Brazilian Journal of Anesthesiology最新文献

{"title":"VCISpain: protocol for a prospective multicenter observational study to validate a standardized classification tool for tracheal intubation using videolaryngoscopy","authors":"Miguel Ángel Fernández-Vaquero ,&nbsp;Pedro Charco-Mora ,&nbsp;Jose Alfonso Sastre-Rincon ,&nbsp;Manuel Ángel Gomez-Rios ,&nbsp;Johanes Cardenas-Gomez ,&nbsp;Eugenio Martinez-Hurtado ,&nbsp;Norma Aracil-Escoda ,&nbsp;Andrea Vallejo-Tarrat ,&nbsp;Inés Thion-Soriano ,&nbsp;David Peral-Sanchez ,&nbsp;Miguel Castañeda-Pascual ,&nbsp;Miguel Rodriguez del Rio ,&nbsp;Nekari de Luis-Cabezon ,&nbsp;Joseba Gonzalez-Garcia ,&nbsp;Jesus Acosta-Martinez ,&nbsp;Silvia Gonzalez-Santos ,&nbsp;Xavier Onrubia-Fuertes ,&nbsp;Estefania Martinez-Gonzalez ,&nbsp;Andres Roca de Togores-Lopez ,&nbsp;Iratxe Gonzalez-Mendibil ,&nbsp;Marc Vives Santacana","doi":"10.1016/j.bjane.2025.844653","DOIUrl":"10.1016/j.bjane.2025.844653","url":null,"abstract":"<div><h3>Background and objective</h3><div>Videolaryngoscopy have transformed airway management by improving intubation success rates compared to direct laryngoscopy. However, its widespread adoption has been hindered by the lack of standardized classification tools for documentation and communication. This manuscript outlines the rationale and study design of the VCISpain project, which aims to evaluate the interobserver reproducibility of the Video Classification of Intubation (VCI) scale in the context of airway management using videolaryngoscopy in Spain.</div></div><div><h3>Methods</h3><div>This manuscript presents the planned methodology of the VCISpain study, a prospective, observational, multicenter, open-label study. The study will collect data on tracheal intubations performed in operating rooms, intensive care units, and emergency departments. In each case, two anesthesiologists will independently apply the VCI scale to assess blade type, Percentage of Glottic Opening (POGO), and ease of intubation.</div></div><div><h3>Ethics and registration</h3><div>The study was approved by the University of Navarra Ethics Committee (2022.079 mod1) and registered on ClinicalTrials.gov (NCT06537531). It is endorsed by the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR) and the European Airway Management Society (EAMS).</div></div><div><h3>Conclusions</h3><div>VCISpain seeks to establish a standardized classification tool for documenting and communicating findings related to videolaryngoscopy in airway management. By presenting the study rationale and design, this protocol aims to promote transparency, ensure methodological rigor, and encourage broader discussion to refine the study prior to implementation.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844653"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487354","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":"Comparison of automatic versus constant CPAP in elderly patients after major abdominal surgery: a randomized noninferiority trial","authors":"Nguyen Dang Thu ,&nbsp;Nguyen Thi Thuy ,&nbsp;Le Sau Nguyen ,&nbsp;Cong Quyet Thang ,&nbsp;Nguyen Ngoc Thach ,&nbsp;Nguyen Trung Kien","doi":"10.1016/j.bjane.2025.844642","DOIUrl":"10.1016/j.bjane.2025.844642","url":null,"abstract":"<div><h3>Background</h3><div>Geriatric patients undergoing major open abdominal surgery are at high risk for postoperative pulmonary complications and hypoxemia. Continuous Positive Airway Pressure (CPAP) after surgery may improve postoperative lung function. This randomized controlled trial compared two CPAP techniques ‒ automatic via nasal mask and constant via facial mask ‒ regarding pulmonary function and patient tolerance.</div></div><div><h3>Methods</h3><div>Sixty patients (≥ 60 years) were randomized (1:1) to receive either automatic CPAP (2–10 cm H₂O) via a nasal mask (Group A) or constant CPAP (7.5 cm H₂O) via a facial mask (Group C) upon arrival in the post-anesthesia care unit. Oxygenation (PaO₂, PaO₂/FiO₂, SpO₂) and spirometry (FVC, FEV₁, PEF) were assessed preoperatively, postoperatively, and one hour after treatment. Comfort scores (0–10, with 0 indicating the best comfort) and complications were recorded.</div></div><div><h3>Results</h3><div>PaO₂/FiO₂ improvement was lower in Group A (32.6 ± 26.3 mmHg) than in Group C (52.9 ± 40.1 mmHg; p = 0.023). FVC improvement was also lower in Group A (3.7% ± 4.0%) than in Group C (6.7% ± 4.9%; p = 0.012). However, Group A had better tolerance, with lower comfort scores (2 [2–3] vs. 3 [2–4], p = 0.002). Pulmonary function benefits were more pronounced in patients over 70 and those undergoing upper abdominal surgery.</div></div><div><h3>Conclusion</h3><div>Both CPAP techniques prevent pulmonary decline in geriatric patients post-surgery. While automatic CPAP provides better comfort, constant CPAP improves oxygenation. Although our findings are short-term, they suggest that CPAP mode selection should be tailored based on patient-specific needs.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844642"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102902","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":"Effect of propofol and sevoflurane anesthesia on the optic nerve sheath: systematic review and meta-analysis","authors":"Rodolfo Otávio Tomaz Bertti ,&nbsp;Luiz Antonio Vane ,&nbsp;José Mariano Soares de Moraes ,&nbsp;Paulo do Nascimento Junior ,&nbsp;Lucas Fachini Vane ,&nbsp;Norma Sueli Pinheiro Módolo ,&nbsp;Matheus Fachini Vane","doi":"10.1016/j.bjane.2025.844646","DOIUrl":"10.1016/j.bjane.2025.844646","url":null,"abstract":"<div><h3>Background</h3><div>To facilitate the surgical view, laparoscopic and robotic pelvic surgeries require a pneumoperitoneum with the Trendelenburg position, which may result in elevated Intracranial Pressure (ICP). The choice of anesthetic agents may also influence ICP. Ultrasonographic evaluation of the Optic Nerve Sheath Diameter (ONSD) is a promising way to evaluate ICP. In this systematic review, we aimed to evaluate the ONSD, as an indirect estimation of ICP, in patients undergoing laparoscopic/robotic surgeries under pneumoperitoneum and Trendelenburg position.</div></div><div><h3>Methods</h3><div>A literature search was performed to identify prospective randomized clinical trials in which the primary endpoint was the evaluation of the ONSD using sevoflurane or propofol anesthesia after the onset of pneumoperitoneum and Trendelenburg position. The mean and the standard deviation of the ONSD in each intervention group were extracted from the included trials for analysis. Mean difference with 95% Confidence Interval (95% CI) was calculated.</div></div><div><h3>Results</h3><div>Five randomized controlled trials, with 277 subjects, were allocated to this study. Compared with the baseline, there was an increase in ONSD from 0.5h to 3 hours (p &lt; 0.05) in both propofol and sevoflurane groups. Furthermore, propofol reduced the ONSD compared to sevoflurane (mean difference: -0.23 mm, 95% CI: -0.37 to -0.10; studies = 5; I² = 23%).</div></div><div><h3>Conclusion</h3><div>There is evidence indicating, through ultrasonographic analysis of the ONSD, that propofol probably reduces ICP compared to sevoflurane in robotic and laparoscopic pelvic surgeries.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844646"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251104","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":"Comparison of pericapsular nerve group block and anterior quadratus lumborum block for hip fracture surgery: a randomized clinical trial","authors":"Mustafa Aslan ,&nbsp;Alper Kilicaslan ,&nbsp;Funda Gök ,&nbsp;Ahmet Fevzi Kekec ,&nbsp;Tahsin Sami Colak","doi":"10.1016/j.bjane.2025.844643","DOIUrl":"10.1016/j.bjane.2025.844643","url":null,"abstract":"<div><h3>Objective</h3><div>This study compared the Pericapsular Nerve Group (PENG) block combined with the Lateral Femoral Cutaneous Nerve (LFCN) block to the anterior Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA).</div></div><div><h3>Methods</h3><div>In this prospective, double-blind trial, 80 adults scheduled for THA under spinal anesthesia were randomized to receive either an anterior QLB (n = 40) with 30 mL of 0.25% bupivacaine or a combined PENG + LFCN block (n = 40) using 25 mL of 0.25% bupivacaine for PENG and 5 mL for LFCN. The primary outcome was cumulative 24 hour postoperative intravenous morphine consumption. Secondary outcomes included pain scores, quadriceps strength, patient satisfaction and side effects.</div></div><div><h3>Results</h3><div>No significant differences were observed between the groups in morphine consumption or pain scores during the first 12 hours (p &gt; 0.05). At 24 hours, the PENG + LFCN group demonstrated significantly lower morphine consumption (p = 0.027) and resting VAS scores (p &lt; 0.001). Quadriceps weakness occurred in 15% (6/40) of anterior QLB patients at 6 hours (p = 0.026), whereas no weakness was observed in the PENG + LFCN group within 24 hours. Patient satisfaction and the incidence of complications were comparable between the groups.</div></div><div><h3>Conclusion</h3><div>Both anterior QLB and PENG + LFCN blocks provide effective analgesia for up to 12 hours post-THA. However, the PENG + LFCN combination offers prolonged analgesia, reduced opioid requirements and better preservation of quadriceps strength.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844643"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144668","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":"Perceived stress among Brazilian anesthesiologists before and after a mindfulness-based program: preliminary findings","authors":"Elisa Duarte Candido ,&nbsp;DurvalCampos Kraychete","doi":"10.1016/j.bjane.2025.844638","DOIUrl":"10.1016/j.bjane.2025.844638","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844638"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082566","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":"Dexmedetomidine for preventing postoperative delirium in neurosurgical patients: a meta-analysis of randomized controlled trials","authors":"Virgilio Astori ,&nbsp;Bruno Pandolfi Arruda ,&nbsp;Pedro Guimarães Marcarini ,&nbsp;Lucas Destefani Natali ,&nbsp;Marcos Sampaio Meireles ,&nbsp;Daniele Fernandes Holanda","doi":"10.1016/j.bjane.2025.844662","DOIUrl":"10.1016/j.bjane.2025.844662","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844662"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621496","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":"Pain thresholds in elderly individuals: a cross-sectional observational study of the influence of gender and chronic non-cancer pain","authors":"Áquila Lopes Gouvêa ,&nbsp;Pedro Adde Anuardo ,&nbsp;João Paulo Consentino Solano ,&nbsp;Ângela Maria Sousa ,&nbsp;Hazem Adel Ashmawi","doi":"10.1016/j.bjane.2025.844665","DOIUrl":"10.1016/j.bjane.2025.844665","url":null,"abstract":"<div><h3>Background</h3><div>The older population is growing, and it is estimated that, by 2050, people aged 60-years or more will have reached two billion. The increased life expectancy has led to a higher incidence of chronic degenerative diseases, contributing to increased pain complaints. This study aims to compare the pain threshold after mechanical stimulation in older adults according to gender and presence or absence of chronic pain and find the prevalence and intensity of chronic pain in this population.</div></div><div><h3>Methods</h3><div>This was a cross-sectional observational study with a convenience sample in the outpatient clinic at two research centers. All participants answered sociodemographic and clinical questionnaires, and the Pressure Pain Threshold (PPT) was assessed with an algometer. Patients reporting chronic pain answered the Geriatric Pain Measure (GPM) questionnaire.</div></div><div><h3>Results</h3><div>The sample consisted of 230 individuals, aged 60 to 96 years, 67.8% women and 32.2% men. Chronic pain prevalence was 47.8%, 29.7% in men and 56.4% in women. PPT was significantly lower in women (4.49 ± 1.78 kg) than in men (6.41 ± 1.92 kg). PPT in older individuals presenting chronic pain (4.58 ± 1.93 kg) was lower than in older individuals without chronic pain (5.58 ± 2.01 kg). There was no significant difference between genders in pain assessment by GPM.</div></div><div><h3>Conclusions</h3><div>Pressure pain threshold was lower in older women and in patients with chronic pain, the association between gender and lower pain threshold was stronger than observed with chronic pain.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844665"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762529","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":"Beneath the surface: the emerging concern of covert stroke in surgery","authors":"Adrian W. Gelb ,&nbsp;Bruna Bastiani ,&nbsp;Cristiane Tavares","doi":"10.1016/j.bjane.2025.844669","DOIUrl":"10.1016/j.bjane.2025.844669","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844669"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925075","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":"Comparison of the effect of intra-cuff normal saline, dexamethasone or ketamine for prevention of postoperative sore throat: a randomized controlled trial","authors":"Arun Mukesh ,&nbsp;Ankur Sharma ,&nbsp;Priyabrat Karan ,&nbsp;Darshna Rathod ,&nbsp;Shilpa Goyal ,&nbsp;Kamlesh Kumari ,&nbsp;Manbir Kaur ,&nbsp;Tanvi Meshram ,&nbsp;Pradeep Bhatia","doi":"10.1016/j.bjane.2025.844651","DOIUrl":"10.1016/j.bjane.2025.844651","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative Sore Throat (POST) may result in patient dissatisfaction and distress, which could possibly delay discharge. Various pharmacological and non-pharmacological approaches have been explored, yet effective techniques remain elusive. This research evaluates the impact of intra-cuff Dexamethasone, Ketamine, and normal saline on alleviating POST symptoms.</div></div><div><h3>Methods</h3><div>In this randomized controlled trial, 405 adult patients aged 18‒60 years undergoing short pelvic laparoscopic surgeries under general anesthesia for 1‒3 h requiring endotracheal intubation were enrolled. Patients were randomized into Group N (intra-cuff normal saline), Group D (intra-cuff Dexamethasone), and Group K (intra-cuff Ketamine). The primary outcome of this study was the incidence and severity of POST at 2, 6, 12, and 24 hours after extubation. Secondary outcomes were the incidence and severity of postoperative hoarseness of voice and postoperative cough at various time intervals.</div></div><div><h3>Results</h3><div>There were more patients in Group D without symptoms of POST (92.59 %) than in Group K (74.07 %) and Group N (67.41 %) (<em>p</em> &lt; 0.0001) at 2 h. Similarly, more patients had no symptoms of postoperative hoarseness of voice (93.33 %) and postoperative cough (93.33 %) in Group D at 2 h. Furthermore, Group D consistently exhibited the lowest incidence of POST, postoperative hoarseness of voice, and postoperative cough at various time intervals.</div></div><div><h3>Conclusions</h3><div>Intra-cuff Dexamethasone appears to be a favourable intervention for symptom alleviation of POST, postoperative hoarseness of voice, and postoperative cough during the early postoperative period.</div></div><div><h3>Clinical Trial Registry Number</h3><div>CTRI/2022/08/044,664.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844651"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303817","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":"Preemptive regional nerve blocks for sternotomy in pediatric cardiac surgery: a Bayesian network meta-analysis","authors":"Bruno F.M. Wegner ,&nbsp;Gustavo R.M. Wegner ,&nbsp;Jaime A. Arias ,&nbsp;Tatiana S. Nascimento","doi":"10.1016/j.bjane.2025.844652","DOIUrl":"10.1016/j.bjane.2025.844652","url":null,"abstract":"<div><h3>Background</h3><div>Effective pain management and expedited recovery are critical in pediatric cardiac surgery. While regional anesthesia techniques provide targeted pain control and may reduce opioid use and related complications, comparative evidence among regional nerve blocks in this population is limited. This study aimed to conduct a systematic review and network meta-analysis to support clinical decision-making for optimal analgesia.</div></div><div><h3>Methods</h3><div>We conducted a Bayesian Network Meta-Analysis (NMA) including Randomized Controlled Trials (RCTs) of pediatric patients (0–12 years) undergoing cardiac surgery by sternotomy and receiving preemptive regional nerve blocks. Primary outcomes included pain scores, opioid consumption and extubation time. Both direct and indirect evidence were synthesized to rank interventions probabilistically. This study was registered on PROSPERO (CRD42024585785) and followed PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions.</div></div><div><h3>Results</h3><div>The NMA incorporated 12 RCTs, comprising 969 participants, and evaluated seven regional nerve blocks. Among the techniques studied, transversus Thoracis Muscle Plane Block (TTPB) consistently ranked among the most effective for pain relief and recovery. Other blocks, including thoracic retrolaminar block and thoracic paravertebral block, also demonstrated notable performances. Adverse events were infrequent but inconsistently reported, preventing an adequate analysis.</div></div><div><h3>Conclusion</h3><div>This NMA identified TTPB as a consistently top-performing technique across outcomes. These findings provide promising support for its inclusion in ERAS protocols, although further high-quality trials are needed.</div></div><div><h3>Registration</h3><div>PROSPERO ID: CRD42024585785.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844652"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369669","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}