Anesthesiology Research and Practice最新文献

Background: Effective pain management after lumbar fixation in situ is crucial for improving recovery and quality of life. Epidural neuroplasty via the Racz catheter is a potential method to enhance analgesia by targeting epidural inflammation and nerve compression. This work assessed the analgesic efficacy of epidural neuroplasty via a Racz catheter during lumbar fixation in situ for lumbosacral spondylolisthesis.

Methods: This randomized, double-blinded, controlled study was conducted on 50 patients aged 18-65 years, of both sexes, who had Grade 1 spondylolisthesis, facet osteoarthropathy, and a small disc on radiological findings. Participants were randomly assigned to two equal groups. Group S received epidural neuroplasty via a Racz catheter during lumbar fixation, and Group C received conventional lumbar steroid injections.

Results: Visual analog scale and Oswestry low back disability questionnaire scores were significantly diminished immediately postprocedure and at 1, 2, 4, and 6 m in Group S than in Group C (p < 0.05). Hypotension, paraesthesia, bleeding, and headache exhibited comparability between the two groups. The patient satisfaction level was significantly elevated in the Racz catheter group as opposed to the conventional lumbar group (p < 0.05).

Conclusions: Epidural neuroplasty using a Racz catheter during lumbar fixation provides enhanced short-term analgesia, functional recovery, and patient satisfaction compared with conventional lumbar treatment in Grade-1 spondylolisthesis, without increased adverse effects, providing preliminary evidence that warrants validation in larger, long-term studies. Trial Registration: ClinicalTrials.gov identifier: NCT06684821.

Background: The purpose of this meta-analysis was to compare the adverse reactions of remimazolam and propofol in hysteroscopic anesthesia and to evaluate the efficacy of remimazolam in alleviating adverse reactions.

Methods: We conducted a database search using China National Knowledge Infrastructure (CNKI), PubMed, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing the use of remimazolam with propofol for hysteroscopy procedures. We extracted data on the occurrence of adverse reactions such as hypotension, respiratory depression, dizziness, nausea, and vomiting for meta-analysis. Literature published until July 2024 was screened from each database, and the quality of the included studies was assessed using the bias risk assessment tool recommended by Cochrane. Data analysis was performed using RevMan 5.3 software, developed by the Cochrane Collaboration in the United Kingdom.

Results: The pooled results demonstrated significant differences in favor of remimazolam when compared to propofol for procedural sedation. Patients receiving remimazolam showed a lower risk of respiratory depression (RR: 0.19; 95% CI: [0.11, 0.33]; I ² = 0%; p < 0.00001), dizziness (RR: 0.10; 95% CI: [0.04, 0.31]; I ² = 0%; p < 0.0001), and postoperative nausea and vomiting (RR: 0.60; 95% CI: [0.15, 2.46]; I ² = 0%; p = 0.48). No significant differences were observed in anesthesia recovery time between the remimazolam and propofol groups (MD: -0.07; 95% CI: [-0.18-1.04]; I ² = 98%; p = 0.90).

Conclusion: Compared to propofol, remimazolam reduces the occurrence of hypotension, respiratory depression, dizziness, and postoperative nausea and vomiting in the anesthesia management of hysteroscopy procedures.

Background: This study aimed to investigate the association between serum anion gap (AG) levels and postoperative delirium (POD) incidence in intensive care unit (ICU) patients undergoing gastric surgery.

Methods: We conducted a retrospective study using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients who underwent gastric surgery were included to investigate the potential association between serum AG and POD risk. Restricted cubic spline (RCS) regression was used to evaluate nonlinear relationships, and receiver operating characteristic (ROC) curves were used to assess predictive performance. Subgroup and sensitivity analyses were performed to verify the reliability and consistency of the results.

Results: Among the 2467 ICU patients who underwent gastric surgery, elevated serum AG levels were independently associated with increased POD risk. The RCS analysis revealed a nonlinear positive correlation between serum AG levels and the risk of POD. ROC curve analysis indicated that serum AG levels had a statistically significant but limited predictive value for POD, with an area under the curve (AUC) of 0.606 (95% CI: 0.584-0.628). Both subgroup and sensitivity analyses confirmed the robustness of these findings.

Conclusions: This study establishes an independent association between serum AG and increased POD risk in ICU patients following gastric surgery, suggesting that serum AG may serve as a biomarker of physiological vulnerability for POD.

Background: Anesthesia trainers frequently experienced desaturation, airway trauma, and failed intubation with novice hands-on training for facemask and endotracheal intubation. Laryngeal mask airway (LMA) adaptation in anesthesia practice has ensured trainers' ease in safely transforming sufficient airway management skills to develop competency among novice trainees. This study was designed to evaluate the manikin-based standard versus rotational LMA insertion techniques to analyze insertion ease and priority LMA insertion technique among novice anesthesia trainees.

Methods: Our randomized controlled crossover trial has enrolled 13 novice anesthesia trainees from multicenter hospitals. The study comprised three phases. Initially, the study participants were inquired on a preformed questionnaire for supraglottic airway device knowledge, insertion techniques, and experiences. In the second phase, trainees have undergone educational tutorial, video presentation, and hands-on practice on a manikin for standard and rotational LMA insertion techniques. Following that, the participants were divided into two study groups to evaluate LMA insertion, 10 times each with standard and rotational in a crossover manner. The third phase of the study was also questionnaire-based; trainees were inquired about the preferred LMA insertion technique for beginners.

Result: The trainee's prior knowledge of supraglottic airway devices and practical experience were equivocal. There were no insertion failure attempts with both standard and rotational LMA insertion techniques. The time duration for the first attempt with standard LMA insertion was significantly shorter (7.92 ± 2.43 s) compared to the time duration for the first attempt with rotational LMA insertion (11.80 ± 3.41 s) on manikin. The post-study analysis revealed trainees' preference for the standard LMA insertion technique.

Conclusion: Our study concludes that the standard LMA insertion technique is relatively easy to learn and practice on manikin compared to the rotational technique. Besides this, the novice anesthesia trainees have preferred standard LMA insertion as a priority technique in their clinical practice.

Trial registration: ClinicalTrials.gov identifier: NCT05544838.

Background/objectives: Over 18 million orthopedic procedures were performed in the United States in 2022 with pharmacological management being the primary mode of analgesia. Percutaneous neuromodulation in the form of temporary peripheral nerve stimulation (tPNS) may provide a new method of postsurgical analgesia devoid of systemic side effects and the potential for substance addiction. tPNS can also be used for chronic pain long after surgery.

Methods: The initial literature search of PubMed/MEDLINE, Web of Science, and Cochrane was conducted on September 21, 2023, and repeated on May 23, 2025. Included studies had patients over 18 years of age with implanted tPNS in the first 2 years following orthopedic surgery of the knee, shoulder, hip, foot, or ankle.

Results: Eleven articles of nine distinct studies were found: eight articles from six randomized trials and three articles from three case series. Seven publications assessed implanted tPNS in the acute perioperative phase, and four publications assessed implanted tPNS for chronic postoperative pain. This systematic review's aim was to compile current literature on the safety and efficacy of percutaneous tPNS both immediately after orthopedic surgery and for longer-term postsurgical persistent pain. This collection of evidence suggests using percutaneous tPNS is safe and may reduce pain and postoperative opioid consumption.

Conclusions: This emerging treatment may reduce postoperative pain and opioid consumption, is safe, and warrants further robust trials. Future studies with robust, multimodal treatment designs are needed to specifically delineate the role of tPNS within the context of current pain management.

Objective: The purpose of this study was to investigate the effects of acupuncture on pain, prostaglandin E2 (PGE2), and interleukin-6 (IL-6) levels during septorhinoplasty surgeries.

Materials and methods: This randomized, controlled study included 70 patients. The patients were divided into two groups: an acupuncture group (n = 35) and a control group (n = 35). The acupuncture group received bilateral press needle acupuncture at the PC 6 and ST 36 points 24 h before surgery. Blood samples were collected for analysis and comparison of preoperative and postoperative levels of IL-6 and PGE2. The primary outcomes were the postoperative visual analog scale (VAS) scores.

Results: In terms of evaluating postoperative pain, no statistically significant differences were observed between the study groups with regard to VAS scores. At 30 min after surgery, fewer patients in the acupuncture group needed analgesics than in the control group (p = 0.044). Postoperative IL-6 levels were lower in the acupuncture group than in the control group (p = 0.014). There was no significant difference in postoperative PGE2 levels between the groups (p = 0.568). The acupuncture group had lower diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) at 30 min intraoperatively and lower DBP at 60 min (p = 0.012, p = 0.026, and p = 0.012, respectively). At 15 min into the operation, the heart rate was higher in the acupuncture group than in the control group (p = 0.039). After surgery, the acupuncture group had lower blood pressure at 5 min and 6 h after surgery than the control group (p = 0.034 and p = 0.041, respectively).

Conclusions: The evidence from this study suggests that acupuncture can reduce the need for pain medication after septorhinoplasty surgery, and by decreasing IL-6 levels, it may contribute to the inflammatory process.

Trial registration: ClinicalTrials.gov: NCT04009070.

Background: A common and distressing consequence that may arise after spinal anesthesia (SA) is shivering. Research focuses on the role of intravenous (IV) nefopam, dexmedetomidine (DEX), and meperidine in averting shivering episodes in adult individuals receiving SA for surgical interventions on the lower abdomen or limbs.

Methods: This prospective, randomized, controlled, double-blind trial involved 210 patients, aged 21-60 years, of both sexes, scheduled for abdominal or limb surgeries under SA. Patients were equally randomized into three groups: Groups N, D, and P received IV nefopam (0.2 mg/kg), DEX (0.5 μg/kg), and pethidine (0.5 mg/kg), respectively. The medications were infused over 20 min.

Results: Heart rate and mean arterial pressure were significantly increased in Groups N and P as opposed to Group D (p < 0.05), with no considerable difference between Groups N and P. Oxygen saturation and core temperature remained similar across all groups at all measurement points. The incidence of shivering was significantly lower in Group N (6 [8.57%]) as opposed to Group P (19 [27.14%]) and Group D (39 [55.71%]) (p < 0.001). Shivering onset, grade, duration, frequency of rescue drug administration, and total rescue drug dosage were comparable among groups. However, sedation levels were significantly lower in Groups N (1 [1-2]) and P (2 [1-2]) as opposed to Group D (2 [1-2]) (p < 0.001 and p = 0.009), with no significant difference between Groups N and P (p = 0.06).

Conclusions: IV nefopam was more effective than DEX and pethidine in preventing shivering under SA, with fewer hemodynamic and sedative side effects.

Trial registration: ClinicalTrials.gov identifier: NCT06627816.

Background: Total knee arthroplasty (TKA) is a common surgical procedure that may be associated with blood loss. The aim of this study is to evaluate intraoperative hemodynamic stability during TKA under general (GA) or spinal anesthesia (SA).

Methods: Any adult undergoing primary TKA under GA or SA was retrospectively selected over a 10-year period and compared. The primary outcome was the presence of intraoperative hemodynamic instability, defined by starting a norepinephrine infusion, as the variation of the patient's blood pressure exceeded 30% of its baseline value for more than 5 min. Secondary outcomes included intraoperative dose of ephedrine, phenylephrine, blood loss, and volume of fluid administered. Demographic and intraoperative anesthetic variables associated with norepinephrine use were entered in a multivariate logistic regression model.

Results: The analysis included 1,441 patients; 59% received a SA. 3.6% of patients under SA required a norepinephrine infusion versus 10.4% under GA (p < 0.001). Ephedrine administered was lower in the SA group (mean dose 19 mg vs. 31 mg, p < 0.001), while phenylephrine was not statistically different (414 μg for SA and 481 μg for GA, p = 0.09). Intraoperative blood loss was identical in both groups (402 mL for SA and 415 mL for GA, p = 0.35), while mean intraoperative fluid income was higher in the GA group (862 mL vs. 725 mL, p < 0.001). Variables associated with norepinephrine use were GA and age, among others.

Conclusions: GA requires more norepinephrine infusion compared to SA in patients during primary TKA, suggesting intraoperative hemodynamic stability is better preserved during neuraxial anesthesia.

Background: Preoperative prolonged fasting can lead to metabolic disturbances and discomfort in pediatrics. This work aimed to assess the systemic effect of different preoperative carbohydrate (CHO) loads in pediatrics undergoing elective surgery.

Methods: This randomized single-blinded controlled trial was performed on 90 children, aged 5-10 years old, who were scheduled for elective surgery. Three equal groups were randomly assigned to patients. 2 h before surgery, patients received 10 mL/kg apple juice in Group 1, 1.75 mg/kg anhydrous glucose in Group 2, or water in Group 3. All patients followed standard fasting guidelines.

Results: Inflammatory markers were notably elevated in Group 3 than in Groups 1 and 2 at the induction of anesthesia and 4 h after operation (p < 0.001). Insulin resistance (IR) markers significantly decreased in Group 3 at the induction of anesthesia but were significantly higher at 4 h after operation than in Groups 1 and 2 (p < 0.05). Random blood sugar was notably lower in Group 3 than in Groups 1 and 2 at induction of anesthesia and intraoperative but was significantly higher at 4 h after operation (p < 0.05). The patients' parents were significantly more satisfied in Groups 1 and 2 in comparison to Group 3 (p = 0.003).

Conclusions: In pediatrics undergoing elective surgeries, preoperative CHO loading is a safe alternative to standard fasting as it results in better preservation of IR markers, inflammatory response, and parents' satisfaction levels.

Trial registration: ClinicalTrials.gov identifier: NCT06833671.

Purpose: We conducted a retrospective observational study to assess if the combinational continuous suprainguinal fascia iliaca block and pericapsular nerve group block would be effective in inhibiting postoperative pain in patients undergoing total hip arthroplasty.

Methods: In 40 patients who underwent elective total hip arthroplasty via anterior approach (April, 2023-April, 2024), suprainguinal fascia iliaca block and PENG block were performed with 25 mL of 0.2% levobupivacaine before induction of general anesthesia. Postoperatively, 0.125% levobupivacaine was continuously infused (at 4 mL h^-1) for suprainguinal fascia iliaca block. Postoperatively, the numerical rating scale (NRS) of pain at rest was recorded immediately after surgery and at 2, 6, 12, 24, and 48 h after surgery. Primary outcome measure was the incidence of rebound pain, and secondary outcome measure was the incidence of postoperative acute pain.

Results: Postoperative acute pain was observed in 22 of 39 patients (56% [95% confidence interval: 40%-72%]). In the remaining 17 patients, rebound pain was observed in 2 (12% [95% confidence interval: 0%-27%]).

Conclusions: We conclude that in the patients who underwent total hip arthroplasty via anterior approach, combinational use of continuous suprainguinal fascia iliaca block and PENG block may frequently be insufficient to prevent postoperative acute pain but may be effective in reducing the incidence of rebound pain.