BMC Anesthesiology最新文献

{"title":"Expert perspectives on the requirements for implementing prehospital peripheral nerve blocks: a survey among members of the European Society of Regional Anaesthesia (ESRA).","authors":"Christine Gaik, Alan Jr Macfarlane, Eleni Moka, Axel R Sauter, Ann-Kristin Schubert, Thomas Volk, Hinnerk Wulf, Benjamin Vojnar","doi":"10.1186/s12871-026-04093-3","DOIUrl":"10.1186/s12871-026-04093-3","url":null,"abstract":"<p><strong>Background: </strong>Evidence on prehospital regional anesthesia (RA) is limited, with only a few trials comparing peripheral nerve blocks (PNBs) to standard opioid analgesia. Although well established in hospitals, their use in prehospital care remains rare. This survey aimed to capture expert perspectives on prerequisites, barriers, and preferred block techniques for broader implementation of prehospital PNBs.</p><p><strong>Methods: </strong>Members of the European Society of Regional Anaesthesia (ESRA) were invited to participate in an anonymous online survey. The 30-item questionnaire collected demographic data, professional background, information on the organization of emergency medical services (EMS), and ultrasound availability. Participants were also asked about their experience with in-hospital and prehospital RA, perceived training requirements, and necessary equipment. Finally, respondents assessed the advantages, disadvantages, and suitability of specific RA techniques for prehospital scenarios. Data were analyzed descriptively and are presented as absolute numbers and percentages.</p><p><strong>Results: </strong>A total of 415 fully completed questionnaires were included in the analysis. 82% (342/415) of respondents supported prehospital RA, but only 20% (73/415) reported its current use in their EMS area. Onethird of this group had personally performed RA procedures, with fascia iliaca compartment blocks (FICB) and femoral nerve blocks (FNB) being the most frequently used techniques. The most commonly cited key requirements for performing prehospital RA included ultrasound devices (87%; 359/415) and lipid solution (68%; 282/415). 58% (240/415) of respondents reported ultrasound availability in prehospital care. 63% (262/415) believed only specialists or residents with additional training should perform PNBs.</p><p><strong>Conclusion: </strong>While most respondents supported the concept of prehospital RA, only few indicated that such approaches are currently implemented in their local EMS systems. FICB and FNB were identified as the preferred options for managing proximal femur fractures. Key concerns regarding implementation included limited team experience, time constraints, and procedural complications such as local anesthetic systemic toxicity (LAST), emphasizing the need for structured training, clear protocols, and expert guidance to ensure safe implementation.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13371537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444478","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":"Regional anesthesia for hysterectomies across a large healthcare system: location matters.","authors":"Naomi Goldstein, Liam Sasser, Nicholas A Giordano, Alexander Velosky, Michael S Patzkowski, Krista B Highland","doi":"10.1186/s12871-026-04083-5","DOIUrl":"10.1186/s12871-026-04083-5","url":null,"abstract":"<p><strong>Purpose: </strong>While guidelines emphasize the benefits of multimodal anesthesia for hysterectomy procedures, including regional anesthesia (RA), utilization rates remain understudied. This study described multilevel factors associated with RA receipt across the US Military Health System.</p><p><strong>Methods: </strong>This retrospective cohort study included patients undergoing a hysterectomy between January 2022 and April 2025 (N = 5,150). Patient- (e.g., demographic and clinical information), care- (e.g., route, surgical duration, adjuncts), and system- (e.g., facility) level factors were covariates in a generalized additive mixed-effects model (GAMM) evaluating RA receipt.</p><p><strong>Results: </strong>Overall, 13% received RA. Across 33 facilities, RA use ranged from 0 to 66% (median 9%, IQR 3-15%). In the GAMM, surgical facility accounted for 23% of the outcome variance. Odds (95% CI) of RA receipt were higher for patients with a Charlson Comorbidity Index of 1 relative to 0 (OR = 1.33, 1.03-1.71, p = 0.03), with leiomyoma diagnoses (OR = 1.26, 1.01-1.58, p = 0.04), and who received an open hysterectomy (OR = 6.02, 4.55-7.96, p < 0.001) and more adjuncts (OR = 1.15, 1.05-1.27, p = 0.005). The smooth effect of age was significant (p = 0.03), such increasing age was associated with lower odds of RA receipt.</p><p><strong>Conclusion: </strong>RA receipt was not common; variability was largely attributed to facility. Patients receiving RA tended to receive more adjuncts (e.g., dexmedetomidine, ketamine, NSAID, acetaminophen, gabapentinoids), which suggests anesthesia clinicians who use RA are also those who more frequently use multimodal analgesia. Further research is needed to evaluate acute and subacute hysterectomy outcomes that accounts for the full range of anesthesia and analgesia selection, as well as clinician practice patterns and motivations for RA use.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454796","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":"Intertransverse process and modified thoracolumbar interfascial plane blocks compared with conventional analgesia in lumbar disc herniation surgery: a randomized controlled trial.","authors":"Dinmuhammed Asker, Çağdaş Baytar, Merve Sena Baytar, Gizem Kurada, Keziban Bollucuoğlu, Rahşan Dilek Okyay, Bengü Gülhan Köksal İncegül, Özcan Pişkin, Hilal Ayoğlu","doi":"10.1186/s12871-026-04094-2","DOIUrl":"10.1186/s12871-026-04094-2","url":null,"abstract":"<p><strong>Background: </strong>Lumbar disc herniation surgery is associated with considerable postoperative pain despite its minimally invasive nature. Regional fascial plane blocks may reduce opioid consumption and improve recovery as part of multimodal analgesia. This study compared the analgesic efficacy of ultrasound-guided intertransverse process (ITP) and modified thoracolumbar interfascial plane (mTLIP) blocks with conventional analgesia in patients undergoing lumbar disc herniation surgery.</p><p><strong>Methods: </strong>In this prospective randomized controlled trial, 84 patients undergoing elective lumbar disc herniation surgery under general anesthesia were allocated to a Control group, an mTLIP group, or an ITP group (n = 28 each). The primary outcome was cumulative morphine consumption during the first 24 postoperative hours. Secondary outcomes included postoperative pain scores, Quality of Recovery-15 (QoR-15) scores, intraoperative remifentanil consumption, and adverse events.</p><p><strong>Results: </strong>Twenty-four-hour morphine consumption was significantly higher in the Control group than in the mTLIP and ITP groups (28.79 ± 10.11 mg vs. 16.93 ± 10.11 mg and 12.86 ± 6.14 mg, respectively; both p < 0.001), with no difference between the block groups. Intraoperative remifentanil consumption was significantly lower in the ITP and mTLIP groups than in the Control group (p < 0.001 and p = 0.001, respectively). Resting pain scores were significantly lower in the ITP group than in the Control group throughout the postoperative period, while dynamic pain scores were lower at the PACU time point and at 6, 12, and 24 h. No significant differences in pain scores were observed between the mTLIP and Control groups or between the two block groups. QoR-15 scores at 24 h were significantly higher in the ITP group than in the Control group (137 [102-150] vs. 130 [60-147]; p = 0.010). No significant differences in postoperative nausea and vomiting were observed, and no block-related complications occurred.</p><p><strong>Conclusions: </strong>Both ITP and mTLIP blocks reduced perioperative opioid requirements after lumbar disc herniation surgery, with no significant difference between the two blocks. Compared with conventional analgesia, the ITP block was additionally associated with lower postoperative pain scores and improved recovery quality. Both techniques appear to be safe, comparably effective, opioid-sparing components of multimodal analgesia.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT06391541. Prospectively registered on April 26, 2024.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444437","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":"Zero-heat flux skin temperature tracks nasopharyngeal temperature during cardiac surgery with cardiopulmonary bypass: a prospective observational study.","authors":"Kyoung-Woon Joung, Chung-Sik Oh, Ju-Youn Kim, Suryeon Lee, Dong-Kyu Lee, Tae-Yop Kim, In-Cheol Choi","doi":"10.1186/s12871-026-04068-4","DOIUrl":"10.1186/s12871-026-04068-4","url":null,"abstract":"<p><strong>Background: </strong>Monitoring both nasopharyngeal temperature (T_NP) and arterial blood temperature at the CPB arterial outlet is routinely used in cardiac surgery with cardiopulmonary bypass (CPB). We examined the agreement and temperature tracking ability of zero-heat-flux skin temperature (T_ZHF) compared with T_NP in cardiac surgery.</p><p><strong>Methods: </strong>Of 40 patients scheduled to undergo cardiac surgery with CPB, paired T_ZHF and T_NP measurements were recorded for 33 patients, yielding 8610 measurements across pre-CPB, CPB-cooling, CPB-maintenance, CPB-rewarming, and post-CPB.</p><p><strong>Results: </strong>In the final, trimmed dataset, T_ZHF and T_NP at 30 min after CPB weaning, the primary endpoint, showed similar mean values (35.57 ± 0.69 °C vs. 35.69 ± 0.61 °C; P = 0.181), with a mean difference of -0.12 °C (95% Confidence Interval: -0.29 to 0.06). Bland-Altman analysis showed a small mean bias between T_ZHF and T_NP across all intraoperative phases, ranging from - 0.55 to 0.28 °C. However, the limits of agreement (LOA) exceeded the clinically acceptable ± 0.5 °C during CPB-cooling and CPB-rewarming. Mixed-effects modeling showed considerable between-patient variability in the difference between T_ZHF and T_NP measurements during periods of rapid temperature change. Consistent with the Bland-Altman results, correlation coefficients between T_ZHF and T_NP measurements remained high (ranging from 0.798 to 0.958), and their intraclass correlation coefficients were high (ranging from 0.82 to 0.99) across all intraoperative phases.</p><p><strong>Conclusions: </strong>Our results indicate that T_ZHF tracked T_NP trends, but its large LOA limits its accuracy and reliability. Simultaneous blood temperature monitoring would enhance T_ZHF's effectiveness, as is currently done in cardiac surgery, where both blood temperature and T_NP are monitored.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04160845.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444445","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 of opioid-free versus opioid-inclusive anesthesia on postoperative nausea, vomiting, and quality of recovery in patients undergoing video-assisted thoracoscopic surgery: a systematic review and meta-analysis.","authors":"Shosaburo Jotaki, Norio Yamamoto, Eriya Imai, Yudai Goto, Takahiro Tamura","doi":"10.1186/s12871-026-04081-7","DOIUrl":"10.1186/s12871-026-04081-7","url":null,"abstract":"<p><strong>Background: </strong>Postoperative nausea and vomiting (PONV) is common after video-assisted thoracoscopic surgery (VATS). Opioid-free anesthesia (OFA) may reduce PONV; however, procedure-specific evidence remains limited. This review evaluated the effects of OFA versus opioid-inclusive anesthesia (OIA) on PONV, pain, and recovery after VATS lung resection.</p><p><strong>Methods: </strong>Randomized controlled trials (RCTs) involving adults who underwent VATS lung resection and compared OFA, defined as no intraoperative opioid use, with OIA, were included. MEDLINE, Embase, and Cochrane Central were searched until January 18, 2026, and ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched on January 19, 2026. The risk of bias was assessed using the RoB 2 tool. Random-effects meta-analyses were performed, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation framework. The primary outcomes were PONV and pain at 24 h.</p><p><strong>Results: </strong>Eleven RCTs involving 1183 participants were included, all of which used regional anesthesia. Most studies were conducted in China (n = 8), with one study each conducted in Poland, Turkey, and South Korea. Across the included studies, the mean age of participants ranged from 44.6 to 67.8 years. OFA was associated with reduced PONV within 24 h compared with OIA (eight studies; risk ratio, 0.58; 95% confidence interval [CI], 0.41-0.81; moderate certainty). Pain scores at 24 h were lower with OFA (eleven studies; mean difference, - 0.30; 95% CI, - 0.54 to - 0.07), although the difference did not reach the minimally important difference. OFA improved the quality of recovery (QoR) at 24 h (three studies; standardized mean difference, 0.40; 95% CI, 0.07 to 0.72; moderate certainty). No meaningful difference was observed in postoperative opioid consumption, and adverse event findings were inconsistent.</p><p><strong>Conclusions: </strong>In selected patients undergoing VATS lung resection within multimodal pathways including regional analgesia, OFA protocols probably reduce PONV and improve early QoR compared with heterogeneous OIA regimens, while having little or no clinically important effect on acute postoperative pain. However, the independent contribution of intraoperative opioid avoidance remains uncertain owing to heterogeneity in regional analgesia, comparator opioid exposure, antiemetic strategies, and anesthetic management.</p><p><strong>Trial registration: </strong>PROSPERO CRD420261292925.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444428","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 dexmedetomidine vs. magnesium sulfate on hemodynamics in spine surgeries: a systematic review and meta-analysis.","authors":"Eman Mohamed Teema, Ahmed Oun, Bassma Raslan, Sara Helmy, Mohamed K Elghobashy, Omima Samaha, Aiman Al-Touny","doi":"10.1186/s12871-026-04009-1","DOIUrl":"10.1186/s12871-026-04009-1","url":null,"abstract":"<p><strong>Background: </strong>Blood loss and hemodynamic instability are common challenges in spine surgery, often managed with controlled hypotension. Dexmedetomidine (DEX), a selective α2-adrenoceptor agonist, and magnesium sulfate (MgSO₄), an NMDA receptor antagonist and calcium channel blocker, are commonly used for this purpose, but their comparative efficacy and safety remain unclear. This comprehensive systematic review and meta-analysis aim to critically evaluate and compare the hemodynamic effects of both drugs in spinal surgeries.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines, searching PubMed, Scopus, Web of Science, and Google Scholar up to August 15, 2025. We identified randomized controlled trials comparing intravenous DEX vs. MgSO₄ in spine surgeries. Outcomes included blood loss; changes in mean arterial pressure (MAP), heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP); recovery time; first time to analgesic needs; total opioid consumption; extubation time; and incidence of bradycardia and tachycardia. Effect sizes were pooled using random-effects models.</p><p><strong>Results: </strong>Analysis of nine RCTs involving 463 patients showed that DEX significantly reduced intraoperative blood loss (MD = - 1.447 mL; p = 0.009), SBP (MD = - 0.448 mmHg; p = 0.012), tachycardia (RR = 0.330; p = 0.004), and prolonged the time to first analgesic request (MD = 1.409 min; p = 0.004). DEX was associated with an increased risk of bradycardia (RR = 4.819; p = 0.001) and delayed MAP recovery (p = 0.030). No significant differences were observed for MAP, HR, DBP, recovery time, postoperative opioid use, extubation time, or ephedrine requirement. Several outcomes showed high heterogeneity.</p><p><strong>Conclusions: </strong>Our study showed that dexmedetomidine offers superior blood-sparing and analgesic effects compared to magnesium sulfate but carries a higher risk of bradycardia and delayed MAP recovery. Magnesium sulfate remains effective for analgesia and muscle relaxation. Larger, well-designed RCTs are required to validate these findings and guide drug selection in spine surgery. Nevertheless, these findings should be interpreted with caution, given the extremely high heterogeneity observed across several pooled outcomes, which considerably constrains the reliability and generalizability of the estimates.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13361986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429760","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":"Early childhood exposure to general anesthesia and subsequent risk of learning disabilities: a systematic review and meta-analysis of cohort studies.","authors":"Huimin Zhou, Yadong Jin, Hao Zhou, Xin Chen, Hoi Yan Mak, Hamdan Hamdan, Chaoxuan Dong","doi":"10.1186/s12871-026-04096-0","DOIUrl":"10.1186/s12871-026-04096-0","url":null,"abstract":"<p><strong>Background: </strong>Potential neurodevelopmental consequences of early childhood exposure to general anesthesia (GA) remain uncertain, with existing studies reporting inconsistent findings regarding later learning disabilities (LDs). This meta-analysis assessed whether early childhood exposure to general anesthesia is associated with subsequent LDs and whether risks differ by exposure frequency, duration, or LD subtype.</p><p><strong>Methods: </strong>PubMed, Embase, Ovid, CINAHL, Web of Science, and the Cochrane Library were searched from inception to September 1, 2024. Cohort studies reporting LD outcomes after early childhood GA exposure were included. The primary meta-analysis was restricted to independent cohorts to avoid double-counting participants, whereas overlapping cohorts and studies reporting non-clinical educational outcomes were analyzed separately in sensitivity or secondary analyses. Random-effects models were used to pool risk ratios (RRs), study quality was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using GRADE.</p><p><strong>Results: </strong>Seven cohort studies comprising 167,848 children were analyzed. The primary meta-analysis, restricted to three independent cohorts reporting clinically diagnosed learning disabilities (LDs), showed that early childhood exposure to general anesthesia (GA) was associated with an increased risk of subsequent LDs (RR = 1.23, 95% CI: 1.06-1.43). Exploratory subgroup analyses showed no significant association following a single GA exposure (RR = 1.02, 95% CI: 0.89-1.16), whereas multiple GA exposures were associated with a significantly increased risk of LDs (RR = 2.29, 95% CI: 1.72-3.05). Similarly, no increased risk was observed for GA durations shorter than 60 min, whereas exposures longer than 60 min were associated with progressively higher risk estimates. The certainty of evidence ranged from very low to moderate, with low-certainty evidence for the primary outcome.</p><p><strong>Conclusion: </strong>Low-certainty evidence suggests that early childhood exposure to GA is associated with an increased risk of subsequent LDs, with larger pooled effect estimates observed following repeated or prolonged exposures. These findings should be interpreted cautiously because residual confounding related to underlying disease, surgical complexity, and hospitalization cannot be excluded. In addition, all included cohorts comprised children born in 2000 or earlier; therefore, the findings may not fully reflect contemporary pediatric anesthesia practice. Further well-designed prospective studies are required.</p><p><strong>Trial registration: </strong>PROSPERO, CRD42024603831.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435035","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":"Exploratory study of electroencephalogram markers of responsiveness to surgical noxious stimuli under propofol anaesthesia.","authors":"Vidushani Dhanawansa, Jamie Sleigh, Amy Gaskell, Adeel Razi, Levin Kuhlmann","doi":"10.1186/s12871-026-04064-8","DOIUrl":"10.1186/s12871-026-04064-8","url":null,"abstract":"<p><strong>Background: </strong>While general anaesthesia typically induces unconsciousness, some patients retain the capacity to respond behaviourally to noxious stimulation. Reduced frontal alpha (8-12 Hz) power has been proposed as a marker of arousal, but its clinical reliability remains inconsistent. This exploratory study aimed to identify multichannel EEG spectral and connectivity markers associated with intraoperative behavioural responsiveness around noxious stimulation.</p><p><strong>Methods: </strong>Sixty-four-channel EEG was recorded intraoperatively from seven patients undergoing microlaryngoscopy under propofol anaesthesia with analgesia. Responsiveness was assessed via reactions to verbal commands. Alpha-band spectral features of responders and non-responders were compared pre- and post-noxious stimulation using descriptive statistics. Linear mixed models evaluated the relationship between channel-wise spectral power, and the factors of noxious stimulation and responsiveness. Event-related synchronization/desynchronization and connectivity via weighted Symbolic Mutual Information (wSMI) were analysed across frequency bands and response categories, with correction for multiple comparisons.</p><p><strong>Results: </strong>Alpha power and global coherence showed minimal changes following noxious stimulation across patients. In contrast, volitional responses to noxious stimulation were associated with increased high-frequency power in sensory-motor and auditory cortices. These responses showed event-related synchronisation in left-central channels, whereas incoherent movements were marked by desynchronisation in the same areas. Theta-band activity further differentiated response types: cognitive responses showed suppression, while incoherent movements showed enhancement, particularly over the same regions. Cognitive responses were associated with increased global whole-brain integration, especially in the theta-band linking motor, auditory, and premotor cortices. Incoherent movements, by contrast, were associated with reductions in global brain connectivity. None of these patients reported postoperative awareness with recall.</p><p><strong>Conclusion: </strong>These preliminary findings suggest that localised high-frequency power increases and enhanced theta-band connectivity may reflect \"connected consciousness,\" in which patients retain the capacity to process sensory input despite anaesthesia. As this state may precede awareness with recall, particularly during noxious stimulation, its detection remains a key clinical challenge, underscoring the potential of these multichannel EEG features as markers. Despite limitations in sample size and variability in anaesthetic and patient factors, the surgical setting enhances the clinical relevance of these findings. However, further validation is required before clinical application for intraoperative monitoring and optimisation of analgesia prior to noxious stimulation.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435196","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":"Clinical evaluation of the SeptiScore biomarker for the diagnosis of healthcare-associated infections in critically ill trauma patients: a multicenter derivation and validation cohort study.","authors":"Marwan Bouras, Lisa Neutre, Chloé Douarec, Thomas Goronflot, Cécile Poulain, Alexandre Bourdiol, Alexiane Blanc, Charlotte Arbelot, Marc Leone, Marc G Denis, Antoine Roquilly","doi":"10.1186/s12871-026-04088-0","DOIUrl":"10.1186/s12871-026-04088-0","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing healthcare-associated infections (HCAIs) in critically ill trauma patients is difficult, because trauma-related non-septic systemic inflammatory response syndrome (SIRS) closely mimics infection and conventional biomarkers lack specificity. SeptiCyte RAPID is a fully automated host-response assay that quantifies the expression of two genes and returns a SeptiScore within one hour, making it suitable for bedside use. Our primary objective was to determine an optimal SeptiScore threshold for identifying HCAIs in a derivation cohort and to evaluate it in an independent validation cohort; secondary objectives were to assess diagnostic performance and to compare SeptiScore with conventional biomarkers.</p><p><strong>Methods: </strong>This two-center diagnostic study included a prospective derivation cohort (82 samples, 44 patients) and a retrospective validation cohort (31 samples, 31 patients), comprising adult ICU trauma patients with SIRS and hemodynamic failure. SeptiScore was measured at clinical suspicion, before microbiological confirmation. Because some patients contributed several samples, the association between SeptiScore and infection was analyzed using linear mixed-effects models with a random patient intercept, and confidence intervals for diagnostic metrics were estimated using a patient-level cluster bootstrap. Diagnostic accuracy was assessed by ROC curves, the Youden index, and negative likelihood ratios (LR -), and compared with C-reactive protein, procalcitonin, and leukocyte count.</p><p><strong>Results: </strong>Overall, 113 samples (71 trauma-related SIRS, 42 HCAIs) were analyzed. SeptiScore was higher in HCAIs (median 8.05, IQR 6.83-8.80) than in trauma-related SIRS (5.80, 5.08-7.05), and infection status remained independently associated with SeptiScore after accounting for within-patient correlation (p < 0.001). In the derivation cohort, the area under the ROC curve was 0.79 (95% CI 0.72-0.87). A threshold of 6.7 yielded sensitivity 0.84 (0.72-0.97), specificity 0.66 (0.53-0.79), and LR - 0.24 (0.04-0.53), outperforming conventional biomarkers. In the smaller validation cohort, the pre-specified threshold showed consistent performance (AUC 0.98; 95% CI 0.94-1.00), although these estimates are imprecise given the limited number of events.</p><p><strong>Conclusions: </strong>SeptiScore showed promising performance for distinguishing HCAIs from trauma-related SIRS and outperformed conventional biomarkers. These hypothesis-generating findings require confirmation in larger, adequately powered multicenter studies before clinical use.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418892","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":"Circulating leptin level associates with emergence time from general anesthesia in obese patients: a prospective study.","authors":"Xin Liu, Tongtong Pei, Ranxi Wang, Jierui Shi, Yanjing Tian, Haidong Wei, Pengbo Zhang","doi":"10.1186/s12871-026-04086-2","DOIUrl":"10.1186/s12871-026-04086-2","url":null,"abstract":"<p><strong>Background: </strong>General anesthesia administration in obese patients presents significant challenges. In addition to the complexity of dosage and parameter management, delayed recovery from anesthesia substantially increases the risk of postoperative complications. Thus, promoting rapid recovery in this population is crucial. However, factors associated with delayed recovery in obese patients remain poorly understood. Given the influence of metabolism on brain activity and connectivity, this exploratory study aimed to identify metabolic factors associated with delayed recovery in obese individuals.</p><p><strong>Methods: </strong>This study included 102 obese patients undergoing minor or moderate surgery under total intravenous anesthesia, with depth of anesthesia guided by the bispectral index. Peripheral circulating levels of leptin, orexin A, adiponectin, and lipid profiles were measured. Emergence time was defined as the duration from discontinuation of anesthetics to eye opening on command.</p><p><strong>Results: </strong>The median emergence time was 8 min (IQR 6-12). Univariate analysis indicated that patient height, sex, and leptin concentration were correlated with emergence time. Multivariate analysis revealed that circulating leptin was an independent factor associated with emergence time (β = -0.91, 95% CI: -1.42 to - 0.39, adjusted R² of 0.18).</p><p><strong>Conclusions: </strong>Circulating leptin level is associated with emergence time from general anesthesia in obese patients. However, it explains only a limited portion of the variability in emergence time given the low R². The findings support an association rather than a ready‑to‑use predictive marker, and external validation is required before any clinical translation.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410431","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}