BMC Anesthesiology最新文献

{"title":"Association and predictive value of preoperative high-sensitivity C-reactive protein for postoperative atrial fibrillation after video-assisted thoracoscopic lobectomy: a cohort study using the INSPIRE database.","authors":"Han Wu, Zhipeng Zhou, Long Huang, Xiyuan Xie, Liangcheng Qiu, Xiaodan Wu","doi":"10.1186/s12871-026-04035-z","DOIUrl":"10.1186/s12871-026-04035-z","url":null,"abstract":"<p><strong>Background: </strong>Postoperative atrial fibrillation (POAF) is a common and serious complication following video-assisted thoracoscopic surgery (VATS), which affects patients' medical outcomes and quality of life. The predictive value of high-sensitivity C-reactive protein (hs-CRP) as an inflammatory marker for POAF in non-cardiac surgeries remains unclear. This study aims to investigate the association and predictive capability of preoperative hs-CRP levels with postoperative new-onset atrial fibrillation.</p><p><strong>Methods: </strong>This study employed a retrospective cohort design, analyzing data from the INSPIRE database, which included 3,219 patients who underwent thoracoscopic lobectomy. Patients were classified into low-risk, moderate-risk, and high-risk groups based on preoperative hs-CRP levels. Multivariable logistic regression models were used to assess the independent association of hs-CRP with the occurrence of POAF in different risk groups. Additionally, the incremental predictive utility of hs-CRP for POAF was evaluated using C-statistics, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI), in order to quantify the improvement in predictive accuracy when including hs-CRP in existing risk models. Feature importance calculations and predictive models were generated using the Boruta algorithm and machine learning methods.</p><p><strong>Results: </strong>The incidence of clinically recognized POAF increased progressively across hs-CRP categories (2.9% in the low-risk group, 6.0% in the intermediate-risk group, and 9.3% in the high-risk group; P for trend < 0.001). After multivariable adjustment using preoperatively available covariates, the high hs-CRP group remained significantly associated with clinically recognized POAF compared with the low hs-CRP group (OR 2.33, 95% CI 1.31-4.14; P = 0.004). Adding hs-CRP to a baseline clinical model including age, sex, BMI, RCRI score, and extent of resection improved the C-statistic from 0.758 to 0.845 (P < 0.001), with significant improvements in continuous NRI and IDI. However, these reclassification metrics should be interpreted as statistical risk refinement rather than evidence of clinically actionable reclassification.</p><p><strong>Conclusion: </strong>Preoperative high-sensitivity C-reactive protein is associated with an increased risk of clinically recognized POAF after VATS lobectomy. Its inclusion in baseline models improves statistical risk stratification, pending further prospective clinical validation.</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/PMC13632401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative systemic immune inflammation index predicts early complications and 30-day mortality after heart valve surgery: a retrospective cohort study.","authors":"IMade Adi Parmana, Dudy Arman Hanafy, Cindy Elfira Boom","doi":"10.1186/s12871-026-04076-4","DOIUrl":"10.1186/s12871-026-04076-4","url":null,"abstract":"<p><strong>Background: </strong>The systemic immune-inflammation index (SII) is considered a promising inflammatory index for predicting adverse outcomes in cardiovascular diseases. However, its prognostic value in patients undergoing heart valve surgery remains unclear. This study aimed to investigate the predictive significance of preoperative SII for early postoperative complications and 30-day mortality.</p><p><strong>Methods: </strong>This was a retrospective, single-center cohort study conducted at the National Cardiovascular Center Harapan Kita in Jakarta, Indonesia, a tertiary cardiac surgery referral hospital. It included adults (> 18 years) who underwent elective aortic, mitral, or combined valve surgery between January 2020 and December 2024. After applying exclusion criteria, 1347 patients were stratified by SII into low (< 551 × 10³/mm³, n = 927) and high (≥ 551 × 10³/mm³, n = 420) groups.</p><p><strong>Results: </strong>High preoperative SII was significantly associated with acute kidney injury (AKI) (p = 0.002), prolonged mechanical ventilation (p = 0.039), extended total hospital length of stay (LOS-H) (p = 0.004), and 30-day mortality (p = 0.026). Multivariate logistic regression identified SII (OR 2.169; 95% CI 1.600-2.941; p < 0.001) as independent predictor of adverse postoperative outcomes. When analyzed as a continuous variable, preoperative SII remained independently associated with adverse postoperative outcomes (adjusted OR per 100-unit increase 1.196; 95% CI 1.148-1.245; p < 0.001). Subgroup analysis revealed the highest predictive value in patients undergoing aortic valve surgery, with an area under the curve (AUC) of 0.797 (95% CI 0.728-0.866).</p><p><strong>Conclusions: </strong>Elevated preoperative SII is independently associated with an increased risk of early postoperative complications and 30-day mortality in patients undergoing heart valve surgery. As a simple and cost-effective inflammatory index, SII may aid in preoperative risk stratification and support more personalized perioperative care.</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/PMC13632052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418802","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":"Continuous adductor canal block versus continuous femoral nerve block for analgesia after open reduction and internal fixation of patellar fractures: a randomized controlled trial.","authors":"Man Li, Yin Zhou, Fu Yao, Zhijun Qin","doi":"10.1186/s12871-026-04087-1","DOIUrl":"10.1186/s12871-026-04087-1","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the analgesic efficacy, impact on quadriceps muscle strength, and safety of continuous adductor canal block (CACB) versus continuous femoral nerve block (CFNB) in patients undergoing open reduction and internal fixation (ORIF) of patellar fractures, and to provide evidence for selecting the optimal perioperative analgesic regimen in clinical practice.</p><p><strong>Methods: </strong>A total of 80 patients scheduled for primary unilateral ORIF of patellar fractures at our hospital from August 2018 to May 2019 were enrolled in this randomized controlled trial. Patients were randomly allocated to the CACB group (experimental group) or CFNB group (control group) at a 1:1 ratio using a computer-generated random number table, with 40 patients in each group. Ultrasound-guided nerve block catheterization was performed before anesthesia induction in both groups, with an initial bolus of 20 mL 0.2% ropivacaine. Postoperative patient-controlled analgesia (PCA) with 0.175% ropivacaine was administered in both groups. The primary outcome was quadriceps muscle strength at 2 h, 12 h, 24 h, and 48 h postoperatively. Secondary outcomes included intraoperative sufentanil consumption, Visual Analogue Scale (VAS) pain scores at rest and during 45° active knee flexion at multiple postoperative time points, rate of rescue analgesia, incidence of adverse events, and patient satisfaction with analgesia.</p><p><strong>Results: </strong>There were no significant differences in baseline demographic and clinical characteristics between the two groups (all P > 0.05). No significant differences were found in intraoperative sufentanil consumption, VAS scores at rest and during movement at all postoperative time points, or rescue analgesia rate between the two groups (all P > 0.05). Quadriceps muscle strength at 2 h, 12 h, 24 h, and 48 h postoperatively was significantly higher in the CACB group than in the CFNB group (all P < 0.001). The total incidence of adverse events was significantly lower in the CACB group (17.5%) than in the CFNB group (32.5%, P = 0.045), and patient satisfaction with analgesia was significantly higher in the CACB group (P = 0.048).</p><p><strong>Conclusion: </strong>Ultrasound-guided CACB yields comparable analgesic efficacy compared with CFNB in patients undergoing ORIF of patellar fractures; CACB resulted in significantly less impairment of quadriceps muscle strength than CFNB, with fewer adverse events and higher patient satisfaction. CACB creates favorable conditions for early postoperative functional rehabilitation, aligns with ERAS principles, and is a safe and effective regional analgesic technique worthy of further clinical validation and consideration in appropriate patient populations undergoing patellar fracture surgery.</p><p><strong>Trial registration: </strong>This trial was registered with ChiCTR (ChiCTR1800017828) on August 16, 2018.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410398","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 intraoperative inhalational versus intravenous anesthesia on perioperative neurological outcomes and long-term prognosis in patients with moyamoya disease undergoing revascularization surgery: a systematic review and meta-analysis.","authors":"Mengting Hu, Ye Ma","doi":"10.1186/s12871-026-04085-3","DOIUrl":"10.1186/s12871-026-04085-3","url":null,"abstract":"<p><strong>Background: </strong>Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of intracranial carotid arteries and abnormal collateral network formation. Surgical revascularization is the standard treatment for stroke prevention, but the optimal intraoperative anesthetic strategy to minimize perioperative neurological complications remains controversial. This meta-analysis compares inhalational versus intravenous anesthesia for perioperative neurological outcomes in MMD patients undergoing revascularization.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Cochrane Library, and Web of Science from database inception to April 2026, including randomized controlled trials and high-quality observational studies comparing the two anesthesia regimens. Two investigators independently completed literature screening, data extraction, and risk of bias assessment. Random-effects models were applied to pool effect sizes. Primary outcomes included postoperative transient neurological events (TNEs), post-anesthesia care unit (PACU) delirium, and postoperative stroke. Evidence quality was graded using the GRADE system.</p><p><strong>Results: </strong>Eleven studies (1673 patients, 2232 procedures) were included, with 6 studies constituting the core quantitative analysis set. Outcome coverage varied: 5 studies reported TNEs, 2 reported postoperative stroke, and only 1 single-center study reported PACU delirium. Pooled results showed no significant intergroup difference in TNEs (OR = 0.87, 95% CI: 0.55-1.38, P = 0.56, I² = 61%) or postoperative stroke (OR = 1.05, 95% CI: 0.50-2.17, P = 0.91, I² = 0%). Based on limited pediatric data, inhalational anesthesia may be associated with increased PACU delirium risk in children. Qualitative evidence indicated both regimens maintained stable cerebral oxygenation, while propofol-based intravenous anesthesia had advantages in reducing intracranial pressure and improving surgical field exposure.</p><p><strong>Conclusions: </strong>Current low-to-very-low quality evidence shows no significant difference in major perioperative neurological complications between the two anesthetic regimens for MMD revascularization. Intravenous anesthesia has potential advantages in intraoperative cerebral physiology and surgical conditions, and may be considered preferentially for children at high delirium risk, with limited evidence strength.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251272930.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410362","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":"Pulse pressure variation-guided versus low central venous pressure-guided fluid management during elective open hepatectomy: a randomized non-inferiority trial.","authors":"Ashish Singh Aditya, Anjali V, Kamal Kajal, Amarjyoti Hazarika, Shiv Lal Soni, Sameer Sethi, Lileswar Kaman","doi":"10.1186/s12871-026-04063-9","DOIUrl":"10.1186/s12871-026-04063-9","url":null,"abstract":"<p><strong>Background: </strong>Low central venous pressure (LCVP)-guided fluid management is widely used to reduce blood loss during liver resection; however, LCVP is an unreliable marker of preload. Pulse pressure variation (PPV) is a dynamic index of fluid responsiveness. This study evaluated whether a PPV-guided fluid management strategy is non-inferior to conventional LCVP-guided management in reducing intraoperative blood loss during elective open hepatectomy.</p><p><strong>Methods: </strong>In this single-center, randomized, non-inferiority trial, adult patients (18-65 years) with American Society of Anesthesiologists physical status I-II scheduled for elective, non-donor open hepatic resection involving two or more segments were randomized to either an LCVP-guided group or a PPV-guided group. Fluid administration in both groups followed predefined hemodynamic algorithms. The primary outcome was intraoperative blood loss. Secondary outcomes included total intraoperative fluid administration, urine output, serum lactate concentrations, and postoperative renal function. Non-inferiority was assessed using a prespecified margin of 98 ml.</p><p><strong>Results: </strong>Sixty-four patients (32 in each group) were included in the final analysis. Intraoperative blood loss was comparable between the LCVP and PPV groups (683 ± 276 ml vs. 726 ± 223 ml, respectively). The mean difference in blood loss was - 43 ml (95% confidence interval: -169 to 83 ml), with the upper limit remaining below the predefined non-inferiority margin, confirming non-inferiority of the PPV-guided strategy. Total crystalloid and colloid administration, urine output, surgical field grading, and perioperative serum lactate levels were similar between the two groups. Postoperative serum creatinine levels at 24 h did not differ significantly.</p><p><strong>Conclusions: </strong>PPV-guided fluid management was non-inferior to an LCVP-based strategy for reducing intraoperative blood loss during elective open hepatic resection, without evidence of compromised tissue perfusion. These findings suggest that PPV-guided fluid management may be a feasible alternative to CVP-targeted fluid management in this setting.</p><p><strong>Trial registration: </strong>The trial was registered prospectively with the Clinical Trials Registry of India (CTRI/2018/01/011547; registered on 24 January 2018).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403574","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":"Ultrasound guided external oblique intercostal plane block versus posterior transversus abdominis plane block for postoperative analgesia in adult patients undergoing open nephrectomy: a randomized trial.","authors":"Amgad Elshikh, Lashin S Ali, Mohammed S ElSharkawy, Sameh M Fathy, Bahaa G Mohamed, Khaled Hamama, Mahmoud A Elmohasseb, Eman H Abu Shanab, Zainab T Ragab, Saad A Moharam, Ahmed F Mady","doi":"10.1186/s12871-026-03935-4","DOIUrl":"10.1186/s12871-026-03935-4","url":null,"abstract":"<p><strong>Background: </strong>Nephrectomy procedures result in considerable postoperative discomfort, and limitations on the use of traditional management include opioid-related adverse effects and epidural-associated side effects. A prospective comparison was conducted to evaluate the relative effectiveness of two regional anesthetic techniques, the external oblique intercostal plane block (EOIPB) and the ultrasound-guided posterior transversus abdominis plane block (TAPB), in reducing postsurgical pain after open nephrectomy (OPN).</p><p><strong>Methods: </strong>Forty adults who underwent elective OPN were included in the study. The study population was randomly divided into two groups to receive either EOIPB or TAPB in a volume of 20 mL with 0.5% bupivacaine after the induction phase. The primary outcome was cumulative 24-hour pethidine consumption. Secondary outcomes included intraoperative fentanyl requirements, time to first rescue analgesia, pain scores at 0, 4, 8, 12, 18, and 24 h postoperatively, hemodynamic parameters, adverse events, and patient satisfaction.</p><p><strong>Results: </strong>The EOIPB group had significantly lower pain scores at 4, 8, 12, and 18 h after surgery compared to the TAPB group (p < 0.05). The EOIPB group used significantly less pethidine than the other group (61.5 ± 24.77 mg vs. 114 ± 12.31 mg, p < 0.001), and it took them longer to receive their first rescue analgesia (7.25 ± 0.91 vs. 6.1 ± 1.55 h, p = 0.007). The EOIPB group exhibited significantly higher patient satisfaction (p = 0.045), although the two groups had similar profiles of adverse events.</p><p><strong>Conclusions: </strong>In adults undergoing OPN, EOIPB provided superior early postoperative analgesia compared to TAPB during the first 18 h after surgery, as evidenced by lower pain scores, reduced opioid requirements, delayed time first to rescue analgesia, and higher patient satisfaction. Both blocks demonstrated comparable safety profiles.</p><p><strong>Clinical trial: </strong>Registration occurring at ClinicalTrials.gov (ID: NCT06452238), (URL: https://clinicaltrials.gov/study/NCT06452238?cond=NCT06452238&rank=1 ), Date: (30-5-2024).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395983","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":"Acute psychogenic mutism following total hip arthroplasty under general anesthesia in an elderly patient: a case report.","authors":"Ya Guo, Yongbo Duan, Xiaoxue Feng, Ruijuan Liu, Chengjian Wang, Yingqiang Guo, Wenjun Yan","doi":"10.1186/s12871-026-04082-6","DOIUrl":"10.1186/s12871-026-04082-6","url":null,"abstract":"<p><p>Postoperative neuropsychiatric complications most commonly manifest as delirium or cognitive impairment; however, acute isolated mutism in the absence of frank delirium or structural brain injury-referred to in some literature as acute psychogenic mutism (APM)-represents an exceedingly rare and poorly understood postoperative phenomenon. This report presents a case of APM in a 69-year-old woman following elective total hip arthroplasty under general anesthesia. The patient developed acute selective aphonia upon emergence from anesthesia, despite preserved comprehension and nonverbal communication abilities, with symptoms resolving spontaneously 44 h postoperatively. Emergent neuroimaging revealed no evidence of acute ischemic or hemorrhagic stroke, making a macro-scale cerebrovascular event unlikely.This case is notable for three distinctive features: (1) context-dependent preoperative anxiety, reflected by an Observational Anxiety Scale (OAS) score of 0 in the presence of family preoperatively, which escalated to elevated situational anxiety (HADS-A score 12, suggesting clinically relevant anxiety but not necessarily pathological) upon entry into the operating room; (2) the potential contribution of severe cerebral white matter lesions (Fazekas grade III), which may have disrupted prefrontal-limbic regulation under anesthetic stress; and (3) its occurrence in an older patient undergoing orthopedic surgery, challenging the prior association of APM predominantly with younger plastic surgery patients. We propose a tripartite etiological model integrating environmental triggers, neural vulnerability, and psychogenic dissociation, offering preliminary insights into perioperative mental health risk stratification that warrant further investigation. Non-convulsive status epilepticus was considered unlikely given the patient's alertness and interactive behavior, though EEG was not performed acutely.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403516","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 median effective dose (ED₅₀) of remimazolam combined with esketamine for conscious sedation in patients with dental anxiety undergoing outpatient dental surgery: a prospective, dose-finding study.","authors":"Mengjiao Che, Cuiyao Kang, Cuiyun Zhou, Yaoheng Yang, Yuxuan Zhou, Yifeng Yang, Feifei Li, Danru Xie, Yanjing Zhang, Yiwen Zhang","doi":"10.1186/s12871-026-04032-2","DOIUrl":"10.1186/s12871-026-04032-2","url":null,"abstract":"<p><strong>Background: </strong>Dental anxiety presents a significant barrier to treatment. Conscious sedation is widely used to alleviate anxiety. Although remimazolam has demonstrated its efficacy and advantages for outpatient dental procedures, research on the effective dose of remimazolam combined with esketamine remains limited. Thus, the purpose of our research was to estimate the effective dose of remimazolam with esketamine for conscious sedation in patients with dental anxiety undergoing outpatient dental surgery.</p><p><strong>Methods: </strong>The study enrolled outpatients with dental anxiety aged 18-65 years who received dental operations and were classified under ASA grades I-II. Using the modified Dixon up-and-down method, each patient was first administered by infusing esketamine 0.1 mg/kg, followed by an assigned dose of remimazolam. The initial dose of remimazolam was 0.1 mg/kg, with a dose gradient of 0.01 mg/kg. Sedation success was defined as achieving a MOAA/S score of 3-4 within 5 min after the initial loading dose, without requiring additional remimazolam. The primary outcome was the ED₅₀ of remimazolam and its 95% confidence interval (CI). Secondary outcomes included security indicators, patient satisfaction and memory of the procedure, dentist satisfaction, duration of treatment, and discharge time.</p><p><strong>Results: </strong>The study achieved 10 transition points (from sedation success to failure) with a total enrollment of 32 individuals. The ED₅₀ and ED₉₅ of remimazolam with 0.1 mg/kg esketamine, for conscious sedation during outpatient dental surgery, were 0.069 mg/kg (95% CI: 0.050-0.080 mg/kg) and 0.099 mg/kg (95% CI: 0.085-0.200 mg/kg), respectively. No circulatory and respiratory adverse events requiring intervention were observed during anesthesia induction.</p><p><strong>Conclusions: </strong>For outpatient dental procedures in patients with dental anxiety, the ED₅₀ and ED₉₅ of remimazolam with esketamine for conscious sedation were 0.069 mg/kg and 0.099 mg/kg, respectively. The ED₅₀ provides a preliminary reference for initial dose selection in this clinical setting. However, the wide confidence interval of the ED₉₅ limits its clinical utility and requires validation in larger studies.</p><p><strong>Trial registration: </strong>This study was registered in the Chinese Clinical Trial Registry (ChiCTR2500104775; first registered on 23/06/2025).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403569","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":"Baseline peak VO₂ and treatment effect consistency of perioperative rehabilitation in cardiac valve surgery: an exploratory subgroup analysis of the PORT trial.","authors":"Rou Wang, Zengyan Huang, Zhongxing Jiang, Bingqing Bai, Jinna Chang, Junshuo Zhu, Kaixuan Lin, Huan Ma","doi":"10.1186/s12871-026-04074-6","DOIUrl":"10.1186/s12871-026-04074-6","url":null,"abstract":"<p><strong>Background: </strong>In the PORT trial (Perioperative Rehabilitation in Patients Undergoing Elective Cardiac Valve Surgery: A Randomised Controlled Trial), a short-term multidomain perioperative rehabilitation programme was associated with a reduced incidence of postoperative pneumonia in patients undergoing elective cardiac valve surgery. Whether baseline peak oxygen consumption (peak VO₂), a marker of cardiorespiratory reserve, modifies the effect of this intervention remains uncertain.</p><p><strong>Objectives: </strong>To evaluate whether the association between perioperative rehabilitation and postoperative outcomes differs according to baseline peak VO₂ (≤ 20 vs. > 20 mL·kg⁻¹·min⁻¹).</p><p><strong>Methods: </strong>This exploratory subgroup analysis included 702 participants from the PORT trial who underwent preoperative cardiopulmonary exercise testing. Patients were stratified by baseline peak VO₂ and randomized to perioperative rehabilitation-comprising education, inspiratory muscle training, active cycle of breathing techniques, and early mobilization-or usual care. The primary endpoint was a composite of in-hospital all-cause mortality, postoperative pulmonary complications (PPCs), and prolonged hospitalization (> 7 days). Logistic and Cox regression models adjusted for prespecified covariates were used to estimate treatment effects within peak VO₂ strata, and treatment-by-peak VO₂ interactions were tested.</p><p><strong>Results: </strong>Of 702 participants, 202 (29%) had peak VO₂ >20 and 500 (71%) had peak VO₂ ≤20 mL·kg⁻¹·min⁻¹. The composite primary endpoint did not differ significantly between rehabilitation and usual care in either stratum (interaction P = 0.62). Perioperative rehabilitation was associated with a lower incidence of postoperative pneumonia in both peak VO₂ >20 mL·kg⁻¹·min⁻¹ (adjusted OR 0.30; 95% CI 0.13-0.71) and ≤ 20 mL·kg⁻¹·min⁻¹ (adjusted OR 0.65; 95% CI 0.47-0.90), with no significant interaction between peak VO₂ category and treatment effect (P for interaction = 0.12). No significant effect modification was observed for other outcomes, including SICU stay, total hospitalization duration, or 3-month mortality.</p><p><strong>Conclusions: </strong>In this exploratory analysis of the PORT trial, the reduction in postoperative pneumonia associated with short-term perioperative rehabilitation was consistent across strata of baseline peak VO₂. These findings suggest that the pneumonia benefit of respiratory-focused perioperative rehabilitation may not depend on baseline cardiorespiratory fitness, although adequately powered studies are required to definitively assess effect modification. Although the observed reduction in pneumonia was statistically significant and biologically plausible, it arose from a secondary exploratory analysis without adjustment for multiple comparisons and should therefore be interpreted with caution.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395930","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":"Nebulized magnesium sulfate reduces postoperative sore throat following general anesthesia: a systematic review, meta-analysis, and trial sequential analysis.","authors":"Sandara Bashir, Muhammad Mustafa Khan, Muhammad Hamad Khan, Abdul Haseeb, Abdullah Abdullah, Abdul Saboor, Habib Ur Rehman, Rayaan Jan, Aman Ullah, Hassan Khalil, Sayed Shahabuddin, Abdul Muiz, Yahya Samadi, Asiya Shahzad","doi":"10.1186/s12871-026-04066-6","DOIUrl":"10.1186/s12871-026-04066-6","url":null,"abstract":"<p><strong>Background: </strong>Post-operative sore throat (POST) frequently complicates general anesthesia involving endotracheal intubation, affecting roughly 60% of individuals and markedly hindering postoperative recovery. The current systematic review and meta-analysis assessed both the safety profile and prophylactic efficacy of preoperative magnesium sulfate administered via nebulization against POST.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing preoperative nebulized magnesium sulfate with placebo or normal saline for POST prevention in adults undergoing elective surgery under general anesthesia was conducted. The primary outcome was POST incidence at 24 h. Secondary outcomes included POST at 2, 4, 8, and 12 h, hoarseness, cough, and hemodynamic adverse events. PROSPERO registration: CRD420261308633.</p><p><strong>Results: </strong>Twelve RCTs comprising 1,023 patients were included. Nebulized Magnesium Sulfate significantly reduced POST at 24 h compared to control (RR = 0.25; 95% CI: 0.14-0.42; p < 0.00001; I² = 62%). Sensitivity analysis excluding an outlier reduced heterogeneity (I² = 7%) while maintaining significance. Significant reductions were also observed at 2 h (RR = 0.43; 95% CI: 0.32-0.58), 4 h (RR = 0.38; 95% CI: 0.19-0.77), and 12 h (RR = 0.34; 95% CI: 0.14-0.79). Subgroup analysis demonstrated comparable efficacy between the 225 mg dose and higher doses, with no statistically significant difference observed. No significant reduction was observed for hoarseness (RR = 0.44; 95% CI: 0.17-1.18) or cough (RR = 0.39; 95% CI: 0.15-1.04), and no increased hemodynamic risk was detected. Trial sequential analysis confirmed robust evidence for POST prevention.</p><p><strong>Conclusion: </strong>The administration of preoperative nebulized magnesium sulfate serves as an effective and safe measure to decrease POST incidence among adult patients, thereby justifying its inclusion in standard perioperative management protocols.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395973","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}