Minerva anestesiologica最新文献

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy and fluoroscopy to diagnose and treat numerous pancreatic and biliary diseases. The advantage of high-flow nasal oxygenation (HFNO) over conventional low-flow oxygen is not adequately established.

Evidence acquisition: Literature searches of EMBASE, PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were performed to identify randomized controlled trials (RCTs) comparing HFNO and conventional oxygen therapy (COT) for patients undergoing ERCP under sedation. The primary outcome was hypoxemia incidence. Secondary outcomes included the percentage of patients who required procedure interruption and/or airway maneuvers, the incidence of hypercarbia, and the lowest recorded SpO2 values during the procedure. A subgroup analysis of the primary outcome was conducted to evaluate perioperative risk based on age differences.

Evidence synthesis: We analyzed 581 patients from five RCTs: 291 in the HFNO group and 290 in the COT group. Our results demonstrated a significantly lower number of hypoxemic events (risk ratio 0.44, 95% CI [0.21, 0.92], P=0.03) and higher lowest mean values of SpO2 (mean difference [MD] 2.29, 95% CI [0.94, 3.64], P<0.001) in the HFNO group, no significant differences regarding the requirement for rescue interventions (risk ratio 0.29, 95% CI [0.07, 1.21], P=0.09).

Conclusions: HFNO therapy decreased the incidence of hypoxemia and provided a higher mean lowest SpO2 in patients undergoing ERCP. A cost-benefit analysis to identify the populations that could benefit the most from the treatment should be considered.

Background: The incidence of postoperative delirium (POD) has been reported to be up to 53% following cardiac surgery. This trial aimed to determine the effect of perioperative administration of pregabalin versus dexmedetomidine (DEX) on the POD incidence in elderly patients planned for cardiac surgery, together with other secondary outcome measures. We hypothesized that pregabalin, with its sedative analgesic effects, would be non-inferior to DEX regarding POD prevention.

Methods: This randomized, double-blind, parallel-controlled, non-inferiority trial was conducted on 60 elderly cases planned for cardiac surgery. The cases were randomly assigned equally into a pregabalin group (group P) and DEX group (group D). The non-inferiority margin was set to 20%. The primary outcome was the POD incidence. Secondary endpoints included analgesic profile, sedation scale, and adverse events.

Results: Pregabalin was non-inferior to DEX regarding the reduction in the incidence of POD (17.86% vs. 21.43%; risk difference, -3.6%; two-sided 95% CI, - 24.25% to 17.41%; meeting non-inferiority criteria). POD onset and duration showed an insignificant difference between the groups. The total morphine consumption in the first 48 hours after surgery was significantly lower in group P (25.64±7.04 mg) than in group D (34.66±9.25 mg; 95% CI, -13.42 to -4.61; P=0.0001). Both groups were insignificantly different regarding the visual analog scale score, sedation agitation scale measurements, recovery time, and adverse events.

Conclusions: Pregabalin is non-inferior to DEX in terms of delirium prevention after cardiac surgeries with comparable sedative effects, but it has a superior analgesic profile in the form of a significantly lower 48-hour opioid dose.

Background: Propofol consumption during total intravenous anesthesia (TIVA) is influenced by patient's gender and females consume greater amount than males. As gender difference on propofol consumption during TIVA has only been assessed with manually titrated or target-controlled infusion, its validation with automated delivery systems, is desirable. This study evaluated effects of gender differences on propofol consumption during automated propofol TIVA administered by closed-loop anesthesia delivery system (CLADS).

Methods: The enrolled patients (N.=80) were allocated to two groups based on gender- males and females, and all received automated propofol TIVA by CLADS. Cumulative intraoperative propofol consumption (primary outcome variable), anesthesia depth consistency, anesthesia delivery system performance, intraoperative hemodynamics (heart rate, mean blood pressure), recovery from anesthesia (time-to-eye-opening, time-to-tracheal extubation), and postoperative sedation (secondary outcome variables); were analyzed.

Results: While no difference was found for propofol consumption during induction (males: 1.5±0.5 mg/kg versus females: 1.4±0.4 mg/kg, P=0.628) and maintenance (males: 4.9±1.3 mg/kg/h versus females: 4.9±0.8 mg/kg/h, P=0.457) based on total body weight, when calculated by lean body weight; females exhibited significantly greater propofol consumption for induction (males: 1.9±0.6 mg/kg versus females: 2.2±0.5 mg/kg, P<0.001) and maintenance (males: 6.4±1.5 mg/kg/h versus females: 7.8±1.3 mg/kg/h, P<0.001). Time to eye-opening (males: 7.2 [5.2, 9.3] minutes versus females: 4.6 [3.1, 6.7] minutes, P<0.001) and the time to tracheal-extubation (males: 8.1 [6.4, 10.5] minutes versus females: 6.4 [4.5, 9.1] minutes, P=0.010) were significantly lower in females.

Conclusions: While females consumed greater amount of propofol for induction and maintenance of propofol TIVA, they exhibited faster recovery than males.

Background: The impact of dexmedetomidine on postoperative delirium (POD) remains a subject of debate in elderly patients undergoing noncardiac surgeries. This study aimed to assess the efficacy and safety of dexmedetomidine infusion without an induction dose in reducing the incidence of POD while maintaining hemodynamic stability in geriatric patients undergoing major surgeries. The loading dose was omitted based on the hypothesis that continuous dexmedetomidine infusion without a loading dose would lower the incidence of POD while preserving cardiovascular safety.

Methods: This randomized, double-blind clinical trial was conducted on 122 elderly patients, belonging to the American Society of Anesthesiologists I or II physical status, who were scheduled for major noncardiac surgeries. Patients were randomly allocated into two equal groups. Patients in Group I received 0.5 μg/kg/h of dexmedetomidine, diluted in 50 mL of isotonic normal saline, while patients in Group II received 50 mL of isotonic normal saline as a placebo. The primary outcome was the incidence of POD. Secondary outcomes included intraoperative and postoperative hemodynamics.

Results: Postoperative delirium was observed in only one (1.64%) patient in Group I on the first postoperative day, whereas 21 (34.4%) patients in Group II experienced POD with a statistically significant difference (P<0.001). Furthermore, patients in group I exhibited a significant reduction in intraoperative mean arterial pressure and heart rate, along with a notably high incidence of intraoperative hypotension but without bradycardia. Postoperatively, the mean heart rates, the incidence of hypotension, and bradycardia were comparable between groups without the need for rescue hypotensive medications (all P>0.05).

Conclusions: In elderly patients undergoing non-cardiac surgery, dexmedetomidine infusion without an induction dose effectively and safely reduces the incidence of POD. Dexmedetomidine significantly preserves postoperative hemodynamics.

Introduction: Pediatric infraumbilical surgeries often lead to significant postoperative pain. Sacral erector spinae plane block (S-ESPB) is a novel ultrasound-guided technique that targets the sacral fascial plane and may provide extended analgesia with minimal motor block. This systematic review and meta-analysis evaluate the efficacy and safety of S-ESPB in pediatric patients compared to conventional regional techniques or no block at all.

Evidence acquisition: This review adhered to PRISMA 2020 guidelines and was registered with PROSPERO (CRD420251054390). A systematic search of PubMed, Scopus, Web of Science, and CENTRAL was conducted. Eligible studies included randomized controlled trials comparing S-ESPB to caudal blocks, penile blocks, ring blocks, or no block in pediatric patients. The primary outcome was time to first request for rescue analgesia. Secondary outcomes encompassed early postoperative (Face, Legs, Activity, Cry, Consolability) FLACC scores, 24-hour paracetamol consumption, the need for rescue analgesia, and adverse events. The risk of bias was evaluated using RoB 2, and the evidence's certainty was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Evidence synthesis: Six trials involving 437 participants were included in the review. S-ESPB significantly prolonged the time to first request for rescue analgesia compared to caudal, ring, penile, or no block (SMD: 4.02; 95% CI: 0.92-7.11; P=0.011). Subgroup analyses revealed significantly longer durations with S-ESPB compared to caudal block (SMD: 4.64; 95% CI: 0.84-8.44), ring block (SMD: 1.61; 95% CI: 0.97-2.25), and no block (SMD: 3.97; 95% CI: 2.90-5.04). Cumulative paracetamol consumption at 24 hours was significantly reduced with S-ESPB (SMD: -2.24; 95% CI: -3.13 to -1.35; P<0.001). No significant differences were found in early pain scores or rates of rescue analgesia. Adverse events were rare and comparable to those in the control groups.

Conclusions: S-ESPB provides prolonged postoperative analgesia and reduces systemic analgesic consumption in pediatric infraumbilical surgery, with a favorable safety profile.

Background: This study investigated the effects of high-flow nasal cannula (HFNC) and Procedural Oxygen Mask^™ (POM^™) on oxygenation during endoscopic retrograde cholangiopancreatography (ERCP) performed under sedation in the semi-prone position.

Methods: In this prospective, randomized, parallel-group trial, 198 patients scheduled for ERCP between March 7^th and June 3^rd, 2025, were assessed; 150 were randomized to receive oxygen via HFNC or POM^™ (75 each). The primary outcome was the incidence of hypoxemia (SpO2<90% for ≥10 seconds) during ERCP. Secondary outcomes included the duration of hypoxemia, the number of hypoxemic episodes per patient, and the lowest recorded SpO2, along with the incidence of airway interventions, the incidence of procedure-disrupting body motions, hemodynamic changes, and satisfaction scores from both gastroenterologists and patients.

Results: Hypoxemia occurred in five patients (6.7%) in the HFNC group and in one patient (1.3%) in the POM^™ group; however, this difference was not statistically significant (P=0.209). No significant differences were found in any secondary outcomes between the groups (P>0.003). In multiple logistic regression analysis, only weight was significantly associated with hypoxemia risk (aOR=1.091; 95% CI: 1.001-1.189; P=0.048), while no significant difference was found between the HFNC and POM^TM groups (aOR=9.357; 95% CI: 0.815-107.447; P=0.073).

Conclusions: POM^™ appears to be a practical alternative to HFNC for oxygen supplementation during ERCP under sedation in the semi-prone position, with comparable hypoxemia incidence and airway-related outcomes. These results suggest that POM^™ can be effectively used in this clinical setting.