BMC Anesthesiology最新文献

{"title":"Post-traumatic stress disorder following intensive care for COVID-19: a single-center retrospective follow-up study.","authors":"Carsten Zeiner, Pascal D Schmitt, Julius J Weise, Torben M Rixecker, Robert Bals, Philipp M Lepper","doi":"10.1186/s12871-026-04256-2","DOIUrl":"10.1186/s12871-026-04256-2","url":null,"abstract":"<p><strong>Background: </strong>Severe COVID-19 frequently required prolonged intensive care, including mechanical ventilation or extracorporeal membrane oxygenation (ECMO). Survivors of such critical illness may develop post-traumatic stress disorder (PTSD).</p><p><strong>Methods: </strong>We conducted a single-center retrospective follow-up study of COVID-19 ICU survivors at Saarland University Medical Center, Germany, assessing ICD-11 trauma-related disorders using the validated International Trauma Questionnaire (ITQ) and analyzing associations with clinical factors.</p><p><strong>Results: </strong>Of 110 eligible patients, 42 (38.2%) valid datasets were obtained. The overall prevalence of ICD-11 trauma-related disorders (PTSD or CPTSD) was 23.8% (95% CI 12.1-39.5%; n = 10), with PTSD diagnosed in 6 participants (14.3%; 95% CI 5.4-28.5%) and CPTSD in 4 participants (9.5%; 95% CI 2.7-22.6%). No statistically significant associations were found for any of the examined variables. Exploratory subgroup analyses revealed numerically higher rates of trauma-related disorders in patients with prior psychiatric treatment (40.0% vs. 21.6%), ECMO therapy (33.3% vs. 16.7%), or renal replacement therapy (50.0% vs. 17.6%); however, these findings should be interpreted with caution given the limited sample size.</p><p><strong>Conclusions: </strong>Nearly one quarter of COVID-19 ICU survivors met the diagnostic criteria for PTSD or CPTSD, a prevalence comparable to that observed in other critically ill populations. No statistically significant associations were identified, and the observed subgroup differences should be regarded as exploratory and hypothesis-generating. The reported prevalence of PTSD/CPTSD highlights the potential value of systematic screening for trauma-related disorder and the integration of psychological support into post-ICU care. Larger prospective multicenter studies are needed to confirm these findings and further characterize potential risk factors.</p><p><strong>Trial registration: </strong>The study was reviewed and approved by the Ethics committee of the Medical Association of Saarland (Number 98/22).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954780","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":"Local anesthetic systemic toxicity with liposomal bupivacaine: a case series and literature review.","authors":"Liu Zhang, Yanjun Lin, Yan Qiu","doi":"10.1186/s12871-026-03922-9","DOIUrl":"10.1186/s12871-026-03922-9","url":null,"abstract":"<p><strong>Background: </strong>Local Anesthetic Systemic Toxicity (LAST) is an uncommon complication, with manifestations ranging from mild, non-specific neurological symptoms to severe cardiac arrest. Toxicity specifically associated with liposomal bupivacaine is even more rarely documented in the literature. We report two cases of LAST following the administration of liposomal bupivacaine and provide a review of previously reported cases.</p><p><strong>Case presentation: </strong>Case 1: A 55-year-old male received 266 mg of liposomal bupivacaine via intercostal nerve block during thoracoscopic lobectomy. During skin closure, he developed cardiac arrest and recurrent ventricular fibrillation. He was successfully extubated and weaned off all vasopressors two hours after lipid emulsion administration and subsequently recovered. Case 2: A 67-year-old male received 266 mg of liposomal bupivacaine via incision infiltration after lobectomy. Shortly after PACU arrival, he developed agitation, fixed gaze, and increased muscle tone. Lipid emulsion infusion led to neurological improvement within five minutes, and he was subsequently discharged successfully.</p><p><strong>Conclusions: </strong>These two cases highlight the potential for catastrophic LAST associated with liposomal bupivacaine. To mitigate this risk, we recommend reducing the dose of local anesthetics when injecting into highly vascular areas and performing careful aspiration during injection to prevent intravascular injection. Furthermore, the early administration of intravenous lipid emulsion should be strongly considered upon any suspicion of LAST.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954730","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 ophthalmic draping on end-tidal CO₂, cerebral oximetry, and optic nerve sheath diameter in cataract surgery: an observational comparison by COVID-19 pneumonia history with randomized oxygen flow allocation.","authors":"Kivanc Ozturk, Ozlem Ersoy Karka, Sengul Cangur, Gizem Demir Senoglu, Ilknur Suidiye Yorulmaz, Gulbin Sezen, Yavuz Demiraran","doi":"10.1186/s12871-026-04213-z","DOIUrl":"10.1186/s12871-026-04213-z","url":null,"abstract":"<p><strong>Background: </strong>Ophthalmic draping during cataract surgery creates an isolated surgical field but may lead to carbon dioxide (CO₂) accumulation beneath the drape. Elevated CO₂ can cause hypercapnia, cerebral vasodilation, and increased intracranial pressure, potentially reflected by changes in cerebral oximetry and optic nerve sheath diameter (ONSD). Patients with a history of COVID-19 pneumonia may exhibit residual pulmonary dysfunction that influences these parameters during surgery. This study aimed to investigate the effects of ophthalmic draping on end-tidal CO₂, cerebral oximetry, and ONSD in patients undergoing cataract surgery and to determine whether these effects differ between patients with and without a history of COVID-19 pneumonia.</p><p><strong>Methods: </strong>This prospective comparative study included 80 ASA I-III patients aged > 18 years with and without a history of COVID-19 pneumonia who underwent unilateral phacoemulsification under local anesthesia. Participants were divided into two main groups: those with (Group A, n = 40) and without (Group B, n = 40) a history of COVID-19 pneumonia. Within each predefined COVID-19 history stratum, patients were randomly allocated by block randomization to receive either 2 L/min (A-2, B-2) or 4 L/min (A-4, B-4) oxygen insufflation beneath the surgical drape. End-tidal CO₂ and hemodynamic parameters were continuously monitored, while cerebral oximetry parameters (rSO₂, ΔO₂Hb, ΔHHb, ΔcHb) were measured bilaterally every five minutes. ONSD was assessed ultrasonographically before and after surgery.</p><p><strong>Results: </strong>ETCO₂ values showed no significant group-by-time differences. Postoperative ONSD values were significantly higher than preoperative values within both main groups and all oxygen-flow subgroups; however, the between-group comparisons were not statistically significant. Right frontal relative deoxyhemoglobin changes (ΔHHb-right) differed significantly between Groups A and B at the 10th minute (p = 0.003), while the other cerebral oximetry parameters demonstrated no significant group- or time-dependent differences. No patient developed hypoxia or neurological deterioration.</p><p><strong>Conclusions: </strong>In patients undergoing short-duration unilateral phacoemulsification under local anesthesia with supplemental oxygen at 2-4 L/min, ophthalmic draping was not associated with clinically meaningful differences in ETCO₂ or ONSD, regardless of the history of COVID-19 pneumonia. Although selected cerebral oximetry parameters showed statistically significant differences between groups, all measured respiratory, hemodynamic, and cerebral physiological variables remained within physiological limits throughout the procedure. These findings should be interpreted within the context of the specific clinical settings studied.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT05571683. Retrospectively registered on 7 October 2022.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178900","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":"Correction: Esketamine-led opioid-free anaesthesia reduces postoperative pulmonary complications in bariatric surgery patients: a prospective randomized controlled trial.","authors":"He-Liang Sun, Han-Yu Liu, Chen-Qi Jiang, Zi-Feng Wu, Wen-Li Wang, Si-Qi Yang, Hui Liang, Shi-Bo Lin, Cun-Ming Liu, Chun Yang","doi":"10.1186/s12871-026-04193-0","DOIUrl":"10.1186/s12871-026-04193-0","url":null,"abstract":"","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856887","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":"Norepinephrine infusion for prophylaxis against spinal-induced hypotension in elderly patients undergoing hip surgery: a randomized controlled comparison of two doses.","authors":"Michael Wahib, Maha Mostafa, Ahmed Hasanin, Eman Alaa Alashmawy, Mahmoud Mustafa, Mai Y Taha, Sarah Amin, Dina Zakaria, Doaa Fawzy","doi":"10.1186/s12871-026-04174-3","DOIUrl":"10.1186/s12871-026-04174-3","url":null,"abstract":"<p><strong>Background: </strong>We aimed to compare the hemodynamic response to two norepinephrine infusion rates for prophylaxis against post-spinal hypotension in elderly population undergoing hip surgery.</p><p><strong>Methods: </strong>This randomized non-inferiority clinical trial included elderly patients scheduled for hip surgery under spinal anesthesia. Patients received norepinephrine infusion at a rate of 0.1 mcg/kg/min (0.1-mcg group) or 0.07 mcg/kg/min (0.07-mcg group) after spinal anesthesia. Intraoperative mean arterial pressure (MAP) and heart rate were recorded every 2 min for 46 min after spinal anesthesia. The primary outcome was the noninferiority comparison between the two groups regarding the average MAP readings. Non-inferiority was declared if the average post-spinal MAP in the 0.07-mcg group was within 8 mmHg of the 0.1-mcg group. Secondary outcomes were incidence of post-spinal hypotension (MAP < 70% of baseline or < 65 mmHg), bradycardia, and hypertension. The secondary outcomes were assessed for superiority.</p><p><strong>Results: </strong>Eighty-four patients were analyzed. The average intraoperative MAP was 87.9 ± 9.5 mmHg in the 0.1-mcg group and 84.5 ± 8.5 mmHg in the 0.07-mcg group, with a mean difference of -3.5 mmHg (95% confidence interval: -7.4 to 0.4 mmHg) and the lower bound of the 95% confidence interval did not cross the prespecified non-inferiority margin. The incidence of hypotension, hypertension, and bradycardia was comparable between the two groups.</p><p><strong>Conclusion: </strong>In elderly patients undergoing hip surgery under spinal anesthesia, a norepinephrine infusion rate of 0.07 mcg/kg/min was not inferior to 0.1 mcg/kg/min in maintaining post-spinal MAP. Both infusion rates had comparable profile regarding adverse events, namely reactive hypertension and bradycardia.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov identifier NCT07077265. URL: https://www.</p><p><strong>Clinicaltrials: </strong>gov/study/NCT07077265?term=NCT07077265&rank=1 .</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863618","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":"Opening editorial for the BMC Anesthesiology collection: recent advances in anesthesia for congenital cardiac diseases.","authors":"Kirsten C Odegard, Erin A Gottlieb","doi":"10.1186/s12871-026-04165-4","DOIUrl":"https://doi.org/10.1186/s12871-026-04165-4","url":null,"abstract":"<p><p>Congenital cardiac anesthesia has evolved substantially over recent decades, contributing to improving outcomes and survival for patients with congenital heart disease (CHD). BMC Anesthesiology has initiated a new Collection, Recent Advances in Anesthesia for Congenital Cardiac Diseases, to highlight emerging research and encourage large-scale studies addressing knowledge gaps, implementation barriers, and future opportunities in the field.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757767","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":"Predicting difficult laryngoscopy via three-dimensional graphical modeling and hybrid artificial intelligence using standard facial photographs in elective surgery patients.","authors":"Bahar Uslu Bayhan, Ilkay Sibel Kervancı, Tuğçe Gazioğlu Kişi, Burak Cemil Balık, Medine Atmaca, Kazim Ersin Altinsoy","doi":"10.1186/s12871-026-04160-9","DOIUrl":"10.1186/s12871-026-04160-9","url":null,"abstract":"<p><strong>Background: </strong>Unexpected difficult laryngoscopy remains one of the leading causes of life-threatening complications in anesthetic practice. Conventional airway assessment tests (e.g., Mallampati classification, thyromental distance) are inherently subjective and demonstrate limited diagnostic accuracy. We aimed to develop a hybrid artificial intelligence model that extracts three-dimensional geometric ratios from standardized facial photographs using deep learning and graph-based modeling to predict difficult laryngoscopy.</p><p><strong>Methods: </strong>In this prospective observational study, consecutive patients scheduled for elective surgery were enrolled. Preoperatively, standardized facial photographs were obtained from eight projection angles. Instead of raw pixel-based image analysis, the images were transformed into three-dimensional anatomical graph structures following local illumination normalization using Contrast Limited Adaptive Histogram Equalization (CLAHE), combined with MediaPipe Face Mesh (468 landmark points) and Pose Estimation (33 skeletal key points). Clinically relevant anatomical indices, including Retrognathia, Overjet, Neck Bulk, and Airway Visibility, were mathematically derived from these coordinates and combined with routinely collected clinical and anthropometric variables as structured model inputs. Cormack-Lehane (CL) grading was used as the reference standard (Grades I-II: non-difficult laryngoscopy; Grades III-IV: difficult laryngoscopy). The structured dataset was used to train XGBoost, Random Forest, and Tabular Transformer models incorporating multi-head attention. To prevent data leakage, Synthetic Minority Over-sampling Technique (SMOTE) augmentation and scaling were applied exclusively to the training set.</p><p><strong>Results: </strong>Preoperative images and anatomical ratios of 198 patients were analyzed. Among the derived indices, the Mouth Opening Ratio and Oropharyngeal Visibility Index showed the highest landmark acquisition success, with extraction in 193 of 198 patients (97.5%). The proposed hybrid artificial intelligence (AI) model achieved a test-set accuracy of 80.0%, sensitivity (recall) of 85.7%, and an area under the curve (AUC) of 0.808 for difficult laryngoscopy prediction.</p><p><strong>Conclusions: </strong>Unlike conventional convolutional neural networks (CNNs) relying on raw pixel processing, the proposed model combines standardized pixel-space measurements and normalized geometric ratios. This landmark-based representation may reduce sensitivity to some acquisition-related variability under standardized imaging conditions. These findings support the feasibility of a landmark-based, geometry-driven approach for objective preoperative airway risk assessment. However, external validation and direct comparison with standardized bedside airway assessment are required before routine clinical implementation.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179114","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":"Temporal distribution of recorded intensive care unit deaths across the 24-hour cycle: a 15-year retrospective hospital-based study.","authors":"Meltem Ceylan Delice, Serpil Sevimli Deniz, Ibrahim Dogan, Baran Tureli, Halide Aydin Sakar, Nilgun Kavrut Ozturk","doi":"10.1186/s12871-026-04180-5","DOIUrl":"10.1186/s12871-026-04180-5","url":null,"abstract":"<p><strong>Background: </strong>Whether recorded deaths in intensive care units (ICUs) follow a uniform temporal distribution throughout the 24-hour cycle remains uncertain. Previous studies have primarily compared broad day-night periods, potentially overlooking finer temporal patterns. We investigated the temporal distribution of recorded ICU deaths using both predefined time intervals and continuous-time modeling.</p><p><strong>Objective: </strong>To characterize the temporal distribution of recorded intensive care unit deaths across the 24-hour cycle using continuous-time and interval-based analyses.</p><p><strong>Methods: </strong>This retrospective observational study included all recorded ICU deaths occurring between 1 January 2010 and 30 June 2025 at a tertiary referral hospital. Exact clock time of death, age, sex, and ICU type were extracted from the hospital information system. The primary analysis evaluated the temporal distribution of recorded ICU deaths using generalized additive models (GAMs) with cyclic cubic regression splines. The cyclic spline specification preserved continuity across midnight and accommodated the periodic nature of the 24-hour cycle.</p><p><strong>Results: </strong>A total of 9,889 recorded ICU deaths were analyzed. Continuous-time analysis demonstrated a significant non-uniform temporal distribution of recorded deaths across the 24-hour cycle (global Wald χ² = 101.88, df = 12, p < 0.001). The fitted generalized additive model identified the highest relative frequency of recorded deaths during the late-morning period (approximately 11:15), whereas the lowest relative frequency occurred during the early overnight hours (approximately 03:36). Secondary interval-based analyses also demonstrated significant temporal heterogeneity (three-interval analysis: χ² = 60.3, p < 0.001; four-interval analysis: χ² = 65.3, p < 0.001), although the corresponding effect sizes were small (Cramer's V = 0.055 and 0.047, respectively). Calendar-period sensitivity analyses indicated that the overall temporal pattern remained broadly consistent despite substantial expansion of the ICU system over the study period.</p><p><strong>Conclusions: </strong>Recorded ICU deaths were not uniformly distributed across the 24-hour cycle. Continuous-time modeling identified significant temporal clustering that would not have been fully captured using conventional interval-based analyses alone. Because denominator data (e.g., ICU occupancy, patient census, admissions, and the population at risk) were unavailable, the present study was designed to evaluate the temporal distribution of recorded ICU deaths rather than temporal variation in mortality risk. The observed temporal differences were statistically significant but quantitatively modest.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954774","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":"Liposomal bupivacaine versus ropivacaine in four-in-one nerve block for total knee arthroplasty: a randomized controlled trial.","authors":"Meirong Wang, Jing Li, Xiao Wu, Jiaming Dai, Wenlue Wu, Chuiliang Liu","doi":"10.1186/s12871-026-04036-y","DOIUrl":"10.1186/s12871-026-04036-y","url":null,"abstract":"<p><strong>Background: </strong>Effective postoperative pain control following total knee arthroplasty (TKA) is essential to enhance for early functional recovery. Liposomal bupivacaine (LB) is a sustained-release formulation of bupivacaine is used to prolong analgesia after regional nerve block. This study evaluated the analgesic efficacy of a single injection of LB for a four-in-one nerve block after TKA.</p><p><strong>Methods: </strong>Between September 2023 and July 2024, 120 patients aged 65-80 years undergoing unilateral TKA under spinal anesthesia were randomized into two groups: LB (n = 60) and RP (ropivacaine, n = 60). This was a randomized, single-blinded trial. In the post-anesthesia care unit, a four-in-one nerve block was performed under ultrasound guidance using either LB or RP. The primary endpoint was the visual analog scale pain score at rest (VAS-R) at 72 h postoperatively. Secondary outcomes included the visual analog scale pain score during movement (VAS-M) over 72 h, opioid consumption on Post Operative Day 1-3 (POD1-3), muscle strength (Medical Research Council [MRC] scale) over 72 h, range of motion (ROM), and length of hospital stay (LOS).</p><p><strong>Results: </strong>Over time, VAS-R and VAS-M from 24 to 72 h postoperatively were significantly lower in the LB group compared with the RP group (P < 0.001), effect size analysis revealed moderate effects (r = 0.53-0.88). But the effects in VAS-R and VAS-M within 12 h postoperatively and the VAS-R AUC over 72 h revealed small effects (r = 0.20-0.45). No opioid consumption was recorded in either group on POD 1, whereas opioid consumption was lower in the LB group on POD2 and POD3 (P < 0.001). Knee ROM and Medical Research Council (MRC) grades were higher in the LB group during the first 72 h postoperatively (P < 0.001). LOS did not differ between groups (P = 0.980). Prolonged numbness occurred in 5 patients (8.3%) in the LB group and in none of the RP group, although the between-group difference was not statistically significant.</p><p><strong>Conclusion: </strong>In patients undergoing four-in-one nerve block after TKA, a single injection of LB provided statistically significant but modest improvement in analgesia, particularly between 24 and 72 h postoperatively. LB was also associated with lower opioid consumption on POD2-3 and better early functional recovery. However, the clinical significance of these findings remains uncertain.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR2500102073. Reg Date 08/05/2025. Retrospectively registered.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763731","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":"Thrombin generation, viscoelastic coagulation profiles, and disease severity in critically Ill COVID-19 patients: a prospective observational study.","authors":"Florian Espeter, Lena Garczarek, David Künne, Henning Kuhlmann, Stefan Heitmeier, Thomas Schmoch, Thorsten Brenner, Karsten Schmidt","doi":"10.1186/s12871-026-04166-3","DOIUrl":"10.1186/s12871-026-04166-3","url":null,"abstract":"<p><strong>Background: </strong>COVID-19-associated coagulopathy is characterized by complex alterations in haemostasis. While thrombin generation assays (TGA) provide a global assessment of coagulation potential, data on thrombin generation in critically ill COVID-19 patients, particularly those requiring extracorporeal membrane oxygenation (ECMO), remain limited.</p><p><strong>Objective: </strong>To describe thrombin generation, viscoelastic coagulation profiles, and contact pathway-related markers in critically ill COVID-19 patients and to explore their association with disease severity during the first week of intensive care treatment.</p><p><strong>Methods: </strong>In this prospective single-center observational study, 48 critically ill patients with COVID-19-associated acute respiratory distress syndrome were included. TGA parameters, rotational thromboelastometry (ROTEM), and contact pathway-related markers were assessed on days 1, 3, and 7 after ICU admission. Associations with disease severity were explored using the Sequential Organ Failure Assessment (SOFA) score. Analyses were exploratory and primarily descriptive.</p><p><strong>Results: </strong>Endogenous thrombin potential (ETP) was inversely correlated with SOFA score on day 1 (r = - 0.43), day 3 (r = - 0.49), and day 7 (r = - 0.31). Peak thrombin showed similar inverse correlations on days 1 and 3. No significant differences in thrombin generation parameters were observed according to SIC status or SAC categories 24 h after ICU admission. ROTEM analyses demonstrated increased clot firmness together with elevated lysis indices and mildly prolonged EXTEM clotting times. Contact pathway-related markers, including factor XI, factor XII, and plasma kallikrein, were inversely associated with disease severity, while factor Xa activity decreased during the observation period.</p><p><strong>Conclusion: </strong>In this cohort of critically ill COVID-19 patients, thrombin generation parameters were inversely associated with disease severity, whereas no association was observed with SIC or SAC-defined coagulopathy. Viscoelastic testing demonstrated increased clot firmness and elevated lysis indices, while contact pathway-related markers decreased with increasing disease severity. These findings provide a descriptive characterization of coagulation abnormalities in critically ill COVID-19 patients and should be interpreted in the context of frequent ECMO support and systemic anticoagulation.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757446","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}