Anesthesia and pain medicine最新文献

Traditionally, anesthesiologists have recommended performing auscultation of breath and heart sounds with a precordial or esophageal stethoscope during anesthesia. The stethoscope is generally considered the most important single device used for monitoring. Unfortunately, many anesthesiologists neglect the perioperative use of a stethoscope, even though it provides a wealth of information about the circulatory system, heart, and lungs. Although point-of-care ultrasound appears to offer greater diagnostic value in some situations, it is premature to dismiss the stethoscope, and its diminished perioperative role should be reconsidered. Recent technological advances have allowed changes in the roles of these modalities to help attending anesthesiologists perform easy assessments using clinically meaningful information from auscultation. The phonocardiopulmogram (PCPG), a real-time visual acoustic monitor, is a rediscovered and renovated technique that allows non-invasive continuous heart-lung function monitoring. However, the novel role of the PCPG as a continuous acoustic monitor, particularly for S1 and S2 heart sounds and their respiratory variations, remains relatively unexplored. This device may convey information about cardiac contractility, cardiac output, and fluid responsiveness. Furthermore, continuous lung sound visualization has potential as a monitoring modality during anesthesia, including during bronchospasm and endobronchial intubation. With its ease of use and intuitive mechanism, the PCPG can be applied during general anesthesia and follow-up in both post-anesthesia and intensive care unit settings, particularly for the detection of acute adverse events during the perioperative period.

Neuropathic pain represents a serious complication arising from a spectrum of disorders that precipitate lesions within the central and peripheral nervous systems. This disabling pain can persist for years, severely diminishing the quality of life of the affected individuals. The treatment options available for neuropathic pain at present have limited efficacy. Moreover, the adverse effects associated with these options restrict their application. The exact etiological mechanisms underlying the pathogenesis of neuropathic pain remain unclear. However, neuroinflammatory processes mediated by the immune system play significant roles in the initiation and progression of neuropathic pain in various models. The nucleotide-binding domain and leucine-rich repeat pyrin-containing protein-3 (NLRP3) inflammasome, a pivotal element of the innate immune system, plays an indispensable role in the pathophysiological mechanisms of central and peripheral neuropathic pain. However, the precise mechanisms facilitating its activation in disparate neuropathic pain conditions remain to be elucidated. Gaining insights into the regulatory mechanisms affecting NLRP3 inflammasome activation in diverse neuropathic pain-associated disorders will aid in developing novel therapeutic avenues. Therefore, this review summarizes the current knowledge on the role of the NLRP3 inflammasome in the pathophysiology of several neuropathic pain-related conditions, such as diabetic neuropathic pain, chemotherapy-induced neuropathic pain, peripheral nerve compression, central nervous system neuropathic pain, radiculopathy, and morphine analgesic tolerance. In addition, this review also discusses the possible use of this inflammasome as a therapeutic target to alleviate the pain-related symptoms of these diseases.

Ultrasound-guided phrenic nerve blocks (UPNBs) have emerged as a promising intervention for clinical conditions involving the diaphragm and adjacent structures. However, UPNB is often understood as an unintended but potentially critical complication of interscalene brachial plexus block (ISB) rather than a planned procedure. Therefore, we review the existing data on the effectiveness of UPNBs in enhancing respiratory functioning. We searched Medline, EMBASE, Web of Science, and Google Scholar for clinical data related to UPNBs up until May 2025. The primary outcome of this review was to determine the impact of UPNB in minimizing dyspnea or desaturation among patients. Secondary outcomes included UPNB's effectiveness in reducing the intensity and frequency of hiccups and enhancing pulmonary function testing (PFT) and arterial blood gas (ABG) values. Twenty-six studies met the inclusion criteria. The findings show that UPNB does not induce or worsen dyspnea among patients. The injection produced better saturation, with some studies reporting 99% and 96% - 100% oxygen saturation. Besides, phrenic nerve block injection is vital in reducing diaphragmatic pain. Patients who exhibited intractable or persistent hiccups had their frequency and severity reduced or vanished after the nerve block injection. Our findings show that UPNB positively affected ABG samples (fair PaO2, PaCO2, and arterial pH) and spirometry/PFT values (fair FEV1, FVC, and PEF). UPNB enhanced oxygen saturation, reduced intractable hiccups, and preserved PFT and ABG values. Additionally, UPNB did not induce or worsen dyspnea and desaturation. Nevertheless, more clinical trials are needed to confirm these findings.

Point-of-care ultrasonography (POCUS) has emerged as a valuable tool in airway management, providing real-time visualization of airway anatomy with significant advantages in both routine and emergency settings. This review highlights key ultrasonographic techniques, anatomical landmarks, and clinical evidence supporting the growing role of POCUS in modern airway management. It also outlines the clinical applications of POCUS, including prediction of difficult airways and real-time guidance during emergency procedures such as cricothyrotomy and tracheostomy. In non-operating room anesthesia and emergency settings, POCUS enables rapid, portable assessment and facilitates aspiration risk evaluation through gastric ultrasonography, particularly in patients with delayed gastric emptying or unknown fasting status. Pediatric-specific applications-such as selection of the appropriate endotracheal tube size, confirmation of tube depth, and detection of supraglottic airway malposition-are also discussed. As airway challenges persist despite technological progress, integrating POCUS into airway management protocols enhances patient safety, reduces complications, and supports individualized approaches to airway management.

Background: The clinical manifestations of metastatic brachial plexopathy include pain, sensory loss, paresthesia, weakness, and reduced range of motion. These symptoms closely resemble those of shoulder disorders and peripheral nerve entrapment, which are commonly diagnosed in pain clinics, increasing the risk of misdiagnosis or delayed diagnosis, particularly in patients with a history of malignancy.

Case: A 51-year-old woman with a history of breast cancer in complete remission for 19 years presented with shoulder pain, arm weakness, and tingling in the fingers. Initial treatments for suspected cervical radiculopathy, shoulder disorders, and nerve entrapment were ineffective. Electromyography and nerve conduction studies revealed electrophysiological abnormalities consistent with left brachial plexopathy. Magnetic resonance imaging of the brachial plexus confirmed metastatic involvement. The patient is currently undergoing chemotherapy.

Conclusions: Clinicians must be vigilant of the possibility of malignancy in patients with a history of cancer and should pursue comprehensive diagnostic evaluations to exclude cancer recurrence.

Background: Combining lidocaine with bupivacaine in brachial plexus blocks seeks to blend rapid onset with extended duration; yet, clinical advantages are uncertain. This systematic review assesses their efficacy against bupivacaine alone in ultrasound-guided brachial plexus blocks.

Methods: A systematic search of PubMed, EMBASE, and Cochrane databases was conducted in May 2025. Randomized controlled trials (RCTs) comparing lidocaine-bupivacaine mixtures with bupivacaine alone in ultrasound-guided brachial plexus blocks were included. The primary outcome was sensory block onset time. Secondary outcomes included motor block onset time, sensory and motor block durations, and conversion to general anesthesia. Data were analyzed using a random-effects model, with heterogeneity assessed via I² statistics.

Results: Of 1,490 identified articles, 7 RCTs (358 patients) met the inclusion criteria. No significant difference was found in sensory block onset time (mean difference [MD] -1.81 min, 95% confidence interval [CI] -3.92 to 0.29; P = 0.09; I² = 98%) or motor block onset time (MD 0.02 min, 95% CI -2.34 to 2.39; P = 0.99; I² = 95%) between groups. The mixture reduced sensory (MD -172.88 min, 95% CI -215.18 to -130.59; P<0.00001; I² = 90%) and motor block durations (MD -212.13 min, 95% CI -374.99 to -49.28; P = 0.01; I² = 93%).

Conclusions: No clinical benefit was observed from combining lidocaine with bupivacaine, as there was no improvement in block onset times and a reduction in block durations. Given the very low certainty of evidence, these findings should be interpreted with caution, and further high-quality RCTs are needed.

The measurement and interpretation of blood pressure in the perioperative period is a basic and fundamental practice for quality perioperative care. Children present unique considerations and challenges in the measurement and interpretation of blood pressure intraoperatively due to their varying anatomical size and developing physiology. This narrative review will investigate how hypotension is defined in anesthetized children, describe the challenges in noninvasive automated blood pressure monitoring, identify complications of intraoperative hypotension, and discuss how to individualize blood pressure management strategies in children under anesthesia.