BMC Anesthesiology最新文献

{"title":"Comparison of postoperative pain severity between primary and repeated cesarean section: a prospective cohort study.","authors":"Zemedkun Getahun, Mebratu Kebede, Mebratu Tilla, Gedion Asnak, Margherita Iuzzolino, Alemu Urmale, Hailemariam Getachew, Abebayehu Zemedkun, Tsegaye Demeke, Milion Abdi, Ashagire Sintayehu, Getahun Dendir","doi":"10.1186/s12871-025-02951-0","DOIUrl":"10.1186/s12871-025-02951-0","url":null,"abstract":"<p><strong>Background: </strong>The cesarean section was associated with moderate to severe postoperative pain. Uncertain differences exist between parturient who undergo a primary cesarean section and a repeat cesarean section in terms of post-operative pain.</p><p><strong>Objective: </strong>To compare the degree of postoperative pain in patients who had primary and repeat cesarean sections.</p><p><strong>Method: </strong>An institutional-based prospective cohort study was conducted on 336 patients who fulfilled eligibility criteria and underwent caesarian section under spinal anesthesia. Study participants were selected by a systematic random sampling technique. An independent sample t test and a Mann-Whitney U test were used to compare symmetric and asymmetric data, respectively. Time to first analgesic request was analyzed using log rank Kaplan-Meier survival curves and cox-regression for covariates. Comparisons of categorical variables between groups were done using the chi-square test. The significance was determined at a P value of < 0.05.</p><p><strong>Results: </strong>There was a high Risk of moderate to severe postoperative pain in repeated caesarean section compared to primary caesarean section in both incisional pain (RR, 1.364[95% CI, 1.12-1.66], p = 0.002) and visceral pain (RR, 1.66[95% CI, 1.40-1.66], p = 0.001). In comparison to the primiparas, parturient with repeated cesarean sections had highest post-operative pain severity in NRS with median NRS of 5(IQR, 3-5) at the 4th hour (p < 0.001) for the incisional pain and 6(IQR, 5-7) at the 8th hour for visceral pain, respectively, for the repeated group. The primiparas group had a longer median time to first rescue analgesic administration (median [minute], 875.7[95% CI, 750.3-1001]; P < 0.001)) than the repeated group (median [minute], 534.8 [95% CI, 426.8-642.8]; P < 0.001.</p><p><strong>Conclusions: </strong>Compared to primary CS, repeated cesarean had a high incidence of moderate to severe postoperative pain, both visceral and incisional; within 48-h. In future endeavors of crafting postoperative analgesic plans, it is imperative to take into account individual variations and distinctions.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"97"},"PeriodicalIF":2.3,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476299","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":"Predictive value of the neutrophil-to-lymphocyte ratio for epidural labor analgesia-associated intrapartum fever: a retrospective single-center study.","authors":"Lei Li, Xiao-Tong Yang, Jiang Zou, Jian Zhang, Xiao-Hai Xie, Jing-Hui Liu, Ben-Zhen Chen","doi":"10.1186/s12871-025-02972-9","DOIUrl":"10.1186/s12871-025-02972-9","url":null,"abstract":"<p><strong>Background: </strong>Studies have indicated that epidural analgesia increases the risk of maternal fever during labor, possibly due to non-infectious inflammation. The neutrophil-to-lymphocyte ratio (NLR) is a crucial indicator of inflammation, with a higher NLR potentially signaling worse patient adverse outcomes. The present study explores whether NLR has clinical predictive value for epidural analgesia-related maternal fever (ERMF).</p><p><strong>Methods: </strong>A retrospective analysis was performed for 1602 women who voluntarily requested analgesia for epidural labor from January 2023 to June 2024. Univariate and multivariate logistic regression analyses were applied to identify the factors influencing intrapartum fever, and the association between NLR and ERMF was explored. The receiver operating characteristic (ROC) curve was used to assess the area under the curve (AUC) of NLR for intrapartum fever, and the nearest ascending index was utilized to determine the cut-off value.</p><p><strong>Results: </strong>A total of 1602 parturients were included, of which 160 (10%) had intrapartum fever. Body mass index (BMI) (OR = 1.132, 95% CI: 1.027-1.246, P = 0.012), the duration of the first stage of labor (OR = 1.002, 95% CI: 1.001-1.003, P < 0.001), percentage of lymphocytes (OR = 1.205, 95%CI: 1.073-1.354, P = 0.012) and NLR (OR = 1.964, 95% CI: 1.462-2.639, P < 0.001) were independent risk factors for intrapartum fever. High NLR levels were associated with a higher incidence of ERMF at subgroups of ages < 35 years (OR = 1.343, 95%CI: 1.215-1.486, P < 0.001), ages ≥ 35 years (OR = 1.274, 95%CI: 1.105-1.468, P = 0.01), BMI < 24 kg/m² (OR = 1.326, 95% CI: 1.176-1.495, P < 0.001), BMI ≥ 24 kg/m² (OR = 1.515, 95%CI: 1.147-2.000, P = 0.003), first stage of labor < 600 min (OR = 1.466, 95%CI: 1.241-1.733, P < 0.001), and first stage of labor ≥ 600 min (OR = 1.257, 95%CI: 1.109-1.424, P < 0.001). Maternal NLR levels greater than 6.305 (AUC = 0.702, 95%CI: 0.634-0.768, P < 0.001) were good predicators of intrapartum fever.</p><p><strong>Conclusions: </strong>High NLR is associated with EMRF, and NLR is a viable predictor of early identification of the occurrence of EMRF, which may be beneficial for pregnancy outcomes.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"96"},"PeriodicalIF":2.3,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476302","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 of impostor phenomenon and burnout among Swiss residents and junior anaesthesiologists: results of a cross-sectional survey.","authors":"Mia Gisselbaek, Melanie Suppan, Sarah Saxena, Patricia Hudelson, Georges L Savoldelli","doi":"10.1186/s12871-025-02957-8","DOIUrl":"10.1186/s12871-025-02957-8","url":null,"abstract":"<p><strong>Background: </strong>Imposter phenomenon (IP) can impact professional performance and has been described as a risk factor for burnout within healthcare workers. We hypothesize that IP and burnout are prevalent among Swiss anaesthesiology residents and junior anaesthesiologists, and that specific risk factors are significantly associated with these conditions.</p><p><strong>Methods: </strong>We conducted a cross-sectional web-based survey of anaesthesiologists working in regions of Switzerland. The survey included demographic questions, the Clance Impostor Phenomenon Scale (CIPS), and the Maslach Burnout Inventory for Medical Personnel (MBI-HSS-MP). Descriptive statistics and logistic regression were used to identify demographic variables predictive of IP and burnout and to examine the association between IP and burnout.</p><p><strong>Results: </strong>A total of 318 people were eligible to participate. Of those, 136 (42.8%) participants completed the CIPS, and 127 (39.9%) completed the MBI-HSS-MP. Among CIPS respondents, 55% (75/136) identified as women, and 59% (80/136) were Swiss nationals. The prevalence of IP was 56% (76/136) and burnout was 10.2% (13/127). Women were more at risk of IP and burnout (p = 0.037). Independent covariates associated with IP were woman gender (p = 0.015) and Swiss nationality (p = 0.023). Additionally, the presence of IP was correlated with an increased likelihood of burnout (p = 0.04).</p><p><strong>Conclusions: </strong>IP was correlated with the presence of burnout in anaesthesiologists in training. Additionally, IP affected more than half of the participants. Two risk factors were identified for IP: being a woman and a Swiss national. The rates of IP and its concerning association with burnout among resident and junior anaesthesiologists needs to be addressed.</p><p><strong>Trial registration: </strong>NCT06097325, https://www.</p><p><strong>Clinicaltrials: </strong>gov/study/NCT06097325.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"98"},"PeriodicalIF":2.3,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476271","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":"Use of tranexamic acid in hepatectomy under controlled low central venous pressure: a randomized controlled study.","authors":"Jia-Yan Luo, Chen Zhou, Shu-Xian Shi, Qiu-Xuan Wei, Ying Chen, Jie Ouyang, Yong-Yu Si","doi":"10.1186/s12871-025-02935-0","DOIUrl":"10.1186/s12871-025-02935-0","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to investigate the efficacy and safety of tranexamic acid (TXA) in hepatectomy when administered as per the standardized protocol of controlled low central venous pressure (CLCVP).</p><p><strong>Methods: </strong>This study was a randomized, double-blind, controlled study. Patients who fulfilled the inclusion criteria were randomly assigned to the TXA group (group T) or the placebo group (group N). The central venous pressure (CVP) was maintained at below 5 cmH2O before complete dissection of the liver parenchyma. Patients in group T received an intravenous infusion of 10 mg/kg of TXA 30 min before surgery, and it was continuously pumped intravenously at a rate of 1 mg/(kg.h) until the end of surgery. Patients in group N were infused with 1 mL/kg of normal saline 30 min before surgery, and it was continuously pumped intravenously at a rate of 0.1 mL/(kg.h) until the end of surgery. The primary outcome indicators were intraoperative blood loss, blood transfusion rate, intraperitoneal drainage at 24 h after surgery, and the occurrence of compound bleeding within 30 days.</p><p><strong>Results: </strong>The baseline indicators were similar (P > 0.05), and there was no significant difference in intraoperative blood loss between the two groups, but the red blood cell transfusion rate was lower in the T group than in the N group (P < 0.05). The infusion volume, surgical field grade, and surgery duration were comparable between the two groups (P > 0.05). Patients in group T had a shorter hilar occlusion time, lower D-dimer and fibrinogen degradation products (FDPs) on the day of surgery, and significantly less intraperitoneal drainage at 24 h after surgery (all P < 0.05). There were two cases of compound bleeding and three cases of thromboembolism among patients in group N, but there were no such complications in group T.</p><p><strong>Conclusion: </strong>The use of TXA in hepatectomy under CLCVP reduced the intraoperative blood transfusion rate and improved the postoperative bleeding outcome without increasing the risk of adverse events such as hepatic and renal insufficiency and thrombosis.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"94"},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472252","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":"Vagal activity mediates the relationship between active housework and delayed neurocognitive recovery in elderly patients: a prospective nested case-control study.","authors":"Junfang Niu, Xiang Liu, Xupeng Wang, Fang Gao, Peixia Yu, Qi Zhou, Qiujun Wang","doi":"10.1186/s12871-025-02968-5","DOIUrl":"10.1186/s12871-025-02968-5","url":null,"abstract":"<p><strong>Background: </strong>Regular physical activity has been shown to ameliorate cognitive decline associated with aging, and to improve autonomic nervous function. However, the effect of active housework, a form of light to moderate physical activity, on postoperative cognitive function in the elderly remain unknown. The aim of this study is to investigate whether active housework exerts a protective effect against delayed neurocognitive recovery (dNCR), and to explore the role of vagal activity in this relationship.</p><p><strong>Methods: </strong>This is a prospective nested case-control study that enrolled 152 elderly patients scheduled for elective knee replacement surgery. The neuropsychological assessments were conducted to evaluate dNCR both preoperatively and one week postoperatively. Physical activity levels were quantified based on the Physical Activity Scale for the Elderly and categorized into active housework and sedentary behavior groups using hierarchical clustering. High-frequency spectral analysis of heart rate variability was used to assess vagal activity. Multivariable logistic regression analysis was employed to examine the association between active housework, vagal activity, and dNCR. Additionally, mediation analysis was performed to explore the possible mediating effect of vagal activity.</p><p><strong>Results: </strong>dNCR occurred in 33/141 (23.4%) patients. Active housework was associated with 84.7% lower odds of developing dNCR [OR = 0.153, 95% CI (0.042 to 0.550), p = 0.004]. There was significant interaction between vagal activity and dNCR [OR = 0.003, 95% CI (0.001 to 0.052), p < 0.001]. Vagal activity mediated the association between active housework and dNCR, accounting for 31.92% of the mediation effect.</p><p><strong>Conclusions: </strong>Active housework is associated with decreased incidence of dNCR, with vagal activity serving as a mediating factor. This study provides valuable insights for predicting and preventing of perioperative neurocognitive disorders in elderly patients.</p><p><strong>Trial registration: </strong>Trial registration number: ChiCTR2300070834, date of registration: April 24, 2023.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"95"},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472254","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 periprocedural cerebral desaturation during transcatheter aortic valve implantation and postprocedural delirium: a prospective observational study.","authors":"Hulya Yilmaz Ak, Baris Sandal, Yasemin Ozsahin, Ziya Salihoglu, Ahmet Yildiz, Esra Erturk Tekin, Mehmet Ali Yesiltas, Mustafa Yildiz, Kerem Erkalp","doi":"10.1186/s12871-025-02950-1","DOIUrl":"10.1186/s12871-025-02950-1","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to investigate whether the level of decrease in cerebral oxygen saturation during the valve placement phase of the transcatheter aortic valve implantation (TAVI) procedure under sedation has an effect on postoperative delirium (POD).</p><p><strong>Methods: </strong>The study initially assessed 50 patients between the ages of 50 and 90 years with an indication for TAVI by the cardiac team. Regional cerebral oxygen saturation (rScO2) was measured using Near-infrared spectroscopy (NIRS) before the procedure (T1), during surgical field sterilization (T2), catheter placement (T3), wire manipulation (T4), valve placement (T5) and access site artery repair (T6). Confusion Assessment Method for The Intensive Care Unit (ICU-CAM) test was performed on intensive care unit and the presence of POD was questioned. Patients were divided into two groups as those without POD (Group 1) and those with POD (Group 2).</p><p><strong>Results: </strong>The study was completed with 41 patients in total. While POD was present in 12 (29.3%) of the patients evaluated intensive care unit, POD was not observed in 29 (70.7%) patients. The rScO2 value measured at T5 was significantly lower in Group 2 compared to Group 1 (p < 0.001).</p><p><strong>Conclusions: </strong>In our study, the rate of POD after TAVI was as high as 29.3%. Low rScO2 during valve placement was associated with delirium. Our findings indicate that NIRS devices could be a useful tool for assessing the risk of POD during the TAVI procedure; however, further research is needed to validate their routine clinical use.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"93"},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466410","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":"An ultrasound-guided modified iliac fascia and sacral plexus block application in a critically ill patient undergoing artificial femoral head replacement surgery: a case report.","authors":"Muyan Shi, Ping Huang, Jie Tian, Ruixin Lin, Xiaoqiang Wang, Qiuyue Lian, Diansan Su, Zhenling Huang","doi":"10.1186/s12871-025-02969-4","DOIUrl":"10.1186/s12871-025-02969-4","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures have become a significant clinical concern on a global scale in recent years. The burgeoning aging population has exacerbated this issue, leading to a rise in the number of hip fracture cases coupled with concomitant geriatric ailments. Therefore, it poses a huge challenge to anesthesiologists with the increasing number of critically ill patients who are not suitable for general anesthesia and intrathecal anesthesia. Ultrasound-guided nerve blocks combined with sedation have not previously been documented in critically ill patients.</p><p><strong>Case presentation: </strong>We administered an ultrasound-guided modified iliac fascia block combined with sacral plexus block to an 88-year-old male patient with a left femoral fracture suffering from severe multi-systemic diseases. Concurrently, the patient received intravenous anesthesia via propofol and dexmedetomidine, with monitoring conducted through bispectral index. Subsequently, the surgery was completed smoothly and the patient demonstrated accelerated postoperative recovery without significant discomfort and a successful discharge.</p><p><strong>Conclusions: </strong>This innovative approach significantly contributed to achieving successful surgical anesthesia and postoperative analgesia, thereby facilitating early recovery and discharge from the hospital. We propose that ultrasound-guided nerve blocks with sedation show promise for critically ill patients.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"92"},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466407","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 modified effect of mechanical ventilation setting on relationship between fluid balance and hospital mortality for sepsis patients: a retrospective study.","authors":"Dawei Zhou, Yi Lv, Chao Wang, Dan Li","doi":"10.1186/s12871-025-02954-x","DOIUrl":"10.1186/s12871-025-02954-x","url":null,"abstract":"<p><strong>Background: </strong>Fluid supplement may be affected by ventilatory management due to physiological interaction between heart and lung. The aim of the present study was to explore the effects of ventilator strategies on the relationship of fluid balance and hospital mortality for sepsis patients.</p><p><strong>Methods: </strong>This was a retrospective cohort study included sepsis patients with invasive mechanical ventilation (MV) over 24 h from Medical Information Mart for Intensive Care (MIMIC) IV database. The accumulative fluid balance increased by 6 h intervals were calculated as fluid intake minus fluid output. The modes (assisted or controlled) and levels (high or low) of positive end-expiratory pressure (PEEP) of MV every 6 h were recorded. The modification effect for modes and levels of PEEP on the relationship of fluid balance and hospital mortality were tested by multivariable regression models, respectively.</p><p><strong>Results: </strong>A total of 4466 sepsis patients with invasive MV were included, of which hospital mortality was 26.5%. Fluid balance seemed to have U-shape relationship with hospital mortality. The majority of patients used controlled ventilation at the beginning, and switched to assisted ventilation gradually; however, the PEEP level did not change a lot during the first 24 h. The relationship between fluid balance and hospital mortality was not modified by the ventilator mode; while the PEEP level may modify the relationship.</p><p><strong>Conclusions: </strong>For sepsis patients admitted to ICU with invasive MV, the PEEP level, but not the mode of MV, appeared to modify the relationship of fluid balance and hospital mortality. The setting of mechanical ventilation may be an important consideration for fluid therapy.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"91"},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466646","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":"Additive effect of a single intravenous dose of acetaminophen administered at the end of laparoscopic hysterectomy on postoperative pain control with nefopam and fentanyl-based patient-controlled analgesia: a double-blind, randomized controlled trial.","authors":"Seungpyo Nam, Seokha Yoo, Sun-Kyung Park, Jin-Tae Kim","doi":"10.1186/s12871-025-02971-w","DOIUrl":"10.1186/s12871-025-02971-w","url":null,"abstract":"<p><strong>Background: </strong>Acetaminophen is a widely used analgesic for postoperative pain management. However, data on its combined use with nefopam for managing postoperative pain following laparoscopic hysterectomy are limited. This study evaluated the effects of a single intravenous dose of acetaminophen combined with fentanyl- and nefopam-based patient-controlled analgesia (PCA) in patients undergoing laparoscopic hysterectomy.</p><p><strong>Methods: </strong>In this prospective, double-blind, randomized controlled trial, 84 patients were randomized to receive either 1 g of intravenous acetaminophen (treatment group, n = 42) or normal saline (control group, n = 42) at the end of surgery. All patients received fentanyl and nefopam via PCA, postoperatively. PCA consumption, pain scores at rest, and postoperative nausea and vomiting (PONV) scores were assessed at 1, 6, and 24 h postoperatively. Patient satisfaction and opioid-related side effects were also evaluated. The primary outcome was the total PCA consumption within the first 24 h.</p><p><strong>Results: </strong>No significant difference in 24-h PCA consumption was observed between the control and treatment groups (27.9 ± 16.6 vs. 26.4 ± 11.2, P = 0.623). The pain scores at rest measured at 1, 6, and 24 h after surgery were also not significantly different between the two groups. There were no differences in the satisfaction scores, PONV scores, rescue analgesic use, adverse effects, or length of hospital stay between the groups.</p><p><strong>Conclusions: </strong>A single intraoperative dose of intravenous acetaminophen, combined with nefopam- and fentanyl-based PCA, did not significantly reduce analgesic requirements, pain scores at rest, or opioid-related side effects compared with placebo in laparoscopic hysterectomy patients.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (Identifier: NCT03644147 | August 21, 2018).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"88"},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466404","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":"Cerebral oxygenation and hemodynamic changes during ephedrine and phenylephrine administration for transient intraoperative hypotension in patients undergoing major abdominal surgery: a randomized controlled trial.","authors":"Xueyan Li, Yijun Zheng, Jun Zhang","doi":"10.1186/s12871-025-02944-z","DOIUrl":"10.1186/s12871-025-02944-z","url":null,"abstract":"<p><strong>Background: </strong>Phenylephrine and ephedrine are frequently used vasopressors for treating intraoperative hypotension. However, their impact on cerebral oxygenation and blood flow remains a subject of debate. This study aims to understand their effects on cerebral oxygen saturation and hemodynamics when used for treatment of intraoperative hypotension.</p><p><strong>Methods: </strong>The adult patients undergoing major abdominal surgery under general anesthesia were randomly assigned into ephedrine (ED) group or phenylephrine (PE) group. They received an intravenous bolus of either ephedrine or phenylephrine for treating intraoperative transient hypotension. The primary outcome was their effects on regional cerebral oxygen saturation (rScO₂). The secondary outcomes included cerebral hemodynamics middle cerebral artery velocity (MCAvm), pulsatility index (PI), and resistance index (RI), as well as systemic hemodynamics arterial blood pressure (ABP), heart rate (HR), cardiac output (CO), cardiac index (CI), stroke volume (SV) and stroke volume index (SVI). Additionally, two indices of cerebral autoregulation, mean flow index (Mx_a) and cerebral oximetry index (CO_X), were calculated in real-time via ICM + software.</p><p><strong>Results: </strong>Forty patients were included in this study. The initial results showed ephedrine increased rScO₂ (p < 0.001), while phenylephrine increased Mx_a (p < 0.02) and CO_X (p < 0.007), respectively. However, upon further linear-mix model analysis, the effects of both drugs on rScO₂ (p = 0.944), Mx_a (p = 0.093) and CO_X (p = 0.084) were found to be non-significant. Compared with the hemodynamic parameters during hypotension, the systolic blood pressure (SBP) (p < 0.001), diastolic blood pressure (DBP) (p < 0.001), mean arterial pressure (MAP) (p < 0.001), and MCAvm (p < 0.001) significantly increased after both ephedrine and phenylephrine administration. However, no significant differences were found between the two groups in terms of the changes in MAP (p = 0.549) and MCAvm (p = 0.173). And there were significant increases in CO (p < 0.001), HR (p < 0.001), and CI (p < 0.001) following ephedrine administration, while decreases in HR (p < 0.001), CO (p < 0.001), and CI (p < 0.001) after phenylephrine administration.</p><p><strong>Conclusion: </strong>In the management of intraoperative hypotension, both phenylephrine and ephedrine effectively increase MAP and MCAvm, albeit with their differential effects on CO and HR. It seems that neither vasopressor has a significant impact on cerebral oxygenation and cerebral autoregulation.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"87"},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466413","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}