BMC Anesthesiology最新文献

Background: Elevated intraocular pressure (IOP) during emergence from general anesthesia may precipitate visual complications, particularly in patients with predisposing ocular conditions. Anticholinergics used with neostigmine for neuromuscular blockade reversal can transiently increase IOP, whereas sugammadex avoids anticholinergic use and may offer a safer ocular profile. This meta-analysis aimed to compare the effects of sugammadex versus neostigmine-anticholinergic combinations on IOP after extubation.

Methods: We systematically searched PubMed, Embase, Scopus, Web of Science, and Google Scholar from inception to September 30, 2025. Eligible studies were randomized controlled trials (RTCs) comparing sugammadex with neostigmine plus atropine in adult surgical patients undergoing general anesthesia, reporting IOP as an outcome. Data extraction and risk of bias assessment were performed following standard methodological practices. Meta-analysis was performed using a random-effects model. Trial sequential analysis (TSA) was used to evaluate the conclusiveness of findings. The review was reported in accordance with PRISMA guidelines.

Results: Three RCTs with a total of 156 patients were included. Compared with neostigmine-atropine, sugammadex was associated with significantly lower IOP at 1 min (mean difference [MD], - 3.95 mmHg; 95% confidence interval [CI], - 5.75 to - 2.14; P < 0.001) and 5 min (MD, - 3.84 mmHg; 95% CI, - 5.01 to - 2.66; P < 0.001) after extubation. No statistically significant differences were observed at 2-10 min. Mean arterial pressure and heart rate were similar between groups. TSA confirmed conclusive evidence at 1 and 5 min.

Conclusion: Sugammadex was associated with improved early post-extubation IOP control without hemodynamic compromise. However, the evidence is based on a small number of heterogeneous trials and limited to short-term postoperative measurements, and the findings should be interpreted with caution.

Background: Patients undergoing non-elective surgery frequently require rapid sequence induction (RSI) because of concerns related to recent oral intake, impaired gastric emptying, or uncertain fasting status. Previous randomized controlled trials have reported mixed results regarding the effectiveness of high-flow nasal cannula (HFNC) in preventing oxygen desaturation during RSI. This study evaluated the effect of HFNC compared with facemask ventilation (FMV) during RSI in a non-elective surgical population.

Methods: In this randomized controlled study, adult ASA I-II patients undergoing non-elective surgery were allocated to HFNC (100% O₂, 60 L·min⁻¹) or FMV (FiO₂ 1.0, 10 L·min⁻¹) during RSI. A modified RSI protocol was applied, including predefined induction agents, cricoid pressure, gentle facemask ventilation as needed, and cuffed tracheal intubation. The primary outcome was peri-intubation oxygenation. Secondary outcomes included CO₂ accumulation, hemodynamic variables, gastric volume, patient comfort, and adverse events. Trial registration was performed retrospectively.

Results: Among 214 analyzed patients (107 per group), no desaturation events (SpO₂ < 94%) occurred in the HFNC group versus 12.1% in FMV (p < 0.001). HFNC yielded higher PaO₂ after preoxygenation (445.7 ± 16.8 vs. 314.2 ± 14.5 mmHg) and after intubation (405.5 ± 17.7 vs. 236.5 ± 58.5 mmHg; both p < 0.001). End-tidal oxygen concentrations were also higher with HFNC (86.0 ± 11.4% vs. 75.7 ± 12.3%; p < 0.001). CO₂ accumulation, hemodynamic variables, gastric volume, and aspiration incidence were similar between groups. Mild nasal dryness reduced comfort with HFNC, and one patient withdrew because of discomfort; overall tolerance remained acceptable.

Conclusion: HFNC appeared to improve oxygenation compared with FMV in this low-risk, non-elective surgical cohort. Within the limits of this physiologically stable population, HFNC was well tolerated and did not increase measured gastric or hemodynamic complications.

Trial registration: ClinicalTrials, NCT06879600. Retrospectively registered on 05 March 2025, https://clinicaltrials.gov/study/NCT06879600.

Objective: This review aimed to assess whether hypoalbuminaemia can predict postoperative pulmonary complications (PPCs) and mortality in patients receiving general anaesthesia for surgery.

Methods: PubMed, Web of Science, EMBASE, and the Cochrane Library were searched for relevant articles published up to 18 July 2024. Three authors independently reviewed the studies and assessed the quality of related articles via the Newcastle‒Ottawa Scale. The data were recorded, and a meta-analysis was performed using Review Manager version 5.4.1.

Results: A total of 40 studies with 477,701 patients were included in the meta-analysis. Adjusted data were pooled to calculate the odds ratio (OR). A sensitivity test was conducted. A meta-analysis of 18 studies demonstrated that hypoalbuminaemia was a significant predictor of PPCs and mortality after general anaesthesia (OR: 2.88, 95% CI 2.50 to 3.32, P < 0.01, I² = 90%). The 40 studies were divided into 4 groups based on surgical site: the orthopaedic surgery group (OR: 4.03, 95% CI 3.49 to 4.64, P < 0.01, I² = 43%), the thoracic surgery group (OR: 1.82, 95% CI 1.46 to 2.26, P < 0.01, I² = 23%), the abdominal surgery group (OR: 2.48, 95% CI 1.81 to 3.40, P < 0.01, I² = 95%) and the other surgery group (OR: 2.34, 95% CI 1.66 to 3.29, P < 0.01, I² = 87%). In addition, patients with hypoalbuminaemia had increased mortality (OR: 4.31, 95% CI 4.124.51, P, I² = 68%).

Conclusions: Preoperative hypoalbuminaemia is significantly associated with postoperative pulmonary complications and has different correlation coefficients in different types of surgeries.

Trial registration: This systematic review and meta-analysis was registered at the International Prospective Register of Systematic Reviews (Number CRD42024540493).

Background: Irrigation fluid absorption is an unpredictable complication during transurethral resection of the prostate (TURP). This prospective study aimed to compare the Endoscopic Surgical Monitoring System (ESMS) and blood parameters for evaluating fluid absorption volume in patients undergoing bipolar plasmakinetic TURP.

Methods: Bipolar TURP was performed using 0.9% saline for bladder irrigation. The ESMS measured fluid absorption volumes in real time. In addition, arterial blood samples were collected for blood gas analysis immediately before irrigation and after surgery, with the absorption volume calculated using equations based on changes in plasma sodium, chloride, potassium, calcium, and hemoglobin concentrations.

Results: A total of 420 patients (mean age 69.8 ± 7.7 years) were included. All calculated volumes based on blood parameters were higher than the ESMS-measured volume. The volume calculated from plasma chloride concentration changes showed the closest agreement with the ESMS volume (867.5 ± 748.9 vs. 843.3 ± 722.1 mL, P = 0.416), with a mean bias of 14.4 mL and 95% agreement limits of -385.7 to 414.5 mL. Regression analysis demonstrated a strong linear relationship between plasma chloride elevation and actual absorption volumes (R²=0.776, P = 0.001). However, further analysis revealed a mean percentage bias of + 19%, indicating a systematic overestimation tendency in blood chloride method. Furthermore, a clinically significant discrepancy (> 300 mL) between the blood chloride method and ESMS was associated with altered clinical management, including increased diuretic use (36.7% vs. 15.0%, P < 0.001) and limitation of intravenous fluids (33.3% vs. 17.5%, P = 0.004).

Conclusions: Among the blood parameters, plasma chloride provides the most accurate estimation of irrigation fluid absorption and can serve as a practical hematologic indicator when ESMS is unavailable. However, clinicians should be aware of its inherent overestimation tendency and the potential for clinically significant discrepancies to impact patient management.

Trial registration: This study was prospectively registered in the Chinese Clinical Trial Registry on December 25, 2023 (www.chictr.org.cn; Registration Number: ChiCTR2300079095).

Background: Postoperative nausea and vomiting (PONV) is a common complication following general anesthesia, and may lead to delayed recovery and prolonged hospital length of stay. While propofol has been shown to reduce PONV risk, volatile anesthetics like sevoflurane are associated with a higher incidence.

Objective: This study compares the incidence of PONV within 24 h after surgery between propofol based total intravenous anesthesia (TIVA) and a hybrid technique using low-dose propofol infusion with sevoflurane in patients with a prior history of PONV and/or motion sickness.

Design: A prospective, single-blind, randomized controlled clinical trial was conducted in adult patients undergoing laparoscopic surgery at Penn State Health Milton S. Hershey Medical Center from February 2024 to March 2025.

Intervention: Patients received either TIVA or a low-dose propofol infusion combined with sevoflurane. The primary outcome was the cumulative incidence of PONV within 24 hours postoperatively. Secondary outcomes included PONV in the post-anesthesia care unit (PACU) and use of rescue antiemetics.

Results: A total of 65 patients were included, (32 hybrid anesthesia, 33 propofol TIVA). PONV occurred in 28% of patients receiving hybrid anesthesia compared to 21% receiving TIVA (p = 0.44). At 24 h, PONV was reported by 59% in the hybrid group and 42% in the TIVA group (p = 0.17).

Conclusion: Low-dose propofol infusion combined with sevoflurane resulted in PONV rates that were not statistically different from propofol-based TIVA.

Trial registration: NCT05759481, registered on 02/22/2023.