BMC Anesthesiology最新文献

{"title":"Effect of early lollipop sucking in the post-anesthesia care unit on recovery quality in children undergoing outpatient dental treatment under general anesthesia: a prospective randomized controlled trial.","authors":"Yaqiu Zhang, Zhenzhen Gao, Long Wu, Rui Lu, Yan Liu, Bing Liu","doi":"10.1186/s12871-026-03887-9","DOIUrl":"https://doi.org/10.1186/s12871-026-03887-9","url":null,"abstract":"<p><strong>Background: </strong>Enhanced Recovery After Surgery (ERAS) protocols emphasize multimodal strategies to improve postoperative outcomes. In children undergoing dental treatment under general anesthesia, the recovery is often accompanied by pain, agitation, and oral discomfort. Although lollipop sucking may alleviate these issues through physiological and psychological mechanisms, some evidence supporting its use remains limited. In this work, we evaluated whether early lollipop sucking enhances recovery quality and satisfaction in the population.</p><p><strong>Methods: </strong>From March to October 2025, we conducted a randomized controlled trial (RCT) at School of Stomatology, Fourth Military Medical University, China. The participants included children aged 2 to 10 years who underwent outpatient dental treatment under general anesthesia. 140 patients were randomly divided into two groups: one group received a lollipop, while the other group did not, after awakening from anesthesia. We compared the primary and secondary outcome measures, which included postoperative recovery quality (QoR-15 score), pain (FLACC scale), emergence agitation (PAED scale), duration of PACU stay, time to discharge, and the parental satisfaction.</p><p><strong>Results: </strong>In this study, we collected and analyzed data from 140 patients. The lollipop group demonstrated significantly superior outcomes compared to the non-lollipop group. Specifically, they exhibited higher QoR-15 scores (131.81 ± 1.52 vs. 126.70 ± 0.90, P < 0.01) and lower FLACC pain scores (2.44 ± 1.07 vs. 4.03 ± 1.99, P < 0.001). Emergence agitation was also significantly reduced, with median PAED scores of 5.00 [4.00,6.00] versus 7.00 [5.00,10.00] (P < 0.01). Furthermore, the lollipop group experienced shorter durations of PACU stay (20.46 ± 3.75 min vs. 25.79 ± 3.04 min, P < 0.001) and expedited discharge times (median 120.00 [120.00,135.00] min vs. 140.00 [135.00,150.00] min, P < 0.001). Parental satisfaction was also significantly higher in the lollipop group (P = 0.030). After adjusting for potential confounders, lollipop use remained independently associated with improved recovery quality, reduced pain and agitation, and shortened recovery times.</p><p><strong>Conclusions: </strong>Early lollipop use in the post-anesthesia care unit (PACU) significantly improves postoperative recovery in children undergoing outpatient dental procedures under general anesthesia. This intervention effectively reduces pain and emergence agitation, shortens recovery and discharge times, and enhances parental satisfaction. As a simple, safe, and non-pharmacological approach, it aligns well with the principles of Enhanced Recovery After Surgery (ERAS) and offers a practical approach to optimizing pediatric perioperative care.</p><p><strong>Trial registration number: </strong>The trial was registered at the Chinese Clinical Trial Registry (ChiCTR2500099389) on March 24, 2025.</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":"147811117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of serial pancreatic stone protein, C-reactive protein and procalcitonin for the diagnosis of infection and sepsis in critically Ill patients: a multicentre prospective study.","authors":"Vinod Jaiswal, Kalpana Krishnareddy, Sanjay Nihalani, Nimisha Abdul Majeed, Ribin Raj, Alanduru Nirmala Veenanjani, Prashant Nasa","doi":"10.1186/s12871-026-03883-z","DOIUrl":"https://doi.org/10.1186/s12871-026-03883-z","url":null,"abstract":"<p><strong>Background: </strong>The serial performance of C-reactive protein (CRP), procalcitonin, and emerging biomarker pancreatic stone protein (PSP) was evaluated for the diagnosis of infection and sepsis in patients admitted to the intensive care unit (ICU).</p><p><strong>Methods: </strong>All consecutive adult patients with suspected infection or sepsis upon their admission to the ICUs of three multi-speciality hospitals in the UAE were enrolled. CRP, procalcitonin, and PSP levels were measured at admission and repeated within 24-48 h. Patients were categorized into infection vs. non-infection, sepsis vs. non-sepsis groups, and into culture-positive and culture-negative subgroups.</p><p><strong>Results: </strong>A total of 272 ICU patients were analyzed. All biomarkers could be used to distinguish infection with CRP (AUROC 0.77; 95% confidence intervals [CI] 0.70-0.83) and procalcitonin (AUROC 0.75; 95% CI 0.68-0.81) showing fair performance. Moreover, serial monitoring at 24-48 h improved performance, especially for procalcitonin (p = 0.04). Among patients with infection, PSP levels were higher in culture-positive compared to culture-negative patients, but the difference did not reach statistical significance (median 229 vs. 142 ng/ml, p = 0.05). However, all three biomarkers failed to discriminate sepsis with an AUROC of 0.56 (95% CI 0.49-0.64) for CRP, 0.54 (95% CI 0.46-0.62) for procalcitonin, and 0.58 (95% CI 0.50-0.66) for PSP, respectively. Combining biomarkers improved specificity (93.85%) but with reduced accuracy.</p><p><strong>Conclusion: </strong>Despite a significant rise in all biomarkers, procalcitonin has overall better performance for diagnosing infections. None of the biomarkers could differentiate sepsis at admission.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811142","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":"Allergic reaction to nalbuphine administration in a pre-adolescent patient: a case report and literature review.","authors":"Shengnan Li","doi":"10.1186/s12871-026-03864-2","DOIUrl":"https://doi.org/10.1186/s12871-026-03864-2","url":null,"abstract":"<p><strong>Background: </strong>Nalbuphine is synthetic agonist-antagonist opioid compound. Allergic reactions to nalbuphine hydrochloride are exceedingly rare. We present a case of hypersensitivity reaction to nalbuphine in a pre-adolescent patient.</p><p><strong>Case presentation: </strong>A male patient, aged 11 years, underwent general anesthesia for the correction of congenital strephexopodia. Nalbuphine hydrochloride was administered as part of the postoperative analgesia regimen. However, the patient subsequently developed an allergic reaction characterized by pulmonary edema, wheezing, tachycardia and cutaneous rash. Prompt initiation of anti-allergic therapy resulted in significant clinical improvement. The patient was subsequently transferred to the general ward following complete resolution of symptoms.</p><p><strong>Conclusions: </strong>This case report highlights a hypersensitivity reaction to nalbuphine in pre-adolescent patient, manifesting with both cutaneous and respiratory symptoms. To improve the safety profile of nalbuphine in pre-adolescent populations, further research is necessary to elucidate the underlying mechanisms of such adverse reactions.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811182","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":"Association between intranasal dexmedetomidine dose and delayed awakening after sedation in children: a retrospective cohort study.","authors":"Shunzhong Jing, Liping Jiang, Yixing Lu, Jiamei Liang, Xiaoqiang Sun, Yunan Lin","doi":"10.1186/s12871-026-03876-y","DOIUrl":"https://doi.org/10.1186/s12871-026-03876-y","url":null,"abstract":"<p><strong>Background: </strong>Intranasal dexmedetomidine is widely used in pediatric procedural sedation; however, its dose-related effect on delayed awakening remains insufficiently characterized.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included pediatric patients who received oral midazolam combined with intranasal dexmedetomidine for procedural sedation at the Sedation Center of Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital between March 2022 and March 2024. The exposure was the intranasal dexmedetomidine dose (μg/kg). The primary outcome was delayed awakening, defined as a time of ≥ 90 min from the last sedative administration (including rescue/secondary sedatives when applicable) to full awakening documented by the anesthesiologist on duty using routinely recorded standardized criteria (Modified Aldrete score ≥ 9). Firth penalized multivariable logistic regression models were applied to evaluate the association between dexmedetomidine dose and delayed awakening, adjusting for age group, sex, weight, fasting duration, procedure type, and midazolam dose. Dose-response relationships and subgroup analyses restricted to baseline/procedural characteristics were also conducted.</p><p><strong>Results: </strong>A total of 2,116 children were included, with an overall delayed awakening incidence of 2.6%. When stratified by tertiles of dexmedetomidine dose, the incidence of delayed awakening increased from 1.1% in the low-dose group to 2.9% in the medium-dose group and 4.1% in the high-dose group (P = 0.004). In multivariable analyses, each 1 μg/kg increase in intranasal dexmedetomidine dose was associated with a significantly higher risk of delayed awakening (adjusted odds ratio [OR] 3.665, 95% confidence interval [CI] 2.091-6.636; P < 0.001). Dose-response analysis demonstrated a positive linear association (no evidence of nonlinearity, P = 0.451) between dexmedetomidine dose and delayed awakening. This corresponds to an aOR of 1.91 per 0.5 μg/kg increase (and 1.99 per IQR increase); adjusted predicted probabilities were 0.96% at 2 μg/kg, 3.37% at 3 μg/kg, and 10.70% at 4 μg/kg.</p><p><strong>Conclusions: </strong>In pediatric procedural sedation, higher intranasal dexmedetomidine dose is associated with delayed awakening and demonstrates a positive dose-response relationship. Younger children appear to be more susceptible to this adverse outcome. Clinically, dexmedetomidine dosing should be carefully individualized-particularly in younger patients-to balance effective sedation with recovery efficiency.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811191","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":"A color Doppler ultrasound-guided protocol for the precise placement of nerve catheters: an anatomical validation study in fresh and fixed cadavers.","authors":"Benedikt Büttner, Holger Rosemann, Nilas Zieseniss, Caspar Mewes, José Hinz, Ashham Mansur, Ingo Bergmann","doi":"10.1186/s12871-026-03873-1","DOIUrl":"https://doi.org/10.1186/s12871-026-03873-1","url":null,"abstract":"<p><strong>Background: </strong>Continuous analgesia via peripheral nerve catheters (PNCs) is highly effective but prone to tip malposition. Direct ultrasound-guided localization of the PNC tip remains challenging, and no universal method is currently established. This cadaver-based study aimed to validate a color Doppler ultrasound-guided protocol for accurate PNC tip placement at the brachial plexus.</p><p><strong>Methods: </strong>Eleven ultrasound-guided PNC placements were performed (5 fixed/6 fresh cadavers) according to our specific protocol. PNC tip positioning was repeatedly assessed by visualizing bolus injections via color Doppler ultrasound following 0.5 cm retraction if applicable. Good placement was defined as a color Doppler signal directly adjacent to the brachial plexus concomitant with hydrodissection within its fascial compartment. Verification was obtained through anatomical dissection of the PNC tip in situ and evaluation of the maximal staining site after dye injection via the PNC.</p><p><strong>Results: </strong>The diagnostic agreement between the color Doppler signal and anatomical findings was 100%. In fixed cadavers, correct PNC tip placement was confirmed in 100% (5/5) of the specimens. Among the fresh cadavers, 83.3% (5/6) were correctly placed. One secondary malposition was detected by ultrasound and confirmed macroscopically. Qualitative analysis of dye staining revealed good localization in 81.8%, acceptable localization in 9.1%, and poor localization in 9.1% of the samples.</p><p><strong>Conclusion: </strong>Our standardized color Doppler ultrasound-guided protocol reliably facilitates precise PNC tip placement in both fixed and fresh cadavers. Using this method, practitioners can accurately verify and adjust PNC tip position in cadavers. This universally applicable approach may translate to clinical practice but warrants further investigation.</p><p><strong>Trial registration number: </strong>DRKS00005626 The present validation report was derived from an unpublished study. This study was registered with the German Clinical Trials Register under the clinical trial number DRKS00005626 in July 2015 [Weblink: https://drks.de/search/de/trial/DRKS00005626 ].</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811289","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":"Mediation of postoperative length of stay by major adverse cardiovascular events in elderly patients underwent major thoracic and abdominal surgery receiving peripheral nerve blocks.","authors":"Zhen Zhang, Chen Li, Zhen-Zhen Xu, Jia-Hui Ma","doi":"10.1186/s12871-026-03879-9","DOIUrl":"https://doi.org/10.1186/s12871-026-03879-9","url":null,"abstract":"<p><strong>Background: </strong>The association between preoperative peripheral nerve block (PNB), major adverse cardiovascular events (MACE), and postoperative length of hospital stay (LOS) in elderly patients who underwent major thoracic and abdominal surgery remains unclear. This study aims to explore the potential mediating effect of MACE on the association between preoperative PNB and postoperative LOS using a statistical mediation framework.</p><p><strong>Methods: </strong>In this retrospective cohort study, perioperative data were collected from elderly patients (aged over 65 years) who underwent major thoracic and abdominal surgery. Mediation analysis was employed to examine the relationships between PNB, MACE, and postoperative LOS.</p><p><strong>Results: </strong>A total of 1915 patients were included in the analysis, with 68.7% (1316/1915) receiving preoperative PNB. Compared to patients who did not receive PNB, those who did had a significantly lower incidence of MACE (P < 0.001) and a shorter postoperative LOS (P < 0.001). The adjusted total and direct associations of PNB with postoperative LOS were - 0.809 days (95% confidence interval [CI], -1.236 to -0.390; P < 0.001) and - 0.661 days (95% CI, -1.077 to -0.250; P = 0.003), respectively. A statistically significant indirect association via MACE was observed (adjusted β=-0.149 days; 95% CI, -0.271 to -0.060; P < 0.001), indicating that 18.1% (95% CI, 6.7% to 41.0%) of the total association was statistically attributable to the indirect pathway through MACE under the model assumptions. A sensitivity analysis excluding postoperative covariates yielded consistent results (proportion mediated: 25.3%).</p><p><strong>Conclusions: </strong>Our findings suggest that the observed association between preoperative PNB and reduced postoperative LOS in elderly patients following major thoracic and abdominal surgery may be partly explained by a statistically significant indirect pathway through a reduction in MACE, potentially accounting for approximately 18% of the total effect. These findings are hypothesis-generating and represent statistical associations rather than demonstrated causal mechanisms.</p><p><strong>Trial registration: </strong>ChiCTR2400087610; https://www.chictr.org.cn.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811297","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":"Investigating the potential of the isometric handgrip exercise as a test of cardiovascular reactivity to blood pressure fluctuations.","authors":"Anna C Zimmermann, Dominik P Guensch, Julia Abegg, Louis Setz, Bernd Jung, Mario D Neuenschwander, Christoph D Utz, Leonard Grob, Hendrik von Tengg-Kobligk, Adrian T Huber, Kady Fischer","doi":"10.1186/s12871-026-03880-2","DOIUrl":"https://doi.org/10.1186/s12871-026-03880-2","url":null,"abstract":"<p><strong>Background: </strong>In the perioperative setting, blood-pressure fluctuations can cause adverse outcomes, underscoring the need to identify vulnerable patients preoperatively. Imaging-based cardiovascular diagnostic tests are rapidly evolving, yet few are developed with anaesthesia in mind. This highlights an opportunity to develop techniques that evaluate the cardiovascular response to changes in blood pressure, but early feasibility studies in healthy controls are needed before clinical application. In combination with cardiovascular magnetic resonance (CMR) imaging, the isometric handgrip test has the potential to comprehensively assess how the heart and ascending aorta respond to transiently elevated blood pressure. We investigated the effect of an isometric handgrip exercise on myocardial tissue features with atrial, ventricular, and aortic function and coupling in healthy adults, assessed by CMR.</p><p><strong>Methods: </strong>In a single-centre observational study, 45 healthy adults underwent a CMR exam. Following acquisition of non-invasive blood pressure as well as cardiac and aortic rest images, participants sustained a grip of a dynamometer at 30% of their maximal strength. After a 2.5 min adjustment period, identical images were acquired. Myocardial blood volume and oxygenation were measured using parametric mapping and oxygenation-sensitive imaging. Furthermore, aortic function was assessed via vascular strain and flow parameters, while atrial and ventricular function were assessed through long-axis shortening. Coupling was calculated from atrial, ventricular and aortic parameters.</p><p><strong>Results: </strong>The isometric handgrip exercise improved left ventricular and left atrial systolic (-18.4±2.6% to -19.3±3.3%, p < 0.05 and 36.2±6.4% to 39.6±7.9%, p < 0.01) and late diastolic function (4.4 ± 1.7% to 5.1 ± 1.6%, p = 0.04 and -11.5 ± 4.5% to -14.8 ± 5.3%, p < 0.01), assessed by long-axis shortening. Aortic strain, reflecting vascular elasticity, decreased (31.0±11.3% to 26.1±12.3%, p < 0.01). The ventricular-arterial systolic coupling index dropped (31.0 ± 11.3% to 26.1 ± 12.3%, p < 0.01), while atrio-ventricular coupling remained unchanged. While myocardial blood volume did not change (T1: 1193±25ms to 1194±22ms, p = 0.77), myocardial oxygenation decreased (-2.9% [95%CI: -4.4, -1.3], p = 0.02).</p><p><strong>Conclusions: </strong>The isometric handgrip exercise effectively increased afterload and elicited augmented cardiovascular function and myocardial oxygen demand in healthy adults. Our data demonstrate the physiological changes expected from increased afterload in healthy hearts. Future studies in patient cohorts are warranted to investigate if it has potential as diagnostic tool for preoperative stress testing.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811294","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":"Intraoperative hemodynamic instability and metabolic recovery are associated with early allograft dysfunction after combined liver-kidney transplantation: a single-center cohort study.","authors":"Taylan Sahin, Ali Sait Kavakli, Alaaddin Aydin, Cansu Altuntas, Eryigit Eren, Mehmet Tasdemir, Hakan Parlak, Mehmet Tokac, Fatih Ensaroglu, Ali Kocyigit, Ayhan Dinckan","doi":"10.1186/s12871-026-03875-z","DOIUrl":"https://doi.org/10.1186/s12871-026-03875-z","url":null,"abstract":"<p><strong>Background: </strong>Combined liver-kidney transplantation (CLKT) is associated with substantial intraoperative hemodynamic instability and metabolic stress. The role of modifiable intraoperative perfusion-related exposures in early allograft dysfunction (EAD) remains incompletely defined.</p><p><strong>Methods: </strong>In this retrospective cohort study, adult and pediatric CLKT recipients (2016-2025) were evaluated. Intraoperative exposures included cumulative duration of mean arterial pressure (MAP) below 65 and 55 mmHg, norepinephrine area under the curve, and serial serum lactate measurements. EAD was defined using established criteria. Discriminatory performance was assessed using receiver operating characteristic analysis, and associations were explored using logistic regression.</p><p><strong>Results: </strong>Among 25 recipients, EAD occurred in 8 (32%). Patients with EAD had significantly longer cumulative durations of MAP < 65 mmHg and higher end-of-surgery serum lactate levels. The cumulative duration of MAP < 65 mmHg demonstrated strong discriminatory performance for EAD (AUC 0.85; 95% CI 0.60-1.00), and end-of-surgery serum lactate also showed robust discrimination (AUC 0.82). Vasopressor exposure did not differ between groups. In multivariable analysis, cumulative MAP < 65 mmHg exposure showed a borderline association with EAD. Thirty-day and 90-day mortality were markedly higher in the EAD group (50% and 62.5%, respectively) compared with 0% in the non-EAD group; however, given the small number of events and complete separation between groups, these findings should be regarded as exploratory.</p><p><strong>Conclusions: </strong>EAD after CLKT is associated with sustained moderate hypotension and impaired metabolic recovery. These hypothesis-generating findings suggest that intraoperative perfusion adequacy may represent a potentially modifiable determinant of early graft function, warranting prospective validation in larger, multicenter cohorts.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811158","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 impact of patient positioning during spinal anesthesia induction on the incidence and severity of post-dural puncture headache and hemodynamic stability: a prospective cohort study.","authors":"Geresu Gebeyehu, Adugna Aregawi, Mulatu Milkiyas","doi":"10.1186/s12871-026-03882-0","DOIUrl":"https://doi.org/10.1186/s12871-026-03882-0","url":null,"abstract":"<p><strong>Background: </strong>Post-dural puncture headache is a common complication of spinal anesthesia and can significantly affect postoperative recovery. Patient positioning during spinal anesthesia has been suggested as a potential influencing factor, although evidence remains inconsistent. This study aimed to compare the incidence of PDPH and perioperative hemodynamic changes between sitting and lateral decubitus positions.</p><p><strong>Methods: </strong>This prospective observational cohort study was conducted from January to April 2024 at a tertiary teaching hospital. A total of 84 adult, ASA I/II patients undergoing elective orthopedic surgery under spinal anesthesia were included. Patients were allocated into either sitting or lateral decubitus position based on routine clinical practice. The primary outcome was incidence and severity of PDPH assessed over five postoperative days using a visual analog scale. Secondary outcomes included changes in mean arterial pressure and heart rate. Multivariable logistic regression was used to adjust for potential confounders, including age, sex, needle gauge, and number of puncture attempts. A p value less than 0.05 was declared as a statistically significant.</p><p><strong>Results: </strong>The incidence of PDPH was significantly higher in the sitting group compared with the lateral group (23.8% vs. 7.1%, p = 0.04). Severity of headache was also greater in the sitting group, with all severe cases occurring in this cohort. After adjustment, sitting position remained associated with increased odds of PDPH (adjusted OR = 3.85, 95% CI: 1.05-14.10). Mean arterial pressure decreased in both groups after spinal anesthesia, with more pronounced early hypotension observed in the lateral group at 10 and 15 min (p < 0.01). Heart rate changes were not significantly different between groups.</p><p><strong>Conclusion: </strong>Patient positioning during spinal anesthesia was associated with differences in PDPH incidence and early hemodynamic changes. The sitting position showed a higher association with PDPH compared with the lateral position. However, given the observational design, these findings should be interpreted as associative rather than causal. Further randomized controlled studies are needed to confirm these results.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811271","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 impact of frailty and sarcopenia index on postoperative nausea and vomiting in elderly patients undergoing sedation-assisted gastrointestinal endoscopy.","authors":"Dongxu Sun, Jinguang Zhang, Zhilin Chen, Rui Liu, Mingming Zuo, Yazhao Sun","doi":"10.1186/s12871-026-03874-0","DOIUrl":"https://doi.org/10.1186/s12871-026-03874-0","url":null,"abstract":"<p><strong>Background: </strong>Frailty and sarcopenia are age-related syndromes characterized by diminished physiological reserve and are associated with adverse health outcomes. This study aimed to investigate the combined impact of frailty and sarcopenia on postoperative nausea and vomiting (PONV) in elderly patients undergoing gastrointestinal endoscopy with sedation.</p><p><strong>Methods: </strong>This prospective cohort study enrolled 703 patients aged ≥ 60 years who underwent sedation-assisted gastrointestinal endoscopy at Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from June 2025 to December 2025. Frailty was assessed using the Fried Frailty Phenotype, and sarcopenia was evaluated using the sarcopenia index (SI). The primary outcome was the incidence of PONV. Multivariable logistic regression, considering reflux esophagitis, motion sickness history, and intraoperative hypotension, was performed, and ROC curve analyses were performed to evaluate the associations of frailty and SI with PONV.</p><p><strong>Results: </strong>The overall incidence of PONV was 31.6%. Multivariable logistic regression showed that frail patients had a significantly increased risk of PONV (OR = 3.237, 95%CI 2.287-4.594, P < 0.001). Similarly, lower SI levels were independently associated with an increased risk of PONV (OR = 0.887, 95%CI 0.799-0.982, P = 0.022). ROC curve analysis showed that frailty predicted PONV with an AUC of 0.642 (sensitivity 51.8%, specificity 76.5%), whereas SI alone showed limited discriminative ability (AUC 0.559). However, when frailty and SI were added to the base model (which included reflux esophagitis, motion sickness history, and intraoperative hypotension), the model's predictive performance significantly improved: the AUC increased from 0.587 to 0.664 (DeLong test P < 0.001), with a NRI of 0.563 (95%CI 0.404-0.721) and an IDI of 0.072 (95%CI 0.040-0.117). Employing the SI cutoff value of 6.442, we categorized patients into four groups. Using the non-frailty + high SI group as a reference, the risk of PONV increased progressively in the non-frailty + low SI group (OR = 1.760, 95%CI 1.077-2.843), frailty + high SI group (OR = 2.888, 95%CI 1.922-4.350), and frailty + low SI group (OR = 6.916, 95%CI 3.856-12.717). Interaction analysis showed a significant additive interaction between frailty and low SI on PONV.</p><p><strong>Conclusions: </strong>Frailty and low SI in elderly patients are significantly associated with an increased risk of PONV following gastrointestinal endoscopy with sedation. Although SI alone has modest discriminative ability, combining it with frailty enhances risk stratification. These findings indicate that assessing physiological reserve using the Fried phenotype and SI may improve preoperative risk evaluation and guide individualized antiemetic prophylaxis in older patients undergoing sedation-assisted endoscopy.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762830","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}