Brazilian Journal of Anesthesiology最新文献

{"title":"Pulmonary arterial catheter vs. prediction index software in patients undergoing orthotopic liver transplantation: “We cannot lump together everything”","authors":"Luigi Vetrugno","doi":"10.1016/j.bjane.2025.844605","DOIUrl":"10.1016/j.bjane.2025.844605","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844605"},"PeriodicalIF":1.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The side effects of the pandemic on all-cause postoperative mortality in a COVID reference Hospital in Brazil: a before and after cohort study with 15156 patients","authors":"Luciana C. Stefani ,&nbsp;Brasil Silva Neto ,&nbsp;Débora Roberta de Avila Dornelles ,&nbsp;Mariana Brandão ,&nbsp;Marcio Rahel Guimarães ,&nbsp;Pedro Knijnik ,&nbsp;Jeruza N. Neyeloff ,&nbsp;Stela M.J. Castro ,&nbsp;Paulo Corrêa da Silva Neto ,&nbsp;Gilberto Braulio","doi":"10.1016/j.bjane.2025.844600","DOIUrl":"10.1016/j.bjane.2025.844600","url":null,"abstract":"<div><h3>Background</h3><div>Before the pandemic, healthcare systems in Low-Middle Income Countries (LMIC) experienced a limited capacity to treat postoperative complications. It is uncertain whether the interference of the Coronavirus (COVID-19) pandemic on surgical systems has increased postoperative mortality.</div></div><div><h3>Methods</h3><div>This before and after cohort study aimed to assess the pandemic's impact on in-hospital postoperative mortality in a university COVID-19 reference hospital in southern Brazil. Data from patients who underwent surgery before (January 2018 to December 2019) the pandemic were compared to data from patients who underwent surgery during the pandemic (February to December 2020). The primary outcome was in-hospital mortality. We developed Poisson regression models to examine the mortality risk of being operated on during the COVID-19 pandemic.</div></div><div><h3>Results</h3><div>We assessed 15156 surgical patients, 12207 of whom underwent surgery before the pandemic and 2949 during the first year of the pandemic. Mortality rates were 2.5% (309/12207) in the pre-pandemic versus 7.2% (212/2949) in the pandemic. Of these, 25.8% (32/124) of patients with COVID-19 and 6.4% (80/2816) of patients without COVID-19 died. The proportion of urgent surgeries and ASA-PS III was higher in the pandemic group. After adjusting for mortality-related variables, the Relative Risk (RR) associated with undergoing surgery during the pandemic was 1.51 (95% CI 1.27 to 1.79). We excluded COVID-19-positive to perform a sensitivity analysis that confirmed the increased risk of undergoing surgery during the pandemic RR = 1.50 (95% CI 1.27 to 1.78).</div></div><div><h3>Conclusion</h3><div>The substantial number of additional deaths, even amongst those without COVID-19 infection, suggests the pandemic disrupted the surgical service in an LMIC context. Fragile surgical systems may suffer more significant adverse impacts from external stressors such as a pandemic, and urging measures are needed to increase their performance and resilience.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844600"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing a well-being curriculum in anesthesiology residency: insights from a teaching hospital in Brazil","authors":"Claudia M.R.P. Cavaliere ,&nbsp;Lorena I.M. Carvalho ,&nbsp;Liana M.T.A. Azi ,&nbsp;Edgar Yugue ,&nbsp;Renata de Paula Lian ,&nbsp;Marcos A.C. Albuquerque","doi":"10.1016/j.bjane.2025.844601","DOIUrl":"10.1016/j.bjane.2025.844601","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844601"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of right ventricular systolic pressure and ARISCAT score in perioperative pulmonary risk assessment","authors":"Yoshio Tatsuoka ,&nbsp;Zili He ,&nbsp;Hung-Mo Lin ,&nbsp;Andrew P. Notarianni ,&nbsp;Zyad J. Carr","doi":"10.1016/j.bjane.2025.844597","DOIUrl":"10.1016/j.bjane.2025.844597","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative Pulmonary Complications (PPC) are a significant source of increased morbidity and mortality after surgical procedures. Measures to enhance 30-day PPC risk stratification are an area of significant clinical interest, and integrating common preoperative investigations, such as echocardiography, may enhance quantitative risk prediction when combined with clinical score-based systems, particularly for high-risk populations. The authors hypothesized that Right Ventricular Systolic Pressure (RVSP) would significantly enhance the predictive capabilities of the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score in the prediction of 30-day PPC in a Pulmonary Hypertension (PH) study cohort.</div></div><div><h3>Methods</h3><div>277 patients with the diagnosis of PH, ARISCAT score, and echocardiography-derived RVSP within 12-months of surgical procedure were analyzed. The primary endpoint was the 59-variable 30-day Agency for Healthcare Research and Quality PPC composite. Secondary endpoints included sub composites of Pneumonia (PNA), Respiratory Failure (RF), Pulmonary Aspiration (ASP) and thromboembolic Phenomenon (PE). Adjusted multivariable logistic regression models followed by Receiver Operating Characteristic Curves (ROC) and Area Under the Curve (AUC) analysis were employed to assess the prediction of 30-day PPC.</div></div><div><h3>Results</h3><div>Mean RVSP was 52.1 mmHg (±17.4). Overall PPC incidence was 29.9%, with RF (19.5%), PNA (12.3%), ASP (5.4%), and PE (3.6%) composites. Logistic regression showed no significant association between RVSP and PPC (Odds Ratio [OR = 1.01], p = 0.307). The ARISCAT score was associated with 30-day PPC risk (OR = 1.02, p = 0.037). Receiver Operating Characteristic (ROC) curve analysis revealed an Area Under the Curve (AUC) of 0.555 for RVSP alone, 0.575 for the ARISCAT score, and 0.591 for the combination of RVSP+ARISCAT for the primary endpoint.</div></div><div><h3>Conclusion</h3><div>RVSP demonstrated limited efficacy as a standalone predictor of 30-day PPC in patients with PH. Although integrating RVSP with ARISCAT scoring yielded marginal improvements in predictive accuracy, neither metric, independently or in combination, achieved adequate clinical significance for reliable risk stratification. These findings highlight a critical gap in the current preoperative risk assessment for PH-specific predictive tools. Future research should focus on alternative measures that better capture vulnerability to the hemodynamic complexities underscoring PPC in this high-risk population.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844597"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 erector spinae plane block in pain management for patients with herpes zoster: a systematic review and meta-analysis","authors":"Alexandre Yamada Fujimura Júnior ,&nbsp;Carolina Braga Moura ,&nbsp;Arnaldo Bastos dos Santos","doi":"10.1016/j.bjane.2025.844598","DOIUrl":"10.1016/j.bjane.2025.844598","url":null,"abstract":"<div><h3>Objectives</h3><div>Systematic review and meta-analysis to evaluate the efficacy of the Erector Spinae Plane Block (ESPB) in managing pain related to Herpes Zoster.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase, Cochrane Library, and CNKI for randomized trials comparing ESPB plus standard clinical treatment with clinical treatment alone. The population included patients with acute infection and those with Postherpetic Neuralgia (PHN). The primary outcome was pain intensity, and secondary outcomes included analgesic consumption. Mean Difference (MD) was used for continuous outcomes, and Risk Ratio (RR) for binary outcomes.</div></div><div><h3>Results</h3><div>Seven trials with 362 patients were included. ESPB significantly reduced pain up to eight weeks (MD = -1.21; 95% CI -2.17 to -0.24; I² = 89%). In the subgroup analysis of patients in the acute stage, the benefit seemed to extend with pain reduction lasting up to 12-weeks (MD = -1.49; 95% CI -2.61 to -0.37; I² = 0%), and a reduction in the incidence of PHN (RR = 0.49; 95% CI 0.28 to 0.85; I²: 0%). In the PHN subgroup, pain reduction was notable only at four weeks (MD = -1.08; 95% CI -1.81 to -0.35; I² = 86%). ESPB also reduced acetaminophen (MD = -0.6 g.day^-1; 95% CI -1.05 to -0.14; I² = 49%) and pregabalin consumption (-68.58 mg.day^-1; 95% CI -127.18 to -9.97; I² = 41%) over 12 weeks.</div></div><div><h3>Conclusion</h3><div>ESPB seems to provide pain relief in Herpes Zoster patients, with a prolonged benefit in the acute stage. Also, ESPB reduced the need for analgesics over 12 weeks. More research is needed to corroborate this practice.</div></div><div><h3>Study Registration Number and Date</h3><div>This article was prospectively registered in PROSPERO (<span><span>www.crd.york.ac.uk/prospero</span><svg><path></path></svg></span>, CRD42024566674).</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844598"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-agent versus combination regimens containing propofol: a retrospective cohort study of recovery metrics and complication rates in a hospital-based endoscopy suite","authors":"Guozhen Xie ,&nbsp;Maria Estevez ,&nbsp;Kiyan Heybati ,&nbsp;Matthew Vogt ,&nbsp;Michael Smith ,&nbsp;Christine Moshe ,&nbsp;Johanna Chan ,&nbsp;Vivek Kumbhari ,&nbsp;Ryan Chadha","doi":"10.1016/j.bjane.2025.844602","DOIUrl":"10.1016/j.bjane.2025.844602","url":null,"abstract":"<div><h3>Background</h3><div>Anesthesiologists are often tasked with overseeing sedation in non-surgical settings. We aim to determine whether adding adjuvant sedatives to propofol affects the recovery times and complication rates after endoscopy.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of adults (≥18) who received propofol while undergoing esophagogastroduodenoscopy (EGD) and/or colonoscopy (COL) at a large academic institution over a four-year period. Patients receiving propofol alone were compared against patients receiving propofol in combination with midazolam, fentanyl, ketamine, or dexmedetomidine. The primary outcome was PACU length of stay, adjusted for age, sex, and ASA Score. Secondary outcomes included incidence of PACU postoperative nausea and vomiting, hypoxemia (SpO₂ &lt; 90%), bradycardia (HR &lt; 60 bpm), and escalation of care (hospital admission), reported in adjusted odds ratios and their 95% confidence intervals.</div></div><div><h3>Results</h3><div>Across the study period, 28,532 cases were included. Colonoscopies performed under propofol+fentanyl sedation were associated with significantly longer PACU LOS compared to propofol alone. Adjusted mean PACU LOS was significantly longer in patients receiving adjuvant fentanyl, compared to propofol alone (p &lt; 0.01) and propofol + dexmedetomidine (p &lt; 0.01). Patients receiving propofol alone exhibited a 9.4% incidence of bradycardia, 16.0% hypoxia, 0.89% PONV, and 0.40% hospitalization. Adjuvant fentanyl use was associated with higher odds of hypoxia across all procedure types (p &lt; 0.05). Adjuvant dexmedetomidine was associated with higher rates of bradycardia, but lower rates of hypoxia, PONV, and hospitalization (p &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>With the exception of fentanyl, combining propofol with other sedatives was not associated with longer recovery times. The incidence of complications differed significantly with the use of adjuvant fentanyl or dexmedetomidine.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844602"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of total intravenous anesthesia and inhalational anesthesia in patients undergoing liver surgery: a systematic review and meta-analysis","authors":"Gustavo R.M. Wegner ,&nbsp;Bruno F.M. Wegner ,&nbsp;Henrik G. Oliveira ,&nbsp;Luis A. Costa ,&nbsp;Luigi W. Spagnol ,&nbsp;Valentine W. Spagnol ,&nbsp;Jorge R.M. Carlotto ,&nbsp;Eugénio Pagnussatt Neto","doi":"10.1016/j.bjane.2025.844604","DOIUrl":"10.1016/j.bjane.2025.844604","url":null,"abstract":"<div><h3>Background</h3><div>The impact of choosing between inhalational anesthetics and propofol for maintenance anesthesia in liver transplantation or liver resections remains uncertain.</div></div><div><h3>Methods</h3><div>A systematic search was conducted on PubMed, Scopus, Embase, Web of Science, and the Cochrane Library on September 5, 2023, adhering to the Cochrane Handbook and PRISMA guidelines.</div></div><div><h3>Results</h3><div>Fifteen randomized controlled trials and five observational studies, comprising 1,602 patients, were included. The statistical analysis was categorized into three groups: liver transplantation (four studies), living donor hepatectomy (four studies), and liver mass hepatectomy (twelve studies). The liver mass hepatectomy group was further subdivided based on the performance of the Pringle maneuver and the use of pharmacological preconditioning. Statistically significant results are described below. In liver transplant recipients, propofol anesthesia was associated with lower AST levels on the first postoperative day. Hepatic donors anesthetized with propofol had higher total infusion volumes and intraoperative urine output. Patients undergoing liver mass resection with the Pringle maneuver and propofol anesthesia had higher peak AST and ALT levels compared to those who received pharmacological preconditioning. Patients undergoing liver mass resection with the Pringle maneuver and propofol anesthesia had higher AST and ALT levels on both the first and third postoperative days, increased total infusion volumes, and shorter hospital stays, when compared to pharmacological conditioning.</div></div><div><h3>Conclusions</h3><div>Our findings do not offer sufficient evidence to inform clinical practice. The choice between propofol-based and inhalational anesthesia should be tailored to the individual patient's condition and the nature of the procedure being performed.</div></div><div><h3>Registration</h3><div>PROSPERO ID: CRD42023460715.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844604"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pragmatic view on general anesthesia in mechanical thrombectomy for acute ischemic stroke","authors":"Alessandro Scudellari ,&nbsp;Federico Bilotta","doi":"10.1016/j.bjane.2025.844599","DOIUrl":"10.1016/j.bjane.2025.844599","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844599"},"PeriodicalIF":1.7,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming perioperative care in Brazil: challenges and opportunities for improving outcomes","authors":"Luciana C. Stefani ,&nbsp;Liana M.T.A. Azi ,&nbsp;Andre P. Schmidt","doi":"10.1016/j.bjane.2025.844596","DOIUrl":"10.1016/j.bjane.2025.844596","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844596"},"PeriodicalIF":1.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home mechanical ventilation: a narrative review and a proposal of practical approach","authors":"Simone Chaves Fagondes ,&nbsp;Carmem Lúcia Oliveira da Silva ,&nbsp;Anneliese Hoffmann ,&nbsp;Rita de Cássia Guedes de Azevedo Barbosa ,&nbsp;Daiane Falkembach ,&nbsp;Ângela Beatriz John","doi":"10.1016/j.bjane.2025.844595","DOIUrl":"10.1016/j.bjane.2025.844595","url":null,"abstract":"<div><div>Growing evidence of the benefits of home ventilatory support in patients with chronic respiratory failure along with technological advances in ventilators have enabled their use in overly complex situations, shaping a new scenario for physicians. This has further given rise to new challenges related to their incorporation into current medical practice. However, this evolution needs to be coupled with knowledge and skills of physicians who are willing to prescribe Home Mechanical Ventilation (HMV), in order to prevent them from making inappropriate choices or adjustments that may ultimately have ethical and legal implications. This article aims to provide guidance and information to support the indication for HMV and the ventilation modalities to be implemented, review basic ventilation concepts, including the ventilator modes most commonly used in patients outside the hospital setting, list the brands and models available in the Brazilian market, provide the means for obtaining equipment for HMV, and finally, describe the requirements for selection of equipment, taking into account the individual characteristics of the patient to ensure safe perioperative care and earlier dehospitalization.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844595"},"PeriodicalIF":1.7,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}