BMC Anesthesiology最新文献

{"title":"Effects of liquid resuscitation guided by internal jugular vein variability during deep inhalation on preventing propofol-induced hypotension in elderly patients.","authors":"Xue-Lian Wei, Ya-Zhi Xi, Lei Xie, Zhen-Ping Li, Huan-Liang Tang, Qing-He Zhou","doi":"10.1186/s12871-025-03227-3","DOIUrl":"10.1186/s12871-025-03227-3","url":null,"abstract":"<p><strong>Background: </strong>Methods for reliably predicting hypotension in patients during general anesthesia induction are currently lacking. Deep inhalation has been shown to enhance the variability of the internal jugular vein (IJV). In this study, we aim to investigate the relationship between internal jugular vein variability (IJVV) during deep inhalation and the extent of blood pressure decrease during propofol induction, as well as the potential of utilizing IJVV as a guide for pre-anesthesia fluid resuscitation.</p><p><strong>Methods: </strong>Before general anesthesia induction, bedside ultrasonic measurement was performed to evaluate the maximum diameter (IJVmax-D) and minimum diameter (IJVmin-D) of the IJV and the maximum cross-sectional area (IJVmax-A) and minimum cross-sectional area (IJVmin-A), and then calculated the IJV diameter variability (IJVV-D) and IJV area variability (IJVV-A). A receiver operating characteristic (ROC) curve was used to determine the diagnostic value of IJVV-D and IJVV-A for predicting propofol induced hypotension (blood pressure decreased ≥ 20%) and calculate the cut-off value. The following prospective randomized controlled trial aimed to compare the incidence of anesthesia-induced hypotension between the IJVV-D or IJVV-A guided fluid administration (Group A) and the standard fluid administration group (Group B) in patients with the variability value > optimal cut-off value. The occurrence rate of hypotension during the propofol induction period was observed and compared between the two groups.</p><p><strong>Results: </strong>A total of 60 patients were included in the final analysis. A significant strong correlation exists between IJVV-A and the degree of blood pressure decrease during deep inhalation (r = 0.858, p < 0.001). The AUC of IJVV-A was 0.900 (95% CI 0.821-0.979, p < 0.001) with a cut-off value of 23.42% (sensitivity: 81.5%, specificity: 84.8%). At the same time, a total of 87 patients with IJVV-A > 23.42% during deep inhalation were included in the data analysis. The incidence of hypotension in Group A was 26.8%, compared to 63.0% in Group B, revealing a statistically significant difference (P < 0.001).</p><p><strong>Conclusions: </strong>A significant relationship was observed between IJVV levels during deep inhalation and the blood pressure decline following propofol induction. Administering IJVV-A guided fluid infusion can significantly reduce propofol-induced hypotension by keeping the IJVV-A less than 23.42% during deep inspiration.</p><p><strong>Trial registration: </strong>Successfully registered on Clinicaltrials.gov on November 1, 2023 (NCT06112769) and on August 1, 2024 (NCT06641505).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"350"},"PeriodicalIF":2.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658419","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 prevents carboprost-induced adverse reactions during cesarean section under combined spinal-epidural anesthesia: a double-blind, randomized trial.","authors":"Feng Zhou, Qingling Ma, Fanqing Meng, Han Bao, Wei Liu, Guangfen Zhang, Yue Tian","doi":"10.1186/s12871-025-03173-0","DOIUrl":"10.1186/s12871-025-03173-0","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate adverse reactions to carboprost reduced by intravenous esketamine administered after childbirth via cesarean delivery with the patient under combined spinal-epidural anesthesia.</p><p><strong>Methods: </strong>The study enrolled pregnant women aged 20-40 years, with American Society of Anesthesiologists (ASA) class II or III, and a gestational age of 37 weeks or more. These women had a scheduled cesarean section procedure with the administration of combined spinal-epidural anesthesia. Patients were randomized to receive esketamine 0.5 mg/kg (Group E) or volume-matched normal saline (Group C) immediately after fetal delivery, prior to carboprost administration (250 µg intramuscularly). The primary outcome was the incidence of vomiting during surgery. The secondary outcomes were the incidence of adverse reactions (nausea, chest rigidity, flushed face, tachycardia, cough, shivering), vital signs (HR, RR, MAP, SPO₂) and postoperative pain assessed using a Visual Analogue Scale (VAS).</p><p><strong>Results: </strong>Eighty-one pregnant women completed the study. The incidence of vomiting (22.5% vs. 56.1%, p < 0.001) and the incidence of nausea, chest rigidity, flushed face, and hypertension were significantly lower in group E than in group C (all p < 0.01), but the incidence of tachycardia was higher in group E (45% vs. 19.5%, p < 0.001). Furthermore, the patients' arterial partial pressure of oxygen was significantly higher in group E than in group C (91.90 ± 5.14 vs. 79.76 ± 3.96, p < 0.001). Postoperative pain at the incision site, as assessed by Visual Analogue Scale (VAS) score, was significantly reduced at 6 h in the Esketamine group compared to the control group. However, there was no significant difference in uterine contraction pain between the two groups at any time point.</p><p><strong>Conclusion: </strong>For women undergoing cesarean delivery under combined spinal-epidural anesthesia, intravenous esketamine administered after delivery of the fetus and prior to carboprost administration during cesarean section under combined spinal - epidural anesthesia was associated with a reduction in the incidence of carboprost - induced adverse reactions and a decrease in postoperative incision pain at 6 h. However, it did not significantly affect postoperative uterine contraction pain.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry (Registration number# ChiCTR2100054985); Date of Registration: 30/12/2021.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"345"},"PeriodicalIF":2.3,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12255002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616233","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":"Bromodomain-containing protein 4 contributes to chronic postsurgical pain via activating TLR4/NF-kappaB-dependent neuroinflammation.","authors":"Ruichen Shu, Yuan Li, Zengli Zhang, Xuan Zhang, Shan Guan, Kaiyuan Wang, Yiqing Yin","doi":"10.1186/s12871-025-03216-6","DOIUrl":"10.1186/s12871-025-03216-6","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain affects 1.5 billion individuals worldwide but remains woefully undertreated, particularly occurring in the populations undergoing surgical procedures. Increasing evidence indicates that epigenetic modifications are involved in the pathogenesis of chronic pain. This study aimed to investigate the role of bromodomain-containing protein 4 (Brd4) in chronification of pain after surgery.</p><p><strong>Methods: </strong>Male Sprague-Dawley rats were subjected to skin/muscle incision and retraction surgery to induce chronic postsurgical pain. Nociceptive thresholds and locomotor activity were assessed. The spinal cord was collected to detect the expressions of Brd4, toll-like receptor 4 (TLR4)/nuclear factor-kappaB (NF-κB) pathway, and proinflammatory cytokines and chemokines release. The BET inhibitor JQ1 was used to verify the contribution of Brd4 to chronic postsurgical pain.</p><p><strong>Results: </strong>Significant upregulation of spinal Brd4 expression, accompanied by activation of the TLR4/NF-κB signaling cascade and increased release of proinflammatory mediators were presented in the rat model of chronic postsurgical pain. The BET inhibitor JQ1 prevented the development of chronic postsurgical pain in a dose-dependent manner. Moreover, JQ1 obviously suppressed the activation of TLR4 and the phosphorylation and translocation of NF-κB as well as subsequently cytokines and chemokines release, including IL-1β, IL-6, TNF-α, CXCL1, CXCL2 and CCL2.</p><p><strong>Conclusions: </strong>The epigenetic regulator Brd4 initiates neuroinflammation in spinal cord through activating TLR4/NF-κB signaling pathway and enhancing cytokine and chemokines release, thereby contributing to the transition to chronic postsurgical pain. JQ1 halts chronic pain development, providing a novel therapy for patients at high risk of persistent pain.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"346"},"PeriodicalIF":2.3,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616232","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":"Exploration of mortality-associated creatinine thresholds for acute kidney injury in cardiac surgery patients with impaired kidney function: a single-center retrospective cohort study.","authors":"Wuhua Jiang, Jiarui Xu, Zhe Luo, Xialian Xu, Xiaoqiang Ding, Yi Fang","doi":"10.1186/s12871-025-03175-y","DOIUrl":"10.1186/s12871-025-03175-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute kidney injury (AKI) is a frequent and severe complication following cardiac surgery, particularly in patients with impaired kidney function. The existing Kidney Disease: Improving Global Outcomes (KDIGO) criteria do not specifically address acute-on-chronic kidney injury in this high-risk population. Previous studies have proposed alternative diagnostic thresholds that identify more AKI cases than KDIGO and are associated with adverse outcomes. However, their association with endpoints including mortality and clinical utility in cardiac surgery patients remain unclear. This study aims to explore optimal perioperative serum creatinine (SCr) change thresholds associated with in-hospital mortality and compare their predictive performance with KDIGO and other proposed thresholds.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study included 1,081 adult cardiac surgery patients with impaired preoperative kidney function (eGFR 15-60 mL/min/1.73 m²). Postoperative SCr changes were assessed as maximum absolute increases within 48 h and maximum fold increases within 7 days. Multivariable Cox regression and restricted cubic spline (RCS) analyses were used to evaluate associations with endpoints including in-hospital mortality, the initiation of KRT, failure of kidney function recovery by hospital discharge (or death), and major adverse kidney events (MAKE), defined as a composite of in-hospital mortality, dialysis dependence at discharge, or non-recovery of kidney function by hospital discharge (or death). Optimal thresholds were derived using receiver operating characteristic (ROC) curve analysis and Youden's index. The predictive performance and net clinical benefit for in-hospital mortality were compared across KDIGO definition, previously proposed thresholds, and the newly derived thresholds using ROC and decision curve analysis (DCA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both the absolute increase in SCr within 48 h and the fold increase within 7 days were independently associated with in-hospital mortality (HR 1.66 and 1.59, respectively), RRT (OR 3.10 and 3.62, respectively), kidney function non-recovery (OR 1.43 and 1.38, respectively), and MAKE (OR 2.32 and 2.24, respectively). For in-hospital mortality, the optimal thresholds identified were 38 µmol/L and 2.177-fold, respectively. ROC analysis showed comparable predictive performance with KDIGO definition and other standards. For in-hospital mortality, decision curve analysis suggested a marginally higher net benefit for the new thresholds within the 10-30% threshold probability range.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study proposes new SCr thresholds specific to cardiac surgery patients with impaired kidney function. If externally validated, these thresholds may aid in improving risk stratification and guiding perioperative management. Nonetheless, further studies are warranted to refine diagnostic approaches to AKI in this high-risk population","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"344"},"PeriodicalIF":2.3,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12247409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616143","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":"Anterior quadratus lumborum block is superior to erector spinae plane block for analgesia after renal transplantation: a randomized controlled trial.","authors":"Yi An, Lixia Li, Zhongjia Li, Fei Lan, Tianlong Wang, Tongwen Ou, Chuanyu Liang, Pei Wang, Xuefei Jia, Hongyi Song, Ke Cui, Huifang Luo, Lei Zhao","doi":"10.1186/s12871-025-03209-5","DOIUrl":"10.1186/s12871-025-03209-5","url":null,"abstract":"<p><strong>Background: </strong>Clinical evidence revealed patients suffered from moderate to severe pain after renal transplantation. Both quadratus lumborum block (QLB) and erector spinae plane block (ESPB) are effective strategies in perioperative analgesia. This trial aims to detect whether truncal blocks are utility in alleviating postoperative pain after renal transplantation.</p><p><strong>Methods: </strong>Ninety-two patients underwent renal transplantation were recruited and randomized to QLB group, ESPB group and control group (C group). Patients in QLB or ESPB group received 0.5% ropivacaine 30 mL for single injection before surgery respectively and patients in C group did not receive any local anesthetic injection before general anesthesia induction. Postoperative pain intensity was evaluated at 0, 2, 4, 6, 8, 12, 24 and 48 h after surgery in the present study. Intraoperative medication and postoperative complications were also recorded and analyzed.</p><p><strong>Results: </strong>The proportion of moderate to severe pain in the first 24 h when moving was lowest in the QLB group (41.9% in QLB group vs. 83.9% in ESPB group vs. 96.7% in C group, P < 0.001). Pain intensity score (NRS) in the QLB group was significantly improved at 0, 2, 4, 6, 8 and 12 h after surgery (P < 0.05). Area under curve (AUCs) of NRS scores were significantly lower in the QLB group than in the ESPB group and C group (P < 0.001). We also observed a reduction of remifentanil consumption in the QLB group than in either the ESPB or C groups (P = 0.008 and P < 0.001, respectively).</p><p><strong>Conclusions: </strong>Quadratus lumborum block before surgery more effectively suppressed pain after renal transplantation relative to erector spinae plane block.</p><p><strong>Trial registration: </strong>This study was registered on October 2, 2020. ChiCTR2000038803.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"343"},"PeriodicalIF":2.3,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607384","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":"Anesthesia information system-assisted detection and effective management of sugammadex-induced anaphylaxis: a case report.","authors":"Yuhei Mae, Michiyoshi Sanuki","doi":"10.1186/s12871-025-03226-4","DOIUrl":"10.1186/s12871-025-03226-4","url":null,"abstract":"","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"341"},"PeriodicalIF":2.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583121","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 mandibular nerve block combined with superficial cervical plexus nerve block in patients undergoing radical surgery for tongue canceron: a randomized controlled trial.","authors":"Yongjun Liu, Wenjie Sun, Shibiao Chen, Shiping Yin, Gaofeng Fan","doi":"10.1186/s12871-025-03219-3","DOIUrl":"10.1186/s12871-025-03219-3","url":null,"abstract":"<p><strong>Background: </strong>This prospective randomized controlled trial evaluates the effectiveness of bilateral mandibular nerve block and bilateral superficial cervical plexus nerve block under general anesthesia for patients undergoing extensive tongue cancer surgery. Given the considerable size of the surgical area and the prolonged duration associated with radical tongue cancer procedures, these factors significantly hinder postoperative recovery, particularly in elderly patients.</p><p><strong>Methods: </strong>For this study, 60 patients scheduled for elective radical tongue cancer surgery were enlisted. These individuals were methodically allocated into three distinct groups through randomization: a group receiving both mandibular and superficial cervical plexus nerve blocks (MC group, n = 20), a group receiving only the mandibular nerve block (M group, n = 20), and a group subjected solely to the superficial cervical plexus nerve block (C group, n = 20).</p><p><strong>Results: </strong>During the first 12 h postoperatively, VAS scores in groups M and C were significantly higher than those in group MC (P < 0.001). The proportion of patients requiring activation of the patient-controlled analgesia pump was greater in groups M and C (45% and 55%, respectively) than in group MC (10%; P = 0.021). Postoperative MAP and HR increased above baseline in groups M and C, and both parameters were significantly elevated compared with group MC (P = 0.03). At the time of tongue incision, group C differed significantly from group M (mean difference, 95% CI 2.43-8.17; P < 0.001) and group MC (mean difference, 95% CI 4.33-10.07; P < 0.001). QOR-15 scores at 24 h and 48 h postoperatively were higher in group MC (91.10 ± 4.98 and 92.65 ± 4.88, respectively) than in group M (83.50 ± 5.89 and 87.95 ± 5.59; P < 0.001) and group C (83.15 ± 6.24 and 88.90 ± 5.63; P < 0.001). Intraoperative remifentanil and sufentanil consumption was lower in group MC than in groups M and C (P < 0.001).</p><p><strong>Conclusions: </strong>Utilizing ultrasound guidance for mandibular and superficial cervical plexus nerve blocks under general anesthesia substantially mitigates postoperative pain and enhances recovery rates following extensive tongue cancer surgeries, with no significant adverse effects observed.</p><p><strong>Trial registration: </strong>China Clinical Trial Registration Center (registration number ChiCTR2400086380).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"340"},"PeriodicalIF":2.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583123","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 intravenous nalbuphine and sufentanil on the median effective effect-site concentration of propofol to attenuate the response to cervical dilation during hysteroscopy: a double-blind, dose-response study.","authors":"Shu-Xi Li, Yan-Hong Zhou, Ying-Jie Yang, Qian Wang, Wan Lei, Jian-Jun Shen, Xin-Zhong Chen, Li-Li Xu","doi":"10.1186/s12871-025-03208-6","DOIUrl":"10.1186/s12871-025-03208-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Nalbuphine, a synthetic opioid receptor agonist, exhibits comparable analgesic activity to morphine while demonstrating superior safety. Recent reports suggest that it is more effective than sufentanil in relieving uterine contraction pain. The objective of our study was to investigate the role of nalbuphine in reducing effect-site propofol concentration (Ce&lt;sub&gt;prop&lt;/sub&gt;) required to suppress response to cervical dilation in 50% of patients (EC&lt;sub&gt;50&lt;/sub&gt;) undergoing hysteroscopy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Ninety patients having monitored anesthesia care for hysteroscopy were randomized to receive 0.15 mg·kg&lt;sup&gt;-1&lt;/sup&gt;, 0.2 mg·kg&lt;sup&gt;-1&lt;/sup&gt; intravenous nalbuphine or 0.15 μg·kg&lt;sup&gt;-1&lt;/sup&gt; intravenous sufentanil, followed by a target controlled infusion (TCI) of propofol. The initial target effect-site propofol concentration (Ce&lt;sub&gt;prop&lt;/sub&gt;) was 3.5 μg·ml&lt;sup&gt;-1&lt;/sup&gt; which was increased or decreased in subsequent patients by steps of 0.5 μg·ml&lt;sup&gt;-1&lt;/sup&gt; according to whether there was loss of response to cervical dilation in the previous patient. We used up-down sequential analysis to determine values of Ce&lt;sub&gt;prop&lt;/sub&gt; that produced an effective response in 50% of patients (EC&lt;sub&gt;50&lt;/sub&gt;). Probit analysis was applied as a backup and sensitivity test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The calculated EC&lt;sub&gt;50&lt;/sub&gt; of propofol in nalbuphine Group of 0.2 mg·kg&lt;sup&gt;-1&lt;/sup&gt; (3.57 [95% CI 3.36 to 3.79] μg·ml&lt;sup&gt;-1&lt;/sup&gt;) were lower compared to propofol in nalbuphine Group of 0.15 mg·kg&lt;sup&gt;-1&lt;/sup&gt; (4.04 [95% CI 3.85 to 4.22] μg·ml&lt;sup&gt;-1&lt;/sup&gt;) and sufentanil Group of 0.15 μg·kg&lt;sup&gt;-1&lt;/sup&gt; (4.07 [95% CI 3.88 to 4.25] μg·ml&lt;sup&gt;-1&lt;/sup&gt;) (P = 0.002). Differences between EC&lt;sub&gt;50&lt;/sub&gt; values for propofol in nalbuphine Group of 0.15 mg·kg&lt;sup&gt;-1&lt;/sup&gt; and sufentanil Group of 0.15 μg·kg&lt;sup&gt;-1&lt;/sup&gt; were not statistically significant. Minutely propofol requirement was also lower in 0.2 mg·kg&lt;sup&gt;-1&lt;/sup&gt; nalbuphine Group (0.22 [0.19 to 0.27] mg·kg&lt;sup&gt;-1&lt;/sup&gt;·min&lt;sup&gt;-1&lt;/sup&gt;) compared with 0.15 mg·kg&lt;sup&gt;-1&lt;/sup&gt; nalbuphine Group (0.30 [0.25 to 0.33] mg·kg&lt;sup&gt;-1&lt;/sup&gt;·min&lt;sup&gt;-1&lt;/sup&gt;) and 0.15 μg·kg&lt;sup&gt;-1&lt;/sup&gt; sufentanil Group (0.27 [0.24 to 0.37] mg·kg&lt;sup&gt;-1&lt;/sup&gt;·min&lt;sup&gt;-1&lt;/sup&gt;) (P = 0.020).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;During hysteroscopic surgery, when compared with sufentanil, 0.2 mg·kg&lt;sup&gt;-1&lt;/sup&gt; nalbuphine significantly reduced the EC&lt;sub&gt;50&lt;/sub&gt; for propofol to inhibit cervical dilation response and the propofol requirement, and did not delay the emergence from anesthesia. Whether 0.2 mg·kg&lt;sup&gt;-1&lt;/sup&gt; nalbuphine could improve perioperative prognosis is worthy of further studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;The study was then registered on August 9th, 2023 at the Chinese Clinical Trial Registry which participates in the World Health Organization International Clinical Trials Registry Platform (Identifier: ChiCTR2300074513) before enrolling the first pa","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"342"},"PeriodicalIF":2.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583122","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 multicenter analysis of registry data on postoperative orthopedic pain: a retrospective cohort study.","authors":"Bram Thiel, Marc B Godfried, Seppe J H A Koopman, Marina Huijboom, Krijna Opschoor, Martijn Aarnoudse, Rudolf W Poolman, Jorrit-Jan Verlaan, Joep Kitzen, Cor J Kalkman","doi":"10.1186/s12871-025-03212-w","DOIUrl":"10.1186/s12871-025-03212-w","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain can lead to complications, prolonged hospital stays, and increased healthcare costs. Orthopedic surgeries are particularly associated with severe pain. This study aimed to identify orthopedic procedures that cause severe pain in hospitalized patients within 72 h post-surgery.</p><p><strong>Methods: </strong>Pain scores were retrospectively analyzed for patients undergoing inpatient orthopedic surgery between October 15, 2015, and December 31, 2019, at three hospitals. Patient and procedure details and maximum pain scores were collected up to 72 h postoperatively. Procedures were classified using the International Classification of Health Interventions and ranked by median numeric pain scores.</p><p><strong>Results: </strong>The analysis included 9,918 patients. Median highest pain scores were 4 (IQR 3-6) within 24 h, 4 (IQR 2-5) between 24 and 48 h, and 3 (IQR 2-4) between 48 and 72 h. Open reduction and device implantation into the humerus (e.g., plate fixation) had the highest median scores: 6 (IQR 4-7) at 3-48 h and 5 (IQR 4-6) at 48-72 h. Other high-pain procedures included open shoulder joint surgeries, ankle surgeries, and lumbar spine fusions.</p><p><strong>Conclusions: </strong>Surgeries involving the humerus, shoulder, and lumbar spine were associated with higher pain scores. Further studies incorporating analgesic data are needed to identify effective pain management strategies for these procedures.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"338"},"PeriodicalIF":2.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567055","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 the effects of esketamine/midazolam and remifentanil/midazolam on respiratory mechanics in mechanically ventilated patients with acute respiratory distress syndrome.","authors":"Dujuan Qiao, Wei Liu, Huanjia Xue, Rui Liu, Ya Gao, Jingzhi Dong, Wei Wu, Junkai Feng, Min Li, Linong Yao","doi":"10.1186/s12871-025-03211-x","DOIUrl":"10.1186/s12871-025-03211-x","url":null,"abstract":"<p><strong>Background: </strong>Esketamine exerts analgesic effects and has pharmacological properties of bronchodilation and elevation of mean arterial pressure, making it an interesting analgesic agent for patients with ARDS. Therefore, we conducted a randomized controlled trial comparing the effects of esketamine/midazolam and remifentanil/midazolam on respiratory mechanics and oxygenation in mechanically ventilated patients with ARDS.</p><p><strong>Methods: </strong>In this prospective, randomized, controlled study, patients with ARDS who were undergoing mechanical ventilation were randomly assigned to receive either remifentanil/midazolam (n = 25) or esketamine/midazolam (n = 25). Both groups maintained equivalent levels of sedation and analgesia. The primary outcomes were airway resistance (R_aw) and static respiratory system compliance (C_st) at 24, 48, and 72 h post-medication administration. Plateau Pressure (P_plat), peak airway pressure (P_peak), hemodynamic parameters, mechanical ventilation duration, and ICU length of stay were also recorded.</p><p><strong>Results: </strong>C_st at 72 h post-medication in esketamine group (49.8 ± 13.8) was higher than that in control group (42.4 ± 11.9) (P < 0.05). There was no significant difference in R_aw at 24 h, 48 h and 72 h post-medication between the two groups (P > 0.05). At 72 h post-medication, both P_plat and P_peak in the esketamine group [(15.6 ± 3.1); (25.7 ± 3.8)] were significantly lower than those in the control group[(17.7 ± 4.2); (28.5 ± 4.7)] (P < 0.05). Additionally, the esketamine group [(256.6 ± 89.1); (266.4 ± 88.4); (284.92 ± 84.45)] demonstrated significantly higher PaO₂/FiO₂ ratios compared to the control group [(208.7 ± 61.5);(219.52 ± 61.28); (222.00 ± 68.54)] at all measured time points (P < 0.05). MAP and heart rate were higher in the esketamine group than in the control group, while cumulative doses of vasoactive drugs were comparatively lower in the esketamine group. The duration of mechanical ventilation and ICU length of stay did not-differ (P > 0.05).</p><p><strong>Conclusion: </strong>Esketamine/midazolam leads to improved in C_st and PaO₂/FiO₂ ratio compared to remifentanil/midazolam in mechanically ventilated patients with ARDS.</p><p><strong>Clinical trial registration: </strong>This study was registered at Chinese Clinical Trial Registry (ChiCTR2300070733) on April 21, 2023. URL: https://www.chictr.org.cn/ .</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"339"},"PeriodicalIF":2.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567056","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}