BMC Anesthesiology最新文献

{"title":"Analgesic efficacy of uni-level erector spinae plane block in breast cancer surgery patients: a systematic review and Meta-analysis.","authors":"Basma M El-Khalifa, Hamza Khelifa, Mahmoud Mohamed Gad, Jamal Ahmad, Hazem M Mazy, Asmaa Soliman, Eman Ayman Nada, Bahaa Elfakharany, Tarek H Elmeneizee, Israa Ahmed Qutob","doi":"10.1186/s12871-026-04328-3","DOIUrl":"10.1186/s12871-026-04328-3","url":null,"abstract":"<p><strong>Background: </strong>Surgery remains the cornerstone of management in breast cancer patients. Regional anesthesia techniques, such as the erector spinae plane block (ESPB), have emerged as adjuncts to standard therapy for postoperative pain control.</p><p><strong>Methods: </strong>Studies comparing ESPB and standard procedure of general anesthesia and opioids were included. Primary outcomes were postoperative pain scores, analgesia duration, and postoperative morphine consumption.</p><p><strong>Results: </strong>VAS pain scores were significantly reduced with the ESPB group. Similarly, longer analgesia duration (MD 7.03, 95%CI 4.92, 9.14, P < 0.0001), and lower postoperative morphine consumption (MD -5.77; 95% CI, -7.89, -3.65; P < 0.0001) were observed in the ESPB group. NRS pain scores at 24 h, intraoperative fentanyl, and postoperative tramadol consumption also decreased with ESPB. No significant differences were observed for NRS scores at 12 h. However, heterogeneity was high and most of the included studies had high or unclear risk of bias.</p><p><strong>Conclusion: </strong>ESPB may reduce opioid consumption and postoperative pain scores compared to the control groups. However, these results should be taken cautiously, due to the high risk of bias among the included studies and low certainty.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Thrombin generation, viscoelastic coagulation profiles, and disease severity in critically Ill COVID-19 patients: a prospective observational study.","authors":"Florian Espeter, Lena Garczarek, David Künne, Henning Kuhlmann, Stefan Heitmeier, Thomas Schmoch, Thorsten Brenner, Karsten Schmidt","doi":"10.1186/s12871-026-04297-7","DOIUrl":"https://doi.org/10.1186/s12871-026-04297-7","url":null,"abstract":"","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-ECMO characteristics, organ dysfunction and exploratory mortality prediction in COVID-19 versus non-COVID-19 ARDS treated with veno-venous ECMO: a retrospective cohort study.","authors":"Mirja Mittermaier, Jan Adriaan Graw, Alexander H Thieme, Johann Lieberwirth, Oliver Hunsicker, Daniel Zickler, Jan M Kruse, Alexander Uhrig, Panagiotis Pergantis, Carmen Garcia, Felix Machleidt, Till Jacobi, Victoria Bünger, Michaela Ludmilla Merten, Micha Landoll, Christian Karagiannidis, Leif-Erik Sander, Kai-Uwe Eckardt, Claudia Spies, Martin Witzenrath, Steffen Weber-Carstens, Mario Menk, Holger Müller-Redetzky","doi":"10.1186/s12871-026-04306-9","DOIUrl":"10.1186/s12871-026-04306-9","url":null,"abstract":"<p><strong>Objective: </strong>The transferability of pre-ECMO characteristics and established mortality prediction tools across COVID-19 (C-19) and non-COVID-19 (nC-19) acute respiratory distress syndrome (ARDS) remains uncertain. We compared clinical characteristics, organ dysfunction, respiratory support and outcome in a large cohort of patients treated with veno-venous extracorporeal membrane oxygenation (vvECMO), and explored mortality prediction in C-19 ARDS.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included n = 600 vvECMO patients (C-19: n = 245, nC-19: n = 355) hospitalized at the Charité ARDS ECMO Center from 01/2007 to 12/2018 (nC-19) and 03/2020-01/2022 (C-19). Pre-ECMO clinical and laboratory variables were compared between cohorts and by ICU survival. RESP score performance was assessed, and an exploratory C-19 ECMO mortality prediction (CEMP) score was derived from pre-ECMO variables using an explainable machine-learning workflow with SHapley Additive exPlanations (SHAP).</p><p><strong>Results: </strong>C-19 patients were older (median 57.0 vs. 51.0 years, p < 0.0001), more often male (74.7% vs. 66.8%, p = 0.0337), and had a higher BMI (29.3 vs. 26.0 kg/m², p < 0.0001). nC-19 patients had a higher CCI (3 vs. 2, p = 0.0137) and SOFA score (12 vs. 11, p = 0.0004). Septic shock before vvECMO initiation was more prevalent in nC-19 patients (65.4% vs. 13.9%, p < 0.0001), and nC-19 patients had higher median baseline bilirubin, creatinine, and lactate levels (all p < 0.0001). nC-19 patients had higher median PEEP, pPeak, and plateau pressure than C-19 patients, whereas their PaO₂/FiO₂ ratio was lower (p < 0.0001). Duration of vvECMO support was longer in C-19 patients (26.0 vs. 12.6 days, p < 0.0001); ICU mortality did not differ significantly (55.1% vs. 47.9%, p = 0.0966). RESP showed limited discrimination in C-19 patients, and the CEMP derivation analysis yielded an apparent AUC of 0.757 (95% CI 0.69-0.82).</p><p><strong>Conclusion: </strong>This large single-center comparative vvECMO cohort highlights differences between C-19 and nC-19 ARDS in organ dysfunction burden, respiratory characteristics, and treatment duration. ICU mortality did not differ significantly between groups. RESP showed limited discrimination in C-19; CEMP remains exploratory and requires calibration and independent external validation before clinical application.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"VIDD or CIADD? The ventilator remains a bona fide culprit.","authors":"Juan Liu, Xueyan Yuan, Yi Yang","doi":"10.1186/s12871-026-04298-6","DOIUrl":"10.1186/s12871-026-04298-6","url":null,"abstract":"<p><p>Rosà and colleagues recently proposed that mechanical ventilation (MV) may not be the primary driver of diaphragm dysfunction in critically ill patients, advocating the term \"critical illness-associated diaphragm dysfunction\" (CIADD) over \"ventilator-induced diaphragm dysfunction\" (VIDD). While we support distinguishing VIDD from CIADD, we contend that the review's central conclusion underestimates the causal role of MV itself.This commentary addresses three questions in turn. First, does MV injure the diaphragm under controlled conditions? Here the evidence is strong: brain-dead donor studies-dismissed by the authors as a \"unique patient category\"-are a uniquely informative, though not pure, human model of controlled MV exposure, and their dismissal creates an unfalsifiable position. Second, how much does MV contribute to diaphragm dysfunction in critically ill patients? This is considerably less certain: the molecular abnormalities observed in critically ill patients (ubiquitin-proteasome activation, RyR1 calcium leak, mitochondrial oxidative stress) coincide with pathways that MV reliably induces in controlled animal experiments, providing biological plausibility-though not proof-that MV contributes to the molecular phenotype of critical illness. Third, do MV and critical illness interact? We propose that CIADD should serve as an umbrella term encompassing VIDD as a distinct mechanistic subtype-rather than replacing it-analogous to how \"pneumonia\" subsumes VAP, HAP, and CAP, and we propose three differentiated model types for future research: pure VIDD models, pure CIADD models, and combined models with factorial design.VIDD and CIADD are mechanistically distinct but interacting entities. Future research should employ models that minimize confounding from critical illness to isolate ventilation-specific injury pathways. Importantly, establishing that VIDD exists is not equivalent to establishing that preventing VIDD is beneficial; clinical trials are needed to demonstrate the feasibility and benefit of diaphragm-protective strategies. Diminishing MV's role risks undermining the mechanistic foundation of diaphragm-protective ventilation strategies.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and candidate risk factors for postoperative delirium in older ward patients: a prospective pilot study.","authors":"Shaymaa Al-Dabooni, F Wappler, J Weber, T Annecke, M Fritz, R Lefering, I Feinkohl, J Defosse","doi":"10.1186/s12871-026-04321-w","DOIUrl":"10.1186/s12871-026-04321-w","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a frequent neuropsychiatric complication after surgery, characterized by acute disturbances in attention, awareness, and cognition. This pilot study assessed the feasibility of a multidimensional assessment protocol and investigated candidate risk factors for POD in older patients undergoing elective surgery.</p><p><strong>Methods: </strong>This prospective, observational, non-interventional, single-center pilot study enrolled 150 patients aged ≥ 65 years undergoing elective surgery lasting ≥ 60 min. Patients with dementia, neurological disorders (documented diagnoses), or emergency procedures were excluded. After enrollment, 10 patients were excluded due to surgery postponement or unplanned ICU admission, leaving 140 patients for analysis. Data were collected preoperatively, on postoperative days 1-3. Intraoperative and laboratory data were obtained from databases. Handgrip strength was measured by dynamometry. POD was assessed using the CAM-ICU once daily on postoperative days 1-3 by a single trained investigator. Cognitive function and reserve were evaluated using MMSE and MWT-B, frailty with the Clinical Frailty Scale, nutritional status with screening tools, and pain via the Numeric Rating Scale. Descriptive and inferential statistics were applied.</p><p><strong>Results: </strong>POD incidence was 5.0% (n = 7/140; 95% CI: 2.0%-10.0%). Frailty (n = 4/7 [57%] vs. n = 26/133 [20%]) and malnutrition (n = 4/7 [57%] vs. n = 29/133 [22%]) were more common in the delirium group. In an exploratory, unpowered male subgroup analysis, patients with POD had lower preoperative handgrip strength; no statistically meaningful difference was testable in women (n = 3 with POD). During anesthesia induction, patients with POD experienced more hypotensive episodes (MAP<55 mmHg), (n = 3/7 [43%] vs. n = 11/133 [8.0%]). No comparison remained significant after Holm-Bonferroni correction.</p><p><strong>Conclusion: </strong>This pilot study demonstrates the feasibility of prospective POD assessment on a general surgical ward and provides an incidence estimate (5.0%) to inform sample-size calculation for confirmatory trials. Frailty, lower preoperative handgrip strength in men, and induction hypotension were more frequent among patients with POD. Given the low event rate and multiple comparisons, these associations are hypothesis-generating and require validation in adequately powered studies.</p><p><strong>Trial registration: </strong>German Clinical Trials Register DRKS00031157. Registered 20.03.2023.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tranexamic acid use and the risk of postoperative delirium after spine surgery: a retrospective cohort study.","authors":"Paula Petersein, Juliane Schulze, Johannes Ehler, Antje Vogelgesang, Johanna Ruhnau, Robert Fleischmann","doi":"10.1186/s12871-026-04302-z","DOIUrl":"10.1186/s12871-026-04302-z","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a common complication after major surgery and has been linked to perioperative neuroinflammation. Tranexamic acid (TXA), an antifibrinolytic agent, may influence inflammatory pathways, but its effect on POD remains unclear. This post hoc analysis investigated the association between intraoperative TXA administration, POD, and perioperative biomarkers of inflammation and neuronal injury.</p><p><strong>Methods: </strong>This post hoc analysis of the prospective CONFESS cohort included patients aged ≥ 60 years undergoing elective spine surgery. POD was assessed using the Nursing Delirium Screening Scale and DSM-5 criteria. Multivariable logistic regression evaluated the association between TXA and POD. Perioperative changes in IL-6, S100β, sTREM2, and Gasdermin D were analyzed using repeated-measures ANOVA. False discovery rate correction was applied for multiple testing.</p><p><strong>Results: </strong>Among 93 enrolled patients, POD screening was available for 89, of whom 42 (47.2%) received intraoperative TXA. Overall, 17 patients (18.7%) developed POD, including 12 (70.6%) who had received TXA. In univariate analysis, TXA administration was associated with POD (OR 3.36, 95% CI 1.07-10.54; p = 0.035), but this association was not maintained after multivariable adjustment and false discovery rate correction. Gasdermin D was the only biomarker independently associated with POD (OR = 0.212 [0.046-0.974], p = 0.046). Significant perioperative biomarker changes were observed, with a significant time × treatment interaction only for IL-6 (p = 0.028). In exploratory subgroup analyses, TXA exposure was associated with a higher incidence of POD among patients aged ≥ 75 years, whereas no association was observed in younger patients.</p><p><strong>Conclusion: </strong>In this exploratory post hoc analysis, intraoperative TXA administration was not independently associated with postoperative delirium after adjustment for relevant confounders. Although perioperative biomarker dynamics reflected the expected inflammatory response to surgery, only IL-6 demonstrated differential temporal changes according to TXA exposure, while Gasdermin D emerged as a potential biomarker associated with POD. Given the observational design, limited sample size, and small number of delirium events, these findings should be regarded as hypothesis-generating. Larger randomized studies using standardized TXA protocols are warranted to clarify the relationship between TXA, perioperative neuroinflammation, and postoperative delirium.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remimazolam versus sevoflurane for maintenance of anesthesia and postoperative nausea and vomiting in laparoscopic gynecologic oncology surgery: a randomized controlled trial.","authors":"Chaopeng Ou, Xuanwei Huang, Hongyu Wei, Yingjun Zhang, Jingdun Xie","doi":"10.1186/s12871-026-04251-7","DOIUrl":"10.1186/s12871-026-04251-7","url":null,"abstract":"<p><strong>Background: </strong>Postoperative nausea and vomiting (PONV) remains a frequent complication following laparoscopic gynecologic surgery, particularly in female patients with multiple established risk factors receiving volatile anesthetics. Remimazolam, a short-acting benzodiazepine, is an alternative intravenous anesthetic, but its effect on PONV compared with sevoflurane remains unclear.</p><p><strong>Methods: </strong>In this single-center, prospective randomized controlled trial, 116 patients were enrolled and 113 were included in the final analysis (sevoflurane n = 56, remimazolam n = 57). Patients were randomly assigned to receive either sevoflurane-based or remimazolam-based maintenance of anesthesia. The primary outcome was the incidence of PONV within 24 h after surgery. Exploratory analyses were performed to evaluate the associations between PONV and perioperative factors, including intraoperative hemodynamic variables, fluid administration, and opioid consumption.</p><p><strong>Results: </strong>The incidence of PONV within 24 h was lower in the remimazolam group than in the sevoflurane group (21.1% vs. 44.6%, P = 0.013). Remimazolam was associated with reduced PONV incidence compared with sevoflurane. Although remimazolam was associated with higher intraoperative mean arterial pressure (MAP), exploratory analyses did not identify a significant association between intraoperative MAP and PONV. The observed absolute reduction in PONV incidence was 23.6%, which was slightly lower than the predefined effect size used for sample size estimation.</p><p><strong>Conclusions: </strong>Remimazolam-based anesthesia was associated with a lower incidence of PONV compared with sevoflurane in patients undergoing laparoscopic gynecologic oncology surgery. Although statistically significant, the observed reduction was slightly smaller than the effect size predefined during sample size estimation, and its clinical relevance requires further evaluation.</p><p><strong>Trial registration: </strong>ChiCTR2600128362. (Retrospectively registered). The initial registration date was 07/17/2026.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Omitting face-mask ventilation before tracheal intubation in low-risk adults: a randomized non-inferiority trial.","authors":"Hyoung Woo Chang, Namo Kim, Darhae Eum, Hae Dong Kim, Joung Goo Cho, Hyun Joo Kim","doi":"10.1186/s12871-026-04276-y","DOIUrl":"10.1186/s12871-026-04276-y","url":null,"abstract":"<p><strong>Background: </strong>Face-mask ventilation (FMV) is routinely performed between the induction of general anesthesia and tracheal intubation, but it can cause gastric insufflation, and its necessity in low-risk patients is uncertain. We examined whether omitting FMV before intubation is non-inferior to routine FMV for oxygen desaturation, and whether the two approaches differ in gastric insufflation.</p><p><strong>Methods: </strong>In this single-center, randomized, group-sequential non-inferiority trial, low-risk adults undergoing elective thyroid surgery were assigned to tracheal intubation with FMV (rocuronium 0.6 mg/kg) or without FMV (rocuronium 1.2 mg/kg). The primary outcome was the incidence of desaturation (peripheral oxygen saturation [SpO₂] ≤ 95%) from induction to the first intubation attempt, with a non-inferiority margin of 2% (absolute risk difference). The pre-specified secondary outcome was the gastric antral cross-sectional area (CSA) after intubation, measured by ultrasonography. The trial began as a fixed-sample design; a single interim analysis at 50% of enrollment (O'Brien-Fleming spending function) was added by protocol amendment after enrollment had begun. Gastric insufflation, defined by a qualitative ultrasonographic sign and by an antral CSA increase greater than 30%, was analyzed post hoc.</p><p><strong>Results: </strong>The trial was stopped at the interim analysis with 288 participants (144 per group), a decision made in the absence of any events rather than by a stopping rule. No patient in either group reached the desaturation threshold (0% vs. 0%; risk difference 0%, 95% confidence interval - 2.6% to 2.6%). The gastric antral CSA after intubation did not differ between groups (median 3.7 cm² in both groups; P = 0.99). In post hoc analyses, gastric insufflation occurred only in the FMV group, both by the qualitative sign (8/144 [5.6%] vs. 0/144; P = 0.007) and by the antral CSA threshold (9/144 [6.2%] vs. 0/144; P = 0.003).</p><p><strong>Conclusions: </strong>In low-risk adults undergoing elective thyroid surgery, no patient reached the desaturation threshold whether or not FMV was performed before intubation. Because the trial was stopped at the interim analysis with zero events, the upper limit of the confidence interval for the risk difference exceeded the pre-specified 2% margin, and formal non-inferiority was not established. In exploratory post hoc analyses, gastric insufflation occurred only in the FMV group. These hypothesis-generating findings warrant confirmation in adequately powered trials before routine FMV is omitted in low-risk patients.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT02400931. Registered 23 March 2015.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variable pressure support ventilation vs. biphasic positive airway pressure/airway pressure release ventilation in experimental acute respiratory failure.","authors":"Thomas Bluth, Maren Thiel, Dirk Haufe, Thomas Kiss, Thea Koch, Marcelo Gama de Abreu, Peter Markus Spieth, Andreas Güldner","doi":"10.1186/s12871-026-04228-6","DOIUrl":"10.1186/s12871-026-04228-6","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous breathing during mechanical ventilation (MV) can improve cardiorespiratory function and lung protection. Biphasic Positive Airway Pressure (BIPAP) and Airway Pressure Release Ventilation (APRV) are common MV modes that combine spontaneous breathing with controlled ventilation. Variable pressure support ventilation (PSV), which varies breath-by-breath pressure support randomly, has been shown to improve gas exchange and reduce lung injury compared to conventional MV modes. This study aimed to compare the short-term effects of variable PSV with BIPAP in a model of acute respiratory failure, hypothesizing that variable PSV would improve lung function without increasing lung damage or inflammation.</p><p><strong>Methods: </strong>In an exploratory randomized study with 18 pigs, lung injury was induced by lung lavage. Over 4 h, two lung protective strategies were applied with individually optimized PEEP: (1) BIPAP with non-assisted spontaneous breathing and (2) variable PSV, maintaining a mean tidal volume of 6 ml/kg body weight while varying pressure support. Plasma and bronchoalveolar lavage fluid samples were collected for inflammation markers, and lung damage was assessed histologically. Gene expression of inflammatory cytokines was also measured.</p><p><strong>Results: </strong>Variable PSV resulted in slightly improved gas exchange with higher mean tidal volumes and minute ventilation compared to BIPAP, as well as reduced work of breathing. Histopathological analysis showed alveolar damage to be mild, with no significant overall difference between the groups. However, variable PSV caused more alveolar edema, especially in gravity-dependent lung regions, and increased the wet-to-dry ratio compared with BIPAP. Despite these differences, there were no significant changes in systemic or pulmonary inflammatory cytokines or gene expression between the two groups.</p><p><strong>Conclusion: </strong>In this model of acute respiratory failure, variable PSV with a protective tidal volume of 6 ml/kg resulted in marginal, but clinically insignificant improvements in gas exchange and reduced work of breathing compared to BIPAP with non-assisted spontaneous breathing. Although inflammatory markers and overall diffuse alveolar damage did not differ between ventilation modes, the findings suggest a possible association between variable PSV and increased pulmonary oedema compared with BIPAP.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasoactive-inotropic score and major cardiovascular events in patients undergoing esophagectomy: a retrospective analysis of intravenous lidocaine and thoracic epidural anesthesia.","authors":"Syed Hasan Metwaly, Anne Kamphausen, Wolfgang Hitzl, Luca Giulini, Patrick Heger, Markus K Diener, Jens Christian Kubitz","doi":"10.1186/s12871-026-04198-9","DOIUrl":"10.1186/s12871-026-04198-9","url":null,"abstract":"<p><strong>Background: </strong>Esophagectomy is associated with clinically relevant perioperative morbidity and mortality. Analgesia may be provided using opioids in conjunction with thoracic epidural anesthesia (TEA) or lidocaine infusion. This study evaluates whether perioperative vasoactive requirements and cardiopulmonary outcomes differ between patients receiving these two analgesic regimens.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included 441 patients undergoing esophagectomy from 2013 to 2023. The primary endpoint was the intraoperative maximum vasoactive-inotropic score (VISmax OP). Propensity-score full matching used age, sex, body mass index, Lee Revised Cardiac Risk Index, operative time, surgical approach, and year of surgery, followed by covariate adjustment. Secondary endpoints included postoperative VISmax (VISmax ICU), major adverse cardiovascular events (MACE), pulmonary complications, postoperative arrhythmias (atrial fibrillation), and 30-day mortality.</p><p><strong>Results: </strong>One hundred sixty-nine patients received lidocaine, and 272 received TEA. The lidocaine group demonstrated a significantly higher VISmax OP than the TEA group after propensity-score full matching and multivariable covariate adjustment (adjusted mean: 14.6 [95% CI: 13.0-16.3] vs. 12.5 [95% CI: 11.3-13.8]; adjusted mean difference: 2.14, 95% CI 0.22-4.10; p = 0.029). VISmax ICU was also significantly higher in the lidocaine group than in the TEA group (adjusted mean, 37.1 [95% CI, 26.1-48.1] vs. 22.7 [95% CI, 17.1-28.3]; adjusted mean difference, 14.4 [95% CI, 2.48-26.3]; p = 0.019). Postoperative atrial fibrillation occurred more frequently in the lidocaine group (40.4% vs. 21.4%; adjusted ratio 0.55, 95% CI 0.38-0.79; p = 0.001), whereas no significant differences were observed in pulmonary complications, 30-day mortality, or cardiopulmonary arrest after matching and adjustment.</p><p><strong>Conclusion: </strong>The lidocaine group demonstrated a significantly higher VISmax OP (intraoperative) and VISmax ICU (postoperative) compared to the TEA group after adjustment for BMI, age, sex, Lee RCI, operative time, surgical approach, and year of surgery. Higher VISmax was associated with significantly increased odds of postoperative arrhythmias. However, these findings should be interpreted cautiously and externally validated in future prospective studies on optimal perioperative analgesia strategies in esophagectomy.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}