Brazilian Journal of Anesthesiology最新文献

{"title":"Developing a concise multivariable predictive model for cesarean delivery following neuraxial analgesia during labor: a prospective observational cohort study","authors":"Paula Daniele Lopes da Costa ,&nbsp;Murilo Henrique da Veiga Ferreira ,&nbsp;Joelcio Francisco Abbade ,&nbsp;Claudia Garcia Magalhães ,&nbsp;Norma Sueli Pinheiro Módolo ,&nbsp;Guilherme Antonio Moreira de Barros ,&nbsp;Gabriel Ricardo Correa Turco ,&nbsp;Pedro Henrique Esteves Trindade ,&nbsp;Paulo do Nascimento Junior","doi":"10.1016/j.bjane.2026.844732","DOIUrl":"10.1016/j.bjane.2026.844732","url":null,"abstract":"<div><h3>Background</h3><div>Sometimes, planned vaginal deliveries with neuraxial analgesia may result in unplanned cesareans. We aimed to determine the incidence of cesarean among parturients receiving neuraxial analgesia for vaginal delivery, identify associated factors, and develop a predictive model.</div></div><div><h3>Methods</h3><div>In this prospective observational cohort study, we evaluated parturients receiving neuraxial analgesia for vaginal delivery and analyzed factors associated with progression to cesarean. Multiple logistic regression with a <em>step-up</em> procedure was performed. The dataset was split into training (70%) and testing (30%) databases, with the latter used to assess performance metrics. Bootstrap validation with 5,000 repetitions was performed.</div></div><div><h3>Results</h3><div>We evaluated 331 parturients and 94 (28.4%) underwent cesarean. Variables differing between cesarean and vaginal delivery groups (p &lt; 0.05) included patient age, body mass index, gestational age, cervical dilation at analgesia initiation, time under analgesia, labor conducted/monitored by nurses, and oxytocin use after analgesia initiation. Three variables remained predictive [odds ratio (95% Confidence Interval (95% CI))]: patient age: 1.0436 (1.0091 to 1.0835), p = 0.018; time under analgesia: 1.0043 (1.0008 to 1.0081), p = 0.018; and oxytocin use after analgesia initiation: 0.0921 (0.0400 to 0.1945), p &lt; 0.001. Predictive area under the curve (95% CI) was 71.8% (60.5%‒83.1%). Arrest of descent (35.1%) and fetal distress (34.0%) were the leading indications for cesarean.</div></div><div><h3>Conclusions</h3><div>Among parturients receiving neuraxial labor analgesia, older patients, longer analgesia duration, and no oxytocin use after analgesia initiation increase the probability of cesarean, with moderate predictivity. Arrest of descent and fetal distress were the main causes of cesarean.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 3","pages":"Article 844732"},"PeriodicalIF":1.9,"publicationDate":"2026-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic misconceptions: the protective role of the perioperative team","authors":"Britta S. von Ungern-Sternberg ,&nbsp;Aine Sommerfield","doi":"10.1016/j.bjane.2025.844720","DOIUrl":"10.1016/j.bjane.2025.844720","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844720"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical needle guidance for ultrasound-guided parasagittal oblique in-plane paravertebral blocks: a cadaveric study","authors":"Hesham Elsharkawy ,&nbsp;Ece Yamak Altinpulluk ,&nbsp;Tetsuya Shimada ,&nbsp;Ilker Ince ,&nbsp;Guangmei Mao ,&nbsp;Nicolas Mario Mas D Alessandro ,&nbsp;Loran Mounir Soliman ,&nbsp;Nair Harsha ,&nbsp;Marta Kelava ,&nbsp;Richard Drake ,&nbsp;Xuan Pu ,&nbsp;Daniel I. Sessler ,&nbsp;Alparslan Turan","doi":"10.1016/j.bjane.2025.844716","DOIUrl":"10.1016/j.bjane.2025.844716","url":null,"abstract":"<div><h3>Background</h3><div>Paravertebral blocks provide analgesia for a range of thoracoabdominal surgeries. However, visualizing the needle tip during the procedure can be challenging, especially for clinicians with limited experience, because the target is deep. We therefore tested the primary hypothesis that needle guidance by the Infiniti Plus system improves ultrasound visualization of the needle tip during thoracic paravertebral blocks performed by novice residents.</div></div><div><h3>Methods</h3><div>Nineteen clinical anesthesia residents each performed 20 bilateral ultrasound-guided thoracic paravertebral blocks (T2–T11) on 17 unembalmed cadavers, with and without the use of a fixed-angle mechanical needle guide in a randomized crossover design. The primary outcome, percent perfect needle visibility, was compared between guided and unguided methods using a paired <em>t</em>-test. Secondary outcomes, including time to needle visualization, number of needle insertion attempts, and subjective ease-of-use ratings, were analyzed using paired <em>t</em>-tests and Wilcoxon signed-rank tests, respectively. Inter-rater reliability for overall perception ratings was assessed using the Intraclass Correlation Coefficient (ICC).</div></div><div><h3>Results</h3><div>There were no significant differences in needle-target visualization (62% ± 17% with guidance vs. 64% ± 18% without, p = 0.15), time to target (HR = 1.00 [95% CI 0.86–1.16], p = 0.99), procedural difficulty scores, or number of insertion attempts between guided and unguided blocks.</div></div><div><h3>Conclusion</h3><div>The Infiniti Plus mechanical needle guide did not demonstrate improved ultrasound needle tip visualization during thoracic paravertebral blocks performed by novice clinicians in cadavers.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844716"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Between oceans and deserts: fluid balance and outcomes after liver transplantation","authors":"Sergio Henrique Loss ,&nbsp;Edino Parolo ,&nbsp;Felippe Leopoldo Dexheimer Neto","doi":"10.1016/j.bjane.2026.844721","DOIUrl":"10.1016/j.bjane.2026.844721","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844721"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative tranexamic acid in burn surgery: systematic review and meta-analysis of randomized controlled trials","authors":"Maria Eduarda Molinari,&nbsp;Ramon Huntermann,&nbsp;Julia C. Bernardi,&nbsp;Nicoly Fiorese Andrade,&nbsp;Gustavo Barbosa David,&nbsp;Nicolas Ramos,&nbsp;Caroline de Oliveira Fischer Bacca","doi":"10.1016/j.bjane.2025.844719","DOIUrl":"10.1016/j.bjane.2025.844719","url":null,"abstract":"<div><h3>Introduction</h3><div>Burn injuries often require surgery, posing challenges due to significant intraoperative blood loss and transfusion risks. Tranexamic Acid (TXA), an antifibrinolytic agent, stabilizes clots and reduces fibrinolysis, with proven efficacy in various surgical settings. However, the benefits in burn patients are yet to be established.</div></div><div><h3>Methods</h3><div>We performed a systematic review and meta-analysis. PubMed, Embase, and Cochrane databases were searched for Randomized Clinical Trials (RCTs) comparing TXA versus control in burned patients. Risk Ratios (RR) and Mean Differences (MD) with 95% CIs were computed for binary and continuous outcomes, respectively. The primary endpoint of interest was blood loss. Statistical analyses were performed using RStudio software (version 4.2.2). The certainty of the evidence was evaluated using the GRADE approach.</div></div><div><h3>Results</h3><div>Four RCTs comprising 204 patients were included, with 102 (50%) assigned to the TXA group. The mean patient age across studies ranged from 32.15 to 39.70 years. TXA significantly reduced total blood loss (MD = -183.93 mL; 95% CI: -278.44 to -89.42; p &lt; 0.01), need for packed red blood cell transfusions (RR = 0.42, 95% CI 0.26 to 0.66; p &lt; 0.01), while also improving hematocrit (MD = 3.49%; 95% CI: 1.58 to 5.41; p &lt; 0.01) and hemoglobin levels (MD = 0.87 g.dL^-1; 95% CI: 0.35 to 1.39; p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>In patients with burns, TXA was associated with reduced blood loss and packed cell transfusions. However, certainty is limited by the small number and heterogeneity of available trials</div></div><div><h3>Registration</h3><div>PROSPERO ID: CRD420251000356. Registered on 07 March 2025.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 2","pages":"Article 844719"},"PeriodicalIF":1.9,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter to the Editor regarding “Lateral versus posterior quadratus lumborum block in children undergoing open orchiopexy: a double-blind randomized clinical trial”","authors":"Ozgecan P. Zanbak Mutlu,&nbsp;Pinar Kendigelen,&nbsp;Ayse C. Tutuncu","doi":"10.1016/j.bjane.2025.844718","DOIUrl":"10.1016/j.bjane.2025.844718","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 2","pages":"Article 844718"},"PeriodicalIF":1.9,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145709127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intranasal dexmedetomidine for procedural sedation in children: a systematic review and meta-analysis","authors":"Kelvin Oliveira Rocha ,&nbsp;Ellen Renata Ferreira de Araújo Santos ,&nbsp;Mariana Madureira Pombeiro ,&nbsp;Márcia Nayara da Silva Leite Fidelis ,&nbsp;Fabiana Maria Kakehasi ,&nbsp;Daniela Caldas Teixeira","doi":"10.1016/j.bjane.2025.844717","DOIUrl":"10.1016/j.bjane.2025.844717","url":null,"abstract":"<div><h3>Background</h3><div>Intranasal Dexmedetomidine (IN-DEX) is a promising agent for pediatric procedural sedation due to its non-invasive route and favorable safety profile. However, a comprehensive synthesis quantifying its clinical timeline and safety as monotherapy is lacking. This meta-analysis assesses the efficacy and adverse events of IN-DEX as a standalone sedative in children.</div></div><div><h3>Methods</h3><div>Following PRISMA 2020 guidelines and PROSPERO registration (CRD420250652456), this meta-analysis systematically searched PubMed, ScienceDirect, and SciELO for intranasal dexmedetomidine monotherapy in children under 18 years from January 1, 2003, to July 1, 2025. Key outcomes included sedation success, onset, and duration. Data were pooled using a random-effects model, with risk-of-bias assessed via RoB2. We performed sensitivity and subgroup analyses and evaluated evidence certainty using the GRADE approach.</div></div><div><h3>Results</h3><div>Twenty-eight RCTs were included. The overall pooled mean onset time was 18.9 minutes and duration was 60.3 minutes, though both had very low evidence certainty due to high heterogeneity (I² &gt; 99%). The overall success rate was 79.58%. Notably, in a subgroup of low-to-moderate risk-of-bias studies, a dose of [2, 3) mcg.kg^-1 achieved an 84.04% success rate, supported by high-quality evidence (GRADE: High, I² = 0%). The pooled proportions for key adverse events were hypotension (8.24%), bradycardia (5.08%), and desaturation (2.76%).</div></div><div><h3>Conclusion</h3><div>IN-DEX is an effective monotherapy for pediatric procedural sedation. Doses of [2, 3) mcg.kg^-1 are associated with high success rates, supported by high-quality evidence. While IN-DEX demonstrates a favorable respiratory profile with low desaturation rates, its use requires vigilant hemodynamic monitoring due to the risks of hypotension and bradycardia.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844717"},"PeriodicalIF":1.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative and postoperative anemia in major elective surgery: insights from a retrospective cohort in a Brazilian University Hospital","authors":"Lorena dos Santos Goiabeira ,&nbsp;Sara Silva Meireles ,&nbsp;Allan Santos Silva Leocádio ,&nbsp;Heitor J.S. Medeiros ,&nbsp;Fernanda Cunha Soares ,&nbsp;Aline Macedo Pinheiro ,&nbsp;Wallace Andrino da Silva","doi":"10.1016/j.bjane.2025.844715","DOIUrl":"10.1016/j.bjane.2025.844715","url":null,"abstract":"<div><h3>Background</h3><div>Anemia is a common and critical condition in the perioperative management of patients undergoing major elective surgeries, posing significant risks to postoperative recovery. This study aimed to evaluate the prevalence of preoperative and postoperative anemia in surgical patients from a university hospital in northeastern Brazil.</div></div><div><h3>Methods</h3><div>This retrospective study included 508 patients aged 18 years or older who underwent major elective surgeries between October 2021 and October 2022. Anemia was defined according to World Health Organization criteria (hemoglobin &lt; 13 g.dL^-1 for men and &lt; 12 g.dL^-1 for women). Data were extracted from medical records and included preoperative and postoperative hemoglobin levels, surgical types, and transfusion requirements.</div></div><div><h3>Results</h3><div>Preoperative anemia was observed in 59.6% of 508 patients analyzed, with a mean Hb level of 11.66 (±/ 2.75) g.dL^-1 and 11.13 (± 2.08) g.dL^-1 for women and men, respectively. In the postoperative period, the anemia rate increased to 94.6%, with a mean Hb level of 9.36 (± 1.55) g.dL^-1 and 9.49 (± 1.36) g.dL^-1 for women and men, respectively. The transfusion rate was 27% in the total sample. Patients with preoperative anemia were 4.6 times more likely to require intraoperative transfusion compared to non-anemic patients (OR = 4.58; 95% CI: 2.78–7.52; p &lt; 0.001). Higher preoperative hemoglobin levels were identified as protective against transfusion (OR = 0.65; 95% CI: 0.59–0.72; p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Preoperative anemia is a highly prevalent and modifiable risk factor associated with increased transfusion requirements and adverse perioperative outcomes. The study highlights the importance of implementing patient blood management protocols in surgical practice.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 2","pages":"Article 844715"},"PeriodicalIF":1.9,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145590103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of a point-of-care CoaguChek test versus standard laboratory coagulation monitoring in cardiac surgery involving cardiopulmonary bypass: randomized clinical trial","authors":"Fabrício Tavares Mendonça,&nbsp;Sérgio Honorato de Matos,&nbsp;Larissa Goveia Moreira,&nbsp;Igor Louza Pereira,&nbsp;Lorenzo Leite Dino,&nbsp;Matheus Beserra Braga,&nbsp;Gustavo Henrique dos Santos Dias","doi":"10.1016/j.bjane.2025.844714","DOIUrl":"10.1016/j.bjane.2025.844714","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative coagulopathies are common in complex surgeries, and timely coagulation monitoring is crucial. We assessed the accuracy of the point-of-care CoaguChek XS test against standard laboratory measurements in patients undergoing cardiac surgery with Cardiopulmonary Bypass (CPB).</div></div><div><h3>Methods</h3><div>We conducted a single-center, diagnostic accuracy study to assess the coagulation profile of 50 participants before and after CPB. The index test was the CoaguChek XS device and the reference test was the standard laboratory assay. The primary outcome was the accuracy of the CoaguChek device in measuring the International Normalized Ratio (INR). We pre-specified a tolerance range of ± 0.5 INR units. Secondary outcomes included accuracy in measuring prothrombin time and prothrombin activity.</div></div><div><h3>Results</h3><div>We included 50 patients undergoing cardiac surgery with CPB between October 2023 and January 2024. The mean (standard deviation) age was 59.2 (12.3) years, and 32 participants (64%) were male. For INR values, Lin’s coefficient was 0.72 (95% CI: 0.60‒0.82) pre-CPB and 0.66 (95% CI: 0.50‒0.77) post-CPB, both indicating good agreement. In the pre-CPB period, on average, the index test readings exceeded reference readings by 0.045 INR units (95% CI: 0.030‒0.059, p &lt; 0.001), while in post-CPB period, index readings were, on average, 0.064 INR units lower (95% CI: -0.09 to -0.04, p &lt; 0.001). Although statistically significant differences were observed, they fell within predefined tolerance range and were considered clinically irrelevant. Analyses of secondary outcomes were consistent with the primary outcome findings.</div></div><div><h3>Conclusion</h3><div>In patients undergoing cardiac surgery with cardiopulmonary bypass, CoaguChek XS provided results comparable to standard laboratory coagulation monitoring, both pre-and post-cardiopulmonary bypass.</div></div><div><h3>Research Board Approval</h3><div>Plataforma Brasil CAAE 70266023.8.0000.5553.</div></div><div><h3>Clinical Trials Registration</h3><div>(<span><span>https://clinicaltrials.gov/study/NCT06037720</span><svg><path></path></svg></span>) NCT06037720, 14/09/2023.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 2","pages":"Article 844714"},"PeriodicalIF":1.9,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding lateral versus posterior quadratus lumborum block in children undergoing open orchiopexy: a double-blind randomized clinical trial","authors":"Parth Aphale,&nbsp;Himanshu Shekhar,&nbsp;Shashank Dokania","doi":"10.1016/j.bjane.2025.844713","DOIUrl":"10.1016/j.bjane.2025.844713","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844713"},"PeriodicalIF":1.9,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145590073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}