BMC Anesthesiology最新文献

{"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}

{"title":"Esketamine-augmented stellate ganglion block improves postoperative sleep quality after gynecological laparoscopic surgery: a randomized controlled trial.","authors":"Ying-Long Wang, Ling Zhou, Rui Xu, Na Yang, Rui-Xing Kuang, Li-Hong Li, Li-Hua Peng","doi":"10.1186/s12871-026-04042-0","DOIUrl":"10.1186/s12871-026-04042-0","url":null,"abstract":"<p><strong>Background: </strong>Postoperative sleep disturbance (PSD) is common after gynecological laparoscopic surgery and is associated with delayed recovery and adverse emotional outcomes. Stellate ganglion block (SGB) and esketamine have each been reported to modulate perioperative stress responses. We hypothesized that adding an esketamine-adjuvanted SGB to a perioperative multimodal sleep (PMS) strategy based on intraoperative esketamine and dexmedetomidine would reduce PSD.</p><p><strong>Methods: </strong>In this prospective randomized controlled trial, 220 of 222 screened patients scheduled for elective gynecological laparoscopic surgery were randomized and assigned to either a control group receiving intraoperative esketamine and dexmedetomidine or an intervention group receiving an esketamine-adjuvanted SGB before anesthesia induction in addition to the same intraoperative regimen. The primary outcome was the incidence of PSD on postoperative days 1 and 3. Secondary outcomes included postoperative anxiety and depression, pain intensity, use of rescue medication, and perioperative complications.</p><p><strong>Results: </strong>A total of 192 patients were included in the per-protocol (PP) analysis. The incidence of PSD was significantly lower in the intervention group than in the control group on postoperative day 1 (62.9% vs. 83.2%, P = 0.002) and postoperative day 3 (25.8% vs. 42.1%, P = 0.017). The intervention group also exhibited a lower incidence of early postoperative anxiety. In subgroup analyses, the intervention was associated with a significantly lower incidence of PSD in patients with preoperative depressive symptoms. Independent risk factors for PSD included preoperative sleep disturbance, preoperative anxiety, resting pain, abdominal drainage tube placement, and total hysterectomy. No significant differences in adverse events were observed between the two groups.</p><p><strong>Conclusions: </strong>In this single-center randomized trial, adding an esketamine-adjuvanted stellate ganglion block to intraoperative esketamine and dexmedetomidine was associated with a lower incidence of postoperative sleep disturbance after gynecological laparoscopic surgery, without an apparent increase in perioperative complications. These findings require confirmation in larger multicenter studies incorporating objective sleep assessments.</p><p><strong>Trial registration: </strong>This study was registered in the Chinese Clinical Trial Registry (ChiCTR2300078436) on December 8, 2023.</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/PMC13621594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395934","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":"Guideline-informed vancomycin therapeutic drug monitoring indications in an adult intensive care unit: a retrospective descriptive study.","authors":"Yunus Emre Ayhan, Rabia Sarı Küçük, Aslı Nur Özkan, Hilal Akay Gedi̇k, Funda Şi̇mşek, Muhammed Yunus Bektay","doi":"10.1186/s12871-026-04078-2","DOIUrl":"10.1186/s12871-026-04078-2","url":null,"abstract":"<p><strong>Background: </strong>Vancomycin is widely used in intensive care units (ICUs) for severe Gram-positive infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA). Because critically ill patients have high pharmacokinetic variability and toxicity risk, therapeutic drug monitoring (TDM) is recommended in selected high-risk conditions. However, real-world data quantifying guideline-informed TDM eligibility in ICUs where TDM is not available remain limited. This study aimed to estimate the burden and criterion-level profile of TDM eligibility among adult ICU patients receiving vancomycin.</p><p><strong>Methods: </strong>A retrospective descriptive study was conducted in an adult ICU between January 1, 2024, and July 1, 2025. TDM eligibility was assessed using guideline-derived domains from the 2020 IDSA/ASHP/PIDS/SIDP consensus recommendations, operationalized for retrospective ICU assessment. Because vancomycin TDM was not performed during the study period, drug concentrations, area under the curve (AUC) estimates, target attainment, and TDM-guided dose modifications were unavailable. Data were summarized descriptively, and between-group comparisons were performed using chi-square test, Fisher's exact test, and Mann-Whitney U test, as appropriate.</p><p><strong>Results: </strong>During the study period, 341 of 1894 ICU admissions (18.0%) involved vancomycin therapy, and 331 patients were included in the final analysis. Overall, 319 patients (96.4%) met at least one TDM indication criterion. The most frequent indications were prolonged therapy, defined as observed treatment duration exceeding 5 days during the treatment course (276, 83.4%), altered pharmacokinetics (227, 68.6%), renal dysfunction (180, 54.4%), nephrotoxic co-administration (174, 52.6%), and serious or invasive MRSA infection (25, 7.6%). Indications frequently overlapped, with a median of 3 (IQR: 2-4) criteria per patient.</p><p><strong>Conclusion: </strong>Nearly all vancomycin-treated ICU patients met guideline-informed TDM eligibility criteria, indicating a substantial burden of monitoring eligibility in this Turkish ICU where TDM was not available. These findings primarily inform local resource planning, but may also be relevant to institutions with similar reimbursement, laboratory, or infrastructure constraints. Prospective pre-post implementation studies should evaluate target attainment, nephrotoxicity, clinical outcomes, and costs.</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/PMC13617823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395925","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":"Bilevel positive airway pressure reduces anaesthesiologist workload and turnover time in electroconvulsive therapy: a randomized controlled trial.","authors":"Yingyuan Li, Xiaoyu Lin, Jirong Yang, Taojia Ran, Jinyan Xu, Ning Shen, Pinjie Huang","doi":"10.1186/s12871-026-04067-5","DOIUrl":"10.1186/s12871-026-04067-5","url":null,"abstract":"<p><strong>Background: </strong>The increasing clinical demand for electroconvulsive therapy (ECT) highlights specific challenges in anaesthetic management, particularly the reliance on continuous mask ventilation. Bilevel positive airway pressure (BPAP) provides automated, hands-free ventilatory support and may enhance efficiency. This study aims to compare the impact of BPAP versus face mask ventilation on procedural turnover time during ECT.</p><p><strong>Methods: </strong>In this single-blind, randomized controlled trial, 110 patients were enrolled with a history of at least two prior ECT sessions. Participants were randomly allocated to receive either BPAP or face mask ventilation. The primary outcome was the turnover time, defined as the duration from anaesthesia induction to entry into the post-anaesthesia care unit (PACU). Secondary outcomes included the total ECT duration, breathing and consciousness recovery times, incidence of hypoxemia (SpO2 < 94% for > 5 s), adverse events and operator-centered measures, including upper limb discomfort, anxiety and satisfaction scores.</p><p><strong>Results: </strong>The BPAP group demonstrated a significantly shorter median turnover time ccompared to the face mask group (332 [286-415] s vs. 426 [348-472] s; median difference 84 s, 95% CI 44-119, P < 0.001). No significant differences in the total ECT duration, breathing recovery time, consciousness recovery time, or incidence of hypoxemia. The incidence of anaesthesiologist-reported upper limb discomfort was lower in the BPAP group (P < 0.001), and operator satisfaction scores were higher (P < 0.001).</p><p><strong>Conclusions: </strong>In patients with prior ECT experience, BPAP safely reduced procedural turnover time and significantly decreased the physical burden on anaesthesiologists compared to face mask ventilation. BPAP represents a viable strategy to improve workflow efficiency and operator comfort in high-volume ECT settings.</p><p><strong>Trial registration: </strong>ChiCTR2100051837, the Chinese Clinical Trial, 20-211-006. Research registration number: ChiCTR2100051837, the Chinese Clinical Trial Registry. IRB number: [2021] 02-203-01, the Research Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.</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/PMC13613697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148389938","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 opioid-free anesthesia on postoperative anxiety in patients undergoing modified radical mastectomy for breast cancer: a randomized controlled trial.","authors":"Cong Deng, Xianming Wen, Sisi Liu, Feng Lu, Weidong Liang, Fuzhou Hua, Junming Ye, Maolin Zhong, Shihong Li","doi":"10.1186/s12871-026-04069-3","DOIUrl":"10.1186/s12871-026-04069-3","url":null,"abstract":"<p><strong>Background: </strong>Opioid-free anesthesia (OFA) improves somatic recovery after breast cancer surgery, but its effect on postoperative anxiety has not been evaluated. We hypothesized that OFA would reduce postoperative state anxiety in patients undergoing modified radical mastectomy.</p><p><strong>Methods: </strong>In this single-center, randomized, participant- and assessor-blinded trial, 106 patients undergoing modified radical mastectomy were assigned to OFA (n = 53) or opioid-based anesthesia (OA; n = 53). Both groups received a serratus anterior plane block. The OFA group received dexmedetomidine and esketamine intraoperatively and esketamine-based postoperative patient-controlled analgesia; the OA group received intraoperative opioids and sufentanil-based postoperative patient-controlled analgesia. The primary outcome was the State Anxiety Inventory (SAI) score 24 h after surgery. Secondary outcomes were exploratory.</p><p><strong>Results: </strong>Preoperative SAI scores were comparable between groups. Postoperative SAI scores were significantly lower with OFA at 24 hours (median, 41 vs. 48; P < 0.001) and 72 hours (41.43 ± 4.53 vs. 45.55 ± 4.37; P < 0.001). The QoR-15 score at 24 hours was higher with OFA (median, 104 vs. 99; P < 0.001). NRS pain scores showed a modest rightward distributional shift with OFA at postoperative 24 hours (median, 3[3-4] vs. 3[3-3]; P = 0.014) but were significantly lower at postoperative 72 hours (median, 1 vs. 2; P < 0.001). The incidence of postoperative nausea and vomiting (PONV) was lower with OFA (13.21% vs. 32.08%; P = 0.020). Time to tracheal extubation and PACU length of stay were shorter with OFA (both P < 0.001). Intraoperative hemodynamic parameters and other adverse event rates did not differ significantly between groups.</p><p><strong>Conclusions: </strong>The evaluated multicomponent opioid-free perioperative regimen reduced early postoperative state-anxiety scores compared with the opioid-based regimen. Because intraoperative drugs and postoperative analgesia differed between groups, the effects of opioid avoidance cannot be disentangled from the direct effects of dexmedetomidine, esketamine, or postoperative PCIA. The clinical importance and longer-term durability of the observed anxiety difference require confirmation.</p><p><strong>Trial registration: </strong>ChiCTR2500101756, 04/29/2025.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381606","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":"Age-related differences in the performance of the self-pressurising air-Q intubating laryngeal airway: a prospective comparative study.","authors":"Zeynep Koc, Gokcen Kulturoglu, Seyyid Furkan Kina, Cem Koray Cataroglu, Savas Altinsoy, Julide Ergil","doi":"10.1186/s12871-026-04033-1","DOIUrl":"10.1186/s12871-026-04033-1","url":null,"abstract":"<p><strong>Purpose: </strong>The clinical performance of supraglottic airway devices (SADs) may be affected by anatomical and physiological changes of the oropharyngeal structure that occur with aging. We aimed to evaluate the performance of self-pressurized air-Q intubating laryngeal airway (air-Q SP) in young, middle-aged, and elderly patient groups undergoing elective surgery under general anesthesia with the use of an air-Q SP.</p><p><strong>Methods: </strong>A total of 153 patients, aged 18-85 years, with American Society of Anesthesiologists physical status I-III who underwent urological surgery were included in this prospective, comparative study. Patients were equally allocated into groups according to parient age, Group Young: 18-40 years; Group Middle-aged: 41-64 years and Group Elderly: 65-85 years. The primary outcome was oropharyngeal leak pressure (OLP); SAD insertion time, first-attempt success rate, ease of insertion, maneuvers required for successful ventilation, fiberoptic grading of the glottic view, peak inspiratory pressure (PIP) and postoperative complications were also assessed. Analysis of variance was used for comparisons between patient groups, and adjusted p values were reported in the post hoc tests. Multivariate regression analyses were performed to evaluate factors associated with OLP values.</p><p><strong>Results: </strong>The median [IQR] OLP values were 29 [26-35] cm H₂O, 24 [14-39] cm H₂O and 26 [21-29] cm H₂O in Groups Young, Middle-aged and Elderly respectively. The OLP values in Group Young were significantly higher than those in Group Middle-aged and Group Elderly (p = 0.001, and p = 0.014 respectively). Air-Q SP insertion in Group Young was significantly faster and easier, required fewer maneuvers, provided better fiberoptic views, lower PIP and higher postoperative first hour dysphagia and dysphonia rate. Multivariate analysis revaled that BMI was associated with OLP (OR 0.335, 95%CI) (R² = 0.111, F = 4.639, p = 0.001). A negative correlation was found between patients' age and OLP values (r = -0.239, p = 0.003).</p><p><strong>Conclusion: </strong>Compared with the middle-aged and elderly groups, the young group had superior sealing and insertion characteristics with use of air-Q SP but transient early postoperative dysphagia and dysphonia. The air-Q SP was sufficient for adequate ventilation in all groups.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387257","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":"Prospective randomized controlled trial of computer simulation versus high-fidelity mannequin simulation in advanced cardiovascular life support (ACLS) training for anesthesiology novice clinicians.","authors":"Jiafeng Yu, Qian Wang, Ling Yin, Fang Yuan, Yufei Kan, Zengkun Wang, Yonghao Yu, Qing Li, Yang Yu","doi":"10.1186/s12871-026-04080-8","DOIUrl":"10.1186/s12871-026-04080-8","url":null,"abstract":"<p><strong>Background: </strong>Traditionally, cardiopulmonary resuscitation (CPR) and advanced cardiovascular life support (ACLS) training programs have relied heavily on paper-based instructional materials and multimedia theoretical presentations. This study conducts the inaugural comparative analysis of the effectiveness of high-fidelity mannequin simulators versus computer simulators in ACLS training for anesthesiology novice clinicians. Additionally, it aims to identify an optimal training cycle for ACLS.</p><p><strong>Methods: </strong>This prospective randomized controlled study included 62 participants, 30 first-year residents and 32 interns from 2020-2021, who were randomly divided into three groups: the computer simulator group (Group C), the high-fidelity mannequin group (Group M), and the combined computer-mannequin group (Group SM). Baseline (T0) and immediate post-training (T1) assessments were performed, covering technical skills, non-technical skills, and self-confidence and satisfaction. Group performance, CPR initiation time, and defibrillation time were analyzed. Follow-up assessments were conducted at 1, 3, 6, and 12 months (T2-T5) to identify the optimal ACLS training interval.</p><p><strong>Results: </strong>Groups C, M, and SM showed significant improvements in technical skills at T1 versus T0 (P < 0.05), with higher megacode scores and reduced times to initiate CPR and defibrillation at T1 (all P < 0.05); no significant differences were observed among the three groups (all P > 0.05). Non-technical skill scores in all groups improved significantly at T1 compared to T0 (P < 0.05), and Groups M and SM had generally higher overall non-technical skill scores than Group C (P < 0.05). For self-confidence and satisfaction, Groups M and SM scored higher than Group C in \"this mode can stimulate my interest\" (P < 0.05). Temporal trends of technical and non-technical skills varied among groups, but all indicated a consistent decline at T5, indicating reduced memory retention.</p><p><strong>Conclusion: </strong>Both computer simulator training and high-fidelity mannequin-based scenario simulation effectively improve novice clinicians' ACLS technical and non-technical skills, though scenario simulation is more advantageous for enhancing non-technical skills. Thus, computers can complement scenario simulators in ACLS training. ACLS training effectiveness appears to decline over time, with notable reductions in knowledge retention and test scores observed at 12 months, which supports the necessity of annual retraining.</p><p><strong>Trial registration: </strong>The study was retrospectively registered at the ClinicalTrials.gov(NCT05001659) on June 23, 2021.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381671","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 versus continuous flow monitoring for fluid responsiveness prediction during passive leg raising: a prospective diagnostic accuracy study.","authors":"Fatemeh Monjazebi, Vahid Zamanzadeh, Mansoureh Ashoub, Babak Jahangirifard","doi":"10.1186/s12871-026-04072-8","DOIUrl":"10.1186/s12871-026-04072-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Accurate prediction of fluid responsiveness is essential in managing circulatory shock. While passive leg raising (PLR) is recommended in international guidelines, its diagnostic validity depends critically on the monitoring modality used to detect hemodynamic responses. In resource-limited settings, manual blood pressure measurement remains the predominant available technology, yet its adequacy for PLR interpretation has not been rigorously evaluated in an adequately powered study with an independent reference standard.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the diagnostic accuracy of manual pulse pressure change (ΔPP%) versus continuous flow monitoring (USCOM-1 A, ΔSV%) for predicting fluid responsiveness during PLR in intensive care unit (ICU) patients with undifferentiated shock, using echocardiographic cardiac output assessment as an independent reference standard.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Prospective single-center diagnostic accuracy study enrolling consecutive ICU patients with undifferentiated shock at Sina Educational and Medical Center, Tehran, Iran (2020-2021). A standardized PLR protocol was performed with simultaneous blinded measurements by three independent operators: manual blood pressure via calibrated sphygmomanometer, continuous flow monitoring via USCOM-1 A, and echocardiographic velocity-time integral (VTI) measurement as the reference standard. Fluid responsiveness was defined as ≥ 15% cardiac output increase following 500 mL crystalloid challenge. Primary outcome was area under the receiver operating characteristic curve (AUC). The study followed Standards for Reporting Diagnostic Accuracy Studies (STARD) 2015 guidelines (Ethics approval: IR.SBMU.PHARMACY.REC.1399.316).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 124 patients analyzed (mean age 58.1 ± 19.8 years, 65.3% female), 58 (46.8%) were fluid responders. Continuous flow monitoring demonstrated acceptable diagnostic accuracy (AUC 0.712, 95% confidence interval [CI] 0.622-0.802; sensitivity 81.0%; specificity 61.8%; negative predictive value [NPV] 79.2%). Manual pulse pressure demonstrated significantly inferior discrimination (AUC 0.601, 95%CI 0.502-0.700; DeLong test P = 0.029) with critically low sensitivity (32.8%) and clinically inadequate NPV (57.8%). Bootstrap-corrected performance estimates confirmed the robustness of findings (USCOM AUC 0.708; Manual pulse pressure [PP] AUC 0.596). Mean pulse pressure remained essentially unchanged during PLR (+ 0.4 ± 4.6 mmHg, P = 0.287) despite significant proportional increases in both systolic (+ 3.7%) and diastolic (+ 5.6%) pressures, and despite echocardiographically confirmed stroke volume augmentation (left ventricular outflow tract [LVOT] VTI + 15.9%). The correlation between ΔPP% and ΔSV% was weak (r = 0.39, R²=0.15). Baseline method comparison between USCOM-derived and echocardiography-derived cardiac output showed low paired bias, although the percentage error exceeded the conven","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387189","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":"Sevoflurane blood concentrations in patients undergoing mild and moderate hypothermic cardiac surgery: a prospective observational study.","authors":"Takahiro Tamura, Atsushi Mori, Takahiro Imaizumi, Tatsuro Yokoyama, Kimitoshi Nishiwaki","doi":"10.1186/s12871-026-04053-x","DOIUrl":"10.1186/s12871-026-04053-x","url":null,"abstract":"<p><strong>Background: </strong>We aimed to clarify the changes in sevoflurane blood concentrations in cardiovascular surgeries with cardiopulmonary bypass (CPB) under mild to moderate hypothermia.</p><p><strong>Methods: </strong>In this single-center, prospective observational study, we included patients undergoing elective cardiac surgery with CPB under mild and moderate hypothermia using four types of oxygenators. Radial artery blood samples were collected at repeated time points, both before and during CPB. Simultaneously, bladder temperature was recorded. Sevoflurane blood concentration was measured using gas chromatography.</p><p><strong>Results: </strong>Sevoflurane blood concentrations gradually increased during general anesthesia induction via native lung ventilation. When using CPB under mild hypothermia, the concentration dropped sharply after switching to an oxygenator but then gradually increased and reached equilibrium. These changes were observed in all four oxygenators, with no significant differences among them. In moderate hypothermic surgeries, the bladder temperature gradually decreased during the pre-circulatory-arrest phase, and the sevoflurane blood concentration increased accordingly. As rewarming began after the distal aortic anastomosis, the bladder temperature gradually increased, and the sevoflurane blood concentration returned to levels observed during native lung ventilation. In total, 85 patients undergoing mild hypothermic cardiac surgery (SE, n = 21; LI, n = 21; TE, n = 22; ME, n = 21) and 25 patients undergoing moderate hypothermic cardiac surgery were analyzed. Using a linear mixed-effects model, bladder temperature was significantly associated with sevoflurane blood concentration in both mild hypothermia (β = - 5.90 μg/mL per °C; n = 73 patients, 1,123 observations; p < 0.001) and moderate hypothermia (β = - 2.11 μg/mL per °C; n = 25 patients, 378 observations; p < 0.001) cardiac surgery. No significant differences in sevoflurane blood concentrations were observed among the four oxygenator types.</p><p><strong>Conclusions: </strong>We demonstrated chronological changes in sevoflurane blood concentrations during mild and moderate hypothermic cardiac surgery, showing an inverse correlation with bladder temperature.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381668","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}