BMC Anesthesiology最新文献

{"title":"Perineural or intravenous administration of dexmedetomidine combined with anterior quadratus lumborum block for analgesia after retroperitoneal laparoscopic surgery: a prospective, randomized controlled trial.","authors":"Yunru Jiang, Hengrui Zhang, Chenyang Shi, Yang Niu, Han Gao, Yuxiang Meng, Zhibiao Xu, Li Zhang, Sumin Yuan, Zijie Ling, Linlin Zhao","doi":"10.1186/s12871-026-04103-4","DOIUrl":"10.1186/s12871-026-04103-4","url":null,"abstract":"<p><strong>Purpose: </strong>The duration of a single anterior quadratus lumborum block (QLB) cannot fully meet the postoperative analgesic needs of patients undergoing retroperitoneal laparoscopic surgery. We investigated whether perineural or intravenous dexmedetomidine (Dex) administration combined with anterior QLB could improve analgesic efficacy.</p><p><strong>Methods: </strong>Ninety-six patients were randomized, and 88 were included in the modified per-protocol analysis. A total of 88 patients scheduled for retroperitoneal laparoscopic surgery under general anesthesia combined with anterior QLB were randomly assigned to one of three groups: (1) control group (R): 0.375% ropivacaine 30 mL; (2) ropivacaine plus perineural Dex (RD): 0.375% ropivacaine 30 mL plus 1 µg/kg Dex, (3) ropivacaine plus intravenous Dex (RDiv): 0.375% ropivacaine 30 mL plus intravenous 1 µg/kg Dex. The primary outcome was the 48 h postoperative sufentanil consumption. Secondary outcomes included Numerical Rating Scale (NRS) scores at different postoperative time points, intraoperative hemodynamic parameters, and adverse effects.</p><p><strong>Results: </strong>The 48 h postoperative sufentanil consumption was significantly lower in group RD than in groups R and RDiv [median (IQR): 31.0 (16.3, 39.0) vs. 40.1 (27.2, 60.7) vs. 42.0 (31.5, 57.9); adjusted P < 0.05, Bonferroni post-hoc test], with between-group differences of -17.2 µg (95%CI -23.4 to -11.3) and - 16.7 µg (95%CI -23.2 to -10.8). Fewer patients in group RD (14% vs. 40% vs. 34%; P = 0.069) required rescue analgesia, though the difference did not reach statistical significance. Group RD exhibited significantly lower resting and dynamic NRS pain scores at key postoperative time points (P < 0.05). QoR-15 was statistically higher in group RD, although the between-group difference was below the reported minimal clinically important difference (MCID). Dexmedetomidine was associated with lower MAP and HR at selected intraoperative time points, without a statistically significant increase in postoperative bradycardia or hypotension. No significant differences were observed among the three groups in adverse events, time to first flatus, ambulation, or length of stay( all P > 0.05).</p><p><strong>Conclusions: </strong>Perineural administration of 1 µg/kg dexmedetomidine combined with anterior QLB could provide better postoperative analgesia, which reduced 48-hour postoperative sufentanil consumption and improved pain scores at several time points. However, intravenous dexmedetomidine at the same dose did not confer comparable benefits in this setting.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry (ChiCTR2300074778) Registration date 16/08/2023.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497115","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 venous flow per respiratory cycle of right external iliac vein flow by ultrasound in the different position for predicting post-spinal hypotension during cesarean delivery.","authors":"Xiaoguo Ruan, Mingyang Sun, Ningtao Li, Yongfeng Zhu, Jiaqiang Zhang, Enqing Chang, Pengfei Niu","doi":"10.1186/s12871-026-03991-w","DOIUrl":"10.1186/s12871-026-03991-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Post-spinal anesthesia hypotension during cesarean delivery results from reduced systemic vascular resistance due to the blockade of autonomic nerves, which is further worsened by inferior vena cava (IVC) compression by the gravid uterus. The study aimed to determine whether venous flow per respiratory cycle of right external iliac vein flow (REIVF) in the inguinal region, as measured on ultrasound in the deferent positions, could reflect the degree of IVC compression and further identify parturients at risk of post-spinal hypotension.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;One hundred and twenty parturients scheduled for elective cesarean delivery under spinal anesthesia were enrolled in this study. Venous flow (VF) per respiratory cycle of the REIVF was measured using ultrasound before anesthesia in the supine position and a left tilt of 15°(A 15° slope pad is placed under the waist of the pregnant woman)Respond 1. All patients were divided into a hypotension group (n = 64) and a non-hypotension group (n = 53) Respond 11. based on whether SHS occurred. The primary outcomes included preoperative ultrasound parameters of REIVF obtained in different positions, the correlation between these parameters and SHS, and the magnitude of changes in REIVF induced by postural alteration (ΔREIVF). Hypotension was defined as a more than 20% reduction in systolic blood pressure relative to baseline. Respond 4. Multivariate logistic regression analysis was performed to explore the relationship between ΔREIVF and post-spinal hypotension. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance of relevant parameters for post-spinal hypotension. The corresponding area under the curve (AUC) and optimal cut-off values were subsequently calculated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;At a 15° left tilt, REIVF was significantly higher in the non-hypotensive group than in the hypotensive group. In both groups, REIVF per respiratory cycle at a 15° left tilt was significantly higher than that in the supine position (P &lt; 0.001).The difference in right external iliac vein flow between the supine position and 15° left tilt (ΔREIVF) was independently associated with post-spinal hypotension (SHS) following spinal anesthesia for cesarean delivery (OR = 1.071, 95% CI: 1.038-1.104, P &lt; 0.001).Although systolic blood pressure (SBP) declined in both subgroups (ΔREIVF &gt; 125.85 mL/min vs. ΔREIVF ≤ 125.85 mL/min), the reduction in SBP was markedly greater in the ΔREIVF &gt; 125.85 mL/min group at 4 and 5 min after spinal anesthesia (P = 0.001 and P &lt; 0.001, respectively). In addition, heart rate (HR) increased significantly in the ΔREIVF ≤ 125.85 mL/min group at 4 min after spinal anesthesia (P = 0.011).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Variations in REIVF among different positions prior to anesthesia are predictive of subsequent post-spinal hypotension (SHS). Respond 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;This","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497159","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":"Prognostic impact of sepsis-induced coagulopathy on mortality and clinical outcomes in ICU patients.","authors":"Ayşe Çapar, Derya Özyiğitoğlu, Cemre Abacı, Şeyma Başlılar","doi":"10.1186/s12871-026-04104-3","DOIUrl":"10.1186/s12871-026-04104-3","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the prognostic impact of sepsis-induced coagulopathy (SIC) on mortality and clinical outcomes in patients with sepsis admitted to the intensive care unit (ICU).</p><p><strong>Materials and methods: </strong>This retrospective cohort study included 1,305 adult patients with sepsis admitted to a tertiary pulmonary ICU between January 2016 and May 2025. SIC was defined using the International Society on Thrombosis and Haemostasis (ISTH) criteria, based on platelet (PLT) count, prothrombin time/international normalized ratio (PT/INR), and total Sequential Organ Failure Assessment (SOFA) score components. The primary outcome was in-hospital mortality, and secondary outcomes included vasopressor requirement, escalation to second-line vasopressor therapy, invasive mechanical ventilation (IMV), and continuous renal replacement therapy (CRRT). Multivariable logistic regression and receiver operating characteristic (ROC) analyses were conducted to assess the prognostic value of SIC.</p><p><strong>Results: </strong>The prevalence of SIC was 19.2%. Patients with SIC had significantly higher in-hospital mortality than those without SIC (79.3% vs. 60.6%, p < 0.001). Vasopressor use and escalation to second-line vasopressor therapy were more frequent in the SIC-positive group (98.0% vs. 92.5%, p = 0.001; 45.8% vs. 31.3%, p < 0.001, respectively). In multivariable analyses, both SIC positivity (OR: 2.172, 95% CI: 1.528-3.087, p < 0.001) and the SIC score (OR: 1.324, 95% CI: 1.175-1.492, p < 0.001) were independently associated with mortality. ROC analysis showed that the SIC score had moderate discriminative performance for predicting mortality (AUC: 0.619, 95% CI: 0.588-0.649, p < 0.001), with an SIC score ≥ 4 identified as the clinically interpreted threshold.</p><p><strong>Conclusion: </strong>SIC was independently associated with higher in-hospital mortality and greater need for vasopressor support in critically ill patients with sepsis. These findings suggest that SIC may provide complementary prognostic information when interpreted alongside established severity assessment tools; however, prospective studies are needed to clarify its clinical relevance and potential role in patient management.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497117","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":"Leukoerythroblastosis was associated with 90-day mortality in adult ICU patients with sepsis: a retrospective cohort study.","authors":"Emi Fujii, Tomoki Tanaka, Naoto Mizumura, Yuka Segoe, Yugo Matsumoto, Mitsuhiro Fujino, Hidemitsu Miyatake, Junji Shimizu, Takuma Kishimoto, Kazunori Fujino, Yasuyuki Tsujita, Hirotoshi Kitagawa, Naoto Shiomi","doi":"10.1186/s12871-026-04065-7","DOIUrl":"10.1186/s12871-026-04065-7","url":null,"abstract":"<p><strong>Background: </strong>Leukoerythroblastosis (LEB), defined as the concurrent detection of immature granulocytes (IG) and nucleated red blood cells (NRBC) in peripheral blood, may reflect profound bone marrow stress in sepsis. Although IG or NRBC positivity has been associated with poor outcomes, it remains uncertain whether LEB itself confers an increased risk of mortality in patients with sepsis and how its prognostic significance compares with other smear-based patterns, including isolated IG or NRBC positivity and Double-negative findings.</p><p><strong>Methods: </strong>This single-center retrospective cohort study comprised adult intensive care unit (ICU) patients with sepsis between April 2011 and March 2023. If the automated hematology analyzer generated an abnormal flag, smear microscopy was performed, and the patients were classified accordingly. The LEB group was defined as concurrent IG and NRBC on the same smear; the single-positive group included IG-only, NRBC-only, and non-concurrent both-positive findings; and the Double-negative group was defined as undetectable IG and NRBC on smear review or no smear review due to the absence of analyzer flags. To minimize immortal-time bias, we performed a day-7 landmark analysis including only patients who survived for at least 7 days after ICU admission. Associations with 90-day mortality were evaluated using Cox proportional hazards models adjusted for prespecified covariates.</p><p><strong>Results: </strong>Among 569 eligible patients, 110 (19.3%) were classified into the LEB group, 163 (28.6%) into the single-positive group, and 296 (52.0%) into the Double-negative group. The 90-day survival differed significantly among groups (log-rank p < 0.001), driven by worse survival in the LEB group. In the multivariable Cox model (complete-case analysis; n = 553; 112 events), the LEB group had higher 90-day hazard of death than the Double-negative group (adjusted hazard ratio 1.917; 95% confidence interval 1.178-3.120; P = 0.009), whereas the single-positive group did not differ significantly (adjusted hazard ratio 1.025; 95% confidence interval 0.629-1.672; P = 0.921).</p><p><strong>Conclusions: </strong>Among ICU patients with sepsis who survived for 7 days after ICU admission, LEB identified within 7 days after ICU admission was independently associated with increased 90-day mortality. Thus, LEB may reflect severe systemic stress and sepsis-associated hematopoietic dysfunction.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497140","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 ultrasound-guided erector spinae plane block to intrathecal morphine for postoperative analgesia in patients undergoing elective lumbar fusion operations under general anesthesia: a randomized controlled trial.","authors":"Tarek Mohamed Ashoor, Hany Abdelnaby Shehata Abdelaal, Gamal Eldin Mohammad Elewa, Ibrahim Mamdouh Esmat, Amal Hamed Rabie, Aly Ibrahim Soliman Ibrahim, Ahmed Kamal Mohamed","doi":"10.1186/s12871-026-04030-4","DOIUrl":"10.1186/s12871-026-04030-4","url":null,"abstract":"<p><strong>Background: </strong>Postoperative (PO) pain management after spine surgery is challenging. For such surgeries, erector spinae plane block (ESPB) and intrathecal morphine (ITM) may offer effective PO analgesia. However, the lack of availability of US machines in low-resource settings and proper dose of ITM that confine the side effects may limit the use of either. Nalbuphine presents an effective approach for managing opioid-induced pruritus without diminishing PO pain relief. In first 24 h after lumbar fusion operations under general anesthesia, the researchers examined effectiveness of bilateral ultrasound (US)-guided ESPB on PO pain and analgesic intake in comparison with ITM.</p><p><strong>Methods: </strong>One hundred twenty patients premedicated with 4 mg intravenous ondansetron were randomized into group E; bilateral US-guided ESPB, group M; ITM (0.2 mg) or group C; control group. Time to first rescue analgesic (ketorolac) was the primary outcome while parameters of PO analgesic regimen and side effects were considered as secondary outcomes.</p><p><strong>Results: </strong>Compared to C group, E & M groups had longer duration to first rescue analgesic and reduced analgesic consumption within 24 h postoperatively (P < 0.001). Twenty-four hours after surgery, the M group had lower pain scores (P < 0.001) and higher rates of nausea and pruritus (P < 0.001) than the other two groups without any cases of respiratory depression.</p><p><strong>Conclusions: </strong>The analgesic effect of 0.2 mg intrathecal morphine after lumbar fusion operation under general anesthesia provided lower pain scores and lower analgesic demands than erector spinae plane block at the expense of a higher incidence of manageable side effects of intrathecal morphine within the first 24 h postoperatively. IRB: FMASU MD 102/2022.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05338320. The date that the clinical trial was registered in the ClinicalTrials.gov. : April 14, 2022.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13377722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469134","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 stellate ganglion block on perioperative psychological symptoms and recovery after total hip arthroplasty for osteonecrosis of the femoral head in non-elderly patients: a randomized controlled trial.","authors":"Xiaomin Fan, Ziqi Huang, Xia Li, Jing Li, Baojia Lin, Xinjian Zhang","doi":"10.1186/s12871-026-04097-z","DOIUrl":"10.1186/s12871-026-04097-z","url":null,"abstract":"<p><strong>Objective: </strong>The incidence of osteonecrosis of the femoral head (ONFH) in non-elderly patients is increasing. Psychological distress, including anxiety and depression related to both the disease itself and total hip arthroplasty (THA), may adversely affect postoperative outcomes. This study aimed to evaluate the effects of stellate ganglion block (SGB) on perioperative psychological symptoms and postoperative recovery in patients undergoing THA for ONFH.</p><p><strong>Methods: </strong>A total of 94 patients undergoing THA were enrolled in this study and randomly divided into the stellate ganglion block group (SGB group) and the control group (CON group). Patients in the SGB group received ultrasound-guided unilateral stellate ganglion block before surgery with an injection of 4 mL of 0.8% lidocaine; patients in the CON group underwent the same procedure, with an equal volume of normal saline replacing lidocaine. On postoperative days 1 and 4, the degree of anxiety and depression, pain intensity, sleep quality, recovery status, and occurrence of complications were evaluated in all patients.</p><p><strong>Results: </strong>Compared with the CON group, patients receiving SGB treatment showed favorable trends in GAD-7 scores and improved postoperative recovery quality, as reflected by the primary mixed-effects analysis (P < 0.05) and significantly higher QoR-15 scores. However, additional ANCOVA adjusting for baseline GAD-7 scores did not confirm a significant between-group difference in GAD-7 outcomes. The observed GAD-7 effect was therefore not robust to baseline adjustment. Although HADS scores tended to be lower in the SGB group, the difference did not reach statistical significance. SGB did not significantly affect pain intensity (VAS score) or the incidence of adverse events, including hypotension, dizziness, nausea and vomiting, and nightmares (all P > 0.05).</p><p><strong>Conclusion: </strong>Among non-elderly patients undergoing THA, SGB was associated with some favorable trends in perioperative psychological symptoms and postoperative recovery quality. However, the evidence was inconsistent across different psychological assessment scales and sensitive to baseline adjustment. Therefore, these findings should be considered hypothesis-generating rather than conclusive.</p><p><strong>Trial registration: </strong>This study was registered in the Chinese Clinical Trial Registry. (ChiCTR2400089542) on 2024/09/10.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469040","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":"Perioperative outcomes in patients with myalgic encephalomyelitis/chronic fatigue syndrome undergoing general anesthesia: a retrospective matched-pair study.","authors":"Felix M Steinkirchner, Christina K Kaufmann, Richard F Kraus, Maximilian Käss, Elisabeth Schieffer, Bernhard M Graf, Christoph Lassen, Viktoria Kimmerling, Alexander Dejaco","doi":"10.1186/s12871-026-04102-5","DOIUrl":"10.1186/s12871-026-04102-5","url":null,"abstract":"<p><strong>Background: </strong>Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic multisystem disease characterized by profound fatigue, post-exertional malaise, cognitive impairment, and autonomic dysfunction. Despite features with potential relevance for anesthesia and perioperative care, empirical data on perioperative outcomes in patients with ME/CFS remains limited. We therefore performed a retrospective matched-pair analysis to generate clinical data on perioperative responses and identify areas for future research.</p><p><strong>Methods: </strong>We conducted a retrospective matched-pair analysis at a single tertiary center. All patients with ME/CFS undergoing general anesthesia from 2015 to 2026 were identified using ICD-10-GM codes with additional manual verification and matched 1:1 to controls for comparison. Patients with confounding diagnoses or American Society of Anesthesiologists physical status above III were excluded. The analysis focused on intraoperative hemodynamic parameters, including baseline, post-induction, median, and lowest recorded systolic blood pressure and heart rate, as well as early postoperative outcomes in the post-anesthesia care unit (PACU), including maximum pain scores and requirement for rescue analgesia.</p><p><strong>Results: </strong>Out of 189 individuals identified through ICD-10 codes, 15 matched pairs were included after application of exclusion criteria. Patients with ME/CFS exhibited lower minimum intraoperative systolic blood pressure (90.0 [82.5-95.0] vs. 100.0 [90.0-110.0] mmHg, p = 0.044) and lower minimum heart rate (50.0 [40.0-57.5] vs. 60.0 [50.0-65.0] bpm, p = 0.012). Vasopressor use and fluid administration did not differ, and no episodes of severe hypotension or perioperative adverse events were observed. Postoperative pain was higher in ME/CFS, with higher maximum pain scores (NRS 5.0 [4.0-6.0] vs. 1.0 [0.0-4.0], p = 0.008) and more frequent opioid rescue analgesia (80% vs. 33%, p = 0.039). Postoperative nausea or vomiting, oxygen supplementation, and PACU length of stay were similar between groups.</p><p><strong>Conclusions: </strong>In this small exploratory cohort, general anesthesia was not associated with clinically relevant hemodynamic instability in patients with ME/CFS. Postoperative pain scores and opioid rescue requirements were higher in the ME/CFS group. Post-exertional malaise, a key disease feature with potentially delayed onset and significant impact, was not captured and remains an important target for future research. These findings should be considered hypothesis-generating and support prospective studies evaluating perioperative management and patient-relevant outcomes in ME/CFS.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469051","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":"Perioperative anesthetic management and procedural sedation in a child with type 1 congenital long QT Syndrome undergoing serial procedures: a case report.","authors":"Youbing Tu, Dajun Xing, Zhongjie Liu","doi":"10.1186/s12871-026-04101-6","DOIUrl":"10.1186/s12871-026-04101-6","url":null,"abstract":"<p><strong>Background: </strong>Congenital long QT syndromes (cLQTS) are inherited cardiac channelopathies that predispose pediatric patients to ventricular arrhythmias, particularly Torsades de Pointes (TdP), during the perioperative period. Data regarding repeated anesthetic and sedation exposures in this high-risk population remain limited.</p><p><strong>Case presentation: </strong>We present an 8-year-old boy with genetically confirmed LQT1 and multiple systemic comorbidities who underwent five general anesthetics and four procedural sedations within a four-month timeframe. Management focused on preserving hemodynamic stability, attenuating autonomic fluctuations, minimizing drug-induced prolongation of cardiac repolarization, and ensuring immediate availability of rescue resources. Anesthesia was maintained via balanced volatile or intravenous regimens, while procedural sedation employed dexmedetomidine-midazolam based anxiolysis. Across all nine interventions, no TdP, malignant ventricular tachyarrhythmia, treatment-requiring bradycardia, or cardiac arrest was documented.</p><p><strong>Conclusions: </strong>This single-patient experience describes repeated general anesthesia and procedural sedation in a child with LQT1 without documented adverse cardiac events.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454655","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 physiology-guided ketofol-based anaesthetic approach for emergency burr hole craniotomy in a child with Eisenmenger syndrome: a case report.","authors":"Saad Ahmed Naved, Samiah Ijaz, Bushra Maryum Zahid, Muhammad Ashraf","doi":"10.1186/s12871-026-04098-y","DOIUrl":"10.1186/s12871-026-04098-y","url":null,"abstract":"<p><strong>Background: </strong>Eisenmenger syndrome presents substantial perioperative risk because small perturbations in systemic or pulmonary vascular resistance may precipitate cardiovascular collapse. Evidence guiding anaesthetic management during emergency neurosurgery in paediatric patients remains limited.</p><p><strong>Case presentation: </strong>We report an 11-year-old boy with Eisenmenger syndrome and severe pulmonary hypertension who underwent emergency burr hole craniotomy for drainage of a cerebral abscess. Perioperative management was guided by physiology-driven strategy encompassing invasive haemodynamic monitoring, preserving systemic vascular resistance, limiting pulmonary vascular resistance, and avoiding hypoxia and hypercarbia using vasoactive support and lung-protective ventilation. General anaesthesia was maintained using a self-prepared 1:4 ketamine-propofol (ketofol) infusion titrated to a bispectral index of 45-60, incorporated as one component of this approach. The intraoperative course remained stable without major desaturation or haemodynamic instability. The patient was extubated at the end of surgery, vasoactive support was subsequently weaned, and he was discharged with favourable neurological and clinical outcomes.</p><p><strong>Conclusion: </strong>This case illustrates that ketofol-based general anaesthesia can be incorporated into a physiology-driven perioperative strategy for emergency neurosurgery in selected patients with Eisenmenger syndrome. However, favourable outcomes cannot be attributed to the anaesthetic agent alone, and conclusions regarding superiority or generalisability cannot be drawn from a single case report.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454621","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":"Association between preoperative sleep quality and postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: a prospective observational study.","authors":"Turgay Atay, Mehmet Akif Yazar, Mustafa Aydemir, Ömer Keklicek, Betül Özçelik, Muhammed Ali Akbulut","doi":"10.1186/s12871-026-04100-7","DOIUrl":"10.1186/s12871-026-04100-7","url":null,"abstract":"<p><strong>Background: </strong>Postoperative nausea and vomiting (PONV) remains a common and distressing complication after surgery. Although established risk factors are well defined, the role of preoperative sleep quality has not been fully elucidated. This study aimed to evaluate the association between preoperative sleep quality and PONV in patients undergoing laparoscopic cholecystectomy.</p><p><strong>Methods: </strong>This single-center prospective observational study included 145 patients undergoing elective laparoscopic cholecystectomy. Preoperative sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) one day before surgery. PONV risk was evaluated using the Apfel score. The incidence of PONV within the first 24 h postoperatively was recorded, and nausea severity was assessed using a numeric rating scale (NRS). Multivariable logistic regression analysis was performed to identify independent predictors of PONV.</p><p><strong>Results: </strong>Overall, PONV occurred in 119 of 145 patients (82.1%, 95% CI 75.0-87.5). Vomiting occurred in 48 patients (33.1%). Patients who developed PONV had significantly higher PSQI scores than those who did not (median 6 vs. 3, p < 0.001). A PSQI score ≥ 5 was more frequent among patients with PONV (70.6% vs. 26.9%, p < 0.001). PSQI scores were moderately correlated with postoperative nausea severity (ρ = 0.626, p < 0.001). In multivariable analysis, PSQI score remained independently associated with PONV (OR 1.33, 95% CI 1.12-1.58, p = 0.001), whereas the Apfel score was not statistically significant.</p><p><strong>Conclusions: </strong>Preoperative sleep quality was independently associated with both the occurrence and severity of PONV. These findings suggest that sleep quality may represent a relevant factor associated with early postoperative outcomes. However, further studies with broader adjustment for potential confounders, external validation, and formal evaluation of predictive performance are needed before PSQI can be incorporated into routine PONV risk assessment.</p><p><strong>Trial registration: </strong>Not applicable. As an observational study, trial registration was not required.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469120","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}