Pub Date : 2025-11-21DOI: 10.1016/j.accpm.2025.101706
Pierre Pardessus, Charlotte Benoit, Kelly Brouns, Bardara Cadre, Beatrice Bruneau, Rachida Abdat, Yara Maroun, Roksic Stefan, Maxime Deliere, Thierry Van Den Abbeele, Natacha Teissier, Souhayl Dahmani, Florence Julien-Marsollier
Background: Despite the available evidence for the use of non-steroidal anti-inflammatory drugs (NSAIDs) as the preferred therapeutic option for managing postoperative pain after tonsillectomy in children, many physicians still use postoperative corticosteroids as a therapeutic option in place of NSAIDS. The aim of the current meta-analysis was to explore the analgesic efficacy of oral prednisolone after tonsillectomy in children.
Methods: The study consisted of a quantitative review of randomised controlled studies performed during paediatric tonsillectomy that examined the effect of postoperative prednisolone given during several postoperative days in comparison to placebo, on postoperative pain intensity and nausea, and vomiting. Quality of evidence was assessed using GRADE recommendations.
Results: Oral prednisolone did not reduce pain intensity at postoperative day 1 (MD = -0.38 [-0.99, 0.33], I² = 84 %, p of I² < 0.002), postoperative day 3 (MD = -1.02 [-2.78, 0.75], I² = 97 %, p of I² < 0.0001) and between the postoperative days 5 and 7 (MD = -0.15 [-0.35, 0.04], I² = 84 %, p of I² < 0.001). Oral prednisolone did not reduce postoperative nausea and vomiting. The quality of evidence according to GRADE recommendations ranged from low to very low.
Discussion: The current meta-analysis indicates that the administration of oral prednisolone postoperatively does not decrease postoperative pain in paediatric patients following tonsillectomy. In conclusion, the paucity of studies, the high heterogeneity of results, and the low grade of evidence mandatory to perform further studies to confirm the results of the current review.
{"title":"Oral Prednisolone for Postoperative Analgesia Management in Paediatrics Tonsillectomy: A Meta-Analysis of Published Studies.","authors":"Pierre Pardessus, Charlotte Benoit, Kelly Brouns, Bardara Cadre, Beatrice Bruneau, Rachida Abdat, Yara Maroun, Roksic Stefan, Maxime Deliere, Thierry Van Den Abbeele, Natacha Teissier, Souhayl Dahmani, Florence Julien-Marsollier","doi":"10.1016/j.accpm.2025.101706","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101706","url":null,"abstract":"<p><strong>Background: </strong>Despite the available evidence for the use of non-steroidal anti-inflammatory drugs (NSAIDs) as the preferred therapeutic option for managing postoperative pain after tonsillectomy in children, many physicians still use postoperative corticosteroids as a therapeutic option in place of NSAIDS. The aim of the current meta-analysis was to explore the analgesic efficacy of oral prednisolone after tonsillectomy in children.</p><p><strong>Methods: </strong>The study consisted of a quantitative review of randomised controlled studies performed during paediatric tonsillectomy that examined the effect of postoperative prednisolone given during several postoperative days in comparison to placebo, on postoperative pain intensity and nausea, and vomiting. Quality of evidence was assessed using GRADE recommendations.</p><p><strong>Results: </strong>Oral prednisolone did not reduce pain intensity at postoperative day 1 (MD = -0.38 [-0.99, 0.33], I² = 84 %, p of I² < 0.002), postoperative day 3 (MD = -1.02 [-2.78, 0.75], I² = 97 %, p of I² < 0.0001) and between the postoperative days 5 and 7 (MD = -0.15 [-0.35, 0.04], I² = 84 %, p of I² < 0.001). Oral prednisolone did not reduce postoperative nausea and vomiting. The quality of evidence according to GRADE recommendations ranged from low to very low.</p><p><strong>Discussion: </strong>The current meta-analysis indicates that the administration of oral prednisolone postoperatively does not decrease postoperative pain in paediatric patients following tonsillectomy. In conclusion, the paucity of studies, the high heterogeneity of results, and the low grade of evidence mandatory to perform further studies to confirm the results of the current review.</p><p><strong>Registration: </strong>PROSPERO database (CRD420251088747).</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101706"},"PeriodicalIF":4.7,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1016/j.accpm.2025.101703
Ji Hyeon Lee , Jin-Hee Kim , Jiyoun Lee , Sung-Hee Han , Jin-Woo Park
Background
Benzodiazepines facilitate mask ventilation due to their airway relaxant properties. Remimazolam, an ultra-short-acting benzodiazepine, may offer advantages during anaesthesia induction. This study evaluated the difficulty of mask ventilation between remimazolam and propofol during the induction of general anaesthesia.
Methods
Seventy-six adult patients scheduled for elective surgery under general anaesthesia were randomised into propofol and remimazolam groups. In the propofol group, general anaesthesia was induced with target-controlled infusion of propofol at an effect-site concentration of 4 µg/mL. In the remimazolam group, continuous infusion of remimazolam was performed at 12 mg/kg/h. The primary outcome was mask ventilation difficulty assessed by the Warters scale. Secondary outcomes included time to achieve loss of consciousness (LOC) and mean blood pressure during induction.
Results
The remimazolam group exhibited significantly lower Warters score compared to the propofol group (0.0 [0.0–0.8] vs. 1.0 [0.0–3.0], P = 0.002). The occurrence of mask ventilation difficulties requiring more than one airway device during anaesthetic induction was also significantly lower in the remimazolam group than in the propofol group (odds ratio [95% confidence interval], 0.23 [0.08–0.68]; P = 0.006). Mean blood pressure immediately after LOC was higher in the remimazolam group (P = 0.037), although the incidence of hypotension after induction was comparable between groups. The time required to achieve LOC was longer in the remimazolam group (P < 0.001).
Conclusion
Compared to propofol, remimazolam induction was associated with easier mask ventilation and more stable blood pressure after LOC, despite a longer time to achieve LOC.
Registration
University Hospital Medical Information Network Clinical Trials Registry (registration number: UMIN000053553; registration date: 7 February 2024; registration URL: https://center6.umin.ac.jp/cgi-bin/ctr_e/ctr_view_reg.cgi?recptno=R000061086)
{"title":"Comparison of effects of remimazolam and propofol on mask ventilation during general anaesthesia induction: A randomised controlled trial","authors":"Ji Hyeon Lee , Jin-Hee Kim , Jiyoun Lee , Sung-Hee Han , Jin-Woo Park","doi":"10.1016/j.accpm.2025.101703","DOIUrl":"10.1016/j.accpm.2025.101703","url":null,"abstract":"<div><h3>Background</h3><div>Benzodiazepines facilitate mask ventilation due to their airway relaxant properties. Remimazolam, an ultra-short-acting benzodiazepine, may offer advantages during anaesthesia induction. This study evaluated the difficulty of mask ventilation between remimazolam and propofol during the induction of general anaesthesia.</div></div><div><h3>Methods</h3><div>Seventy-six adult patients scheduled for elective surgery under general anaesthesia were randomised into propofol and remimazolam groups. In the propofol group, general anaesthesia was induced with target-controlled infusion of propofol at an effect-site concentration of 4 µg/mL. In the remimazolam group, continuous infusion of remimazolam was performed at 12 mg/kg/h. The primary outcome was mask ventilation difficulty assessed by the Warters scale. Secondary outcomes included time to achieve loss of consciousness (LOC) and mean blood pressure during induction.</div></div><div><h3>Results</h3><div>The remimazolam group exhibited significantly lower Warters score compared to the propofol group (0.0 [0.0–0.8] <em>vs.</em> 1.0 [0.0–3.0], <em>P</em> = 0.002). The occurrence of mask ventilation difficulties requiring more than one airway device during anaesthetic induction was also significantly lower in the remimazolam group than in the propofol group (odds ratio [95% confidence interval], 0.23 [0.08–0.68]; <em>P</em> = 0.006). Mean blood pressure immediately after LOC was higher in the remimazolam group (<em>P</em> = 0.037), although the incidence of hypotension after induction was comparable between groups. The time required to achieve LOC was longer in the remimazolam group (<em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Compared to propofol, remimazolam induction was associated with easier mask ventilation and more stable blood pressure after LOC, despite a longer time to achieve LOC.</div></div><div><h3>Registration</h3><div>University Hospital Medical Information Network Clinical Trials Registry (registration number: UMIN000053553; registration date: 7 February 2024; registration URL: <span><span>https://center6.umin.ac.jp/cgi-bin/ctr_e/ctr_view_reg.cgi?recptno=R000061086</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101703"},"PeriodicalIF":4.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1016/j.accpm.2025.101704
Mickael Vourc'h, Elodie Boissier, Karim Lakhal, Sandrine Grosjean, François Labaste, Emmanuel Robin, Adrien Bougle, Mathieu Mattei, Jérôme Morel, Véronique Wurtz, Paul-Michel Mertes, Diane Zlotnik, David Lagier, Antoine Beurton, Emmanuel Rineau, Marc-Olivier Fischer, Marc-Antoine May, Anne Médard, Guillaume Guimbretiere, Isabelle Durand-Zaleski, Morgane Pere, Bertrand Rozec, Jean-Christophe Rigal
Background: The IMOTEC study aims to determine whether a point-of-care viscoelastic hemostatic assay (VHA)-guided algorithm is cost-effective for the management of ongoing bleeding.
Methods: Stepped wedge cluster randomized trial, patient blinded, conducted at 16 French academic cardiac surgery centers from 01/2017 to 02/2020. Adults undergoing elective or urgent cardiac surgery with ongoing bleeding were enrolled during 2 successive inclusion periods: 1) transfusion guided on standard hemostasis tests (control period), and 2) transfusion using a VHA-guided algorithm. The primary objective was to estimate the efficiency of VHA based on the 1-year incremental cost-utility ratio (ICUR, primary outcome). Secondary outcomes included transfusion, postoperative complications, duration of stay in-hospital, reintervention, and mortality.
Results: 1095 patients were randomized, and 1044 (95.3%) were analyzed. The mean utility was 0.60 (±0.30) in the VHA vs. 0.61 (±0.30) in the control period, adjusted difference, -0.01 [95% CI, -0.09 to 0.07]. The ICUR did not suggest that the VHA-guided algorithm was cost-effective. One-year mortality was 12.0% for VHA and 10.9% for control, Hazard Ratio, 1.69 [95% CI, 0.98 to 2.89], P = .06. The frequency of plasma and platelet transfusions was significantly lower in the VHA compared to the control period (respectively, 48.8% vs. 72.4%, P < 0.0001 and 52.3% vs. 74.1%, P = .0002), whereas fibrinogen administration was more frequent in the VHA period (58.4% vs. 47.0 %, P = .002). The median in-hospital length of stay was significantly shorter in the VHA vs. control period: 11.0 days (8.0 to 18.0) vs. 14.0 (9.0 to 22.0), P = .02.
Conclusions: The ICUR did not suggest that VHA was cost-effective in cardiac surgery patients with ongoing bleeding, compared with standard tests.
Trial registration: Clinical trial submission: November 2, 2016 Registry name: Cost-Utility Analysis of Management of Peri Operative Hemorrhage Following Cardiac Surgery With Cardiopulmonary Bypass (IMOTEC) ClinicalTrials.gov Identifier: NCT02972684 URL registry: https://clinicaltrials.gov/study/NCT02972684.
{"title":"Cost-utility of point-of-care viscoelastic hemostatic assays in the management of bleeding during cardiac surgery: a single-blinded prospective multicenter stepped wedge cluster randomized trial in French context.","authors":"Mickael Vourc'h, Elodie Boissier, Karim Lakhal, Sandrine Grosjean, François Labaste, Emmanuel Robin, Adrien Bougle, Mathieu Mattei, Jérôme Morel, Véronique Wurtz, Paul-Michel Mertes, Diane Zlotnik, David Lagier, Antoine Beurton, Emmanuel Rineau, Marc-Olivier Fischer, Marc-Antoine May, Anne Médard, Guillaume Guimbretiere, Isabelle Durand-Zaleski, Morgane Pere, Bertrand Rozec, Jean-Christophe Rigal","doi":"10.1016/j.accpm.2025.101704","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101704","url":null,"abstract":"<p><strong>Background: </strong>The IMOTEC study aims to determine whether a point-of-care viscoelastic hemostatic assay (VHA)-guided algorithm is cost-effective for the management of ongoing bleeding.</p><p><strong>Methods: </strong>Stepped wedge cluster randomized trial, patient blinded, conducted at 16 French academic cardiac surgery centers from 01/2017 to 02/2020. Adults undergoing elective or urgent cardiac surgery with ongoing bleeding were enrolled during 2 successive inclusion periods: 1) transfusion guided on standard hemostasis tests (control period), and 2) transfusion using a VHA-guided algorithm. The primary objective was to estimate the efficiency of VHA based on the 1-year incremental cost-utility ratio (ICUR, primary outcome). Secondary outcomes included transfusion, postoperative complications, duration of stay in-hospital, reintervention, and mortality.</p><p><strong>Results: </strong>1095 patients were randomized, and 1044 (95.3%) were analyzed. The mean utility was 0.60 (±0.30) in the VHA vs. 0.61 (±0.30) in the control period, adjusted difference, -0.01 [95% CI, -0.09 to 0.07]. The ICUR did not suggest that the VHA-guided algorithm was cost-effective. One-year mortality was 12.0% for VHA and 10.9% for control, Hazard Ratio, 1.69 [95% CI, 0.98 to 2.89], P = .06. The frequency of plasma and platelet transfusions was significantly lower in the VHA compared to the control period (respectively, 48.8% vs. 72.4%, P < 0.0001 and 52.3% vs. 74.1%, P = .0002), whereas fibrinogen administration was more frequent in the VHA period (58.4% vs. 47.0 %, P = .002). The median in-hospital length of stay was significantly shorter in the VHA vs. control period: 11.0 days (8.0 to 18.0) vs. 14.0 (9.0 to 22.0), P = .02.</p><p><strong>Conclusions: </strong>The ICUR did not suggest that VHA was cost-effective in cardiac surgery patients with ongoing bleeding, compared with standard tests.</p><p><strong>Trial registration: </strong>Clinical trial submission: November 2, 2016 Registry name: Cost-Utility Analysis of Management of Peri Operative Hemorrhage Following Cardiac Surgery With Cardiopulmonary Bypass (IMOTEC) ClinicalTrials.gov Identifier: NCT02972684 URL registry: https://clinicaltrials.gov/study/NCT02972684.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101704"},"PeriodicalIF":4.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1016/j.accpm.2025.101700
Bernd Saugel
{"title":"Editorial on the guidelines for perioperative hemodynamic optimization in adults of the French Society for Anaesthesia and Intensive Care","authors":"Bernd Saugel","doi":"10.1016/j.accpm.2025.101700","DOIUrl":"10.1016/j.accpm.2025.101700","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 1","pages":"Article 101700"},"PeriodicalIF":4.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1016/j.accpm.2025.101702
Ruth Landau
{"title":"Hemodynamic optimization for cesarean delivery under spinal anesthesia: four recommendations to improve maternal and neonatal outcomes","authors":"Ruth Landau","doi":"10.1016/j.accpm.2025.101702","DOIUrl":"10.1016/j.accpm.2025.101702","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 1","pages":"Article 101702"},"PeriodicalIF":4.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1016/j.accpm.2025.101705
Sigismond Lasocki , Jérémie Théreaux , Marie Dalichampt , Mohammed Bennani , Cécile Hauville , Olivia Dialla , Eric Garrigue , Alexandre Theissen
Background
Correction of preoperative iron deficiency (with or without anemia) is widely recommended but data on oral iron therapy in this setting are limited. This study evaluated the impact of preoperative oral iron supplementation on postoperative morbidity and mortality in patients undergoing major surgery.
Methods
Using retrospective data from the French Système National des Données de Santé (SNDS) database, this study included patients who underwent major surgeries (orthopedic, onco-digestive, cardiac, onco-urologic, onco-gynecologic) between January 2017 and September 2019. Postoperative morbidity (re-hospitalization, venous thromboembolism, renal insufficiency, infection, stroke/myocardial infarction, intensive care unit admission) or mortality until postoperative day 90 (POD90) was assessed in patients who received oral iron in the 8 weeks before surgery versus those with no iron supplementation. The probability of postoperative morbidity or mortality was estimated by adjusted logistic regression.
Results
In total, 947,468 patients underwent 975,852 surgeries, of whom only 69,377 (7.1%) had received oral iron preoperatively. The incidence of postoperative morbidity or mortality was lower in the “oral iron” versus “no iron” group (20.2% vs. 21.6%; p < 0.001). In the adjusted logistic regression analysis, oral iron was associated with a lower probability of POD90 morbidity or mortality (odds ratio [OR] 0.95; 95% confidence interval [CI] [0.93, 0.97]; p < 0.001) and POD90 mortality (OR 0.85; 95% CI [0.79, 0.92]; p < 0.001) versus no iron.
Conclusion
In this large, real-world cohort study of patients undergoing major surgery, preoperative oral iron was associated with a lower probability of postoperative morbidity or mortality compared with no iron therapy.
{"title":"Effect of preoperative oral iron on postoperative morbidity or mortality after major surgery: A French nationwide healthcare database study","authors":"Sigismond Lasocki , Jérémie Théreaux , Marie Dalichampt , Mohammed Bennani , Cécile Hauville , Olivia Dialla , Eric Garrigue , Alexandre Theissen","doi":"10.1016/j.accpm.2025.101705","DOIUrl":"10.1016/j.accpm.2025.101705","url":null,"abstract":"<div><h3>Background</h3><div>Correction of preoperative iron deficiency (with or without anemia) is widely recommended but data on oral iron therapy in this setting are limited. This study evaluated the impact of preoperative oral iron supplementation on postoperative morbidity and mortality in patients undergoing major surgery.</div></div><div><h3>Methods</h3><div>Using retrospective data from the French <em>Système National des Données de Santé</em> (SNDS) database, this study included patients who underwent major surgeries (orthopedic, onco-digestive, cardiac, onco-urologic, onco-gynecologic) between January 2017 and September 2019. Postoperative morbidity (re-hospitalization, venous thromboembolism, renal insufficiency, infection, stroke/myocardial infarction, intensive care unit admission) or mortality until postoperative day 90 (POD90) was assessed in patients who received oral iron in the 8 weeks before surgery <em>versus</em> those with no iron supplementation. The probability of postoperative morbidity or mortality was estimated by adjusted logistic regression.</div></div><div><h3>Results</h3><div>In total, 947,468 patients underwent 975,852 surgeries, of whom only 69,377 (7.1%) had received oral iron preoperatively. The incidence of postoperative morbidity or mortality was lower in the “oral iron” <em>versus</em> “no iron” group (20.2% <em>vs.</em> 21.6%; <em>p</em> < 0.001). In the adjusted logistic regression analysis, oral iron was associated with a lower probability of POD90 morbidity or mortality (odds ratio [OR] 0.95; 95% confidence interval [CI] [0.93, 0.97]; <em>p</em> < 0.001) and POD90 mortality (OR 0.85; 95% CI [0.79, 0.92]; <em>p</em> < 0.001) <em>versus</em> no iron.</div></div><div><h3>Conclusion</h3><div>In this large, real-world cohort study of patients undergoing major surgery, preoperative oral iron was associated with a lower probability of postoperative morbidity or mortality compared with no iron therapy.</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101705"},"PeriodicalIF":4.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1016/j.accpm.2025.101699
Ru-Ping Dai , Wei Luo , Wen Wang , Yun-Xuan Huang , Cong Luo , Zhao-Lan Hu , Pei Zhou , Ru-Yi Luo
Background
Fiberoptic bronchoscopy (FB) procedures have become increasingly lengthy and complex. Maintaining deep sedation while preventing hypoxemia with conventional oropharyngeal/nasopharyngeal airways presents a significant clinical challenge. Supraglottic airway devices, such as the laryngeal mask airway (LMA), may provide improved oxygenation and procedural efficiency during FB. However, despite the variety of LMA designs, no previous studies have definitively established the optimal type of LMA for FB procedures.
Methods
96 patients were randomized to either the i-gel LMA group (group I) or Jiancheng dual-channel LMA group (group J). Remimazolam besylate, ciprofol, and sufentanil were used for anesthesia induction and maintenance in both groups. We measured and recorded the success rate of LMA insertion and entering the main airway through the LMA at first attempt, operational interference, mid-procedure LMA adjustments, procedure interruptions, vital signs, and major adverse events.
Results
The patients in group J experienced higher success rates of first-attempt LMA insertion (P < 0.01) and entry into the main airway (P < 0.01) than those in group I. The incidence of coughing was significantly higher in group I than in group J (P < 0.01). The incidence of cardiopulmonary adverse reactions, including respiratory arrest, airway obstruction, airway spasm, laryngospasm, hypertension, and hypotension, was comparable between the two groups. Group I demonstrated a tendency toward prolonged recovery time compared with group J (P = 0.05).
Conclusions
The Jiancheng dual-channel LMA is associated with higher first-attempt success for airway insertion and bronchoscopy compared to the i-gel LMA, warranting consideration for broader clinical application.
Trial registration
https://www.chictr.org.cn/showproj.html?proj=265357 (registration no. ChiCTR2500100990, principal investigator: Ru-Ping Dai, date of registration: April 17, 2025).
{"title":"Jiancheng dual-channel vs. i-gel laryngeal mask airway for fiberoptic bronchoscopy: A randomized trial","authors":"Ru-Ping Dai , Wei Luo , Wen Wang , Yun-Xuan Huang , Cong Luo , Zhao-Lan Hu , Pei Zhou , Ru-Yi Luo","doi":"10.1016/j.accpm.2025.101699","DOIUrl":"10.1016/j.accpm.2025.101699","url":null,"abstract":"<div><h3>Background</h3><div>Fiberoptic bronchoscopy (FB) procedures have become increasingly lengthy and complex. Maintaining deep sedation while preventing hypoxemia with conventional oropharyngeal/nasopharyngeal airways presents a significant clinical challenge. Supraglottic airway devices, such as the laryngeal mask airway (LMA), may provide improved oxygenation and procedural efficiency during FB. However, despite the variety of LMA designs, no previous studies have definitively established the optimal type of LMA for FB procedures.</div></div><div><h3>Methods</h3><div>96 patients were randomized to either the i-gel LMA group (group I) or Jiancheng dual-channel LMA group (group J). Remimazolam besylate, ciprofol, and sufentanil were used for anesthesia induction and maintenance in both groups. We measured and recorded the success rate of LMA insertion and entering the main airway through the LMA at first attempt, operational interference, mid-procedure LMA adjustments, procedure interruptions, vital signs, and major adverse events.</div></div><div><h3>Results</h3><div>The patients in group J experienced higher success rates of first-attempt LMA insertion (<em>P</em> < 0.01) and entry into the main airway (<em>P</em> < 0.01) than those in group I. The incidence of coughing was significantly higher in group I than in group J (<em>P</em> < 0.01). The incidence of cardiopulmonary adverse reactions, including respiratory arrest, airway obstruction, airway spasm, laryngospasm, hypertension, and hypotension, was comparable between the two groups. Group I demonstrated a tendency toward prolonged recovery time compared with group J (<em>P</em> = 0.05).</div></div><div><h3>Conclusions</h3><div>The Jiancheng dual-channel LMA is associated with higher first-attempt success for airway insertion and bronchoscopy compared to the i-gel LMA, warranting consideration for broader clinical application.</div></div><div><h3>Trial registration</h3><div><span><span>https://www.chictr.org.cn/showproj.html?proj=265357</span><svg><path></path></svg></span> (registration no. ChiCTR2500100990, principal investigator: Ru-Ping Dai, date of registration: April 17, 2025).</div></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 2","pages":"Article 101699"},"PeriodicalIF":4.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1016/j.accpm.2025.101679
Jiaxin Yao, Qiushi Gao, Nan Sun, Haiyin Ji, Meiying Cui, Ping Zhao
Introduction: High positive end-expiratory pressure (PEEP) is commonly used to improve pulmonary ventilation in infants with injured lungs. However, its intraoperative application in infants with healthy lungs remains controversial. This study aimed to evaluate the effect of high PEEP on perioperative pulmonary outcomes (PPCs) in this population.
Methods: Neonates and small infants aged 0-6 months undergoing surgery were randomly assigned to receive mechanical ventilation with a conventional PEEP of 5 cmH2O or a high PEEP of 8 cmH2O. Lung ultrasound (LUS) score was measured at four time points: T1, after intubation; T2, at the end of surgery; T3, 30 minutes after extubation; and T4, 24 hours postoperatively. The primary outcome was the LUS score at four time points. The secondary outcome was the incidence of PPCs within the first 7 postoperative days.
Results: A total of 1,056 ultrasonographic images were obtained from 44 subjects. At the end of surgery, the total LUS score was significantly higher in the PEEP 5 cm H2O group compared to the PEEP 8 cmH2O group (14.5 [5.1] vs. 11.4 [4.4]; p = 0.039). However, no significant difference between groups was observed at T3 or T4. The incidence of PPCs during the first 7 postoperative days remained low in both groups.
Conclusions: Although high PEEP is more effective than conventional PEEP in reducing intraoperative atelectasis, it does not appear to provide any postoperative benefits. The advantages of intraoperative high PEEP may not extend beyond the duration of surgery in neonates and infants with healthy lungs.
Registration: Chinese Clinical Trial Register (ChiCTR2300069230), date of registration: March 10, 2023.
{"title":"Effect of High Positive End-Expiratory Pressure on Perioperative Atelectasis in Neonates and Small Infants (0-6 months) with Healthy Lungs: A Randomized Controlled Trial.","authors":"Jiaxin Yao, Qiushi Gao, Nan Sun, Haiyin Ji, Meiying Cui, Ping Zhao","doi":"10.1016/j.accpm.2025.101679","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101679","url":null,"abstract":"<p><strong>Introduction: </strong>High positive end-expiratory pressure (PEEP) is commonly used to improve pulmonary ventilation in infants with injured lungs. However, its intraoperative application in infants with healthy lungs remains controversial. This study aimed to evaluate the effect of high PEEP on perioperative pulmonary outcomes (PPCs) in this population.</p><p><strong>Methods: </strong>Neonates and small infants aged 0-6 months undergoing surgery were randomly assigned to receive mechanical ventilation with a conventional PEEP of 5 cmH<sub>2</sub>O or a high PEEP of 8 cmH<sub>2</sub>O. Lung ultrasound (LUS) score was measured at four time points: T1, after intubation; T2, at the end of surgery; T3, 30 minutes after extubation; and T4, 24 hours postoperatively. The primary outcome was the LUS score at four time points. The secondary outcome was the incidence of PPCs within the first 7 postoperative days.</p><p><strong>Results: </strong>A total of 1,056 ultrasonographic images were obtained from 44 subjects. At the end of surgery, the total LUS score was significantly higher in the PEEP 5 cm H<sub>2</sub>O group compared to the PEEP 8 cmH<sub>2</sub>O group (14.5 [5.1] vs. 11.4 [4.4]; p = 0.039). However, no significant difference between groups was observed at T3 or T4. The incidence of PPCs during the first 7 postoperative days remained low in both groups.</p><p><strong>Conclusions: </strong>Although high PEEP is more effective than conventional PEEP in reducing intraoperative atelectasis, it does not appear to provide any postoperative benefits. The advantages of intraoperative high PEEP may not extend beyond the duration of surgery in neonates and infants with healthy lungs.</p><p><strong>Registration: </strong>Chinese Clinical Trial Register (ChiCTR2300069230), date of registration: March 10, 2023.</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101679"},"PeriodicalIF":4.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1016/j.accpm.2025.101701
Annika Reintam Blaser , Xavier Chapalain , Eric Levesque
{"title":"Predict clinically important gastrointestinal bleeding with machine learning algorithm: A way for precision medicine at the bedside","authors":"Annika Reintam Blaser , Xavier Chapalain , Eric Levesque","doi":"10.1016/j.accpm.2025.101701","DOIUrl":"10.1016/j.accpm.2025.101701","url":null,"abstract":"","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"45 1","pages":"Article 101701"},"PeriodicalIF":4.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-17DOI: 10.1016/j.accpm.2025.101681
Khaled Sarhan, Omar Abdelgawad, Bassant Abdelhamid, Hossam El-Ashmawi, Dina Soliman, Dina Turki, Hebatallah Salah, Mahmoud Badry
Background: This study compared ultrasound-guided supraclavicular subclavian vein (SCV) cannulation and internal jugular vein (IJV) cannulation in neonates and infants weighing less than 5 kg.
Methods: A total of 108 neonates and infants were randomly assigned to either the SCV group (n = 54) or the IJV group (n = 54). The primary outcome was the success rate on the first insertion attempt. Secondary outcomes included procedure times, adverse events, and other characteristics of venous cannulation.
Results: In neonates and infants weighing less than 5 kg, the SCV group demonstrated a significantly higher first-attempt success rate compared to the control group [43 (79.6%) vs. 30 (55.6%), relative risk (95% CI): 0.7 (0.53-0.92), p = 0.007]. Additionally, the SCV group experienced fewer adverse events (5.6 % vs. 29.6%, p = 0.002).
Conclusion: Ultrasound-guided SCV cannulation resulted in a significantly higher first-attempt success rate and a lower incidence of adverse events compared to IJV cannulation in neonates and infants weighing under 5 kg. These findings indicate that SCV cannulation may offer a preferable approach for improving success rates.
{"title":"Efficacy of Ultrasound-Guided Internal Jugular Vein versus Subclavian Vein Cannulation in Neonates and Infants Weighing Less Than 5 kg: A Prospective, Randomized Controlled Trial.","authors":"Khaled Sarhan, Omar Abdelgawad, Bassant Abdelhamid, Hossam El-Ashmawi, Dina Soliman, Dina Turki, Hebatallah Salah, Mahmoud Badry","doi":"10.1016/j.accpm.2025.101681","DOIUrl":"https://doi.org/10.1016/j.accpm.2025.101681","url":null,"abstract":"<p><strong>Background: </strong>This study compared ultrasound-guided supraclavicular subclavian vein (SCV) cannulation and internal jugular vein (IJV) cannulation in neonates and infants weighing less than 5 kg.</p><p><strong>Methods: </strong>A total of 108 neonates and infants were randomly assigned to either the SCV group (n = 54) or the IJV group (n = 54). The primary outcome was the success rate on the first insertion attempt. Secondary outcomes included procedure times, adverse events, and other characteristics of venous cannulation.</p><p><strong>Results: </strong>In neonates and infants weighing less than 5 kg, the SCV group demonstrated a significantly higher first-attempt success rate compared to the control group [43 (79.6%) vs. 30 (55.6%), relative risk (95% CI): 0.7 (0.53-0.92), p = 0.007]. Additionally, the SCV group experienced fewer adverse events (5.6 % vs. 29.6%, p = 0.002).</p><p><strong>Conclusion: </strong>Ultrasound-guided SCV cannulation resulted in a significantly higher first-attempt success rate and a lower incidence of adverse events compared to IJV cannulation in neonates and infants weighing under 5 kg. These findings indicate that SCV cannulation may offer a preferable approach for improving success rates.</p><p><strong>Registration: </strong>ClinicalTrial.gov(NCT05956028).</p>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":" ","pages":"101681"},"PeriodicalIF":4.7,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号