Pub Date : 2025-07-29DOI: 10.1016/j.bjane.2025.844667
José Fernando Amaral Meletti , Marina Gasparotto Fernandes , Eduardo Toshiyuki Moro , Evaldo Marchi
Introduction
Laparoscopic Cholecystectomy (LC) is a commonly performed surgical procedure. The pneumoperitoneum and the depth of Neuromuscular Blockade (NMB) may impact the occurrence of postoperative pain and the quality of recovery.
Methods
A randomized, double-blind, and prospective clinical trial with 124 patients undergoing LC, divided into 4 groups: SP/MB (Standard Pneumoperitoneum pressure and Moderate NMB); LP/MB (Low Pneumoperitoneum pressure and Moderate NMB); SP/DB (Standard Pneumoperitoneum pressure and Deep NMB); and LP/DB (Low Pneumoperitoneum pressure and Deep NMB). Recovery quality was assessed using the Quality of Recovery Questionnaire (QoR-40), and postoperative pain was evaluated using a Verbal Numerical Rating Scale (VNRS).
Results
No difference was observed between groups regarding the total QoR-40 score 24 hours after surgery (p = 0.903). Despite better surgical conditions (scored from 0 to 5) in the LP/DB group (4.7 ± 0.52) and lower in the LP/MB group (4.1 ± 0.95), the LP/DB group showed a longer stay in the Post-Anesthesia Care Unit (PACU), a higher need for rescue treatment for nausea and vomiting in the ward (p = 0.044), and greater resting pain at 24 hours (p = 0.027).
Conclusion
The use of different pneumoperitoneum pressures under moderate or deep neuromuscular blockade in patients undergoing Laparoscopic Cholecystectomy (LC) did not alter patients’ perception of postoperative recovery quality. The combination of standard pneumoperitoneum pressure with deep neuromuscular blockade was associated with a better perception of surgical field quality as evaluated by the surgeon.
{"title":"Quality of recovery after laparoscopic cholecystectomy: a randomized trial of pneumoperitoneum pressure and neuromuscular blockade depth","authors":"José Fernando Amaral Meletti , Marina Gasparotto Fernandes , Eduardo Toshiyuki Moro , Evaldo Marchi","doi":"10.1016/j.bjane.2025.844667","DOIUrl":"10.1016/j.bjane.2025.844667","url":null,"abstract":"<div><h3>Introduction</h3><div>Laparoscopic Cholecystectomy (LC) is a commonly performed surgical procedure. The pneumoperitoneum and the depth of Neuromuscular Blockade (NMB) may impact the occurrence of postoperative pain and the quality of recovery.</div></div><div><h3>Methods</h3><div>A randomized, double-blind, and prospective clinical trial with 124 patients undergoing LC, divided into 4 groups: SP/MB (Standard Pneumoperitoneum pressure and Moderate NMB); LP/MB (Low Pneumoperitoneum pressure and Moderate NMB); SP/DB (Standard Pneumoperitoneum pressure and Deep NMB); and LP/DB (Low Pneumoperitoneum pressure and Deep NMB). Recovery quality was assessed using the Quality of Recovery Questionnaire (QoR-40), and postoperative pain was evaluated using a Verbal Numerical Rating Scale (VNRS).</div></div><div><h3>Results</h3><div>No difference was observed between groups regarding the total QoR-40 score 24 hours after surgery (p = 0.903). Despite better surgical conditions (scored from 0 to 5) in the LP/DB group (4.7 ± 0.52) and lower in the LP/MB group (4.1 ± 0.95), the LP/DB group showed a longer stay in the Post-Anesthesia Care Unit (PACU), a higher need for rescue treatment for nausea and vomiting in the ward (p = 0.044), and greater resting pain at 24 hours (p = 0.027).</div></div><div><h3>Conclusion</h3><div>The use of different pneumoperitoneum pressures under moderate or deep neuromuscular blockade in patients undergoing Laparoscopic Cholecystectomy (LC) did not alter patients’ perception of postoperative recovery quality. The combination of standard pneumoperitoneum pressure with deep neuromuscular blockade was associated with a better perception of surgical field quality as evaluated by the surgeon.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 6","pages":"Article 844667"},"PeriodicalIF":1.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762530","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}
Pub Date : 2025-07-05DOI: 10.1016/j.bjane.2025.844661
Ozgecan P. Zanbak Mutlu, Pinar Kendigelen, Ayse C. Tutuncu
Background
Quadratus Lumborum Block (QLB) has recently become an effective analgesic regional technique frequently used in abdominal surgeries. However, due to the heterogeneity in studies regarding block approaches, a direct comparison of QLB types is needed. In this double-blind prospective randomized trial, we aimed to compare the effects of lateral and posterior approaches of QLB on pain and analgesic use in children undergoing orchiopexy.
Methods
Patients aged 6 months – 12 years undergoing elective unilateral open orchiopexy were included in the study. Patients were randomized into two groups using the closed-envelope method. Lateral or posterior QLB was applied under ultrasonography with 0.4 mL/kg 0.25% bupivacaine for both groups before the surgery. The primary outcome was the assessment of postoperative pain for 24 hours. Analgesic usage, parental satisfaction, and complications were recorded as secondary outcomes.
Results
Analyses were conducted on 80 patients. Both study groups achieved clinically adequate analgesia, and no significant pain score distinctions were observed within 24 hours (Total mean scores: FLACC [lateral QLB: 2.86 ± 4.69 vs. posterior QLB: 2.87 ± 3.71, p = 0.466], Wong-Baker [lateral QLB: 0.86 ± 2.03 vs. posterior QLB: 1.24 ± 1.85, p = 0.151]). No significant interaction effect between groups and postoperative time intervals on pain scores was observed (FLACC score p-interaction: 0.425, Wong-Baker score p-interaction: 0.451). There were no statistical differences in the number of patients necessitating intraoperative and postoperative analgesics. Parental satisfaction exhibited similarity between the groups, and no perioperative complications were observed in either group.
Conclusion
Lateral and posterior QLB provided similar perioperative analgesia in pediatric patients undergoing orchiopexy.
{"title":"Lateral versus posterior quadratus lumborum block in children undergoing open orchiopexy: a double-blind randomized clinical trial","authors":"Ozgecan P. Zanbak Mutlu, Pinar Kendigelen, Ayse C. Tutuncu","doi":"10.1016/j.bjane.2025.844661","DOIUrl":"10.1016/j.bjane.2025.844661","url":null,"abstract":"<div><h3>Background</h3><div>Quadratus Lumborum Block (QLB) has recently become an effective analgesic regional technique frequently used in abdominal surgeries. However, due to the heterogeneity in studies regarding block approaches, a direct comparison of QLB types is needed. In this double-blind prospective randomized trial, we aimed to compare the effects of lateral and posterior approaches of QLB on pain and analgesic use in children undergoing orchiopexy.</div></div><div><h3>Methods</h3><div>Patients aged 6 months – 12 years undergoing elective unilateral open orchiopexy were included in the study. Patients were randomized into two groups using the closed-envelope method. Lateral or posterior QLB was applied under ultrasonography with 0.4 mL/kg 0.25% bupivacaine for both groups before the surgery. The primary outcome was the assessment of postoperative pain for 24 hours. Analgesic usage, parental satisfaction, and complications were recorded as secondary outcomes.</div></div><div><h3>Results</h3><div>Analyses were conducted on 80 patients. Both study groups achieved clinically adequate analgesia, and no significant pain score distinctions were observed within 24 hours (Total mean scores: FLACC [lateral QLB: 2.86 ± 4.69 vs. posterior QLB: 2.87 ± 3.71, p = 0.466], Wong-Baker [lateral QLB: 0.86 ± 2.03 vs. posterior QLB: 1.24 ± 1.85, p = 0.151]). No significant interaction effect between groups and postoperative time intervals on pain scores was observed (FLACC score p-interaction: 0.425, Wong-Baker score p-interaction: 0.451). There were no statistical differences in the number of patients necessitating intraoperative and postoperative analgesics. Parental satisfaction exhibited similarity between the groups, and no perioperative complications were observed in either group.</div></div><div><h3>Conclusion</h3><div>Lateral and posterior QLB provided similar perioperative analgesia in pediatric patients undergoing orchiopexy.</div></div><div><h3>Clinical trial registration number</h3><div>NCT05056038.</div></div><div><h3>Date of registration</h3><div>02 June 2021.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 6","pages":"Article 844661"},"PeriodicalIF":1.9,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585752","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}
Pub Date : 2025-07-05DOI: 10.1016/j.bjane.2025.844660
Rafael M. Linhares , Eduardo Tibiriça
{"title":"Perioperative microcirculatory monitoring using handheld video microscopy: a proof-of-concept observation","authors":"Rafael M. Linhares , Eduardo Tibiriça","doi":"10.1016/j.bjane.2025.844660","DOIUrl":"10.1016/j.bjane.2025.844660","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 6","pages":"Article 844660"},"PeriodicalIF":1.9,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585753","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}
Pub Date : 2025-07-05DOI: 10.1016/j.bjane.2025.844659
Lucas Cael Azevedo Ramos Bendaham , Altair Pereira de Melo Neto , Hilária Saugo Faria , André Richard da Silva Oliveira Filho , Carlos Henrique de Oliveira Ferreira , Marcela da Silva Kazitani Cunha , Victor Gonçalves Soares , Ocílio Ribeiro Gonçalves , Milene Vitória Sampaio Sobral , Mohamed Doma , Denis Maltz Grutcki , Fabrício Tavares Mendonça
Background
Tracheal extubation after general anesthesia may cause hemodynamic and respiratory complications, with no established strategies to prevent them. We conducted a meta-analysis to evaluate the safety and efficacy of beta-blockers in patients undergoing tracheal extubation.
Methods
We searched the MEDLINE, EMBASE and CENTRAL databases for randomized controlled trials up to 2024 comparing beta-blockers to placebo in patients undergoing tracheal extubation. Primary outcome: cough intensity; secondary: bronchospasm, bucking, hypertension. Risk Ratios (RR) with 95% Confidence Intervals (95% CI) were computed. Leave-one-out sensitivity and meta-regression analyses were performed for outcomes with high heterogeneity.
Results
We included 31 randomized studies, comprising 1,803 patients, of whom 965 received beta-blockers. The risk of moderate/severe cough (RR = 0.21; 95% CI 0.13 to 0.34; p < 0.001; I2 = 0%) and hypertension (RR = 0.28; 95% CI 0.13 to 0.58; p < 0.001; I2 = 45%) was significantly lower in the beta-blockers group compared with the placebo group. There were no statistically significant differences between groups in the risk of bronchospasm (RR = 0.58; 95% CI 0.17 to 1.94; p = 0.375; I2 = 0%) or bucking (RR = 0.47; 95% CI 0.20 to 1.13; p = 0.093; I2 = 72%). Sensitivity analysis identified Mendonça (2023) as the main heterogeneity source in bucking.
Conclusion
Our study demonstrates that beta-blockers reduced moderate/severe cough and hypertension in patients undergoing tracheal extubation compared with placebo with no significant difference in the risk of bronchospasm and bucking. These findings suggest beta-blockers may be a valuable strategy for preventing peri-extubation hemodynamic instability and airway hyperresponsiveness.
{"title":"Respiratory outcomes of adrenergic beta-antagonists in patients undergoing tracheal extubation: a systematic review and meta-analysis of randomized controlled trials","authors":"Lucas Cael Azevedo Ramos Bendaham , Altair Pereira de Melo Neto , Hilária Saugo Faria , André Richard da Silva Oliveira Filho , Carlos Henrique de Oliveira Ferreira , Marcela da Silva Kazitani Cunha , Victor Gonçalves Soares , Ocílio Ribeiro Gonçalves , Milene Vitória Sampaio Sobral , Mohamed Doma , Denis Maltz Grutcki , Fabrício Tavares Mendonça","doi":"10.1016/j.bjane.2025.844659","DOIUrl":"10.1016/j.bjane.2025.844659","url":null,"abstract":"<div><h3>Background</h3><div>Tracheal extubation after general anesthesia may cause hemodynamic and respiratory complications, with no established strategies to prevent them. We conducted a meta-analysis to evaluate the safety and efficacy of beta-blockers in patients undergoing tracheal extubation.</div></div><div><h3>Methods</h3><div>We searched the MEDLINE, EMBASE and CENTRAL databases for randomized controlled trials up to 2024 comparing beta-blockers to placebo in patients undergoing tracheal extubation. Primary outcome: cough intensity; secondary: bronchospasm, bucking, hypertension. Risk Ratios (RR) with 95% Confidence Intervals (95% CI) were computed. Leave-one-out sensitivity and meta-regression analyses were performed for outcomes with high heterogeneity.</div></div><div><h3>Results</h3><div>We included 31 randomized studies, comprising 1,803 patients, of whom 965 received beta-blockers. The risk of moderate/severe cough (RR = 0.21; 95% CI 0.13 to 0.34; p < 0.001; I<sup>2</sup> = 0%) and hypertension (RR = 0.28; 95% CI 0.13 to 0.58; p < 0.001; I<sup>2</sup> = 45%) was significantly lower in the beta-blockers group compared with the placebo group. There were no statistically significant differences between groups in the risk of bronchospasm (RR = 0.58; 95% CI 0.17 to 1.94; p = 0.375; I<sup>2</sup> = 0%) or bucking (RR = 0.47; 95% CI 0.20 to 1.13; p = 0.093; I<sup>2</sup> = 72%). Sensitivity analysis identified Mendonça (2023) as the main heterogeneity source in bucking.</div></div><div><h3>Conclusion</h3><div>Our study demonstrates that beta-blockers reduced moderate/severe cough and hypertension in patients undergoing tracheal extubation compared with placebo with no significant difference in the risk of bronchospasm and bucking. These findings suggest beta-blockers may be a valuable strategy for preventing peri-extubation hemodynamic instability and airway hyperresponsiveness.</div></div><div><h3>Prospero register</h3><div>CRD42024542103.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 6","pages":"Article 844659"},"PeriodicalIF":1.9,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585754","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}
Pub Date : 2025-06-20DOI: 10.1016/j.bjane.2025.844652
Bruno F.M. Wegner , Gustavo R.M. Wegner , Jaime A. Arias , Tatiana S. Nascimento
Background
Effective pain management and expedited recovery are critical in pediatric cardiac surgery. While regional anesthesia techniques provide targeted pain control and may reduce opioid use and related complications, comparative evidence among regional nerve blocks in this population is limited. This study aimed to conduct a systematic review and network meta-analysis to support clinical decision-making for optimal analgesia.
Methods
We conducted a Bayesian Network Meta-Analysis (NMA) including Randomized Controlled Trials (RCTs) of pediatric patients (0–12 years) undergoing cardiac surgery by sternotomy and receiving preemptive regional nerve blocks. Primary outcomes included pain scores, opioid consumption and extubation time. Both direct and indirect evidence were synthesized to rank interventions probabilistically. This study was registered on PROSPERO (CRD42024585785) and followed PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions.
Results
The NMA incorporated 12 RCTs, comprising 969 participants, and evaluated seven regional nerve blocks. Among the techniques studied, transversus Thoracis Muscle Plane Block (TTPB) consistently ranked among the most effective for pain relief and recovery. Other blocks, including thoracic retrolaminar block and thoracic paravertebral block, also demonstrated notable performances. Adverse events were infrequent but inconsistently reported, preventing an adequate analysis.
Conclusion
This NMA identified TTPB as a consistently top-performing technique across outcomes. These findings provide promising support for its inclusion in ERAS protocols, although further high-quality trials are needed.
{"title":"Preemptive regional nerve blocks for sternotomy in pediatric cardiac surgery: a Bayesian network meta-analysis","authors":"Bruno F.M. Wegner , Gustavo R.M. Wegner , Jaime A. Arias , Tatiana S. Nascimento","doi":"10.1016/j.bjane.2025.844652","DOIUrl":"10.1016/j.bjane.2025.844652","url":null,"abstract":"<div><h3>Background</h3><div>Effective pain management and expedited recovery are critical in pediatric cardiac surgery. While regional anesthesia techniques provide targeted pain control and may reduce opioid use and related complications, comparative evidence among regional nerve blocks in this population is limited. This study aimed to conduct a systematic review and network meta-analysis to support clinical decision-making for optimal analgesia.</div></div><div><h3>Methods</h3><div>We conducted a Bayesian Network Meta-Analysis (NMA) including Randomized Controlled Trials (RCTs) of pediatric patients (0–12 years) undergoing cardiac surgery by sternotomy and receiving preemptive regional nerve blocks. Primary outcomes included pain scores, opioid consumption and extubation time. Both direct and indirect evidence were synthesized to rank interventions probabilistically. This study was registered on PROSPERO (CRD42024585785) and followed PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions.</div></div><div><h3>Results</h3><div>The NMA incorporated 12 RCTs, comprising 969 participants, and evaluated seven regional nerve blocks. Among the techniques studied, transversus Thoracis Muscle Plane Block (TTPB) consistently ranked among the most effective for pain relief and recovery. Other blocks, including thoracic retrolaminar block and thoracic paravertebral block, also demonstrated notable performances. Adverse events were infrequent but inconsistently reported, preventing an adequate analysis.</div></div><div><h3>Conclusion</h3><div>This NMA identified TTPB as a consistently top-performing technique across outcomes. These findings provide promising support for its inclusion in ERAS protocols, although further high-quality trials are needed.</div></div><div><h3>Registration</h3><div>PROSPERO ID: CRD42024585785.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844652"},"PeriodicalIF":1.7,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369669","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}
Pub Date : 2025-06-18DOI: 10.1016/j.bjane.2025.844653
Miguel Ángel Fernández-Vaquero , Pedro Charco-Mora , Jose Alfonso Sastre-Rincon , Manuel Ángel Gomez-Rios , Johanes Cardenas-Gomez , Eugenio Martinez-Hurtado , Norma Aracil-Escoda , Andrea Vallejo-Tarrat , Inés Thion-Soriano , David Peral-Sanchez , Miguel Castañeda-Pascual , Miguel Rodriguez del Rio , Nekari de Luis-Cabezon , Joseba Gonzalez-Garcia , Jesus Acosta-Martinez , Silvia Gonzalez-Santos , Xavier Onrubia-Fuertes , Estefania Martinez-Gonzalez , Andres Roca de Togores-Lopez , Iratxe Gonzalez-Mendibil , Marc Vives Santacana
Background and objective
Videolaryngoscopy have transformed airway management by improving intubation success rates compared to direct laryngoscopy. However, its widespread adoption has been hindered by the lack of standardized classification tools for documentation and communication. This manuscript outlines the rationale and study design of the VCISpain project, which aims to evaluate the interobserver reproducibility of the Video Classification of Intubation (VCI) scale in the context of airway management using videolaryngoscopy in Spain.
Methods
This manuscript presents the planned methodology of the VCISpain study, a prospective, observational, multicenter, open-label study. The study will collect data on tracheal intubations performed in operating rooms, intensive care units, and emergency departments. In each case, two anesthesiologists will independently apply the VCI scale to assess blade type, Percentage of Glottic Opening (POGO), and ease of intubation.
Ethics and registration
The study was approved by the University of Navarra Ethics Committee (2022.079 mod1) and registered on ClinicalTrials.gov (NCT06537531). It is endorsed by the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR) and the European Airway Management Society (EAMS).
Conclusions
VCISpain seeks to establish a standardized classification tool for documenting and communicating findings related to videolaryngoscopy in airway management. By presenting the study rationale and design, this protocol aims to promote transparency, ensure methodological rigor, and encourage broader discussion to refine the study prior to implementation.
{"title":"VCISpain: protocol for a prospective multicenter observational study to validate a standardized classification tool for tracheal intubation using videolaryngoscopy","authors":"Miguel Ángel Fernández-Vaquero , Pedro Charco-Mora , Jose Alfonso Sastre-Rincon , Manuel Ángel Gomez-Rios , Johanes Cardenas-Gomez , Eugenio Martinez-Hurtado , Norma Aracil-Escoda , Andrea Vallejo-Tarrat , Inés Thion-Soriano , David Peral-Sanchez , Miguel Castañeda-Pascual , Miguel Rodriguez del Rio , Nekari de Luis-Cabezon , Joseba Gonzalez-Garcia , Jesus Acosta-Martinez , Silvia Gonzalez-Santos , Xavier Onrubia-Fuertes , Estefania Martinez-Gonzalez , Andres Roca de Togores-Lopez , Iratxe Gonzalez-Mendibil , Marc Vives Santacana","doi":"10.1016/j.bjane.2025.844653","DOIUrl":"10.1016/j.bjane.2025.844653","url":null,"abstract":"<div><h3>Background and objective</h3><div>Videolaryngoscopy have transformed airway management by improving intubation success rates compared to direct laryngoscopy. However, its widespread adoption has been hindered by the lack of standardized classification tools for documentation and communication. This manuscript outlines the rationale and study design of the VCISpain project, which aims to evaluate the interobserver reproducibility of the Video Classification of Intubation (VCI) scale in the context of airway management using videolaryngoscopy in Spain.</div></div><div><h3>Methods</h3><div>This manuscript presents the planned methodology of the VCISpain study, a prospective, observational, multicenter, open-label study. The study will collect data on tracheal intubations performed in operating rooms, intensive care units, and emergency departments. In each case, two anesthesiologists will independently apply the VCI scale to assess blade type, Percentage of Glottic Opening (POGO), and ease of intubation.</div></div><div><h3>Ethics and registration</h3><div>The study was approved by the University of Navarra Ethics Committee (2022.079 mod1) and registered on ClinicalTrials.gov (NCT06537531). It is endorsed by the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR) and the European Airway Management Society (EAMS).</div></div><div><h3>Conclusions</h3><div>VCISpain seeks to establish a standardized classification tool for documenting and communicating findings related to videolaryngoscopy in airway management. By presenting the study rationale and design, this protocol aims to promote transparency, ensure methodological rigor, and encourage broader discussion to refine the study prior to implementation.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844653"},"PeriodicalIF":1.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487354","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}
Postoperative Sore Throat (POST) may result in patient dissatisfaction and distress, which could possibly delay discharge. Various pharmacological and non-pharmacological approaches have been explored, yet effective techniques remain elusive. This research evaluates the impact of intra-cuff Dexamethasone, Ketamine, and normal saline on alleviating POST symptoms.
Methods
In this randomized controlled trial, 405 adult patients aged 18‒60 years undergoing short pelvic laparoscopic surgeries under general anesthesia for 1‒3 h requiring endotracheal intubation were enrolled. Patients were randomized into Group N (intra-cuff normal saline), Group D (intra-cuff Dexamethasone), and Group K (intra-cuff Ketamine). The primary outcome of this study was the incidence and severity of POST at 2, 6, 12, and 24 hours after extubation. Secondary outcomes were the incidence and severity of postoperative hoarseness of voice and postoperative cough at various time intervals.
Results
There were more patients in Group D without symptoms of POST (92.59 %) than in Group K (74.07 %) and Group N (67.41 %) (p < 0.0001) at 2 h. Similarly, more patients had no symptoms of postoperative hoarseness of voice (93.33 %) and postoperative cough (93.33 %) in Group D at 2 h. Furthermore, Group D consistently exhibited the lowest incidence of POST, postoperative hoarseness of voice, and postoperative cough at various time intervals.
Conclusions
Intra-cuff Dexamethasone appears to be a favourable intervention for symptom alleviation of POST, postoperative hoarseness of voice, and postoperative cough during the early postoperative period.
{"title":"Comparison of the effect of intra-cuff normal saline, dexamethasone or ketamine for prevention of postoperative sore throat: a randomized controlled trial","authors":"Arun Mukesh , Ankur Sharma , Priyabrat Karan , Darshna Rathod , Shilpa Goyal , Kamlesh Kumari , Manbir Kaur , Tanvi Meshram , Pradeep Bhatia","doi":"10.1016/j.bjane.2025.844651","DOIUrl":"10.1016/j.bjane.2025.844651","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative Sore Throat (POST) may result in patient dissatisfaction and distress, which could possibly delay discharge. Various pharmacological and non-pharmacological approaches have been explored, yet effective techniques remain elusive. This research evaluates the impact of intra-cuff Dexamethasone, Ketamine, and normal saline on alleviating POST symptoms.</div></div><div><h3>Methods</h3><div>In this randomized controlled trial, 405 adult patients aged 18‒60 years undergoing short pelvic laparoscopic surgeries under general anesthesia for 1‒3 h requiring endotracheal intubation were enrolled. Patients were randomized into Group N (intra-cuff normal saline), Group D (intra-cuff Dexamethasone), and Group K (intra-cuff Ketamine). The primary outcome of this study was the incidence and severity of POST at 2, 6, 12, and 24 hours after extubation. Secondary outcomes were the incidence and severity of postoperative hoarseness of voice and postoperative cough at various time intervals.</div></div><div><h3>Results</h3><div>There were more patients in Group D without symptoms of POST (92.59 %) than in Group K (74.07 %) and Group N (67.41 %) (<em>p</em> < 0.0001) at 2 h. Similarly, more patients had no symptoms of postoperative hoarseness of voice (93.33 %) and postoperative cough (93.33 %) in Group D at 2 h. Furthermore, Group D consistently exhibited the lowest incidence of POST, postoperative hoarseness of voice, and postoperative cough at various time intervals.</div></div><div><h3>Conclusions</h3><div>Intra-cuff Dexamethasone appears to be a favourable intervention for symptom alleviation of POST, postoperative hoarseness of voice, and postoperative cough during the early postoperative period.</div></div><div><h3>Clinical Trial Registry Number</h3><div>CTRI/2022/08/044,664.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844651"},"PeriodicalIF":1.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303817","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}
Pub Date : 2025-06-11DOI: 10.1016/j.bjane.2025.844650
Joanna Tohme, Joan Chehade, Hicham Abou Zeid, Rhea Mattar, Nicole Naccache, Khalil Jabbour, Mohammad Ali Ismail, Christine Dagher
Background
Post Spinal Anesthesia Shivering (PSAS) is common and linked to increased morbidity. While various methods exist to prevent it, no study has compared Nefopam and Ondansetron. This study aims to compare Ondansetron and Nefopam in preventing PSAS.
Methods
A prospective, randomized, controlled, and double-blind trial was conducted in the operating room of a tertiary university hospital from April 5, 2021 to April 30, 2022. It included patients aged between 18 and 65 years scheduled for surgery under spinal anesthesia. Patients received either 8 mg of Ondansetron or 20 mg of Nefopam administered intravenously over 30 min before spinal anesthesia. Main outcome measures included the number and grades of shivering episodes post spinal anesthesia at 15-minute intervals until post-anesthesia care unit discharge. Secondary outcomes included number of episodes of hypotension, bradycardia, nausea and/or vomiting. Tympanic temperature and pain at the injection site were also recorded.
Results
The study included 150 patients, evenly divided between the two groups. The Ondansetron group had a higher incidence of shivering compared to the Nefopam group (23.9 % vs. 16 %; p = 0.038), as well as higher incidences of hypotension (16 % vs. 5.3 %; p = 0.035) and bradycardia (13.3 % vs. 2.7 %; p = 0.016). The Ondansetron group had a significantly lower incidence of nausea and vomiting (12 % vs. 1.3 %; p = 0.010). More patients in the Nefopam group (45.3 %) reported pain during drug infusion.
Conclusions
Nefopam seems to be more effective than Ondansetron in preventing PSAS with fewer cardiovascular side effects. However, Ondansetron reduces the incidence of nausea and vomiting and causes no pain during administration.
背景：脊髓麻醉后寒战（PSAS）是常见的，并与发病率增加有关。虽然有多种预防方法，但没有研究比较奈福泮和昂丹司琼。本研究旨在比较昂丹司琼和奈福泮预防PSAS的效果。方法：于2021年4月5日至2022年4月30日在某三级大学附属医院的手术室进行前瞻性、随机、对照、双盲试验。其中包括年龄在18岁至65岁之间的患者，他们计划在脊髓麻醉下进行手术。患者在脊髓麻醉前30分钟内静脉给予8mg昂丹司琼或20mg奈福泮。主要结局指标包括脊髓麻醉后每隔15分钟发抖的次数和等级，直至麻醉护理单位出院。次要结局包括低血压、心动过缓、恶心和/或呕吐的发作次数。同时记录注射部位的鼓室温度和疼痛。结果：共纳入150例患者，平均分为两组。与奈福泮组相比，昂丹司琼组的寒战发生率更高(23.9% vs. 16%；P = 0.038)，以及更高的低血压发生率(16% vs. 5.3%；P = 0.035)和心动过缓(13.3% vs. 2.7%； = 0.016页)。昂丹司琼组恶心呕吐发生率显著降低(12% vs 1.3%； = 0.010页)。奈福泮组有更多的患者（45.3%）报告在输注过程中出现疼痛。结论：在预防PSAS方面，奈福泮似乎比昂丹司琼更有效，且心血管副作用更少。然而，昂丹司琼减少恶心和呕吐的发生率，并且在给药期间不会引起疼痛。
{"title":"Prevention of shivering post spinal anesthesia: Ondansetron vs. Nefopam ‒ a prospective randomized controlled trial","authors":"Joanna Tohme, Joan Chehade, Hicham Abou Zeid, Rhea Mattar, Nicole Naccache, Khalil Jabbour, Mohammad Ali Ismail, Christine Dagher","doi":"10.1016/j.bjane.2025.844650","DOIUrl":"10.1016/j.bjane.2025.844650","url":null,"abstract":"<div><h3>Background</h3><div>Post Spinal Anesthesia Shivering (PSAS) is common and linked to increased morbidity. While various methods exist to prevent it, no study has compared Nefopam and Ondansetron. This study aims to compare Ondansetron and Nefopam in preventing PSAS.</div></div><div><h3>Methods</h3><div>A prospective, randomized, controlled, and double-blind trial was conducted in the operating room of a tertiary university hospital from April 5, 2021 to April 30, 2022. It included patients aged between 18 and 65 years scheduled for surgery under spinal anesthesia. Patients received either 8 mg of Ondansetron or 20 mg of Nefopam administered intravenously over 30 min before spinal anesthesia. Main outcome measures included the number and grades of shivering episodes post spinal anesthesia at 15-minute intervals until post-anesthesia care unit discharge. Secondary outcomes included number of episodes of hypotension, bradycardia, nausea and/or vomiting. Tympanic temperature and pain at the injection site were also recorded.</div></div><div><h3>Results</h3><div>The study included 150 patients, evenly divided between the two groups. The Ondansetron group had a higher incidence of shivering compared to the Nefopam group (23.9 % vs. 16 %; <em>p</em> = 0.038), as well as higher incidences of hypotension (16 % vs. 5.3 %; <em>p</em> = 0.035) and bradycardia (13.3 % vs. 2.7 %; <em>p</em> = 0.016). The Ondansetron group had a significantly lower incidence of nausea and vomiting (12 % vs. 1.3 %; <em>p</em> = 0.010). More patients in the Nefopam group (45.3 %) reported pain during drug infusion.</div></div><div><h3>Conclusions</h3><div>Nefopam seems to be more effective than Ondansetron in preventing PSAS with fewer cardiovascular side effects. However, Ondansetron reduces the incidence of nausea and vomiting and causes no pain during administration.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844650"},"PeriodicalIF":1.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295428","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}
Pub Date : 2025-06-10DOI: 10.1016/j.bjane.2025.844649
Vitor Alves Felippe , Ana C. Pinho , Lucas M. Barbosa , Ivo Queiroz , Arthur H. Tavares , Rodrigo Diaz , Carlos Darcy Bersot , Jean-Louis Vincent
Background
The efficacy of the Hypotension Prediction Index (HPI) for reducing Intraoperative Hypotension (IOH) among patients undergoing non-cardiac surgeries remains unclear. We aimed to perform a systematic review, meta-analysis, and trial sequential analysis to determine whether the HPI is effective for adult patients undergoing non-cardiac surgeries. This study was prospectively registered in the PROSPERO database (CRD42024571931).
Methods
PubMed, Embase, and Cochrane were systematically searched for Randomized Controlled Trials (RCTs) comparing HPI-guided therapy with standard care in non-cardiac surgeries. We computed Mean Difference (MD) and Risk Ratios (RR) for continuous and binary outcomes, respectively, with 95 % Confidence Intervals (95 % CI). Statistical analyses were performed using R Software, version 4.2.3.
Results
We included 11 RCTs, comprising a total of 789 patients, of whom 395 (50.1 %) received HPI-guided management. HPI significantly reduced the Time-Weighted Average (TWA) of Mean Arterial Pressure (MAP) < 65 mmHg (MD = -0.23 mmHg.min-1; 95 % CI -0.35 to -0.10; p < 0.01) and the Area Under the Curve (AUC) of MAP < 65 mmHg (MD = -97.2 mmHg.min-1; 95 % CI -143.4 to -50.98; p < 0.01). HPI also decreased the duration of MAP < 65 mmHg (MD = -16.22 min; 95 % CI -25.87 to -6.57; p < 0.01) and the number of hypotensive episodes per patient (MD = -3.38; 95 % CI -5.38 to -1.37; p < 0.01). No significant differences were observed in the number of hypotensive events, phenylephrine use, or AKI incidence (p > 0.05).
Conclusion
In adult patients undergoing non-cardiac surgeries, HPI use was associated with a reduction in the duration and severity of IOH, with no significant difference for adverse events. Limitations include significant heterogeneity across studies, differences in HPI implementation, and lack of long-term outcome data.
{"title":"Effectiveness of the hypotension prediction index in non-cardiac surgeries: a systematic review, meta-analysis and trial sequential analysis","authors":"Vitor Alves Felippe , Ana C. Pinho , Lucas M. Barbosa , Ivo Queiroz , Arthur H. Tavares , Rodrigo Diaz , Carlos Darcy Bersot , Jean-Louis Vincent","doi":"10.1016/j.bjane.2025.844649","DOIUrl":"10.1016/j.bjane.2025.844649","url":null,"abstract":"<div><h3>Background</h3><div>The efficacy of the Hypotension Prediction Index (HPI) for reducing Intraoperative Hypotension (IOH) among patients undergoing non-cardiac surgeries remains unclear. We aimed to perform a systematic review, meta-analysis, and trial sequential analysis to determine whether the HPI is effective for adult patients undergoing non-cardiac surgeries. This study was prospectively registered in the PROSPERO database (CRD42024571931).</div></div><div><h3>Methods</h3><div>PubMed, Embase, and Cochrane were systematically searched for Randomized Controlled Trials (RCTs) comparing HPI-guided therapy with standard care in non-cardiac surgeries. We computed Mean Difference (MD) and Risk Ratios (RR) for continuous and binary outcomes, respectively, with 95 % Confidence Intervals (95 % CI). Statistical analyses were performed using R Software, version 4.2.3.</div></div><div><h3>Results</h3><div>We included 11 RCTs, comprising a total of 789 patients, of whom 395 (50.1 %) received HPI-guided management. HPI significantly reduced the Time-Weighted Average (TWA) of Mean Arterial Pressure (MAP) < 65 mmHg (MD = -0.23 mmHg.min<sup>-1</sup>; 95 % CI -0.35 to -0.10; <em>p</em> < 0.01) and the Area Under the Curve (AUC) of MAP < 65 mmHg (MD = -97.2 mmHg.min<sup>-1</sup>; 95 % CI -143.4 to -50.98; <em>p</em> < 0.01). HPI also decreased the duration of MAP < 65 mmHg (MD = -16.22 min; 95 % CI -25.87 to -6.57; <em>p</em> < 0.01) and the number of hypotensive episodes per patient (MD = -3.38; 95 % CI -5.38 to -1.37; <em>p</em> < 0.01). No significant differences were observed in the number of hypotensive events, phenylephrine use, or AKI incidence (<em>p</em> > 0.05).</div></div><div><h3>Conclusion</h3><div>In adult patients undergoing non-cardiac surgeries, HPI use was associated with a reduction in the duration and severity of IOH, with no significant difference for adverse events. Limitations include significant heterogeneity across studies, differences in HPI implementation, and lack of long-term outcome data.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844649"},"PeriodicalIF":1.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287408","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}
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