BMC Anesthesiology最新文献

Background: Desflurane is a widely used inhalational anesthetic known for its advantageous properties in clinical settings. This study aimed to investigate the effects of desflurane inhalation on male reproductive hormones, testicular tissue integrity, and sperm morphology in a rat model.

Methods: Thirty male rats were allocated into six experimental groups: Control group (C): Administered 2 L/min of O₂ for 18 minutes daily over seven days. Group D1: Exposed to 1 minimum alveolar concentration (MAC) of desflurane and 2 L/min of O₂ for 18 minutes daily over seven days. Group D2: Received the same treatment as Group 1 for seven days, followed by a seven-day recovery period without intervention. Group D3: Administered 1 MAC desflurane and 2 L/min of O₂ for 18 minutes daily over 14 days. Group D4: Received the same treatment as Group 3 for 14 days, followed by a seven-day recovery period without intervention. Group D5: Administered the same treatment as Group 3 for 14 days, followed by a 14-day recovery period without intervention.Biochemical analyses were conducted to measure serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and inhibin B. Histopathological evaluations were performed to assess testicular tissue integrity, and sperm morphology was examined to identify abnormalities.

Results: Significant histopathological damage was observed in all experimental groups compared to the control group (p < 0.05). The proportion of morphologically abnormal spermatozoa was significantly higher in Groups D2, D3, D4, and D5 compared to the control group (p = 0.030, p = 0.002, p < 0.001, and p = 0.016, respectively). Compared to the control group, serum FSH levels showed a slight decrease across desflurane-exposed groups (ranging from -1.4% to +4.02%). The LH levels demonstrated a gradual reduction of approximately 0.32%-7.38%, while serum testosterone concentrations increased markedly, reaching up to 178% of the control level in the D4 group. Inhibin-B levels exhibited a progressive elevation of nearly 23-95% compared to control group.

Conclusion: Chronic inhalation of desflurane, a modern inhalational anesthetic, was found to adversely affect testicular histology, sperm morphology, and the regulation of male reproductive hormones in rats. These findings highlight potential reproductive toxicity associated with prolonged desflurane exposure.

Background: Intensive care unit-acquired weakness (ICU-AW) is a common complication among critically ill patients, including those with COVID-19. While viral myopathy and established ICU-related risk factors predispose patients with COVID-19 to muscle dysfunction, few studies have directly compared muscle wasting and weakness between ICU populations with and without COVID-19 using both structural and functional assessment modalities.

Methods: This was a small, non-concurrent, propensity score-matched ICU study which compared muscle wasting and strength in patients with and without COVID-19 who remained in the ICU for ≥ 7 days. Muscle thickness was assessed using ultrasound (US), body composition using bioelectrical impedance analysis (BIA), and functional strength using handgrip dynamometry. Measurements were performed on ICU days 1, 5, and 7. To reduce baseline differences, propensity score matching was applied using illness severity, nutritional risk, and mechanical ventilation parameters.

Results: In total, 143 patients were included (101 without COVID-19, 42 with COVID-19). After propensity score matching, 23 pairs were analysed. US revealed significant within-group reductions in muscle thickness over time in both matched cohorts, with no statistically significant between-group differences. BIA-derived phase angle (PhA) values were consistently lower in patients with COVID-19; however, between-group differences in PhA change lost statistical significance after matching. Handgrip dynamometry revealed a significantly higher incidence of muscle weakness in patients with COVID-19 initially, but this difference was non-significant. Absolute and residual strength remained similar between groups.

Conclusions: ICU patients both with and without COVID-19 experienced comparable degrees of muscle wasting and weakness when adjusted for baseline characteristics. ICU-AW appears more closely associated with the severity of critical illness and ICU treatments than with SARS-CoV-2 infection itself. US measurements appeared less affected by differences in fluid balance, whereas BIA-derived phase angle was more closely related to hydration status. Handgrip dynamometry provided a simple, objective measure of functional muscle strength at ICU discharge.

Background: Regional anesthesia provides significant perioperative benefits, but patients often require sedation for comfort and immobility. Common sedatives such as propofol or dexmedetomidine can cause hemodynamic instability or prolonged recovery. Remimazolam, a newer ultra-short-acting benzodiazepine, has a rapid onset and offset with potentially improved safety. This systematic review aimed to assess the efficacy and safety of remimazolam for sedation during regional anesthesia.

Method: PubMed, Scopus, Web of Science, and Embase were systematically searched up to July 2025 for randomized controlled trials (RCTs) comparing remimazolam with other sedatives (propofol, dexmedetomidine) or placebo during regional anesthesia, including neuraxial techniques (spinal, epidural, combined spinal-epidural) and peripheral nerve blocks. Key outcomes included onset of sedation, depth/quality of sedation, and recovery characteristics, hemodynamic and respiratory events, postoperative nausea and vomiting (PONV), neurocognitive outcomes, and satisfaction. Data were extracted and qualitatively synthesized.

Results: Six RCTs involving 677 patients were included. Remimazolam consistently provided a rapid onset of sedation (about 4-5 min), faster than dexmedetomidine and comparable to propofol. Recovery was also shorter with remimazolam (approximately 7-11 min) compared with both comparators. It provided greater hemodynamic stability, with fewer episodes of bradycardia than dexmedetomidine and less hypotension than propofol. Respiratory safety was favorable, with no serious adverse events and lower risk in some indices compared with dexmedetomidine. The incidence of postoperative nausea and vomiting was low and similar across groups. Remimazolam was not associated with increased delirium or cognitive impairment and in some outcomes showed advantages over propofol. Patient and clinician satisfaction were consistently high.

Conclusion: Remimazolam appears to be an effective and safe sedative option for regional anesthesia, offering a rapid onset and recovery, stable hemodynamics, and minimal respiratory and neurocognitive side effects. Based on the currently limited evidence, it may represent a favorable alternative to traditional sedatives for maintaining patient comfort during regional anesthesia procedures; however, larger, high-quality trials are warranted.