Brazilian Journal of Anesthesiology最新文献

英文中文

Ciprofol versus propofol for sedation in colonoscopy: a systematic review and meta-analysis of randomized controlled trials 环丙酚与异丙酚在结肠镜检查中的镇静作用：随机对照试验的系统回顾和荟萃分析。

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-11-17 DOI: 10.1016/j.bjane.2025.844710

Saul Dominici , Italo C. Martins , Breno Dias L. Ribeiro , Victor Arthur Ohannesian , Brunno Braga Sauaia , Abdias Rocha Santos , Caio Márcio Barros de Oliveira , Plínio da Cunha Leal

Background

Ciprofol has emerged as a potential alternative sedative with improved safety and efficacy. However, comparative data for colonoscopy sedation remain limited.

Methods

A systematic search in PubMed, Embase, Cochrane Library, and Web of Science identified RCTs published through August 2025. Studies included patients undergoing colonoscopy using ciprofol or propofol, reporting relevant efficacy or safety outcomes. Risk Ratios (RRs) and Mean Differences (MDs) were calculated using the Mantel-Haenszel random-effects model and 95% Confidence Intervals. The heterogeneity was assessed with I² statistics and Cochrane Q test. Primary outcomes were procedure success rate and patient satisfaction (assessed on a 1-to-10 scale). Secondary outcomes included sedation onset time(s), respiratory depression, injection pain, and hemodynamic adverse events (hypotension and bradycardia). The statistical analyses were performed in R software (version 4.4.1.)

Results

Three RCTs with 645 patients were included. Colonoscopy success rates were similar between ciprofol and propofol (RR = 1.005; 95% CI 0.992–1.019). Ciprofol showed a lower risk of respiratory depression (RR = 0.24; 95% CI 0.08–0.71), injection pain (RR = 0.04; 95% CI 0.01–0.15), and hypotension (RR = 0.85; 95% CI 0.75–0.96). Patient satisfaction was slightly higher with ciprofol (MD = 0.18; 95% CI 0.08–0.29). No significant differences were found in sedation onset time (s) (MD = 2.49s; 95% CI -3.77–8.74) or bradycardia (RR = 0.88; 95% CI 0.44–1.77).

Conclusion

Ciprofol provides comparable efficacy to propofol for colonoscopy sedation, with a lower incidence of respiratory depression, injection pain, and hypotension. Patient satisfaction was slightly higher with ciprofol, while bradycardia occurrence was similar. These findings suggest ciprofol as a promising alternative, though further large-scale studies are needed to confirm its clinical benefits.

背景：环丙酚已成为一种潜在的替代镇静剂，具有更好的安全性和有效性。然而，结肠镜镇静的比较数据仍然有限。方法：系统检索PubMed、Embase、Cochrane Library和Web of Science，确定到2025年8月发表的rct。研究包括使用环丙酚或异丙酚进行结肠镜检查的患者，报告相关的疗效或安全性结果。采用Mantel-Haenszel随机效应模型和95%置信区间计算风险比（rr）和平均差异（md）。采用I²统计量和Cochrane Q检验评估异质性。主要结果是手术成功率和患者满意度（以1到10的量表评估）。次要结局包括镇静起效时间(s)、呼吸抑制、注射疼痛和血流动力学不良事件（低血压和心动过缓）。采用R软件（4.4.1版）进行统计分析。结果：纳入3项随机对照试验，共645例患者。环丙酚和异丙酚结肠镜检查成功率相似（RR = 1.005;95% CI 0.992-1.019）。环丙酚出现呼吸抑制（RR = 0.24;95% CI 0.08-0.71）、注射疼痛（RR = 0.04;95% CI 0.01-0.15）和低血压（RR = 0.85;95% CI 0.75-0.96）的风险较低。环丙酚组患者满意度略高（MD = 0.18;95% CI 0.08-0.29）。镇静起效时间(s) （MD = 2.49s; 95% CI -3.77-8.74）或心动缓（RR = 0.88;95% CI 0.44-1.77）无显著差异。结论：环丙酚用于结肠镜镇静的疗效与异丙酚相当，呼吸抑制、注射疼痛和低血压的发生率较低。环丙酚的患者满意度略高，而心动过缓的发生率相似。这些发现表明环丙酚是一种很有希望的替代品，尽管需要进一步的大规模研究来证实其临床益处。

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引用次数: 0

Moving toward a standardized regional anesthesia approach in clavicle surgery 锁骨手术中标准化区域麻醉方法的发展。

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-11-16 DOI: 10.1016/j.bjane.2025.844711

Martin Julian Schaefer, Martin Zoremba

引用次数: 0

Association between troponin and NT-proBNP levels, cytokines, and clinical outcomes in early sepsis response: a cohort study 肌钙蛋白和NT-proBNP水平、细胞因子和早期败血症反应临床结果之间的关系：一项队列研究

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-11-15 DOI: 10.1016/j.bjane.2025.844712

Wagner Nedel , Luis Valmor Portela

引用次数: 0

Analgesia nociception index as a tool to assess the effectiveness of paravertebral block in total mastectomy: a prospective cohort study 镇痛痛觉指数作为评估全乳切除术椎旁阻滞效果的工具：一项前瞻性队列研究。

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-11-07 DOI: 10.1016/j.bjane.2025.844699

Julien Raft , Anne-Sophie Lamotte , Cécile Huin Schohn , Caroline Fritz , Philippe Richebé

Background

Single-injection Paravertebral Block (PVB) is commonly used for analgesia in major breast surgery; however, its sensory effectiveness may be variable. This study investigated whether intraoperative changes in the Analgesia Nociception Index (ANI) are associated with PVB effectiveness.

Methods

This prospective observational study included 100 women scheduled for total mastectomy. A single-injection PVB was performed preoperatively under ultrasound guidance at the T3 level. Sensory testing was performed from T1 to T10, but block effectiveness was evaluated in the surgical field (T2–T6). PVBs were classified as effective (complete loss of cold sensation in all T2‒T6 dermatomes) or incomplete (partial cold sensation in this range). ANI variations, intraoperative remifentanil consumption, postoperative pain scores, and morphine use were compared.

Results

Ninety-three patients were analyzed. PVB was effective in 75% and incomplete in 25%. The mean ANI variation was significantly greater in the effective group (+1.4 ± 10.3) compared to the incomplete group (-11.0 ± 7.1), with a mean difference of 12.4 (95% CI: 8.8 to 16.0; p < 0.0001). Remifentanil consumption was higher in the incomplete group (0.072 ± 0.018 µg.kg⁻¹.min⁻¹ vs. 0.054 ± 0.008 µg.kg⁻¹.min⁻¹), mean difference 0.018 (95% CI: 0.010 to 0.026; p < 0.0001). Pain score and morphine consumption were significantly higher for patients with incomplete PVB.

Conclusion

In this observational study, a significant decrease in ANI values following skin dissection was associated with incomplete PVB. Early ANI monitoring may help identify insufficient regional block during total mastectomy, thus guiding intraoperative analgesic adjustment to improve patient comfort.

背景：单次注射椎旁阻滞（PVB）是乳房大手术中常用的镇痛方法；然而，它的感官效果可能是可变的。本研究探讨术中镇痛伤害感觉指数（ANI）的变化是否与PVB的有效性相关。方法：这项前瞻性观察研究包括100名计划进行全乳切除术的妇女。术前在超声引导下在T3水平进行单次PVB注射。从T1到T10进行感觉测试，但在手术野（T2-T6）评估阻滞效果。pvb被分为有效（所有T2-T6皮节完全失去冷感觉）和不完全（在这个范围内部分失去冷感觉）。比较ANI变化、术中瑞芬太尼用量、术后疼痛评分和吗啡使用情况。结果：对93例患者进行分析。PVB有效率75%，不完全率25%。有效组的ANI平均值（+1.4±10.3）明显大于不完全组（-11.0±7.1），平均差异为12.4 （95% CI: 8.8 ~ 16.0; p < 0.0001）。不完全组瑞芬太尼消耗量更高（0.072±0.018µg.kg-1）。Min-1 vs. 0.054± 0.008µg.kg-1。min-1)，平均差异0.018 （95% CI: 0.010 ~ 0.026; p < 0.0001）。不完全性PVB患者的疼痛评分和吗啡用量均显著增高。结论：在这项观察性研究中，皮肤剥离后ANI值的显著下降与PVB不完全性有关。早期ANI监测有助于发现全乳切除术中区域阻滞不足，从而指导术中镇痛调整，提高患者舒适度。

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引用次数: 0

Effect of preoperative clear carbohydrate beverage on emergence delirium in children – a randomized controlled trial 术前清糖饮料对儿童出现性谵妄的影响——一项随机对照试验。

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-11-03 DOI: 10.1016/j.bjane.2025.844698

Karan Cheema , Aakriti Gupta , Ajay Singh , Preethy J. Mathew

引用次数: 0

Efficacy of pectoserratus plane block versus erector spinae plane block on acute and chronic pain after mastectomy: randomized clinical trial 胸锯肌平面阻滞与竖脊肌平面阻滞对乳房切除术后急性和慢性疼痛的疗效：随机临床试验

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-11-01 DOI: 10.1016/j.bjane.2025.844691

Fabrício T. Mendonça, Marcus Alexandre B. de Aviz, Ana Paula S. Bezerra, Lucas G. Silva, Estefane E. Gaspar, Bárbara N. Terol, Lucianna R. e Silva, Liliana M. Andrade

Objectives

To compare Pectoserratus Plane Block (PSPB) and Erector Spinae Plane (ESP) block regarding perioperative opioid consumption and chronic pain risk among women undergoing elective mastectomy.

Methods

Single-blind (patients), randomized (1:1) trial. The primary outcome was the composite measure defined as the use of fentanyl intraoperatively or tramadol postoperatively. Secondary outcomes encompassed intraoperative hemodynamics, short (24h), medium (3 months) and long-term (6 months) postoperative pain intensity and complications.

Results

99 patients were randomized (50 in the PSPB group and 49 in the ESP block group). Of these, 93 patients had complete data for the primary outcome. Use of either fentanyl or tramadol was required for 20 of 47 patients (43%) in the PSPB group and 28 of 46 patients (61%) in the ESP block group (Relative Risk [RR] 0.70, 95% Confidence interval [95% CI] 0.47‒1.05, p = 0.09). PSPB-treated patients had a lower risk of tramadol (RR = 0.31, 95% CI 0.12-0.77, p = 0.01) and dipyrone (RR = 0.60, 95% CI 0.39‒0.92, p = 0.02) consumption than ESP block-treated patients. PSPB lowered chronic pain risk at 3 months (RR = 0.66, 95% CI 0.47‒0.92, p = 0.02), with lower scores for the Short-Form McGill Pain Questionnaire (Mean Difference [MD] -2.55, 95% CI -4.31 to -0.78, p = 0.005) and the Douleur Neuropathique 4 Questions questionnaire (MD = -1.08, 95% CI -2.05 to -0.11, p = 0.03). By 6 months, pain outcomes were statistically comparable between groups. Hemodynamic variables and complications were comparable between groups.

Conclusion

PSPB and ESP block resulted in similar overall opioid consumption among women undergoing mastectomy. However, PSPB was associated with lower postoperative tramadol consumption.

目的比较胸锯肌平面阻滞（PSPB）和竖棘平面阻滞（ESP）对择期乳房切除术妇女围手术期阿片类药物消耗和慢性疼痛风险的影响。方法单盲（患者）、随机（1:1）试验。主要终点是术中芬太尼或术后曲马多使用的综合指标。次要结果包括术中血流动力学、短期（24小时）、中期（3个月）和长期（6个月）术后疼痛强度和并发症。结果99例患者随机分组，其中PSPB组50例，ESP阻滞组49例。其中，93例患者具有完整的主要结局数据。PSPB组47例患者中有20例（43%）需要使用芬太尼或曲马多，ESP阻断组46例患者中有28例（61%）需要使用芬太尼或曲马多（相对危险度[RR] 0.70, 95%可信区间[95% CI] 0.47-1.05, p = 0.09）。pspb治疗组服用曲马多（RR = 0.31, 95% CI 0.12-0.77, p = 0.01）和双吡隆（RR = 0.60, 95% CI 0.39-0.92, p = 0.02）的风险低于ESP阻滞治疗组。PSPB降低了3个月时的慢性疼痛风险（RR = 0.66, 95% CI 0.47-0.92, p = 0.02），短形式McGill疼痛问卷（平均差异[MD] -2.55, 95% CI -4.31至-0.78,p = 0.005）和Douleur神经病变4个问题问卷（MD = -1.08, 95% CI -2.05至-0.11,p = 0.03）得分较低。6个月时，两组疼痛结果具有统计学上的可比性。两组间血流动力学变量和并发症具有可比性。结论pspb和ESP阻断导致乳房切除术妇女阿片类药物的总体消耗相似。然而，PSPB与术后曲马多用量降低有关。

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引用次数: 0

Retrospective review of spinal magnetic resonance images to determine the margin of safety for epidural analgesia in pediatric patients 脊髓磁共振图像的回顾性分析，以确定小儿患者硬膜外镇痛的安全范围。

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-11-01 DOI: 10.1016/j.bjane.2025.844687

Noah Letofsky , Dana Archibald , Anthony M.-H. Ho , Lais Helena N. e Lima , Rodrigo M. e Lima , Vinicius C. Quintão , Fernando B. Cançado , Ricardo V. Carlos , Leopoldo M. da Silva , Fernando N. Bellicieri , Saullo Q. Silveira , Arvin Haghighat , Rachel Phelan , Glenio B. Mizubuti

Background

Deeply sedated children cannot provide feedback if an epidural needle traumatizes the Spinal Cord (SC). Knowing relevant structure depths may, therefore, improve safety. We aimed to determine the epidural margin of safety, i.e., distances from the Ligamentum Flavum (LF) and from the dura mater to the SC in pediatric patients measured (i) Perpendicular to the SC and (ii) Parallel to the spinous process (to approximate needle trajectory).

Methods

Retrospective review of pediatric (0‒12 years-old) T2-weighted sagittal MRI spine scans without spinal pathology. Three investigators independently measured distances from the ventral edge of the LF, and from the ventral edge of the dura mater to the SC at T5/T6, T9/T10, and L1/L2. All measurements were taken perpendicular to the SC and parallel to the angle of the spinous process of the inferior vertebra.

Results

111 MRI scans [52 females, 0.08‒12 (median 7) years-old] were analyzed. The conus medullaris was identified superior to the L1 vertebra in 47 scans, requiring L1/L2 measurement exclusion. When all ages were combined, the largest median (range) depth [dura-mater–SC = 4.87 (2.30‒10.30) mm, LF–SC = 8.10 (4.57‒12.53) mm, measured perpendicular to the SC; and dura-mater–SC = 8.20 (3.75‒19.57) mm; LF–SC = 13.40 (5.50‒39.77) mm, measured at the angle parallel to the inferior spinous process] was at T5/T6.

Conclusion

Our results suggest that the margin of safety (dura-mater–SC distance and LF–SC distance) for performing epidurals in children may be greatest at the mid-thoracic spinal region. The measured ranges were very wide. Further studies are warranted to validate these findings in pediatric patients with other relevant “epidural placement” positions.

背景：如果硬膜外针头损伤脊髓（SC），深度镇静儿童不能提供反馈。因此，了解相关的结构深度可以提高安全性。我们的目的是确定硬膜外安全边缘，即儿童患者从黄韧带（LF）和硬脑膜到SC的距离测量(i)垂直于SC和（ii）平行于棘突（以近似针头轨迹）。方法：回顾性分析无脊柱病理的儿童（0-12岁）t2加权矢状位MRI脊柱扫描。三位研究者分别测量了从LF腹侧边缘和硬脑膜腹侧边缘到SC在T5/T6、T9/T10和L1/L2的距离。所有测量均垂直于SC平行于下椎棘突角度。结果：分析了111例MRI扫描（52例女性，年龄0.08 ~ 12岁，中位年龄7岁）。在47次扫描中发现髓圆锥优于L1椎体，需要排除L1/L2测量。当所有年龄合并时，最大中位（范围）深度[硬脑膜-物质-SC = 4.87 (2.30-10.30)mm, LF-SC = 8.10 (4.57-12.53)mm，垂直于SC测量；硬脑膜-物质- sc = 8.20 (3.75 ~ 19.57)mm；LF-SC = 13.40 (5.50-39.77)mm，以与下棘突平行的角度测量]为T5/T6。结论：我们的研究结果表明，在儿童中胸椎区域进行硬膜外麻醉的安全范围（硬脑膜-材料- sc距离和LF-SC距离）可能最大。测量的范围很广。需要进一步的研究在其他相关的“硬膜外放置”体位的儿科患者中验证这些发现。

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