Pub Date : 2025-09-01Epub Date: 2025-07-29DOI: 10.1016/j.bjane.2025.844665
Áquila Lopes Gouvêa , Pedro Adde Anuardo , João Paulo Consentino Solano , Ângela Maria Sousa , Hazem Adel Ashmawi
Background
The older population is growing, and it is estimated that, by 2050, people aged 60-years or more will have reached two billion. The increased life expectancy has led to a higher incidence of chronic degenerative diseases, contributing to increased pain complaints. This study aims to compare the pain threshold after mechanical stimulation in older adults according to gender and presence or absence of chronic pain and find the prevalence and intensity of chronic pain in this population.
Methods
This was a cross-sectional observational study with a convenience sample in the outpatient clinic at two research centers. All participants answered sociodemographic and clinical questionnaires, and the Pressure Pain Threshold (PPT) was assessed with an algometer. Patients reporting chronic pain answered the Geriatric Pain Measure (GPM) questionnaire.
Results
The sample consisted of 230 individuals, aged 60 to 96 years, 67.8% women and 32.2% men. Chronic pain prevalence was 47.8%, 29.7% in men and 56.4% in women. PPT was significantly lower in women (4.49 ± 1.78 kg) than in men (6.41 ± 1.92 kg). PPT in older individuals presenting chronic pain (4.58 ± 1.93 kg) was lower than in older individuals without chronic pain (5.58 ± 2.01 kg). There was no significant difference between genders in pain assessment by GPM.
Conclusions
Pressure pain threshold was lower in older women and in patients with chronic pain, the association between gender and lower pain threshold was stronger than observed with chronic pain.
{"title":"Pain thresholds in elderly individuals: a cross-sectional observational study of the influence of gender and chronic non-cancer pain","authors":"Áquila Lopes Gouvêa , Pedro Adde Anuardo , João Paulo Consentino Solano , Ângela Maria Sousa , Hazem Adel Ashmawi","doi":"10.1016/j.bjane.2025.844665","DOIUrl":"10.1016/j.bjane.2025.844665","url":null,"abstract":"<div><h3>Background</h3><div>The older population is growing, and it is estimated that, by 2050, people aged 60-years or more will have reached two billion. The increased life expectancy has led to a higher incidence of chronic degenerative diseases, contributing to increased pain complaints. This study aims to compare the pain threshold after mechanical stimulation in older adults according to gender and presence or absence of chronic pain and find the prevalence and intensity of chronic pain in this population.</div></div><div><h3>Methods</h3><div>This was a cross-sectional observational study with a convenience sample in the outpatient clinic at two research centers. All participants answered sociodemographic and clinical questionnaires, and the Pressure Pain Threshold (PPT) was assessed with an algometer. Patients reporting chronic pain answered the Geriatric Pain Measure (GPM) questionnaire.</div></div><div><h3>Results</h3><div>The sample consisted of 230 individuals, aged 60 to 96 years, 67.8% women and 32.2% men. Chronic pain prevalence was 47.8%, 29.7% in men and 56.4% in women. PPT was significantly lower in women (4.49 ± 1.78 kg) than in men (6.41 ± 1.92 kg). PPT in older individuals presenting chronic pain (4.58 ± 1.93 kg) was lower than in older individuals without chronic pain (5.58 ± 2.01 kg). There was no significant difference between genders in pain assessment by GPM.</div></div><div><h3>Conclusions</h3><div>Pressure pain threshold was lower in older women and in patients with chronic pain, the association between gender and lower pain threshold was stronger than observed with chronic pain.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844665"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762529","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 : 2025-09-01Epub Date: 2025-08-21DOI: 10.1016/j.bjane.2025.844669
Adrian W. Gelb , Bruna Bastiani , Cristiane Tavares
{"title":"Beneath the surface: the emerging concern of covert stroke in surgery","authors":"Adrian W. Gelb , Bruna Bastiani , Cristiane Tavares","doi":"10.1016/j.bjane.2025.844669","DOIUrl":"10.1016/j.bjane.2025.844669","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844669"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925075","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 : 2025-09-01Epub Date: 2025-06-03DOI: 10.1016/j.bjane.2025.844647
Güvenç Doğan , Onur Küçük , Selçuk Kayır , Gökçe Çiçek Dal , Bahadır Çiftçi , Musa Zengin , Ali Alagöz
Background
Video-Assisted Thoracoscopic Surgery (VATS) is a minimally invasive procedure associated with faster recovery and fewer complications compared to open thoracotomy. Effective postoperative pain management is important for optimizing recovery. This study compares the analgesic efficacy of the Serratus Posterior Superior Intercostal Plane Block (SPSIPB) and Thoracic Paravertebral Block (TPVB) for postoperative pain following VATS.
Methods
In this randomized, prospective, double-blind study, 70 patients aged 18–65 years (ASA I–III) undergoing VATS were randomly assigned to Group TPVB (n = 35) or Group SPSIPB (n = 35). The primary outcome was the 24-hour postoperative Visual Analog Scale (VAS) pain score at rest. Secondary outcomes included VAS pain scores during coughing, time to first opioid request, total opioid consumption within 24 hours, patient satisfaction, and Quality of Recovery-15 (QoR-15) scores. Opioid consumption was assessed using intravenous tramadol through Patient-Controlled Analgesia (PCA), with additional morphine, if required.
Results
The mean age of the patients was 52 ± 11 years, and 64.2% were male. VAS pain scores were evaluated at 24 hours and at seven time points. There was no significant difference between groups (p > 0.05) except at 1 hour postoperatively, where the TPVB group had a significantly lower resting VAS score (19 [8–28] vs. 26 [18.5–33], p = 0.031). The total 24 hour tramadol consumption was 220 mg (135–260) in the TPVB group versus 150 mg (110–230) in the SPSIPB group (p = 0.129). The proportion of patients requiring additional analgesia was 25.7% in the TPVB group versus 28.5% in the SPSIPB group (p = 0.788). Preoperative and postoperative QoR-15 scores were similar between the groups (preoperative: 137 vs. 136, p = 0.878; postoperative: 133 vs. 132, p = 0.814). Patient satisfaction scores were also comparable (8 [7–10] vs. 9 [7–10], p = 0.789).
Conclusion
SPSIPB provides analgesic efficacy similar to TPVB for VATS, with comparable pain scores, opioid consumption, and recovery outcomes. Given its ease of use and safety profile, SPSIPB represents a promising alternative to TPVB in multimodal analgesia for minimally invasive thoracic surgery.
背景：视频辅助胸腔镜手术（VATS）是一种微创手术，与开胸手术相比，恢复更快，并发症更少。有效的术后疼痛管理对于优化恢复非常重要。本研究比较了锯肌后上肋间平面阻滞（SPSIPB）和胸椎旁阻滞（TPVB）对VATS术后疼痛的镇痛效果。方法：在这项随机、前瞻性、双盲研究中，70例年龄在18-65岁（ASA I-III）接受VATS的患者被随机分为TPVB组（n = 35）和SPSIPB组（n = 35）。主要终点是术后24小时视觉模拟评分（VAS）休息时疼痛评分。次要结局包括咳嗽时VAS疼痛评分、到第一次请求阿片类药物的时间、24小时内阿片类药物总消耗、患者满意度和恢复质量-15 （QoR-15）评分。通过患者自控镇痛（PCA）静脉注射曲马多来评估阿片类药物的消耗，如果需要，额外使用吗啡。结果：患者平均年龄52±11岁，男性占64.2%。分别在24小时和7个时间点评估VAS疼痛评分。两组间差异无统计学意义（p > 0.05），但术后1小时TPVB组静息VAS评分显著低于对照组（19[8-28]比26 [18.5-33],p = 0.031）。TPVB组24小时曲马多总消耗量为220 mg(135-260)，而SPSIPB组为150 mg (110-230) （p = 0.129）。TPVB组需要额外镇痛的患者比例为25.7%，而SPSIPB组为28.5% （p = 0.788）。术前和术后QoR-15评分各组间相似(术前：137 vs. 136, p = 0.878；术后：133 vs 132， p = 0.814)。患者满意度评分也具有可比性（8[7-10]对9 [7-10]，p = 0.789）。结论：SPSIPB对VATS的镇痛效果与TPVB相似，疼痛评分、阿片类药物消耗和恢复结果相似。鉴于其易用性和安全性，SPSIPB在微创胸外科手术的多模态镇痛中有望取代TPVB。
{"title":"Serratus posterior superior intercostal plane block versus thoracic paravertebral block for pain management after video-assisted thoracoscopic surgery: a randomized prospective study","authors":"Güvenç Doğan , Onur Küçük , Selçuk Kayır , Gökçe Çiçek Dal , Bahadır Çiftçi , Musa Zengin , Ali Alagöz","doi":"10.1016/j.bjane.2025.844647","DOIUrl":"10.1016/j.bjane.2025.844647","url":null,"abstract":"<div><h3>Background</h3><div>Video-Assisted Thoracoscopic Surgery (VATS) is a minimally invasive procedure associated with faster recovery and fewer complications compared to open thoracotomy. Effective postoperative pain management is important for optimizing recovery. This study compares the analgesic efficacy of the Serratus Posterior Superior Intercostal Plane Block (SPSIPB) and Thoracic Paravertebral Block (TPVB) for postoperative pain following VATS.</div></div><div><h3>Methods</h3><div>In this randomized, prospective, double-blind study, 70 patients aged 18–65 years (ASA I–III) undergoing VATS were randomly assigned to Group TPVB (n = 35) or Group SPSIPB (n = 35). The primary outcome was the 24-hour postoperative Visual Analog Scale (VAS) pain score at rest. Secondary outcomes included VAS pain scores during coughing, time to first opioid request, total opioid consumption within 24 hours, patient satisfaction, and Quality of Recovery-15 (QoR-15) scores. Opioid consumption was assessed using intravenous tramadol through Patient-Controlled Analgesia (PCA), with additional morphine, if required.</div></div><div><h3>Results</h3><div>The mean age of the patients was 52 ± 11 years, and 64.2% were male. VAS pain scores were evaluated at 24 hours and at seven time points. There was no significant difference between groups (p > 0.05) except at 1 hour postoperatively, where the TPVB group had a significantly lower resting VAS score (19 [8–28] vs. 26 [18.5–33], p = 0.031). The total 24 hour tramadol consumption was 220 mg (135–260) in the TPVB group versus 150 mg (110–230) in the SPSIPB group (p = 0.129). The proportion of patients requiring additional analgesia was 25.7% in the TPVB group versus 28.5% in the SPSIPB group (p = 0.788). Preoperative and postoperative QoR-15 scores were similar between the groups (preoperative: 137 vs. 136, p = 0.878; postoperative: 133 vs. 132, p = 0.814). Patient satisfaction scores were also comparable (8 [7–10] vs. 9 [7–10], p = 0.789).</div></div><div><h3>Conclusion</h3><div>SPSIPB provides analgesic efficacy similar to TPVB for VATS, with comparable pain scores, opioid consumption, and recovery outcomes. Given its ease of use and safety profile, SPSIPB represents a promising alternative to TPVB in multimodal analgesia for minimally invasive thoracic surgery.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844647"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236097","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 : 2025-09-01Epub 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":"2025-09-01","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}
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":"2025-09-01","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 : 2025-09-01Epub Date: 2025-08-13DOI: 10.1016/j.bjane.2025.844671
Daniel Perin, Mauricio Luiz Malito, Maurício do Amaral Neto
{"title":"Imaging classification in videolaryngoscopy: are we on the right track?","authors":"Daniel Perin, Mauricio Luiz Malito, Maurício do Amaral Neto","doi":"10.1016/j.bjane.2025.844671","DOIUrl":"10.1016/j.bjane.2025.844671","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844671"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859892","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 : 2025-09-01Epub Date: 2025-08-13DOI: 10.1016/j.bjane.2025.844670
Marcello Fonseca Salgado-Filho , Luiz Guilherme Villares da Costa , Eric Benedet Lineburger , Bruno Francisco de Freitas Tonelotto
{"title":"Thoracic wall blocks in cardiac and thoracic procedures: expanding frontiers for perioperative regional analgesia","authors":"Marcello Fonseca Salgado-Filho , Luiz Guilherme Villares da Costa , Eric Benedet Lineburger , Bruno Francisco de Freitas Tonelotto","doi":"10.1016/j.bjane.2025.844670","DOIUrl":"10.1016/j.bjane.2025.844670","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844670"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859893","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 : 2025-07-01Epub Date: 2025-03-28DOI: 10.1016/j.bjane.2025.844614
Flavio M. Ferreira, David D. Araujo, Gustavo M. Dantas, Ligia Cristina C. Cunha, Suely P. Zeferino, Filomena B. Galas
Introduction
Low Cardiac Output Syndrome (LCOS) remains a significant perioperative challenge in pediatric cardiac surgery. This study evaluated whether a hemodynamic protocol aimed at optimizing continuous central venous Oxygen Saturation (SvcO2) using the PediaSat catheter could reduce postoperative complications in pediatric patients undergoing congenital heart surgery.
Methods
Conducted at the Instituto do Coração in São Paulo, this randomized clinical trial compared a group receiving SvcO2-based goal-directed therapy via PediaSat (intervention) against conventional care (control). The main objective was assessing 24-hour lactate clearance post-surgery, with secondary outcomes including Vasoactive-Inotropic Score (VIS), Mechanical Ventilation (MV) duration, vasopressor use, and ICU/hospital stay lengths.
Results
From July 13, 2014, to March 17, 2016, 391 patients were evaluated for eligibility. After applying inclusion and exclusion criteria, 65 patients were included and randomized ‒ 33 to the control group and 32 to the PediaSat group. There were no losses to follow-up in either group. Lactate clearance did not significantly differ between the intervention and control groups. However, the PediaSat group showed significantly shorter mechanical ventilation times, reduced vasopressor use, and shorter ICU stays. No significant differences were observed in hospital stay length or incidence of postoperative complications between the group.
Conclusions
While optimizing SvcO2 did not affect overall lactate clearance, it was associated with shorter MV duration, decreased vasopressor need, and shorter ICU stays in pediatric cardiac surgery patients. These findings highlight the potential benefits of continuous SvcO2 monitoring in postoperative care.
{"title":"Goal-directed therapy with continuous SvcO2 monitoring in pediatric cardiac surgery: the PediaSat single-center randomized trial","authors":"Flavio M. Ferreira, David D. Araujo, Gustavo M. Dantas, Ligia Cristina C. Cunha, Suely P. Zeferino, Filomena B. Galas","doi":"10.1016/j.bjane.2025.844614","DOIUrl":"10.1016/j.bjane.2025.844614","url":null,"abstract":"<div><h3>Introduction</h3><div>Low Cardiac Output Syndrome (LCOS) remains a significant perioperative challenge in pediatric cardiac surgery. This study evaluated whether a hemodynamic protocol aimed at optimizing continuous central venous Oxygen Saturation (SvcO<sub>2</sub>) using the PediaSat catheter could reduce postoperative complications in pediatric patients undergoing congenital heart surgery.</div></div><div><h3>Methods</h3><div>Conducted at the Instituto do Coração in São Paulo, this randomized clinical trial compared a group receiving SvcO<sub>2</sub>-based goal-directed therapy via PediaSat (intervention) against conventional care (control). The main objective was assessing 24-hour lactate clearance post-surgery, with secondary outcomes including Vasoactive-Inotropic Score (VIS), Mechanical Ventilation (MV) duration, vasopressor use, and ICU/hospital stay lengths.</div></div><div><h3>Results</h3><div>From July 13, 2014, to March 17, 2016, 391 patients were evaluated for eligibility. After applying inclusion and exclusion criteria, 65 patients were included and randomized ‒ 33 to the control group and 32 to the PediaSat group. There were no losses to follow-up in either group. Lactate clearance did not significantly differ between the intervention and control groups. However, the PediaSat group showed significantly shorter mechanical ventilation times, reduced vasopressor use, and shorter ICU stays. No significant differences were observed in hospital stay length or incidence of postoperative complications between the group.</div></div><div><h3>Conclusions</h3><div>While optimizing SvcO<sub>2</sub> did not affect overall lactate clearance, it was associated with shorter MV duration, decreased vasopressor need, and shorter ICU stays in pediatric cardiac surgery patients. These findings highlight the potential benefits of continuous SvcO<sub>2</sub> monitoring in postoperative care.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844614"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756127","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 : 2025-07-01Epub Date: 2025-03-28DOI: 10.1016/j.bjane.2025.844615
Mariana F.L. Neville , Victor Guimarães de Almeida , Pamela Vieira Andrade , Joilson Moura Santos , Masashi Munechika , David Ferez , Mary dos Santos Silva , Leonardo Ayres Canga , Ana Cristina Tripoloni , Thierry Girard , Helga Cristina Almeida da Silva
Introduction
Simulation-based training is particularly beneficial for rare and life-threatening diseases such as Malignant Hyperthermia (MH). In addition, cognitive aids, including flowcharts and checklists, can be used as guidance in crisis, reducing cognitive demand and simplifying patient care. We assessed the technical and non-technical performance of anesthesiology residents when diagnosing and treating a hypothetical case of MH in three different scenarios.
Methods
This was an observational, cross-sectional, and controlled study. Pairs of anesthesiology residents participated in a validated high-fidelity MH realistic simulation in one of three different scenarios: 1) Control (no access to cognitive aids), 2) Poster, or 3) Mobile application. Both poster and mobile application provided a flowchart and information related to MH diagnosis and treatment. Demographic data, perceived stress levels, and technical and non-technical skills were registered and compared among the groups.
Results
Thirty residents (5-pairs for each scenario) participated in the simulations. The mean score in the technical skill survey was significantly higher in the poster and mobile application groups compared with the control group (83 [4.4], 83 [3.8], and 74 [8.2], respectively, ANOVA, p = 0.047). A significantly higher score for non-technical skills was also found for the poster and mobile application groups compared with the control group (55 [2.5], 57 [0.8], 52 [2.1], respectively, ANOVA, p = 0.03).
Conclusion
In a realistic high-fidelity MH simulation, the participants had satisfactory performance regarding technical and non-technical skills. However, the groups with access to cognitive aids achieved better scores, with no difference between the groups with access to the MH poster and the MH mobile application.
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