BMC Anesthesiology最新文献

Background: Residual neuromuscular blockade (rNMB) after surgery can lead to complications such as respiratory distress, increased length of hospital stay, and higher healthcare costs. Sugammadex, a selective relaxant-binding agent, has shown efficacy in reversing rocuronium-induced neuromuscular blockade more rapidly than neostigmine. This study aimed to evaluate the effectiveness of a low dose of sugammadex (0.5 mg.kg^-1) compared to standard neostigmine with glycopyrrolate for the reversal of moderate rocuronium-induced neuromuscular blockade.

Methods: This randomized, double-blind, controlled trial included adult patients undergoing surgery with rocuronium-induced moderate neuromuscular blockade. Participants were randomized to receive either low-dose sugammadex or standard-dose neostigmine with glycopyrrolate at the end of surgery. The primary outcome was the time to achieve a Train-of-Four (TOF) ratio of ≥ 0.9 after administration of the reversal agent. Secondary outcomes included extubation time, incidence of sugammadex rescue therapy for incomplete reversal, and postoperative complications. Statistical analysis used t-tests and Mann-Whitney-Wilcoxon tests for continuous variables and chi-square tests for categorical variables, with significance set at p < 0.05.

Results: The median time to reach TOF ratio of ≥ 0.9 was significantly shorter in the sugammadex group (4.3 min, IQR: 3.2-6) compared to the neostigmine group (20.6 min, IQR: 10.1-21.3, p < 0.001). Extubation times were also reduced with sugammadex, with a median of 11.6 (IQR: 8.6-15.1) minutes versus 25.9 (IQR: 17.7-29.7) minutes in the neostigmine group (p < 0.001). Only 4.8% of patients in the sugammadex group required rescue therapy to reverse the neuromuscular block with TOF ratio of ≥ 0.9, compared to 60.6% in the neostigmine group (p < 0.001). No significant differences were observed in postoperative respiratory complications or PACU length of stay.

Conclusions: Low-dose sugammadex provides a faster and more reliable reversal of moderate neuromuscular blockade than standard-dose neostigmine, with implications for improved operating room efficiency and patient safety. Continuous neuromuscular monitoring remains essential, as a small proportion of patients may still require additional intervention.

Trial registration: Registered retrospectively at ClinicalTrials.gov with registration number NCT05718934 on 2023-02-08.

Background: Intranasal dexmedetomidine is commonly used preoperatively in pediatric anesthesia to reduce agitation and emergence delirium. Esketamine, with sedative and analgesic ef-fects and minimal respiratory depression at clinical doses, is also widely used in chil-dren. However, current evidence remains limited regarding the efficacy and safety of combining intranasal esketamine with dexmedetomidine versus dexmedetomidine alone in improving cooperation during anesthesia induction and reducing postoperative complications.

Methods: This meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD420251084757). A systematic search of PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials.gov, and Wanfang was conducted up to May 25, 2025. The primary outcome included the incidence of emergence delirium, emergence time, mask acceptance score (MAS), parental separation anxiety score (PSAS), and the incidence of adverse events, with pooled effect estimate reported as proportions and relative risk (RR) with 95% confidence intervals (CIs). Sensitivity analysis were performed to assess the robustness of the results and to identify sources of heterogeneity.

Results: Six studies involving a total of 515 pediatric patients were included. Compared with dexmedetomidine alone, intranasal esketamine combined with dexmedetomidine significantly reduces the incidence of emergence delirium (RR = 0.27, 95% CI: [0.17-0.44], P < 0.00001, I² = 0%). The incidence of bradycardia is also significantly lower in the combination group (RR = 0.24, 95% CI: [0.08-0.72], P = 0.01). No statistically significant differences are observed between the two groups in terms of emergence time or the incidence of nausea and vomiting. The combination group shows lower parental separation anxiety scores and better mask acceptance scores, indicating improved cooperation during anesthesia induction.

Conclusion: Preoperative intranasal administration of esketamine combined with dexmedetomidine significantly reduces the incidence of emergence delirium and bradycardia compared with dexmedetomidine alone.Improved cooperation during anesthesia induction further supports the potential of this combination as a safe and effective alternative to dexmedetomidine monotherapy in pediatric anesthesia.

Trial registration: Not applicable.

Background: Cost of living is one of the key factors in residency selection among U.S. medical graduates, given rising student loan debt. No studies have investigated anesthesiology stipends relative to regional cost of living. This study aimed to compare anesthesiology resident stipends nationwide using the Cost-of-Living Index (COLI) to assess purchasing power.

Methods: The AAMC directory was queried to obtain accredited anesthesiology residency programs for the 2024-2025 academic year. CA1 (post graduate year 2) stipends were collected via internet search and residency programs were assigned to metro areas using region specific COLI metrics. City, state, geographic region, and reputation ranking were recorded and absolute and relative discrepancies were calculated.

Results: Of 174 anesthesiology residency programs, 118 (67.8%) were analyzed. The national average CA-1 stipend was $70,757 ± $9,718, with medians of $66,137 in low COLI areas and $74,046 in high COLI areas (median difference $7,909, [95% CI $5,969-$12,728, p < 0.001]. California showed the largest adjusted deficit (-$26,969, -30.98%), whereas Oklahoma had a $13,096 surplus (+ 21.00%). In the 10 major cities, average stipends decreased from $76,052 ± $10,860 to $59,499 ± $11,252 after COLI adjustment (-21.8%, p < 0.001). The absolute discrepancy between small and medium programs was not significant (-$3,498, p = 0.19), while large programs faced a 12.82% shortfall ($9,742) despite higher unadjusted salaries. Among the top 12 programs based on reputation ranking, stipends were higher in high COLI regions with half showing > 30% loss after COLI adjustment.

Conclusions: Anesthesiology residency stipends showed substantial variation after adjusting for regional cost of living, with many high COLI areas experiencing marked reductions in real purchasing power. Given rising educational debt, applicants should consider COLI adjusted stipends when evaluating programs to better assess regional affordability and financial impact.

Trial registration: N/A.

Background: Intensive Care Units manage patients with life-threatening conditions. Despite all efforts, mortality in these units remains high in many low-resource settings. There is limited evidence on the outcomes and Factors Associated with mortality among adult patients admitted to intensive care in the Sidama region of Ethiopia.

Objective: To assess clinical outcomes and Factors Associated with Mortality among Adults Admitted to the Intensive Care Unit at Hawassa University Comprehensive Specialized Hospital, Ethiopia.

Methods and materials: A facility-based retrospective chart review was conducted among adult patients admitted to the ICU of Hawassa University Comprehensive Specialized Hospital between 1 January 2022 and 10 April 2024. Data were extracted from 401 patient charts using a structured checklist. The study participants' cards were selected consecutively using a list of their medical record numbers. The collected data were checked for completeness and consistency. The coded data were checked and entered into the EPI data version 4.6. The data were then exported into SPSS version 26 for analysis. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with ICU mortality. Variables with a p-value < 0.05 were considered significant.

Results: The overall intensive care unit mortality was 28% (95% CI: 23.5-32.5). In the multivariate analysis, mortality was associated with mechanical ventilation requirements in patients (AOR = 5.71, 95% CI: 1.49-21.8) and unconscious mental status at admission (AOR = 4.76, 95% CI: 1.38-16.44). Patients who stayed less than four days in ICU are two times more likely to die than those who survived (AOR = 2.10, 95% CI: 1.25-3.53).

Conclusion and recommendation: In this study, Mortality among adult patients admitted to the ICU was high. Mechanical ventilation, impaired level of consciousness at admission, and shorter ICU length of stay were factors associated with increased mortality. These findings highlight the need for improved early identification, stabilization, and management of critically ill patients in resource-limited settings.