Pub Date : 2025-07-01Epub Date: 2025-05-03DOI: 10.1016/j.bjane.2025.844636
Nicole Morem Pilau Moritz , Getúlio Rodrigues de Oliveira Filho , José Eduardo Moritz , Jefferson Luiz Traebert
Introduction
The choice of anesthetic agents plays a crucial role in procedural success. This study aimed to compare the effects of propofol-fentanyl and propofol-dexmedetomidine combinations, focusing on patient and surgeon perspectives in outpatient procedures.
Methods
A randomized, controlled, triple-blind clinical trial including 128 adult patients undergoing elective outpatient surgical procedures with sedation and local anesthesia. Patients were randomized to receive either propofol-fentanyl (PF, n = 64) or propofol-dexmedetomidine (PDex, n = 64). Primary outcomes were patient satisfaction, assessed using the ISAS-Br score, and the adequacy of sedation, evaluated by the surgeon and measured by a Numerical Rating Scale (NRS) for movement. Respiratory and hemodynamic changes, as well as awakening from anesthesia, adverse events during recovery, and time to hospital discharge were compared.
Results
No difference between patient satisfaction scores (median ISAS-Br [IQR]: PF 2.64 [2.45‒3.00] vs. PDex 3.00 [2.45‒3.00], p = 0.252). The PF group had a significantly lower movement score (median NRS [IQR]: 0.5 [0.00‒2.25] vs. 2.0 [0.00‒5.00], p = 0.006). The incidence of intraoperative events related to respiration and hemodynamics, as postoperative pain and postoperative nausea/vomiting were similar. A higher proportion of patients sedated with PF awoke in the operating room (75% vs. 35.9%, p < 0.001), and 98.4% of the PF group vs. 92.2% of the PDex group were ready for hospital discharge in less than thirty minutes, p = 0.208.
Conclusion
Single doses of fentanyl or dexmedetomidine combined with propofol resulted in equivalent patient satisfaction, safety, and discharge times. The propofol-fentanyl combination demonstrated superior sedation adequacy from the surgeon’s perspective and facilitated a faster emergence from anesthesia.
前言：麻醉药物的选择对手术成功起着至关重要的作用。本研究旨在比较异丙酚-芬太尼和异丙酚-右美托咪定组合在门诊手术中的效果，重点关注患者和外科医生的观点。方法：一项随机、对照、三盲临床试验，包括128例在镇静和局部麻醉下接受选择性门诊手术的成年患者。患者随机接受异丙酚-芬太尼（PF, n = 64）或异丙酚-右美托咪定（PDex, n = 64）治疗。主要结果为患者满意度（使用ISAS-Br评分进行评估）和镇静的充分性（由外科医生评估并使用数字评定量表（NRS）对运动进行测量）。比较呼吸和血流动力学变化、麻醉苏醒、恢复期间不良事件和出院时间。结果：患者满意度评分无差异（ISAS-Br [IQR]中位数：PF 2.64 [2.45-3.00] vs. PDex 3.00 [2.45-3.00], p = 0.252）。PF组运动评分显著低于对照组（中位NRS [IQR]: 0.5 [0.00-2.25] vs. 2.0 [0.00 - 5.50], p = 0.006）。术中与呼吸和血流动力学相关的事件，如术后疼痛和术后恶心/呕吐的发生率相似。使用PF镇静的患者在手术室醒来的比例更高（75%对35.9%,p < 0.001）， 98.4%的PF组比92.2%的PDex组在30分钟内准备出院，p = 0.208。结论：单剂量芬太尼或右美托咪定联合异丙酚可获得相同的患者满意度、安全性和出院时间。从外科医生的角度来看，异丙酚-芬太尼组合显示出优越的镇静充分性，并有助于更快地从麻醉中恢复。
{"title":"Propofol-fentanyl versus propofol-dexmedetomidine in outpatient procedures sedation: a triple-blind, randomized controlled clinical trial","authors":"Nicole Morem Pilau Moritz , Getúlio Rodrigues de Oliveira Filho , José Eduardo Moritz , Jefferson Luiz Traebert","doi":"10.1016/j.bjane.2025.844636","DOIUrl":"10.1016/j.bjane.2025.844636","url":null,"abstract":"<div><h3>Introduction</h3><div>The choice of anesthetic agents plays a crucial role in procedural success. This study aimed to compare the effects of propofol-fentanyl and propofol-dexmedetomidine combinations, focusing on patient and surgeon perspectives in outpatient procedures.</div></div><div><h3>Methods</h3><div>A randomized, controlled, triple-blind clinical trial including 128 adult patients undergoing elective outpatient surgical procedures with sedation and local anesthesia. Patients were randomized to receive either propofol-fentanyl (PF, n = 64) or propofol-dexmedetomidine (PDex, n = 64). Primary outcomes were patient satisfaction, assessed using the ISAS-Br score, and the adequacy of sedation, evaluated by the surgeon and measured by a Numerical Rating Scale (NRS) for movement. Respiratory and hemodynamic changes, as well as awakening from anesthesia, adverse events during recovery, and time to hospital discharge were compared.</div></div><div><h3>Results</h3><div>No difference between patient satisfaction scores (median ISAS-Br [IQR]: PF 2.64 [2.45‒3.00] vs. PDex 3.00 [2.45‒3.00], p = 0.252). The PF group had a significantly lower movement score (median NRS [IQR]: 0.5 [0.00‒2.25] vs. 2.0 [0.00‒5.00], p = 0.006). The incidence of intraoperative events related to respiration and hemodynamics, as postoperative pain and postoperative nausea/vomiting were similar. A higher proportion of patients sedated with PF awoke in the operating room (75% vs. 35.9%, p < 0.001), and 98.4% of the PF group vs. 92.2% of the PDex group were ready for hospital discharge in less than thirty minutes, p = 0.208.</div></div><div><h3>Conclusion</h3><div>Single doses of fentanyl or dexmedetomidine combined with propofol resulted in equivalent patient satisfaction, safety, and discharge times. The propofol-fentanyl combination demonstrated superior sedation adequacy from the surgeon’s perspective and facilitated a faster emergence from anesthesia.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844636"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060295","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: 2025-05-09DOI: 10.1016/j.bjane.2025.844637
Luis Henrique Cangiani , Rodrigo Leal Alves , Glenio B. Mizubuti , Rodrigo Moreira e Lima , Lais Helena Navarro e Lima
Background
Ultrasound (US) allows for rapid bedside airway assessment. We aimed to evaluate the US-measured cutaneous-epiglottic distance (CED) in predicting difficult laryngoscopy (Cormack-Lehane grades 3‒4). We also evaluated the potential association between CED, sex, patient’s body mass index (BMI), and the independent associations between CED and increased odds for Cormack-Lehane grades 3‒4 (secondary outcomes).
Methods
Patients aged 18‒70 years scheduled for elective surgeries under general anesthesia with tracheal intubation were included. Those with a BMI > 35 kg.m-2 and/or previous history of difficult intubation were excluded. CED was measured with patients anesthetized before tracheal intubation. Age, sex, BMI, type of surgery, and number of attempts until successful tracheal intubation were recorded. Receiver operator characteristic (ROC) curve analysis was performed to evaluate CED’s clinical relevance. Secondary analyses compared the association between CED and BMI in patients with Cormack-Lehane grades 1‒2 versus those with grades 3‒4. The relationship between CED and BMI was assessed using multiple linear regression. Binary logistic regression was employed for predicting Cormack-Lehane grades 3‒4 as a dichotomous outcome with CED and BMI as a covariate.
Results
ROC curve analysis revealed an area under the curve of 0.899 (p < 0.001). The maximum CED cut-off point (by Youden index) was 25.6 mm. CED and BMI were positively correlated, and both were independently associated with an increased odds for difficult laryngoscopy [odds ratio for CED = 1.81, 95% confidence interval (CI) 1.35‒2.41; BMI = 1.30, 95% CI 1.05‒1.59].
Conclusion
US-measured CED has a high discriminatory capability for predicting lower (1‒2) and higher (3‒4) Cormack-Lehane grades during direct laryngoscopy. CED was positively correlated with BMI and was independently associated with higher odds for difficult laryngoscopy.
{"title":"Ultrasound-measured cutaneous-epiglottic distance for predicting difficult laryngoscopy: an observational study","authors":"Luis Henrique Cangiani , Rodrigo Leal Alves , Glenio B. Mizubuti , Rodrigo Moreira e Lima , Lais Helena Navarro e Lima","doi":"10.1016/j.bjane.2025.844637","DOIUrl":"10.1016/j.bjane.2025.844637","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasound (US) allows for rapid bedside airway assessment. We aimed to evaluate the US-measured cutaneous-epiglottic distance (CED) in predicting difficult laryngoscopy (Cormack-Lehane grades 3‒4). We also evaluated the potential association between CED, sex, patient’s body mass index (BMI), and the independent associations between CED and increased odds for Cormack-Lehane grades 3‒4 (secondary outcomes).</div></div><div><h3>Methods</h3><div>Patients aged 18‒70 years scheduled for elective surgeries under general anesthesia with tracheal intubation were included. Those with a BMI > 35 kg.m<sup>-2</sup> and/or previous history of difficult intubation were excluded. CED was measured with patients anesthetized before tracheal intubation. Age, sex, BMI, type of surgery, and number of attempts until successful tracheal intubation were recorded. Receiver operator characteristic (ROC) curve analysis was performed to evaluate CED’s clinical relevance. Secondary analyses compared the association between CED and BMI in patients with Cormack-Lehane grades 1‒2 versus those with grades 3‒4. The relationship between CED and BMI was assessed using multiple linear regression. Binary logistic regression was employed for predicting Cormack-Lehane grades 3‒4 as a dichotomous outcome with CED and BMI as a covariate.</div></div><div><h3>Results</h3><div>ROC curve analysis revealed an area under the curve of 0.899 (p < 0.001). The maximum CED cut-off point (by Youden index) was 25.6 mm. CED and BMI were positively correlated, and both were independently associated with an increased odds for difficult laryngoscopy [odds ratio for CED = 1.81, 95% confidence interval (CI) 1.35‒2.41; BMI = 1.30, 95% CI 1.05‒1.59].</div></div><div><h3>Conclusion</h3><div>US-measured CED has a high discriminatory capability for predicting lower (1‒2) and higher (3‒4) Cormack-Lehane grades during direct laryngoscopy. CED was positively correlated with BMI and was independently associated with higher odds for difficult laryngoscopy.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844637"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059869","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 : 2025-05-01Epub Date: 2025-04-04DOI: 10.1016/j.bjane.2025.844618
Fabio Vieira Toledo, Daniel De Carli, Jose Fernando Amaral Meletti, Herman Yuri Almeida Togo, Italo Pires Gomes, Renato Makoto Sakashita, Lucas Felix Montes, Rafael Santos Tiburcio, Cesar de Araujo Miranda
Background
Blood transfusions are associated with increased morbidity and mortality, and maintaining global blood supplies can be a challenge. This systematic review investigates the impact of preoperative iron supplementation on the risk of blood transfusion among non-anemic patients undergoing major surgeries.
Methods
We conducted a systematic search of PubMed, Embase, and Cochrane Central for randomized controlled trials published up to May 2024. Studies involving the use of erythropoietin, or patients already using iron supplementation when trial randomization was conducted were excluded. Outcomes assessed included the number of individuals who received blood transfusions, and mean hemoglobin levels at the first day and by the first postoperative week.
Results
A total of 1,162 non-anemic patients from 9 studies were included. Of these, 54% received preoperative iron supplementation. The average age was 71 years, and 44% were women. Preoperative iron supplementation was associated with a significantly lower risk of receiving a blood transfusion (OR = 0.54; 95% CI 0.40 to 0.75; p < 0.001). At the first postoperative day, the iron supplementation group had significantly higher mean hemoglobin levels compared to the no-treatment group (MD = 0.22 g.dL-1; 95% CI 0.02 to 0.42; p = 0.03). However, the pooled results could not rule out the null hypothesis for the difference in mean hemoglobin levels throughout the first week (MD = 0.12 g.dL-1; 95% CI -0.12 to 0.35; p = 0.34).
Conclusion
Preoperative intravenous iron supplementation in non-anemic patients undergoing major surgeries, particularly cardiac procedures, significantly reduces transfusion requirements. However, the benefits of oral iron remain uncertain, and further research is warranted to establish standardized perioperative supplementation protocols.
PROSPERO identifier
CRD42024552559.
背景：输血与发病率和死亡率增加有关，维持全球血液供应可能是一项挑战。本系统综述调查术前补铁对大手术非贫血患者输血风险的影响。方法：我们对PubMed、Embase和Cochrane Central进行了系统检索，检索截至2024年5月发表的随机对照试验。包括使用促红细胞生成素的研究，或在试验随机化时已经使用铁补充剂的患者被排除在外。评估的结果包括接受输血的人数，以及第一天和术后第一周的平均血红蛋白水平。结果：9项研究共纳入1162名非贫血患者。其中54%的患者术前补铁。平均年龄为71岁，其中44%为女性。术前补铁与输血风险显著降低相关(OR = 0.54；95% CI 0.40 ~ 0.75；P < 0.001)。术后第一天，补铁组的平均血红蛋白水平明显高于未治疗组(MD = 0.22 g.dL-1；95% CI 0.02 ~ 0.42； = 0.03页)。然而，合并结果不能排除第一周平均血红蛋白水平差异的零假设(MD = 0.12 g.dL-1；95% CI -0.12 ~ 0.35； = 0.34页)。结论：在接受大手术，特别是心脏手术的非贫血患者术前静脉补铁可显著减少输血需求。然而，口服铁的益处仍然不确定，需要进一步的研究来建立标准化的围手术期补充方案。普洛斯彼罗标识符：CRD42024552559。
{"title":"Preoperative iron supplementation in non-anemic patients undergoing major surgery: a systematic review and meta-analysis","authors":"Fabio Vieira Toledo, Daniel De Carli, Jose Fernando Amaral Meletti, Herman Yuri Almeida Togo, Italo Pires Gomes, Renato Makoto Sakashita, Lucas Felix Montes, Rafael Santos Tiburcio, Cesar de Araujo Miranda","doi":"10.1016/j.bjane.2025.844618","DOIUrl":"10.1016/j.bjane.2025.844618","url":null,"abstract":"<div><h3>Background</h3><div>Blood transfusions are associated with increased morbidity and mortality, and maintaining global blood supplies can be a challenge. This systematic review investigates the impact of preoperative iron supplementation on the risk of blood transfusion among non-anemic patients undergoing major surgeries.</div></div><div><h3>Methods</h3><div>We conducted a systematic search of PubMed, Embase, and Cochrane Central for randomized controlled trials published up to May 2024. Studies involving the use of erythropoietin, or patients already using iron supplementation when trial randomization was conducted were excluded. Outcomes assessed included the number of individuals who received blood transfusions, and mean hemoglobin levels at the first day and by the first postoperative week.</div></div><div><h3>Results</h3><div>A total of 1,162 non-anemic patients from 9 studies were included. Of these, 54% received preoperative iron supplementation. The average age was 71 years, and 44% were women. Preoperative iron supplementation was associated with a significantly lower risk of receiving a blood transfusion (OR = 0.54; 95% CI 0.40 to 0.75; p < 0.001). At the first postoperative day, the iron supplementation group had significantly higher mean hemoglobin levels compared to the no-treatment group (MD = 0.22 g.dL<sup>-1</sup>; 95% CI 0.02 to 0.42; p = 0.03). However, the pooled results could not rule out the null hypothesis for the difference in mean hemoglobin levels throughout the first week (MD = 0.12 g.dL<sup>-1</sup>; 95% CI -0.12 to 0.35; p = 0.34).</div></div><div><h3>Conclusion</h3><div>Preoperative intravenous iron supplementation in non-anemic patients undergoing major surgeries, particularly cardiac procedures, significantly reduces transfusion requirements. However, the benefits of oral iron remain uncertain, and further research is warranted to establish standardized perioperative supplementation protocols.</div></div><div><h3>PROSPERO identifier</h3><div>CRD42024552559.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844618"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796376","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}
Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an effective intervention for restoring adequate circulatory perfusion after cardiac arrest. Ensuring high-quality Cardiopulmonary Resuscitation (CPR) before initiating Extracorporeal Membrane Oxygenation (ECMO) is critical to mitigate tissue hypoxia and ischemia. This study aimed to evaluate the effect of End-Tidal Carbon Dioxide (ETCO2) Goal-Directed CPR (GDCPR) on neurological function before ECMO using a retrospective case-control analysis.
Methods
The medical records of all patients who received ECPR treated at Zhongshan City People's Hospital were collected between January 2020 and March 2023. In this retrospective cohort study, the patients were divided into Conventional CPR (CCPR) and ETCO2-GDCPR groups based on whether ETCO2 was used as a guide for CPR.
Results
A total of 71 patients were included, of whom 46 comprised the CCPR group and 25 comprised the GDCPR group. Approximately 37% of patients who received ECPR had good cerebral function at discharge, with a higher rate in the GDCPR group (52%) compared with the CCPR group (28%) (p = 0.047). Multivariate analysis showed that the Highest Interleukin-6 (H-IL6) levels after ECMO (Odds Ratio [OR = 1.001], 95% Confidence Interval [95% CI 1.000–1.003], p = 0.005) was a risk factor for neurological function at discharge. The other risk factors for poor prognosis in patients who received ECPR included pre-ECMO CPR protocols (OR = 10.74, 95% CI 1.90–60.48, p = 0.007) and IL6 levels after ECMO (OR = 1.002, 95% CI 1.001–1.003, p = 0.005). ECMO duration (OR = 0.83, 95% CI 0.74–0.94, p = 0.002) was identified as a protective factor. Patients with short ECMO duration have a poor prognosis. The area under the curve for ECMO duration was 0.86 (0.77–0.94, p < 0.01), while that for H-IL6 was 0.19 (0.09–0.29, p < 0.01).
Conclusion
ETCO2-guided ECPR is associated with improved neurological prognosis and patient outcomes. Therefore, monitoring ETCO2 levels should be considered a crucial component of evaluating resuscitation efficacy during CPR.
背景：体外心肺复苏（ECPR）是心脏骤停后恢复充足循环灌注的有效干预措施。在启动体外膜氧合（ECMO）之前确保高质量的心肺复苏（CPR）对于减轻组织缺氧和缺血至关重要。本研究旨在通过回顾性病例对照分析，评估潮末二氧化碳（ETCO2）目标导向CPR （GDCPR）对ECMO前神经功能的影响。方法：收集2020年1月至2023年3月在中山市人民医院接受ECPR治疗的所有患者病历。在本回顾性队列研究中，根据是否使用ETCO2作为CPR指导，将患者分为常规CPR （Conventional CPR， CCPR）组和ETCO2- gdcpr组。结果：共纳入71例患者，其中CCPR组46例，GDCPR组25例。约37%接受ECPR的患者出院时脑功能良好，GDCPR组（52%）高于CCPR组（28%）（p = 0.047）。多因素分析显示，ECMO后最高的白细胞介素-6 （H-IL6）水平（优势比[OR = 1.001]，95%可信区间[95% CI 1.000-1.003], p = 0.005）是出院时神经功能的危险因素。接受ECPR患者预后不良的其他危险因素包括ECMO前CPR方案（OR=10.74, 95% CI 1.90-60.48, p = 0.007）和ECMO后il -6水平（OR = 1.002,95% CI 1.001-1.003, p = 0.005）。ECMO持续时间（OR = 0.83,95% CI 0.74-0.94, p = 0.002）被确定为保护因素。ECMO持续时间短的患者预后较差。ECMO持续时间曲线下面积为0.86 (0.77 ~ 0.94,p < 0.01)， H-IL6曲线下面积为0.19 （0.09 ~ 0.29,p < 0.01）。结论：etco2引导下的ECPR可改善神经系统预后和患者预后。因此，监测ETCO2水平应被视为评估心肺复苏术中复苏效果的重要组成部分。
{"title":"End-tidal carbon dioxide-guided extracorporeal cardiopulmonary resuscitation improves neurological prognosis in patients: a single-center retrospective cohort study","authors":"Xiaozu Liao, Chen Gu, Zhou Cheng, Kepeng Liu, Qing Yin, Binfei Li","doi":"10.1016/j.bjane.2025.844588","DOIUrl":"10.1016/j.bjane.2025.844588","url":null,"abstract":"<div><h3>Background</h3><div>Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an effective intervention for restoring adequate circulatory perfusion after cardiac arrest. Ensuring high-quality Cardiopulmonary Resuscitation (CPR) before initiating Extracorporeal Membrane Oxygenation (ECMO) is critical to mitigate tissue hypoxia and ischemia. This study aimed to evaluate the effect of End-Tidal Carbon Dioxide (ETCO<sub>2</sub>) Goal-Directed CPR (GDCPR) on neurological function before ECMO using a retrospective case-control analysis.</div></div><div><h3>Methods</h3><div>The medical records of all patients who received ECPR treated at Zhongshan City People's Hospital were collected between January 2020 and March 2023. In this retrospective cohort study, the patients were divided into Conventional CPR (CCPR) and ETCO<sub>2</sub>-GDCPR groups based on whether ETCO<sub>2</sub> was used as a guide for CPR.</div></div><div><h3>Results</h3><div>A total of 71 patients were included, of whom 46 comprised the CCPR group and 25 comprised the GDCPR group. Approximately 37% of patients who received ECPR had good cerebral function at discharge, with a higher rate in the GDCPR group (52%) compared with the CCPR group (28%) (p = 0.047). Multivariate analysis showed that the Highest Interleukin-6 (H-IL6) levels after ECMO (Odds Ratio [OR = 1.001], 95% Confidence Interval [95% CI 1.000–1.003], p = 0.005) was a risk factor for neurological function at discharge. The other risk factors for poor prognosis in patients who received ECPR included pre-ECMO CPR protocols (OR = 10.74, 95% CI 1.90–60.48, p = 0.007) and IL6 levels after ECMO (OR = 1.002, 95% CI 1.001–1.003, p = 0.005). ECMO duration (OR = 0.83, 95% CI 0.74–0.94, p = 0.002) was identified as a protective factor. Patients with short ECMO duration have a poor prognosis. The area under the curve for ECMO duration was 0.86 (0.77–0.94, p < 0.01), while that for H-IL6 was 0.19 (0.09–0.29, p < 0.01).</div></div><div><h3>Conclusion</h3><div>ETCO<sub>2</sub>-guided ECPR is associated with improved neurological prognosis and patient outcomes. Therefore, monitoring ETCO<sub>2</sub> levels should be considered a crucial component of evaluating resuscitation efficacy during CPR.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844588"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-04-04DOI: 10.1016/j.bjane.2025.844619
Suzana Margareth Lobo , Pedro Saggioro Paulucci , Lucas Martins Tavares , Graziela Benardin Luckemeyer , Luana Fernandes Machado , Neymar Elias de Oliveira , Silvia Prado Minhoto , Rita Cassia Alves Silva , Renato Ferreira da Silva , Marlon Souza Freitas , Francisco Ricardo Marques Lobo , Joana Berger-Estilita
Introduction
This study evaluates the impact of Fluid Balance (FB) patterns on outcomes after Orthotopic Liver Transplantation (OLT). It hypothesizes that deviations from optimal FB increase morbidity.
Methods
In a single-center cohort post hoc analysis of 73 post-OLT patients, FB was categorized into three groups based on cumulative FB at 72 hours: Lowest (negative FB), Intermediate (0-2000 mL), and Highest (> 2000 mL). We analyzed Sequential Organ Failure Assessment (SOFA) scores, mortality rates, and causes of death. Logistic regression identified mortality predictors.
Results
The Highest FB group had the highest SOFA scores and mortality (Group “Lo”: 18.2%, Group “In”: 8.6%, Group “Hi”: 40.5%, p = 0.009). A U-shaped relationship between FB and hospital mortality was observed, with extremes of FB associated with higher mortality. Cumulative FB independently predicted all-cause mortality with a 29.5% increase in the risk of death. FB on day 3 also predicted all-cause mortality, increasing the risk by 83.9%. Furthermore, FB on day 1 was linked to a 134.5% increase in the risk of death due to primary non-function of the liver. SOFALIVER score strongly predicted all-cause mortality, with a one-point increase associated with a 98.8% to 114.7% increase in mortality risk.
Discussion
These findings suggest that both negative and positive extremes of FB are associated with worse outcomes after OLT, reinforcing the U-shaped relationship between FB and mortality. Our results underscore the importance of balanced fluid management, particularly in the early postoperative period. The study highlights the need for individualized FB strategies to optimize organ function and reduce mortality. The use of SOFALIVER scores as a predictor of mortality further emphasizes the importance of liver function monitoring in post-OLT patients. However, the single-centre design and convenience sample limit the generalizability of our findings, necessitating validation through multicenter studies.
Conclusion
Our study provides valuable insights into the relationship between FB patterns and mortality in OLT patients. Both negative and positive extremes of FB are associated with higher mortality, suggesting the need for a balanced and individualized fluid management approach. The strong predictive value of SOFALIVER scores for all-cause mortality highlights the importance of early and continuous monitoring of liver function. Future multicenter randomized controlled trials are needed to validate these findings and develop optimized fluid management protocols for OLT patients.
{"title":"Fluid balance dynamics and early postoperative outcomes in orthotopic liver transplantation: a prospective cohort study","authors":"Suzana Margareth Lobo , Pedro Saggioro Paulucci , Lucas Martins Tavares , Graziela Benardin Luckemeyer , Luana Fernandes Machado , Neymar Elias de Oliveira , Silvia Prado Minhoto , Rita Cassia Alves Silva , Renato Ferreira da Silva , Marlon Souza Freitas , Francisco Ricardo Marques Lobo , Joana Berger-Estilita","doi":"10.1016/j.bjane.2025.844619","DOIUrl":"10.1016/j.bjane.2025.844619","url":null,"abstract":"<div><h3>Introduction</h3><div>This study evaluates the impact of Fluid Balance (FB) patterns on outcomes after Orthotopic Liver Transplantation (OLT). It hypothesizes that deviations from optimal FB increase morbidity.</div></div><div><h3>Methods</h3><div>In a single-center cohort post hoc analysis of 73 post-OLT patients, FB was categorized into three groups based on cumulative FB at 72 hours: Lowest (negative FB), Intermediate (0-2000 mL), and Highest (> 2000 mL). We analyzed Sequential Organ Failure Assessment (SOFA) scores, mortality rates, and causes of death. Logistic regression identified mortality predictors.</div></div><div><h3>Results</h3><div>The Highest FB group had the highest SOFA scores and mortality (Group “Lo”: 18.2%, Group “In”: 8.6%, Group “Hi”: 40.5%, p = 0.009). A U-shaped relationship between FB and hospital mortality was observed, with extremes of FB associated with higher mortality. Cumulative FB independently predicted all-cause mortality with a 29.5% increase in the risk of death. FB on day 3 also predicted all-cause mortality, increasing the risk by 83.9%. Furthermore, FB on day 1 was linked to a 134.5% increase in the risk of death due to primary non-function of the liver. SOFA<sub>LIVER</sub> score strongly predicted all-cause mortality, with a one-point increase associated with a 98.8% to 114.7% increase in mortality risk.</div></div><div><h3>Discussion</h3><div>These findings suggest that both negative and positive extremes of FB are associated with worse outcomes after OLT, reinforcing the U-shaped relationship between FB and mortality. Our results underscore the importance of balanced fluid management, particularly in the early postoperative period. The study highlights the need for individualized FB strategies to optimize organ function and reduce mortality. The use of SOFA<sub>LIVER</sub> scores as a predictor of mortality further emphasizes the importance of liver function monitoring in post-OLT patients. However, the single-centre design and convenience sample limit the generalizability of our findings, necessitating validation through multicenter studies.</div></div><div><h3>Conclusion</h3><div>Our study provides valuable insights into the relationship between FB patterns and mortality in OLT patients. Both negative and positive extremes of FB are associated with higher mortality, suggesting the need for a balanced and individualized fluid management approach. The strong predictive value of SOFA<sub>LIVER</sub> scores for all-cause mortality highlights the importance of early and continuous monitoring of liver function. Future multicenter randomized controlled trials are needed to validate these findings and develop optimized fluid management protocols for OLT patients.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844619"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796369","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 : 2025-05-01Epub Date: 2025-03-28DOI: 10.1016/j.bjane.2025.844617
Cheng Lin , Ana Larissa Guerrero , Joshua Jesin , Rohin Tangri , Nasong Anthony Luginaah , Kamal Kumar , Christopher Hansebout
Introduction
Results from Randomized Controlled Trials (RCTs) on mixed Local Anesthetics (LA) are conflicting. We conducted a systematic review and meta-analysis on whether using mixed LA leads to faster onset of surgical block.
Method
We conducted systemic review and meta-analysis of RCTs. Medline and Embase without language restriction from inception to June 15, 2024, were searched. Included RCTs had to compare mixed LA to long-acting LA in adult surgical patients for onset or duration of nerve blocks. Onset time to surgical block was the primary outcome. The Cochrane Risk of Bias Tool with GRADE methodology was utilized to assess evidence quality.
Results
Nineteen trials including 1060 participants met the inclusion criteria. Mixed LA modestly reduced time to surgical block (-8.4 minutes; 95% CI -12.0 to -4.8 minutes; p = 0.0001; I2 = 0.99), sensory block duration (-226.2 minutes; 95% CI -352.2 to -100.1 minutes; p = 0.002; I2 = 0.98) and motor block duration (-259.2 minutes; 95% CI -399.5 to -119.0 minutes; p = 0.003; I2 = 0.98) but not time to analgesic request duration (-130.5 minutes; 95% CI -265.9 to 4.9 minutes; p = 0.057; I2 = 0.98). GRADE scoring ranged from low to very low.
Conclusion
The existing evidence showed mixed LA led to a modest reduction in surgical block latency but also shortened block duration. Future studies should evaluate the role of mixed LA in lower limb blocks and optimal dosing of long-acting LA to balance onset latency and analgesic duration.
PROSPERO registration
CRD42024552801.
简介：混合局麻药（LA）的随机对照试验（RCTs）结果是相互矛盾的。我们进行了一项系统回顾和荟萃分析，研究使用混合物是否会导致手术阻滞更快发生。方法：对随机对照试验进行系统评价和荟萃分析。检索了从成立到2024年6月15日没有语言限制的Medline和Embase。纳入的随机对照试验必须比较混合LA和长效LA在成年外科患者神经阻滞的发作或持续时间。到手术阻滞的发病时间是主要观察指标。采用Cochrane偏倚风险工具和GRADE方法评估证据质量。结果：19项试验1060名受试者符合纳入标准。混合LA适度缩短了手术阻滞时间(-8.4分钟；95% CI -12.0 ~ -4.8分钟；p = 0.0001;I2 = 0.99)，感觉阻滞时间(-226.2分钟；95% CI -352.2 ~ -100.1分钟；p = 0.002;I2 = 0.98)和运动阻滞持续时间(-259.2分钟；95% CI -399.5 ~ -119.0分钟；p = 0.003;I2 = 0.98)，但没有时间到镇痛要求持续时间(-130.5分钟；95% CI -265.9 ~ 4.9分钟；p = 0.057;I2 = 0.98)。GRADE评分范围从低到非常低。结论：现有证据表明混合LA可适度减少手术阻滞潜伏期，但也缩短阻滞持续时间。未来的研究应评估混合LA在下肢阻滞中的作用，以及长效LA的最佳剂量，以平衡发病潜伏期和镇痛持续时间。普洛斯彼罗注册：CRD42024552801。
{"title":"Comparing block characteristics of mixtures of short/intermediate- and long-acting local anesthetics for peripheral nerve block: a systematic review and meta-analysis","authors":"Cheng Lin , Ana Larissa Guerrero , Joshua Jesin , Rohin Tangri , Nasong Anthony Luginaah , Kamal Kumar , Christopher Hansebout","doi":"10.1016/j.bjane.2025.844617","DOIUrl":"10.1016/j.bjane.2025.844617","url":null,"abstract":"<div><h3>Introduction</h3><div>Results from Randomized Controlled Trials (RCTs) on mixed Local Anesthetics (LA) are conflicting. We conducted a systematic review and meta-analysis on whether using mixed LA leads to faster onset of surgical block.</div></div><div><h3>Method</h3><div>We conducted systemic review and meta-analysis of RCTs. Medline and Embase without language restriction from inception to June 15, 2024, were searched. Included RCTs had to compare mixed LA to long-acting LA in adult surgical patients for onset or duration of nerve blocks. Onset time to surgical block was the primary outcome. The Cochrane Risk of Bias Tool with GRADE methodology was utilized to assess evidence quality.</div></div><div><h3>Results</h3><div>Nineteen trials including 1060 participants met the inclusion criteria. Mixed LA modestly reduced time to surgical block (-8.4 minutes; 95% CI -12.0 to -4.8 minutes; p = 0.0001; I<sup>2</sup> = 0.99), sensory block duration (-226.2 minutes; 95% CI -352.2 to -100.1 minutes; p = 0.002; I<sup>2</sup> = 0.98) and motor block duration (-259.2 minutes; 95% CI -399.5 to -119.0 minutes; p = 0.003; I<sup>2</sup> = 0.98) but not time to analgesic request duration (-130.5 minutes; 95% CI -265.9 to 4.9 minutes; p = 0.057; I<sup>2</sup> = 0.98). GRADE scoring ranged from low to very low.</div></div><div><h3>Conclusion</h3><div>The existing evidence showed mixed LA led to a modest reduction in surgical block latency but also shortened block duration. Future studies should evaluate the role of mixed LA in lower limb blocks and optimal dosing of long-acting LA to balance onset latency and analgesic duration.</div></div><div><h3>PROSPERO registration</h3><div>CRD42024552801.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844617"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755653","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 : 2025-05-01Epub Date: 2025-04-01DOI: 10.1016/j.bjane.2025.844621
Andre P. Schmidt , Eduarda S. Martinelli , Virgínia C. de Moura , Liana M.T.A. Azi
{"title":"Hemodynamic management in liver transplantation: toward an evidence-based perioperative strategy","authors":"Andre P. Schmidt , Eduarda S. Martinelli , Virgínia C. de Moura , Liana M.T.A. Azi","doi":"10.1016/j.bjane.2025.844621","DOIUrl":"10.1016/j.bjane.2025.844621","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844621"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-01-26DOI: 10.1016/j.bjane.2025.844595
Simone Chaves Fagondes , Carmem Lúcia Oliveira da Silva , Anneliese Hoffmann , Rita de Cássia Guedes de Azevedo Barbosa , Daiane Falkembach , Ângela Beatriz John
Growing evidence of the benefits of home ventilatory support in patients with chronic respiratory failure along with technological advances in ventilators have enabled their use in overly complex situations, shaping a new scenario for physicians. This has further given rise to new challenges related to their incorporation into current medical practice. However, this evolution needs to be coupled with knowledge and skills of physicians who are willing to prescribe Home Mechanical Ventilation (HMV), in order to prevent them from making inappropriate choices or adjustments that may ultimately have ethical and legal implications. This article aims to provide guidance and information to support the indication for HMV and the ventilation modalities to be implemented, review basic ventilation concepts, including the ventilator modes most commonly used in patients outside the hospital setting, list the brands and models available in the Brazilian market, provide the means for obtaining equipment for HMV, and finally, describe the requirements for selection of equipment, taking into account the individual characteristics of the patient to ensure safe perioperative care and earlier dehospitalization.
{"title":"Home mechanical ventilation: a narrative review and a proposal of practical approach","authors":"Simone Chaves Fagondes , Carmem Lúcia Oliveira da Silva , Anneliese Hoffmann , Rita de Cássia Guedes de Azevedo Barbosa , Daiane Falkembach , Ângela Beatriz John","doi":"10.1016/j.bjane.2025.844595","DOIUrl":"10.1016/j.bjane.2025.844595","url":null,"abstract":"<div><div>Growing evidence of the benefits of home ventilatory support in patients with chronic respiratory failure along with technological advances in ventilators have enabled their use in overly complex situations, shaping a new scenario for physicians. This has further given rise to new challenges related to their incorporation into current medical practice. However, this evolution needs to be coupled with knowledge and skills of physicians who are willing to prescribe Home Mechanical Ventilation (HMV), in order to prevent them from making inappropriate choices or adjustments that may ultimately have ethical and legal implications. This article aims to provide guidance and information to support the indication for HMV and the ventilation modalities to be implemented, review basic ventilation concepts, including the ventilator modes most commonly used in patients outside the hospital setting, list the brands and models available in the Brazilian market, provide the means for obtaining equipment for HMV, and finally, describe the requirements for selection of equipment, taking into account the individual characteristics of the patient to ensure safe perioperative care and earlier dehospitalization.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844595"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-03-03DOI: 10.1016/j.bjane.2025.844605
Luigi Vetrugno
{"title":"Pulmonary arterial catheter vs. prediction index software in patients undergoing orthotopic liver transplantation: “We cannot lump together everything”","authors":"Luigi Vetrugno","doi":"10.1016/j.bjane.2025.844605","DOIUrl":"10.1016/j.bjane.2025.844605","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844605"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-01Epub Date: 2025-03-29DOI: 10.1016/j.bjane.2025.844616
Gustavo R.M. Wegner , Bruno F.M. Wegner , Ramon Huntermann , Manoela L. Pinto , Júlia A.P. Vieira , Amanda P. de Souza , Francisco J.L. Bezerra
Background
Recent randomized clinical trials have compared the perioperative use of Intravenous (IV) lidocaine and Thoracic Epidural Analgesia (TEA) for postoperative analgesia in patients undergoing abdominal surgery.
Methods
A systematic search was conducted on Embase, Web of Science (all databases), Cochrane Library, and PubMed on March 25, 2024, adhering to the Cochrane Handbook and PRISMA guidelines.
Results
Out of 1261 screened studies, 6 were included. TEA provided superior pain relief on a 0 to 10 pain scale at rest compared to IV lidocaine at 2 (n = 335, MD = -0.72, 95% CI -0.19 to -1.25, p = 0.007423, I2 = 83%) and 24 hours postoperatively (n = 402; MD = -0.18, 95% CI -0.12 to -0.23; p < 0.000001, I2 = 18%). However, no statistically significant differences were observed on pain scores at rest at 48 and 72 hours. TEA provided superior pain relief on a 0 to 10 pain scale during coughing at 24 hours postoperatively (n = 360; MD = -0.36, 95% CI -0.19 to -0.52, p = 0.000019, I2 = 2%), but no statistically significant differences were observed in pain scores on coughing at 48 and 72 hours. There were no statistically significant differences in postoperative nausea and vomiting, time to first flatus, or length of hospital stay.
Conclusions
TEA provides more effective postoperative pain relief compared to IV lidocaine during the first postoperative day, as evidenced by analyses of pain both at rest and during coughing.
{"title":"Comparative efficacy of perioperative lidocaine infusion versus thoracic epidural analgesia for pain management in abdominal surgery: systematic review and meta-analysis","authors":"Gustavo R.M. Wegner , Bruno F.M. Wegner , Ramon Huntermann , Manoela L. Pinto , Júlia A.P. Vieira , Amanda P. de Souza , Francisco J.L. Bezerra","doi":"10.1016/j.bjane.2025.844616","DOIUrl":"10.1016/j.bjane.2025.844616","url":null,"abstract":"<div><h3>Background</h3><div>Recent randomized clinical trials have compared the perioperative use of Intravenous (IV) lidocaine and Thoracic Epidural Analgesia (TEA) for postoperative analgesia in patients undergoing abdominal surgery.</div></div><div><h3>Methods</h3><div>A systematic search was conducted on Embase, Web of Science (all databases), Cochrane Library, and PubMed on March 25, 2024, adhering to the Cochrane Handbook and PRISMA guidelines.</div></div><div><h3>Results</h3><div>Out of 1261 screened studies, 6 were included. TEA provided superior pain relief on a 0 to 10 pain scale at rest compared to IV lidocaine at 2 (n = 335, MD = -0.72, 95% CI -0.19 to -1.25, p = 0.007423, I<sup>2</sup> = 83%) and 24 hours postoperatively (n = 402; MD = -0.18, 95% CI -0.12 to -0.23; p < 0.000001, I<sup>2</sup> = 18%). However, no statistically significant differences were observed on pain scores at rest at 48 and 72 hours. TEA provided superior pain relief on a 0 to 10 pain scale during coughing at 24 hours postoperatively (n = 360; MD = -0.36, 95% CI -0.19 to -0.52, p = 0.000019, I<sup>2</sup> = 2%), but no statistically significant differences were observed in pain scores on coughing at 48 and 72 hours. There were no statistically significant differences in postoperative nausea and vomiting, time to first flatus, or length of hospital stay.</div></div><div><h3>Conclusions</h3><div>TEA provides more effective postoperative pain relief compared to IV lidocaine during the first postoperative day, as evidenced by analyses of pain both at rest and during coughing.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844616"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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