Brazilian Journal of Anesthesiology最新文献

{"title":"Reply to comment on “Comparison of automatic versus constant CPAP in elderly patients after major abdominal surgery: a randomized noninferiority trial”","authors":"Nguyen Dang Thu , Nguyen Thi Thuy , Le Sau Nguyen , Nguyen Ngoc Thach , Nguyen Trung Kien","doi":"10.1016/j.bjane.2026.844748","DOIUrl":"10.1016/j.bjane.2026.844748","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 2","pages":"Article 844748"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative and postoperative anemia in major elective surgery: insights from a retrospective cohort in a Brazilian University Hospital","authors":"Lorena dos Santos Goiabeira ,&nbsp;Sara Silva Meireles ,&nbsp;Allan Santos Silva Leocádio ,&nbsp;Heitor J.S. Medeiros ,&nbsp;Fernanda Cunha Soares ,&nbsp;Aline Macedo Pinheiro ,&nbsp;Wallace Andrino da Silva","doi":"10.1016/j.bjane.2025.844715","DOIUrl":"10.1016/j.bjane.2025.844715","url":null,"abstract":"<div><h3>Background</h3><div>Anemia is a common and critical condition in the perioperative management of patients undergoing major elective surgeries, posing significant risks to postoperative recovery. This study aimed to evaluate the prevalence of preoperative and postoperative anemia in surgical patients from a university hospital in northeastern Brazil.</div></div><div><h3>Methods</h3><div>This retrospective study included 508 patients aged 18 years or older who underwent major elective surgeries between October 2021 and October 2022. Anemia was defined according to World Health Organization criteria (hemoglobin &lt; 13 g.dL^-1 for men and &lt; 12 g.dL^-1 for women). Data were extracted from medical records and included preoperative and postoperative hemoglobin levels, surgical types, and transfusion requirements.</div></div><div><h3>Results</h3><div>Preoperative anemia was observed in 59.6% of 508 patients analyzed, with a mean Hb level of 11.66 (±/ 2.75) g.dL^-1 and 11.13 (± 2.08) g.dL^-1 for women and men, respectively. In the postoperative period, the anemia rate increased to 94.6%, with a mean Hb level of 9.36 (± 1.55) g.dL^-1 and 9.49 (± 1.36) g.dL^-1 for women and men, respectively. The transfusion rate was 27% in the total sample. Patients with preoperative anemia were 4.6 times more likely to require intraoperative transfusion compared to non-anemic patients (OR = 4.58; 95% CI: 2.78–7.52; p &lt; 0.001). Higher preoperative hemoglobin levels were identified as protective against transfusion (OR = 0.65; 95% CI: 0.59–0.72; p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Preoperative anemia is a highly prevalent and modifiable risk factor associated with increased transfusion requirements and adverse perioperative outcomes. The study highlights the importance of implementing patient blood management protocols in surgical practice.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 2","pages":"Article 844715"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145590103","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":"Accuracy of a point-of-care CoaguChek test versus standard laboratory coagulation monitoring in cardiac surgery involving cardiopulmonary bypass: randomized clinical trial","authors":"Fabrício Tavares Mendonça,&nbsp;Sérgio Honorato de Matos,&nbsp;Larissa Goveia Moreira,&nbsp;Igor Louza Pereira,&nbsp;Lorenzo Leite Dino,&nbsp;Matheus Beserra Braga,&nbsp;Gustavo Henrique dos Santos Dias","doi":"10.1016/j.bjane.2025.844714","DOIUrl":"10.1016/j.bjane.2025.844714","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative coagulopathies are common in complex surgeries, and timely coagulation monitoring is crucial. We assessed the accuracy of the point-of-care CoaguChek XS test against standard laboratory measurements in patients undergoing cardiac surgery with Cardiopulmonary Bypass (CPB).</div></div><div><h3>Methods</h3><div>We conducted a single-center, diagnostic accuracy study to assess the coagulation profile of 50 participants before and after CPB. The index test was the CoaguChek XS device and the reference test was the standard laboratory assay. The primary outcome was the accuracy of the CoaguChek device in measuring the International Normalized Ratio (INR). We pre-specified a tolerance range of ± 0.5 INR units. Secondary outcomes included accuracy in measuring prothrombin time and prothrombin activity.</div></div><div><h3>Results</h3><div>We included 50 patients undergoing cardiac surgery with CPB between October 2023 and January 2024. The mean (standard deviation) age was 59.2 (12.3) years, and 32 participants (64%) were male. For INR values, Lin’s coefficient was 0.72 (95% CI: 0.60‒0.82) pre-CPB and 0.66 (95% CI: 0.50‒0.77) post-CPB, both indicating good agreement. In the pre-CPB period, on average, the index test readings exceeded reference readings by 0.045 INR units (95% CI: 0.030‒0.059, p &lt; 0.001), while in post-CPB period, index readings were, on average, 0.064 INR units lower (95% CI: -0.09 to -0.04, p &lt; 0.001). Although statistically significant differences were observed, they fell within predefined tolerance range and were considered clinically irrelevant. Analyses of secondary outcomes were consistent with the primary outcome findings.</div></div><div><h3>Conclusion</h3><div>In patients undergoing cardiac surgery with cardiopulmonary bypass, CoaguChek XS provided results comparable to standard laboratory coagulation monitoring, both pre-and post-cardiopulmonary bypass.</div></div><div><h3>Research Board Approval</h3><div>Plataforma Brasil CAAE 70266023.8.0000.5553.</div></div><div><h3>Clinical Trials Registration</h3><div>(<span><span>https://clinicaltrials.gov/study/NCT06037720</span><svg><path></path></svg></span>) NCT06037720, 14/09/2023.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 2","pages":"Article 844714"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589999","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":"Implementation of a difficult airway rapid response team: a Brazilian experience","authors":"Bernard Marcel Barban ,&nbsp;Verônica Neves Fialho Queiroz ,&nbsp;Ayrton Bentes Teixeira ,&nbsp;Daniel Sousa Cesar ,&nbsp;Flavia Baldavira Hirano ,&nbsp;Michele Jaures ,&nbsp;Waldyr Muniz Oliva Neto ,&nbsp;Roseny dos Reis Rodrigues ,&nbsp;Maria José Carvalho Carmona","doi":"10.1016/j.bjane.2026.844741","DOIUrl":"10.1016/j.bjane.2026.844741","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 2","pages":"Article 844741"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147373575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative anemia as a marker of postoperative outcomes: a retrospective cohort study","authors":"Liege Caroline Immich ,&nbsp;Liliane Ghi Mei Law ,&nbsp;Igor Heineck Ouriques ,&nbsp;Yan Prates Pimentel ,&nbsp;Christian Camatti Menegon ,&nbsp;Florentino Fernandes Mendes","doi":"10.1016/j.bjane.2026.844747","DOIUrl":"10.1016/j.bjane.2026.844747","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative anemia is common and associated with adverse postoperative outcomes.</div></div><div><h3>Objective</h3><div>To evaluate the association between preoperative anemia severity and clinical outcomes in patients undergoing elective noncardiac surgery.</div></div><div><h3>Methods</h3><div>This retrospective cohort included 23,579 adults assessed preoperatively between January 2015 and August 2025, all with documented hemoglobin (Hb) and hospitalized for noncardiac surgery. Patients were stratified as no anemia (≥ 13 g.dL⁻¹), mild (11.1‒12.9 g.dL⁻¹), moderate (8.1‒11.0 g.dL⁻¹), or severe anemia (≤ 8.0 g.dL⁻¹). Outcomes were in-hospital mortality, Intensive Care Unit (ICU) admission, and Length of Stay (LOS). Analyses used Poisson regression with robust variance adjusted for confounders.</div></div><div><h3>Results</h3><div>Among the participants, 15,909 (67.5%) had no anemia, 6,396 (27.1%) mild, 1,174 (5.0%) moderate, and 100 (0.4%) severe anemia. Overall, 62.6% were female, and the mean age was 60.7 years (SD ±15.4). Compared with no anemia, all anemia categories were independently associated with higher in-hospital mortality, increased ICU admission, and longer LOS. Severe anemia was the strongest predictor of in-hospital mortality (adjusted RR = 24.7; 95% CI 13.3‒46.0; p &lt; 0.001). Intermediate or major surgeries (RR = 4.7; 95% CI 3.4‒6.6), age &gt; 54 years (RR = 4.4; 95% CI 2.6‒7.6), and male sex (RR = 2.1; 95% CI 1.6‒2.9) were also independent predictors of in-hospital mortality.</div></div><div><h3>Conclusions</h3><div>Preoperative anemia, even when mild, was independently associated with higher in-hospital mortality, greater ICU admission, and prolonged hospitalization. These results support systematic screening and targeted management, including Patient Blood Management (PBM) strategies, to improve perioperative outcomes.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 2","pages":"Article 844747"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582184","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 Blood Management in Brazil: between evidence, reality and transformation","authors":"Guilherme Machado Rabello ,&nbsp;Angel Augusto Pérez-Calatayud ,&nbsp;Luís Vicente Garcia ,&nbsp;Liana Maria Tôrres de Araújo Azi","doi":"10.1016/j.bjane.2026.844738","DOIUrl":"10.1016/j.bjane.2026.844738","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 2","pages":"Article 844738"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345817","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":"Bleeding management in adolescent idiopathic scoliosis: the role of low-dose tranexamic acid","authors":"Paula Alexandra Sá ,&nbsp;Filipa Pereira ,&nbsp;Daniel Soares ,&nbsp;António Oliveira ,&nbsp;Eugénia Cruz ,&nbsp;Sibylle Langenecker","doi":"10.1016/j.bjane.2026.844746","DOIUrl":"10.1016/j.bjane.2026.844746","url":null,"abstract":"<div><h3>Background</h3><div>Despite advances in surgical and blood management techniques, it continues to carry risks of excessive blood loss and transfusion. Tranexamic Acid (TXA), an antifibrinolytic agent, has shown efficacy in reducing these risks across various surgeries. This retrospective cohort study evaluated factors influencing intraoperative blood loss in Adolescent Idiopathic Scoliosis (AIS) surgery, focusing on low-dose TXA administration.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 187 AIS patients undergoing posterior spinal fusion with or without intraoperative TXA. Patients were grouped into non-TXA (116 patients) and TXA (71 patients) cohorts. The TXA group received a 10 mg.kg^-1 intravenous loading dose over 15 minutes, followed by a continuous infusion of 1 mg.kg^-1.h^-1 until skin closure. Outcomes included estimated blood loss, transfusion needs, length of stay, and thromboembolic or neurologic complications. Multivariate regression adjusted intraoperative blood volume loss for potential covariates.</div></div><div><h3>Results</h3><div>Baseline demographic characteristics were similar between groups. However, differences in surgical complexity cannot be excluded and are acknowledged. TXA use was associated with a 39% reduction in estimated intraoperative blood volume loss compared with the non-TXA group. Blood loss correlated significantly with TXA use, sex, ASA status, number of fused levels, curve type, and surgery duration.</div></div><div><h3>Conclusion</h3><div>Low-dose TXA significantly reduced intraoperative blood loss and transfusion requirements during AIS surgery. Greater blood loss was linked to longer procedures and more fused levels, whereas lumbar curve type appeared protective. This study provides insights into AIS outcomes and their associations with predictive factors and TXA use.</div></div><div><h3>Level of evidence</h3><div>Level III – retrospective cohort study.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 2","pages":"Article 844746"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391789","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":"Independent preoperative predictors of day-of-surgery red cell transfusion in major orthopedic surgery: a six-year retrospective cohort of 7072 patients","authors":"José R. Ortiz-Gómez ,&nbsp;Andrea Ortiz-Domínguez ,&nbsp;Inocencia Fornet-Ruíz ,&nbsp;Francisco J. Palacio-Abizanda","doi":"10.1016/j.bjane.2025.844685","DOIUrl":"10.1016/j.bjane.2025.844685","url":null,"abstract":"<div><h3>Background</h3><div>Major Orthopedic Surgery (MOS) is frequently associated with significant blood loss, potentially resulting in perioperative anemia and the need for allogeneic blood transfusion, which carries inherent risks. This study aimed to identify independent preoperative predictors of early Packed Red Blood Cell (PRBC) transfusion in patients undergoing MOS.</div></div><div><h3>Methods</h3><div>We analyzed, retrospectively, data from 7072 patients who underwent MOS. The variables assessed included age, sex, weight, height, Body Mass Index (BMI), ASA (American Society of Anesthesiologists) physical status classification, surgical category (hip, knee, spine), type of procedure (primary or revision total hip/knee arthroplasty, spinal arthrodesis, scoliosis surgery), preoperative hemoglobin levels and levels at 8:00 AM on postoperative day 1, hemoglobin thresholds (&gt; 13, &lt; 13, &lt; 12, &lt; 11, and &lt; 10 g.dL^-1), administration of tranexamic acid, and the requirement for PRBC transfusion.</div></div><div><h3>Results</h3><div>The overall transfusion rate was 4.8 % (3.6 % for hip, 2.7 % for knee, and 15.0 % for spine surgery). Independent predictors of PRBC transfusion included: preoperative hemoglobin &lt; 13 g.dL^-1 (Relative Risk [RR] 6.55), high-risk surgical procedures (RR = 7.40), ASA physical status III‒IV (RR = 2.00), absence of tranexamic acid use (RR = 2.52), and, to a lesser extent, age &gt; 75 years (RR = 1.50). The combination of all identified risk factors was associated with a markedly increased transfusion risk (RR = 14.55; <em>p</em> &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>These findings have informed modifications to our clinical practice, aimed at enhancing quality standards through the implementation of more effective Patient Blood Management (PBM) strategies.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 2","pages":"Article 844685"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287856","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":"A physiology-driven approach to postoperative sedation after urgent liver transplantation for acute liver failure","authors":"Deepak K. Tempe ,&nbsp;Luiz Guilherme V. da Costa","doi":"10.1016/j.bjane.2026.844742","DOIUrl":"10.1016/j.bjane.2026.844742","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 2","pages":"Article 844742"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391797","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":"Perioperative tranexamic acid in burn surgery: systematic review and meta-analysis of randomized controlled trials","authors":"Maria Eduarda Molinari,&nbsp;Ramon Huntermann,&nbsp;Julia C. Bernardi,&nbsp;Nicoly Fiorese Andrade,&nbsp;Gustavo Barbosa David,&nbsp;Nicolas Ramos,&nbsp;Caroline de Oliveira Fischer Bacca","doi":"10.1016/j.bjane.2025.844719","DOIUrl":"10.1016/j.bjane.2025.844719","url":null,"abstract":"<div><h3>Introduction</h3><div>Burn injuries often require surgery, posing challenges due to significant intraoperative blood loss and transfusion risks. Tranexamic Acid (TXA), an antifibrinolytic agent, stabilizes clots and reduces fibrinolysis, with proven efficacy in various surgical settings. However, the benefits in burn patients are yet to be established.</div></div><div><h3>Methods</h3><div>We performed a systematic review and meta-analysis. PubMed, Embase, and Cochrane databases were searched for Randomized Clinical Trials (RCTs) comparing TXA versus control in burned patients. Risk Ratios (RR) and Mean Differences (MD) with 95% CIs were computed for binary and continuous outcomes, respectively. The primary endpoint of interest was blood loss. Statistical analyses were performed using RStudio software (version 4.2.2). The certainty of the evidence was evaluated using the GRADE approach.</div></div><div><h3>Results</h3><div>Four RCTs comprising 204 patients were included, with 102 (50%) assigned to the TXA group. The mean patient age across studies ranged from 32.15 to 39.70 years. TXA significantly reduced total blood loss (MD = -183.93 mL; 95% CI: -278.44 to -89.42; p &lt; 0.01), need for packed red blood cell transfusions (RR = 0.42, 95% CI 0.26 to 0.66; p &lt; 0.01), while also improving hematocrit (MD = 3.49%; 95% CI: 1.58 to 5.41; p &lt; 0.01) and hemoglobin levels (MD = 0.87 g.dL^-1; 95% CI: 0.35 to 1.39; p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>In patients with burns, TXA was associated with reduced blood loss and packed cell transfusions. However, certainty is limited by the small number and heterogeneity of available trials</div></div><div><h3>Registration</h3><div>PROSPERO ID: CRD420251000356. Registered on 07 March 2025.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 2","pages":"Article 844719"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844452","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}