BMC Anesthesiology最新文献

{"title":"Combining ropivacaine transversus abdominis plane block with intravenous lidocaine infusion in adults undergoing colorectal cancer surgery: an open-label, dose-escalation exploratory trial.","authors":"Mengmeng Zhou, Feng Yu, Yan Xu, Jingwen Wu, Lajing Luowu, Qianqian Tang, Xiaoting Hao, Kun Shao, Mao Ye, Lulong Bo, Li Zhou, Chunling Jiang","doi":"10.1186/s12871-025-03225-5","DOIUrl":"https://doi.org/10.1186/s12871-025-03225-5","url":null,"abstract":"<p><strong>Background: </strong>The concurrent use of a ropivacaine transversus abdominis plane (TAP) block with intravenous lidocaine infusion, though effective for pain relief, raises safety concerns regarding local anesthetic systemic toxicity (LAST). This study aimed to assess the dose-risk relationship of LAST in this combination by escalating the ropivacaine dose while fixing the lidocaine dose.</p><p><strong>Methods: </strong>In this dose-escalation study, adult patients undergoing colorectal cancer surgery received a 0.2% ropivacaine TAP block (1.5, 2.0 or 2.5 mg kg^-1) and intravenous lidocaine infusion (2 mg kg^-1 bolus, followed by 2 mg kg^-1 h^-1), both dosed according to ideal body weight (IBW). The primary outcome was the occurrence of LAST, identified by clinical symptoms, new-onset ECG irregularities, etc. Secondary outcomes included plasma concentrations of ropivacaine and lidocaine.</p><p><strong>Results: </strong>Nine patients were included in the per-protocol analysis, and 26 were included in the intention-to-treat analysis. No signs of LAST were observed. Plasma ropivacaine concentrations remained consistently below 2.2 µg mL^-1, however, eight patients in the intention-to-treat population and three patients in the per-protocol population had plasma lidocaine concentrations exceeding 5.0 µg mL^-1 at 10 min post-bolus. In the per-protocol population, peak plasma ropivacaine concentrations occurred at 30 min (range, 20-60) post-TAP block, with median values of 1.14 (range, 0.85-1.18), 1.42 (range, 1.29-1.80), and 1.96 (range, 1.47-2.06) µg mL^-1 across dose groups. The peak plasma lidocaine concentrations in patients occurred at 10 min post-bolus infusion, with median values of 4.59 µg mL^-1 (range, 3.24-6.67) and gradually decreased after 2 h. The intention-to-treat analysis found similar results.</p><p><strong>Conclusion: </strong>Although no signs of LAST were observed with the combination of a 1.5 to 2.5 mg kg^-1 ropivacaine TAP block and intravenous lidocaine infusion under general anaesthesia, extreme caution is still warranted regarding the potential risk of LAST.</p><p><strong>Trial registration: </strong>This trial was registered at ClinicalTrials.gov (NCT06006026) on 23 August 2023.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"357"},"PeriodicalIF":2.3,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688954","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":"Effects of the beach chair position on respiratory mechanics in patients with chronic obstructive pulmonary disease hospitalized in intensive care unit.","authors":"Gulseren Yilmaz, Pelin Kilic Erol, Osman Esen, Taylan Ozbey, Bedih Balkan, Ebru Kaya, Ayca Sultan Sahin, Ziya Salihoglu","doi":"10.1186/s12871-025-03199-4","DOIUrl":"10.1186/s12871-025-03199-4","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD), which exhibits high morbidity and mortality rates, is a respiratory illness associated with persistent airflow obstruction. This study aimed to examine effects of beach chair position on respiratory mechanics in individuals with COPD hospitalized in intensive care unit (ICU) to assess its effectiveness compared to supine position.</p><p><strong>Methods: </strong>Forty-six participants with COPD, admitted to the ICU and receiving either invasive or non-invasive mechanical ventilation were included in this prospective study. The subjects were initially placed in the supine position. After a few hours, the patients were positioned to spend at least 16 h a day in the beach chair position. Mechanical ventilator data were recorded every hour in each position. The primary outcome of this study included comparison of compliance, elastance, and peak airway resistance, time constant, airway resistance, pH, pCO2 and pO2 data in supine and beach chair positions.</p><p><strong>Results: </strong>In compared with supine positioning, beach chair positioning resulted in significant enhancement in compliance (35.98 ± 17.51 mL/cmH₂O vs. 44.69 ± 28.74 mL/cmH₂O, p- value = 0.009) and elastance (29.59 ± 11.87 cmH₂O/L vs. 39.86 ± 41.55 cmH₂O/L, p-value = 0.009) whereas peak airway pressure, time constant, airway resistance, pH, pCO₂ and pO₂ did not significantly differ between supine and beach chair position.</p><p><strong>Conclusions: </strong>Beach chair positioning improves lung compliance and elastance in individuals with COPD in ICU when compared to supine positioning. This study suggests that the beach chair position may offer significant respiratory benefits in terms of respiratory mechanics for COPD patients.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"355"},"PeriodicalIF":2.3,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682003","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":"Esketamine mitigates endotoxin-induced acute lung injury by suppressing caspase-11-driven pyroptosis.","authors":"Yunfei Bao, Zhihao Feng, Yanyan Niu, Qing Hu, Haijie Liu, Hongbo Zhang, Jianling Li","doi":"10.1186/s12871-025-03220-w","DOIUrl":"10.1186/s12871-025-03220-w","url":null,"abstract":"<p><strong>Background: </strong>Acute lung injury (ALI) is a common complication of endotoxemia, which carries a high risk of morbidity and mortality. Currently, no effective drugs exist to treat endotoxin-induced ALI. This study evaluated esketamine's protective effects against endotoxin-induced ALI and explored its underlying mechanisms.</p><p><strong>Methods: </strong>Cecal ligation and puncture (CLP) was used to create a rat model of endotoxin-induced ALI. Esketamine (10 mg/kg) was injected into the tail vein of rats for drug treatment. The murine sepsis score (MSS) was used to evaluate the state of rats. Hematoxylin and eosin (HE) staining was used to evaluate lung tissue morphology and calculate the lung injury scores. The degree of lung tissue edema was assessed using the wet-to-dry weight (W/D) ratio. The expressions of caspase-11 and gasdermin D (GSDMD)-N, linked to the atypital pyroptosis pathway, were examined using immunohistochemistry (IHC) and western blot (WB) analysis. Caspase-11 and GSDMD mRNA levels were determined using quantitative real-time polymerase chain reaction (qRT-PCR). The expression of PI3K/AKT pathway was assessd using western blotting analysis. Interleukin (IL)-1β levels were quantified via enzyme-linked immunosorbent assay (ELISA).</p><p><strong>Results: </strong>Esketamine treatment improved lung tissue structure, reduced pulmonary edema, and mitigated the inflammatory response in ALI. Esketamine inhibited caspase-11 and GSDMD expressions and decreased IL-1β levels, while reversing the inhibition of the PI3K/AKT pathway in ALI.</p><p><strong>Conclusion: </strong>Esketamine mitigates CLP-induced ALI by suppressing the caspase-11-GSDMD pathway and reducing inflammation. The PI3K/AKT pathway may be involved in these protective effects.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"356"},"PeriodicalIF":2.3,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682004","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 median Effective Dose (ED₅₀) and the 95% Effective Dose (ED₉₅) of alfentanil in inhibiting responses to cervical dilation when combined with ciprofol during hysteroscopic procedure: a prospective, double-blind, dose-finding clinical study.","authors":"Run Gao, Shu-Xi Li, Yan-Hong Zhou, Li Xing, Jin-Peng Fu, Jian-Jun Shen, Xin-Zhong Chen, Li-Li Xu","doi":"10.1186/s12871-025-03217-5","DOIUrl":"10.1186/s12871-025-03217-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Alfentanil, a short-acting µ opioid receptor agonist, has recently been confirmed that when combined with propofol for daytime hysteroscopy, it provided more stable hemodynamics compared with sufentanil, and has a lower incidence of hypoxemia and postoperative nausea and vomiting. The object of the trial was to determine the median effective dose (ED&lt;sub&gt;50&lt;/sub&gt;) and the 95% effective dose (ED&lt;sub&gt;95&lt;/sub&gt;) of alfentanil in inhibiting responses to cervical dilation when combined with ciprofol and explore the effect of alfentanil on reducing ciprofol requirement during hysteroscopy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;One hundred and forty patients scheduled hysteroscopy under monitored anesthesia care were randomized to receive a bolus of 8 µg·kg&lt;sup&gt;-1&lt;/sup&gt;, 10 µg·kg&lt;sup&gt;-1&lt;/sup&gt;, 12 µg·kg&lt;sup&gt;-1&lt;/sup&gt;, 14 µg·kg&lt;sup&gt;-1&lt;/sup&gt; intravenous alfentanil or 0.15 µg⋅kg&lt;sup&gt;-1&lt;/sup&gt; intravenous sufentanil followed by a bolus of 0.5 mg·kg&lt;sup&gt;-1&lt;/sup&gt; ciprofol. Whether there was loss of response to cervical dilation or not in each patient was recorded. We used the probit analysis to determine ED&lt;sub&gt;50&lt;/sub&gt; and ED&lt;sub&gt;95&lt;/sub&gt; of alfentanil in inhibiting responses to cervical dilation when combined with ciprofol. The requirement of ciprofol, the emergence time, the visual analogue scale score of pain at five time points, and the incidence of adverse events were recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The calculated ED&lt;sub&gt;50&lt;/sub&gt; and ED&lt;sub&gt;95&lt;/sub&gt; of alfentanil were 9.73 [95% CI 8.57 to 10.56] µg·kg&lt;sup&gt;-1&lt;/sup&gt; and 15.02 [95% CI 13.57 to 18.12] µg·kg&lt;sup&gt;-1&lt;/sup&gt;, respectively. Ciprofol requirements were lower in patients given 10 µg·kg&lt;sup&gt;-1&lt;/sup&gt; (0.795 [ 0.707 to 0.889] mg·kg&lt;sup&gt;-1&lt;/sup&gt;), 12 µg·kg&lt;sup&gt;-1&lt;/sup&gt; (0.799 [0.601 to 0.913] mg·kg&lt;sup&gt;-1&lt;/sup&gt;), and 14 µg·kg&lt;sup&gt;-1&lt;/sup&gt; (0.789 [0.660 to 0.968] mg·kg&lt;sup&gt;-1&lt;/sup&gt;) alfentanil than those given 8 µg·kg&lt;sup&gt;-1&lt;/sup&gt; alfentanil (1.082 [ 0.853 to 1.271] mg·kg&lt;sup&gt;-1&lt;/sup&gt;) alfentanil and 0.15 µg⋅kg&lt;sup&gt;-1&lt;/sup&gt; sufentanil (1.046 [0.861 to 1.427] mg·kg&lt;sup&gt;-1&lt;/sup&gt;) (P &lt; 0.001). Emergence time was lower in patients given 10 µg·kg&lt;sup&gt;-1&lt;/sup&gt; (0.9 [0.8 to 1.2] min), 12 µg·kg&lt;sup&gt;-1&lt;/sup&gt; (0.8 [0.6 to 1.0] min) than those given 8 µg·kg&lt;sup&gt;-1&lt;/sup&gt; (1.9 [1.0 to 2.8] min) and 14 µg·kg&lt;sup&gt;-1&lt;/sup&gt; (1.5 [1.0 to 2.3] min) alfentanil, and 0.15 µg·kg&lt;sup&gt;-1&lt;/sup&gt; sufentanil (1.4 [1.0 to 2.0] min) (P &lt; 0.001). The visual analogue scale score of pain at the time of 30 min and 1 h after surgery was lower in patients given 10 µg·kg&lt;sup&gt;-1&lt;/sup&gt;, 12 µg·kg&lt;sup&gt;-1&lt;/sup&gt;, and 14 µg·kg&lt;sup&gt;-1&lt;/sup&gt; alfentanil when compared with 8 µg·kg&lt;sup&gt;-1&lt;/sup&gt; alfentanil and 0.15 µg⋅kg&lt;sup&gt;-1&lt;/sup&gt; sufentanil (P &lt; 0.001). The incidence of intraoperative hypotension was lower in patients given 8 µg·kg&lt;sup&gt;-1&lt;/sup&gt;, 10 µg·kg&lt;sup&gt;-1&lt;/sup&gt;, 12 µg·kg&lt;sup&gt;-1&lt;/sup&gt; alfentanil, and 14 µg·kg&lt;sup&gt;-1&lt;/sup&gt; alfentanil than those given 0.15 µg·kg&lt;sup&gt;-1&lt;/sup&gt; sufentanil (P = 0.044), while the inciden","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"353"},"PeriodicalIF":2.3,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667176","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":"Efficacy and safety of ciprofol versus propofol for anesthesia in patients undergoing gastrointestinal endoscope: a systematic review and meta-analysis of randomized controlled trials (RCT).","authors":"Zhaoxuan Wang, Siru Wang, Lu Liu, Xiaolu Zhang, Meijuan Ren, Qianqian Zhang, Chang Liu","doi":"10.1186/s12871-025-03079-x","DOIUrl":"10.1186/s12871-025-03079-x","url":null,"abstract":"<p><strong>Background: </strong>Ciprofol is considered an alternative to propofol and can be used to achieve anesthesia at a lower dose with a lower incidence of adverse events. The primary objective of this study was to compare the efficacy and safety of ciprofol and propofol used in patients undergoing gastrointestinal endoscopes.</p><p><strong>Methods: </strong>The databases of PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure were retrieved for randomized controlled trials of ciprofol and propofol used in gastrointestinal endoscopes from inception to May 10, 2024. All statistical analyses were conducted using Stata 14.0. Primary outcomes encompassed a successful rate of sedation and other safety outcomes, including injection pain, hypotension, bradycardia, overall respiratory disorders, and hypoxemia. Secondary outcomes concluded time to onset of successful induction, waking time, and discharge time.</p><p><strong>Results: </strong>A total of 20 studies were included, involving 3779 patients. The results of the meta-analysis showed that the successful rate of anesthesia and waking time were not significantly different between ciprofol and propofol, while ciprofol was better than propofol in injection pain (RR: 0.10, 95% CI: 0.07 to 0.16, p < 0.001, I² = 46.4%, moderate certainty), hypotension (RR: 0.68, 95% CI: 0.59 to 0.77, p < 0.001, I² = 49.2%, moderate certainty), bradycardia (RR: 0.67, 95% CI: 0.52 to 0.85, p = 0.001, I² = 0.0%, moderate certainty), hypoxemia (RR: 0.45, 95% CI: 0.33 to 0.61, p < 0.001, I² = 9.2%, moderate certainty), and overall respiratory disorders (RR: 0.45, 95% CI: 0.27 to 0.75, p < 0.001, I² = 77.1%, moderate certainty). In addition, compared to propofol, shorter time to onset of successful induction (MD: -0.16, 95% CI: -0.24 to - 0.08, p < 0.001, I² = 97.2%, very low certainty) and longer discharge time (MD: 0.420, 95% CI: 0.29 to 0.54, p < 0.001, I² = 29.4%, moderate certainty) were related to ciprofol.</p><p><strong>Conclusion: </strong>Based on the results of pooled analysis, we conclude that ciprofol takes longer for cipofol to recover after surgery, it may greatly improve the pain problem and hemodynamic stability of intravenous propofol. Therefore, we believe that ciprofol can be used as an excellent substitute for propofol.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"354"},"PeriodicalIF":2.3,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667175","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":"Evaluation of dexmedetomidine as an adjuvant to low-concentration lidocaine/ropivacaine mixtures in ultrasound-guided axillary brachial plexus block.","authors":"Qi Wang, Lu Feng","doi":"10.1186/s12871-025-03221-9","DOIUrl":"10.1186/s12871-025-03221-9","url":null,"abstract":"<p><strong>Background: </strong>Dexmedetomidine (DEX) can be used with local anesthetics (LAs) to enhance the efficiency of a peripheral nerve block. However, there have been few studies on the combination of DEX and two different LAs for a brachial plexus block (BPB). The effects of adding DEX to low concentrations of lidocaine (LIDO) mixed with ropivacaine (ROP) on block onset, duration of anesthesia, and efficacy of analgesia in ultrasound-guided axillary (UGA) BPB were investigated.</p><p><strong>Methods: </strong>The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Harbin Medical University (ChiCTR-IPR-16007742, January 12, 2016), China. Seventy-five patients designated as American Society of Anesthesiologists Physical Status Classification System I or II and scheduled for forearm or hand surgery were assigned to three groups: (1) R group (n = 25), 0.25% ROP (30 mL) with 0.9% NaCl (3 mL); (2) RL group (n = 25), 0.25% ROP (15 ml) and 0.5% LIDO (15 mL) with 0.9% NaCl (3 mL); and (3) RLD group (n = 25), 0.25% ROP (15 ml) and 0.5% LIDO (15 mL) with DEX (0.75 µg/kg) (3 mL). Data on hemodynamic alterations, the bi-spectral index score (BIS), occurrence and timing of sensory and motor blocks, duration of analgesia, and requirement for rescue analgesia > 48 h were collected.</p><p><strong>Results: </strong>The timings of the onsets of sensory and motor blocks were considerably reduced in the RL and RLD groups relative to the R group (p < 0.0001), with no substantial variation between the RL and RLD groups (p > 0.05). Compared with the R and RL groups, the analgesic and block periods in the RLD group were markedly increased (p < 0.0001). The requirement for flurbiprofen rescue intervention was markedly reduced in the RLD group relative to the R and RL groups (p < 0.0001). The BIS was markedly lower in the RLD group, between 20 and 60 min (p < 0.05).</p><p><strong>Conclusion: </strong>The combination of ROP and LIDO led to a reduction in the onset time in UGA BPB. The addition of DEX to ROP/LIDO prolonged the duration of sensory and motor blocks. DEX also resulted in an extension of the analgesia time and provided significant sedation.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"347"},"PeriodicalIF":2.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658420","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":"High-altitude adaptation as a protective factor against postoperative pulmonary complications in liver resection: a prospective matched cohort study.","authors":"Qingyong Luo, Yu Zhang, Shiyao Gu, Li Liu, Si Zeng, Qian Lei","doi":"10.1186/s12871-025-03215-7","DOIUrl":"10.1186/s12871-025-03215-7","url":null,"abstract":"<p><strong>Background: </strong>High-altitude adaptation (HAA), induced by chronic hypoxia, has clinically significant cardioprotective effects; however, its impact on postoperative pulmonary complications (PPCs) in patients undergoing liver resection remains uncertain.</p><p><strong>Methods: </strong>We conducted a single-center prospective matched cohort study enrolling 292 consecutive patients undergoing elective liver resection. Patients were divided into two groups based on their long-term residential altitude: high-altitude group (≥ 1500 m) and plain group (< 1500 m). Propensity score matching (1:2 ratio) was applied to control for confounding factors, including demographic variables, clinical characteristics, preoperative oxygen saturation, ARISCAT score, and surgical factors. The primary outcome was the incidence of PPCs within 7 days after surgery. Secondary outcomes included the severity of PPCs, surgical complication grading, and length of hospital stay. Statistical analysis was performed using R software and SPSS 22.0.</p><p><strong>Results: </strong>After matching, 212 patients were included in the analysis. The incidence of PPCs within 7 days postoperatively in the high-altitude group was significantly lower than that in the plain group (61.5% vs. 76.1%, RR 0.80, 95% CI 0.66-0.98, P = 0.024). Furthermore, the high-altitude group showed milder complication severity and a shorter hospital stay (6 [4-8] vs. 7 [5-11] days, P = 0.005). Multivariate logistic regression analysis showed that HAA was an independent protective factor against PPCs (OR 0.31, 95% CI 0.12-0.83, P = 0.020). Further exploratory analysis revealed that during hepatic pedicle clamping, blood glucose levels remained more stable in the high-altitude group ([9.30 [7.25-11.90] vs. 10.95 [7.90-14.00] mmol/L, P < 0.001), with lower lactate accumulation after multiple clamps (1.55 [1.10-2.17] vs. 1.70 [1.10-2.50] mmol/L, P = 0.042).</p><p><strong>Conclusion: </strong>HAA may reduce the incidence and severity of PPCs after liver resection, potentially due to enhanced metabolic stability associated with chronic hypoxia in high-altitude residents.</p><p><strong>Trial registration: </strong>This study is registered with ChiCTR (ID: ChiCTR2200061915), registered on July 11, 2022.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"352"},"PeriodicalIF":2.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658421","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":"Development of a machine learning-derived model to predict unplanned ICU admissions after major non-cardiac surgery.","authors":"Catherine Chiu, Matthias R Braehler, Anne L Donovan, Atul J Butte, Romain Pirracchio, Andrew M Bishara","doi":"10.1186/s12871-025-03195-8","DOIUrl":"10.1186/s12871-025-03195-8","url":null,"abstract":"<p><strong>Background: </strong>Unplanned postoperative intensive care unit admissions (UIAs) are rare events that cause significant challenges to perioperative workflow. We describe the development of a machine-learning derived model to predict UIAs using only widely used preoperative variables.</p><p><strong>Methods: </strong>This was a 3-year retrospective review of all adult surgeries under the General, Vascular, and Thoracic surgical services with anticipated length of greater than 180 minutes at a single institution. A UIA was defined as any post-operative patient recovering in the post-anesthesia care unit (PACU) requiring direct transfer to the intensive care unit (ICU) for higher level of care. We developed our prediction model with a gradient-boosting decision tree algorithm (XGBoost). The model incorporated sixteen generalizable predictor variables that were derived from the demographics and surgical booking details. Validation and evaluation were performed with 10-fold cross validation, and model performance was evaluated using the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, and likelihood ratio.</p><p><strong>Results: </strong>A total of 4658 patients were included for analysis. The incidence of UIAs was 2.3%. With 10-fold cross validation, the area under the ROC curve was 0.80 (95% CI 0.74-0.86). Two decision thresholds were used, which achieved the best specificity of 94% (95% CI 92-96%), best positive likelihood ratio of 4.22 (95% CI 0.99-8.79), and best sensitivity of 82% (95% CI 58-100%).</p><p><strong>Conclusions: </strong>Our machine learning-derived model is a reliable tool for the perioperative clinician to predict a rare outcome in high-risk patients using only preoperative variables. Future studies will include prospective validation of this model at other institutions and real-time incorporation for improvement in perioperative workflow.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"351"},"PeriodicalIF":2.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658454","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":"Distal versus conventional radial artery catheterization for hemodynamic monitoring in intensive care setting: a randomized, controlled, non-inferiority trial.","authors":"Chao Peng, Wen Wu, Yupei Zhang, Zhenzhong Han, Xiaojie Deng, Jinbo Tan, Zuyang Xi, Rong Zhang","doi":"10.1186/s12871-025-03228-2","DOIUrl":"10.1186/s12871-025-03228-2","url":null,"abstract":"<p><strong>Background: </strong>Arterial catheterization is fundamental for hemodynamic monitoring in critically ill patients, yet instability and loss of arterial pressure waveform remain clinically significant issues. The distal radial artery (dRA) approach has been proposed as a potential alternative to the conventional radial artery (RA) approach. This is the first randomized clinical trial to assess the comparative efficacy and reliability of dRA versus RA catheterization by examining first-attempt success rates and the stability of arterial pressure waveforms in critically ill ICU patients.</p><p><strong>Methods: </strong>This randomized controlled trial enrolled 200 critically ill patients requiring arterial catheterization, assigning them to either dRA (n = 100) or conventional RA (n = 100) groups. All procedures utilized a standard 20-gauge polyurethane peripheral intravenous catheter. Co-primary outcomes included first-attempt success rate and frequency of arterial pressure waveform loss during the initial 72-h period. Secondary outcomes included catheterization time, complications during insertion and management, hemostasis time, and catheter duration. Bonferroni correction was applied for multiple testing (α = 0.025).</p><p><strong>Results: </strong>First-attempt success rates were comparable between dRA and RA groups (86% vs. 84%, P = 0.688). The dRA group experienced significantly fewer arterial pressure waveform losses across all three days (Day 1: 1.0 [0.0, 2.0] vs. 2.0 [1.0, 2.0]; Day 2: 1.0 [0.0, 1.0] vs. 2.0 [1.0, 2.0]; Day 3: 0.0 [0.0, 1.0] vs. 1.0 [1.0, 2.0]; all P < 0.001). Both groups achieved 100% procedural success with no site crossovers. Arterial catheterization time was longer in the dRA group (P < 0.001). Complication rates during catheterization, management, and after removal were similar between groups. Hemostasis time was significantly shorter in the dRA group (2.6 ± 1.5 min vs. 4.2 ± 0.9 min, P < 0.001). Catheter duration was similar between groups (76.6 ± 16.7 vs. 77.4 ± 16.4 h, P = 0.724).</p><p><strong>Conclusions: </strong>While first-attempt success rates were similar, the dRA approach offered greater arterial pressure waveform stability and shorter hemostasis time than the conventional RA approach, without increasing complications. Thus, dRA may be a preferable option for arterial catheterization in critically ill patients.</p><p><strong>Trial registration: </strong>This study is registered in the Chinese Clinical Trials Registry (registration number: ChiCTR2400086284, registration date: 27/06/2024).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"348"},"PeriodicalIF":2.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658455","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 resource requirements of perioperative patient warming in German hospitals - the results of a prospective, multicenter activity-based costing study.","authors":"Stefan Nardi-Hiebl, Jan Wallenborn, Martin Schniertshauer, Tilo Koch, Tobias Gruebl, Alexander Torossian","doi":"10.1186/s12871-025-03240-6","DOIUrl":"10.1186/s12871-025-03240-6","url":null,"abstract":"<p><strong>Background: </strong>Perioperative warming is essential in preventing hypothermia during surgery, a condition linked to adverse outcomes like increased infection rates, impaired coagulation, and extended hospital stays. Despite the availability of various active warming methods, such as forced-air warming (FAW) and electric warming systems, their implementation and associated costs vary significantly across hospitals, impacting resource allocation and patient care.</p><p><strong>Method: </strong>This study used a prospective, multicenter, activity-based costing approach across four German hospitals with diverse capacities. The activity-based costing model identified and measured staff time, material use, and direct costs linked to perioperative warming processes in a sample of 225 surgical patients. Warming processes were assessed across stages, including pre-warming, intraoperative warming, and post-anesthesia care.</p><p><strong>Results: </strong>Findings show significant variability in the time and cost associated with perioperative warming across institutions. The average total cost per patient between all sites ranged from EUR 3.52 to EUR 49.26, with an overall mean cost of EUR 12.29 per patient. Staff time also varied, with nurses contributing most of the required time dedicated to warming activities. At all sites, FAW was the available method during surgery, but inconsistent practices and reliance on supplemental strategies lead to considerable cost variations.</p><p><strong>Conclusion: </strong>This study illustrates potential operational and financial challenges of perioperative warming, revealing significant variability in costs and resource requirements across hospitals, influenced by institutional infrastructure, workflow efficiency and case mix. The findings also emphasize the importance of optimizing workflows and adopting best practices tailored to resource constraints. Future research should address these gaps by exploring cost-effective warming protocols, balancing efficiency with care quality, and refining workflows to enhance patient outcomes.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"349"},"PeriodicalIF":2.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658422","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}