BMC Anesthesiology最新文献

{"title":"Effect of sugammadex titration versus manufacturer's recommendation for reversal of rocuronium-induced neuromuscular block: a prospective, randomized, controlled trial.","authors":"Lingqi Gao, Bing Li, Jingjing Shen, Yuran Zhao, Jiazheng Qi, Tingting Gu, Wenxiang Bao, Yue Hu, Zhoujing Yang, Bo Xu, Zhao Zhang, Bingyan Zhang, Mengqiang Luo, Qiong Yu, Yingwei Wang","doi":"10.1186/s12871-025-03398-z","DOIUrl":"https://doi.org/10.1186/s12871-025-03398-z","url":null,"abstract":"<p><strong>Background: </strong>Both under-dosing and over-dosing of sugammadex for reversing neuromuscular block pose risks to patients, yet the optimal dosage for different degrees of neuromuscular block remains undefined. This study compared titration with single bolus of sugammadex recommended by manufacturer to determine the optimal dose for achieving a train-of-four ratio (TOFR) of 0.9 or greater while minimizing residual paralysis.</p><p><strong>Methods: </strong>Patients were randomly assigned to titrated group or manufacturer-recommended group. In titrated group, sugammadex was given in 50-mg increments every 5 min until a TOFR of 0.9 or greater was reached. In recommended group, a single dose (2 mg/kg or 4 mg/kg) was given based on train-of-four count (TOFC). Neuromuscular block was monitored continuously, and residual paralysis was assessed in the post-anesthesia care unit (PACU).</p><p><strong>Results: </strong>Of 210 enrolled patients, 205 were evaluated. The median dose of sugammadex for reversing different depths of neuromuscular block induced by rocuronium was ascertained via the titration method in this study. Titrated group required significantly less sugammadex to achieve a TOFR of at least 0.9 compared to recommended group (P < 0.001). Residual paralysis incidence was similar between groups (5.4% in titrated group vs. 4.9% in recommended group; P = 0.564). Although recovery time was longer in titrated group, extubation time and length of stay in the PACU were comparable.</p><p><strong>Conclusions: </strong>Titrated sugammadex administration significantly reduces required dosage without increasing residual paralysis risk. Continuous neuromuscular monitoring postoperatively is strongly recommended due to individual variability in dosage needs.</p><p><strong>Trial registration: </strong>The study was registered in the Chinese Clinical Trial Registry on March 4, 2024(ChiCTR2400081540).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"521"},"PeriodicalIF":2.6,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367565","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 efficacy and safety of peripheral nerve blocks for postoperative analgesia following total hip arthroplasty: a network meta-analysis.","authors":"Yanyan Yang, Yan Xu, Hong Tang, Yiwen Hu, Fuhai Bai","doi":"10.1186/s12871-025-03395-2","DOIUrl":"https://doi.org/10.1186/s12871-025-03395-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pain management following total hip arthroplasty (THA) remains challenging. Multiple peripheral nerve block techniques have emerged, but their comparative effectiveness requires systematic evaluation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library, were systematically searched to identify relevant randomized clinical trials, with the time frame limited from database inception to November 2024. In this study, the primary outcomes were defined as 24-hour postoperative dynamic and static pain scores, while the secondary outcomes were 24-hour postoperative oral morphine equivalents (OME) and the incidence of postoperative nausea and vomiting. A Bayesian-based random-effects network meta-analysis was implemented. Results were reported as mean difference (MD) with 95% credible interval (CrI) or risk ratio (RR) with 95% CrI. The surface under the cumulative ranking curve (SUCRA) was used to rank interventions. Study quality was evaluated through the Cochrane Risk of Bias 2.0 (RoB2.0) tool. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment was performed using this network meta-analysis (CINeMA) online tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our analysis incorporated data from 18 clinical trials spanning 12 countries, with 1,180 participants receiving 11 different nerve block interventions. Network meta-analysis results indicated that infrainguinal fascia iliaca compartment block (I_FICB) ranked highest for both 24-hour postoperative dynamic pain scores (SUCRA = 85.71%) and static pain scores (SUCRA = 88.90%). I_FICB was associated with lower 24-hour postoperative dynamic pain scores than suprainguinal fascia iliaca compartment block (S_FICB) (MD = -2.94, 95% CrI: -4.72, -1.16) and circum-psoas block (CPB) (MD = -2.37, 95% CrI: -4.18, -0.57). Additionally, I_FICB was associated with lower 24-hour postoperative static pain scores than L4 erector spinae plane block (L4_ESPB) (MD = -1.88, 95% CrI: -3.56, -0.20). Regarding other outcomes, lumbar plexus block (LPB) ranked first for 24-hour OME after surgery (SUCRA = 78.10%), while lumbar erector spinae plane block at the L4 vertebra level (L4_ESPB) ranked first for both postoperative nausea (SUCRA = 81.22%) and postoperative vomiting (SUCRA = 76.09%). The overall certainty of evidence for all these outcomes was rated as low or very low.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This meta-analysis indicated that among the various nerve block interventions included in this study for THA, I_FICB ranked highest in reducing 24-hour postoperative dynamic and static pain scores (SUCRA values: 85.71% and 88.90%, respectively), LPB ranked highest in reducing postoperative 24-hour OME (SUCRA value: 78.10%), and L4_ESPB ranked highest in controlling postoperative nausea and vomiting (SUCRA values: 81.22% and 76.09%, respectively). Further high-quality randomized controlled trials are neede","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"522"},"PeriodicalIF":2.6,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367509","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 organ protective effects of penehyclidine hydrochloride (PHC) in patients undergoing cardiac surgery: a systematic review and meta-analysis.","authors":"Lijuan Tian, Jingfei Guo, Yuntai Yao","doi":"10.1186/s12871-025-03396-1","DOIUrl":"10.1186/s12871-025-03396-1","url":null,"abstract":"<p><strong>Background: </strong>As a novel selective anticholinergic drug, penehyclidine hydrochloride (PHC) provided the potential to protect organs by inhibiting the inflammatory response, attenuating oxidative stress, and alleviating ischemia / reperfusion injury. This study aimed to evaluate the organ protective effects of PHC in patients undergoing cardiac surgery.</p><p><strong>Methods: </strong>Six electronic databases were searched systematically for randomized-controlled trials (RCTs) published April 30th 2025 that explored the application of PHC on cardiac surgical patients. Primary outcomes of interest included the biomarkers and variables of major organs (e.g. heart, lung, gastrointestinal tract and immune system) injury. Secondary outcomes of interest included the mechanical ventilation duration and hospital length of stay (LOS). Mean difference (MD) with 95% confidence interval (CI) or odds ratios (OR) with 95% CI were employed to analyze the data.</p><p><strong>Results: </strong>A total of 37 RCTs with 1929 cardiac surgical patients (PHC group, 1043 patients; Control group, 886 patients) were included. The current study demonstrated that the adult patients in PHC group had lower cardiac troponin I (cTnI) [MD: -1.70, 95%CI: -2.63 to -0.77, P = 0.0003, with heterogeneity (P < 0.00001)] and creatine kinase (CK)-MB levels on post-operative day (POD)-1 after cardiac surgery, while the pediatric patients had lower cardiac troponin T (cTnT) (MD: -0.10, 95%CI: -0.12 to -0.09, P < 0.00001, without heterogeneity) in PHC group on POD-1. The levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α were significantly lower in both adult and pediatric patients of PHC group on POD-1. The incidence of postoperative pulmonary infection was significantly reduced in the PHC group, and the duration of mechanical ventilation and hospital LOS were shortened in adult patients.</p><p><strong>Conclusions: </strong>This meta-analysis demonstrated that PHC could provide myocardial protection and suppress the inflammatory response in patients undergoing cardiac surgery, thereby potentially facilitating rapid recovery.</p><p><strong>Clinical trial number: </strong>PROSPERO registration number CRD42020183260.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"516"},"PeriodicalIF":2.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12542034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343506","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":"Variations of nociception level (NOL^®) measurements during robot-assisted laparoscopic prostatectomy - a monocentric retrospective analysis.","authors":"Julia Heiden, Jonas Hoefermann, Katharina Hoeter, Jens Kamuf, Robert Kuchen, Miriam Renz, Robert Ruemmler, Alexander Ziebart","doi":"10.1186/s12871-025-03397-0","DOIUrl":"10.1186/s12871-025-03397-0","url":null,"abstract":"<p><strong>Background: </strong>Inadequate analgesia during anaesthesia is associated with a range of complications. While anaesthesiologists routinely monitor the depth of anaesthesia and neuromuscular blockade, no system currently in routine clinical use provides an objective assessment of adequacy of anti-nociception. Although various monitoring systems have been developed in recent years, their impact on the optimization of analgesic therapy remains uncertain. Moreover, the influence of perioperative surgical and non-surgical procedures and events on the measured parameters is not yet fully understood. Nonetheless, this knowledge is essential for the accurate interpretation and effective clinical application of these emerging monitoring technologies.</p><p><strong>Methods: </strong>Thirty-three patients undergoing robot-assisted laparoscopic prostatectomy using the da Vinci Surgical System were retrospectively analysed. At five specific stimuli (gastric tube placement, urinary catheter placement, initiation of capnoperitoneum, transition to the steep Trendelenburg position and administration of sufentanil) NOL^®-Index, bispectral index (BIS™), heart rate and mean arterial blood pressure were measured after one, three and five minutes.</p><p><strong>Results: </strong>We noticed a significant increase in NOL^®-Index with capnoperitoneum (Beta 14.22, p < 0.001), while the NOL^®-Index decreased after steep Trendelenburg position (Beta - 8.89, p = 0.002) and sufentanil application (Beta - 17.67, p < 0.001). No significant changes were observed during gastric tube placement and urinary catheter insertion. The BIS^™ analysis showed no relevant deviation during anaesthesia.</p><p><strong>Conclusion: </strong>The NOL^®-Index showed characteristic changes during robot-assisted laparoscopic prostatectomy. Our study shows plausible results that can be used as a basis for future prospective studies to evaluate the clinical relevance of nociceptive monitoring.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"515"},"PeriodicalIF":2.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12542441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343501","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 systemic inflammatory markers in total knee arthroplasty under spinal vs general anesthesia: a retrospective study.","authors":"Ali Genç, Sezer Astan, Mehtap Gürler Balta, Vildan Kölükçü, Ahmet Tuğrul Şahin, Hakan Tapar, Tuğba Karaman, Serkan Karaman","doi":"10.1186/s12871-025-03399-y","DOIUrl":"10.1186/s12871-025-03399-y","url":null,"abstract":"<p><strong>Purpose: </strong>In total knee arthroplasty (TKA), both surgical trauma and the type of anesthesia administered can significantly affect systemic inflammation, which may influence postoperative recovery. This retrospective study aimed to compare perioperative changes in blood-derived systemic inflammatory markers-specifically the systemic immune-inflammation index (SII) and the systemic inflammation response index (SIRI)-in patients undergoing TKA under general versus spinal anesthesia.</p><p><strong>Methods: </strong>This retrospective analysis included 849 patients who underwent elective primary TKA between January 2020 and April 2025. Inclusion criteria were age 18-75 years and ASA physical status I-II. Patients with BMI ≥ 40 kg/m², ASA ≥ III, major comorbidities, active infection, revision surgery, or incomplete lab data were excluded. Patients were categorized into spinal anesthesia (Group S) and general anesthesia (Group G) groups. Pre- and postoperative hemograms were used to calculate SII and SIRI values; ΔSII and ΔSIRI were defined as absolute differences. Groups were compared in terms of inflammatory markers, total opioid requirement, postoperative complications, and hospital stay. Group comparability regarding age, ASA, and comorbidities was assessed, and multivariate linear regression models were applied to evaluate predictors of ΔSII and ΔSIRI.</p><p><strong>Results: </strong>A total of 849 patients were included in the study. The median ΔSII value was significantly higher in the general anesthesia group [Group G: 1448.47 (IQR: 677.78-2670.86)] compared to the spinal anesthesia group [Group S: 1060.75 (IQR: 463.69-2093.28); p < 0.001]. Similarly, the ΔSIRI value was higher in Group G [4.56 (IQR: 2.31-9.23)] than in Group S [3.69 (IQR: 1.70-7.05); p = 0.002]. The total opioid requirement within the first 24 postoperative hours was also significantly greater in Group G (p < 0.001). No statistically significant differences were found between the groups in terms of postoperative complication rates (p = 0.48) or length of hospital stay (p = 0.18).</p><p><strong>Conclusion: </strong>Compared to general anesthesia, spinal anesthesia was associated with a lower postoperative increase in systemic inflammatory blood markers in patients undergoing TKA. While no difference was observed in short-term clinical outcomes, these findings suggest that spinal anesthesia may offer an immunological advantage. Given the retrospective nature of the study, prospective research is warranted to determine whether these biomarker differences have meaningful clinical implications.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"518"},"PeriodicalIF":2.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12542252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343479","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":"Cardiac tamponade due to internal jugular catheterization after lung resection: a rare but life-threatening complication (case report).","authors":"Süleyman Gökalp Güneş, Barış Gülmez, Kübra Saçar, Beniz İrem Ersoy Şığva","doi":"10.1186/s12871-025-03403-5","DOIUrl":"10.1186/s12871-025-03403-5","url":null,"abstract":"<p><strong>Introduction: </strong>Internal jugular venous catheterization is an invasive procedure, and there are life-threatening complications that require urgent intervention. In this study, we present a young patient who developed myocardial injury due to internal jugular catheterization.</p><p><strong>Case: </strong>The patient underwent middle lobectomy for bronchiectasis. Right internal jugular venous catheterization was performed. In the fourth postoperative hour, resuscitation was initiated due to sudden hypotension, tachycardia, and altered consciousness. Bedside echocardiography, performed to evaluate the etiology of the acute presentation, revealed diffuse fluid accumulation in the pericardial cavity. Following fluid drainage, hemodynamic stability was achieved.</p><p><strong>Discussion: </strong>Possible complications can be life-threatening, and rapid diagnosis along with prompt treatment may be life-saving.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"519"},"PeriodicalIF":2.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12542343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343489","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":"Transnasopharyngeal positive pressure ventilation during balloon dilation of severe subglottic stenosis in a low-weight infant: a case report.","authors":"Shaochao Wang, Chao Wang, Wen Zhao, Xiaoli Zhu","doi":"10.1186/s12871-025-03401-7","DOIUrl":"10.1186/s12871-025-03401-7","url":null,"abstract":"<p><strong>Background: </strong>Acquired subglottic stenosis (ASGS) is a significant cause of pediatric airway obstruction and presents various anesthetic challenges due to the complexities of altered airway anatomy. While balloon dilation serves as a first-line minimally invasive intervention, shared airway management between surgeons and anesthesiologists requires meticulous coordination. This case report demonstrates the successful implementation of nasopharyngeal airway-assisted positive pressure ventilation during balloon dilation in a critically ill infant with grade III ASGS. This approach proposes a new ventilation strategy for complex airway procedures.</p><p><strong>Case presentation: </strong>A 3.2 kg, 3-month-old male infant presented with progressive respiratory failure secondary to Cotton-Myer grade III ASGS. Following multidisciplinary consensus, emergency balloon dilation was performed under general anesthesia with tracheostomy contingency planning. Initial ventilation attempts using a laryngeal mask proved inadequate, causing surgical field obstruction. Transitioning to a nasopharyngeal airway connected to the anesthesia machine in pressure-controlled ventilation mode successfully maintained adequate gas exchange (SpO₂ 95 ~ 100%).The procedure was completed successfully without hemodynamic compromise or airway reflexes, ultimately avoiding tracheostomy. Postoperative recovery was uneventful, with the patient returning to pediatric respiratory intensive care unit for continued respiratory support.</p><p><strong>Conclusion: </strong>Using a nasopharyngeal airway assisted positive pressure ventilation can effectively maintain oxygenation and surgical access during pediatric ASGS interventions, proposing a novel ventilation strategy for complex airway procedures. While demonstrating procedural feasibility in this critical scenario, larger-scale prospective studies are required to validate its efficacy and safety profile across varying stenosis severities.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"520"},"PeriodicalIF":2.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12542127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343532","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":"Awake craniotomy for brain tumor resection: anesthetic management and clinical experience from a high complexity hospital in Latin America.","authors":"David Esteban Eraso-Bolaños, Laura Libreros-Peña, Claudia Y Komaromy-Obando, Isabel C Soto-González","doi":"10.1186/s12871-025-03393-4","DOIUrl":"10.1186/s12871-025-03393-4","url":null,"abstract":"<p><strong>Background: </strong>Awake craniotomy is the gold standard for resecting brain tumors in eloquent areas. This technique requires tailored anesthetic management to ensure patient safety and cooperation. We aimed to describe clinical characteristics, anesthetic management, and intraoperative outcomes in patients undergoing awake craniotomy at a high-complexity hospital in southwestern Colombia.</p><p><strong>Methods: </strong>We conducted a retrospective case series. Sociodemographic, clinical, and intraoperative data were obtained from electronic medical records. Descriptive statistics were used to summarize the findings.</p><p><strong>Results: </strong>Fifteen patients underwent awake craniotomy with monitored anesthesia care using dexmedetomidine and remifentanil. All patients received a scalp block, non-opioid analgesics, and antiemetic prophylaxis. The most frequent adverse event was transient bradycardia without hemodynamic instability. No respiratory or neurological complications occurred. All procedures were successfully completed.</p><p><strong>Conclusions: </strong>Awake craniotomy under monitored anesthesia care with dexmedetomidine and remifentanil was feasible, safe, and well tolerated in this cohort. The absence of serious complications highlights the value of structured anesthetic protocols and trained multidisciplinary teams. This experience provides reference for the adoption of similar strategies in hospital settings across Latin America, where implementation of awake craniotomy remains limited.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"517"},"PeriodicalIF":2.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12542270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343491","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":"Ultrasound-guided erector spinae plane block versus rhomboid intercostal sub-serratus plane block for postoperative analgesia in open radical nephrectomy: a randomized clinical study.","authors":"Doaa Abd Eltwab, Sayed M Abed, Ahmad Saad, Maha A Abdel Aliem, Khaled A Elsamahy, Fatma H Elshamy, Ahmed F Gad, Walaa Y Elsabeeny","doi":"10.1186/s12871-025-03377-4","DOIUrl":"10.1186/s12871-025-03377-4","url":null,"abstract":"<p><strong>Background: </strong>Open radical nephrectomy often results in significant acute postoperative pain. Regional anesthesia offers an alternative analgesic approach in these situations. This study aims to assess and compare the effectiveness of ultrasound-guided rhomboid intercostal sub-serratus (RISS) block with Erector Spinae Plane Block (ESPB) in patients undergoing open radical nephrectomy.</p><p><strong>Methods: </strong>This randomized clinical trial included 42 patients scheduled for open radical nephrectomy (RN). Patients were randomly assigned to one of two groups: the ESPB Group (n = 21), which received an ESPB with 30 ml of bupivacaine 0.25%, or the RISS Group (n = 21), which received a RISS block with 30 ml bupivacaine 0.25%. Total morphine consumption was set as the primary outcome while pain scores, perioperative hemodynamics and time to postoperative analgesia were considered as secondary outcomes.</p><p><strong>Results: </strong>Total morphine consumption within the first 24 postoperative hours was significantly lower for the ESPB group (16.4 ± 2.5 mg) compared to the RISS group (18.2 ± 1.8 mg), p = 0.011. VAS pain scores at rest were significantly lower in the ESPB group at 12 and 18 h (p = 0.002, p = 0.018) respectively. VAS scores with movement were significantly lower for the ESPB group at 8 h,12 h, and 18 h (p = 0.011, p = 0.001, and p = 0.018 respectively). The first time to receive postoperative analgesia was significantly longer in the ESPB group (7.3 ± 2.1 h) than in the RISS group (6.0 ± 2.1 h), p = 0.048. Both groups were comparable in the number of PCA boluses, the number of patients requiring intraoperative fentanyl increments, or recovery time.</p><p><strong>Conclusion: </strong>Ultrasound-guided ESPB provides slightly superior postoperative analgesia compared with RISS block in patients undergoing open radical nephrectomy via subcostal anterior incision for renal malignancies.</p><p><strong>Trial registration: </strong>The trial was registered at Clinical Trials.gov. https://clinicaltrials.gov/study/NCT05822011 , trial ID (NCT05822011, 14 March 2023).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"514"},"PeriodicalIF":2.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12542437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343543","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":"Impact of diastolic blood pressure time under range on mortality and acute kidney injury in septic patients: a retrospective cohort study.","authors":"Jian Zhao, Si Tong Lin, Ai Hua Qin, Cheng Rui Zhou, Xiang Dong Huang, Hua Guo Chen, Shu Qin Zhou, Hu Peng, Yuan Zhuo Chen","doi":"10.1186/s12871-025-03382-7","DOIUrl":"10.1186/s12871-025-03382-7","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines for sepsis management focus on maintaining mean arterial pressure, while the impact of low diastolic blood pressure (DBP) exposure remains unclear. This study investigated whether the time under range of DBP (DBP-TUR) is associated with clinical outcomes in septic patients who achieved conventional blood pressure targets.</p><p><strong>Methods: </strong>In this retrospective cohort study using the MIMIC-IV database, we included 12,114 adult patients with sepsis. DBP-TUR was defined as the proportion of time with DBP < 50 mmHg while maintaining systolic blood pressure > 90 mmHg or mean arterial pressure > 65 mmHg during the first 48 h after ICU admission. Primary outcome was 28-day mortality, and secondary outcome was acute kidney injury (AKI).</p><p><strong>Results: </strong>Among the cohort, 6,192 patients (51.1%) experienced low DBP exposure. Patients were stratified into quartiles based on DBP-TUR (Q1: ≤5%, Q2: 5-15%, Q3: 15-50%, Q4: >50%). After adjusting for confounders, compared with Q1, both Q3 (OR:1.25, 95% CI:1.02-1.54) and Q4 (OR:1.27, 95% CI:1.02-1.57) showed significantly higher 28-day mortality. Similarly, AKI risk increased in Q3 (OR:1.47, 95% CI:1.14-1.91) and Q4 (OR:1.60, 95% CI:1.20-2.14). DBP-TUR demonstrated moderate predictive value for both mortality (AUC:0.73) and AKI (AUC:0.71).</p><p><strong>Conclusion: </strong>Low DBP exposure, despite achieving conventional blood pressure targets, was independently associated with increased mortality and AKI risk in septic patients. Monitoring DBP-TUR might provide additional value in hemodynamic management of sepsis.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"512"},"PeriodicalIF":2.6,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12538847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343460","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}