Anesthesiology Research and Practice最新文献

{"title":"Intraoperative Hemodynamic Management and Cerebral Protection During Awake Craniotomy: Evidence-Based Approaches.","authors":"Marc Knezevic Maragh, Alanna Pagan Garcia, Yuliia Oliinyk, Jayottri Acharjee, Alex Emmanuel Binoy, Feaven Tewfik, Khalil Garada, Loveleen Johal, Nafrin Kormath, Abdulaziz Alkhalidi, Nusaiba Ali, Khalé Reyes","doi":"10.1155/anrp/5356459","DOIUrl":"10.1155/anrp/5356459","url":null,"abstract":"<p><p>Awake craniotomy is a standard neurosurgical technique that enables real-time assessment of brain functions during tumor resection, with high success rates. Although highly effective, the procedure is associated with hemodynamic disturbances, including blood pressure variability and impaired cerebral perfusion, compromising intraoperative safety. A focused literature search of PubMed, Embase, and Google Scholar was performed to identify relevant studies on intraoperative hemodynamic management during awake craniotomy. Findings were synthesized narratively to summarize current evidence, highlight emerging strategies, and identify knowledge gaps. Hypertension (8%-34%) was the most common disturbance, often triggered by painful surgical stimuli or emergence from sedation, with repeat craniotomy, impaired autoregulation, and glioma pathology as additional risk factors. Hypotension (10%-11%) was linked to perioperative stroke and mortality. Cerebral hypoperfusion contributed to poor outcomes, with stroke up to 23% and neurological morbidity in 68% of patients. Preventive strategies, such as scalp blocks, individualized blood pressure targets, and the use of dexmedetomidine and midazolam, improved intraoperative stability, while short-acting agents, including esmolol and labetalol, were preferred for rapid control. Advanced monitoring modalities, including arterial lines, near-infrared spectroscopy, and cerebral autoregulation indices, enhance safety and support accurate functional mapping. Hemodynamic instability during awake craniotomy influences outcomes. Current evidence supports multimodal prevention, tailored blood pressure control, and short-acting pharmacological agents; practice variation and the lack of randomized trials limit standardization. Looking ahead, advanced monitoring and emerging AI systems may provide new opportunities to enhance cerebral protection and optimize patient safety. This review summarizes evidence on intraoperative hemodynamic control in awake craniotomy, emphasizing strategies that enable maximal safe resection while preserving neurological function.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"5356459"},"PeriodicalIF":1.5,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856911","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":"Incidence, Onset Time and Predictors of Postdural Puncture Headache Among Mothers Who Underwent Caesarean Section in Hospitals, Ethiopia: A Prospective Cohort Study.","authors":"Esubalew Tesfahun, Eden Takele, Dereje Andargie, Solomon Hailemeskel","doi":"10.1155/anrp/5645773","DOIUrl":"10.1155/anrp/5645773","url":null,"abstract":"<p><strong>Background: </strong>Postdural puncture headache (PDPH) is a significant complication of spinal anaesthesia, especially in obstetric patients. It is triggered by the leakage of cerebrospinal fluid (CSF) through the puncture in the Dura mater. Understanding the timing of PDPH onset is crucial for early diagnosis and treatment, but previous studies have not fully explored its timing and associated factors.</p><p><strong>Aim: </strong>To determine the incidence and predictors of PDPH in women who deliver by caesarean section under spinal anaesthesia.</p><p><strong>Methods: </strong>A prospective follow-up study was conducted from March 7 to May 8, 2025, among 365 mothers who underwent caesarean section under spinal anaesthesia at government hospitals found in Debre Berhan, Ethiopia. Data were collected using a structured interviewer-administered questionnaire. The Kaplan-Meier method was used to estimate the survival time for PDPH, with the log-rank test for curve comparison. Cox regression analysis was conducted to identify predictor variables.</p><p><strong>Results: </strong>The cumulative incidence of PDPH was 33.7% (95% CI: 28.9%, 38.7%), and incidence density was 3.75 (95% CI: 3.11, 4.47) per 1000 person-hours of observation. The mean time to onset of PDPH was 28.9 h (approximately 1.4 days). The restricted mean survival time was 28.98 Hr (95% CI: 25.78, 32.17). Multiple attempts during the procedure AHR 1.69 (95% CI: 1.104, 2.606; <i>p</i> < 0.01), larger needle size AHR 8.22 (95% CI: 4.94, 13.67; <i>p</i> < 0.001) and anaesthetist having less than 3 years of experience AHR 2.7 (95% CI 1.62, 4.51; <i>p</i> < 0.001) were found to be predictors of PDPH.</p><p><strong>Conclusion: </strong>This study confirmed that reducing the magnitude of PDPH requires limiting the number of puncture attempts and usage of Quincke spinal needles (22G) or fine-gauge needles (24G-26G).</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"5645773"},"PeriodicalIF":1.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811574","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":"The Effect of Preoperative Medication Intervention on Early Postoperative Cognitive Function in Elderly Patients With Poor Sleep Quality.","authors":"Chao Xiong, Wenhu Zhai, Rui Deng, Yanhua Peng, Xinwei Liu, Xianjie Zhang","doi":"10.1155/anrp/5588639","DOIUrl":"10.1155/anrp/5588639","url":null,"abstract":"<p><p>To investigate the impact of preoperative zolpidem administration on early postoperative cognitive function in elderly patients with poor sleep quality, elderly patients undergoing gastrointestinal surgery with sleep disorders were enrolled and randomly allocated to two groups. The experimental group received 5 mg of oral zolpidem at bedtime for three consecutive nights preoperatively, whereas the control group was given a placebo. Data collected included patients' sleep quality after medication, demographic characteristics, intraoperative parameters, and the incidence of postoperative delirium (POD). Results showed that zolpidem effectively improved preoperative sleep quality in elderly patients. However, the preoperative administration of zolpidem did not yield a statistically significant reduction in the incidence of POD in this cohort, likely attributable to inadequate statistical power. Preoperative zolpidem intervention did not significantly reduce the incidence of POD in this population. Logistic multivariate regression analysis indicated that early POD was correlated with patient age, blood transfusion, postoperative pain, and the frequency of intraoperative hypotensive episodes; however, no significant association was observed between preoperative sleep quality and the recovery of early postoperative cognitive function. In conclusion, preoperative zolpidem intervention can safely and effectively enhance sleep quality in elderly patients undergoing gastrointestinal surgery. However, the observed effect size was smaller than anticipated (Cohen's <i>h</i> = 0.15), and the confidence interval for the difference in delirium incidence included both clinically meaningful benefit and harm. Therefore, we cannot draw definitive conclusions about whether short-term improvement in preoperative sleep quality reduces the incidence of early POD. These findings should be considered exploratory and require validation through larger, adequately powered multicenter prospective studies with objective sleep measures and longer intervention durations.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"5588639"},"PeriodicalIF":1.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787084","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":"Early Postoperative Cognitive Performance After Total Arch Replacement: A Prospective Observational Study.","authors":"Kyosuke Takahashi, Misa Kajitani, Wataru Takayama","doi":"10.1155/anrp/4717530","DOIUrl":"10.1155/anrp/4717530","url":null,"abstract":"<p><strong>Background: </strong>Early postoperative cognitive trajectories following total arch replacement remain insufficiently characterized. This study evaluated serial postoperative recovery patterns with particular focus on cognitive performance during the first postoperative week.</p><p><strong>Methods: </strong>Adult patients undergoing elective total arch replacement were enrolled. Recovery was assessed using the Postoperative Quality of Recovery Scale (PostopQRS) at baseline within 14 days before surgery and postoperatively at 3 h and 1, 3, and 7 days after extubation. Cognitive recovery was evaluated according to the revised PostopQRS cognitive recovery algorithm. Recovery trajectories including other PostopQRS domains were summarized descriptively.</p><p><strong>Results: </strong>Forty-one patients were included in the final analysis. The mean (SD) age was 68.4 (10.4) years, and 31 patients (91%) were male. Cognitive recovery was observed in 23/41 (56.1%) of patients at 3 h after extubation, 26/41 (63.4%) at postoperative Day 1, 31/41 (75.6%) at postoperative Day 3, and 30/41 (73.2%) at postoperative Day 7. While physiological, emotive, and activities of daily living domains showed progressive improvement over time, nociceptive recovery remained incomplete throughout follow-up and was primarily driven by persistent pain rather than nausea.</p><p><strong>Conclusion: </strong>Cognitive recovery after total arch replacement improved gradually during the early postoperative period but remained incomplete in a substantial proportion of patients at postoperative Day 7. These findings highlight the heterogeneous nature of postoperative cognitive recovery and support the importance of serial cognitive assessment after complex aortic surgery.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"4717530"},"PeriodicalIF":1.5,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13454786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705142","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 on the Effectiveness of Intravenous Magnesium Sulphate and Intravenous Dexmedetomidine in Reducing Emergence Agitation in Adults Undergoing Otorhinolaryngology Surgery.","authors":"Girhanif Amri Yunda, Riyadh Firdaus, Aino Nindya Auerkari","doi":"10.1155/anrp/5531396","DOIUrl":"10.1155/anrp/5531396","url":null,"abstract":"<p><strong>Background: </strong>Emergence agitation (EA) is a phenomenon commonly occurring in otorhinolaryngology surgery. It may increase the risk of injury and prolong recovery. Dexmedetomidine is the standard preventive agent, but limited due to its high cost, limited accessibility, extubation time, and incidence of bradycardia and hypotension. Magnesium sulphate (MgSO₄) is considered a potential alternative but is there is insufficient research available. This study aimed to compare the effectiveness of intravenous MgSO₄ and dexmedetomidine in reducing EA.</p><p><strong>Methods: </strong>This study is a multicentered, double-blinded, randomized controlled trial involving 64 adult patients undergoing otorhinolaryngology surgery. They were divided into two groups in a 1:1 ratio, with one group receiving MgSO₄ 20 mg/kgBW/h and another receiving dexmedetomidine 0.5 μg/kgBW/h from induction until the procedure ends. We measured the proportion of EA, onset, and duration of EA, intraoperative ephedrine dose, perioperative heart rate and mean arterial pressure (MAP), pain scores, perioperative fentanyl use, intraoperative sevoflurane use, and extubation time.</p><p><strong>Results: </strong>The proportion of EA was not significantly different between the MgSO₄ and dexmedetomidine groups (12.5% vs. 15.6%, <i>p</i> > 0.05). No differences in the severity, onset and duration of EA. The reduction of MAP and heart rate were greater in the dexmedetomidine group. The intraoperative ephedrine was significantly lower in the MgSO₄ group (0 vs. 5 mg, <i>p</i> < 0.05). No significant differences in fentanyl and sevoflurane use, postoperative pain scores, and extubation time.</p><p><strong>Conclusion: </strong>Intravenous MgSO₄ and dexmedetomidine showed no statistically significant difference in the incidence of EA in adult patients undergoing otorhinolaryngologic surgery. <b>Trial Registration:</b> ClinicalTrials.gov: NCT07544173.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"5531396"},"PeriodicalIF":1.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13382349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597731","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":"Hypertension and Postoperative Outcomes: A Retrospective Cohort Study.","authors":"Taeko Fukuda, Norihiko Inoue, Kazushi Maruo, Hiromasa Horiguchi","doi":"10.1155/anrp/1180205","DOIUrl":"10.1155/anrp/1180205","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of hypertension is high. However, hypertensive patients often remain undiagnosed or poorly controlled, posing challenges for anesthesiologists before surgery. Although well-established guidelines have been proposed, some uncertainties remain. This study aimed to test the hypothesis that the closer the preoperative blood pressure (BP) is to normal, the lower the incidence of unfavorable postoperative outcomes in hypertensive patients using data from 2016 onward.</p><p><strong>Methods: </strong>Medical records of adult patients under general anesthesia for surgery at 68 hospitals in Japan between 2016 and 2021 were reviewed. In accordance with World Health Organization criteria, patients were categorized based on their maximum BP recorded the day before surgery into five groups: true normotension, controlled hypertension (patients with prior diagnosis and/or treatment of hypertension), and Stages 1, 2, and 3 hypertension groups. Postoperative mortality rates and incidence of unfavorable outcomes, including ischemic heart disease, cerebrovascular disease, aortic dissection, and acute renal failure, were compared using multivariable logistic regression analysis.</p><p><strong>Results: </strong>Data from 272,594 patients (either sex, aged between 20 and 106 years) were analyzed, excluding those undergoing cardiac, brain, and obstetric surgery. Mortality did not differ significantly between the four hypertension groups and the true normotension group. Compared with the true normotension group, the odds of ischemic heart disease were higher in the controlled, Stage 2, and Stage 3 hypertension groups. The odds of cerebrovascular disease and acute renal failure increased with hypertension stage, whereas the odds of aortic dissection were elevated only in Stage 3 hypertension.</p><p><strong>Conclusions: </strong>Our results showed that the closer preoperative BP was to normal, the better the postoperative outcomes for cerebrovascular disease and acute renal failure, but not for mortality, ischemic heart disease, or aortic dissection. Since the risk in the controlled hypertension group was higher than initially expected, our hypothesis was rejected.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"1180205"},"PeriodicalIF":1.5,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13370321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454477","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":"Operating Room Professionals' Awareness of Possible Unconscious Auditory Perception During General Anesthesia: A Cross-Sectional Survey Study.","authors":"Emine Özcan","doi":"10.1155/anrp/9936739","DOIUrl":"10.1155/anrp/9936739","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Explicit recall during general anesthesia is rare; however, experimental and clinical evidence suggests that auditory stimuli may sometimes be processed at an implicit or unconscious level. Routine intraoperative conversations differ from structured therapeutic suggestions; nevertheless, they form part of the auditory environment surrounding anesthetized patients. This study aimed to assess operating room professionals' awareness of possible unconscious auditory perception related to intraoperative conversations during general anesthesia, their previous educational exposure, and their professional attitudes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this cross-sectional survey, an anonymous 19-item online questionnaire was distributed to operating room health professionals in Türkiye through professional communication networks. Descriptive statistics were reported as &lt;i&gt;n&lt;/i&gt; (%). A study-specific 9-item exploratory Awareness/Professional Attitude Index was calculated with two items reverse-coded, and internal consistency was assessed using Cronbach's alpha. Between-group comparisons were performed using the Mann-Whitney &lt;i&gt;U&lt;/i&gt; test and the Kruskal-Wallis test. A &lt;i&gt;p&lt;/i&gt; value &lt; 0.05 was considered statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 251 responses were analyzed, and 96.4% of participants reported that they were actively working in the operating room. Most participants agreed that intraoperative communication should remain within appropriate professional boundaries (97.2%) and that awareness-oriented education on this topic is needed (88.0%). However, 74.5% reported that they had not received formal education on this topic, and only 19.5% reported exposure to related scientific education or activities. The study-specific exploratory Awareness/Professional Attitude Index was 3.61 ± 0.67 and showed high internal consistency (Cronbach's alpha = 0.83). Index scores were higher in women than in men (3.76 vs 3.43; &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and differed across professional groups (&lt;i&gt;p&lt;/i&gt; = 0.001) and experience groups (&lt;i&gt;p&lt;/i&gt; = 0.023). These findings indicate a gap between the perceived importance of communication around anesthetized patients and formal educational exposure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Operating room professionals reported substantial awareness of the importance of intraoperative conversations in the context of possible unconscious auditory perception during general anesthesia. However, formal educational exposure to this topic was limited. These descriptive findings do not demonstrate effects on patient outcomes; however, they identify an awareness-education gap and support awareness-oriented education, clearer communication norms around anesthetized patients, and further research using standardized measurement approaches, as well as observational or interventional designs. &lt;b&gt;Trial registration:&lt;/b&gt; ClinicalTrials.gov, NCT07396727. Registration date: September 26, 2025.&lt;","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"9936739"},"PeriodicalIF":1.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444085","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":"Pharmacological Modulation of Perioperative Pain in Laparoscopic Bariatric Surgery: An Updated Evidence-Based Narrative Review of Intravenous Lidocaine, Dexmedetomidine, Opioid-Free and Opioid-Sparing Anesthesia, and ERAS-Based Protocols.","authors":"Carlos Zavaleta-Corvera, Erick Auccacusi Pachari, Julian Espinoza-Portilla, Wendy Farfán-Martinez, Mario Bolarte-Arteaga","doi":"10.1155/anrp/6019290","DOIUrl":"10.1155/anrp/6019290","url":null,"abstract":"<p><p>Laparoscopic bariatric surgery is associated with specific analgesic challenges because opioid-related adverse effects may be especially relevant in patients with obesity, obstructive sleep apnea, and cardiometabolic comorbidities. Inadequate perioperative analgesia in this population may impair early mobilization and functional recovery, while excessive opioid use increases the risk of respiratory depression, postoperative nausea and vomiting (PONV), and prolonged hospital stay. This narrative review synthesizes and critically appraises contemporary evidence on intravenous lidocaine, dexmedetomidine, opioid-free or opioid-sparing anesthesia, and enhanced recovery after surgery (ERAS)-based perioperative strategies in adult patients undergoing laparoscopic bariatric surgery. A structured literature search was conducted in PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library from January 2018 to May 2026. A total of 41 studies were included, comprising randomized controlled trials, observational studies, pharmacokinetic investigations, systematic reviews, meta-analyses, and ERAS implementation studies. Methodological quality was appraised using RoB 2.0, ROBINS-I, and AMSTAR-2 according to study design. Evidence for intravenous lidocaine remains heterogeneous and appears dependent on dosing strategy, infusion duration, and perioperative context; its antiemetic and anti-inflammatory effects may be more consistent than its analgesic benefit when infusion is limited to the intraoperative period. Dexmedetomidine has been associated with reductions in perioperative opioid exposure and PONV through alpha-2-mediated sympatholysis and opioid-sparing mechanisms, although effects on pain scores are variable and hemodynamic monitoring is required. Opioid-free or opioid-sparing strategies may reduce opioid exposure and PONV, but superiority over conventional anesthesia for pain control or length of stay is inconsistent, and protocol heterogeneity limits generalizability. ERAS pathways represent the most comprehensive and evidence-supported framework for perioperative optimization, with benefit proportional to adherence and independent of any single pharmacologic agent. These pharmacologic strategies are best understood as mechanism-based adjuncts to be selectively integrated within high-adherence ERAS programs, not as universal standalone interventions. Rigorous multicenter randomized trials with standardized dosing, detailed ERAS adherence reporting, patient-centered outcome measures, and subgroup analyses by procedure type, OSA status, and PONV risk are needed.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"6019290"},"PeriodicalIF":1.5,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13358357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434818","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":"Effects of Inspired Oxygen Concentrations During Cardiopulmonary Bypass on the Pulmonary Function of Patients Undergoing a Modified Morrow Procedure via a Small Right Axillary Incision.","authors":"Linting Xu, Lixin Wang, Meijuan Yan, Hanwei Wei, Tian Jiang, Haozhou Wang, Jinchen Guo, Yong Cui","doi":"10.1155/anrp/9078621","DOIUrl":"10.1155/anrp/9078621","url":null,"abstract":"<p><strong>Background: </strong>Patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing minimally invasive modified Morrow procedure may be vulnerable to postoperative pulmonary dysfunction. During cardiopulmonary bypass (CPB), lung-protective ventilation has been proposed, but the optimal inspired oxygen concentration under this strategy remains unclear. This study aimed to compare different inspired oxygen concentrations under a fixed lung-protective ventilation strategy during CPB.</p><p><strong>Methods: </strong>This was a prospective clinical observation study involving 97 patients scheduled for modified Morrow procedures via a small right axillary incision between January 2023 and November 2023 at a single center. Patients were randomized to receive CPB ventilation with FiO₂ of 30%, 50%, or 100% under a standardized ultra-low-tidal-volumelung-protective strategy. The primary outcomes included the Horowitz Index (HI = PaO₂/FiO₂), respiratory index (RI = P(A-a)O₂/PaO₂), and alveolar-arterial oxygen pressure difference [P(A-a)O₂] at six different time points within the first 24 h postoperatively, as well as postoperative pulmonary complications. Secondary outcomes included plasma levels of inflammatory cytokines, endothelial glycocalyx (eGC) components, and measures of postoperative rehabilitation and other complications.</p><p><strong>Results: </strong>There were no significant differences in terms of postoperative complications and rehabilitation among the three groups with different inspired oxygen concentrations under a fixed lung-protective ventilation strategy during CPB. Compared with the 100% FiO₂ group, the 30% FiO₂ group exhibited higher HI at 6 h and 24 h postoperatively with lower P(A-a)O₂ at 18 h and 24 h postoperatively and a lower RI at 24 h postoperatively. In addition, the 30% FiO₂ group showed lower plasma levels of inflammatory cytokines and eGC.</p><p><strong>Conclusion: </strong>These findings indicate that the use of 30% 100% FiO₂ group with ultra-low tidal volume ventilation during CPB in patients undergoing a modified Morrow procedure via a small right axillary incision was safe and associated with improved early postoperative oxygenation and attenuated inflammatory response. <b>Trial Registration:</b> Chinese Clinical Trial Registry: ChiCTR2400084443.</p>","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"9078621"},"PeriodicalIF":1.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148358953","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":"The Effect of Unilateral Erector Spinae Plane Block With Dexmedetomidine as an Additive Versus Intrathecal Morphine on Early Mobilization After Total Hip Replacement Under Spinal Anesthesia in Cairo University Hospitals: A Randomized Controlled Trial.","authors":"Ayman Mohamed Hussam Al-Din Abd Al-Latif, Ahmed Abdelhamed Hassan, Osama Mohamed Asaad Farahat, Atef Kamel Salama Salem, Karim Hussein Mourad Ghaleb","doi":"10.1155/anrp/9919921","DOIUrl":"10.1155/anrp/9919921","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Enhanced recovery after surgery (ERAS) is a current concept in surgery that has excellent short-term outcomes. Currently, no standardized ERAS protocol exists for total hip replacement (THR). So, we conducted this study to assess the efficacy of ultrasound-guided erector spinae plane block (ESPB) with dexmedetomidine as an additive in comparison with intrathecal morphine (ITM) for ERAS after THR in Cairo University hospitals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Our randomized controlled study included 70 patients. The patients were randomly allocated to the M group or E group. M group patients received 5 mL of subcutaneous lidocaine 1% and then 3.5 mL of hyperbaric bupivacaine 0.5% with 0.1 mg of morphine in 0.25 mL of normal saline intrathecally. E group patients received ESPB with dexmedetomidine as an additive on the side of surgery and then 3.5 mL of hyperbaric bupivacaine 0.5% with 0.25 mL of normal saline intrathecally. The primary outcome was the time of the first successful walking trial for 10 steps with a walker. Secondary outcomes were postoperative pain score, total morphine consumption, duration of hospital stay, patient satisfaction, and incidence of complications (hypotension, bradycardia, pruritus, nausea, vomiting, and urine retention).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean time of a successful walking trial with a walker of the E group was 12.69 ± 2.42 h which is decreased significantly in comparison to the M group (19.71 ± 3.11 h), with a mean difference of 7.0 (95% CI 8.81-5.2) hours, with a very large effect size (Cohen&lt;sup&gt;'&lt;/sup&gt;s &lt;i&gt;d&lt;/i&gt; = 2.51), and &lt;i&gt;p&lt;/i&gt; value &lt; 0.001. The mean number of failed walking trials in the E group (1.11 ± 0.4 trials) decreased to a statistically significant value in comparison to the mean number of failed walking trials in the M group (2.29 ± 0.52 trials), with a mean difference of 1.18 (95% CI 0.96-1.4) trials, and &lt;i&gt;p&lt;/i&gt; value &lt; 0.001. Duration of hospital stay after surgery was, on average, 33.9% lower in E group in comparison to M group (1.66 ± 0.59 and 2.51 ± 0.51 days, respectively) with a large effect size (Cohen&lt;sup&gt;'&lt;/sup&gt;s &lt;i&gt;d&lt;/i&gt; = 1.54) and &lt;i&gt;p&lt;/i&gt; value &lt; 0.001. There was no significant difference regarding the mean time of the first morphine dose in M and E groups (16.8 ± 4.78 h and 18.86 ± 4.63 h, respectively) and &lt;i&gt;p&lt;/i&gt; value = 0.072. Total morphine consumption in the first 24 h was insignificantly higher in the M group than in the E group (7.36 ± 2.97 mg and 5.76 ± 2.88 mg, respectively), with a mean difference of -1.6 (95% CI -2.99 to -0.2) mg and &lt;i&gt;p&lt;/i&gt; value = 0.025. The patient satisfaction score was better in the E Group than in the M Group. The number of patients with complete satisfaction was more in the E group (24 [68.6%]) than in the M group (10 [28.6%]) and &lt;i&gt;p&lt;/i&gt; value &lt; 0.001. The rate of complications was higher in the M Group than in E Group (56.19% vs. 22.86%, respectively, with an odds ratio of 4.01 (95% CI, 1.43-11","PeriodicalId":7834,"journal":{"name":"Anesthesiology Research and Practice","volume":"2026 ","pages":"9919921"},"PeriodicalIF":1.5,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366855","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}