experienced more complex postoperative courses, with intraoperative tracheostomy, ICU admission, and septic shock occurring exclusively in this group. Spontaneous ventilation postoperatively was associated with earlier discharge (HR = 2.14, 95% CI 1.23, 3.73, p = 0.007), while septic shock (HR = 0.26, 95% CI 0.07, 0.91, p = 0.036) and lower BMI (HR = 0.95, 95% CI 0.90, 1.00, p = 0.040) were associated with delayed discharge.</div></div><div><h3>Conclusion</h3><div>AFOI was preferentially selected for anatomically complex odontogenic infections based on objective criteria, particularly trismus and elevated BMI. The ability to achieve spontaneous ventilation postoperatively serves as a key prognostic indicator, while septic shock is strongly associated with prolonged recovery. These findings support evidence-based airway management protocols and early identification of high-risk patients to optimize outcomes in this challenging population.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 3","pages":"Article 844756"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790571","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":"Patient-centered outcomes and interaction effects in a factorial trial of pneumoperitoneum pressure and neuromuscular blockade depth","authors":"Eylem Yasar ,&nbsp;Melike Korkmaz Toker","doi":"10.1016/j.bjane.2026.844758","DOIUrl":"10.1016/j.bjane.2026.844758","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 3","pages":"Article 844758"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790242","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":"75 years of BJAN: honoring our legacy, sharpening the future of anesthesiology research","authors":"Liana Maria Tôrres de Araújo Azi ,&nbsp;André Prato Schmidt ,&nbsp;Maria José Carvalho Carmona ,&nbsp;Maria Angela Tardelli ,&nbsp;Mario José da Conceição ,&nbsp;Judymara Lauzi Gozzani ,&nbsp;Luiz Marciano Cangiani","doi":"10.1016/j.bjane.2026.844773","DOIUrl":"10.1016/j.bjane.2026.844773","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 3","pages":"Article 844773"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229531","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":"From the Turing Test to AI detectors: an epistemological mismatch in scholarly publishing","authors":"Ahmet Rıdvan Doğan ,&nbsp;Ali İrfan Doğan","doi":"10.1016/j.bjane.2026.844740","DOIUrl":"10.1016/j.bjane.2026.844740","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 2","pages":"Article 844740"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349895","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}