BMC Anesthesiology最新文献

{"title":"The electromyographic single twitch stimulation for monitoring the effect of rocuronium on vocal cord opening - a randomised controlled trial.","authors":"Jennifer Herzog-Niescery, Maximilian von der Gönna, Sarah Joline Werner, Thomas Peter Weber, Adrian Iustin Georgevici","doi":"10.1186/s12871-025-03201-z","DOIUrl":"10.1186/s12871-025-03201-z","url":null,"abstract":"<p><strong>Background: </strong>The European Society of Anaesthesiology and Intensive Care recommends the use of neuromuscular blocking drugs for tracheal intubation, but the monitoring is difficult, because the parameters are mostly relative values (e.g. Train-of-four ratio), which show no or only weak correlations to the vocal cord aperture. We investigated the predictive effect of the quantitative single twitch (0.3 ms duration supramaximal stimulus, frequency 0.1 Hz) to estimate vocal cord aperture (primary endpoint). Secondarily, we focused on rocuronium dose-related differences between single twitch amplitude and maximum vocal cord aperture.</p><p><strong>Methods: </strong>Thirty-six adult patients undergoing elective surgery with tracheal intubation using rocuronium were included. Patients received remifentanil and propofol for induction of anaesthesia before the neuromuscular block baseline was measured electromyographically using the single twitch stimulation pattern of the ulnar nerve from the abductor digiti minimi muscle. A video-laryngoscope was inserted to document baseline conditions before the patient received either 0.3 or 0.9 mg/kg IBW rocuronium. The vocal cord area was continuously videorecorded for four minutes, before the trachea was intubated.</p><p><strong>Results: </strong>Thirty-five patients completed the study; 18 received 0.3 and 17 received 0.9 mg/kg IBW rocuronium. Data showed a strong correlation between single twitch amplitude and vocal cord aperture (bootstrapped Pearson's coefficients, median ± IQR: -0.58 ± 0.22 in rocuronium 0.3 and -0.74 ± 0.18 in rocuronium 0.9 mg/kg IBW; p < 0.001), meaning that the single twitch amplitude may be a reliable predictor of vocal cord opening. The higher rocuronium dose caused a stronger correlation, lower inter-patient variability, and a steeper single twitch decrease, but the effect on the maximum vocal cord aperture was comparable to that in the 0.3 mg/kg IBW rocuronium group.</p><p><strong>Conclusions: </strong>The quantitative, electromyographic single twitch stimulation pattern can dose-independent predict vocal cord opening after rocuronium administration.</p><p><strong>Trial registration: </strong>The study was registered at the German Clinical Trials Register on the 10th of July 2020 (DRKS00021433) prior to enrolment of the patients.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"333"},"PeriodicalIF":2.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12225377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559161","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 oropharyngeal leak pressure between the SaCoVLM™ video laryngeal mask and LMA supreme in adult elective surgery patients: a prospective randomized controlled trial.","authors":"Gaye Gamze Ozden, Burhan Dost, Cengiz Kaya, Esra Turunc, Ersin Koksal, Yasemin Burcu Ustun, Sezgin Bilgin, Sibel Baris","doi":"10.1186/s12871-025-03218-4","DOIUrl":"10.1186/s12871-025-03218-4","url":null,"abstract":"","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"334"},"PeriodicalIF":2.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559160","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":"Jet ventilation dynamics in rigid bronchoscope: insights from a simulated experimental model.","authors":"Mingyuan Yang, Zhuomin Deng, Xin He, Jing Guo, Shuwang Yang, Qinghao Cheng","doi":"10.1186/s12871-025-03200-0","DOIUrl":"10.1186/s12871-025-03200-0","url":null,"abstract":"<p><strong>Background: </strong>Jet ventilation has emerged as a critical technique in airway management during airway interventions involving rigid bronchoscopy. Given the open airway and the lack of objective data on jet ventilation flow dynamics, intraoperative airway management is currently guided primarily by SpO₂ monitoring and arterial blood gas analysis.</p><p><strong>Objective: </strong>To analyze the effects of jet ventilation modes (normal frequency jet ventilation (NFJV), high frequency jet ventilation (HFJV), and superimposed high frequency jet ventilation (SHFJV)), driving pressure, and frequency on airflow dynamics using a simulated airway model.</p><p><strong>Methods: </strong>A 3D-printed rigid bronchoscope and artificial airway were integrated with a jet ventilator, airflow analyzer, and test lung. Peak airway pressure (P_peak), positive end-expiratory pressure (PEEP) and tidal volume, were measured under various conditions.</p><p><strong>Results: </strong>The major trend observed was that as the frequency increases, both P_peak and tidal volume decrease, while PEEP increases; with higher driving pressure, there is an increase in P_peak, PEEP and tidal volume. During NFJV, maxim P_peak 26.0 (0.7) cmH₂O and tidal volume1399 (3) ml were observed at 1.5 bar and12 bpm, while minimum values 11.8 (0.4) cmH₂O and 488 (3) ml occurred at 0.7 bar and 24 bpm. During HFJV, P_peak, PEEP and tidal volume reached their lowest values at 4.7 (0.3) cmH₂O, 0.8 (0.2) cmH₂O and 24 (3) ml (set at 0.3 bar and 300 bpm). When driving pressure was set at 1.1 bar, both P_peak and tidal volume reached their highest values at 22.3 (0.4) cmH₂O and 280 (2) ml when jet frequency was100 bpm; while, the maximum PEEP reaches highest value of 6.1 (0.3) cmH₂O when jet frequency increased to 300 bpm. SHFJV demonstrated dynamic interactions, with tidal volume ranging from 614 (3) ml to 1105 (1) ml as driving pressure increased from 0.3 to 1.1 bar. At 1.1 bar and 100 bpm, P_peak achieved a value of 41.1 (0.3) cmH₂O and PEEP levels increase to 8.4 (0.3) cmH₂O set at 1.1 bar and 1500 bpm.</p><p><strong>Conclusions: </strong>NFJV provides a larger tidal volume and maintains stable peak pressure, whereas HFJV results in lower tidal volumes at high frequencies and low pressures, which may clinically result in CO₂ retention. SHFJV combines the benefits of both modes, showing potential for complex airway conditions. These findings emphasize the importance of protocolized parameter selection based on individualized airway mechanics.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"332"},"PeriodicalIF":2.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552243","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":"Preoperative early physiologic warning scores in the parturients undergoing cesarean section: a prospective study.","authors":"Onurcan Balik, Pınar Karabacak, Ahmet Bi̇ndal, Mehmet Okan Özkaya, Berit Gökçe Ceylan","doi":"10.1186/s12871-025-03205-9","DOIUrl":"10.1186/s12871-025-03205-9","url":null,"abstract":"","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"331"},"PeriodicalIF":2.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552244","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":"Efficacy and safety of corticosteroids in critically ill patients: a systematic review and meta-analysis.","authors":"Lei Cao, Yingying Xiang, Zhuoxi Wu, Qi Chen, Fang Chen, Guiying Yang, Hong Li","doi":"10.1186/s12871-025-03196-7","DOIUrl":"10.1186/s12871-025-03196-7","url":null,"abstract":"<p><strong>Background: </strong>The overall benefits and potential risks of corticosteroids, frequently administered to critically ill patients remain uncertain. This systematic review and meta-analysis evaluated the efficacy and safety of corticosteroid therapy in critically ill patients with severe community-acquired pneumonia, sepsis or septic shock, or acute respiratory distress syndrome. We hypothesized that corticosteroids reduce short-term mortality in critically ill patients.</p><p><strong>Methods: </strong>We performed a search of Medline, Embase, and the Cochrane Central Register of Controlled Trials from database inception up to November 30, 2024. The search was limited to randomized controlled trials in human populations published in English. Dichotomous outcomes are reported as relative risk (RRs) and continuous outcomes as mean differences (MDs), both with 95% confidence intervals (CIs). The primary outcome was short-term mortality (28-day or nearest reported). Secondary outcomes included ICU/hospital length of stay, mechanical ventilation duration, ventilator-free days at 28 days, oxygenation index, reversed shock in sepsis or septic shock, and adverse events. We evaluated heterogeneity using I² and explored it using subgroup and meta-regression analyses.</p><p><strong>Results: </strong>Forty-three randomized controlled trials (n = 10853) were included. Corticosteroids reduced short-term mortality in critically ill patients compared to placebo (RR, 0.85; 95% CI, 0.77-0.94). Corticosteroid treatment for critically ill patients reduced intensive care unit (MD, - 2.02 days; 95% CI, - 3.14 - -0.90) and hospital (MD, - 2.66 days; 95% CI, - 4.58 - -0.74) lengths of stay, and duration of mechanical ventilation (MD, - 4.24 days; 95% CI, - 6.38 - -2.10); it increased ventilator-free days at 28 days (MD, 2.83 days; 95% CI, 1.20-4.47), improved oxygenation index (PaO₂/FiO₂) in patients undergoing mechanical ventilation (MD, 61.41 mmHg; 95% CI, 26.64-96.18), and reversed shock in sepsis or septic shock (RR, 1.20; 95% CI, 1.06-1.35). No significant differences were observed in infection rates (RR, 1.01; 95% CI, 0.92-1.12) and gastrointestinal bleeding (RR, 1.07; 95% CI, 0.86-1.33). Hyperglycemia was more prevalent in the corticosteroid group (RR, 1.10; 95% CI, 1.06-1.14).</p><p><strong>Conclusions: </strong>Subgroup analysis indicated that early initiation (≤ 72 h), low-dose (e.g., < 400 mg/day hydrocortisone equivalent), and prolonged (≥ 7 days) corticosteroid therapy was associated with reduced short-term mortality in critically ill patients with severe community-acquired pneumonia or acute respiratory distress syndrome. For septic shock, combination therapy (hydrocortisone plus fludrocortisone) may enhance efficacy.</p><p><strong>Clinical trial registration: </strong>PROSPERO: CRD42024517843.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"319"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12211793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the effects of remimazolam and propofol on postoperative delirium in elderly surgical patients: a meta-analysis.","authors":"Jiayu Huang, Zhenke Xiao, Junming Lao, Lingli Pan, Zhou Chen, Zehua Lin","doi":"10.1186/s12871-025-03197-6","DOIUrl":"10.1186/s12871-025-03197-6","url":null,"abstract":"","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"329"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538875","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":"The safety and efficacy of two different airway management methods for patients undergoing fiberoptic bronchoscopy: a prospective, randomized, controlled clinical trial.","authors":"Ping Zhang, Zongwang Zhang, Guoying Liu, Jiali Ding, Qianqian Han, Xiangrong Du","doi":"10.1186/s12871-025-03179-8","DOIUrl":"10.1186/s12871-025-03179-8","url":null,"abstract":"","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"298"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538944","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 sacovlm™ video laryngeal mask-guided intubation and fastrach combined with flexible bronchoscopy-guided intubation -a prospective study.","authors":"Yusuf Ozguner, Umut Can Özağar, Seyyid Furkan Kına, Atakan Sezgi, Savaş Altınsoy, Julide Ergil","doi":"10.1186/s12871-025-03172-1","DOIUrl":"10.1186/s12871-025-03172-1","url":null,"abstract":"<p><strong>Background: </strong>Laryngeal masks (LMA) are significant in airway management. The newly developed video LMA (SaCoVLM™) allows direct visualization. In our study, we sought to compare the success of intubation between the SaCoVLM™ and the Fastrack LMA using fiberoptic bronchoscopy guidance. Our primary objective was total intubation time, while our secondary objective was postoperative complications.</p><p><strong>Methods: </strong>Patients (101) intubated with the SaCoVLM™ were categorized as Group V, while those intubated with the Fastrach LMA were categorized as Group F. LMA placement time, intubation time, total intubation time, and postoperative complications within the first 24 h were followed.</p><p><strong>Results: </strong>We found a shorter total intubation time with the SaCoVLM™. Moreover, patients in the Fastrack LMA experienced a higher incidence of sore throat and a greater frequency of blood-stained supraglottic airway devices (SADs). (p < 0.05).</p><p><strong>Conclusions: </strong>We found that the SaCoVLM™ is an effective alternative to the Fastrack LMA in terms of LMA placement success and intubation success.</p><p><strong>Trial registration: </strong>NCT06121895.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"315"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12211361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538874","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 Intranasal dexmedetomidine and esketamine for premedication on postoperative pain after tonsillectomy and adenoidectomy in children: a randomized clinical trial.","authors":"Jun-Wei Qi, Chuang Li, Xin-Yuan Qiu, Xin-Ge Wen, Hua Yin, Qing-Ling Meng, Li Li, Qian Zhang, Yue-Ying Zhang","doi":"10.1186/s12871-025-03203-x","DOIUrl":"10.1186/s12871-025-03203-x","url":null,"abstract":"<p><strong>Background: </strong>Postoperative acute pain is a common issue in children after surgery. Our study aimed to investigate whether preoperative use of a dexmedetomidine-esketamine combination could reduce postoperative pain in children undergoing tonsillectomy and adenoidectomy and reduce side effects, such as bradycardia, hypotension or emergence delirium.</p><p><strong>Methods: </strong>In this double-blind, randomised controlled clinical trial, 180 children were randomly assigned to 3 groups. 30 min before surgery, the control group received 0.9% saline intranasally (Group C), the dexmedetomidine group received intranasal dexmedetomidine at 2.0 μg·kg^-1 (Group D), and the combination group received intranasal dexmedetomidine at 1.0 μg·kg^-1 and esketamine at 0.6 mg·kg^-1 (Group DS). The primary outcome was the area under the curve (AUC) of the pain score within 24 h after surgery. Secondary outcomes included the incidence of emergence delirium (ED), pain scores after hospital discharge, and incidence of perioperative adverse events.</p><p><strong>Results: </strong>A total of 173 children completed the study. The AUC of the pain score at rest within 24 h after surgery was 37.25 (20.25-51.75) in Group C, which was higher than those in Groups D (19.25 [12.50-39.13], P < 0.001) and DS (9.50 [9.00-16.25], P < 0.001). Compared with the control group, the DS group had a lower incidence of ED (12.3% vs. 44.8%, P = 0.001). Heart rates (HRs) in groups DS (P < 0.001) and C (P < 0.001) were higher than those in the dexmedetomidine group at all time points. No serious adverse events occurred.</p><p><strong>Conclusions: </strong>Intranasal dexmedetomidine combined with esketamine for premedication was associated with reduced postoperative pain in children. It can also prevent ED and had fewer side effects.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"330"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12217526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538911","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":"Pediatric fascial plane blocks: an educational review with technique, tips & tricks.","authors":"Can Aksu, Hadi Ufuk Yörükoğlu, Sevim Cesur, Alparslan Kuş","doi":"10.1186/s12871-025-03193-w","DOIUrl":"10.1186/s12871-025-03193-w","url":null,"abstract":"<p><p>Pain management in pediatric patients is of utmost importance to ensure their well-being and prompt recovery. Current analgesia methods are not always sufficient, leading to suboptimal pain control and increased morbidity. Almost 80% of patients undergoing surgery experience postoperative pain. Results of many studies show that treatment of postoperative pain in children is inadequate. As such, in recent years, there has been growing interest in fascial plane blocks. Fascial plane blocks involve the injection of local anesthetics into the fascial planes surrounding targeted nerves, providing prolonged analgesia with reduced risk of systemic side effects. Studies have shown the efficacy of fascial plane blocks in providing effective analgesia for a variety of surgical procedures, including abdominal, thoracic, and orthopedic surgeries. With careful patient selection and appropriate technique, use of fascial plane blocks in pediatric patients can improve the quality of postoperative pain management, reducing the risk of adverse effects associated with systemic analgesics or well-known classical neuraxial regional anesthesia techniques. In addition to better pain control, the use of fascial plane blocks, as a part of multimodal analgesia regimen, may also reduce the need for opioid analgesics, thereby decreasing the risk of opioid-related adverse effects such as respiratory depression. In conclusion, fascial plane blocks represent a promising alternative to traditional analgesia methods for pediatric patients undergoing surgery. While further research is needed to establish their safety and efficacy for specific procedures in pediatric patients, the available evidence suggests that they may offer significant benefits in terms of pain management. Although fascial plane blocks are volume-dependent techniques, to minimize the risk of local anesthetic systemic toxicity, it is advisable to avoid using more than 0.3-0.5 mL/kg of local anesthetic and to prefer lower concentrations.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"320"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12211297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538938","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}