BMC Anesthesiology最新文献

{"title":"Impact of a positive end-expiratory pressure on oxygenation, respiratory compliance, and hemodynamics in obese patients undergoing laparoscopic surgery in reverse Trendelenburg position: a systematic review and meta-analysis of randomized controlled trials.","authors":"Gulfairus A Yessenbayeva, Aizhan M Meyerbekova, Sergey I Kim, Murat B Zhumabayev, Gulbanu S Berdiyarova, Sanzhar B Shalekenov, Dinara S Zharlyganova, Irina Y Mukatova, Yekaterina A Yukhnevich, Dmitriy A Klyuyev, Andrey I Yaroshetskiy","doi":"10.1186/s12871-025-02933-2","DOIUrl":"10.1186/s12871-025-02933-2","url":null,"abstract":"<p><strong>Background: </strong>High and individual positive end-expiratory pressure (PEEP) during laparoscopic surgery may improve oxygenation and respiratory mechanics.</p><p><strong>Methods: </strong>We searched RCTs in PubMed, Cochrane Library, Web of Science, and Google Scholar from from from January 2000 to December 2023 comparing the different intraoperative PEEP (low PEEP (LPEEP): 0-5 mbar; moderate PEEP (MPEEP): 6-9 mbar; high PEEP (HPEEP): >=10 mbar; individualized PEEP (iPEEP): PEEP set by special physiological technique) on arterial oxygenation, respiratory compliance (Cdyn) or driving pressure, mean arterial pressure (MAP), and heart rate (HR) in patients during laparoscopic surgery in reverse Trendelenburg position. We calculated mean differences (MD) with 95% confidence intervals (CI), and predictive intervals (PI) using random-effects models. The Cochrane Bias Risk Assessment Tool was applied.</p><p><strong>Results: </strong>8 RCTs (n = 425) met the inclusion criteria. HPEEP vs. LPEEP increased PaO₂/FiO₂ (+ 129.93 [+ 75.20; +184.65] mmHg, p < 0.0001) with high variation of true effect (Chi² 34.92, p < 0.0001; I² 89%). iPEEP vs. LPEEP also increased PaO₂/FiO₂ + 130.23 [+ 57.18; +203.27] mmHg, p = 0.0005) with high variation of true effect (Chi² 26.95, p < 0.0001; I² 93%). HPEEP vs. LPEEP increased Cdyn (+ 15.06 [5.47; +24.65] ml/mbar, p = 0.002) with high variation of true effect (Chi² 93.16, p < 0.0001; I² 96%). iPEEP vs. LPEEP increased Cdyn (+ 22.46 [+ 8.56; +36.35] ml/mbar, p = 0.002) with high variability of the true effect (Chi² 53.92, p < 0.0001; I² 96%). HPEEP group had higher MAP as compared to LPEEP) + 4.36 [+ 0.36;+8.36], p = 0.03), variability of the true effect was nonsignificant. HR did nit differ between all comparisons.</p><p><strong>Conclusion: </strong>In patients with obesity undergoing surgery in the reverse Trendelenburg position HPEEP and iPEEP may improve oxygenation, decrease driving pressure, and increase dynamic compliance compared to LPEEP with high variation of true effect without relevant hemodynamic compromise. Data with MPEEP comparisons are inconclusive.</p><p><strong>Prospero registration: </strong>CRD42023488971; registered December 14, 2023.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"61"},"PeriodicalIF":2.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363659","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":"Impaired hippocampal neurogenesis associated with regulatory ceRNA network in a mouse model of postoperative cognitive dysfunction.","authors":"Jingrun Lin, Xiaoqiu Zhu, Xuan Li, Yu Hong, Yaohui Liang, Siqi Chen, Chenzhuo Feng, Lin Cao","doi":"10.1186/s12871-025-02928-z","DOIUrl":"10.1186/s12871-025-02928-z","url":null,"abstract":"<p><strong>Background: </strong>Postoperative cognitive dysfunction (POCD) represents a post-surgical complication that features progressive cognitive impairment and memory loss, often occurring in elderly patients. This study aimed to investigate the potential biological mechanisms underlying POCD.</p><p><strong>Methods: </strong>Male C57BL/6 mice (2 and 17 months old) were randomly assigned to surgery or control groups. The surgery group underwent laparotomy under 1.5% isoflurane anesthesia, while controls received no intervention. Cognitive function was assessed 7-10 days post-surgery using open field, Y-maze, and novel object recognition tests. Hippocampal mRNA expression was analyzed using Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment. A competing endogenous RNA (ceRNA) network was constructed using microRNA (miRNA) target prediction databases (miRanda, miRTarbase, miRcode) and sequencing results. Key findings were validated by RT-qPCR and immunofluorescence. The Connectivity Map (CMap) database was queried to predict potential POCD treatments.</p><p><strong>Results: </strong>Aging significantly affected mice's spontaneous activity in the open field test (F1, 28 = 8.933, P < 0.01) and the proportion of time spent in the center area (F1, 28 = 5.387, P < 0.05). Surgery significantly reduced the rate of spontaneous alternations in the Y-maze (F1, 28 = 16.94, P < 0.001) and the recognition index in novel object recognition test (F1, 28 = 6.839, P < 0.05) in aging mice, but had no effect on young mice. Transcriptome analysis revealed that aging and surgery downregulated multiple neurogenesis-related genes in the hippocampus. Doublecortin (DCX) immunofluorescence staining confirmed reduced hippocampal neurogenesis in aging mice, which was further decreased after surgery. We identified several key lncRNAs and miRNAs implicated in neurogenesis regulation. Additionally, drugs were predicted as potential therapeutic candidates for POCD treatment.</p><p><strong>Conclusion: </strong>Both aging and surgery have complex effects on the hippocampal transcriptome in mice. The significant decrease in neurogenesis may be a potential reason for the increased susceptibility of aging mice to POCD. The identified key regulatory lncRNAs, miRNAs, and drugs provide potential therapeutic targets for POCD prevention and treatment.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"60"},"PeriodicalIF":2.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363784","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":"Application of a novel extracorporeal membrane oxygenation system in awake Hu sheep under various durations.","authors":"Shuo Ding, Juan Chen, Yanchao Wu, Huiru Lin, Qiqiang Liang, Gaoqin Teng, Zhenjie Liu, Man Huang","doi":"10.1186/s12871-025-02930-5","DOIUrl":"10.1186/s12871-025-02930-5","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) provides effective support for respiratory and circulatory functions and stands as an essential means in the management of life-threatening conditions. This study aimed to evaluate the safety and efficacy of a novel ECMO system in awake sheep models across various support durations.</p><p><strong>Methods: </strong>Ten healthy Hu sheep were divided into venovenous (VV) and venoarterial (VA) groups, further categorized into short, medium, and long-term observation subgroups. Vital signs and blood indices were meticulously monitored. The integrity of heparin coatings and thrombosis in the ECMO system were assessed at indicated time points, followed by histopathological analysis.</p><p><strong>Results: </strong>All ten sheep survived to their planned endpoints under awake ECMO, exhibiting stable vital signs without notable reductions in blood cells. With the support of ECMO, all sheep demonstrated a significant increase in partial pressure of oxygen (PO₂) and maintained oxygen saturation (SO₂) between 99.8 and 100%. The heparin coating remained relatively intact even after prolonged ECMO operation. Anatomical observations and pathological histology analyses of major organs revealed no apparent abnormalities.</p><p><strong>Conclusions: </strong>In healthy Hu sheep models with different maintenance periods, the novel ECMO support in awake state demonstrated high safety and feasibility.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"59"},"PeriodicalIF":2.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363747","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 randomized controlled trial to compare the effect of oxycodone and sufentanil on postoperative analgesia and immune function for laparoscopic resection of colorectal cancer.","authors":"Chunmei Lin, Zhiqiao Xu, XinLiang, Hong Wei, Xiaoping Wang","doi":"10.1186/s12871-025-02922-5","DOIUrl":"10.1186/s12871-025-02922-5","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study is to evaluate the effect of oxycodone and sufentanil on postoperative analgesia and immune function in patients with laparoscopic resection of colorectal cancer (CRC), as well as the serum level of inflammatory cytokine.</p><p><strong>Methods: </strong>40 patients from August 2023 to August 2024 in Shenzhen Nanshan Hospital undergoing laparoscopic resection of CRC were randomly divided into Group O (n = 20) and Group S (n = 20). The visual analog scale (VAS) score and serial blood samples were assessed during perioperative period. The primary outcomes were VAS scores and immune indicators (including IL-2, C₃, C₄, IgG, IgA, IgE, IgM, CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺) at 24 h and 72 h post-surgery at 24 h and 72 h after surgery. The secondary outcomes were inflammatory markers (including IL-4, IL-6, IL-10, TNF-a and INF-y) at 24 h and 72 h after surgery.</p><p><strong>Results: </strong>The VAS scores at cough in Group O at 24 h and 72 h postoperative were lower than those in Group S (p < 0.001). No significant difference was found in VAS scores at rest between the two groups (P > 0.05). The immune indicators did not show significant changes after using oxycodone or sufentanil for patient-controlled intravenous analgesia (PCIA), respectively. There was no significant difference in inflammatory factors at 24 h and 72 h after surgery between the Group O and Group S.</p><p><strong>Conclusion: </strong>Oxycodone is more effective than sufentanil in alleviating visceral pain, although it does not surpass sufentanil in managing cutting pain. In addition, there is no significant superiority in the effects of oxycodone on immune function and inflammatory cytokine release compared to sufentanil.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry (ChiCTR2400089072).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"58"},"PeriodicalIF":2.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254730","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 the disconnection technique and preemptive one-lung ventilation on lung collapse during one-lung ventilation in thoracoscopic surgery.","authors":"Hongru Zhang, Silin Xiang, Longyong Mei, Yonggeng Feng, Han She, Yi Hu, Li Wang","doi":"10.1186/s12871-025-02899-1","DOIUrl":"10.1186/s12871-025-02899-1","url":null,"abstract":"<p><strong>Background: </strong>During thoracoscopic surgery with one-lung ventilation (OLV), achieving lung collapse is critical for providing surgeons with a good visibility of the surgical field and to minimise tissue compression. The aim of this study was to evaluate the efficacy of both the disconnection technique and preemptive one-lung ventilation in facilitating lung collapse during thoracoscopic surgery using a double-lumen tube (DLT).</p><p><strong>Methods: </strong>Ninety-seven eligible patients were included and randomly divided into three groups.</p><p><strong>Control group: </strong>OLV was initiated when the surgeon started the skin incision and exposed the operative side. Disconnection group: OLV was started two minutes after the DLT was disconnected, this procedure started when the surgeon performed the skin incision. Preemptive group: OLV was initiated promptly after the patient was turned to the lateral position, and the bronchial tube port was clamped on the operative side at the lateral position for no less than 6 min until the pleura was opened. The primary outcome was the time to achieve satisfactory lung collapse, defined as the time required to reach a lung collapse score of eight points. The secondary outcomes included the lung collapse scores at different time points, Pleural opening times, OLV times, blood gas analysis results and the incidence of hypoxemia and pulmonary complications. The hypothesis formulated before data collection was that both the disconnection technique and preemptive OLV decrease the time to satisfactory lung collapse.</p><p><strong>Results: </strong>Compared to the control group, both the disconnection and the preemptive group had a shorter time to satisfactory lung collapse (P < 0.001), lung collapse in the preemptive group was superior to that in the disconnection group at one minute (P = 0.045), no significant differences were found among the three groups in terms of other outcomes.</p><p><strong>Conclusion: </strong>Both the disconnection technique and preemptive OLV decrease the time to satisfactory lung collapse. However, preemptive OLV results in superior early lung collapse and is therefore may more suitable for clinical application than the disconnection technique.</p><p><strong>Trial registration: </strong>The protocol of this study was registered at www. chictr. org. cn (29/07/2022, ChiCTR2200062199).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"55"},"PeriodicalIF":2.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187678","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":"Risk factors for the delayed discharge from anesthesia intensive care unit: a single-center retrospective study.","authors":"Yue Qian, Jing Hao, Wei Zhu, Yan Yang, Zhuan-Yun Zhang, Lu-Yang Zhou, Xiao-Ping Gu, Zheng-Liang Ma, Yu-E Sun","doi":"10.1186/s12871-025-02925-2","DOIUrl":"10.1186/s12871-025-02925-2","url":null,"abstract":"<p><strong>Background: </strong>A single-center retrospective study was designed to investigate the risk factors associated with delayed discharge from the Anesthesia Intensive Care Unit (AICU).</p><p><strong>Methods: </strong>This retrospective study involved patients admitted in the AICU from January 2017 to December 2022. Risk factors for the delayed discharge from the AICU were analyzed by the binary multivariate logistic regression analysis. Nomogram was constructed to predict the risk of delayed discharge from AICU. The performance of the nomogram was assessed using the receiver operating characteristic curve and calibration curve. A decision curve analysis was also performed to determine the net benefit threshold of prediction.</p><p><strong>Results: </strong>A total of 14,338 patients admitted in the AICU were retrospectively recruited, involving 9,271 males and 5,067 females. The incidence of delayed discharge from the AICU in the cohort was 1.54% (221/14,338). Binary multivariate logistic regression analysis showed that younger than 18 years or older than 64 years, the American Society of Anesthesiologists physical status of class III-IV, body mass index of less than 18 kg/m² or greater than 25 kg/m², preoperative complications, emergency surgeries and intraoperative massive hemorrhage were risk factors for the delayed discharge from an AICU. We utilized nomograms to visually express data analysis results. Based on receiver operating characteristic analysis, calibration plots, and decision curve analysis, we concluded that the nomogram model exhibited excellent performance. Patients undergoing spine surgeries suffered from the highest proportion of delayed discharge from the AICU, followed by those receiving orthopedic and vascular surgeries. Postoperative hemorrhage was the major cause of delayed discharge from an AICU, followed by septic shock, hypoperfusion and pulmonary insufficiency.</p><p><strong>Conclusion: </strong>The incidence of delayed discharge from the AICU in a single-center tertiary hospital is 1.54%. It is influenced by various risk factors, including age, ASA physical status classification, BMI, preoperative complications, type of surgery and intraoperative blood loss. The nomogram model exhibits excellent performance.</p><p><strong>Trial registration: </strong>The single-center retrospective study was approved by the Ethics Committee of Nanjing Drum Tower Hospital (No. 2021-563-01, Data: 22 November 2021) and registered on the Chinese Clinical Trial Registry (No. ChiCTR2300078251, Data: 01 December 2023).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"56"},"PeriodicalIF":2.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187767","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":"Mortality and patient disposition after ICU tracheostomy for secretion management vs. prolonged ventilation: a retrospective cohort study.","authors":"Dominique Dundaru-Bandi, Linda M Zhu, Milana Schipper, Paul J Warshawsky, Blair C Schwartz","doi":"10.1186/s12871-025-02912-7","DOIUrl":"10.1186/s12871-025-02912-7","url":null,"abstract":"<p><strong>Background: </strong>There is little research on long-term, patient-centered outcomes in critically ill patients undergoing tracheostomy for secretion management or prolonged ventilation. The goal of this study was to determine and compare hospital and long-term mortality, and incidence of new institutionalization amongst patients who underwent an ICU tracheostomy for these two aforementioned indications.</p><p><strong>Methods: </strong>This was a single center historic cohort study of all ICU patients who received a tracheostomy for secretion management or prolonged ventilation from 2011 to 2022. We compared hospital and long-term mortality and incidence of new institutionalization between these two groups.</p><p><strong>Results: </strong>A cohort of 247 patients (133 secretion management, 114 prolonged ventilation) was established. Overall hospital mortality was 86/247 (35%), mortality at 1 year was 106/207 (51%), and at 3 years was 117/167 (70%), with no significant difference between the two indications. Patients with prolonged ventilation indication had a significantly higher ICU mortality [34/114 (30%) vs. 13/133 (10%), P < 0.001]. Amongst hospital survivors, 49/137 (36%) were unable to return home, with significantly more patients tracheostomized for secretion management requiring new institutionalization [37/78 (47%) vs. 12/59 (20%), P = 0.002].</p><p><strong>Conclusions: </strong>Tracheostomy indication may be an important determinant of short- and long-term patient-centered outcomes. Patients receiving a tracheostomy for secretion management were twice as likely to be discharged to a new institution compared to prolonged ventilation patients. Patient-centered outcomes should be included in future studies and if confirmed, these outcomes should be incorporated into discussions about tracheostomy decision making.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"54"},"PeriodicalIF":2.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122192","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 airway pressure release ventilation (APRV) versus biphasic positive airway pressure (BIPAP) ventilation in COVID-19 associated ARDS using transpulmonary pressure monitoring.","authors":"Sandra Emily Stoll, Tobias Leupold, Hendrik Drinhaus, Fabian Dusse, Bernd W Böttiger, Alexander Mathes","doi":"10.1186/s12871-025-02904-7","DOIUrl":"10.1186/s12871-025-02904-7","url":null,"abstract":"<p><strong>Background: </strong>APRV has been used for ARDS in the past. Little is known about the risk of ventilator- induced lung- injury (VILI) in APRV vs. BIPAP in the management of in COVID19-associated ARDS (CARDS). This study aimed to compare transpulmonary pressures (TPP) in APRV vs. BIPAP in CARDS in regard to lung protective ventilator settings.</p><p><strong>Methods: </strong>This retrospective, monocentric cohort study (ethical approval: 21-1553) assessed all adult ICU- patients with CARDS who were ventilated with BIPAP vs. APRV and monitored with TPP from 03/2020 to 10/2021. Ventilator-settings / -pressures, TPP, hemodynamic and arterial blood gas parameters were compared in both modes.</p><p><strong>Results: </strong>20 non- spontaneously breathing patients could be included in the study: Median TPPendexpiratory was lower / negative in APRV (-1.20mbar; IQR - 4.88 / +4.53) vs. positive in BIPAP (+ 3.4mbar; IQR + 1.95 / +8.57; p < .01). Median TPPendinspiratory did not differ. In APRV, mean tidal- volume per body- weight (7.05 ± 1.28 vs. 5.03 ± 0.77 ml; p < .01) and mean airway- pressure (27.08 ± 1.67 vs. 22.68 ± 2.62mbar; p < .01) were higher. There was no difference in PEEP, peak-, plateau- or driving- pressure, compliance, oxygenation and CO₂- removal between both modes.</p><p><strong>Conclusion: </strong>Despite higher tidal- volumes / airway-pressures in APRV vs. BIPAP, TPPendinspiratory was not increased. However, in APRV median TPPendexpiratory was negative indicating an elevated risk of occult atelectasis in APRV- mode in CARDS. Therefore, TPP- monitoring could be a useful tool for monitoring a safe application of APRV- mode in CARDS.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"52"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073864","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":"Opioid sparing anesthesia in patients with liver cirrhosis undergoing liver resection: a controlled randomized double-blind study.","authors":"Eman Sayed Ibrahim, Ahmed A Metwally, Mohamed Abdullatif, Essam A Eid, Mahmoud G Mousa, Amany A Sultan","doi":"10.1186/s12871-025-02915-4","DOIUrl":"10.1186/s12871-025-02915-4","url":null,"abstract":"<p><strong>Objective: </strong>Opioid metabolism and pharmacodynamics may be affected in hepatic patients. Ketamine and dexmedetomidine are conventional anesthetics used in our daily practice. The opioid-sparing effects of this combination have not been evaluated in patients with liver cirrhosis undergoing liver resection. We aimed to investigate the potential peri-operative opioid-sparing effects of intra-operative dexmedetomidine and ketamine infusions in patients with Child A liver cirrhosis undergoing liver resection.</p><p><strong>Methods: </strong>This study was a randomized controlled double-blind trial. 92 adult patients of both sex with Child class (A) liver cirrhosis aged 18 to 65 years entering and completing the study. We excluded patients with renal or cardiac dysfunction or contraindications from study medications.46 patients in the opioid-sparing group (OS) receiving ketamine and dexmedetomidine infusions and 46 patients in the opioid-based (OB) group as controls. The main outcome measures: were intra-operative fentanyl requirements, postoperative fentanyl requirements, visual analogue pain scores, postoperative nausea, vomiting, ileus, desaturation, intra-operative hemodynamic events, and ICU stay were recorded.</p><p><strong>Results: </strong>The total intra-operative fentanyl consumption was significantly lower in the OS group compared with the OB group, 183.2 ± 35.61 µg and 313.5 ± 75.06 µg, respectively, P < 0.001. The postoperative 1st 48 h fentanyl consumption was significantly lower in the OS group compared with the OB group, 354.5 ± 112.62 µg and 779.1 ± 294.97 ± µg, respectively, P < 0.001. Visual analogue scores were significantly better in the OS group at the early 2-hour assessment point postoperatively. The postoperative adverse events were significantly more frequent in the opioid-based group. ICU stay was significantly shorter in the OS group.</p><p><strong>Conclusions: </strong>Administering dexmedetomidine and ketamine infusions intra-operatively to patients with Child A liver cirrhosis undergoing liver resection resulted in notable opioid-sparing effects, with reductions of approximately 40% intra-operatively and 55% postoperatively. The opioid-sparing group exhibited improved postoperative outcomes, including reduced pain, decreased incidence of opioid-related side effects and shorter ICU stays.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"53"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073876","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":"Development and validation of a nomogram for predicting perioperative transfusion in children undergoing cardiac surgery with CPB.","authors":"Wenting Wang, He Wang, Jia Liu, Yu Jin, Bingyang Ji, Jinping Liu","doi":"10.1186/s12871-025-02917-2","DOIUrl":"10.1186/s12871-025-02917-2","url":null,"abstract":"<p><strong>Background: </strong>Timely recognition of perioperative red blood cell transfusion (PRT) risk is crucial for developing personalized blood management strategies in pediatric patients. In this study, we sought to construct a prediction model for PRT risk in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).</p><p><strong>Methods: </strong>From September 2014 to December 2021, 23,884 pediatric patients under the age of 14 were randomly divided into training and testing cohorts at a 7:3 ratio. Variable selection was performed using univariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression. Multivariate logistic regression was then used to identify predictors, and a nomogram was developed to predict PRT risk. The model's performance was evaluated based on discrimination, calibration, and clinical utility in both cohorts.</p><p><strong>Results: </strong>After multiple rounds of variable selection, eight predictors of PRT risk were identified: age, weight, preoperative hemoglobin levels, presence of cyanotic congenital heart disease, CPB duration, minimum rectal temperature during CPB, CPB priming volume, and the use of a small incision. The predictive model incorporating these variables demonstrated strong performance, with an area under the curve (AUC) of 0.886 (95% CI: 0.880-0.891) in the training cohort and 0.883 (95% CI: 0.875-0.892) in the testing cohort. The calibration plot closely aligned with the ideal diagonal line, and decision curve analysis indicated that the model provided a net clinical benefit.</p><p><strong>Conclusions: </strong>Our predictive model exhibits good performance in assessing PRT risk in pediatric patients undergoing cardiac surgery with CPB, providing clinicians a practical tool to optimize individualized perioperative blood management strategies for this vulnerable population.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"49"},"PeriodicalIF":2.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073866","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}