Brazilian Journal of Anesthesiology最新文献

{"title":"The pulmonary artery catheter in modern anesthesiology and intensive care: indications, benefits, and limitations","authors":"Andre P. Schmidt , Clovis T. Bevilacqua Filho , Eduarda S. Martinelli , Virgínia C. de Moura","doi":"10.1016/j.bjane.2025.844587","DOIUrl":"10.1016/j.bjane.2025.844587","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844587"},"PeriodicalIF":1.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017384","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":"Gender representation in anesthesiology research: a historical perspective from the Brazilian Journal of Anesthesiology","authors":"Stefania Lacerda Garcia , Claudia Marquez Simões , Maria José Carvalho Carmona , Liana Maria Tôrres de Araújo Azi","doi":"10.1016/j.bjane.2024.844584","DOIUrl":"10.1016/j.bjane.2024.844584","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844584"},"PeriodicalIF":1.7,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928759","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 use of methylene blue in adult patients with septic shock: a systematic review and meta-analysis","authors":"Ka Ting Ng ,&nbsp;Pei En Kwok ,&nbsp;Wei En Lim ,&nbsp;Wan Yi Teoh ,&nbsp;Mohd Shahnaz Hasan ,&nbsp;Mohd Fitry Zainal Abidin","doi":"10.1016/j.bjane.2024.844580","DOIUrl":"10.1016/j.bjane.2024.844580","url":null,"abstract":"<div><h3>Objectives</h3><div>Methylene blue exerts its vasopressor properties by inhibiting nitric oxide-mediated vasodilation. Recent studies have advocated the use of methylene blue as a rescue therapy for patients with septic shock. The primary aim was to investigate the effect of methylene blue on the mean arterial pressure among adult patients with septic shock.</div></div><div><h3>Methods</h3><div>Databases of MEDLINE, EMBASE, and CENTRAL were searched from their inception date until October 2023. Randomized Clinical Trials (RCT) comparing methylene blue and placebo in adults with septic shock were included.</div></div><div><h3>Results</h3><div>Our systematic review included 5 studies (n = 257) for data analysis. As compared to the placebo, our pooled analysis showed that methylene blue significantly increased mean arterial pressure (MD: 1.34 mmHg, 95% CI 0.15 to 2.53, p = 0.03, level of evidence: very low). Patients who were given methylene blue were associated with statistically lower mortality rate (OR = 0.49, 95% CI 0.27 to 0.88, p = 0.02, level of evidence: low), reduced serum lactate levels (MD: -0.76 mmoL.L^-1, 95% CI -1.22 to -0.31, p = 0.0009, level of evidence: low), reduced length of hospital stay (MD: -1.94 days, 95% CI -3.79 to -0.08, p = 0.04, level of evidence: low), and increased PaO₂/FiO₂ (MD: 34.78, 95% CI 8.94 to 60.61, p = 0.008, level of evidence: low).</div></div><div><h3>Conclusions</h3><div>This meta-analysis demonstrated that methylene blue administration was associated with an increased in mean arterial pressure and PaO₂/FiO₂ ratio, along with a reduction in mortality rates, serum lactate levels, and length of hospital stay. However, substantial degree of heterogeneity and inadequate number of studies with low level of evidence warrant future adequately powered RCTs to affirm our results.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844580"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775187","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":"Shaping the future of anesthesia research: celebrating progress and embracing new challenges","authors":"Andre P. Schmidt","doi":"10.1016/j.bjane.2024.844582","DOIUrl":"10.1016/j.bjane.2024.844582","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844582"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824961","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 impact of patient- and family-centered care interventions on intensive care unit outcomes: a meta-analysis of randomized controlled trials","authors":"Yangjin LV ,&nbsp;Peng Li ,&nbsp;Ronghui Li ,&nbsp;Ting Zhang ,&nbsp;Kaifang Cai","doi":"10.1016/j.bjane.2024.844577","DOIUrl":"10.1016/j.bjane.2024.844577","url":null,"abstract":"<div><h3>Background</h3><div>Patient and Family-Centered Care (PFCC) interventions are increasingly recognized as a viable approach to address various mental health issues among patients in Intensive Care Units (ICUs). Therefore, this review aims to estimate the effect of Patient and Family-Centered Care Interventions on specific outcomes in adult patients admitted to Intensive Care Units (ICUs).</div></div><div><h3>Methods</h3><div>We systematically searched four major databases for parallel arm Randomized Controlled Trials (RCTs). The PRISMA framework was used to report our review. We included studies involving adult patients (&gt; 18-years) admitted to ICUs and examined the effects of any type of Patient and Family-Centered Care intervention (PFCC) on outcomes such as depression, anxiety, delirium, and length of hospital stay. Data extraction was performed independently by two authors in Medline, Google Scholar, and ScienceDirect, from inception to July 2024. Random effects model was used to pool the data.</div></div><div><h3>Results</h3><div>A total of 11 studies were included in our systematic review and meta-analysis, with a combined sample size of 3352 patients (PFCC group, n = 1681; usual care group, n = 1671). A random-effects model revealed a significant reduction in delirium prevalence in the PFCC group, with a pooled Risk Ratio (RR) of 0.54 (95% CI 0.36 to 0.81). However, no statistical significance was found for other outcomes such as depression, length of ICU stay, and anxiety. It is important to note that all the included studies were assessed to have either a high or unclear risk of bias.</div></div><div><h3>Conclusion</h3><div>PFCC interventions may significantly reduce delirium rates among ICU patients; however, their effects on other outcomes, such as depression, anxiety, and length of stay, were not statistically significant.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 1","pages":"Article 844577"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11714723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752580","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":"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}