BMC Anesthesiology最新文献

{"title":"Comparison of different hydromorphone bolus doses in patient-controlled intravenous analgesia for post-laparoscopic surgery: a randomized controlled trial.","authors":"Xinlong Li, Minjun Liu, Gang Chen, Chunyan Yan","doi":"10.1186/s12871-025-03287-5","DOIUrl":"10.1186/s12871-025-03287-5","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the analgesic efficacy and safety profile of varying bolus doses of hydromorphone administered via patient-controlled intravenous analgesia (PCIA) in patients undergoing laparoscopic surgery.</p><p><strong>Patients and methods: </strong>In this randomized controlled trial, 111 patients undergoing laparoscopic surgery were randomly allocated into three groups, each receiving hydromorphone PCIA without background infusion. The groups differed by bolus dose: Group A (0.20 mg, n = 39), Group B (0.25 mg, n = 34), and Group C (0.30 mg, n = 38). All PCIA solutions consisted of hydromorphone with same concentration (10 mg diluted in 100 mL normal saline, concentration 0.1 mg/mL), with a lockout interval of 10 min. VAS scores for pain at rest and during activity at 24 h postoperatively were assessed as the primary endpoint measures. Secondary outcomes included pain intensity at rest and during activity at other time points (PACU admission, and 4, 8, 12 h postoperatively), bolus frequency, cumulative hydromorphone consumption, catheter removal time, recovery indices (time to first flatus, oral intake, ambulation), vital signs (oxygen saturation, MAP, heart rate, respiratory rate), and postoperative adverse events (postoperative nausea and vomiting [PONV], pruritus, dizzy and respiratory depression).</p><p><strong>Results: </strong>There were no significant differences among the three groups in VAS scores at rest and during activity at 24 h postoperatively. Similarly, VAS scores at rest and during activity at PACU, 4, 8, and 12 h after surgery did not differ significantly among groups. The frequency of bolus administration was significantly higher in Group A compared to Groups B and C (P = 0.002). No significant differences were observed in total hydromorphone consumption, catheter removal time, bowel function recovery, or other recovery parameters. Although the differences were not statistically significant, the incidence of postoperative adverse events-including nausea and vomiting, pruritus, and dizziness-was lowest in Group B. No cases of respiratory depression occurred in any group.</p><p><strong>Conclusion: </strong>Hydromorphone PCIA at bolus doses of 0.20 mg, 0.25 mg, and 0.30 mg provided equivalent analgesic effectiveness in patients following laparoscopic surgery. The 0.20 mg dose group exhibited higher bolus administration frequency, whereas the 0.25 mg dose demonstrated the lowest incidence of adverse events, suggesting an optimal balance between analgesic efficacy and side-effect profile.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"418"},"PeriodicalIF":2.6,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12376419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943367","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":"Gas composition and pressure in the hypopharynx during high-flow oxygen therapy through a nasal cannula in healthy volunteers with different breathing patterns.","authors":"Andrey I Yaroshetskiy, Anna P Krasnoshchekova, Fedor D Tkachenko, Alina V Rubashchenko, Daniil D Zubarev, Vasiliy D Konanykhin, Maxim I Savelenok, Maxim M Nosenko, Zamira M Merzhoeva, Sergey N Avdeev","doi":"10.1186/s12871-025-03267-9","DOIUrl":"https://doi.org/10.1186/s12871-025-03267-9","url":null,"abstract":"<p><strong>Background: </strong>High-flow nasal cannula is widespread in patients with hypoxemic and hypercapnic respiratory failure, but physiological data concerning influence of the combination of breathing pattern, preset flow rate (PFR), and inspiratory oxygen fraction (F_DO₂) on end-expiratory pressure (EEP), capnogram, oxygram, and exhaled tidal volume (VTe) remains insufficient.</p><p><strong>Methods: </strong>The study included 20 healthy subjects with 12 combinations of PFR (30-60-80 L/min) and F_DO₂ (40-60-80-100%) multiplied by 4 breathing patterns: mouth closed (CM), mouth open (OM), and combination of the CM and OM with hyperpnea (HCM and HOM). Pressure, capnogram, oxygram were measured from hypopharyngeal catheter, VTe, and subject's comfort were assessed.</p><p><strong>Results: </strong>Inspiratory oxygen fraction (FiO₂) were close to F_DO₂ at the PFR of 30 L/min (CM), and 60 L/min (HCM). FiO₂ during the OM and HOM were much less than F_DO₂, variable and unpredictable. PFR of 60 L/min was sufficient to keep FiO₂ close to F_DO₂ during the CM and HCM. End-expiratory carbon dioxide (F_ECO₂) decreased with an increase in the PFR and F_DO₂, reaching 1.4 (1.1-1.7)% at F_DO₂ 100% and PFR of 80 L/min. EEP had grown a lot with the PFR increase and were highly variable reaching 11.1 (7.7-14.8) cmH₂O at the PFR of 80 L/min. VTe at the PFR of 60 and 80 L/min were 948.0 (715.0-1204.8) and 948.0 (869.0-1422.0) ml, respectively. PFR of 60 L/min and 80 L/min were associated with discomfort.</p><p><strong>Conclusion: </strong>HCM, OM, and HOM in healthy subjects decreased FiO₂ and F_ECO₂ (more pronounced during OM and HOM). HFNC within the CM and HCM provided flow-dependent CPAP-effects over a wide range and could be associated with lung hyperinflation. An excessive PFR led to discomfort.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT06189716 , registered on 19/12/2023.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"416"},"PeriodicalIF":2.6,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943224","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":"Music intervention as a strategy to reduce preoperative anxiety: an umbrella review.","authors":"Ke-Lu Yang, Elke Detroyer, Ming-Ming Niu, Danny Feike Hoogma, Jin-Hui Tian, Steffen Rex, Koen Milisen","doi":"10.1186/s12871-025-03120-z","DOIUrl":"https://doi.org/10.1186/s12871-025-03120-z","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anxiety is pervasive among patients awaiting surgical procedures and is associated with an increased risk of postoperative complications. Music intervention is a promising strategy to alleviate preoperative anxiety levels and is easily implementable even in busy clinical settings. Our objective was to conduct an umbrella review of systematic reviews studying the efficacy of music intervention in reducing preoperative anxiety among adult patients.</p><p><strong>Methods: </strong>To identify systematic reviews assessing the effects of music intervention on preoperative anxiety in adult surgical patients, we retrieved MEDLINE via PubMed, EMBASE, CINAHL, and the Cochrane Library from inception until 22 August 2024. The primary outcome was to review the overall efficacy of music intervention in reducing preoperative anxiety levels. In addition, specific details regarding the implementation of music intervention were also summarized. We assessed the quality of the included systematic reviews by using A MeaSurement Tool to Assess Systematic Reviews 2 checklist.</p><p><strong>Results: </strong>Six eligible systematic reviews (i.e. one high-quality, four moderate-quality, and one low-quality review) analyzing 40 primary studies were included. The reporting on the intervention content and its implementation process was often unsatisfactory, with some key information missing. The pooled results on the reduction of preoperative anxiety using music intervention were statistically significant (MD = -5.20, 95%CI (-6.32, -4.07), I² = 49%). Subgroup analyses revealed that music intervention had a more pronounced effect when the duration of the intervention was 20 min or longer and in patients younger than 60 years of age.</p><p><strong>Conclusion: </strong>Music intervention may have a beneficial effect on reducing preoperative anxiety levels. However, to optimize the integration of music intervention into routine clinical practice, high-quality evidence and especially clearer reporting on the implementation methods are required.</p><p><strong>Registration: </strong>PROSPERO (CRD42022333246).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"410"},"PeriodicalIF":2.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943186","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 trial evaluating hemodynamics during minor hepatectomy under general anesthesia combined with thoracic epidural anesthesia: remimazolam versus propofol.","authors":"Ying Qian, Wenting Hou, Li Yang, Nianping Chen, Jun Zhang","doi":"10.1186/s12871-025-03290-w","DOIUrl":"https://doi.org/10.1186/s12871-025-03290-w","url":null,"abstract":"<p><strong>Background: </strong>Hemodynamic instability is common during hepatectomy under general anesthesia combined with thoracic epidural anesthesia, along with intraoperative low central venous pressure (LCVP). We hypothesized that remimazolam-based anesthesia would improve hemodynamic instability compared to propofol-based anesthesia.</p><p><strong>Methods: </strong>The patients undergoing elective hepatectomy under general anesthesia combined with thoracic epidural anesthesia were enrolled and randomly allocated to either group R (remimazolam anesthesia) or group P (propofol anesthesia). The hemodynamic instability was evaluated by the hemodynamic instability scores (HI-score) at induction period, during hepatectomy and hemostasis. The advanced hemodynamic parameters (cardiac index CI, system vascular resistance index SVRI) were recorded. The secondary outcomes including length of PACU stay, changes in hemoglobin level, major cardiovascular events within postoperative 3 days, length of hospital stay, postoperative ambulation time, and time to first flatus were also documented.</p><p><strong>Results: </strong>A total of 72 subjects were randomized, and 33 ones under minor hepatectomy surgery in each group were analyzed finally. There was significant hemodynamics instability in both groups, however, the total HI-score was significantly lower in group R (22.8 ± 2.1) than group P (33.0 ± 4.1, P = 0.029). Further analysis demonstrated that the HI-scores were also lower in group R than group P during induction period (11.9 ± 1.0 vs. 22.6 ± 4.2, P = 0.017), hepatectomy period (23.2 ± 3.2 vs. 38.5 ± 6.0, P = 0.027) and hemostasis period (22.2 ± 2.8 vs. 33.5 ± 3.8, P = 0.019). Nevertheless, compared with propofol-based anesthesia, remimazolam-based anesthesia did not reduce incidence of major cardiovascular events and length of hospital stay (P > 0.05).</p><p><strong>Conclusions: </strong>When compared with propofol-based anesthesia, remimazolam-based anesthesia has better intraoperative hemodynamic stability during minor hepatectomy surgery under combined general-epidural anesthesia. However, this improved hemodynamics may not necessarily translate into better perioperative outcomes.</p><p><strong>Trial registration: </strong>Registered at ClinicalTrials.gov (Registration No. NCT06565715 Principal investigator Jun Zhang Date of registration 08/21/2024 https://clinicaltrials.gov/study/NCT06565715?term=NCT06565715&rank=1 ).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"413"},"PeriodicalIF":2.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943284","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":"Driving pressure-guided dynamic PEEP titration reduces atelectasis and improves oxygenation in pediatric laparoscopy: a randomized trial on personalized ventilation strategies.","authors":"Ling-Hui Guo, Jian-Gang Li, Ming Zhang, Ji-Lin Wu, Chao Xie, Yue Lu, Na Li, Bo Feng, Li-Ming Cheng","doi":"10.1186/s12871-025-03274-w","DOIUrl":"https://doi.org/10.1186/s12871-025-03274-w","url":null,"abstract":"","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"412"},"PeriodicalIF":2.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943337","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 selective supraclavicular nerve block combined with modified clavipectoral fascial plane block for midshaft clavicule fracture surgery: a case report.","authors":"Fei Jiang, Na-Na Li, Yong Yang, Di Liu","doi":"10.1186/s12871-025-03300-x","DOIUrl":"https://doi.org/10.1186/s12871-025-03300-x","url":null,"abstract":"<p><strong>Background: </strong>Conventional anesthesia for clavicular fracture surgery poses significant challenges. General anesthesia risks pulmonary complications, while traditional nerve blocks may cause diaphragmatic paralysis or motor impairment. Ultrasound-guided techniques improve precision, but standalone superficial cervical plexus or interscalene brachial plexus blocks often fail to fully anesthetize the deep clavicular region, especially in polytrauma patients. An optimized combined approach could provide effective analgesia while preserving respiratory and motor function.</p><p><strong>Case presentation: </strong>A 65-year-old male patient with a comminuted fracture of the middle right clavicle and multiple injuries underwent surgery with an ultrasound-guided selective supraclavicular nerve block (SSNB) combined with a modified clavipectoral fascial plane block (MCPB), referred to here as SSCPB. The supraclavicular nerve and clavipectoral fascia were precisely located using ultrasound, and 0.4% ropivacaine was administered, supplemented with dexmedetomidine and sufentanil. The patient maintained stable intraoperative vitals with no pain responses and preserved diaphragmatic/limb function. Postoperatively, analgesia was excellent (VAS 0-2 at rest, 3 on movement) without neurological compromise.</p><p><strong>Conclusion: </strong>The SSCPB technique achieves optimal anesthesia for mid-clavicular fracture surgery by combining SSNB with MCPB. This approach effectively prevents diaphragmatic paralysis and upper limb dysfunction, making it particularly suitable for patients with concomitant cardiopulmonary injuries or comminuted fractures. Characterized by its simplicity in operation and high safety profile (avoiding general anesthesia-related risks), SSCPB reduces opioid dependence and promotes postoperative recovery. However, more extensive clinical research is required to establish its long-term safety and efficacy profile, particularly in complicated acromioclavicular joint dislocations where adjunctive sedation or suprascapular nerve blocks might be indicated.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"415"},"PeriodicalIF":2.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943374","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":"Pulmonary protective and antiinflammatory effects of dexmedetomidine in cardiac surgery with cardiopulmonary bypass: a systematic review and metaanalysis.","authors":"Jiapeng Liu, Ruifang Gao, Jing Ma, Jiange Han, Zhigang Guo","doi":"10.1186/s12871-025-03286-6","DOIUrl":"https://doi.org/10.1186/s12871-025-03286-6","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate pulmonary protective and antiinflammatory effects of dexmedetomidine (DEX) in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) by meta-analysis.</p><p><strong>Methods: </strong>Six databases were searched to collect trials on the pulmonary protective and anti-inflammatory effects of DEX in cardiac surgery with CPB. The search period was from the establishment of each database to August 1, 2024. Alveolar arterial oxygen partial pressure difference (AaDO2), Oxygenation index (OI), respiratory index (RI), IL-6, TNF-α, and CRP values were collected in CPB progress, end of operation, postoperative 6 h(POH6), and postoperative 24 h(POH24). The control group was treated with normal saline after anesthesia induction, while the experimental group with DEX.</p><p><strong>Results: </strong>A total of 9 articles were included. In the overall analysis, AaDO2 (SMD=-1.03, 95%CI:-1.62 to -0.44) and RI (SMD=-1.03, 95%CI:-1.90 to -0.16) in the DEX group were significantly lower than those in the control group, whereas OI was significantly increased (SMD = 0.44, 95%CI: 0.29-0.60). For inflammatory markers, levels of IL-6 (SMD= -1.96, 95%CI: -2.31-1.62) and TNF-α (SMD= -1.81, 95%CI: -2.36-1.26) were significantly decreased in the DEX group. Subgroup analyses based on the course of surgery presented a significant reduction in AaDO2 at the end of operation. At the end of operation, OI was significantly increased, while IL-6 and TNF-α were significantly decreased at POH6 and POH12. At POH24, no significant difference was found in CRP between the two groups (P > 0.05).</p><p><strong>Conclusion: </strong>DEX has pulmonary protective and anti-inflammatory effects in patients undergoing cardiac surgery with CPB.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"414"},"PeriodicalIF":2.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943304","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":"Cell-free hemoglobin is associated with microcirculatory perfusion disturbances and acute kidney injury in rats on extracorporeal membrane oxygenation.","authors":"Carolien Volleman, Dionne P C Dubelaar, Philippa G Phelp, Roselique Ibelings, Anita M Tuip-de Boer, Chantal A Polet, Walter M van den Bergh, Alexander P J Vlaar, Charissa E van den Brom","doi":"10.1186/s12871-025-03251-3","DOIUrl":"https://doi.org/10.1186/s12871-025-03251-3","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) is a life-saving treatment, but carries a high risk of complications such as acute kidney injury (AKI). A contributor to AKI is hemolysis, which induces vasoconstriction and renal tubular cytotoxicity. Here, we have investigated a novel hypothesis that ECMO-induced hemolysis contributes to vascular leakage, edema, microcirculatory perfusion disturbances, and AKI in a rat model.</p><p><strong>Methods: </strong>Rats were exposed to 75 min of ECMO or a sham procedure as control (n = 8 per group). Hemodynamic, blood gas, and microcirculatory perfusion parameters were monitored throughout the experiment. Renal vascular leakage and edema were determined by dextran leakage (70 kDa) and wet-to-dry weight ratio. Markers of hemolysis, inflammation, endothelial activation and damage, and AKI were assessed using spectrophotometry, ELISA and Luminex.</p><p><strong>Results: </strong>Initiation of ECMO increased circulating cell-free hemoglobin (CFHb) compared to baseline (4.01 vs. 1.36 OD, p < 0.001). In parallel, ECMO increased circulating levels of TNFα, IL-6, ICAM-1 and angiopoietin-2, whereas levels in the control group remained stable. The number of continuously perfused vessels (4.36 vs. 13.62 vessels/recording, p < 0.001) and the proportion of perfused vessels (PPV; 23.0 vs. 67.4%, p < 0.001) immediately decreased after initiation of ECMO when compared to controls and remained disturbed one hour after weaning from ECMO. Furthermore, NGAL, a marker of kidney injury, in plasma and urine was higher in the ECMO group compared to the controls (respectively 2191 vs. 410 ng/mL, p < 0.001; 1733 vs. 437 ng/mL, p = 0.0059). Wet-to-dry weight ratio showed increased renal edema in the group undergoing ECMO (4.50 ± 0.27 vs. 3.96 ± 0.16, p < 0.001). Moreover, increasing levels of CFHb in plasma were correlated with a decrease in PPV (r=-0.925, p < 0.001) as well as an increase in plasma NGAL (r = 0.895, p < 0.001) in rats on ECMO.</p><p><strong>Conclusion: </strong>In conclusion, ECMO-induced hemolysis is paralleled by endothelial damage, microcirculatory perfusion disturbances, and kidney injury in a rat model. Our findings suggest that CFHb plays an important role in the pathophysiology of AKI, possibly via endothelial damage. Future studies should clarify the causal relationship between CFHb and endothelial damage, and explore whether targeting CFHb can improve microvascular perfusion and preserve kidney function during ECMO support.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"411"},"PeriodicalIF":2.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943292","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":"Dexmedetomidine for the prevention of postoperative delirium in patients undergoing cardiac surgery: a systematic review and meta-analysis with trial sequential analysis.","authors":"Yiyang Zhong, Zhizhen Ren, Jie Gao, Xingjian He, Qian Li","doi":"10.1186/s12871-025-03264-y","DOIUrl":"10.1186/s12871-025-03264-y","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of dexmedetomidine in preventing postoperative delirium (POD) following cardiac surgery remains controversial. This systematic review aimed to evaluate whether dexmedetomidine could prevent POD in patients undergoing cardiac surgery.</p><p><strong>Methods: </strong>PubMed, CENTRAL, and Embase were searched up to 1 November 2024. Randomized controlled trials (RCTs) concerning dexmedetomidine for preventing POD in patients undergoing cardiac surgery were included. The primary outcome was the incidence of POD, and the secondary outcome was the incidence of postoperative atrial fibrillation (POAF). The analyses were performed using RevMan 5.3 and R 4.4.2 to calculate risk ratio (RR) with 95% confidence interval (CI). Trial sequential analysis (TSA) was conducted using TSA 0.9.5.10 Beta.</p><p><strong>Results: </strong>Thirty-two studies with 6046 participants were included. Dexmedetomidine notably reduced the incidence of POD (RR = 0.67, 95% CI 0.59-0.76, P < 0.00001), with sufficient evidence and conclusive result from TSA. Dexmedetomidine was more effective in preventing POD compared with both positive control (RR = 0.47, 95% CI 0.38-0.59, P < 0.00001) and placebo control (RR = 0.83, 95% CI 0.70-0.98, P = 0.02). It reduced the incidence of POD not only in elderly patients (RR = 0.66, 95% CI 0.54-0.81, P < 0.0001) but also in normal age patients (RR = 0.68, 95% CI 0.57-0.80, P < 0.00001). Moreover, dexmedetomidine decreased the incidence of POAF (RR = 0.82, 95% CI 0.74-0.92, P = 0.0005).</p><p><strong>Conclusions: </strong>Dexmedetomidine could reduce the incidence of POD in patients undergoing cardiac surgery and was associated with a decreased incidence of POAF. The findings should be interpreted with caution because of the low to moderate quality of evidence. Further trials are still needed to explore the optimal regimen of dexmedetomidine.</p><p><strong>Registration number: </strong>INPLASY2024110008.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"408"},"PeriodicalIF":2.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of warmed ropivacaine versus room temperature ropivacaine administered spinal anesthesia on recovery of lower limb muscle strength following total knee or hip replacement: a prospective, double-blind, randomized controlled study.","authors":"Min Wang, Lu Meng, XiaoYuan Ma, Fan Li Bi, Jie Gao, Rongrong Wang, Jiawei Fan, Ye Liu, Longze Su, Lei Wang, Jun Zheng, Erfei Zhang","doi":"10.1186/s12871-025-03294-6","DOIUrl":"10.1186/s12871-025-03294-6","url":null,"abstract":"","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"409"},"PeriodicalIF":2.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882206","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}