Anestesia y reanimación cardiovascular

Circ Heart Fail. 2025 Jul 3:e012716. doi: 10.1161/CIRCHEARTFAILURE.124.012716. Online ahead of print.

ABSTRACT

BACKGROUND: Assessment of medication changes in heart failure trials and registries is complex and may not capture the entirety of care. A comprehensive and standardized method is needed. We used different methods to assess the use of guideline-directed medical therapies (GDMT) and verified the association between GDMT intensity score with the STRONG-HF trial (Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing of Heart Failure Therapies) clinical outcomes.

METHODS: We used data from the STRONG-HF trial to examine the baseline GDMT use for all randomized patients by applying the GDMT intensity score and evaluated its change over time. We also examined their basic adherence, indication-corrected adherence, and dose-corrected adherence, and the association with clinical outcomes up to 180 days.

RESULTS: At 90 days, triple therapy indication-corrected use increased from 4.5% to 36% in the usual care group, and from 5.2% to 93.5% in the high-intensity care group (P<0.001 between the 2 groups). Triple therapy dose-corrected use increased from 4.5% to 20.5% in the usual care group, and from 3.3% to 77.4% in the high-intensity care group (P<0.001). The GDMT intensity score at baseline was <6 in 358 (33%) patients, 6 to 7 in 329 (31%) patients, and >7 in 386 (36%) patients. At 90 days, 88.4% of patients in the high-intensity arm achieved a score >7 versus 14.3% in the usual care arm (P<0.0001). The GDMT intensity score was correlated with clinical outcomes at 180 days.

CONCLUSIONS: The GDMT intensity score provides a comprehensive description of medication use by means of standardized measurements and is linked to clinical outcomes. Future studies should consider utilizing this as a trial end point.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03412201.

PMID:40605744 | DOI:10.1161/CIRCHEARTFAILURE.124.012716

BMC Anesthesiol. 2025 Jul 1;25(1):328. doi: 10.1186/s12871-025-03206-8.

ABSTRACT

BACKGROUND: Rhomboid intercostal plane block (RIB) has been described in the last decade. In this study, we aimed to evaluate the outcomes of RIB in terms of perioperative analgesia and patient and physician satisfaction in patients undergoing CIED.

METHODS: The randomized controlled trial was structured into two arms, each comprising 25 patients and allocation was performed using a sealed-envelope randomization technique. Local anaesthesia group-LAG received only local anaesthesia (LA) (prilocaine 2%) as the standard procedure. RIB group-RIBG received RIB in addition to the standard procedure. Demographic and clinical data about the patients and the procedures performed were recorded. The first and second rescue treatments in cases of pain during the procedure and the first and second rescue treatments during the postoperative follow-up were also recorded. Pain levels during the procedure, at the end of the procedure and 3, 6, 12, and 24 h after the procedure were determined according to the NRS-11(Numeric Rating Scale-11). Patient and physician satisfaction were recorded on a five-point Likert scale. The primary outcome of the study was the efficacy of RIB in patients undergoing CIED implantation, assessed by NRS-11 pain scores during the procedure and in the postoperative period. As secondary outcome, patient and physician satisfaction levels were evaluated during the procedure.

RESULTS: There was less need for additional local anaesthetic in the RIBG than in the LAG (p < 0.001). NRS-11 scores during implantation, at the end of the implantation procedure, and at the 3-, 6-, 12-, and 24-hour follow-ups were greater in the LAG (p < 0.001). The satisfaction levels of both doctors and patients were higher in the RIBG (p < 0.001).

CONCLUSIONS: RIB application in CIED implantations showed adequate analgesic efficacy in patients during the perioperative period and up to 24 h postoperatively. At the same time, it provided high procedural satisfaction for patients and physicians. RIB should be considered in the multimodal analgesia approach in the perioperative analgesia of this patient group. There is a need for collaboration between anaesthesiologists and cardiologists to establish protocols, including RIB, for perioperative pain management in patients who undergo CIED implantation.

TRIAL REGISTRATION: This study was registered in the Clinical Trials (ID: NCT06449599, 27/05/2024).

PMID:40597579 | PMC:PMC12220544 | DOI:10.1186/s12871-025-03206-8

BMC Anesthesiol. 2025 Jul 1;25(1):309. doi: 10.1186/s12871-025-03194-9.

ABSTRACT

BACKGROUND: Increased intracranial pressure is a possible cause of postoperative delirium in open heart surgery patients. Optic nerve sheath diameter is a non-invasive measurement method used to monitor intracranial pressure changes. The authors suggested in this study that optic nerve sheath diameter monitoring could identify patients at risk of postoperative delirium.

METHOD: This prospective observational study was conducted by evaluating data from 90 patients undergoing open heart surgery. Optic nerve sheath diameter in patients was recorded before and after anesthesia induction, before and after cardiopulmonary bypass, and after intensive care transfer. Postoperative delirium was evaluated with the Confusion Assessment Method for the Intensive Care Unit scale.

RESULTS: The study was completed with 90 patients and postoperative delirium was observed in 20 of the patients (22.2%). Optic nerve sheath diameter (OR, 5.787; 95% CI, 1.489-22.496; P = 0.011), history of alcohol use (OR, 6.032; 95% CI, 1.052-34.604; P = 0.044), and EuroSCORE II (OR, 3.090; 95% CI, 1.453-6.571; P = 0.003) was associated with postoperative delirium.

CONCLUSIONS: Optic nerve sheath diameter measured by ultrasonography is associated with postoperative delirium. The increase in optic nerve sheath diameter can be used predictively for postoperative delirium in open heart surgery.

TRIAL REGISTRATION: Samsun University Samsun Training and Research Hospital, following ethics committee approval (Samsun University clinical research ethics committee (KAEK) 2023 11/7) and Clinical Trials (NCT05942183 / 05.09.2024) registration.

PMID:40596877 | DOI:10.1186/s12871-025-03194-9

Cureus. 2025 May 27;17(5):e84874. doi: 10.7759/cureus.84874. eCollection 2025 May.

ABSTRACT

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited arrhythmia syndrome affecting the structurally normal heart, occurring during high adrenaline levels triggered by exercise or emotional stress. CPVT results from a mutation in the RyR2 gene and is clinically characterized by episodes of syncope, arrhythmias, or sudden cardiac arrest. Optimal perioperative preparation for patients with CPVT aims to prevent increases in catecholamine levels during venipuncture, surgery, and pain management. Levobupivacaine, a long-lasting local anesthetic, was administered to a 28-year-old female patient for an axillary nerve block during orthopedic surgery. The patient had experienced sudden cardiac arrest at the age of 24, where the RyR2 gene mutation was confirmed, leading to the initiation of beta-blocker therapy. Subsequent hypoxic-ischemic encephalopathy, resulting from resuscitation, caused spastic quadriplegia. The patient's vital parameters, such as electrocardiogram, non-invasive blood pressure (NIBP), and oxygen saturation (SpO2), were monitored throughout the perioperative period. Orthopedic surgery was successfully completed, with no changes observed in the electrocardiogram. Levobupivacaine, being less cardiotoxic, ensured good intraoperative conditions without adverse events and provided adequate postoperative pain control for the patient with CPVT during orthopedic surgery.

PMID:40575238 | PMC:PMC12199132 | DOI:10.7759/cureus.84874

Medicina (Kaunas). 2025 May 25;61(6):975. doi: 10.3390/medicina61060975.

ABSTRACT

Background and Objectives: The aim of this study was to compare the effects of sevoflurane-based anesthesia and propofol-based total intravenous anesthesia (TIVA) on intraocular pressure (IOP) during coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB). Materials and Methods: This prospective observational monocentric study included 68 patients scheduled for CABG with CPB, divided into two groups of propofol-based TIVA (Group P) and sevoflurane-based anesthesia (Group S). Intraocular pressure was measured and recorded at eight predefined time points using a tonometer: before anesthesia induction (T1), 10 min after induction (T2), immediately before the beginning of CPB (T3), 3 min after the beginning of CPB (T4), 3 min after cross-clamping (T5), 3 min after cross-clamp removal (T6), immediately before the weaning of CPB (T7), and at the end of the surgery (immediately after skin closure) (T8). The primary endpoint was to examine the effects of propofol-based TIVA and sevoflurane-based anesthesia methods on IOP during CABG operation. The secondary endpoints included a comparison of hemodynamic variables, blood gas values, and intensive care unit (ICU) and hospital stays. Results: Intraocular pressure values were similar for both groups at all time points. A statistically significant decrease was found in IOP in all measurements after induction compared to pre-induction values in both Group P and Group S (p < 0.05). Compared to IOP measured at 10 min after induction, no statistically significant difference was found at all subsequent time points in both groups. When the right and left IOP values were compared, no statistically significant difference was detected at all time points in both Group P and Group S. Conclusions: The results of the study indicated that propofol-based TIVA and sevoflurane-based anesthesia had similar effects on IOP in patients undergoing CABG with CPB.

PMID:40572662 | PMC:PMC12195263 | DOI:10.3390/medicina61060975

Life (Basel). 2025 Jun 9;15(6):928. doi: 10.3390/life15060928.

ABSTRACT

Sepsis is a life-threatening condition driven by a dysregulated host immune response to infection, with cytokine overproduction contributing to organ dysfunction and high mortality. Levosimendan, a calcium sensitizer used in acute heart failure, has been proposed to exert anti-inflammatory effects, but information on its immunomodulatory effects in early sepsis remains scarce. This study aimed to investigate the dose- and time-dependent effects of levosimendan on cytokine profiles in a rat model of lipopolysaccharide (LPS)-induced sepsis. Thirty-two male Wistar albino rats were randomly assigned to four groups: sham, sepsis control, low-dose levosimendan (1 mg/kg), and high-dose levosimendan (2 mg/kg). Cytokine levels (TNF-α, IL-1β, IL-6, IL-8, IL-17, MCP-1) were measured at 5 and 10 h post-LPS administration. High-dose levosimendan significantly reduced TNF-α, IL-1β, IL-6, and MCP-1 levels by the 10th hour, accompanied by improved Murine Sepsis Scores. IL-17 and IL-6 showed biphasic responses, increasing initially and decreasing significantly later, particularly with high-dose treatment. IL-8 reduction was observed only in the high-dose group. These findings support levosimendan's dose and time-dependent anti-inflammatory effects and suggest it may modulate both early and late-phase cytokines in sepsis. Further studies are warranted to clarify its potential role in clinical sepsis management.

PMID:40566580 | PMC:PMC12193883 | DOI:10.3390/life15060928

Children (Basel). 2025 May 22;12(6):661. doi: 10.3390/children12060661.

ABSTRACT

Objective: To evaluate early and midterm outcomes of cryopreserved aortic homograft implantation in pediatric patients undergoing aortic valve and root replacement. Methods: A retrospective analysis was conducted on 36 pediatric patients aged 2 to 7 years who underwent cryopreserved aortic homograft implantation between January 2016 and December 2024. Indications included complex congenital aortic valve disease, annular hypoplasia, failed Ross procedure, and infective endocarditis. The standard root replacement technique was used under moderate hypothermic cardiopulmonary bypass. Postoperative outcomes were analyzed, including early complications, mortality, echocardiographic parameters, and long-term graft performance. Statistical analyses included the use of chi-square test, the Mann-Whitney U test, and Spearman correlation. Results: There was no 30-day mortality. One patient (2.8%) experienced late mortality at year 3, and two patients (5.6%) underwent reoperation at years 4 and 7 due to root aneurysm and severe regurgitation, respectively. Early postoperative echocardiography showed satisfactory hemodynamic performance with a mean gradient of 8.4 ± 3.2 mmHg. At 5-year follow-up, 92.9% of grafts maintained normal function. Conclusions: Cryopreserved homografts provide a safe and effective option for pediatric aortic valve replacement in the early and midterm period. However, potential late complications such as structural degeneration or root dilation necessitate long-term surveillance. Advances in decellularized grafts may improve future durability and integration.

PMID:40564621 | PMC:PMC12191320 | DOI:10.3390/children12060661

JAMA Cardiol. 2025 Jun 25:e251920. doi: 10.1001/jamacardio.2025.1920. Online ahead of print.

ABSTRACT

IMPORTANCE: The STOP-or-NOT randomized clinical trial compared the outcomes of continuing vs discontinuing renin-angiotensin system inhibitors (RASi) prior to major noncardiac surgery and found no difference in the postoperative risk of death or major complications, but it remains unclear whether preoperative cardiovascular risk stratification influences the response to this intervention. This post hoc analysis explores whether preoperative cardiovascular risk stratification affects the outcomes in patients who continue vs discontinue RASi use before major surgery.

OBJECTIVE: To evaluate whether preoperative cardiovascular risk stratification affects the strategy of RASi management before major noncardiac surgery.

DESIGN, SETTING, AND PARTICIPANTS: This is a post hoc analysis of the multicenter STOP-or-NOT randomized clinical trial, conducted across 40 hospitals in France between January 2018 and April 2023, with follow-up for 28 days postoperatively. Data analysis was performed from September 2024 to January 2025. The participants were patients who had been treated with RASi for at least 3 months and were scheduled for major noncardiac surgery.

INTERVENTION: Patients were randomized to either continue RASi until the day of surgery or to discontinue RASi 48 hours prior to surgery.

MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of all-cause mortality and major postoperative complications. Secondary outcomes were major adverse cardiovascular events and acute kidney injury. Cardiovascular risk stratification was assessed with the Revised Cardiac Risk Index (RCRI), American University of Beirut (AUB)-HAS2 Cardiovascular Risk Index, and systolic blood pressure prior to randomization.

RESULTS: Among the 2222 patients (median [IQR] age, 68 [61-73] years; 771 [35%] female), 1107 were randomized to RASi continuation and 1115 were randomized to RASi discontinuation. Using the RCRI, 592 patients were categorized as low risk (0 points), 1095 as intermediate-low risk (1 point), 418 as intermediate-high risk (2 points), and 117 as high risk (≥3 points). Using the AUB-HAS2 Cardiac Risk Index, 1049 patients were categorized as low risk (0 points), 727 as intermediate-low risk (1 point), 333 as intermediate-high risk (2 points), and 113 as high risk (≥3 points). A total of 2132 patients were split into 4 quartiles of preoperative systolic blood pressure. The risk of postoperative complications and major adverse cardiovascular events varied with RCRI score. However, a strategy of RASi continuation vs discontinuation was not associated with a higher risk of postoperative complications.

CONCLUSIONS: This study found that preoperative cardiovascular risk did not affect patient outcomes with respect to the strategy of continuing vs discontinuing RASi before major noncardiac surgery, suggesting that the decision to continue or discontinue RASi should not be influenced by a patient's preoperative cardiovascular risk assessment.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03374449.

PMID:40560582 | PMC:PMC12199175 | DOI:10.1001/jamacardio.2025.1920

Metabolites. 2025 Jun 5;15(6):371. doi: 10.3390/metabo15060371.

ABSTRACT

Nitazenes represent an emerging class of new synthetic opioids characterized by a high-potency μ-opioid receptor (MOR) agonist activity. Background: We report two 20-year-old males who presented with severe neurorespiratory depression with typical opioid syndrome, but no opioid identification based on routine blood and urine screening tests. The first patient recovered with supportive care, mechanical ventilation, and naloxone infusion, whereas the second patient developed post-anoxic cardiac arrest and died from brain death. Methods: A complementary comprehensive toxicological screening using liquid chromatography coupled with high-resolution mass spectrometry (LC-HRMS) was performed, and data were processed using a dedicated molecular network strategy to profile the metabolites. Results: Protonitazene and protonitazepyne, two nitazenes differing in their ethylamine moieties (i.e., a diethyl versus a pyrrolidine substitution, respectively), were identified. We found an extensive metabolism of protonitazene, leading to the identification of multiple phase I (resulting from hydroxylation, N-desethylation, and O-despropylation) and phase II (resulting from glucuronidation) metabolites. By contrast, protonitazepyne metabolism appeared limited, with one metabolite annotated confidently, protonitazepyne acid, which resulted from the oxidative pyrrolidine ring cleavage. Concusions: To conclude, nitazene detection is highly challenging due to its extensive structural and metabolic diversity. Our findings highlight the contribution of the untargeted LC-HRMS screening approach and suggest that diagnostic product ions can serve as robust markers for nitazene identification.

PMID:40559395 | PMC:PMC12195359 | DOI:10.3390/metabo15060371

Cureus. 2025 Jun 21;17(6):e86482. doi: 10.7759/cureus.86482. eCollection 2025 Jun.

ABSTRACT

Background and objectives This study aimed to compare surgical outcomes, early postoperative complications, and midterm recovery in patients with severe rheumatic mitral insufficiency undergoing either minimally invasive cardiac surgery (MICS) or mitral valve replacement via conventional median sternotomy (CMS). While CMS remains the standard approach, MICS has emerged as a less invasive option with potential benefits. However, comparative data in resource-limited settings remain scarce. Methods This multicenter retrospective study included 55 adults with severe rheumatic mitral Insufficiency (RMI) who underwent elective mechanical mitral valve replacement between 2020 and 2024 in Morocco. Patients were divided into two groups: 27 received minimally invasive surgery (MICS) via minithoracotomy, and 28 underwent conventional sternotomy (CMS). The primary endpoint was 30-day all-cause mortality. Secondary outcomes included operative times, postoperative complications, intensive care unit (ICU)/hospital stay duration, 12-month functional recovery, valve performance, and event-free survival based on Kaplan-Meier analysis. Results Fifty-five patients underwent mechanical mitral valve replacement: 27 via minimally invasive cardiac surgery (MICS) and 28 via conventional median sternotomy (CMS). The 30-day mortality was similar between groups (3.7% vs 3.6%; p = .99). Compared with CMS, MICS was associated with significantly shorter cardiopulmonary bypass (68.3 vs 87.5 minutes; p < .001) and aortic cross-clamp times (54.7 vs 77.1 minutes; p < .001), reduced postoperative pneumonia (0% vs 10.7%; p = .03), and fewer arrhythmias (7.4% vs 39.3%; p = .04). Hospital stay was shorter in the MICS group (6.2 vs 7.3 days; p = .04), with similar ICU duration. At 12 months, both groups showed preserved left ventricular ejection fraction (60.1% vs 58.2%; p = .22) and comparable event-free survival (>90%), without significant differences in valve-related complications. Conclusions In this multicenter retrospective study, minimally invasive cardiac surgery (MICS) for severe rheumatic mitral insufficiency was associated with fewer early complications, shorter operative and recovery times, and equivalent 12-month outcomes compared with conventional median sternotomy. These findings support MICS as a safe and effective alternative in appropriately selected patients when performed in experienced surgical centers.

PMID:40548155 | PMC:PMC12181818 | DOI:10.7759/cureus.86482

J Cardiothorac Vasc Anesth. 2025 May 29:S1053-0770(25)00440-9. doi: 10.1053/j.jvca.2025.05.053. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the analgesic efficacy of superficial parasternal intercostal plane (S-PIP) block and deep parasternal intercostal plane (D-PIP) to determine which technique provides superior pain relief in cardiac surgery.

DESIGN: A systematic search of MEDLINE (via PubMed), Scopus, Embase, Cochrane Library, Web of Science, Google Scholar, and ClinicalTrials.gov from inception until January 18, 2025. Eligible studies included randomized controlled trials (RCTs) and observational studies that compared the S-PIP and D-PIP blocks in patients undergoing cardiac surgery. The primary outcome of the study was postoperative opioid consumption of morphine milligram equivalent (MME) at 24 hours. Secondary outcomes included resting and movement pain scores at 0, 6, 12 and 24 hours, time to first analgesics, incidence of postoperative nausea and vomiting (PONV), extubation time, length of stay (LOS) in the intensive care unit (ICU), and the number of patients requiring rescue analgesics.

MAIN RESULTS: Seven RCTs and 1 observational study, including a total of 510 patients, were identified. The findings demonstrated no statistically significant difference in MME at 24 hours between the S-PIP and D-PIP block groups (mean difference, -1.23; 95% confidence interval, -2.51 to 0.05; p = 0.061). Additionally, there were no significant differences in pain scores, PONV incidence, time to rescue analgesics, extubation time, or ICU LOS of stay between the 2 techniques.

CONCLUSIONS: S-PIP and D-PIP blocks provide comparable postoperative analgesic efficacy in patients undergoing cardiac surgery.

PMID:40541472 | DOI:10.1053/j.jvca.2025.05.053

Korean J Anesthesiol. 2025 Jun 20. doi: 10.4097/kja.24901. Online ahead of print.

ABSTRACT

BACKGROUND: Sugammadex reverses the effects of steroidal neuromuscular-blocking agents, such as rocuronium, by encapsulating these agents. Its cardiovascular adverse effects include QTc prolongation, hypotension, bradycardia, atrioventricular block, atrial fibrillation, and asystole. Additionally, rocuronium has cardiac side effects, such as bradycardia, hypotension, cardiac arrest, circulatory collapse, and ventricular fibrillation. Herein, we investigated the effects of sugammadex, rocuronium, and combined rocuronium + sugammadex on cardiac electrophysiological parameters.

METHODS: In vitro experiments were performed using ventricular myocytes obtained from male Wistar rats. Myocyte contraction and relaxation responses were recorded along with action potential (AP), and L-type calcium (ICaL) and potassium channel currents (Ito, Iss, and IK1).

RESULTS: Sugammadex caused dose-dependent decreases in myocyte contraction and relaxation responses. Rocuronium had no effect in this respect, whereas its co-administration with sugammadex led to decreased contraction responses. Sugammadex prolonged the AP repolarization phase, whereas rocuronium prolonged all AP phases. Co-administration of sugammadex and rocuronium did not significantly affect AP parameters. Sugammadex suppressed the peak ICaL value, while rocuronium caused an even greater decrease. Co-administration of these drugs further decreased the current-voltage characteristics of the ICaL. However, no significant effects were observed on the potassium currents.

CONCLUSIONS: Separate or combined administration of sugammadex and rocuronium had various effects on myocyte contractility, AP, and ICaL, which could cause significant changes leading to adverse cardiac events. Further experimental and clinical studies are required to understand the clinical consequences of the modulatory effects of these drugs on cardiac electrophysiological parameters.

PMID:40538088 | DOI:10.4097/kja.24901

Pediatr Cardiol. 2025 Jun 18. doi: 10.1007/s00246-025-03920-7. Online ahead of print.

ABSTRACT

Extubation on the operating table is increasingly utilized to minimize ventilator-associated complications and promote early recovery in pediatric cardiac surgery. However, its safety across diverse congenital heart disease (CHD) populations remains insufficiently defined. To evaluate the feasibility, safety, and clinical outcomes of on-table extubation across a broad spectrum of corrective and palliative congenital heart surgeries in children. This retrospective multicenter study included 986 pediatric patients (aged 7 days to 16 years) who underwent on-table extubation after CHD surgery between 2019 and 2025. Patients were grouped as corrective (n = 632) or palliative (n = 354) cases. Primary outcomes were reintubation and mortality. Secondary outcomes included ICU and hospital stay durations, and incidence of ventilator-associated pneumonia (VAP). Overall reintubation and mortality rates were 5.78 and 1.22%, respectively. Corrective procedures demonstrated significantly lower reintubation (4.11%) and mortality (0.63%) compared to palliative surgeries (8.76 and 2.26%, respectively; p < 0.01 and p < 0.05). Highest complication rates were observed in HLHS (reintubation and mortality 40%) and aortopulmonary shunt (53.13 and 21.88%). In contrast, Glenn and Fontan procedures showed low reintubation (1.69, 2.91%) and minimal mortality. No cases of VAP were reported. Mean ICU and hospital stays were 3.69 and 9.7 days. Of the 57 reintubation events, 23 (40.4%) occurred within 6 h of extubation, suggesting extubation failure, while 34 (59.6%) occurred between 6 and 24 h, potentially due to secondary complications. Early reintubations (0-6 h) were more common in aortopulmonary shunt (17 cases) and coarctation/IAA repair (3 cases), whereas later reintubations (6-24 h) predominated in ToF (5 cases), truncus arteriosus (4 cases), and TGA (3 cases). A moderate correlation was found between reintubation and mortality (Spearman's r = 0.45, p < 0.01). On-table extubation is a safe and feasible strategy in pediatric cardiac surgery, particularly in corrective procedures and select single-ventricle palliation. However, caution is warranted in high-risk physiologies such as HLHS and shunt-dependent circulation. Careful perioperative evaluation remains essential for optimal outcomes.

PMID:40533645 | DOI:10.1007/s00246-025-03920-7

Turk J Anaesthesiol Reanim. 2025 Jun 17. doi: 10.4274/TJAR.2025.251926. Online ahead of print.

ABSTRACT

Advanced hemodynamic monitoring has revolutionized perioperative medicine and critical care by providing comprehensive insights into cardiovascular physiology and facilitating precise assessment and management of complex parameters such as cardiac output, systemic vascular resistance, fluid responsiveness, and tissue perfusion. These technologies enhance the capacity of clinicians to detect subtle physiological alterations, enabling timely interventions and individualized therapeutic strategies, particularly for critically ill patients and those undergoing major surgical procedures. This two-part review offers a comprehensive analysis of hemodynamic monitoring. Part I examined the fundamental principles of macrohemodynamics and microhemodynamics. Part II focuses on advanced hemodynamic monitoring tools, tracing the evolution of cardiac output measurement techniques from Fick's oxygen consumption method in 1870 to contemporary innovations, such as pulse contour analysis, bioimpedance/bioreactance, and real-time non-invasive modalities like advanced echocardiography. By examining the underlying principles, devices, invasiveness, clinical applications, advantages, and limitations of various monitoring techniques, this review elucidates the clinical utility of advanced tools in addressing the limitations of standard monitoring and optimizing patient outcomes in modern anaesthesia and critical care practices.

PMID:40526033 | DOI:10.4274/TJAR.2025.251926

A A Pract. 2025 Jun 17;19(6):e02000. doi: 10.1213/XAA.0000000000002000. eCollection 2025 Jun 1.

ABSTRACT

The serratus posterior superior intercostal plane block (SPSIPB) is a novel regional anesthesia technique providing broad dermatomal coverage. We present 2 patients who underwent coronary artery bypass grafting via median sternotomy and received bilateral SPSIPB for postoperative analgesia. Both patients exhibited effective pain control with low numeric rating scale scores and minimal morphine consumption (8 mg and 10 mg, respectively) within the first 24 postoperative hours, without any complications. These findings support the potential role of SPSIPB as a safe and effective component of multimodal analgesia in cardiac surgery, particularly in patients at increased risk for neuraxial techniques. .

PMID:40525732 | DOI:10.1213/XAA.0000000000002000

J Clin Med. 2025 May 28;14(11):3786. doi: 10.3390/jcm14113786.

ABSTRACT

Background: Regional anesthesia techniques are increasingly used for pain management in minimally invasive cardiac surgery (MICS). We aimed to evaluate whether the combination of interpectoral plane block (IPB) and superficial serratus anterior plane block (SAPB) provides non-inferior postoperative analgesia compared to erector spinae plane block (ESPB) in adult patients undergoing MICS. Methods: In this prospective, single-center, double-blind, randomized, non-inferiority trial, 40 adult patients scheduled for MICS were allocated to receive either ESPB (n = 20) or a combination of IPB + SAPB (n = 20) prior to surgical incision. All patients received standardized anesthesia. Pain was assessed using the Critical-Care Pain Observation Tool (CPOT) during intubation and the Numerical Rating Scale (NRS) at 6-48 h postoperatively, following extubation. The primary outcome was the NRS score at 24 h. A non-inferiority margin of 2 NRS points was pre-specified, and non-inferiority was evaluated using between-group differences with 95% confidence intervals. Opioid consumption was recorded via PCA fentanyl and rescue analgesics, converted to morphine milligram equivalents (MMEs). Secondary outcomes included extubation time and postoperative nausea and vomiting (PONV). Results: Median 24 h NRS was 3.0 (0-5.0) in the ESPB group and 2.5 (0-5.0) in the IPB + SAPB group. The between-group difference remained within the predefined two-point margin (95% CI: -0.8 to 1.2). Opioid consumption (p = 0.394), extubation time, and PONV incidence were comparable (all p > 0.05). No block-related complications occurred. Conclusions: IPB + SAPB was non-inferior to ESPB for postoperative analgesia in MICS. Despite requiring two injections, it remains an effective alternative. Larger trials are needed to confirm these findings.

PMID:40507548 | PMC:PMC12156317 | DOI:10.3390/jcm14113786

J Clin Med. 2025 May 26;14(11):3711. doi: 10.3390/jcm14113711.

ABSTRACT

Background/Objectives: Remifentanil and dexmedetomidine are widely used agents for pain management during general anesthesia. Adropin acts as a regulator of endothelial function by affecting nitric oxide bioavailability and various hemodynamic factors, including blood flow, vascular dilatation, and mean arterial pressure. We aimed to evaluate the effects of remifentanil and dexmedetomidine on adropin and eNOS levels and hemodynamic parameters in patients undergoing unilateral single-level lumbar microdiscectomy under controlled hypotension. Methods: This study included 40 patients who underwent lumbar microdiscectomy and were randomly assigned to two groups: 20 patients received remifentanil, and 20 received dexmedetomidine. Hemodynamic parameters, preoperative and postoperative VAS scores, and intraoperative blood loss were recorded. Adropin and eNOS mRNA levels were measured with RT-qPCR at three time points: preoperative (T1), intraoperative (T2), and postoperative (T3). Adropin protein levels were evaluated using ELISA. Results: The remifentanil and dexmedetomidine groups had similar heart rate, arterial pressure, intraoperative blood loss, surgery time, and VAS scores. The extubation time was longer with remifentanil. Adropin mRNA level was higher in remifentanil at all time points. At T2, the eNOS mRNA level was higher in the remifentanil group. In the dexmedetomidine group, adropin mRNA levels decreased at T2 compared to T1. Adropin protein levels were higher in the remifentanil group at T2 and T3. In the dexmedetomidine group, serum adropin levels decreased at T3 compared to those at T1. Preoperative VAS scores in patients receiving both remifentanil and dexmedetomidine were higher than postoperative VAS scores. No significant correlation was observed between VAS scores and adropin levels or between intraoperative blood loss and adropin protein levels. Conclusions: Both drugs demonstrated similar effects on the hemodynamics of the patients, and adropin levels were not associated with the VAS score and intraoperative blood loss. These findings suggest that dexmedetomidine mediates vasodilation through adropin-independent mechanisms, while remifentanil may provide more favorable surgical conditions through adropin in patients undergoing unilateral single-level lumbar microdiscectomy.

PMID:40507473 | PMC:PMC12156445 | DOI:10.3390/jcm14113711

Diagnostics (Basel). 2025 May 31;15(11):1404. doi: 10.3390/diagnostics15111404.

ABSTRACT

Background: Hypotension is a common adverse event after the induction of general anesthesia and may lead to serious complications. The Tricuspid Annular Plane Systolic Excursion (TAPSE)/Pulmonary Arterial Systolic Pressure (PASP) ratio is an echocardiographic parameter reflecting right ventricular (RV) function and pulmonary circulation. This study aimed to evaluate the predictive value of the TAPSE/PASP ratio for hypotension after general anesthesia induction. Methods: This prospective observational study included 79 patients with no known cardiac disease who were scheduled for elective surgery and classified as having a physical status of I-III according to the American Society of Anesthesiologists (ASA). TAPSE, PASP, and RV function were assessed using transthoracic echocardiography (TTE) within 5-30 min before surgery, and their hemodynamic changes after general anesthesia induction were recorded. Results: Data analysis revealed a significant association between the TAPSE/PASP ratio and the occurrence of hypotension following the induction of general anesthesia (p < 0.001). In addition, a cut-off value of ≤1.98 was determined for predicting hypotension, which demonstrated a sensitivity of 72.5% and a specificity of 64.1% (AUC = 0.733, 95% CI: 0.621-0.826, p < 0.001). Conclusions: The TAPSE/PASP ratio is a potential predictor of hypotension following the induction of general anesthesia. Further studies are required to validate its predictive accuracy and clinical utility in perioperative hemodynamic management.

PMID:40506977 | PMC:PMC12154500 | DOI:10.3390/diagnostics15111404

J Perianesth Nurs. 2025 Jun 11:S1089-9472(25)00048-6. doi: 10.1016/j.jopan.2025.02.010. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the effect of suprazygomatic maxillary nerve block (SMB) in patients undergoing septoplasty surgery.

DESIGN: Randomized controlled trial.

METHODS: A total of 60 patients who met the inclusion criteria were enrolled in this prospective, randomized controlled study. The patients were divided into two groups: group C (control group) and group B (block group). The groups were compared in terms of demographic variables, American Society of Anesthesiologists scores, hemodynamic parameters (mean arterial pressure and heart rate), visual analog scale (VAS) pain scores, postoperative recovery quality (QoR-15 scores) (Quality of recovery-15 (QoR-15)), and the need for rescue analgesics.

FINDINGS: There were no statistically significant differences between the groups regarding age, gender, or American Society of Anesthesiologists scores (P > .05). Baseline hemodynamic parameters were similar between the groups (P > .05). However, mean arterial pressure and heart rate were significantly lower in group B at 15, 30, 45, and 60 minutes postoperatively (P < .05). Visual analog scale scores at 0, 2, 6, and 12 hours were significantly lower in group B (P < .05). QoR-15 scores were also significantly higher in group B (P < .05), while the patients need rescue analgesics was lower in this group (P < .05). There was no significant difference in the total number of postoperative analgesic doses between the two groups (P > .05).

CONCLUSIONS: The application of SMB during septoplasty surgery provides improved perioperative hemodynamic stability, reduced postoperative pain, and enhanced recovery quality. The SMB can be considered a valuable component of a multimodal analgesic approach in septoplasty surgeries.

PMID:40498428 | DOI:10.1016/j.jopan.2025.02.010

Medicine (Baltimore). 2025 Jun 6;104(23):e42641. doi: 10.1097/MD.0000000000042641.

ABSTRACT

Endoscopic retrograde cholangiopancreatography (ERCP) is an interventional procedure that is often performed under sedation anesthesia and that is used in the diagnosis and treatment of hepatopancreaticobiliary diseases. The objective of this study was to compare the efficacy of hypnosis in conjunction with sedoanalgesia and sedoanalgesia alone in the context of outpatient anesthesia prior to ERCP. Patients undergoing ERCP in the endoscopy unit between March and May 2021 were randomly assigned to 1 of 2 groups: group 1 received hypnosis and sedoanalgesia, and group 2 received sedoanalgesia alone. Both groups were administered 0.5 to 0.6 mg/kg intravenous pethidine hydrochloride (HCl), 1 to 3 mg intravenous midazolam, and 1 to 2 mg/kg intravenous propofol. The first group also received hypnotic induction before the procedure and anesthetic agents. In the event of patients exhibiting movement during the procedure, an anesthesiologist was unaware of the patient's allocation and administered additional propofol and/or pethidine HCl. A statistical comparison was conducted between the 2 groups regarding demographic data, vital parameters, medication requirements, and satisfaction scales. Thirty patients were included in both groups. Following the procedure, the administration of propofol and pethidine HCl was reduced in group 1 (P = .031 and P = .009, respectively). The 5-minute heart rate, baseline peripheral oxygen saturation at 3 and 10 minutes were lower in group 2 (P = .008, P = .011, P = .017, and P = .031, respectively). Although the dose of anesthetic drugs were lower, no significant difference was observed neither in the patient satisfaction scores, nor in patient movements. The use of hypnosis during ERCP enhances the efficacy of sedoanalgesia. Hypnotic anesthesia may be employed as an alternative method in cases where high-dose administration of these agents is contraindicated.

PMID:40489869 | PMC:PMC12150974 | DOI:10.1097/MD.0000000000042641