Yuan Zeng, Weipeng Cai, Fei Cui, Ke Xu, Ying Huang, Wei Wang, Hui Liu, Jun Liu
{"title":"The impact of spontaneous ventilation anesthesia on thrombosis risk for thoracic surgery: a beagle dog model study.","authors":"Yuan Zeng, Weipeng Cai, Fei Cui, Ke Xu, Ying Huang, Wei Wang, Hui Liu, Jun Liu","doi":"10.1186/s12871-025-03282-w","DOIUrl":"https://doi.org/10.1186/s12871-025-03282-w","url":null,"abstract":"","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"478"},"PeriodicalIF":2.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Atef A Hassan, Mohamed A Khalafallah, Noha Rami Ismail, Esraa Menshawy, Abdulrhman Mady, Moaz Abouelmagd, Amr Menshawy, Ahmed Mensahwy
{"title":"Intubation conditions and neonatal outcomes with rocuronium versus suxamethonium in cesarean sections: A systematic review and meta-analysis.","authors":"Atef A Hassan, Mohamed A Khalafallah, Noha Rami Ismail, Esraa Menshawy, Abdulrhman Mady, Moaz Abouelmagd, Amr Menshawy, Ahmed Mensahwy","doi":"10.1186/s12871-025-03321-6","DOIUrl":"https://doi.org/10.1186/s12871-025-03321-6","url":null,"abstract":"<p><strong>Background: </strong>While general anesthesia is necessary for some emergency deliveries, it carries risks such as failed intubation and neonatal complications. This study investigates whether rocuronium and suxamethonium (also known as Succinylcholine) provide equivalent conditions for airway management and neonatal outcomes during cesarean sections. Ensuring the safety and efficacy of these agents is crucial due to the physiological and hemodynamic changes associated with pregnancy and delivery.</p><p><strong>Method: </strong>We conducted a systematic review and meta-analysis following PRISMA guidelines. We included studies involving pregnant women undergoing cesarean sections that used rocuronium as an intervention and suxamethonium as a comparator, reporting outcomes such as Apgar scores, surgery duration, and time-related metrics. A comprehensive search of databases was performed up to July 2025. Statistical analyses were performed using RevMan Software, assessing heterogeneity and summarizing findings through mean differences and risk ratios.</p><p><strong>Results: </strong>Our metaanalysis of six studies comprising 1,122 patients showed that succinylcholine significantly reduced the time from induction to umbilical cord clamping compared with rocuronium (mean difference [MD] 19.21 s; 95% CI 5.15 to 33.27; P = 0.007; I² = 0%). There was no significant difference between groups in time from incision to delivery (MD - 12.72 s; 95% CI - 84.84 to 59.41; P = 0.73; I² = 94%) or in total surgery duration (MD - 1.20 min; 95% CI - 3.70 to 1.30; P = 0.34; I² = 63%). Newborns in the succinylcholine group were more likely to achieve favorable 1 min Apgar scores (risk ratio [RR] 1.87; 95% CI 1.31 to 2.67; P = 0.0006; I² = 0%) and 5 min Apgar scores (RR 2.52; 95% CI 1.21 to 5.25; P = 0.01; I² = 30%), whereas 10 min Apgar scores did not differ significantly (RR 2.51; 95% CI 0.66 to 9.64; P = 0.18; I² = 34%). In the subgroup of scheduled cesarean deliveries, only the 1 min Apgar score remained significantly higher with succinylcholine (RR 1.75; 95% CI 1.10 to 2.77; P = 0.02; I² = 0%).</p><p><strong>Conclusion: </strong>This review suggests that suxamethonium offers benefits like shorter induction-to-cord clamping times and better early Apgar scores. The current evidence is still limited and further well-designed randomized controlled trials are needed to explore the relationship between rocuronium levels and neonatal outcomes.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"476"},"PeriodicalIF":2.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Simon Dubler, Michael Kowarik, Bettina Budeus, Tomas Habanik, Denise Zwanziger, Annabell Skarabis, Florian Espeter, Thorsten Brenner, Frank Herbstreit
{"title":"Outcome of patients with COVID-19 supported by veno-venous extracorporeal membrane oxygenation with major bleeding: a single centre experience.","authors":"Simon Dubler, Michael Kowarik, Bettina Budeus, Tomas Habanik, Denise Zwanziger, Annabell Skarabis, Florian Espeter, Thorsten Brenner, Frank Herbstreit","doi":"10.1186/s12871-025-03380-9","DOIUrl":"https://doi.org/10.1186/s12871-025-03380-9","url":null,"abstract":"<p><strong>Background: </strong>Patients with severe COVID-19 often require veno-venous extracorporeal membrane oxygenation (VV-ECMO) due to acute respiratory distress syndrome (ARDS). Major bleeding complications are common and linked to worse outcomes, though specific risk factors in COVID-19 remain unclear.</p><p><strong>Methods: </strong>A retrospective analysis of 151 critically ill patients with COVID-19 on VV-ECMO (March 2020-December 2021) was conducted. The primary outcome was major bleeding (fatal bleeding, haemoglobin drop ≥ 20 g/L<sup>-1</sup> (1.24 mmol/L<sup>-1</sup>), or symptomatic bleeding in critical organs). Secondary outcomes included 90-day mortality, kidney replacement therapy, and disease severity.</p><p><strong>Results: </strong>Major bleeding occurred in 73/151 patients (48.3%). Only a longer ECMO duration [OR 1.32 (95% CI 1.14-1.53; p < 0.001)] was identified as an independent risk factor. Kidney replacement therapy independently influenced 90-day mortality [OR 4.48 (95% CI 1.83-10.98;p = 0.001). However, major bleeding, intracranial haemorrhage, higher burden of co-morbidity and mean aPTT before major bleeding were not associated with an increased 90-day mortality risk.</p><p><strong>Conclusion: </strong>Major bleeding events, including intracranial haemorrhage, are common in patients with COVID-19 being supported by VV-ECMO. However, our data does not demonstrate a direct association between major bleeding and increased 90-day mortality.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"477"},"PeriodicalIF":2.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Safety, pharmacokinetics, and pharmacodynamics of Dexmedetomidine two-phase flow atomization in healthy subjects: a randomized, parallel study.","authors":"Yujun Lian, Huanqi Luo, Zhijing Yang, Jiadi He, Haozhu Chen, Yanyan Sun","doi":"10.1186/s12871-025-03358-7","DOIUrl":"https://doi.org/10.1186/s12871-025-03358-7","url":null,"abstract":"<p><strong>Background: </strong>In this study, we aimed to compare the sedative effects, pharmacokinetics (PKs), and safety of dexmedetomidine (DEX) administered using a two-phase flow atomization device with those of conventional intranasal drop-based administration in healthy volunteers.</p><p><strong>Methods: </strong>This prospective, parallel, double-blind study compared the PK and pharmacodynamic (PD) profiles of DEX administered via conventional intranasal drop (Group C) or two-phase flow atomization (Group E). Twenty-two healthy adult volunteers were enrolled and randomly assigned to the two groups using a computer-generated randomization sequence. Each participant received DEX at a dose of 2 µg/kg. Sedation was assessed using the Ramsay Sedation Scale and the bispectral index, and PK analysis was performed on blood samples collected at multiple time points.</p><p><strong>Results: </strong>The two-phase flow atomization group exhibited a significantly faster onset of sedation than the conventional intranasal drop-based administration group and a longer duration of sedation. Compared with Group C, Group E presented an increasing trend in the maximum plasma concentration and in the area under the concentration‒time curve from time zero to the last time point (AUC0t). We found no significant differences in other PK parameters between the two groups, with all P-values > 0.05. The plasma concentrations were slightly higher in the two-phase flow atomization group after 30 min. The changes in systolic blood pressure and heart rate of both groups of volunteers were within 25% of the baseline values, with no adverse reactions such as hypotension or sinus bradycardia. CONCLUSIONS : The findings indicate that the two-phase flow atomization device offers faster onset and longer duration of sedation with DEX nasal administration, with a favorable safety profile in healthy volunteers (American Society of Anesthesiologists Physical Status Class 1) under specific conditions. Therefore, based on the sedation dynamics, we infer that this device may enhance drug deposition in the olfactory region of the nasal cavity, thereby enhancing the effects of the drug in the central nervous system through nose-to-brain delivery. This study provides new insights into the optimization of nasal drug delivery devices, particularly for pediatric patients and patients in clinical settings requiring rapid sedation.</p><p><strong>Trial registration: </strong>This study was registered at ChiCTR.org.cn (registration number ChiCTR2400091480) on 29/10/2024.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"475"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seungpyo Nam, Seokha Yoo, Sae Hoon Kim, Sun-Kyung Park, Young-Jin Lim, Jin-Tae Kim
{"title":"Limited effect of leg elevation in preventing intraoperative hypotension during total shoulder arthroplasty in the beach chair position: a randomized controlled trial.","authors":"Seungpyo Nam, Seokha Yoo, Sae Hoon Kim, Sun-Kyung Park, Young-Jin Lim, Jin-Tae Kim","doi":"10.1186/s12871-025-03299-1","DOIUrl":"https://doi.org/10.1186/s12871-025-03299-1","url":null,"abstract":"<p><strong>Background: </strong>The beach chair position, often used in shoulder surgery, increases the risk of hypotension and cerebral hypoperfusion. This randomized controlled trial evaluated the efficacy of leg elevation in preventing hypotension during total shoulder arthroplasty in the beach chair position.</p><p><strong>Methods: </strong>Fifty patients scheduled for total shoulder arthroplasty in the beach chair position were randomly assigned to the control (25 patients) or treatment (25 patients) groups. The treatment group elevated their legs during surgery, whereas the control group maintained a neutral leg position. The primary outcome was the incidence of hypotension. The secondary outcomes included the incidence of cerebral desaturation, hemodynamic variables, and vasoconstrictor use.</p><p><strong>Results: </strong>The incidence of hypotension did not significantly differ between the control and treatment groups (100% [95% CI: 86.3-100%] vs. 87.5% [95% CI: 67.6-97.3%]; p = 0.11). The incidence of cerebral desaturation was also similar between the control and treatment groups (84.0% [95% CI: 63.9-95.5%] vs. 91.7% [95% CI: 73.0-99.0%]; p = 0.67). However, the median [Q1-Q3] dose of phenylephrine was significantly higher in the control group than in the treatment group (3.5 [1.5-5.4] μg/kg vs. 1.6 [0.9-3.0] μg/kg; p = 0.02).</p><p><strong>Conclusions: </strong>Intraoperative hypotension occurred in 93.9% of patients undergoing total shoulder arthroplasty in the beach chair position, regardless of leg elevation. However, leg elevation significantly reduced the need for vasoconstrictors to maintain blood pressure during anesthesia.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (identifier: NCT03393559 , date of registration: 2017-12-26).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"472"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparison of outcomes between total intravenous (propofol and remifentanil) and inhalation (isoflurane) anesthesia in women undergoing abdominal myomectomy: a randomized controlled trial.","authors":"Khadijeh Pouya, Razih Vejdani, Mehdi Taheri, Pouya Hatami Marandi, Fatemeh Aliyar, Parvin Hakimi, Hosein Azizi","doi":"10.1186/s12871-025-03337-y","DOIUrl":"https://doi.org/10.1186/s12871-025-03337-y","url":null,"abstract":"<p><strong>Introduction: </strong>The study aimed to compare anesthesia maintenance using total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) and investigating their effects on bleeding volume, intraoperative hemodynamic changes, and postoperative complications in women patients undergoing abdominal myomectomy.</p><p><strong>Methods: </strong>A double-blind randomized controlled trial was conducted on patients undergoing abdominal myomectomy at a large non-university hospital in northwest Iran in 2023. A total of 60 eligible patients were randomly assigned to two groups of TIVA (n = 30) and IA (n = 30) anesthesia methods. The study groups' allocation was blinded to the anesthesiology provider and she was responsible for anesthesia and patient monitoring. The study outcomes were hemodynamic changes, bleeding during the surgery, anesthesia time, hospitalization, and postoperative complications between the study groups.</p><p><strong>Results: </strong>There were no significant differences in surgical indications, myoma size, hemoglobin levels, or clinical and obstetric characteristics before surgery between the two study groups (p > 0.05). The average blood loss (201.8 vs. 391.0 ml; P = 0.001), postoperative hemoglobin levels (11.6 vs. 10.5; P = 0.005), anesthesia times (100.6 vs. 114.3 min; P = 0.003), and hospitalization days (2.06 vs. 2.36; P = 0.005) showed statistically significant differences between the TIVA and IA groups, respectively. Mean arterial pressure (MAP) and heart rate values were significantly higher in the IA group compared to the TIVA group (P < 0.05). No muscle stiffness, dizziness, or respiratory depression were observed after surgery in either study group. The proportion of shivering in the TIVA and IA groups was 16.7% and 43.3%, respectively, indicating a significant statistical difference (P = 0.024). The proportion of optimal surgeon performance was reported to be higher in the TIVA group compared to the IA group (P = 0.014).</p><p><strong>Conclusion: </strong>According to the findings of this study, the use of the TIVA method compared to IA during the maintenance of general anesthesia was linked to a reduction in intraoperative bleeding and transfusion requirements, as well as increased optimal surgeon performance in patients undergoing abdominal myomectomy. Furthermore, patients in the TIVA group experienced fewer complications during and after surgery, along with a shorter hospital stay.</p><p><strong>Trial registration: </strong>The study protocol was retrospectively registered and confirmed in the Iranian Registry of Clinical Trials under the number (IRCT20220930056059N1). Registration date: 2022-11-13. Expected recruitment start date: 2022-11-11.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"473"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Efficacy and safety of remimazolam for induction and maintenance of general anesthesia in day surgery: a randomized controlled non-inferiority clinical trial.","authors":"Kai-Yuan Liang, Xiao-Ling Nong, Zhi-Jie Liang, Nitin Rana, Ni-Qiao Chen, Yu-Nan Lin","doi":"10.1186/s12871-025-03322-5","DOIUrl":"10.1186/s12871-025-03322-5","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam is a novel ultrashort-acting benzodiazepine anesthetic demonstrated to be safe and effective for painless gastroscopy and bronchoscopy. However, research on the application of remimazolam in general anesthesia for short day surgery is relatively limited. This study aimed to evaluate the efficacy and safety of remimazolam for both the induction and maintenance of general anesthesia in short day surgery.</p><p><strong>Method: </strong>One hundred patients who underwent elective surgery were randomly divided into two groups: the Propofol group and the Remimazolam group. The primary outcomes consisted of the rates of successful anesthesia, defined by the absence of intraoperative awareness, the need for additional sedatives, and any involuntary limb movements, along with the incidence of life-threatening adverse events. The secondary outcomes included mean arterial pressure (MAP), heart rate (HR), time to loss of consciousness (LOC), injection pain, administration of vasopressors, time to extubation and eye opening, length of PACU stay, VAS score, and occurrence of postoperative adverse reactions.</p><p><strong>Results: </strong>The anesthesia efficacy was 100% in both groups. However, the time to LOC in the Propofol group was shorter than that in the Remimazolam group (P < 0.01). Compared with the Remimazolam group, the Propofol group presented a significant decrease in HR and MAP at the time of LOC (P < 0.05) and a significant decrease in MAP at 30 min after the start of surgery (P < 0.05). The use of vasopressors and the incidence of injection pain were significantly greater in the Propofol group than in the Remimazolam group (P < 0.05).</p><p><strong>Conclusion: </strong>Compared with propofol, when the antagonist flumazenil is not used, remimazolam is not inferior to propofol in terms of safety and efficacy in the induction and maintenance of anesthesia for short daytime surgeries, and it does not cause delayed discharge of patients or increase postoperative adverse reactions.</p><p><strong>Trial registration: </strong>This trial was registered with the Chinese Clinical Trial Registry (ChiCTR2400088335, registration date: August 15, 2024).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"467"},"PeriodicalIF":2.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198321","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":"Patient satisfaction and its associated factors with preoperative anesthetic evaluation services at public hospitals in Nekemte town, Nekemte, Ethiopia 2024: - cross-sectional study.","authors":"Gemechisa Akuma Wayesa, Gutu Leta Dinka, Wakjira Birhanu, Nafnati Regasa Jambo","doi":"10.1186/s12871-025-03354-x","DOIUrl":"10.1186/s12871-025-03354-x","url":null,"abstract":"<p><strong>Background: </strong>Patient satisfaction with healthcare services is increasingly recognized as a reliable indicator of treatment quality. The safety and effectiveness of surgical treatments are greatly dependent on the preoperative anesthetic evaluation. It entails evaluating the patient's health, medical background, and other variables that affect the administration of anesthesia and the outcome of surgery. Because it has a direct impact on patient trust, compliance, and the general perception of the quality of care, patient satisfaction with this procedure is crucial. This study aimed to assess patients' satisfaction with preoperative anesthesia evaluation service and its associated factors at public hospitals in Nekemte town, Nekemte, Ethiopia, 2024.</p><p><strong>Method: </strong>The cross-sectional study was conducted from August 1 to October 31, 2024. Data on patient satisfaction with pre-anesthesia evaluation service and its associated factors were collected using a data collection questionnaire and checklist. It was entered into Epi-data 4.6 and exported into SPSS 25. Then, descriptive analyses and logistic regression were carried out. In multivariate variables, p≤0.05 was declared as statistical significance.</p><p><strong>Result: </strong>The study included 311 inpatients and had a 91.74% response rate. The study respondents' average age was 48.75 ± 16.98 years, with minimum and maximum ages of 16 and 83 years, respectively. More than half of the patients were males, 58.59%. Among all participants, 87.14% were less than or equal to ASA II, and 12.86% were ASA III to ASA IV. The overall level of satisfaction of patients with pre-operative anesthesia evaluation service was 68.7%. Concerning the quality of pre-operative evaluation services, 69.13% were satisfied, whereas 64.63% and 68.8% of participants responded they were satisfied with the anesthetist's communication skills during anesthesia evaluation and the physical facility of the pre-operative evaluation area, respectively. The identified associated factors with the level of patient satisfaction with pre-operative anesthesia evaluation service were 18-30 age (AOR=0.6; 95%CI [0.01-0.96], P=0.030), illiteracy (AOR=1.20; 95%CI [1.01,6.97], P=0.024), rural residency (AOR=2.31; 95%CI [1.06-9.42], P=0.006), free of payment/insurance (AOR=2.1; 95%CI [1.19,9.17], P<0.001), and Perioperative new visit (AOR=3.35; 95%CI [3.26,8.27], P=0.014).</p><p><strong>Conclusion: </strong>This study indicates only two-thirds of patients were satisfied with preoperative anesthetic service at the Public Hospital in Nekemte town.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"470"},"PeriodicalIF":2.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198292","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}