BMC Anesthesiology最新文献

{"title":"Portable polysomnography-derived multi-domain EEG markers of anesthetic state transitions during propofol anesthesia for gastrointestinal endoscopy.","authors":"Huimin Li, Yibo Zhao, Yanan Zhang, Aiyue Pei, Fudong Li, Yaru Wang, Lijia Cai, Zan Wang","doi":"10.1186/s12871-026-04125-y","DOIUrl":"https://doi.org/10.1186/s12871-026-04125-y","url":null,"abstract":"<p><strong>Background: </strong>Propofol anesthesia is widely used for gastrointestinal (GI) endoscopy, but electroencephalographic (EEG) features of anesthetic state transitions in this brief and stimulus-rich setting remain incompletely characterized. This study aimed to describe clinically interpretable EEG markers across anesthetic stages using portable polysomnography (PSG)-derived six-channel EEG.</p><p><strong>Methods: </strong>In this prospective observational study, 31 adults undergoing GI endoscopy under propofol-based anesthesia underwent continuous portable PSG recording. EEG analyses focused on six scalp channels (F3, F4, C3, C4, O1, and O2) across four clinically defined stages: baseline, induction, maintenance, and recovery. Relative spectral power, spectral edge frequency at 95% cumulative power (SEF95), and spindle-like event metrics were quantified. Sensor-level functional connectivity was assessed using weighted phase-lag index, imaginary coherence, and amplitude envelope correlation (AEC). Spectral and spindle-like event measures were analyzed using linear mixed-effects models, and connectivity differences were assessed using permutation-based paired tests with false discovery rate correction.</p><p><strong>Results: </strong>Relative delta power decreased from baseline and induction to maintenance and recovery, whereas theta, alpha, sigma, and beta relative power and SEF95 generally increased. Spindle-like event density differed across stages and was highest during recovery, while mean duration and peak frequency remained relatively stable within the 11-16 Hz range. Functional connectivity showed metric-specific modulation: AEC demonstrated the most widespread stage-related differences, whereas phase-based connectivity measures showed only limited edge-specific changes after correction for multiple comparisons.</p><p><strong>Conclusions: </strong>Portable PSG-derived six-channel EEG captured stage-related spectral, spindle-like event, and sensor-level connectivity changes during propofol anesthesia for GI endoscopy. These findings identify candidate EEG features for future evaluation of emergence detection and atypical anesthetic-state identification during procedural anesthesia. Their utility for real-time propofol titration or excessive-sedation warning requires prospective validation.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clavipectoral fascia block associated with intermediate cervical plexus block versus intermediate cervical plexus block alone in clavicle surgeries: a randomized clinical trial.","authors":"Diogo da Conceicao, Pablo Helayel, Jorge Garcia, Joaquim Edson Vieira","doi":"10.1186/s12871-026-04127-w","DOIUrl":"https://doi.org/10.1186/s12871-026-04127-w","url":null,"abstract":"<p><strong>Background: </strong>Midshaft clavicle fractures account for approximately 5% of all bone fractures and frequently require surgical fixation to restore shoulder function. Regional anesthesia techniques are commonly used to improve perioperative analgesia for these procedures; however, the optimal strategy for clavicle surgery remains uncertain. This randomized clinical trial aimed to evaluate whether adding a clavipectoral fascia plane block (CFPB) to an intermediate cervical plexus block (ICPB) improves immediate postoperative analgesia compared with ICPB alone.</p><p><strong>Methods: </strong>In this prospective randomized double-blind trial, 40 adult patients undergoing surgical fixation of midshaft clavicle fractures under general anesthesia were randomly assigned to receive either ICPB combined with CFPB (intervention group) or ICPB alone (control group). All regional blocks were performed under ultrasound guidance using a 38-mm linear transducer. The primary outcome was morphine consumption in the post-anesthesia care unit (PACU). Secondary outcomes included PACU length of stay and perioperative adverse events. Data were analyzed using non-parametric methods, and effect sizes were estimated using Hodges-Lehmann median differences with 95% confidence intervals.</p><p><strong>Results: </strong>Median (interquartile range) morphine consumption in the PACU was 0 (0-0) mg in the intervention group and 0 (0-3) mg in the control group (p = 0.149). The estimated median difference between groups was 0 mg (95% CI - 1 to 0 mg). Median PACU length of stay was 60 (60-82.5) minutes in the intervention group and 75 (60-90) minutes in the control group (p = 0.174), corresponding to an estimated median difference of - 10 min (95% CI - 25 to 5 min). No patients developed dyspnea, signs of Horner's syndrome, or other complications related to the regional anesthesia techniques.</p><p><strong>Conclusion: </strong>In this randomized clinical trial, the addition of a clavipectoral fascia plane block to an intermediate cervical plexus block was not associated with a statistically significant reduction in immediate postoperative morphine consumption or PACU length of stay. However, given the unexpectedly low opioid consumption and the resulting floor effect, modest differences between interventions cannot be excluded. Larger adequately powered studies are required to better define the role of combined regional anesthesia techniques in clavicle surgery.</p><p><strong>Trial registration: </strong>The study was registered with the Brazilian Registry of Clinical Trials (ReBEC) under number U1111-1255-2364.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of surgical risk prediction models with days alive out of hospital at 30 days in colorectal surgeries: a retrospective cohort study.","authors":"Müşerref Beril Dinçer, Mert Canbaz, Esra Saka, Özlem Turhan, Demet Altun, Ahmet Kemalettin Koltka","doi":"10.1186/s12871-026-04121-2","DOIUrl":"https://doi.org/10.1186/s12871-026-04121-2","url":null,"abstract":"<p><strong>Background: </strong>Surgical risk prediction models are widely used in perioperative settings to estimate postoperative risk, but their relationship with patient-centered outcomes remains unclear. Days alive out of hospital (DAOH) integrates postoperative complications, readmissions, and mortality into a single outcome. This study evaluated the associations between established surgical risk prediction models and DAOH following colorectal surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients undergoing colorectal surgery in 2023. Preoperative risk was assessed using the American College of Surgeons (ACS) Surgical Risk Calculator, POSSUM-morbidity, and P-POSSUM mortality scores. Patient characteristics, surgical variables, postoperative complications, readmissions, and mortality were recorded. DAOH at 30 days (DAOH30) and DAOH at 90 days (DAOH90) were calculated; low DAOH30 was defined as below the cohort median. The primary outcome was to evaluate the associations between risk estimates and DAOH30. Secondary outcome analyses included associations between risk estimates and DAOH90, multivariable logistic regression to identify factors associated with low DAOH30, and receiver operating characteristic analysis with area under the curve (AUC) to assess discriminative performance of risk models for low DAOH30.</p><p><strong>Results: </strong>A total of 145 patients were analyzed, with a median DAOH30 of 23 (18-24) days. All risk models were negatively correlated with DAOH30 (ACS-any complication: rho = - 0.603; ACS-serious complication: rho = - 0.515; ACS-death: rho = - 0.447; ACS-readmission: rho = - 0.286; POSSUM-morbidity: rho = - 0.419; P-POSSUM-mortality: rho = - 0.396; all p < 0.001), with similar findings for DAOH90. In multivariable regression analysis, higher ACS-serious complication risk (OR: 1.177; 95% CI: 1.057-1.310; p = 0.003), higher ACS-any complication risk (OR: 1.172; 95% CI: 1.062-1.293; p = 0.002), and longer operative duration were independently associated with low DAOH30. ACS-serious and ACS-any complication estimates demonstrated good discriminative ability for low DAOH30 (AUC = 0.808 [95% CI: 0.735-0.880] and AUC = 0.828 [95% CI: 0.759-0.897], respectively).</p><p><strong>Conclusions: </strong>Surgical risk prediction models were significantly associated with postoperative recovery measured by DAOH following colorectal surgery. The ACS Surgical Risk Calculator estimates for serious and any complication demonstrated good discriminative performance for reduced DAOH30, suggesting their potential utility in identifying patients at risk of impaired postoperative recovery.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dexmedetomidine-based opioid-sparing anesthesia in video-assisted thoracoscopic surgery: a randomized controlled trial.","authors":"Kai-Wei Hsieh, Chun-Hsien Wen, Chen-Hsiu Chen","doi":"10.1186/s12871-026-04070-w","DOIUrl":"https://doi.org/10.1186/s12871-026-04070-w","url":null,"abstract":"<p><strong>Background: </strong>Dexmedetomidine has increasingly been incorporated into opioid-sparing anesthetic strategies during video-assisted thoracoscopic surgery (VATS) because of its analgesic properties and minimal respiratory depression. However, dexmedetomidine remains associated with dose-related hemodynamic adverse effects, particularly bradycardia and hypotension. We evaluated whether a reduced-dose dexmedetomidine regimen decreases intraoperative opioid requirements while maintaining acceptable hemodynamic safety during VATS.</p><p><strong>Methods: </strong>In this prospective randomized controlled trial, 68 patients undergoing VATS were randomly assigned to either a dexmedetomidine group or a control group (34 patients each). The dexmedetomidine group received a loading dose of 0.5 µg/kg followed by continuous infusion at 0.5 µg/kg/h during surgery. The control group received conventional fentanyl-based anesthesia. The primary outcome was maintenance-phase rescue fentanyl consumption. Secondary outcomes included postoperative pain scores, postoperative nausea and vomiting (PONV), postoperative respiratory complications, and perioperative safety outcomes.</p><p><strong>Results: </strong>Maintenance-phase rescue fentanyl consumption was significantly lower in the dexmedetomidine group than in the control group (18.7 vs. 33.2 µg, P = 0.009). Postoperative pain scores, rescue analgesic requirements, PONV, and respiratory complications were comparable between groups. However, the dexmedetomidine group demonstrated a higher incidence of intraoperative bradycardia (23.5% vs. 0%, P = 0.005) and postoperative hypotension during PACU stay (23.5% vs. 2.9%, P = 0.027). These hemodynamic events were transient and responsive to pharmacologic intervention.</p><p><strong>Conclusions: </strong>Dexmedetomidine-based opioid-sparing anesthesia reduced maintenance-phase rescue fentanyl administration during VATS. However, the reduction was modest, was not associated with clear postoperative benefits, and was accompanied by increased bradycardia and hypotension.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT05431322), registered on 14 June 2022. Available at https://clinicaltrials.gov/study/NCT05431322 .</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of dexmedetomidine and droperidol-fentanyl for asleep-awake-asleep techniques in awake craniotomy anesthesia: a randomized controlled study.","authors":"Xiaomei Yang, Dongdong Qu, Yiyan Ren, Yaqiu Guo, Jianpeng Wang, Jianbo Wu, Jianchun Fei, Zhigang Wang, Dejie Liu","doi":"10.1186/s12871-026-04117-y","DOIUrl":"https://doi.org/10.1186/s12871-026-04117-y","url":null,"abstract":"<p><strong>Background: </strong>In this study, we aimed to compare dexmedetomidine with droperidol-fentanyl during the intraoperative awakening phase of awake craniotomy (AC), focusing on wake-up time.</p><p><strong>Methods: </strong>We conducted a single-center randomized controlled trial in China from January 2018 to December 2018. Patients aged 36-60 years, with American Society of Anesthesiologists physical status I-II, scheduled for brain glioma resection, were screened for eligibility; 61 were randomized, and 60 were included in the final analysis. The patients were randomized to either the dexmedetomidine group (intravenous loading dose of dexmedetomidine 0.5 µg·kg^- 1 after discontinuation of propofol and remifentanil, followed by a maintenance infusion of dexmedetomidine 0.3-0.5 µg·kg^- 1·h^- 1) or the droperidol-fentanyl group (intravenous loading doses of fentanyl 2 µg·kg^- 1 and droperidol 5 mg after discontinuation of propofol and remifentanil, followed by continuous maintenance infusions of fentanyl 2 µg·kg^- 1·h^- 1 and droperidol 0.1 mg·kg^- 1·h^- 1). A wake-up assessment was performed during maintenance of the assigned study regimen. The primary outcome measure was wake-up time. Secondary outcomes included the Observer's Assessment of Alertness/Sedation (OAA/S) scale, Numerical Rating Scale (NRS), eloquent brain area mapping status, vital signs, and adverse events.</p><p><strong>Results: </strong>Baseline characteristics were comparable between the groups. Compared with the droperidol-fentanyl group, the dexmedetomidine group had lower mean arterial pressure at T4-T7, lower heart rate at T1-T4 and T7, and a shorter wake-up time, with a between-group difference of 3.5 min (95% CI, 1.95 to 5.05; P < 0.001). No statistically significant differences were detected in OAA/S scores at wake-up (T2), NRS scores, eloquent area mapping status, or adverse events between the groups.</p><p><strong>Conclusion: </strong>No statistically significant differences were detected in OAA/S scores at wake-up or intraoperative brain mapping performance between the two groups. The dexmedetomidine regimen was associated with a shorter measured wake-up time.</p><p><strong>Trial registration: </strong>The Chinese Clinical Trial Registry (ChiCTR1800014329) was retrospectively registered on 6 January 2018.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous intra-arterial versus noninvasive blood pressure monitoring for preventing hypotension during anesthesia induction in patients aged ≥ 75 years undergoing noncardiac surgery: a randomized controlled trial.","authors":"Yihang Li, Shuang Liang, Yuqi Zhang, Ziyu Ye, Qulian Guo, Wangyuan Zou","doi":"10.1186/s12871-026-04123-0","DOIUrl":"10.1186/s12871-026-04123-0","url":null,"abstract":"<p><strong>Background: </strong>Hypotension is common during the period after induction of general anesthesia and before surgical incision, particularly in older patients. The objective of this study was to compare the effectiveness of continuous intra-arterial pressure monitoring with that of noninvasive blood pressure monitoring in preventing hypotension during anesthesia induction in older patients (≥ 75 years) undergoing noncardiac surgery.</p><p><strong>Methods: </strong>In this single-center, randomized controlled trial, 82 older patients who were scheduled for elective noncardiac surgery under general anesthesia were randomly assigned to the continuous intra-arterial pressure monitoring group or the noninvasive blood pressure monitoring group. The primary outcome was the area under the curve for mean arterial pressure (MAP) < 65 mmHg during the first 15 min after induction, based on invasive blood pressure measurements.</p><p><strong>Results: </strong>The area under the curve for mean arterial pressure < 65 mmHg was significantly lower in the continuous intra-arterial pressure monitoring group (median (interquartile range), 0 (0-6.09) mmHg∙min) than in the noninvasive group (3.67 (0-26.45) mmHg∙min; P = 0.008). The continuous intra-arterial pressure monitoring group also had a shorter duration of MAP < 65 mmHg (0 (0-1.42) vs. 0.87 (0-3.88) minutes; P = 0.010), received lower doses of propofol (16.67 (13.34-24.15) vs. 30 (24.17-40.83) mg; P = 0.011) and remifentanil (25.34 (16.67-40.00) vs. 34.18 (25.00-57.00) µg; P = 0.045), and received vasoactive drugs earlier (0.87 (0.67-1.00) vs. 2.33 (1.87-3.33) minutes; P < 0.001) and at higher doses in the continuous intra-arterial pressure monitoring group.</p><p><strong>Conclusions: </strong>Compared with noninvasive blood pressure monitoring, continuous intra‑arterial pressure monitoring initiated before induction was associated with reduced the incidence, severity, and duration of hypotension during anesthesia induction in older patients (≥ 75 years) undergoing noncardiac surgery.</p><p><strong>Trial registration: </strong>This trial was registered in the Chinese Clinical Trial Registry (ChiCTR2400088505) on August 20, 2024 ( https://www.chictr.org.cn/ ).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaesthetic challenges in a nonagenarian with Parkinson's disease undergoing hip fracture surgery: a case report.","authors":"Pushkar Bishwokarma, Rabi Paudel, Shova Dangol","doi":"10.1186/s12871-026-04126-x","DOIUrl":"https://doi.org/10.1186/s12871-026-04126-x","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures in nonagenarian patients with multiple comorbidities present substantial anaesthetic challenges. Parkinson's disease (PD) adds further complexity through motor symptoms, autonomic dysfunction, and the imperative for uninterrupted dopaminergic therapy.</p><p><strong>Case presentation: </strong>We report the perioperative anaesthetic management of a 93-year-old male with hypertension, Parkinson's disease, hypothyroidism, and dyslipidaemia who underwent cemented left hemiarthroplasty for a transcervical neck of femur fracture. The case was additionally complicated by a significant language barrier, as the patient was exclusively fluent in Newari. Spinal anaesthesia was administered at L3-L4 using 3 mL of 0.5% hyperbaric bupivacaine with 5 µg intrathecal dexmedetomidine, selected to prolong anaesthesia based on discussion with the orthopaedic team; the rationale and limitations of this dosing strategy are critically appraised in the Discussion. Intraoperatively, the patient developed three episodes of hypotension, likely related to sympathetic blockade and adjuvant effects, managed with incremental doses of mephentermine. An episode of intraoperative hypoglycaemia (blood glucose 55 mg/dL) was promptly corrected with 50% dextrose. Postoperatively, the patient developed transient hypoactive delirium due to temporary interruption of dopaminergic therapy, which resolved after resumption of enteral medications by postoperative day 2. On postoperative day 3, the patient developed aspiration pneumonia after oral feeding was initiated by family members despite a functioning nasogastric tube. The condition was managed with antibiotics and supportive care. The patient subsequently improved and was discharged on postoperative day 10.</p><p><strong>Conclusion: </strong>Spinal anaesthesia is feasible in nonagenarians with multiple comorbidities, including Parkinson's disease. This case highlights the need for evidence-based dose optimisation and proactive complication prevention. It further emphasises the importance of low-dose bupivacaine-based spinal anaesthesia in very elderly patients, meticulous perioperative glycaemic monitoring, continuation of dopaminergic therapy, structured delirium prevention strategies, caregiver education, and strict adherence to dysphagia-safe feeding protocols in high-risk geriatric patients.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of preoperative forced vital capacity with prolonged mechanical ventilation after coronary artery bypass grafting: a retrospective cohort Study.","authors":"Meng He, Liaoming He, Jinwei Zhang, Yajing Xu, Xiwei Zhang, Xiaoting Li, Jing Nie, Yongqiang Lai, Changwei Ren, Hao Cui","doi":"10.1186/s12871-026-04090-6","DOIUrl":"https://doi.org/10.1186/s12871-026-04090-6","url":null,"abstract":"<p><strong>Background: </strong>Prolonged mechanical ventilation (PMV) is a serious complication after coronary artery bypass grafting (CABG), yet the association between preoperative pulmonary function and PMV risk remains to be comprehensively evaluated.</p><p><strong>Methods: </strong>This study included adult patients who underwent isolated CABG with preoperative pulmonary function testing. Predicted forced vital capacity (FVC), predicted forced expiratory volume in 1 s (FEV₁), and the FEV₁/FVC ratio were assessed for their association with PMV.</p><p><strong>Results: </strong>Among 1,702 patients, 151 (8.9%) experienced PMV. Patients with PMV were older (65.1 ± 8.5 vs. 62.8 ± 8.8 years, P = 0.003), had higher rates of chronic obstructive pulmonary disease (9.9% vs. 5.4%, P = 0.034) and on-pump CABG (8.6% vs. 1.2%, P < 0.001), lower left ventricular ejection fraction (57.1 ± 10.3% vs. 59.1 ± 8.7%, P = 0.007), lower predicted FVC (82.9 ± 14.0% vs. 88.1 ± 14.9%, P < 0.001), and lower predicted FEV₁ (88.7 ± 15.5% vs. 92.6 ± 16.2%, P = 0.007). They also had higher perioperative mortality (4.0% vs. 0.1%, P < 0.001), longer postoperative hospital stays (10.9 ± 4.2 vs. 8.0 ± 2.6 days, P < 0.001), and greater hospitalization costs (25,309.4 [22,119.4-33,359.3] vs. 18,155.4 [16,665.8-20,001.5] USD, P < 0.001). Restricted cubic spline analysis showed no non-linear relationship between pulmonary function parameters and PMV. After multivariable adjustment, predicted FVC remained independently associated with PMV (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.95-0.99, P = 0.005), whereas predicted FEV₁ did not.</p><p><strong>Conclusions: </strong>Nearly one-tenth of patients undergoing CABG required PMV, which was associated with greater healthcare resource utilization and higher perioperative complications. Predicted FVC, but not predicted FEV₁, is an independent predictor of PMV.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced-exposure neuromuscular blockade strategies for total laparoscopic hysterectomy within an ERAS pathway: a randomized controlled trial.","authors":"Quanlong Fan, Liang Ge, Lingguo Kong, Zhenzhen Wu, Peng Zhang, Huaijing Hou, Jing Liu, Xueyan Tao, Xudong Han","doi":"10.1186/s12871-026-04107-0","DOIUrl":"10.1186/s12871-026-04107-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Neuromuscular blocking agents (NMBAs) facilitate tracheal intubation and laparoscopic exposure, but residual neuromuscular blockade remains a perioperative concern. We evaluated whether reducing NMBA exposure during total laparoscopic hysterectomy within an Enhanced Recovery After Surgery (ERAS) pathway maintained airway and operative conditions while limiting interpretation of postoperative neuromuscular outcomes to the available measurements.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this single-center, randomized, patient-, surgeon-, postoperative assessor-, and statistician-blinded, parallel-group trial, 135 patients scheduled for elective total laparoscopic hysterectomy were allocated 1:1:1 to no muscle relaxant (NM), rocuronium for induction only (MI), or rocuronium for induction plus maintenance (MIC). After post-randomization exclusions, 130 patients were included in the modified intention-to-treat cohort. The primary endpoint was the proportion of patients achieving clinically acceptable intubating conditions, defined as excellent or good Cooper grades; the full Cooper grade distribution was reported as a supportive outcome. Surgical workspace quality, Cormack-Lehane grades, extubation time, and recovery measures were secondary or supportive outcomes, whereas pain scores and inflammatory biomarkers were analyzed as exploratory outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Successful tracheal intubation was achieved in all analyzed patients. Clinically acceptable intubating conditions were observed in 43/45 patients (95.6%; 95% CI, 84.9%-99.5%) in the NM group, 43/43 patients (100.0%; 95% CI, 91.8%-100.0%) in the MI group, and 42/42 patients (100.0%; 95% CI, 91.6%-100.0%) in the MIC group, with no statistically significant between-group differences observed. No statistically significant between-group differences were observed in Cormack-Lehane grades, surgical workspace scores, extubation time, PACU stay, or hospital stay. In exploratory analyses, VAS pain scores at 2 and 4 h and immediate postoperative IL-6 concentrations were higher in the MIC group than in the other groups; a between-group difference was also observed for immediate postoperative TNF-alpha, with the highest mean value in the MI group. No chest-wall rigidity, difficult mask ventilation, failed intubation, or rescue NMBA administration for intubation difficulty occurred, and recorded adverse events were mainly postoperative nausea and vomiting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this study, reduced NMBA exposure was not associated with differences in clinically acceptable intubating conditions, surgical workspace quality, or early recovery outcomes among selected patients undergoing elective total laparoscopic hysterectomy within an ERAS pathway. These findings suggest that reducing NMBA exposure may be feasible under carefully standardized anesthetic conditions. Further prospective studies incorporating quantitative neuromuscular monitoring are wa","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817388","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":"Technical feasibility of an angle-free ultrasound-assisted approach for challenging lumbar puncture in complex spinal anatomy: a two-patient case series.","authors":"Xuan Wang, Yijun Luo, Xiaolong Zhang, Xiaolin Lu, Daniel A Diedrich, Chanyan Huang, Ying Xiao","doi":"10.1186/s12871-026-04079-1","DOIUrl":"10.1186/s12871-026-04079-1","url":null,"abstract":"<p><strong>Background: </strong>Lumbar puncture is particularly challenging in patients with abnormal spinal anatomy, such as severe scoliosis or obesity. Conventional ultrasound‑assisted neuraxial techniques have two fundamental limitations: inaccurate projection of the probe's geometric center onto the skin when the probe is tilted and difficulty replicating the exact probe angle during needle insertion. These limitations often result in multiple needle passes, prolonged procedure time, and increased patient discomfort and complication risk. We developed an ultrasound‑assisted technique designed to standardize needle trajectory by eliminating the need for lateromedial and craniocaudal angulation through positional adjustment and report its technical feasibility in a case series.</p><p><strong>Case presentation: </strong>This angle‑free technique was applied to two patients with spinal muscular atrophy requiring repeated intrathecal nusinersen injections. Both patients had extremely complex spinal anatomy, including high body mass index (30 and 35.1 kg/m²) and severe scoliosis (Cobb angles 90° and 83°). The technique followed a four‑step protocol: (1) planning using available imaging; (2) ultrasound‑guided positioning; (3) marking the needle insertion point; and (4) inserting the needle parallel to the floor and perpendicular to the bed edge without lateromedial or craniocaudal angulation. All 22 procedures (11 per patient) were completed successfully without persistent neurological complications. First‑attempt success rates were 81.8% in Case 1 and 100% in Case 2, with first‑pass success rates of 45.5% and 54.5%, respectively. Longitudinal data across sequential procedures showed a rapid decreasing trend in both the number of needle passes and needling time.</p><p><strong>Conclusions: </strong>This angle‑free ultrasound‑assisted lumbar puncture appears technically feasible for patients with complex spinal anatomy. The structured \"4P\" protocol (planning, positioning, perpendicular, and parallel) may offer a practical guide for clinical adoption. The observed reduction in needle passes and needling time may suggest potential learnability, but this finding is preliminary and requires confirmation. Further investigation is warranted to definitively establish its learning curve.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}