Anesthesiology Research and Practice最新文献

{"title":"Can Pillow Use Prevent Postdural Puncture Headache? A Critical Review.","authors":"Aragaw Hamza Yimer, Ahmed Muhye Seid","doi":"10.1155/anrp/3820438","DOIUrl":"10.1155/anrp/3820438","url":null,"abstract":"<p><p>Postdural puncture headache (PDPH) is a recognized complication of neuraxial anesthesia that follows unintentional dural puncture during epidural techniques or intentional dural puncture during spinal anesthesia and other neuraxial procedures. It has traditionally been managed with a period of mandatory supine bed rest and pillow restriction, a practice grounded in the historical belief that recumbency limits ongoing cerebrospinal fluid (CSF) leakage, thereby preventing headaches. This \"no-pillow\" instruction remains widely taught and practiced, including among clinicians, despite an absence of literature support and evidence suggesting the opposite may be true. This review synthesizes the current literature, including randomized controlled trials, Cochrane systematic reviews, and multisociety clinical guidance, to critically examine whether pillow restriction after dural puncture reduces PDPH incidence. Evidence indicates that neither prolonged bed rest nor pillow avoidance reduces PDPH incidence and that enforced postural restriction instead increases patient discomfort, back and neck pain, and the risk of complications associated with prolonged immobilization. This review advocates the revision of institutional protocols to permit pillow use and early postoperative mobilization, as tolerated.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"3820438"},"PeriodicalIF":1.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Intrathecal Bupivacaine Temperature Variation on Prophylaxis of Shivering in Urologic Patients Undergoing Spinal Anesthesia.","authors":"Emad M Abdelhafez, Hala Gomaa, Sherif M Abdelaziz, Esraa Sayed Ewais Muhammad, Heba Bakr","doi":"10.1155/anrp/1005074","DOIUrl":"10.1155/anrp/1005074","url":null,"abstract":"<p><strong>Background: </strong>Postspinal shivering is a frequent complication of spinal anesthesia (SA) and is particularly relevant in urological procedures, where perioperative heat loss can be exacerbated by irrigation fluids. Modifying the temperature of the intrathecal local anesthetic may affect thermoregulatory responses and the properties of the blockade.</p><p><strong>Methods: </strong>This prospective, randomized, double-blind, controlled trial was conducted in 96 patients (ASA I-II, aged 18-60 years) undergoing elective urological procedures under SA. Participants received intrathecal hyperbaric bupivacaine 0.5% (15 mg) combined with fentanyl 25 μg at one of three temperatures: 4°C (cold; <i>n</i> = 32), 24°C (room; <i>n</i> = 32), or 37°C (warm; <i>n</i> = 32). Shivering was graded using the validated Crossley and Mahajan scale. The primary endpoint was the incidence of clinically significant shivering (Grade ≥ 3) throughout the observation period, evaluated at 10-min intervals.</p><p><strong>Results: </strong>Cold bupivacaine demonstrated a significantly higher incidence of clinically significant shivering (Grade ≥ 3) (81.3%) compared with the room-temperature (34.4%) and warm (25%) groups (<i>p</i> < 0.001). The post hoc analysis showed that the difference between the room-temperature and warm groups was not significant. Pharmacological intervention requirements were substantially elevated in the cold group (43.8%, 15.6%, 15.6%; <i>p</i> = 0.01). Warm bupivacaine accelerated sensory and motor block onset (<i>p</i> = 0.001) while reducing residual motor blockade.</p><p><strong>Conclusion: </strong>Warmed intrathecal bupivacaine significantly reduces PSS incidence and severity while optimizing block characteristics without compromising safety in urological patients. <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT07081516.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"1005074"},"PeriodicalIF":1.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact on Respiratory Mechanics of Uniportal-Biportal Robotic Lung Resection Without Capnothorax Versus Multiportal Approach With Capnothorax: A Prospective Cohort Observational Study.","authors":"Ricard Navarro-Ripoll, Stefano Italiano, Ferran Seguí, Álvaro Buñuel, David Revuelta, Manuel López-Baamonde, Anna Ureña, Ricard Ramos, Carlos Ferrando","doi":"10.1155/anrp/5324693","DOIUrl":"10.1155/anrp/5324693","url":null,"abstract":"<p><strong>Background: </strong>Several robotic-assisted thoracic surgery (RATS) techniques have been described. Main differences among them are the location of ports and CO₂ insufflation, with a potential impact on respiratory mechanics. This study assesses the respiratory impact of uniportal or biportal RATS (uRATS) without capnothorax versus a historical cohort of patients who had multiportal RATS (mRATS) with capnothorax.</p><p><strong>Methods: </strong>Prospective, observational, and descriptive study enrolling adult patients (> 18 years/o) undergoing elective uRATS lung resection and comparison to an historical cohort of 30 mRATS patients, from July 2023 to February 2024. Protocolized recruitment maneuvers (RMs) were performed, and optimal positive end-expiratory pressure (PEEP) to best compliance was calculated during one-lung ventilation (OLV). Respiratory parameters were collected intraoperatively: during two-lung ventilation (TLV, T1), OLV before the RM (T2), OLV after the RM (T3), 20 min after the RM (T4), at the end of OLV (T5), and before extubation (T6). To test quantitative variables, a linear mixed-effects model was used.</p><p><strong>Results: </strong>A total of 30 patients undergoing uRATS were enrolled and compared to 30 patients undergoing mRATS in a previous study. At T3, patients in the uRATS group needed significantly lower PEEP (mean difference 5.3 cmH₂O; <i>p</i> < 0.001), which was also translated to a lower <i>P</i> _plat (4.2 cmH₂O; <i>p</i> < 0.001) and <i>P</i> _peak (4 cmH₂O; <i>p</i> = 0.003). These differences were maintained at T4 and T5 but not at T6. Patients in the uRATS groups showed lower mechanical power at T4 and T5 (mean difference at T4 4.8 J/min, <i>p</i> < 0.001, and at T5 5.0 J/min, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Uniportal and biportal robotic lung resection without capnothorax is associated with a lower impact on respiratory mechanics when compared to the multiportal robotic approach with capnothorax. <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT06784037.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"5324693"},"PeriodicalIF":1.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recovery Kinetics and Postoperative Outcomes of Propofol-Based Total Intravenous Anesthesia Versus Sevoflurane in Ambulatory Surgery: A Systematic Review and Meta-Analysis of Randomized Studies.","authors":"Ivan Šitum, Roberto Giurazza, Martina Perić Šitum, Ante Erceg, Slobodan Mihaljević, Marco Rispoli, Francesco Coppolino, Zoran Karlović","doi":"10.1155/anrp/2531080","DOIUrl":"https://doi.org/10.1155/anrp/2531080","url":null,"abstract":"<p><strong>Background: </strong>Optimal anesthetic selection is critical for recovery and patient outcomes in ambulatory surgery. This systematic review and meta-analysis compares propofol-based total intravenous anesthesia (TIVA) with sevoflurane in adults undergoing outpatient procedures, focusing on randomized evidence published since 2014 to reflect contemporary clinical practice.</p><p><strong>Methods: </strong>We performed a PRISMA-compliant, random-effects meta-analysis of 15 randomized controlled trials (<i>n</i> = 1345 randomized participants), published between 2014 and 2025, comparing propofol TIVA with sevoflurane in adults undergoing ambulatory surgery. Primary outcomes were readiness for discharge, postanesthesia care unit (PACU) length of stay (LOS), and emergence time. Secondary outcomes included postoperative nausea and vomiting (PONV) and pain scores, requirement for rescue antiemetics and analgesics, unplanned hospital admissions, and adverse events. All-cause mortality was prespecified for extraction but was not reported in the included trials (PROSPERO: CRD420251151311).</p><p><strong>Results: </strong>Fifteen RCTs were included. For the primary outcomes, discharge readiness was shorter with TIVA in a single core trial (not a pooled meta-analytic estimate) (mean difference [MD] -5.8 min; 95% confidence interval [CI] -10.63 to -0.97; <i>p</i> = 0.019), although no significant differences were observed for PACU LOS (MD -1.3 min; 95% CI -7.3 to 4.8; <i>p</i> = 0.56). Emergence times were not pooled due to extreme heterogeneity between studies. Regarding secondary outcomes, TIVA was associated with a lower risk of PONV (risk ratio 0.67; 95% CI 0.47-0.96; absolute risk difference -0.11; approximate number needed to treat 9), with attenuation toward the null under trim-and-fill, and with lower postoperative pain scores (standardized mean difference [SMD] -0.30; among VAS 0-10 trials, MD -0.29 points). Mortality was not reported in any of the included trials.</p><p><strong>Conclusions: </strong>Contemporary randomized evidence suggests that propofol TIVA may reduce PONV and yield a small reduction in postoperative pain scores. Evidence regarding discharge readiness, PACU LOS, and emergence is limited or inconsistent and does not support a general claim of faster early recovery with either technique. Anesthetic choice should balance these symptomatic effects against patient factors and institutional resources.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"2531080"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pheochromocytoma Across the Perioperative Course: Current Concepts and Clinical Management.","authors":"Aibek E Mirrakhimov, Nicole Bashall","doi":"10.1155/anrp/4406992","DOIUrl":"https://doi.org/10.1155/anrp/4406992","url":null,"abstract":"<p><p>Pheochromocytoma is an uncommon neuroendocrine tumor with myriad nonspecific clinical presentations. If not recognized and treated, it is associated with the development of target organ damage and complications such as myocarditis, cardiomyopathy, cerebrovascular accidents, and diabetes mellitus, among numerous others. The pheochromocytoma diagnosis is based on biochemical proof of catecholamine excess followed by imaging localization of the tumor. Patients with newly diagnosed pheochromocytoma should be seen by a multidisciplinary perioperative team, including the anesthesiologist, operating surgeon, endocrinologist, and cardiologist. Perioperative antihypertensive therapy should be instituted prior to adrenal resection to allow for cardiovascular recovery and to hopefully mitigate the hypertensive response to laryngoscopy and tumor manipulation. The anesthesiologist must be prepared to manage both intraoperative hypertension, hypotension, and glycemic disturbances, among other possible complications. Patients with previously undiagnosed pheochromocytoma who present for unrelated surgery represent a high-risk group. Once intraoperatively suspected, priority should be given to immediate stabilization, cessation of surgery when feasible, and close communication with the surgical team regarding whether the procedure should be aborted, limited, or continued based on the urgency of the operation and the patient's clinical status. In most cases, nonessential surgery should be aborted. The postoperative level of care should be based on intraoperative patient courses and institutional protocols and guidelines to monitor and manage postresection hypoglycemia and vasoplegia, when they occur. This narrative review aims to provide practicing anesthesiologists with an updated, practical framework for the perioperative recognition and management of pheochromocytoma. We integrate contemporary evidence with anesthesia-specific decision-making, including the management of catecholamine-induced cardiovascular dysfunction, perioperative fluid and vasoactive therapy, medication-triggered crises, and a dedicated approach to previously undiagnosed pheochromocytoma presenting during unrelated surgery.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"4406992"},"PeriodicalIF":1.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postextubation Respiratory Muscle Recovery After Sugammadex or Neostigmine: A Randomized Controlled Ultrasonographic Trial in Laparoscopic Cholecystectomy.","authors":"Mohamed A F Ghoneim, Asmaa AboBakr AbdAllah Mohamed, Laila Ali El-Said El-Kafrawy, Ashraf Mahmoud Hazem Mohamed, Ahmed Wageh Ezzat Desoky","doi":"10.1155/anrp/3991360","DOIUrl":"10.1155/anrp/3991360","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sugammadex minimizes the residual neuromuscular block risk. By enhancing the function of expiratory muscles, it improves the clearance of secretions and helps prevent lung collapse, leading to a reduction in early postoperative respiratory issues. The study aims to compare the efficacy of sugammadex in promoting the recovery of expiratory muscle power to that of neostigmine following extubation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study objectives: &lt;/strong&gt;The main objective of this study was to evaluate the effectiveness of sugammadex and neostigmine as a reversal of neuromuscular block, assessed through ultrasonographic evaluation of expiratory muscle strength, specifically the thickening fraction of the internal oblique muscle (TFIO). The secondary objective was to assess diaphragmatic excursion (DE) and to explore the usefulness of ultrasonography in comparison to train-of-four (TOF) monitoring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and methods: &lt;/strong&gt;The study involved a total of 60 patients who underwent laparoscopic cholecystectomy between August 2023 and September 2024. Patients were randomly assessed into two groups for a comparative study. Group A received sugammadex, while Group B received neostigmine. The study utilized ultrasonography to measure the TFIO, reflecting expiratory muscle power, and DE, representing inspiratory muscle strength. Measurements were taken at three points in time: preinduction (baseline), at the TOF ratio recovery (TOFR) to 0.9, and 30 minutes postarrival in the postanesthesia care unit (PACU). The primary outcome was the variation in TFIO from baseline to a TOFR of ≥ 0.9. Secondary outcomes included the postoperative variation in DE from baseline, the incidence of recovery to baseline TFIO and DE, and the time taken for TOFR recovery to 0.95 and 1.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A significant difference in the primary outcome was observed among 60 patients. The alteration in TFIO from baseline to TOFR ≥ 0.9 was markedly reduced with sugammadex relative to neostigmine (mean ± SD: 9.13 ± 6.25 vs. 19.32 ± 5.75; adjusted &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Sugammadex resulted in a significantly smaller reduction in DE from initial values to TOFR ≥ 0.9 compared to neostigmine (right side: 1.91 ± 0.66 vs. 2.34 ± 0.52; adjusted &lt;i&gt;p&lt;/i&gt; &lt; 0.05). Thirty minutes post-PACU arrival, a greater percentage of patients in the sugammadex group reached baseline TFIO in comparison to the neostigmine group (67% vs. 47%); even so, the difference was not of statistical significance (corrected &lt;i&gt;p&lt;/i&gt; value = 0.118). The rate of TFIO and DE returning to initial values remained low for both groups, even after TOFR reached 1. The sugammadex group exhibited a significantly accelerated recovery of neuromuscular function. The median recovery time for the TOFR from 0.9 to 0.95 was 0.32 min, compared to 1.74 min with neostigmine (corrected &lt;i&gt;p&lt;/i&gt; &lt; 0.001). The median recovery time from 0.9 to 1.0 was 0.53 min, compared to 5.13 min (corrected &lt;i&gt;p&lt;/i&gt; ","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"3991360"},"PeriodicalIF":1.5,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Postoperative Pain Severity and Patient Satisfaction Among Post-Caesarean Women in Rajshahi District, Bangladesh.","authors":"Farhana Hasan, Abu Sayed Md Al Mamun, Mst Sabina Yeasmin Swapna, Md Kaderi Kibria, Masuma Amanullah, Md Golam Hossain","doi":"10.1155/anrp/1056316","DOIUrl":"10.1155/anrp/1056316","url":null,"abstract":"<p><strong>Background: </strong>Caesarean delivery (CD) is a common surgical procedure, and effective postoperative pain (POP) management is essential for maternal recovery and psychological well-being. Despite the increasing use of CD in Bangladesh, evidence regarding POP severity, pain-related outcomes, and patient satisfaction remains limited, particularly in regional healthcare settings. This study assessed POP severity, pain management outcomes, patient satisfaction, and factors associated with satisfaction among women undergoing CD in Rajshahi District, Bangladesh.</p><p><strong>Methods: </strong>A hospital-based cross-sectional study was conducted between November and December 2024 among 297 women who had undergone CD within the previous 24 h in selected public and private healthcare facilities in Rajshahi District. Data were collected through face-to-face interviews using the Bangla version of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R). Descriptive statistics, chi-square tests, and binary logistic regression analyses were performed to identify factors associated with satisfaction with pain management.</p><p><strong>Results: </strong>Substantial POP was reported during the first 24 h after CD. Overall, 84.2% of participants experienced moderate-to-severe pain, while 72.1% rated their worst pain as severe. Pain substantially interfered with physical activities, with moderate-to-severe interference reported for activities in bed (84.9%) and out of bed (76.1%). Emotional distress was also considerable, particularly fear (78.1%), anxiety (68.4%), helplessness (54.9%), and depression (52.9%). Despite this pain burden, 65.0% of women were satisfied with their pain management. However, 35.0% reported no pain relief, while only 5.7% reported complete relief. Adverse drug effects were reported by 34.0% of participants. In multivariable analysis, women aged 25-29 years had lower odds of satisfaction than those aged ≥ 30 years (AOR = 0.43, 95% CI: 0.19-0.96), whereas overweight women had higher odds of satisfaction than obese women (AOR = 3.27, 95% CI: 1.26-8.49). Those who received no pain medication also had higher odds of satisfaction (AOR = 5.49, 95% CI: 1.37-22.06).</p><p><strong>Conclusion: </strong>Women undergoing CD in Rajshahi District experienced a substantial burden of POP, physical interference, and emotional distress despite relatively high overall satisfaction with pain management. Limited pain relief and inadequate pharmacological management appear to be important concerns. Strengthening standardized, multimodal, and patient-centered POP management may improve pain control and maternal recovery following CD.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"1056316"},"PeriodicalIF":1.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Low-Dose Propofol Administered at the End of Sevoflurane Anesthesia on Emergence Agitation in Pediatric Patients Undergoing MRI: A Randomized Controlled Trial.","authors":"Thitinuch Ruenhunsa, Santhita Pimonbut, Peerapong Sangsungnern, Prathana Wittayapairoch, Darunee Sripadungkul, Narumon Wongsaneha, Wanatnarin Sorit, Palardej Narrutto","doi":"10.1155/anrp/6532790","DOIUrl":"10.1155/anrp/6532790","url":null,"abstract":"<p><strong>Background: </strong>Emergence agitation (EA) is a common postanesthetic problem in pediatric patients, particularly with sevoflurane anesthesia, and may lead to injury to patients, prolonged postanesthesia care unit (PACU) stay, and a risk of long-term maladaptive behavioral changes. Evidence regarding EA in nonpainful procedures such as magnetic resonance imaging (MRI) remains inconclusive. This study evaluated the effect of low-dose propofol at the end of sevoflurane anesthesia on EA in pediatric patients undergoing MRI.</p><p><strong>Methods: </strong>In this randomized controlled trial, 130 pediatric patients aged 2-8 years undergoing MRI under sevoflurane anesthesia with a laryngeal mask airway were enrolled. Patients were randomly assigned to receive either Group P (<i>n</i> = 61), receiving intravenous propofol 0.5 mg/kg, or Group N (<i>n</i> = 61), receiving normal saline at the end of anesthesia. EA was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale, with EA defined as a score > 12 within the first 30 min of PACU stay. Primary analysis was performed on a per-protocol approach (<i>n</i> = 122), alongside a sensitivity analysis using the intention-to-treat approach (<i>n</i> = 130). Secondary outcomes included emergence time, PACU stay, adverse events, and requirement for EA rescue medication.</p><p><strong>Results: </strong>In the per-protocol analysis (<i>n</i> = 122), the incidence of EA was significantly lower in Group P compared with Group N (18.0% vs 39.3%; <i>p</i> = 0.01), with a relative risk of 0.46 (95% CI 0.25-0.85). Emergence time, PACU stay, adverse events, and requirement of EA rescue medication were comparable between the two groups.</p><p><strong>Conclusions: </strong>Administration of propofol at a dose of 0.5 mg/kg at the end of sevoflurane anesthesia significantly reduces EA in pediatric patients undergoing MRI without prolonging recovery or increasing adverse events. Further large-scale, multicenter studies are warranted to confirm efficacy and evaluate safety. <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT06218680.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"6532790"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Effectiveness of the C-MAC Versus the McGrath Videolaryngoscope for Adult Endotracheal Intubation in Clinical Patients, Simulated Patients, and Manikin Settings: A Systematic Review and Meta-analysis.","authors":"Evgenia Dimou, Diamanto Aretha, Theano Beskou-Kontou, Antonis Kostouros, Matthaios Pappas, Angeliki Panagopoulou, Theodoros Xanthos","doi":"10.1155/anrp/1575867","DOIUrl":"10.1155/anrp/1575867","url":null,"abstract":"<p><strong>Introduction: </strong>Videolaryngoscopes are widely utilized in daily clinical practice within anesthesiology and emergency medicine to enhance airway management techniques and promote patient safety. Among these devices, the C-MAC and McGrath videolaryngoscopes have been extensively evaluated in multiple studies to determine their relative efficacy. This systematic review aims to synthesize the findings of available research comparing the C-MAC and McGrath with respect to first-pass intubation success and intubation time, as well as to conduct a meta-analysis for statistical evaluation.</p><p><strong>Materials and methods: </strong>A systematic review was performed using PubMed, Scopus, Cochrane Library, and Google Scholar in accordance with PRISMA guidelines. Eligible studies directly compared the C-MAC and McGrath videolaryngoscopes in adult clinical patients, simulated-patient clinical scenarios, or adult manikin-based airway models. Because these populations are methodologically and clinically heterogeneous, adult clinical patient studies were strictly separated from simulated-patient and manikin studies. Quantitative meta-analysis was restricted to adult clinical patient studies, whereas simulated-patient and manikin studies were summarized qualitatively. Studies were screened up to June 23, 2025, and assessed for bias with the Cochrane Risk of Bias 2.0 tool. Results are summarized in tables, and meta-analysis was conducted using R (meta-package, V4.4.1), focusing on first-pass intubation success and intubation time, displayed as forest plots. Certainty of evidence for the main outcomes was assessed using a GRADE-based approach, while publication bias and sensitivity analyses were also performed.</p><p><strong>Results: </strong>Nine studies met the inclusion criteria. The evidence base comprised six adult clinical patient studies and three manikin-based airway studies. Adult clinical patient studies and manikin-based studies were reported separately, and manikin datasets were not counted as clinical patients. Six adult clinical patient studies were included in the quantitative meta-analysis, whereas manikin-based studies were summarized qualitatively. No definitive superiority of either device was demonstrated for first-pass intubation success in adult clinical patients. C-MAC showed shorter intubation time in some analyses, but heterogeneity was substantial, and certainty of evidence was limited.</p><p><strong>Discussion: </strong>The available evidence should be interpreted cautiously because of clinical heterogeneity, differences in airway difficulty, operator experience, device blade configuration, and outcome definitions. Simulated-patient and manikin-based airway studies provide useful information on device handling and training but should not be interpreted as directly equivalent to adult clinical patient evidence.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"1575867"},"PeriodicalIF":1.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Perioperative Benzodiazepine Use on Postoperative Delirium in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis.","authors":"Marcela da Silva Kazitani Cunha, Hilária Saugo Faria, Lucas Mendes Barbosa, Leonardo Reischoffer do Nascimento, Carlos Henrique de Oliveira Ferreira, Karlos Daniell Araújo Dos Santos, Lucas Cael Azevedo Ramos Bendaham, Acza Kalica Buarque da Silva, Altair Pereira de Melo Neto, Wellgner Fernandes Oliveira Amador, Ivo Queiroz Costa Neto, Ricardo Esper Treml, Caio Augusto Perete","doi":"10.1155/anrp/5856805","DOIUrl":"10.1155/anrp/5856805","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac surgery anesthesia is associated with risks such as postoperative delirium (POD) and stress-related responses. Benzodiazepines have been used perioperatively to reduce anxiety and promote hemodynamic control. However, their use may increase the risk of delirium, particularly in older adults. This systematic review and meta-analysis aims to evaluate the impact of perioperative benzodiazepine use on the incidence of POD in patients undergoing cardiac surgery.</p><p><strong>Methods: </strong>We systematically searched for randomized controlled trials (RCTs) and observational studies comparing benzodiazepines with placebo or nonbenzodiazepine drugs in adults undergoing cardiac surgery. The primary outcome was POD incidence; secondary outcomes included mini-mental state examination (MMSE), ICU length of stay, and time to extubation. For dichotomous outcomes, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, while mean differences (MDs) were used for continuous outcomes. Analyses were performed using R 4.4.3.</p><p><strong>Results: </strong>Eight studies were included, comprising 36,301 patients, of whom 20,747 (68.5%) received benzodiazepines. Follow-up ranged from 1 day to 12 months. There were no significant differences between groups in the incidence of POD (OR 1.05; 95% CI: 0.88 to 1.25; <i>p</i> = 0.55; I² = 83%). Similarly, there were no significant difference in MMSE score (MD -0.11; 95% CI: -3.17 to 2.95; <i>p</i> = 0.94; I² = 70%), ICU length of stay (MD 4.72 h; 95% CI: -1.37 to 10.80; <i>p</i> = 0.13; I² = 99%), and time to extubation (MD -0.53 h; 95% CI: -2.16 to 1.09; <i>p</i> = 0.52; I² = 72%).</p><p><strong>Conclusion: </strong>Perioperative benzodiazepine use was not significantly associated with POD or with secondary outcomes in adults undergoing cardiac surgery.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"5856805"},"PeriodicalIF":1.5,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}