BMC Anesthesiology最新文献

{"title":"Nebulized dexmedetomidine for post-dural puncture headache after cesarean delivery: a systematic review and meta-analysis.","authors":"Yanyan Yang, Hong Tang, Fuhai Bai","doi":"10.1186/s12871-025-03339-w","DOIUrl":"10.1186/s12871-025-03339-w","url":null,"abstract":"<p><strong>Background: </strong>There are limited effective non-invasive treatment options for post-dural puncture headache (PDPH) following cesarean delivery. This meta-analysis aimed to investigate the efficacy and safety of nebulized dexmedetomidine in treating PDPH after cesarean delivery.</p><p><strong>Methods: </strong>Electronic databases were systematically searched from the inception to March 2025. Primary outcomes included pain scores based on the numerical rating scale (NRS) and the visual analogue scale (VAS) at 6, 12, 24, 48, and 72 h after the intervention. Secondary outcomes included the need for epidural blood patch (EBP) and adverse events, such as bradycardia and dry mouth. The Cochrane Risk of Bias 2 (RoB 2) tool was employed to assess the quality of the included studies, and the certainty of evidence was evaluated using the grading of recommendations assessment, development, and evaluation (GRADE) approach.</p><p><strong>Results: </strong>Four randomized controlled trials with 228 patients were included in this meta-analysis. Compared to participants in the control group who received saline or fentanyl, patients with PDPH who received nebulized dexmedetomidine following cesarean delivery exhibited lower pain scores at 6, 12, 24, 48, and 72 hours after the intervention. The quality of evidence ranged from 'very low' to 'moderate'. The nebulized dexmedetomidine group less frequently needed EBP compared to the control group, while there were no significant differences between the two groups in terms of adverse effects.</p><p><strong>Conclusion: </strong>Nebulized dexmedetomidine is a promising non-invasive option for managing PDPH in patients undergoing cesarean delivery. It effectively reduces pain intensity and decreases the need for invasive procedures, such as epidural blood patches, with an acceptable safety profile. This nebulized delivery method may offer practical advantages over traditional systemic approaches, particularly in the postpartum setting.</p><p><strong>Trial registration: </strong>We registered this network meta-analysis with PROSPERO (registration no. CRD420251016279).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"513"},"PeriodicalIF":2.6,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12542067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343445","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":"Corticosteroids for sepsis and septic shock: a meta-analysis of 18 RCTs with dose-stratified and fludrocortisone subgroup evaluation.","authors":"Lv Ruyuan, Shen Zhangshun, Li Hongling, Su Jianling","doi":"10.1186/s12871-025-03388-1","DOIUrl":"10.1186/s12871-025-03388-1","url":null,"abstract":"<p><strong>Background: </strong>The therapeutic benefit of corticosteroids in managing sepsis and septic shock remains controversial, particularly concerning optimal dosing strategies and the role of adjunctive fludrocortisone. Recent large-scale trials and updated guidelines underscore the need for a dose-stratified synthesis. This meta-analysis aimed to comprehensively evaluate the effects of corticosteroids on short-term mortality in sepsis, with subgroup analyses by steroid type, dosage, and geographic region.</p><p><strong>Methods: </strong>This study followed the PRISMA 2020 guidelines. Randomized controlled trials (RCTs) comparing corticosteroids with placebo in adult patients with sepsis or septic shock were included. Subgroup analyses were pre-specified for daily hydrocortisone-equivalent dose (≤ 200 mg, 201-300 mg, > 300 mg), steroid type (hydrocortisone alone vs. hydrocortisone plus fludrocortisone), and region (China vs. non-China). Risk ratios (RRs) with 95% confidence intervals (CIs) were synthesized using a random-effects model.</p><p><strong>Results: </strong>Eighteen RCTs comprising 7,982 patients were included. Corticosteroid therapy was associated with reduced 28-day mortality (RR = 0.88; 95% CI: 0.79-0.98; I² = 39%). The 28-day mortality was 31.0% in the corticosteroid group versus 35.5% in the control group.The most pronounced benefit was seen with 201-300 mg/day regimens (RR = 0.86; I² = 0%) and with combination therapy including fludrocortisone (RR = 0.89). Regional analysis showed weaker effects in trials conducted in China.</p><p><strong>Conclusion: </strong>Moderate-dose corticosteroids, especially when used in conjunction with fludrocortisone, significantly reduce short-term mortality in septic shock. Findings support guideline-endorsed steroid use and highlight the importance of individualized treatment strategies.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"511"},"PeriodicalIF":2.6,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12538775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343462","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":"Effects of ultrasound-guided adductor canal block at different volumes on postoperative analgesia management in patients undergoing total knee arthroplasty: a prospective clinical study.","authors":"Mursel Ekinci, Ahmet Kaciroglu, Mustafa Dikici, Merih Yildiz Eglen, Fatih Bayrak, İrem Aydogmus, Erkan Cem Çelik, Bahadir Ciftci","doi":"10.1186/s12871-025-03383-6","DOIUrl":"10.1186/s12871-025-03383-6","url":null,"abstract":"<p><strong>Background: </strong>Many different analgesia techniques are performed in knee arthroplasty. Adductor canal block is one of the analgesia techniques following knee arthroplasty. The aim of this study was to evaluate the effectiveness of adductor canal block performed at different volumes (20 ml, 30 ml, 40 ml) for postoperative analgesia management in patients undergoing total knee arthroplasty.</p><p><strong>Methods: </strong>This single-center prospective randomized controlled study included 90 patients, aged between 18 and 65, with ASA classification I-II-III, who were scheduled for total knee arthroplasty surgery under spinal anesthesia. Patients were randomized into three groups: Group 20, group 30 and group 40. Postoperative pain, opioid consumption, and motor block were evaluated. Statistical analysis was conducted to compare the primary and secondary outcomes between groups.</p><p><strong>Results: </strong>The difference in static NRS scores at all times except the 8th hour and in dynamic NRS scores at all times was found to be statistically significant. Group 40 had significantly lower opioid consumption and additional analgesic requirements compared to Group 20, but no statistically significant difference was found compared to Group 30. Group 40 had a statistically significantly higher rate of motor block in the first 8 h compared to Groups 20 and 30. No statistically significant difference was found between Groups 20 and 30 in terms of motor block at all times.</p><p><strong>Conclusions: </strong>The findings of our study showed that the optimal volume of adductor canal block to provide effective analgesia and preserve muscle strength functions in the postoperative period after total knee arthroplasty was 30 ml.</p><p><strong>Clinical trial registration number: </strong>NCT06084403.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"510"},"PeriodicalIF":2.6,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12536519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of Dexmedetomidine on remote organ injury in the lung in rats with pancreatic ischemia reperfusion model.","authors":"Feyza Aktepe, Gülay Kip, Selin Erel, Ayşegül Küçük, Mustafa Arslan, Şaban Cem Sezen, Muharrem Atlı, Hasan Bostancı, Kürşat Dikmen, Fatma Er, Mustafa Kavutçu","doi":"10.1186/s12871-025-03373-8","DOIUrl":"10.1186/s12871-025-03373-8","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic ischemia-reperfusion (IR) injury can trigger acute lung injury by causing remote organ involvement. Dexmedetomidine has been reported to exhibit antioxidant and cytoprotective effects in various organs. This study aimed to evaluate the protective effects of dexmedetomidine on lung tissue at the histopathological and biochemical levels in an experimental pancreatic IR model.</p><p><strong>Methods: </strong>A total of 24 male Wistar-Albino rats were randomly divided into four groups: Sham, Sham + Dexmedetomidine, Ischemia-Reperfusion (IR), and IR + Dexmedetomidine (IR-D). Pancreatic ischemia was induced in the IR and IR-D groups by clamping the inferior splenic and gastroduodenal arteries. In the dexmedetomidine groups, the drug was administered intraperitoneally. Lung tissues were examined using hematoxylin-eosin staining; neutrophil infiltration, alveolar wall thickness, and total injury score were calculated. Levels of thiobarbituric acid reactive substances (TBARS), enzyme activities of catalase, glutathione-S-transferase (GST), and arylesterase were measured as markers of oxidative stress.</p><p><strong>Results: </strong>The IR group exhibited significantly greater neutrophil infiltration/aggregation compared to the Sham group (p = 0.002) and the Sham + Dexmedetomidine group (p = 0.05). Alveolar wall thickness was significantly increased in the IR group compared to both the Sham and Sham + Dexmedetomidine groups (p < 0.001 for both). The total lung injury score was markedly higher in the IR group than in the Sham and Sham + Dexmedetomidine groups (p < 0.001). In the IR-D group, alveolar wall thickness (p = 0.032) and total injury score (p = 0.037) were significantly reduced compared to the IR group. TBARS levels were significantly elevated in the IR group (p = 0.001), while a significant reduction was observed in the IR-D group (p = 0.025). Catalase and arylesterase activities were lower in both IR and IR-D groups compared to the control, but dexmedetomidine significantly increased catalase (p = 0.045) and arylesterase (p = 0.018) activities compared to the IR group.</p><p><strong>Conclusion: </strong>Dexmedetomidine significantly reduced oxidative stress, alleviated alveolar structural damage, and decreased the total injury score in lung tissue in a pancreatic IR model. These findings suggest that dexmedetomidine may be a potential pharmacological agent for preventing pulmonary complications that can arise following pancreatic surgery or severe pancreatitis.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"504"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12532922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312091","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":"Propofol TIVA vs. inhalational anesthesia for spine surgery: in‑hospital mortality and postoperative complications in a nationwide Korean cohort.","authors":"Tak Kyu Oh, Saeyeon Kim, In-Ae Song","doi":"10.1186/s12871-025-03385-4","DOIUrl":"10.1186/s12871-025-03385-4","url":null,"abstract":"<p><strong>Background: </strong>Given propofol's antioxidant and anti‑inflammatory properties compared with volatile/inhalational agents, we aimed to evaluate the association between anesthetic technique and both in‑hospital mortality and postoperative complications following spinal surgery.</p><p><strong>Methods: </strong>In this retrospective, population‑based cohort study, we used South Korea's National Health Insurance Service database to identify adult patients (≥ 18 years) who underwent spinal surgery between January 1, 2016 and December 31, 2021. Primary outcomes were in‑hospital mortality and postoperative complications. Propensity score (PS) matching (1:1) was employed to balance baseline characteristics between the total intravenous anesthesia (TIVA) and volatile/inhalational anesthesia (INH) groups.</p><p><strong>Results: </strong>Among 708,387 patients, 264,728 (37.4%) received TIVA and 443,659 (62.6%) received INH. After PS matching, 460,654 patients remained (230,327 per group). In the PS‑matched cohort, TIVA was associated with significantly lower odds of in‑hospital mortality (OR 0.85; 95% CI 0.80-0.89; P = 0.004) and postoperative complications (11.8% vs. 14.2%; OR 0.81; 95% CI 0.80-0.82; P < 0.001) compared with INH. In the full cohort, multivariable logistic regression confirmed these findings: TIVA remained linked to reduced in‑hospital mortality (OR 0.74; 95% CI 0.63-0.87; P < 0.001) and fewer postoperative complications (OR 0.71; 95% CI 0.70-0.73; P < 0.001).</p><p><strong>Conclusions: </strong>In this nationwide cohort, propofol‑based TIVA was associated with lower in‑hospital mortality and fewer postoperative complications than volatile/inhalational anesthesia in adult spinal surgery patients. Prospective trials are warranted to confirm these findings.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"508"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12533432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312035","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":"Applying positive end-expiratory pressure to facemask ventilation improves post-induction lung atelectasis: a three-arm randomized controlled trial.","authors":"Li Yang, Lei Wu, Jingsi Ye, Zhanqi Zhao, Jun Zhang","doi":"10.1186/s12871-025-03352-z","DOIUrl":"10.1186/s12871-025-03352-z","url":null,"abstract":"","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"509"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12535129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311964","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":"Effect of liposomal bupivacaine for the suprascapular nerve combined with axillary nerve block on postoperative analgesia in patients undergoing shoulder surgery: a randomized, observer-blinded trial.","authors":"Mengting Xu, Huiqing Gao, Renji Zheng, Hong Wu, Kaiming Yuan, Jun Li, Qinsai Wang","doi":"10.1186/s12871-025-03392-5","DOIUrl":"10.1186/s12871-025-03392-5","url":null,"abstract":"","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"505"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12532942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311931","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":"A nomogram to predict hypoxemia in the post-anesthesia care unit after laparoscopic bariatric surgery.","authors":"Min Wang, Yiting Li, Qingyun Gong, Yifan Xu, Xiaodong Chen, Jingjing Fan","doi":"10.1186/s12871-025-03390-7","DOIUrl":"10.1186/s12871-025-03390-7","url":null,"abstract":"","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"507"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12532913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esketamine attenuates hemodynamic oscillations during anesthesia induction in elderly gastrointestinal surgical patients: a randomized trial.","authors":"Chuang-Qiang Zhang, Da-Qing Liu, Bi-Yun Chen, Cong Geng, Yu-Xuan Tan, Hui-Ming Zeng, Zhuo Zhen, Jian He, Han-Bing Wang","doi":"10.1186/s12871-025-03384-5","DOIUrl":"10.1186/s12871-025-03384-5","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing gastrointestinal tumor surgery face heightened susceptibility to hemodynamic instability during anesthesia induction, a risk further exacerbated by preoperative fasting. Oscillatory blood pressure fluctuations increase perioperative risks. Esketamine's sympathomimetic properties may counteract propofol-induced hypotension. This study aimed to evaluate the impact of adjunctive esketamine on hemodynamic instability incidence during induction.</p><p><strong>Methods: </strong>This prospective, double-blind RCT (ChiCTR2200060641, registered on June 6, 2022) enrolled ASA I-III patients (18-75 years) scheduled for gastrointestinal tumor surgery at Foshan First People's Hospital (Jun 2022-May 2023). Patients were randomized 1:1 to receive IV esketamine (0.2 mg/kg) or saline placebo during induction. Anesthesia was induced with propofol (1.5-2.0 mg/kg), sufentanil (0.2 µg/kg), and cisatracurium (0.3 mg/kg). The primary outcome was the incidence of hemodynamic instability (defined as hypertension [MAP > 20% baseline], hypotension [MAP < 65 mmHg or > 20% decrease], tachycardia [HR > 100 bpm], bradycardia [HR < 50 bpm], or vasopressor use) from induction to 5 min post-intubation. The secondary outcomes included intraoperative ephedrine consumption, postoperative recovery time, extubation time, duration of post-anaesthesia care unit (PACU) stay, emergence agitation, cough during intubation, and other adverse effects.</p><p><strong>Results: </strong>The incidence of hemodynamic instability was significantly lower in the esketamine group than in the control group during induction (29.3% vs. 55.9%; OR = 0.33, 95% CI: 0.18-0.60; P < 0.001). Specifically, esketamine reduced hypotension (27.2% vs. 44.1%; P = 0.016) and hypertension (3.3% vs. 12.9%; P = 0.016). Ephedrine use was lower (12.0% vs. 24.7%; P = 0.025). CO was preserved in the esketamine group but declined significantly in the control group post-induction (P < 0.05). Cough incidence was reduced with esketamine (8.7% vs. 32.3%; P < 0.001). No differences existed in recovery times, emergence agitation, or PONV.</p><p><strong>Conclusions: </strong>Adjunctive low-dose esketamine (0.2 mg/kg) during propofol-based induction significantly attenuates hemodynamic instability and preserves cardiac output in gastrointestinal surgery patients, without delaying recovery. This approach enhances cardiovascular safety during high-risk induction.</p><p><strong>Trial registration: </strong>This study was registered with the Chinese Clinical Trial Registry (ChiCTR2200060641) on June 6, 2022.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"506"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12533316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of tranexamic acid in cardiac surgery: a systematic review and network meta-analysis.","authors":"Xiaoli Pan, Mingxuan Tang, Zhao Xu, Hong Yu, Jiapeng Huang, Peng Liang","doi":"10.1186/s12871-025-03365-8","DOIUrl":"10.1186/s12871-025-03365-8","url":null,"abstract":"","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"503"},"PeriodicalIF":2.6,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291061","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}