Brazilian Journal of Anesthesiology最新文献

{"title":"Hemodynamic management in liver transplantation: toward an evidence-based perioperative strategy","authors":"Andre P. Schmidt , Eduarda S. Martinelli , Virgínia C. de Moura , Liana M.T.A. Azi","doi":"10.1016/j.bjane.2025.844621","DOIUrl":"10.1016/j.bjane.2025.844621","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844621"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782157","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 efficacy of perioperative lidocaine infusion versus thoracic epidural analgesia for pain management in abdominal surgery: systematic review and meta-analysis","authors":"Gustavo R.M. Wegner ,&nbsp;Bruno F.M. Wegner ,&nbsp;Ramon Huntermann ,&nbsp;Manoela L. Pinto ,&nbsp;Júlia A.P. Vieira ,&nbsp;Amanda P. de Souza ,&nbsp;Francisco J.L. Bezerra","doi":"10.1016/j.bjane.2025.844616","DOIUrl":"10.1016/j.bjane.2025.844616","url":null,"abstract":"<div><h3>Background</h3><div>Recent randomized clinical trials have compared the perioperative use of Intravenous (IV) lidocaine and Thoracic Epidural Analgesia (TEA) for postoperative analgesia in patients undergoing abdominal surgery.</div></div><div><h3>Methods</h3><div>A systematic search was conducted on Embase, Web of Science (all databases), Cochrane Library, and PubMed on March 25, 2024, adhering to the Cochrane Handbook and PRISMA guidelines.</div></div><div><h3>Results</h3><div>Out of 1261 screened studies, 6 were included. TEA provided superior pain relief on a 0 to 10 pain scale at rest compared to IV lidocaine at 2 (n = 335, MD = -0.72, 95% CI -0.19 to -1.25, p = 0.007423, I² = 83%) and 24 hours postoperatively (n = 402; MD = -0.18, 95% CI -0.12 to -0.23; p &lt; 0.000001, I² = 18%). However, no statistically significant differences were observed on pain scores at rest at 48 and 72 hours. TEA provided superior pain relief on a 0 to 10 pain scale during coughing at 24 hours postoperatively (n = 360; MD = -0.36, 95% CI -0.19 to -0.52, p = 0.000019, I² = 2%), but no statistically significant differences were observed in pain scores on coughing at 48 and 72 hours. There were no statistically significant differences in postoperative nausea and vomiting, time to first flatus, or length of hospital stay.</div></div><div><h3>Conclusions</h3><div>TEA provides more effective postoperative pain relief compared to IV lidocaine during the first postoperative day, as evidenced by analyses of pain both at rest and during coughing.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844616"},"PeriodicalIF":1.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756146","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":"Evaluation of anesthesiology residents in the diagnosis and control of malignant hyperthermia: comparison of three scenarios of realistic simulation ‒ a cross-sectional controlled study","authors":"Mariana F.L. Neville ,&nbsp;Victor Guimarães de Almeida ,&nbsp;Pamela Vieira Andrade ,&nbsp;Joilson Moura Santos ,&nbsp;Masashi Munechika ,&nbsp;David Ferez ,&nbsp;Mary dos Santos Silva ,&nbsp;Leonardo Ayres Canga ,&nbsp;Ana Cristina Tripoloni ,&nbsp;Thierry Girard ,&nbsp;Helga Cristina Almeida da Silva","doi":"10.1016/j.bjane.2025.844615","DOIUrl":"10.1016/j.bjane.2025.844615","url":null,"abstract":"<div><h3>Introduction</h3><div>Simulation-based training is particularly beneficial for rare and life-threatening diseases such as Malignant Hyperthermia (MH). In addition, cognitive aids, including flowcharts and checklists, can be used as guidance in crisis, reducing cognitive demand and simplifying patient care. We assessed the technical and non-technical performance of anesthesiology residents when diagnosing and treating a hypothetical case of MH in three different scenarios.</div></div><div><h3>Methods</h3><div>This was an observational, cross-sectional, and controlled study. Pairs of anesthesiology residents participated in a validated high-fidelity MH realistic simulation in one of three different scenarios: 1) Control (no access to cognitive aids), 2) Poster, or 3) Mobile application. Both poster and mobile application provided a flowchart and information related to MH diagnosis and treatment. Demographic data, perceived stress levels, and technical and non-technical skills were registered and compared among the groups.</div></div><div><h3>Results</h3><div>Thirty residents (5-pairs for each scenario) participated in the simulations. The mean score in the technical skill survey was significantly higher in the poster and mobile application groups compared with the control group (83 [4.4], 83 [3.8], and 74 [8.2], respectively, ANOVA, p = 0.047). A significantly higher score for non-technical skills was also found for the poster and mobile application groups compared with the control group (55 [2.5], 57 [0.8], 52 [2.1], respectively, ANOVA, p = 0.03).</div></div><div><h3>Conclusion</h3><div>In a realistic high-fidelity MH simulation, the participants had satisfactory performance regarding technical and non-technical skills. However, the groups with access to cognitive aids achieved better scores, with no difference between the groups with access to the MH poster and the MH mobile application.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844615"},"PeriodicalIF":1.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756125","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":"Goal-directed therapy with continuous SvcO2 monitoring in pediatric cardiac surgery: the PediaSat single-center randomized trial","authors":"Flavio M. Ferreira,&nbsp;David D. Araujo,&nbsp;Gustavo M. Dantas,&nbsp;Ligia Cristina C. Cunha,&nbsp;Suely P. Zeferino,&nbsp;Filomena B. Galas","doi":"10.1016/j.bjane.2025.844614","DOIUrl":"10.1016/j.bjane.2025.844614","url":null,"abstract":"<div><h3>Introduction</h3><div>Low Cardiac Output Syndrome (LCOS) remains a significant perioperative challenge in pediatric cardiac surgery. This study evaluated whether a hemodynamic protocol aimed at optimizing continuous central venous Oxygen Saturation (SvcO₂) using the PediaSat catheter could reduce postoperative complications in pediatric patients undergoing congenital heart surgery.</div></div><div><h3>Methods</h3><div>Conducted at the Instituto do Coração in São Paulo, this randomized clinical trial compared a group receiving SvcO₂-based goal-directed therapy via PediaSat (intervention) against conventional care (control). The main objective was assessing 24-hour lactate clearance post-surgery, with secondary outcomes including Vasoactive-Inotropic Score (VIS), Mechanical Ventilation (MV) duration, vasopressor use, and ICU/hospital stay lengths.</div></div><div><h3>Results</h3><div>From July 13, 2014, to March 17, 2016, 391 patients were evaluated for eligibility. After applying inclusion and exclusion criteria, 65 patients were included and randomized ‒ 33 to the control group and 32 to the PediaSat group. There were no losses to follow-up in either group. Lactate clearance did not significantly differ between the intervention and control groups. However, the PediaSat group showed significantly shorter mechanical ventilation times, reduced vasopressor use, and shorter ICU stays. No significant differences were observed in hospital stay length or incidence of postoperative complications between the group.</div></div><div><h3>Conclusions</h3><div>While optimizing SvcO₂ did not affect overall lactate clearance, it was associated with shorter MV duration, decreased vasopressor need, and shorter ICU stays in pediatric cardiac surgery patients. These findings highlight the potential benefits of continuous SvcO₂ monitoring in postoperative care.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844614"},"PeriodicalIF":1.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756127","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":"Comparing block characteristics of mixtures of short/intermediate- and long-acting local anesthetics for peripheral nerve block: a systematic review and meta-analysis","authors":"Cheng Lin ,&nbsp;Ana Larissa Guerrero ,&nbsp;Joshua Jesin ,&nbsp;Rohin Tangri ,&nbsp;Nasong Anthony Luginaah ,&nbsp;Kamal Kumar ,&nbsp;Christopher Hansebout","doi":"10.1016/j.bjane.2025.844617","DOIUrl":"10.1016/j.bjane.2025.844617","url":null,"abstract":"<div><h3>Introduction</h3><div>Results from Randomized Controlled Trials (RCTs) on mixed Local Anesthetics (LA) are conflicting. We conducted a systematic review and meta-analysis on whether using mixed LA leads to faster onset of surgical block.</div></div><div><h3>Method</h3><div>We conducted systemic review and meta-analysis of RCTs. Medline and Embase without language restriction from inception to June 15, 2024, were searched. Included RCTs had to compare mixed LA to long-acting LA in adult surgical patients for onset or duration of nerve blocks. Onset time to surgical block was the primary outcome. The Cochrane Risk of Bias Tool with GRADE methodology was utilized to assess evidence quality.</div></div><div><h3>Results</h3><div>Nineteen trials including 1060 participants met the inclusion criteria. Mixed LA modestly reduced time to surgical block (-8.4 minutes; 95% CI -12.0 to -4.8 minutes; p = 0.0001; I² = 0.99), sensory block duration (-226.2 minutes; 95% CI -352.2 to -100.1 minutes; p = 0.002; I² = 0.98) and motor block duration (-259.2 minutes; 95% CI -399.5 to -119.0 minutes; p = 0.003; I² = 0.98) but not time to analgesic request duration (-130.5 minutes; 95% CI -265.9 to 4.9 minutes; p = 0.057; I² = 0.98). GRADE scoring ranged from low to very low.</div></div><div><h3>Conclusion</h3><div>The existing evidence showed mixed LA led to a modest reduction in surgical block latency but also shortened block duration. Future studies should evaluate the role of mixed LA in lower limb blocks and optimal dosing of long-acting LA to balance onset latency and analgesic duration.</div></div><div><h3>PROSPERO registration</h3><div>CRD42024552801.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844617"},"PeriodicalIF":1.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755653","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":"Erector spinae plane block versus transversus abdominis plane block for analgesia after cesarean section: a systematic review and meta-analysis","authors":"Mariana AbdElSayed Mansour ,&nbsp;Saeed Baradwan ,&nbsp;Ahmed Abdelaziz Shama ,&nbsp;Mohamed Ali Mahmoud ,&nbsp;Ayman Salah Abouelnour ,&nbsp;Ayman Mohamed AbdelWahed Mohamed ,&nbsp;Ahmed Fathi Hassan Elkhouly ,&nbsp;Abdelkarem Hussiny Ismail Elsayed ,&nbsp;Zaky Ftouh Rashed ,&nbsp;Ahmed Mohamed Abdelhakim ,&nbsp;Mrooj Mabruk Almutairi ,&nbsp;Mohamed A. Lotfy ,&nbsp;Ahmed Goda Ahmed","doi":"10.1016/j.bjane.2025.844606","DOIUrl":"10.1016/j.bjane.2025.844606","url":null,"abstract":"<div><h3>Background</h3><div>Peripheral abdominal nerve blocks are key components of multimodal analgesia, enhancing recovery after cesarean sections. This systematic review and meta-analysis aimed to assess analgesic efficacy of Erector Spinae Plane Block (ESPB) versus Transversus Abdominis Plane Block (TAPB) under ultrasound guidance following Cesarean Section (CS) under spinal anesthesia.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted across PubMed, Scopus, Cochrane Library, and ISI Web of Science to identify relevant trials. The inclusion criteria followed the PICOS framework: Population (women undergoing elective cesarean delivery), Intervention (ESPB), Comparator (TAPB), Outcomes (postoperative pain, opioid consumption, analgesic duration, and satisfaction), and Study Design (randomized controlled trials).</div></div><div><h3>Results</h3><div>Seven RCTs (380-patients) met the inclusion criteria. The ESPB group had significantly lower postoperative pain scores at rest and during movement, reduced 24-hour opioid consumption (MD = -2.62 MME; 95% CI -4.11 to -1.13; p = 0.006), and longer analgesic duration (SMD = 1.77; 95% CI 1.11 to 2.44; p &lt; 0.001) than the TAPB group. Patient satisfaction was also significantly higher in the ESPB group (OR = 4.75; 95% CI 2.26 to 9.99; p &lt; 0.001). While most outcomes demonstrated low heterogeneity, significant variability was observed in analgesic duration (I² = 83%), requiring cautious interpretation.</div></div><div><h3>Conclusions</h3><div>The ESP block offers superior pain relief, reduces opioid use, and enhances satisfaction compared to the TAP block in cesarean sections. These findings suggest that the implementation of the ESP block in postoperative analgesia protocols could significantly improve patient outcomes, potentially leading to enhanced recovery and reduced reliance on opioids.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844606"},"PeriodicalIF":1.7,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607299","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":"Pulmonary arterial catheter vs. prediction index software in patients undergoing orthotopic liver transplantation: “We cannot lump together everything”","authors":"Luigi Vetrugno","doi":"10.1016/j.bjane.2025.844605","DOIUrl":"10.1016/j.bjane.2025.844605","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844605"},"PeriodicalIF":1.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569160","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 side effects of the pandemic on all-cause postoperative mortality in a COVID reference Hospital in Brazil: a before and after cohort study with 15156 patients","authors":"Luciana C. Stefani ,&nbsp;Brasil Silva Neto ,&nbsp;Débora Roberta de Avila Dornelles ,&nbsp;Mariana Brandão ,&nbsp;Marcio Rahel Guimarães ,&nbsp;Pedro Knijnik ,&nbsp;Jeruza N. Neyeloff ,&nbsp;Stela M.J. Castro ,&nbsp;Paulo Corrêa da Silva Neto ,&nbsp;Gilberto Braulio","doi":"10.1016/j.bjane.2025.844600","DOIUrl":"10.1016/j.bjane.2025.844600","url":null,"abstract":"<div><h3>Background</h3><div>Before the pandemic, healthcare systems in Low-Middle Income Countries (LMIC) experienced a limited capacity to treat postoperative complications. It is uncertain whether the interference of the Coronavirus (COVID-19) pandemic on surgical systems has increased postoperative mortality.</div></div><div><h3>Methods</h3><div>This before and after cohort study aimed to assess the pandemic's impact on in-hospital postoperative mortality in a university COVID-19 reference hospital in southern Brazil. Data from patients who underwent surgery before (January 2018 to December 2019) the pandemic were compared to data from patients who underwent surgery during the pandemic (February to December 2020). The primary outcome was in-hospital mortality. We developed Poisson regression models to examine the mortality risk of being operated on during the COVID-19 pandemic.</div></div><div><h3>Results</h3><div>We assessed 15156 surgical patients, 12207 of whom underwent surgery before the pandemic and 2949 during the first year of the pandemic. Mortality rates were 2.5% (309/12207) in the pre-pandemic versus 7.2% (212/2949) in the pandemic. Of these, 25.8% (32/124) of patients with COVID-19 and 6.4% (80/2816) of patients without COVID-19 died. The proportion of urgent surgeries and ASA-PS III was higher in the pandemic group. After adjusting for mortality-related variables, the Relative Risk (RR) associated with undergoing surgery during the pandemic was 1.51 (95% CI 1.27 to 1.79). We excluded COVID-19-positive to perform a sensitivity analysis that confirmed the increased risk of undergoing surgery during the pandemic RR = 1.50 (95% CI 1.27 to 1.78).</div></div><div><h3>Conclusion</h3><div>The substantial number of additional deaths, even amongst those without COVID-19 infection, suggests the pandemic disrupted the surgical service in an LMIC context. Fragile surgical systems may suffer more significant adverse impacts from external stressors such as a pandemic, and urging measures are needed to increase their performance and resilience.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844600"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494902","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":"Implementing a well-being curriculum in anesthesiology residency: insights from a teaching hospital in Brazil","authors":"Claudia M.R.P. Cavaliere ,&nbsp;Lorena I.M. Carvalho ,&nbsp;Liana M.T.A. Azi ,&nbsp;Edgar Yugue ,&nbsp;Renata de Paula Lian ,&nbsp;Marcos A.C. Albuquerque","doi":"10.1016/j.bjane.2025.844601","DOIUrl":"10.1016/j.bjane.2025.844601","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844601"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494894","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 role of right ventricular systolic pressure and ARISCAT score in perioperative pulmonary risk assessment","authors":"Yoshio Tatsuoka ,&nbsp;Zili He ,&nbsp;Hung-Mo Lin ,&nbsp;Andrew P. Notarianni ,&nbsp;Zyad J. Carr","doi":"10.1016/j.bjane.2025.844597","DOIUrl":"10.1016/j.bjane.2025.844597","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative Pulmonary Complications (PPC) are a significant source of increased morbidity and mortality after surgical procedures. Measures to enhance 30-day PPC risk stratification are an area of significant clinical interest, and integrating common preoperative investigations, such as echocardiography, may enhance quantitative risk prediction when combined with clinical score-based systems, particularly for high-risk populations. The authors hypothesized that Right Ventricular Systolic Pressure (RVSP) would significantly enhance the predictive capabilities of the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score in the prediction of 30-day PPC in a Pulmonary Hypertension (PH) study cohort.</div></div><div><h3>Methods</h3><div>277 patients with the diagnosis of PH, ARISCAT score, and echocardiography-derived RVSP within 12-months of surgical procedure were analyzed. The primary endpoint was the 59-variable 30-day Agency for Healthcare Research and Quality PPC composite. Secondary endpoints included sub composites of Pneumonia (PNA), Respiratory Failure (RF), Pulmonary Aspiration (ASP) and thromboembolic Phenomenon (PE). Adjusted multivariable logistic regression models followed by Receiver Operating Characteristic Curves (ROC) and Area Under the Curve (AUC) analysis were employed to assess the prediction of 30-day PPC.</div></div><div><h3>Results</h3><div>Mean RVSP was 52.1 mmHg (±17.4). Overall PPC incidence was 29.9%, with RF (19.5%), PNA (12.3%), ASP (5.4%), and PE (3.6%) composites. Logistic regression showed no significant association between RVSP and PPC (Odds Ratio [OR = 1.01], p = 0.307). The ARISCAT score was associated with 30-day PPC risk (OR = 1.02, p = 0.037). Receiver Operating Characteristic (ROC) curve analysis revealed an Area Under the Curve (AUC) of 0.555 for RVSP alone, 0.575 for the ARISCAT score, and 0.591 for the combination of RVSP+ARISCAT for the primary endpoint.</div></div><div><h3>Conclusion</h3><div>RVSP demonstrated limited efficacy as a standalone predictor of 30-day PPC in patients with PH. Although integrating RVSP with ARISCAT scoring yielded marginal improvements in predictive accuracy, neither metric, independently or in combination, achieved adequate clinical significance for reliable risk stratification. These findings highlight a critical gap in the current preoperative risk assessment for PH-specific predictive tools. Future research should focus on alternative measures that better capture vulnerability to the hemodynamic complexities underscoring PPC in this high-risk population.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844597"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460973","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}