BMC Anesthesiology最新文献

Background: Cardiac tamponade is a catastrophic hemodynamic emergency. While ventriculoperitoneal (VP) shunt placement is a common neurosurgical procedure, its typical complications include obstruction and infection. No prior cases of intraoperative cardiac tamponade during VP shunt placement have been reported.

Case presentation: We present a case of life-threatening cardiac tamponade that occurred during VP shunt insertion in a patient with severe cerebral edema. The patient developed abrupt hemodynamic collapse, progressing to pulseless electrical activity requiring emergency cardiopulmonary resuscitation.

Conclusions: Prompt diagnosis was achieved by point-of-care ultrasonography, and immediate pericardiocentesis was life-saving. This case illustrates a previously unreported, lethal complication of VP shunt surgery, potentially resulting from unintended cardiac penetration by the ventricular catheter. We alert anesthesiologists and neurosurgeons to consider this etiology in cases of unexplained intraoperative collapse and advocate for the ready availability of ultrasound for rapid diagnosis.

Background: Anterior cruciate ligament reconstruction (ACLr) is among the most common orthopedic procedures, however, large-scale studies analyzing regional anesthesia (RA) as an adjunct to general anesthesia (GA) are lacking.

Methods: TriNetX was used to identify adults undergoing ACLr between January 2014 and January 2024. Patients were categorized as receiving GA (inhalational/intravenous anesthetics with neuromuscular blockers only), RA (local anesthetics for nerve/neuraxial blocks only), or combined anesthesia (general and regional agents). Outcomes were assessed over short-term (1-day to 1-month) and long-term (1-day to 1-year) intervals. Propensity score matching (1:1) balanced demographic and clinical covariates.

Results: In the short-term, GA had increased revision ACLr (RR 2.00, p = 0.01), postoperative pain (RR 1.56, p < 0.01), and opioid dependence (RR 1.96, p < 0.01), but less knee stiffness (RR 0.49, p < 0.01) and physical therapy (PT) (RR 0.87, p < 0.01) than combined anesthesia. RA had higher postoperative pain (RR 1.44, p = 0.02) and opioid prescriptions (RR 1.16, p < 0.01), but less PT (RR 0.62, p < 0.01) than combined anesthesia. GA had less knee stiffness (RR 0.43, p < 0.01) and opioid prescriptions (RR 0.80, p < 0.01), but more PT (RR 1.38, p < 0.01) than RA.

Background: This research aimed to evaluate the analgesic effect of perineural injection or intravenous infusion of dexmedetomidine in ultrasound-guided erector spinae plane block (ESPB) combined with serratus anterior plane block (SAPB) for patients undergoing thoracoscopic surgery.

Methods: In this prospective, double-blind, randomized controlled trial, seventy-five patients scheduled for thoracoscopic surgery were randomly divided into the control group (group R: 40 ml of 0.375% ropivacaine for ESPB combined with SAPB and 40 ml of 0.9% NaCl for intravenous infusion), the intravenous infusion of dexmedetomidine group (group RDiv: 40 ml of 0.375% ropivacaine for ESPB combined with SAPB and 40 ml of 0.9% NaCl containing 1 µg/kg dexmedetomidine for intravenous infusion), and the perineural injection of dexmedetomidine group (group RD: 40 ml of 0.375% ropivacaine containing 1 µg/kg dexmedetomidine for ESPB combined with SAPB and 40 ml of 0.9% NaCl for intravenous infusion). The primary outcome was the duration of effective analgesia, defined as the time from the onset of nerve blocks to the first demand for patient-controlled analgesia. Secondary outcomes included postoperative opioid consumption, rescue analgesia, numeric rating scale (NRS) scores, adverse effects and quality of recovery.

Results: Compared with group R and group RDiv, the duration of effective analgesia in group RD was significantly prolonged (1313.8 ± 372.8 vs. 844.5 ± 285.2 vs. 943.0 ± 417.2 min, P < 0.05), opioid consumption and the number of patients who required rescue analgesia were significantly reduced (P < 0.05), and NRS scores at rest and on movement at 24, 36 and 48 h were all significantly reduced (P < 0.05). Group RD exhibited a reduced incidence of postoperative nausea and vomiting (P < 0.05), along with improved quality of recovery-15 score at 24 h postoperatively (P < 0.05).

Conclusions: Perineural injection of dexmedetomidine in ultrasound-guided erector spinae plane block combined with serratus anterior plane block could still significantly prolong the duration of effective analgesia after thoracoscopic surgery, reduce opioid consumption, and improve the occurrence of adverse effects, thereby improving early-term recovery. However, the same clear benefits were not observed with intravenous dexmedetomidine.

Trial registration: The study was registered at Chinese Clinical Trial Registry (https//www.chictr.org.cn) with the number ChiCTR2400088052 on 08/09/2024.

Endotracheal suctioning remains a critical intervention in the respiratory management of mechanically ventilated patients with brain injury. However, it carries the risk of triggering abrupt intracranial pressure elevations, potentially exacerbating secondary brain injury. This narrative review combines current evidence on pharmacologic and non-pharmacologic strategies to mitigate ICP fluctuations during ETS in neurosurgical patients. The findings support the need for an integrated approach involving analgo-sedation, controlled ventilation, and targeted drug selection to minimize ICP surges and improve outcomes. While each strategy offers distinct benefits, its application must be adapted to the patient's physiological profile and clinical context, and regional resources. The review also highlights the need for continued research into effective dosing, administration techniques, and the integration of real-time monitoring technologies to enhance procedural safety in this high-risk population.

Background: Brugada syndrome occurs typically without structural heart disease and is regarded as an autosomal dominant condition. It is linked to a range of cardiac symptoms as well as potentially fatal ventricular arrhythmias that can cause sudden cardiac death. The patient in this case demonstrated electrocardiographic features consistent with Brugada syndrome, which were unmasked as a diagnostic Type 1 coved ST-segment elevation pattern in the right precordial leads (V1-V3) following Ajmaline provocation testing. The patient also mentioned feeling a little weak and dizzy with a few episodes of palpitations during the entire course of pregnancy. At 37 weeks of gestation, the patient, a pregnant woman, was scheduled for an elective Caesarean section.

Case presentation: An elective Caesarean section was planned for 37 weeks of gestation for a 38-year-old pregnant woman for breech presentation who demonstrated Brugada syndrome, morbid obesity (BMI 41), type 2 diabetes mellitus, anaemia, and a history of laparoscopic myomectomy. Multidisciplinary planning was undertaken involving anesthesiology, cardiology, endocrinology, and obstetrics. The primary plan was spinal anaesthesia with general anaesthesia as a backup due to her heart risk. The administration of 200 µg of morphine and 12.5 mg of bupivacaine intrathecally went satisfactorily. After a stable intraoperative period, the patient was observed in a high-dependency unit until being moved to the maternity ward without any issues.

Conclusion: For certain parturients with Brugada syndrome, spinal anaesthesia can be safely given through preoperative assessment, interdisciplinary collaboration, and close intraoperative and postoperative monitoring.

Study objective: Large language models (LLMs) are used in all areas of life and have become one of the information sources for those seeking healthcare. Although ChatGPT is the most well-known, Claude, CoPilot, and GEMINI are also among the other LLMs. Some of these models have been studied in terms of their response quality metrics to frequently asked questions (FAQs) about broad content areas like anesthesia and to specific FAQs related to obstetric analgesia. However, no studies have yet been conducted on questions related to nerve blocks. In this study, we evaluated the quality of the answers given by the four LLMs to frequently asked questions related to 'nerve block'.

Design: Prospective, Delphi study, Survey.

Intervention: Ten FAQs were identified and presented to four LLMs. A Delphi study was conducted to develop an assessment tool. A survey study was then conducted using the developed tool, in which the evaluators, selected through a thorough process, evaluated the LLM responses.

Measurements: The quality of LLM responses was assessed by raters using the ARQuAT (Assessing Response Quality in AI Texts) tool, determined through Delphi rounds. Evaluation criteria included content criteria such as accuracy, comprehensiveness, security, timeliness, and relevance, as well as communication criteria such as understandability, empathy, ethical considerations, readability, and neutrality.

Main results: ChatGPT and Claude demonstrated superior performance in ARQuAT-Overall scores compared to GEMINI and CoPilot (p < 0.001). ChatGPT and Claude achieved satisfaction rates above 80% in both content and communication quality metrics, significantly outperforming GEMINI (p < 0.001 for both comparisons), while CoPilot showed intermediate performance.

Conclusion: Responses to FAQs related to nerve blocks were well and acceptably addressed by ChatGPT, Claude, and, to a lesser extent, CoPilot. GEMINI performed poorly compared to the others, exhibiting subpar performance on several questions, particularly in terms of safety and relevance.