BMC Anesthesiology最新文献

{"title":"Influence of intravenous lidocaine infusion on haemodynamic response to tracheal intubation and metabolic-hormonal responses during laparoscopic procedures in children: a randomised controlled trial.","authors":"Maciej Kaszyński, Alicja Kuczerowska, Justyna Pietrzyk, Piotr Sawicki, Paweł Witt, Barbara Stankiewicz, Marek Darowski, Izabela Pągowska-Klimek","doi":"10.1186/s12871-024-02885-z","DOIUrl":"10.1186/s12871-024-02885-z","url":null,"abstract":"<p><strong>Background: </strong>Lidocaine, a widely used local anaesthetic, also serves as an adjuvant in pain management. However, its use in children is off-label. This study aimed to determine if intravenous lidocaine alleviates the haemodynamic, metabolic, and hormonal responses to intubation and laparoscopic surgery in children.</p><p><strong>Methods: </strong>A single-centre, parallel, double-masked, randomised, placebo-controlled trial. 132 patients, aged 18 months to 18 years, with no contraindications to lidocaine administration and qualified for laparoscopic appendectomy were enrolled. The intervention studied was a lidocaine bolus of 1.5 mg⋅kg^- 1 over 5 min given before induction of anaesthesia, followed by intraoperative lidocaine infusion at 1.5 mg⋅kg^- 1⋅h^- 1 intraoperatively. Patients in the control group were administered a placebo. Mean arterial pressure, glucose, cortisol, lidocaine blood levels, lidocaine-related side effects, and intraoperative opioid requirements were analysed.</p><p><strong>Results: </strong>132 participants completed the trial. The number of patients who experienced an excessive cardiovascular response to induction of anaesthesia or intubation was 23 (37%) in the control group and 21 (34%) in the lidocaine group (p = 0.707). No statistically significant difference was found between the control and lidocaine groups in the hormonal and metabolic responses, as well as intraoperative fentanyl requirements. Serum lidocaine levels remained below the toxic threshold in all patients.</p><p><strong>Conclusions: </strong>Although the studied intervention appears to be safe, with no clinical side effects observed and serum lidocaine levels remaining below the toxic threshold, its intraoperative administration is not recommended, as it does not demonstrate any significant benefit during the anaesthesia period when compared to placebo.</p><p><strong>Trial registration number: </strong>NCT05238506. The date of first registration: 14/02/2022.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"23"},"PeriodicalIF":2.3,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963259","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 association between preoperative anemia and postoperative mortality among non-cardiac surgical patients in Northwest Ethiopia: a prospective cohort study.","authors":"Misganew Terefe Molla, Amanuel Sisay Endeshaw, Gebrehiwot Asfaw, Fantahun Tarekegn Kumie","doi":"10.1186/s12871-025-02900-x","DOIUrl":"10.1186/s12871-025-02900-x","url":null,"abstract":"<p><strong>Introduction: </strong>In a low-income country, the impact of preoperative anemia on postoperative mortality among noncardiac surgery patients is little understood. As a result, we aim to investigate the association between preoperative anemia and postoperative mortality in noncardiac surgery patients in Northwest Ethiopia.</p><p><strong>Methods: </strong>This is a prospective follow-up study of 3506 noncardiac surgery patients who were included in the final analysis between June 1, 2019, and July 1, 2021. We used a propensity score-match analysis to group anemic and non-anemic patients. The propensity score match analysis took into account age, gender, comorbidities, American Society of Anesthesiologists physical status, urgency of surgery, and trauma. Patients with and without preoperative anemia were divided into a 1:1 ratio in a propensity score balance. The association between preoperative anemia and postoperative mortality was determined using adjusted odds ratios and 95% confidence interval.</p><p><strong>Results: </strong>This study included 3506 noncardiac surgery patients, of which 1532 (43.7%) had preoperative anemia. The propensity score-matching results reveal that one-to-one nearest neighbour propensity score matching without replacement was successful for 1351 pairs of surgical patients. The postoperative 28-day mortality rate for anemic patients was 53 (3.9%), with (OR:1.63; 95% CI: 1.05-2.54).</p><p><strong>Conclusion: </strong>The study found that patients undergoing noncardiac surgery in Northwest Ethiopia had a higher rate of preoperative anemia than those in high-income countries. Preoperative anemia had a significant association with 28-day mortality after surgery.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"19"},"PeriodicalIF":2.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944794","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":"Assessment of bacterial positivity rate changes in anesthesia machine internal circuits within recovery rooms and associated risk factors.","authors":"Shuxiao Zhang, Jingwu Ge, Xuelong Zhou, Yanhong Ji, Junjie Hong, Wensu Xu, Tonglai Li","doi":"10.1186/s12871-024-02886-y","DOIUrl":"10.1186/s12871-024-02886-y","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to investigate bacterial proliferation within the internal circuits of anesthesia machines in post-anesthesia care units (PACUs) following the implementation of the new protocol, where 'a single dedicated external circuit is used for each individual patient.' This measure was introduced during the COVID-19 pandemic, in alignment with a novel prevention and control strategy.</p><p><strong>Methods: </strong>Using the observational technique, we analyzed anesthesia machines in PACUs between July and September 2022. The internal circuits of the anesthesia machines were disinfected every two weeks. Samples were obtained from the internal circuits on the 3rd, 5th, 7th, 10th, 12th, and 14th day following disinfection for bacterial culture. Changes in the positivity rate of bacteria in the internal circuits over time were analyzed using the generalized estimating equation. The anesthesia machines were divided into the positive group (n = 9) and the negative group (n = 41) based on the sampling results on the 14th day after disinfection. Risk factors for positive bacterial culture results in anesthesia machines in PACUs were analyzed using single-factor modified Poisson analysis and multi-factor modified Poisson regression analysis.</p><p><strong>Results: </strong>The positivity rates of the internal circuits of anesthesia machines in PACUs on the 3rd, 5th, 7th, 10th, 12th, and 14th day following disinfection were 10%, 14%, 12%, 20%, 16%, and 18% respectively. There were no statistically significant differences when the positive rates of the next five time points and the third day were compared (P > 0.05). Risk factors for the contamination in the internal circuits of anesthesia machines was the number of elderly patients and the overall surgical use duration, with the difference was statistically significant (P < 0.025).</p><p><strong>Conclusion: </strong>Amid the COVID-19 pandemic, characterized by the adoption of new prevention and control protocols, the disinfection interval for internal circuits of anesthesia machines in PACUs may potentially be extended. However, the emphasis of disinfection should still be placed on those anesthesia machines that have been used for a longer cumulative surgical duration and by a higher number of elderly patients over 60 years old. This approach ensures that resources are allocated effectively.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"17"},"PeriodicalIF":2.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944848","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":"Patients´ experiences of TENS as a postoperative pain relief method in the post-anesthesia care unit after laparoscopic cholecystectomy: a qualitative study.","authors":"Eva Angelini, Charlotta Josefsson, Cecilia Ögren, Paulin Andréll, Axel Wolf, Mona Ringdal","doi":"10.1186/s12871-024-02872-4","DOIUrl":"10.1186/s12871-024-02872-4","url":null,"abstract":"<p><strong>Background: </strong>High-frequency, high-intensity transcutaneous electrical nerve stimulation (HFHI TENS, i.e. 80 Hz and 40-60 mA) is an effective, fast-acting pain relief modality after elective surgery, offering pain relief within 5 min. Few studies have explored patients' perspectives on using TENS in the post-anesthesia care unit. This study investigates patients' experiences and perceptions of TENS as a complementary approach to traditional pharmacological pain management in postoperative care.</p><p><strong>Method: </strong>Patients undergoing elective laparoscopic cholecystectomy were offered TENS as an alternative to conventional pain treatment with IV opioids. Twenty participants attended telephone semi-structured telephone interviews a median of 12 days after surgery. Data were analysed using a thematic analysis according to Braun and Clark.</p><p><strong>Results: </strong>Participants expressed that TENS provided reassurance and relaxation, calmed them, and gave them a sense of control over their pain. Participants perceived a greater degree of autonomy as TENS could be administered independently. They conveyed a preference for TENS, which they experienced as a safe and fast-acting alternative to opioids, despite its limitations in managing severe pain and rapid offset upon discontinuation.</p><p><strong>Conclusion: </strong>To our knowledge, this is the first study that describes patients' views on managing postoperative pain using TENS in the post-anesthesia care unit. This study indicates that patients desire alternatives to drugs for pain control in the postoperative setting. TENS has advantages, such as a rapid onset and offset and supporting patient autonomy, as well as drawbacks, such as being ineffective when pain is too severe. TENS could be included within the routine multimodal analgesia framework for person-centred postoperative pain management.</p><p><strong>Trial registration: </strong>The participants in the current study were retrospectively registered and recruited from a randomized controlled trial (RCT; registered at ClinicalTrials.gov: NCT04114149).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"18"},"PeriodicalIF":2.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944861","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":"Prevention of sufentanil-induced cough during induction of general anesthesia by low-dose esketamine.","authors":"Xueyue Zhou, Chaoping Guo, Boyu Liu, Yongqing Guan, Shengxiang Wang, Jun Ji","doi":"10.1186/s12871-024-02852-8","DOIUrl":"10.1186/s12871-024-02852-8","url":null,"abstract":"<p><strong>Background: </strong>Sufentanil is commonly used to induce general anaesthesia due to its rapid onset of action, strong analgesic effect, long-lasting effect, and stable haemodynamics; however, it often induces cough, increasing the risk of anaesthesia. This study aimed to investigate the preventive effect of low-dose esketamine on sufentanil-induced cough.</p><p><strong>Methods: </strong>This randomised, double-blind, placebo-controlled clinical study was conducted at the Air Force Medical Center between September 2023 and May 2024. A total of 100 adult patients (ASA of Anaesthesiologists class I-II) required general anaesthesia for elective surgery. The patients were randomly assigned to two groups: the esketamine group (Group E, n = 50), receiving 0.2 mg/kg esketamine intravenously, and the control group (Group C, n = 50), receiving an equal volume of normal saline. The incidence and severity of sufentanil-induced cough were assessed 1 min after administering of 0.5 μg/kg sufentanil intravenously. Heart rate (HR), mean arterial pressure (MAP), and adverse reactions were recorded at four time points: before esketamine administration (T0), 3 min after esketamine administration (T1), 1 min after endotracheal intubation (T2), and 3 min after endotracheal intubation (T3). The results were analyzed using appropriate statistical methods.</p><p><strong>Results: </strong>A total of 100 eligible patients were screened, of which 99 participated in this study (1 patient refused to participate), 50 in Group E, and 49 in Group C. The incidence of cough in Group E (6.0%) was significantly lower than that in Group C (34.7%) (P < 0.001), and the severity of cough was also significantly milder than that in Group C (P = 0.038). The differences in the HR and MAP levels at T₀, T₁, T₂, and T₃ between the two groups were not statistically significant (P > 0.05). Two patients in Group C experienced chest wall stiffness, while no adverse reactions were observed in Group E. The difference in the incidence of adverse reactions between the two groups was not statistically significant (P > 0.05).</p><p><strong>Conclusion: </strong>Low-dose esketamine (0.2 mg/kg) can significantly reduce the incidence of sufentanil-induced cough during the induction of general anaesthesia in patients, with a small impact on haemodynamics, no adverse reactions, and good safety.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"14"},"PeriodicalIF":2.3,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944790","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 effect of preoperative topical magnesium sulfate spraying in the oropharyngeal region on postoperative sore throat following gynecological laparoscopic surgery: a randomized clinical trial.","authors":"Linxin Wang, Fangfang Li, Yuqing Liu, Xingyu Xiong, Qin Qiu, Guanglei Wang","doi":"10.1186/s12871-025-02893-7","DOIUrl":"10.1186/s12871-025-02893-7","url":null,"abstract":"<p><strong>Background: </strong>Postoperative sore throat is a common complication following general anesthesia. This study aimed to investigate the impact of preoperative topical magnesium sulfate spraying in the oropharyngeal region on postoperative sore throat following gynecological laparoscopic surgery.</p><p><strong>Methods: </strong>The study included 58 patients scheduled for gynecologic laparoscopic surgery at Xuzhou Medical University Affiliated Hospital. Patients were randomly assigned to either the magnesium sulfate group or the control group, with 29 patients in each group. In the magnesium sulfate group, 25% magnesium sulfate was sprayed at a dose of 15 mg/kg on the mucous membrane of the pharynx and posterior wall of the larynx near the glottis using a laryngoscope under visual guidance during intubation; in the control group, an equal volume of normal saline was used instead. The primary outcome measure was the overall incidence of postoperative sore throat 48 h after surgery.</p><p><strong>Results: </strong>The overall incidence of postoperative sore throat in the magnesium sulfate group was lower than that in the the control group (20.0% vs. 66.7%, P < 0.001). At time points T1 (P < 0.001), T2 (P = 0.02), and T3 (P = 0.015), the incidence of postoperative sore throat in the the magnesium sulfate group was also lower than that in the the control group.</p><p><strong>Conclusion: </strong>This study confirmed that preoperatively spraying magnesium sulfate locally in the Oropharyngeal Region can reduce the frequency and severity of postoperative sore throat.</p><p><strong>Trial registration: </strong>The study was registered at Chictr.org.cn with the number ChiCTR2400087240 on 07/23/2024.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"16"},"PeriodicalIF":2.3,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944770","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":"Comparative study between high and low dose methylene blue infusion in septic cancer patients: a randomized, blinded, controlled study.","authors":"Ehab Hanafy Shaker, Ahmed Mohamed Soliman, Ahmed Abd Elmohsen Bedewy, Mai Mohamed Elrawas","doi":"10.1186/s12871-024-02792-3","DOIUrl":"10.1186/s12871-024-02792-3","url":null,"abstract":"<p><strong>Purpose: </strong>Septic shock is a common threat, and is the primary cause of death in almost all critical care units. Mortality of septic shock remains exceedingly high. The early use of methylene blue (MB) in different doses as adjunctive to vasopressors has promising results.</p><p><strong>Methods: </strong>This double-blind, randomized, controlled trial comprised 90 patients divided into 3 groups: Group A received a 100 ml 0.9% NaCl placebo over 20 min; Group B received an MB bolus of 1 mg/kg in 100 ml 0.9% NaCl, and Group C received MB bolus of 4 mg/kg in 100 ml 0.9% NaCl during the same period. Groups B and C were given a 0.25 mg/kg/hour infusion of MB for 72 h after the bolus dose. All patients were started on noradrenaline at an infusion rate of 0.1-0.2 µ/kg/min and were adjusted accordingly to maintain MAP ≥ 65 mmHg. Time of vasopressor discontinuation was the primary outcome while total doses of vasopressors, ventilation days, vasopressors free days, total ICU stay, total hospital stay, and mortality rate were the secondary outcomes.</p><p><strong>Results: </strong>Groups B and C exhibited significantly decreased time to vasopressor termination, and vasopressor-free days at 28 days in comparison to Group A. However, there was no significant difference between Groups B and C. Groups B and C had significantly lower noradrenaline dosages compared to Group A, however, no significant difference between Group B and Group C was found. The difference between the three groups in mortality rate was near statistical significance (p = 0.083). Using the logistic regression model, the 4 mg/kg group was protective against mortality with a hazard ratio of 0.29 (95%CI: 0.09-0.90).</p><p><strong>Conclusion: </strong>In cancer patients with septic shock, early adjunctive MB delivery reduces the time to a vasopressor stoppage and increases the vasopressor-free days. No significant difference between high and low MB bolus doses, and no significant adverse effects were noted. Compared to placebo, the 4 mg/kg bolus dose shows a survival advantage.</p><p><strong>Trial registration: </strong>Prospectively registered at clinicaltrials.gov [NCT06005558]. (Date of registration 15/08/2023).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"15"},"PeriodicalIF":2.3,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of ultrasound guided erector spinae plane block compared to wound infiltration for postoperative analgesia following laparoscopic living donor nephrectomy: a double-blinded randomized controlled trial.","authors":"Sekar Loganathan, Kamal Kajal, Kashish Garg, Sameer Sethi, Deepesh B Kenwar, Amit Sharma, Ashish Aditya, Varun Mahajan, Naveen B Naik, Rajnikant Kumar","doi":"10.1186/s12871-024-02786-1","DOIUrl":"10.1186/s12871-024-02786-1","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain remains a significant problem in patients undergoing donor nephrectomy despite reduced tissue trauma following laparoscopic living donor nephrectomy (LLDN). Inadequately treated pain leads to physiological and psychological consequences, including chronic neuropathic pain.</p><p><strong>Materials and methods: </strong>This randomized controlled double-blinded trial was conducted in sixty-nine (n = 69) participants who underwent LLDN under general anesthesia. Participants were randomized into Group B (n = 34) and Group C (n = 35). Group B received ultrasound-guided bilateral erector spinae plane block (ESPB) with bupivacaine 0.125% 20 ml on the surgical side and 10 ml on the contralateral side before extubation, while Group C received wound infiltration with bupivacaine 0.125% 15 ml. The primary objective of the study was to compare cumulative 24-hour morphine consumption postoperatively. The secondary objectives were time to first rescue analgesia, visual numeric rating scale (VNRS) pain scores at rest and during movement, incidence of postoperative nausea and vomiting (PONV), and complications associated with ESPB.</p><p><strong>Results: </strong>Participants in Group B required significantly less median (IQR) 24-hour morphine compared to Group C [6 (6-9) mg vs. 15 (12-15) mg; median difference 9; 95% CI in median difference 6-12; p < 0.001), longer median (IQR) time to first rescue analgesia [6 (6-8) hours vs. 1 (1-2) hours; p < 0.001], and lower VNRS at rest and during movement at baseline, 0.5, 1, 2, 4, 6, 8, 12, 24 hours.</p><p><strong>Conclusion: </strong>Ultrasound-guided ESPB provided effective pain relief compared to wound infiltration with local anaesthetic in patients who underwent LLDN.</p><p><strong>Trial registration: </strong>INT/IEC/2021/SPL-514; CTRI/2021/07/045909.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"13"},"PeriodicalIF":2.3,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical practice of one-lung ventilation in mainland China: a nationwide questionnaire survey.","authors":"Hong-Jin Liu, Yong Lin, Wang Li, Hai Yang, Wen-Yue Kang, Pei-Lei Guo, Xiao-Hui Guo, Ning-Ning Cheng, Jie-Chao Tan, Yi-Na He, Si-Si Chen, Yan Mu, Xian-Wen Liu, Hui Zhang, Mei-Fang Chen","doi":"10.1186/s12871-024-02879-x","DOIUrl":"https://doi.org/10.1186/s12871-024-02879-x","url":null,"abstract":"<p><strong>Background: </strong>Limited information is available regarding the application of lung-protective ventilation strategies during one-lung ventilation (OLV) across mainland China. A nationwide questionnaire survey was conducted to investigate this issue in current clinical practice.</p><p><strong>Methods: </strong>The survey covered various aspects, including respondent demographics, the establishment and maintenance of OLV, intraoperative monitoring standards, and complications associated with OLV.</p><p><strong>Results: </strong>Five hundred forty-three valid responses were collected from all provinces in mainland China. Volume control ventilation mode, 4 to 6 mL per kilogram of predictive body weight, pure oxygen inspiration, and a low-level positive end-expiratory pressure ≤ 5 cm H₂O were the most popular ventilation parameters. The most common thresholds of intraoperative respiration monitoring were peripheral oxygen saturation (SpO₂) of 90-94%, end-tidal CO₂ of 45 to 55 mm Hg, and an airway pressure of 30 to 34 cm H₂O. Recruitment maneuvers were traditionally performed by 94% of the respondents. Intraoperative hypoxemia and laryngeal injury were experienced by 75% and 51% of the respondents, respectively. The proportions of anesthesiologists who frequently experienced hypoxemia during OLV were 19%, 24%, and 7% for lung, cardiovascular, and esophageal surgeries, respectively. Up to 32% of respondents were reluctant to perform lung-protective ventilation strategies during OLV. Multiple regression analysis revealed that the volume-control ventilation mode and an SpO₂ intervention threshold of < 85% were independent risk factors for hypoxemia during OLV in lung and cardiovascular surgeries. In esophageal surgery, working in a tier 2 hospital and using traditional ventilation strategies were independent risk factors for hypoxemia during OLV. Subgroup analysis revealed no significant difference in intraoperative hypoxemia during OLV between respondents who performed lung-protective ventilation strategies and those who did not.</p><p><strong>Conclusions: </strong>Lung-protective ventilation strategies during OLV have been widely accepted in mainland China and are strongly recommended for esophageal surgery, particularly in tier 2 hospitals. Implementing volume control ventilation mode and early management of oxygen desaturation might prevent hypoxemia during OLV.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"7"},"PeriodicalIF":2.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944849","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 effect of general versus spinal anesthesia on perioperative innate immune function in patients undergoing total hip arthroplasty.","authors":"Lotte M C Jacobs, Veerle Bijkerk, Lucas T van Eijk, Leo A B Joosten, Christiaan Keijzer, Jetze Visser, Michiel C Warlé","doi":"10.1186/s12871-024-02883-1","DOIUrl":"10.1186/s12871-024-02883-1","url":null,"abstract":"<p><strong>Background: </strong>Increasing evidence shows that postoperative innate immune dysregulation is associated with delayed recovery and infectious complications. The aim of this study was to compare the effects of general versus spinal anesthesia on innate immune function during and after total hip arthroplasty (THA).</p><p><strong>Methods: </strong>This comparative matched cohort study used data from two single-center randomized-controlled trials. Patients from the control group of the HIPPO study received general anesthesia and were matched to control patients from the MAGIC study who received spinal anesthesia in a 2:1 ratio (general(n = 18); spinal(n = 9)). Immune function was assessed by determination of ex vivo cytokine production capacity upon whole blood stimulation with E. coli lipopolysaccharides (LPS) and measurement of plasma cytokines and danger-associated molecular patterns (DAMPs).</p><p><strong>Results: </strong>In the general anesthesia group, ex vivo cytokine production capacity of IL-1β was significantly lower shortly after induction (p = 0.02) and both IL-1β and IL-6 were significantly lower at the end of surgery compared to the spinal anesthesia group (p = 0.002 and p = 0.02, respectively). On postoperative day 1 (POD1), no differences were observed. Plasma cytokine concentrations did not differ between the spinal and general anesthesia group at most timepoints, except for IL-10 at the end of surgery (p = 0.04) and TNF on POD1 (p = 0.04), which were higher in the general anesthesia group. Plasma concentrations of DAMPs did not differ between the groups.</p><p><strong>Conclusions: </strong>General anesthesia has a transient impact on innate immune function in patients undergoing THA, but the clinical significance of anesthesia-induced innate immune dysregulation might be limited as no differences were observed on POD1.</p><p><strong>Trial registration: </strong>The HIPPO study (NCT05562999, date of registration 2022-10-03) and MAGIC study (NCT05723406, date of registration 2023-02-10) are registered at ClinicalTrials.gov.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"10"},"PeriodicalIF":2.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944795","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}