BMC Anesthesiology最新文献

{"title":"Epidural analgesia for a successful vaginal delivery in a parturient with Jarcho-Levin syndrome: case report.","authors":"Eunah Song, Erik Romanelli","doi":"10.1186/s12871-025-02978-3","DOIUrl":"10.1186/s12871-025-02978-3","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of literature regarding obstetric anesthesia management in Jarcho-Levin Syndrome (JLS) patients and existing case reports are limited to pre-planned cesarean deliveries.</p><p><strong>Case presentation: </strong>The patient is a 21-year-old woman with JLS, spondylocostal dysostosis (SCD) subtype, who went through a full-term vaginal delivery with labor neuraxial analgesia. This case report details a successful trial of labor and delivery, which was permitted after an extensive testing of her baseline functional status, as well as a review of the difficulties present in the provision of both neuraxial and general anesthesia. There was an emphasis on multidisciplinary collaboration and planning throughout the patient's peripartum course.</p><p><strong>Conclusion: </strong>A parturient with JLS was able to undergo full-term vaginal delivery using neuraxial analgesia and did not require general anesthesia or a cesarean section. Further research will enhance the management of obstetric anesthesia for patients with JLS.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"157"},"PeriodicalIF":2.3,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787767","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 study of using perfusion index to predict the timing of laryngeal mask insertion: an observational study.","authors":"Weiwei Cai, Yuting Song, Fei Sun, Huiying Shao, Huanhuan Ni","doi":"10.1186/s12871-025-03024-y","DOIUrl":"10.1186/s12871-025-03024-y","url":null,"abstract":"<p><strong>Background: </strong>Currently, no objective indicators are available to predict the optimal timing for laryngeal mask insertion. Anesthesia depth monitoring devices such as the Bispectral Index (BIS) are not widely applicable for day-surgery patients due to their high cost. Previous literature has reported a correlation between the perfusion index (PI) and the anesthesia depth. Thus, the aim of this study is to verify whether the PI can serve as an indicator for predicting the timing of laryngeal mask insertion.</p><p><strong>Methods: </strong>This trial was conducted at a specialized pediatric hospital, with a final enrollment of 164 pediatric patients. After the children entered the room, baseline vital signs and PI₁ were recorded. Three minutes after routine anesthesia induction, PI₂ was recorded, and then a laryngeal mask was inserted. Then children were divided into the body movement group and the non-body movement group. The diagnostic efficacy of PI and the PI ratio for predicting the timing of laryngeal mask insertion were calculated using ROC curves.</p><p><strong>Results: </strong>The area under the ROC curve (AUC) for using PI to predict the timing of laryngeal mask insertion was 0.641 (95% confidence interval, 0.542-0.740), P = 0.009, and the cutoff value was 4.37. When PI > 4.37 was used to predict the timing of laryngeal mask insertion, the sensitivity was 53.2%, and the specificity was 73.7%. The AUC for using the PI ratio to predict the timing of laryngeal mask insertion was 0.751 (95% confidence interval, 0.657-0.844), P < 0.001, and the cutoff value was 2.955. When the PI ratio > 2.955 was used to predict the timing of laryngeal mask insertion, the sensitivity was 85.7%, and the specificity was 63.2%.</p><p><strong>Conclusion: </strong>The PI ratio is more suitable than PI alone for predicting the timing of laryngeal mask insertion. When PI increases to three times the baseline PI after induction, laryngeal mask insertion can be considered.</p><p><strong>Clinical trial registration: </strong>This trial was registered at the Chinese Clinical Trial Registry ( https://www.chictr.org.cn . Registration number ChiCTR2400083111, Weiwei Cai, 16 April 2024.).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"156"},"PeriodicalIF":2.3,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787771","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":"Distribution pattern of different volumes of ropivacaine in ultrasound-guided intertransverse process block: a randomized, blinded, computed tomography imaging study.","authors":"Chao-Wei Wang, Ping Zou, Zu-Xiong Zhang, Mao-Yan Si, Qin-Guo Yi, Li-Fang Zhan","doi":"10.1186/s12871-025-03017-x","DOIUrl":"10.1186/s12871-025-03017-x","url":null,"abstract":"<p><strong>Background: </strong>Intertransverse process (ITP) blocks showed reliable paravertebral spread in cadaveric studies, but specific distribution patterns, spread pathways, and dose‒effect relationships remain unclear. The aim of this study was to evaluate the distribution patterns of three different volumes of local anesthetic (LA) in ITP block in living humans using computed tomography.</p><p><strong>Methods: </strong>Forty-five individuals (18-75 years old) were randomized to receive 0.375% ropivacaine with radiopaque contrast agent at doses of 0.3, 0.4, or 0.5 ml/kg. The primary outcome was the distribution of LA in mediastinal compartments (prevascular, visceral, and paravertebral), retro-superior costotransverse ligament space, erector spinae fascia plane, intercostal space, sympathetic ganglion, costotransverse space, intervertebral foramen, lateral recess, and epidural space. The secondary outcomes included intraoperative and postoperative VAS scores, dermatomal sensory loss, block-related adverse events, and the time required for block administration.</p><p><strong>Results: </strong>The spread pattern of local anesthetic after intertransverse process block includes both forward and backward spread. The LA was concentrated in the visceral compartment (77.5%), paravertebral compartment (93.3%), erector spinae fascia plane (97.8%), intercostal space (97.8%), and sympathetic ganglion (88.9%), with occasional spread to other areas. The overall distribution pattern was significantly influenced by patient position (R² = 0.07, F. Model = 3.43, P = 0.04) rather than anesthetic volume (R² = 0.03, F. Model = 1.60, P = 0.20) and BMI category (R² = 0.03, F. Model = 1.36, P = 0.26). The LA was concentrated in the prevascular compartment when the patient position was changed in the prone position (B = 2.45, 95% CI [0.96, 3.95], P = 0.002). There were no differences in secondary outcomes.</p><p><strong>Conclusions: </strong>ITP block causes the LA to predominantly spread to the paravertebral compartment, visceral compartment, intercostal space, sympathetic ganglion, and erector spinae fascia plane. Within the range of volumes studied (0.3, 0.4, and 0.5 ml/kg), increasing the LA volume did not result in a wider distribution range; the overall distribution pattern was primarily influenced by patient positioning.</p><p><strong>Trial registration: </strong>The trial was registered online on 3 April 2024 in the Chinese Clinical Trial Registry (ChiCTR2400082665).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"155"},"PeriodicalIF":2.3,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787761","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":"Comparison of the effectiveness of transversalis fascia plane block and transversus abdominis plane block for postoperative analgesia in pediatric lower abdominal surgeries: prospective, single blinded study.","authors":"Hasibe İrban, Can Aksu","doi":"10.1186/s12871-025-03023-z","DOIUrl":"10.1186/s12871-025-03023-z","url":null,"abstract":"<p><strong>Background: </strong>Achieving adequate postoperative analgesia in the pediatric age group is also important in terms of future pain perception and chronic pain development in the subsequent period. The primary aim of our study was to compare the effects of Transversus Abdominis Plane (TAP) and Transversalis Fascia Plane (TFP) blocks on pain scores at the 6th postoperative hour in children undergoing lower abdominal surgery. Secondary aims include the observation of pain scores over the first 24 h postoperatively, the duration until the first analgesic requirement, the presence of postoperative nausea and vomiting symptoms, and the satisfaction of parents with the provided analgesia method.</p><p><strong>Methods: </strong>Patients aged between 1 and 7 years, classified as ASA I-II, who were scheduled for elective surgery for undescended testes and inguinal hernia, were included in our study. The study was designed as a prospective observational study. The patients were divided into two groups: TAP block (n = 42) and TFP block (n = 42). Intraoperative remifentanil consumption, hemodynamic parameters, postoperative FLACC pain scores, analgesic requirements, and the time of the first analgesic need were recorded for 24 h.</p><p><strong>Results: </strong>A total of 84 patients were included in the study. The groups were similar in terms of demographic data. No difference was found in FLACC pain scores between the groups that received both TAP and TFP blocks in patients followed for 24 h postoperatively (p > 0.05). Intraoperative remifentanil consumption was similar in TAP blocks 74 (20-100) and TFP blocks 40 (24.75-71) µg, (p: 0.268). When calculating based on the first analgesic consumption for TAP and TFP groups, it is found that the median analgesic effect durations were 12 and 9 h, respectively, for the two groups.</p><p><strong>Conclusions: </strong>In children undergoing lower abdominal surgery, ultrasound-guided TAP and TFP blocks have shown similar effects on pain scores and analgesic requirements for 24 h postoperatively. We believe that both blocks, which we found to provide analgesia without the need for opioids after lower abdominal surgery in pediatric patients, can be safely used in this patient group.</p><p><strong>Clinical trials registration: </strong>NCT06530147.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"154"},"PeriodicalIF":2.3,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787594","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":"The impact of external oblique intercostal block on early postoperative pain and recovery in patients undergoing J-shaped incisions for upper abdominal surgery: a single-center prospective randomized controlled study.","authors":"Shuai Yi, Xinlei Zhang, Yuhong Song, Xiaohui Wang, Han Gao, Zhao Yuan, Mingjian Kong","doi":"10.1186/s12871-025-03030-0","DOIUrl":"10.1186/s12871-025-03030-0","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to investigate the effects of external oblique intercostal nerve block (EOIB) on early postoperative pain and recovery in patients undergoing J-shaped incision surgery in the upper abdomen.</p><p><strong>Methods: </strong>Patients aged 18-85 years, classified as ASA I-III, undergoing elective open upper abdominal J-shaped incision surgery under general anesthesia were included in this study. Patients were randomized into two groups: the external oblique intercostal nerve block group (Group E ) and the control group (Group C ). Following induction of general anesthesia, Group E received 30 ml of 0.375% ropivacaine and 4 mg dexamethasone for ultrasound-guided EOIB on the surgical side, while Group C received no nerve block. Postoperatively, both groups utilized fentanyl patient-controlled intravenous analgesia. The primary outcome of the study was the 24-hour fentanyl consumption recorded for both groups. Patients with a Numeric Rating Scale (NRS) score > 4 were administered 40 mg parecoxib sodium as rescue analgesia.</p><p><strong>Results: </strong>Postoperative fentanyl consumption at 24 h was significantly lower in Group E compared to Group C (832.92 ± 66.42 μg vs. 1021.25 ± 76.63 μg, p = 0.001). Group E demonstrated lower NRS scores at rest and during movement at 0, 2, 4, 12, and 24 h postoperatively compared to Group C, but similar scores at 48 h. The time to first ambulation (49.92 ± 4.21 h vs. 58.38 ± 2.95 h, p = 0.001) and time to first flatus (59.79 ± 2.49 h vs. 67.83 ± 2.48 h, p = 0.001) were both shorter in Group E than in Group C, with higher Quality of Recovery-15 (QoR-15) scores in Group E (108.00 ± 3.80 vs. 97.00 ± 5.13, p = 0.001).</p><p><strong>Conclusion: </strong>EOIB significantly enhances postoperative analgesia in patients undergoing upper abdominal J-shaped incision surgery, reducing opioid consumption and analgesic requirements, and improving the quality of recovery. It may be considered as part of a multimodal analgesic regimen following upper abdominal surgery.</p><p><strong>Trial registration: </strong>This study was registered in the Chinese Clinical Trial Testing Center (ID: ChiCTR2300076653, 10.13.2023).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"158"},"PeriodicalIF":2.3,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787785","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":"The effect of neuromuscular blocking reversal agents on perioperative neurocognitive function after general anaesthesia: a systematic review and meta-analysis.","authors":"Hao Wang, Xinghua Lv, Lin Wu, Fangli Ma, Ling Wang, Yongqi Wang, Xiaoxia Wang, Yulan Li","doi":"10.1186/s12871-025-03019-9","DOIUrl":"10.1186/s12871-025-03019-9","url":null,"abstract":"<p><strong>Background: </strong>Perioperative neurocognitive dysfunction (PND) is influenced by various perioperative factors. Recent studies suggest that neuromuscular blocking reversal agents (NMBRs) may impact on PND. However, the results have been inconsistent. Therefore, we aimed to compare the effects of perioperative NMBRs on PND through this systematic review and meta-analysis.</p><p><strong>Methods: </strong>We searched PubMed, CENTRAL, Embase, Web of Science, Scopus, and China Biology Medicine from their inception until May 2024. Two reviewers independently identified randomized controlled trials (RCTs) that compared the perioperative use of NMBRs with either a placebo or other NMBRs in patients undergoing general anaesthesia. We assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The primary outcome was the incidence of PND within 7 days following surgery, while the secondary outcomes included the time required to achieve a Train-of-Four ratio (TOF) ≥ 0.9 after administration of NMBRs, length of stay (LOS) in both the post-anaesthesia care unit (PACU) and the hospital, as well as the risk of adverse events (i.e. postoperative nausea and vomiting (PONV) and mortality).</p><p><strong>Results: </strong>A total of 10 randomized controlled trials involving 1705 patients compared the effects of NMBRs on PND. Neostigmine and sugammadex are the most commonly used NMBRs in clinical anaesthesia practice. In the primary analyses of all regimens, sugammadex significantly reduced the incidence of PND compared to neostigmine (risk ratio [RR] 0.67; 95% confidence interval [CI]:0.48-0.94; I² = 0%; P = 0.02; moderate quality). However, the results indicated that there is no significant association between neostigmine and PND when compared to placebo (RR 0.76; 95% CI: 0.55-1.05; I² = 35%; P = 0.09; moderate quality). The secondary outcomes revealed that sugammadex could significantly shorten the time of TOF ≥ 0.9 compared to neostigmine (mean difference [MD] -4.52; 95%CI: -5.04 to -3.99; I² = 80%; P < 0.01; Moderate quality). Furthermore, no significant differences were observed in the incidence of adverse events or hospital LOS.</p><p><strong>Conclusions: </strong>This meta-analysis demonstrated that the use of sugammadex was associated with improved early perioperative neurocognitive function compared to neostigmine when used to reverse neuromuscular blockade, without an increase in the incidence of adverse events.</p><p><strong>Systematic review protocol: </strong>PROSPERO CRD42024520287.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"152"},"PeriodicalIF":2.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787714","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":"Role of modified enhanced recovery after surgery (mERAS) in awake craniotomy performed under monitored anesthesia care (MAC); a single center retrospective study.","authors":"Adel Azghadi, Megan Sharpe, Katrina Mikofalvy, Mohamed El-Abtah, Kerrin Sunshine, Varun Shah, Mart Andrew Maravillas, Tiffany R Hodges, Xueqin Ding","doi":"10.1186/s12871-025-02983-6","DOIUrl":"10.1186/s12871-025-02983-6","url":null,"abstract":"<p><strong>Background: </strong>This study aims to explore the safety and efficacy of awake craniotomy procedures under monitored anesthesia care (MAC), focusing on the impact of modified Enhanced Recovery after Surgery (ERAS) protocols on patient outcomes.</p><p><strong>Methods: </strong>Patients undergoing elective awake craniotomy between 2017 and 2022 were divided into two groups: those receiving the ERAS protocol after 2020 and a control group of pre-2020 patients. Factors examined included demographics, intraoperative awakening time, procedure durations, pain management, hospital stay length, complications, discharge disposition, and follow-up symptoms.</p><p><strong>Results: </strong>From 2017 to 2022, 61 patients underwent awake craniotomy using MAC anesthesia at University Hospitals Cleveland Medical Center, with 23 receiving the ERAS protocol after 2020. Demographics were comparable between the control and ERAS groups. Total awake time, time to wake up, and total procedure time showed no significant differences (P > 0.05). Awake craniotomy was discontinued in 8 cases due to anxiety and pain (mERAS = 1, Control = 7). The mERAS group experienced fewer cases of awake failure, nausea/vomiting, and postoperative cognitive and speech deficits, though these differences were not statistically significant. No significant differences were found in postoperative pain medication consumption, complications, or length of hospital stay (P > 0.05).</p><p><strong>Conclusions: </strong>Awake craniotomy under MAC with a modified ERAS protocol is feasible but did not show statistically significant improvements in patient outcomes. Further research with larger sample sizes and multi-center collaboration is necessary to draw more definitive conclusions.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"153"},"PeriodicalIF":2.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787707","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":"Comparison between single bolus dose administration and continuous infusion of remimazolam for general anesthesia induction in non-cardiac surgery: a single-center prospective randomized controlled trial.","authors":"Tsuyoshi Ikeda, Hirotsugu Miyoshi, Kenshiro Kido, Ayako Sumii, Sachiko Otsuki, Takahiro Kato, Ryuji Nakamura, Soshi Narasaki, Yasuo M Tsutsumi","doi":"10.1186/s12871-025-03032-y","DOIUrl":"10.1186/s12871-025-03032-y","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam is a short-acting benzodiazepine anesthetic recommended for continuous infusion during anesthesia induction. However, the safety and efficacy of single bolus dose administration remain under investigation. This study compared continuous infusion with single bolus dose administration and assessed the safety of a single bolus dose administration.</p><p><strong>Methods: </strong>The participants were randomly assigned into three groups based on the method of remimazolam administration the day before surgery: (1) continuous infusion group (continuous infusion at 12 mg/kg/h), (2) single bolus dose administration of 0.1 group (single administration of 0.1 mg/kg), or (3) single bolus dose administration of 0.2 group (single administration of 0.2 mg/kg). The time between drug administration and loss of consciousness was determined, and hemodynamic monitoring was performed.</p><p><strong>Results: </strong>67 patients (continuous infusion group (n = 22), single bolus dose administration of 0.1 group (n = 22), and single bolus dose administration of 0.2 group (n = 23)) were included in the study. The different times to loss of consciousness were 88.2 ± 16.2 s, 59.5 ± 31.5 s, and 42.6 ± 11.4 s in the continuous infusion group, single bolus dose administration of 0.1 group, and single bolus dose administration of 0.2 group, respectively. No significant differences were observed in the incidence of adverse events between the groups. The results are presented as mean ± standard deviation (SD).</p><p><strong>Conclusions: </strong>Single-dose remimazolam is a safe method for anesthesia induction, resulting in shorter time to loss of consciousness compared with continuous infusion, while maintaining a similar incidence of adverse events.</p><p><strong>Trial registration: </strong>jRCTs061230049, registered on 17/08/2023.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"150"},"PeriodicalIF":2.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771305","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":"Elevated risk of perioperative ischemic stroke in noncardiac surgery patients with atrial fibrillation: a retrospective cohort study.","authors":"Yingfu Li, Renhui Xiong, Jiaxin Wang, Huikai Yang, Mengyao Qu, Siyuan Liu, Miao Sun, Likai Shi, Qiang Fu, Yulong Ma","doi":"10.1186/s12871-025-03011-3","DOIUrl":"10.1186/s12871-025-03011-3","url":null,"abstract":"<p><strong>Background: </strong>Stroke is still a significant and growing challenge of global health, however, the impact of Atrial Fibrillation (AF) on the risk of perioperative stroke remains unclear.</p><p><strong>Aim: </strong>This study aims to evaluate the clinical prognostic value of AF in patients undergoing noncardiac surgery, with perioperative ischemic stroke as the primary prognostic indicator.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on patients who underwent noncardiac surgery between January 2008 and August 2019 at The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital. The study included patients with a procedure duration exceeding one hour. Participants were categorized into two groups: an AF group and a non-AF group, based on the presence or absence of AF. The primary outcome was the occurrence of perioperative ischemic stroke. To determine whether AF is an independent prognostic indicator, primary and subgroup analyses were performed. Logistic regression models were used to identify risk factors. Besides, sensitivity analysis, propensity score matching (PSM) analysis were applied to mitigate potential residual confounding effects and assess the robustness of the findings.</p><p><strong>Results: </strong>The primary analysis demonstrated that patients in the AF group had a significantly higher risk of perioperative ischemic stroke (OR: 6.843; 95% CI: 3.73-11.413; P < 0.001). Further modeling analyses confirmed a significant correlation between AF and perioperative ischemic stroke across various models: model 2 (OR: 1.789; 95% CI: 0.958-3.053; P < 0.05), model 3 (OR: 5.121; 95% CI: 2.749-8.716; P < 0.001), and model 4 (OR: 2.122; 95% CI: 1.123-3.677; P < 0.05). Sensitivity analysis excluding neurosurgeries were conducted. The adjusted OR of perioperative ischemic stroke in neurosurgery patients with the AF was 1.623(95% CI: 0.359-5.165; P = 0.463). While, the association between AF and perioperative ischemic stroke remained stable in those non-neurosurgical patients (OR: 2.154;95% CI: 1.044-3.964; P = 0.023). After PSM adjustments, the association between AF and perioperative ischemic stroke remained significant (OR: 2.106; 95% CI: 1.003-4.159; P < 0.05). Subgroup analyses revealed that AF significantly increased the risk of perioperative ischemic stroke, particularly in males, patients aged ≥ 60.5 years, those with an ASA score ≥ 3, those with hypertension, and those not on antiplatelet medication.</p><p><strong>Conclusion: </strong>Atrial fibrillation is an independent prognostic risk factor for perioperative ischemic stroke in patients undergoing noncardiac surgery, especially pronounced in specific subgroups, including males, elderly patients, those with high ASA scores, with hypertension, and not receiving antiplatelet therapy. These findings emphasize the need for heightened awareness and prompt clinical intervention in these high-risk patients.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"151"},"PeriodicalIF":2.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771306","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":"Influence of maxillofacial skeletal morphology on difficult laryngoscopy.","authors":"Reiko Sekino, Minami Hikida, Keiji Shinozuka, Maki Nagasaki, Akemi Kusano, Morio Tonogi, Shunichi Oka","doi":"10.1186/s12871-025-02997-0","DOIUrl":"10.1186/s12871-025-02997-0","url":null,"abstract":"<p><strong>Background: </strong>Although mandibular retrognathia has been recognized as one of the predictors of difficult laryngoscopy, its definition remains vague, with no clearly established skeletal evaluation systems. The Sassouni classification system, used to categorize the maxillofacial morphology systematically (nine types), can be easily performed using preoperative radiographic findings. This study aimed to investigate the relationship between difficult laryngoscopy and Sassouni type 5, a group characterized by a small mandible and a large overbite.</p><p><strong>Methods: </strong>This retrospective study comprised patients diagnosed with jaw deformities who underwent orthognathic surgery for malocclusion under general anesthesia at our clinic. The patients were divided into two groups: Sassouni 5 and non-Sassouni 5 (types 1, 2, 3, 4, 6, 7, 8, and 9). Difficult laryngoscopy was evaluated by examining the degree of difficulty in laryngeal exposure, which was defined as grades 3 and 4 based on the Cormack-Lehane (CL) classification. Additionally, we evaluated the relationships between the Sassouni 5 group and three predictors of difficult laryngoscopy (Mallampati classification, Wilson score, and hyomental distance [HMD]).</p><p><strong>Results: </strong>Of the 187 patients included in this study, 44 belonged to the Sassouni 5 group, and the remaining 143 belonged to the non-Sassouni 5 group. The proportion of patients with CL grade 3 or higher was significantly higher in the Sassouni 5 group (n = 9; 20.5%) than in the non-Sassouni 5 group (n = 6; 4.2%). Furthermore, 10 (22.7%) patients in the Sassouni 5 group had a Mallampati score of 3 or higher, 44 (100%) had a Wilson score of 2 or higher, and 38 (96.7%) had an HMD of less than 3 fingerbreadths. The corresponding numbers in the non-Sassouni 5 group were 8 (5.6%), 48 (33.6%), and 43 (30.1%), respectively. The incidence of difficult laryngoscopy in the Sassouni 5 group was significantly higher than that in the non-Sassouni 5 group (p < 0.001).</p><p><strong>Conclusions: </strong>These findings indicate that the incidence of difficult laryngoscopy can be predicted using the Sassouni classification, which can be easily analyzed using lateral cephalograms obtained routinely before corrective surgical procedures. The Sassouni 5 group could be used as an important predictive tool in clinical practice.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"147"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762920","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}