BMC Anesthesiology最新文献

{"title":"Rescue strategies combining ultra-protective ventilation and veno-venous ECMO in a patient with near-drowning-related severe ARDS: a case report and literature review.","authors":"Li Zhang, Zhekang Peng, Dingdeng Wang, Fei Tian, Xingguang Qu, Zhaohui Zhang, Gaosheng Zhou","doi":"10.1186/s12871-026-03897-7","DOIUrl":"https://doi.org/10.1186/s12871-026-03897-7","url":null,"abstract":"<p><strong>Background: </strong>Drowning can lead to acute respiratory distress syndrome (ARDS), which is associated with high mortality and poses substantial clinical management challenges. Ultra-protective ventilation strategy combined with veno-venous extracorporeal membrane oxygenation (VV-ECMO) present a viable alternative, yet evidence supporting these strategies in drowning-related ARDS patients remains scarce.</p><p><strong>Case presentation: </strong>This case report describes an 18-year-old female who experienced cardiac arrest following near-drowning. After the return of spontaneous circulation, the patient developed severe pulmonary edema leading to ARDS. VV-ECMO was initiated, resulting in a significant improvement in the Horowitz coefficient. Using a combination of VV-ECMO and an ultra-protective ventilation strategy with a lowest tidal volume of 2.8 ml/kg (predicted body weight, PBW), the patient's lung condition improved significantly. Static lung compliance rose from 11 ml/cm H₂O to 46 ml/cm H₂O. The patient was successfully weaned from VV-ECMO on Day 15, extubated on Day 27, and eventually discharged with no obvious pulmonary sequelae.</p><p><strong>Conclusion: </strong>The present case indicate that combining ultra-protective ventilation and VV-ECMO may be an effective approach for managing severe near-drowning-related ARDS by improving lung function and increasing the likelihood of successful extubation. This strategy minimizes ventilator-induced lung injury (VILI) while optimizing oxygenation, providing a new perspective for treating similar patients. Further studies are needed to validate its efficacy and optimize treatment protocols.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855773","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":"Propranolol monotherapy versus combined propranolol-gabapentin for prevention of paroxysmal sympathetic hyperactivity after moderate-severe traumatic brain injury: a randomized controlled trial.","authors":"Essamedin M Negm, Ahmed M Gouda, Mohammed El Mowafy Khatab, Essam Mohamed Elsayed Youssef, AnaSimon Alfred Foad Eskandr, Ola Mohammed Fathi, Heba Mohammed Fathi","doi":"10.1186/s12871-026-03802-2","DOIUrl":"https://doi.org/10.1186/s12871-026-03802-2","url":null,"abstract":"<p><strong>Background: </strong>Paroxysmal sympathetic hyperactivity (PSH) is a serious complication of traumatic brain injury (TBI), characterized by episodic hypertension (HTN), tachycardia, hyperthermia, hyperhidrosis, and dystonia. It is associated with prolonged mechanical ventilation (MV), extended ICU and hospital stays, and worse outcomes. Current guidelines lack prophylactic recommendations.</p><p><strong>Methodology: </strong>This single-center randomized controlled trial (NCT05427474) enrolled 90 adults with moderate-to-severe TBI glasgow coma scale (GCS 3-12). Participants were randomized to: standard care (Group I, n = 30); standard care plus propranolol (40 mg/12 h, Group II, n = 30); or standard care plus propranolol (40 mg/12 h) and gabapentin (100 mg/8 h, Group III, n = 30). The primary endpoint was PSH incidence. Secondary endpoints included ventilator days, ICU and hospital length of stay (LOS), and mortality.</p><p><strong>Results: </strong>PSH incidence was lowest in Group III (10%) vs. Group II (33.3%) and Group I (60%) (p < 0.001). Group II showed the shortest MV duration (5.92 ± 5.15 days) vs. Group III (9.42 ± 6.99 days, p = 0.047) and Group I (12.92 ± 5.98 days, p < 0.001). ICU LOS was shortest in Group II (9.6 ± 5.32 days) vs. Group III (14.69 ± 8.35 days, p = 0.017) and Group I (19.5 ± 8.19 days, p < 0.001). Mortality and GCS improvement did not differ significantly (p > 0.05).</p><p><strong>Conclusion: </strong>Prophylactic propranolol significantly reduces PSH incidence, shortens MV duration, and decreases ICU stay in moderate-to-severe TBI. Although adding gabapentin further reduces PSH, it prolongs recovery time, suggesting a trade-off between efficacy and sedative effects. These findings suggest that propranolol monotherapy is a promising prophylactic strategy, with gabapentin potentially reserved for refractory cases. However, given the study's limitations, these results should be considered hypothesis-generating and warrant confirmation in larger, multicenter trials. Mortality and neurological outcomes were comparable across groups.</p><p><strong>Trial registration: </strong>The trial was prospectively registered at ClinicalTrials.gov (NCT05427474) on June 22, 2022.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855735","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 of IPACK block combined with intra-articular steroid injection in advanced knee osteoarthritis: a retrospective cohort study.","authors":"Halil Ibrahim Altun, Salim Taner Gözükızıl","doi":"10.1186/s12871-026-03896-8","DOIUrl":"https://doi.org/10.1186/s12871-026-03896-8","url":null,"abstract":"<p><strong>Background: </strong>Knee osteoarthritis is a major cause of chronic pain and functional limitation, particularly in advanced stages. Intra-articular steroid injections and genicular nerve interventions are commonly used for pain control; however, these methods mainly target the anterior knee and may not sufficiently relieve pain originating from the posterior capsule. The infiltration between the popliteal artery and the capsule of the knee (IPACK) block is a regional anesthesia technique that provides posterior knee analgesia without causing motor weakness. Evidence regarding its effectiveness in chronic, non-surgical knee osteoarthritis is limited. This study aimed to evaluate whether adding an ultrasound-guided IPACK block to intra-articular steroid injection improves pain and functional outcomes in patients with advanced knee osteoarthritis.</p><p><strong>Methods: </strong>This retrospective observational cohort study included 98 patients with Kellgren-Lawrence stage 3-4 knee osteoarthritis who had persistent pain despite conservative treatment. Patients received either intra-articular steroid injection alone (IASI group, n = 50) or intra-articular steroid injection combined with an IPACK block (IASI+IPACK group, n = 48). Pain severity was assessed using the Numeric Rating Scale (NRS), and functional status was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Evaluations were performed at baseline, 1 month, and 6 months after the procedure. Non-parametric tests were used for statistical analysis, and p < 0.05 was considered significant.</p><p><strong>Results: </strong>Both groups showed significant improvement in NRS and WOMAC scores at 1 and 6 months compared with baseline (p < 0.05). The IASI+IPACK group demonstrated greater pain reduction at 1 month and significantly better WOMAC Function and Total scores at both follow-up visits compared with the IASI group (p < 0.05). Although scores increased slightly between 1 and 6 months in both groups, outcomes remained improved compared with baseline. No major complications were observed during the follow-up period. However, minor adverse events were not systematically recorded due to the retrospective nature of the study.</p><p><strong>Conclusions: </strong>Adding an IPACK block to intra-articular steroid injection may provide additional benefit in early pain relief and functional improvement in patients with advanced knee osteoarthritis. This combined approach appears to be a safe and useful option for patients who are not surgical candidates or are awaiting arthroplasty.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT07269444. Retrospectively registered on 20 November 2025.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833753","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":"Understanding maternal pain and psychological vulnerabilities associated with the development of sub-acute pain after childbirth.","authors":"Chin Wen Tan, Yaochen Liu, Rehena Sultana, Alex Tiong Heng Sia, Ban Leong Sng","doi":"10.1186/s12871-026-03885-x","DOIUrl":"https://doi.org/10.1186/s12871-026-03885-x","url":null,"abstract":"<p><strong>Background: </strong>Current research primarily concentrates on acute and chronic postpartum pain, while sub-acute pain after childbirth (SAPC) remains a significant but often under-recognized health concern. We determined if pain and psychological vulnerabilities, obstetric factors, and analgesic choices were associated with the development of SAPC.</p><p><strong>Methods: </strong>We included women with singleton pregnancy. Pain and psychological vulnerabilities were assessed using validated questionnaires (Angle Labor Pain Questionnaire (A-LPQ), Central Sensitization Inventory (CSI), Edinburgh Postnatal Depression Scale (EDPS), Fear Avoidance Components Scale (FACS), Pain Catastrophizing Scale (PCS), Perceived Stress Scale (PSS), State Trait Anxiety Inventory (STAI)). The primary outcome of SAPC, defined as having postpartum pain lasting for ≥4 weeks, was followed up at 6 to 10 weeks postpartum with online survey.</p><p><strong>Results: </strong>Of the 881 patients recruited, 816 completed the postpartum follow-up, with 99 (12.1%) patients having developed SAPC. Having higher CSI score (adjusted odds ratio (aOR) 1.03, 95%CI 1.01-1.04), increased number of pain relief administrations (aOR 1.55, 95%CI 1.23-1.95), use of artificial rupture of membrane and oxytocic for labor induction (aOR 2.72, 95%CI 1.51-4.91), greater volume of blood loss during delivery (every 10-mL increase; aOR 1.02, 95%CI 1.01-1.03), having had third-degree tear during delivery (aOR 4.12, 95%CI 1.28-13.27) and greater infant weight (aOR 1.15, 95%CI 1.02-1.30) were independently associated with greater risk of SAPC. The use of prostin for labor induction was protective against the risk of SAPC (aOR 0.56, 95%CI 0.34-0.93) (Area under the curve (AUC) = 0.73).</p><p><strong>Conclusion: </strong>Our center's multivariable model demonstrates moderate predictive performance and may inform the future development and refinement of predictive tools to identify patients at increased risk of SAPC, thereby supporting more timely monitoring and early interventions for postpartum pain management.</p><p><strong>Trial registration: </strong>This study was registered on clinicaltrials.gov registry (NCT03167905) on 30/05/2017.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833794","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":"Preoperative airway ultrasonography for predicting difficult intubation in adult female patients: a prospective observational study.","authors":"Uğur Serkan Çitilcioğlu, Hatice Kaya Özdoğan, Hakan Yalım, Ülkü Burçin Atasever","doi":"10.1186/s12871-026-03891-z","DOIUrl":"https://doi.org/10.1186/s12871-026-03891-z","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative prediction of difficult intubation is essential for perioperative safety. Ultrasonographic airway evaluation has emerged as a promising adjunct. However, heterogeneity in study populations has limited the identification of population-specific predictors. This study aimed to evaluate the diagnostic performance of four ultrasonographic airway parameters in non-obese, non-obstetric adult female patients.</p><p><strong>Methods: </strong>This prospective, single-center, single-blinded observational study included adult women undergoing elective surgery. Preoperative airway ultrasonography was performed to measure tongue thickness, skin-to-hyoid bone distance, skin-to-epiglottis distance, and skin-to-anterior commissure of the vocal cords distance. Tracheal intubation was conducted using direct laryngoscopy by anesthesiologists blinded to ultrasonographic findings. Difficult intubation was defined as a restricted composite outcome: a Cormack-Lehane grade III-IV view on initial laryngoscopy plus either failed first-attempt intubation or requirement for adjunct techniques. Diagnostic performance was assessed using receiver operating characteristic analysis and multivariable logistic regression.</p><p><strong>Results: </strong>A total of 379 patients were analyzed, of whom 45 (11.9%) met the criteria for difficult intubation. Tongue thickness was significantly greater in patients with difficult intubation and demonstrated the highest predictive accuracy (AUC 0.92, 95% CI 0.87-0.98). Skin-to-anterior commissure distance showed moderate discriminatory ability (AUC 0.71), whereas other measurements had limited or poor performance. In multivariable analysis, tongue thickness emerged as the strongest independent predictor of difficult intubation.</p><p><strong>Conclusion: </strong>Within this specific cohort, tongue thickness showed the highest discriminatory performance among the evaluated ultrasonographic parameters. Population-specific airway assessment using targeted ultrasonographic parameters may enhance preoperative risk stratification and support safer anesthetic practice.</p><p><strong>Trial registration: </strong>NCT07343557 (retrospectively registered).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833814","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":"Real-time artificial intelligence-based needle tracking for ultrasound-guided regional anesthesia training: a pilot prospective randomized controlled trial.","authors":"Misato Kurota, Kai Kubota, Tatsuya Hayasaka, Hiroaki Toyama","doi":"10.1186/s12871-026-03867-z","DOIUrl":"https://doi.org/10.1186/s12871-026-03867-z","url":null,"abstract":"<p><strong>Background: </strong>Proper needle visualization is a major technical challenge for novices learning ultrasound-guided regional anesthesia (UGRA). We developed a 'You Only Look Once version 5' (YOLOv5)-based system that records quantitative needle trajectory data and delivers real-time visual and auditory feedback to support training. This pilot study aimed to explore whether short-term use of the real-time feedback system improved puncture safety and whether needle oscillation amplitude, a system-derived trajectory-based metric, could serve as an objective indicator of technical proficiency in UGRA training.</p><p><strong>Methods: </strong>Twenty-three medical students with no UGRA experience were randomized into control (n = 12) and YOLOv5 feedback (n = 11) groups. Participants performed three in-plane punctures of increasing difficulty on phantoms: sagittal (puncture A), coronal (puncture B), and transverse (puncture C). Each included watching an instructional video, a 5-minute practice (with feedback for the YOLOv5 group or without for the control group), and a test puncture without feedback. The outcomes were needle tip disappearance frequency compared between the control and YOLOv5 feedback groups and needle oscillation amplitude - the maximum lateral deviation from the ideal insertion line, automatically recorded by the system - compared between punctures classified as safe and unsafe by an independent blinded assessor.</p><p><strong>Results: </strong>Needle tip disappearance frequency did not differ between the control and YOLOv5 feedback groups across all approaches (puncture A: median, 0 vs. 0, P = 0.933; puncture B: 0 vs. 1, P = 0.246; puncture C: 1 vs. 2, P = 0.463). Only puncture C yielded both safe and unsafe punctures, enabling comparative analysis of the needle oscillation amplitude. Participants performing safe punctures (Level 1, n = 9) exhibited significantly smaller needle oscillation amplitudes (136.0 ± 32.1 pixels) than those performing unsafe punctures (Level 3, n = 12, 230.5 ± 85.4 pixels; P = 0.003).</p><p><strong>Conclusions: </strong>This pilot study identified needle oscillation amplitude as a candidate objective proficiency metric in UGRA training, with preliminary evidence differentiating safe from unsafe punctures. Short-term training with the current prototype did not produce measurable improvements in puncture safety. However, the usability challenges encountered with this feedback system provided foundational insights for developing an optimized trajectory-based feedback system.</p><p><strong>Trial registration: </strong>UMIN Clinical Trials Registry (UMIN000055602), registered October 1, 2024.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833763","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":"Esketamine-led opioid-free anaesthesia reduces postoperative pulmonary complications in bariatric surgery patients: a prospective randomized controlled trial.","authors":"He-Liang Sun, Han-Yu Liu, Chen-Qi Jiang, Zi-Feng Wu, Wen-Li Wang, Si-Qi Yang, Hui Liang, Shi-Bo Lin, Cun-Ming Liu, Chun Yang","doi":"10.1186/s12871-026-03886-w","DOIUrl":"https://doi.org/10.1186/s12871-026-03886-w","url":null,"abstract":"<p><strong>Background: </strong>Perioperative management of bariatric surgery patients presents multiple challenges for anesthesiologists, particularly optimizing airway and respiratory outcomes. This study investigated the feasibility of esketamine-led opioid-free anesthesia (OFA) for bariatric surgery and assessed postoperative pulmonary complications (PPCs).</p><p><strong>Methods: </strong>Patients scheduled for laparoscopic bariatric surgery under combined intravenous-inhalation anesthesia were randomized to receive either esketamine-led OFA (S-Ket group) or opioid-balanced anesthesia with sufentanil and remifentanil (SR-Fen group). The primary outcome was post-surgical PPC incidence, and secondary outcomes were total morphine milligram equivalents (MME) and visual analogue scale (VAS) pain scores at multiple postoperative times.</p><p><strong>Results: </strong>Of the 263 patients screened, 100 were enrolled. Incidence of PPCs was significantly lower in the S-Ket group than the SR-Fen group (26.0% vs. 50.0%, risk ratio (RR) 0.52; 95% CI: 030-0.89; P = 0.013), with a notable reduction in hypoxemia (22.0% vs. 42.0%, RR 0.52, 95% CI: 0.28-0.97, P = 0.032). Although VAS scores were comparable between groups at all postoperative time points, opioid consumption within the first 24 h post-surgery was significantly reduced in the S-Ket group (P = 0.025). Nystagmus (56.0% vs. 0; P < 0.001) was observed exclusively in the S-Ket group, while there were no other significant group differences in safety outcomes. Post-anesthesia care unit (PACU) stay was longer in the S-Ket group (P = 0.039).</p><p><strong>Conclusions: </strong>Esketamine-led OFA for laparoscopic bariatric surgery reduced PPC incidence, particularly hypoxemia. However, reduced opioid consumption did not reach the clinical significance threshold (10 MME), and the regimen may prolong PACU stay.</p><p><strong>Trial registration: </strong>This study was registered at the Chinese Clinical Trial Registry ChiCTR2200057066 (Date:27/02/2022).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833796","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":"Postoperative pain management after VATS for spontaneous pneumothorax - a systematic review.","authors":"Quirine C A van Steenwijk, Loes Janssen, Iris Hoogendoorn, Chris Dickhoff, Jerry Braun, Frank J C van den Broek","doi":"10.1186/s12871-026-03865-1","DOIUrl":"https://doi.org/10.1186/s12871-026-03865-1","url":null,"abstract":"<p><strong>Background: </strong>Historically, thoracic epidural analgesia has been the standard for postoperative pain management after surgery for spontaneous pneumothorax. With the advent of enhanced recovery after thoracic surgery protocols, less invasive locoregional analgesic techniques are increasingly considered. Due to lack of high-quality evidence, current guidelines do not address optimal analgesic strategies in this population. This systematic review evaluated the effectiveness of various analgesic techniques following video-assisted thoracoscopic surgery for spontaneous pneumothorax.</p><p><strong>Methods: </strong>Medline, Embase and Cochrane databases were searched until May 2025. Inclusion criteria were patients undergoing video-assisted thoracoscopic surgery for spontaneous pneumothorax, with clearly described postoperative analgesic management (e.g. epidural, locoregional, systemic) and pain scores (visual analgesic score or numeric pain rating score) within 48 h. The primary outcome was pain scores within 48 h postoperatively; secondary outcomes included adjunct analgesic use and complications. Risk of bias was assessed for the primary outcome.</p><p><strong>Results: </strong>Thirty studies comprising 3,203 patients were assessed: risk of bias was low in 3, moderate/some concerns in 24 and high in 3 studies. There were 10 comparative studies and 20 single-arm cohort studies applying solely systemic analgesia (n = 14) or locoregional analgesia (n = 6). No single-arm cohort study applied solely epidural analgesia. Postoperative pain scores within 48 h were higher after systemic analgesia only, compared to the addition of locoregional or epidural analgesia. No clear differences were observed in analgesia-related complications between the analgesic techniques.</p><p><strong>Conclusions: </strong>Locoregional or epidural analgesia as part of a multimodal regimen was associated with the lowest postoperative pain scores, although differences were small. Substantial heterogeneity and low certainty of evidence precluded definitive recommendations. This review provides a foundation for future research investigating optimal analgesic strategies following surgery for spontaneous pneumothorax.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833800","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":"The effect of dexmedetomidine on emergence agitation and pain in post-anesthesia recovery of patients undergoing upper limb elective orthopedic surgery: a double-blind randomized clinical trial.","authors":"Khatereh Isazadehfar, Masood Entezariasl, Ali Abitorabi, Mahzad Yousefian","doi":"10.1186/s12871-026-03850-8","DOIUrl":"https://doi.org/10.1186/s12871-026-03850-8","url":null,"abstract":"<p><strong>Background and objective: </strong>Emergence agitation is a common complication following anesthesia, particularly impacting recovery in patients undergoing elective orthopedic surgeries. This study aimed to test the hypothesis that dexmedetomidine would reduce the incidence of emergence agitation and postoperative pain in patients undergoing upper limb orthopedic surgery under general anesthesia.</p><p><strong>Methods: </strong>This prospective, randomized, double-masked, placebo-controlled clinical trial was conducted at Fatemi Hospital in Ardabil, Iran. Patients scheduled for elective upper limb orthopedic surgeries were randomly assigned to receive either dexmedetomidine (0.4 µg/kg/hr) or a placebo during surgery. The primary outcome was the incidence of emergence agitation, assessed using the Riker Sedation-Agitation Scale. Secondary outcomes included: the severity of emergence agitation, postoperative pain intensity measured with the Visual Analog Scale, hemodynamic parameters, recovery time, and adverse events.</p><p><strong>Results: </strong>A total of 150 patients were enrolled, with 75 in each group. Regarding the primary outcome, the dexmedetomidine group exhibited a significantly lower incidence of emergence agitation (14.7% vs. 48.0%, p = 0.001). Among secondary outcomes, the dexmedetomidine group reported lower pain scores (Visual Analog Scale: 2.32 ± 1.14 vs. 4.77 ± 0.79, p = 0.001) and showed significant differences in heart rate and systolic blood pressure, with lower values in the dexmedetomidine group (p = 0.022 and p = 0.008, respectively).</p><p><strong>Conclusion: </strong>The intraoperative infusion of dexmedetomidine significantly reduces the incidence of emergence agitation and is associated with improved postoperative pain management in adults undergoing elective upper limb orthopedic surgery. These findings support the use of dexmedetomidine as a beneficial adjunct in anesthetic practice to enhance recovery outcomes.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833832","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":"Topical use of tranexamic acid for antifibrinolysis in cardiac surgery with cardiopulmonary bypass: a randomized clinical study.","authors":"Dilnaar Tuerhong, Chen-Xi Li, Lei Yan","doi":"10.1186/s12871-026-03872-2","DOIUrl":"https://doi.org/10.1186/s12871-026-03872-2","url":null,"abstract":"<p><strong>Objective: </strong>To assess the non-inferiority of topical intrapericardial tranexamic acid (TXA) versus intravenous TXA for efficacy and safety in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).</p><p><strong>Methods: </strong>In this single-center randomized trial, 492 patients were assigned 1:1 to topical TXA (2.5 g in 50 mL saline via pericardial drain, clamp 30 min) or standard intravenous TXA.</p><p><strong>Primary endpoints: </strong>allogeneic red blood cell (RBC) transfusion rate (postoperative to discharge); 30-day composite adverse events (mortality, renal dysfunction, stroke, myocardial infarction, thromboembolism, seizures). Secondary endpoints included drainage volume, coagulation, and thromboelastography (TEG). The non-inferiority threshold was established at 10% for sensitivity.</p><p><strong>Results: </strong>RBC transfusion rate was 35.0% (topical) vs. 27.6% (intravenous; 95%CI - 1.2% to 16.0%, P = 0.080). Composite adverse events were 9.8% vs. 15.4% (95%CI - 11.2% to 0.0%, P = 0.057). Topical TXA showed delayed coagulation initiation, lower fibrinogen, and higher 24-hour drainage (all P < 0.05). At 10% margin, efficacy non-inferiority was not confirmed, but safety non-inferiority was verified for all endpoints.</p><p><strong>Conclusion: </strong>Topical intrapericardial TXA is non-inferior to intravenous TXA in safety but fails strict efficacy non-inferiority. Intravenous TXA remains first-line; topical TXA is a reasonable alternative for patients intolerant to systemic administration. Dose and timing optimization is needed to improve hemostasis.</p><p><strong>Trial registration: </strong>http://www.chictr.org.cn, ChiCTR2500113718, Registration date: 2 December 2025. Retrospectively registratered.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833768","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}