Minerva anestesiologica最新文献

Post-mastectomy pain syndrome (PMPS) is a frequent and burdensome complication of breast cancer surgery, manifesting as persistent pain following mastectomy, typically with neuropathic characteristics. This review synthesizes current knowledge on the epidemiology, prevention, and treatment of PMPS, and highlight knowledge gaps to inform future research. PMPS occurs in 28-52% of patients. It is associated with impairment in quality of life, and reductions in physical and psychosocial functioning. Consistently identified risk factors include younger age, extensive axillary surgery, total mastectomy, and preexisting chronic pain. Perioperative preventive strategies, such as topical EMLA cream, pregabalin, PECS II block, i.v. dexmedetomidine and flurbiprofen axetil, show potentially promising effects in reducing the incidence or severity of PMPS. Treatment options for established PMPS with potentially promising effects include topical capsaicin, amitriptyline, venlafaxine, multimodal pharmacological therapy, thermal radiofrequency of the stellate ganglion, and mindfulness-based cognitive therapy. For both preventive and therapeutic strategies, heterogeneity in study design, dosing regimens, and outcome frameworks, as well as the small sample size of most studies, limit the strength of evidence. Large knowledge gaps exist in the understanding of the molecular mechanisms associated with PMPS. Future research focusing on the molecular mechanisms promoting PMPS can facilitate the development of novel effective preventive and therapeutic strategies. Large-scale well-powered clinical trials on interventions aiming to prevent and treat PMPS are highly needed to inform evidence-based clinical practice. Future clinical studies should also aim to identify biomarkers that predict the efficacy of interventions in individual patients, thereby supporting personalized medicine.

Introduction: Intraoperative hypotension during non-cardiac surgery is associated with postoperative complications such as acute kidney injury (AKI), myocardial injury, and stroke, which may increase mortality and severe adverse outcomes. Although the Hypotension Prediction Index (HPI) may help reduce intraoperative hypotension, its clinical value in lowering the incidence of these complications remains uncertain. This meta-analysis evaluates whether HPI-guided hemodynamic management reduces major postoperative complications (including AKI, cardiorenal, and cerebrovascular events) in adult patients undergoing non-cardiac surgery.

Evidence acquisition: A systematic search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science, to identify RCTs assessing HPI in non-cardiac surgery. The outcomes encompassed the incidence of postoperative complications such as AKI, myocardial injury after non-cardiac surgery (MINS), stroke and 30-day mortality. Pooled effect estimates, including odds ratios (ORs) with 95% confidence intervals (95% CIs), were calculated using either fixed-effects or random-effects models based on heterogeneity assessments. Sensitivity analyses were performed by excluding trials with a high or unclear risk of bias to evaluate the robustness of the findings.

Evidence synthesis: A total of 10 RCTs involving 1746 participants were included. The results revealed no statistically significant difference in incidence of AKI (OR: 0.85; 95%CI: 0.65 to 1.10; P=0.21), MINS(OR: 0.62; 95%CI: 0.36 to 1.06; P=0.08), stroke (OR: 0.63; 95%CI: 0.20 to 1.98; P=0.42), and 30-day mortality (OR: 0.87; 95%CI: 0.32 to 2.34; P=0.78) between HPI group and control group.

Conclusions: Hemodynamic management guided by the HPI in adults undergoing non-cardiac surgery does not significantly reduce the incidence of major postoperative complications compared to standard care.