Anestesia y reanimación cardiovascular

Pharmaceuticals (Basel). 2025 Apr 29;18(5):654. doi: 10.3390/ph18050654.

ABSTRACT

Background: Remifentanil, an ultra-short-acting µ-receptor agonist, is used with propofol for optimal laryngeal mask airway (LMA) insertion. However, no studies have assessed its effects when combined with thiopental on LMA conditions. The combined use of thiopental and remifentanil may offer advantages, such as enhanced cardiovascular and respiratory stability. This study aims to compare the administration of thiopental with different doses of remifentanil to assess their combined effects on LMA insertion conditions and success in a prospective, randomised double-blind study. Method: A total of 100 ASA I-II patients (18-65 years), including both male and female participants, were randomly assigned to four remifentanil dose groups (0.5-3 µg.kg-1). Induction involved thiopental (5 mg.kg-1) after remifentanil. LMA insertion conditions were evaluated using a six-variable scale. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and bispectral index monitor (BIS) values, as well as apnoea duration, eyelash reflex loss time, and insertion attempts, were recorded at baseline, before insertion, and at 5 min post-insertion. Results: Time to eyelash reflex loss and LMA insertion were shorter in Groups III and IV than in Groups I and II (p < 0.001). Apnoea duration was longest in Group IV, followed by Group III (p < 0.001). Groups III and IV had significantly better LMA placement, mouth opening, and ease of insertion (p < 0.05). Coughing and gagging were highest in Group I (p < 0.001). SAP, MAP, HR, and DAP were significantly lower in Group IV at various time points (p < 0.05). HR was significantly higher in Group I compared to Groups II and III at multiple time points (p < 0.05). Conclusions: The administration of 5 mg.kg-1 thiopental with 2 μg.kg-1 remifentanil has been found to provide a stable haemodynamic response and 96% excellent or satisfactory laryngeal mask insertion conditions without increasing the duration of apnoea.

PMID:40430473 | PMC:PMC12114569 | DOI:10.3390/ph18050654

Medicina (Kaunas). 2025 May 19;61(5):919. doi: 10.3390/medicina61050919.

ABSTRACT

Background and Objectives: Post-term pregnancies are associated with increased risks of perinatal complications. This study aimed to evaluate potential cardiac electrophysiological changes in pregnant women by comparing the QRS duration, interval of corrected QT (QTc), and frontal QRS-T angle [f(QRS-T)] between term and post-term pregnancies. Materials and Methods: In this observational prospective study, 120 pregnant women were enrolled-60 term (37-41 weeks) and 60 post-term (≥42 weeks). All participants underwent standard 12-lead electrocardiography (ECG) and caesarean section with spinal anaesthesia. The QTc interval, QRS duration, and frontal QRS-T angle were measured. Demographic parameters such as age, gestational week, height, and weight were recorded. The SPSS software was used to analyse the data with p < 0.05 as the threshold for significance. Results: Post-operative QTc interval (417.3 ± 20.5 vs. 410.2 ± 14.5, p = 0.032) and f(QRS-T) (28 [16-55] vs. 22 [14-34], p = 0.042) were significantly higher in the post-term group than in the term group. When the change in the f(QRS-T) angle was analysed, there was a significant widening of this angle in the post-term group (from 21 [11-37] to 28 [16-55], p = 0.002). The increased f(QRS-T) angle reflects greater heterogeneity in ventricular depolarisation and repolarisation, which may indicate sub-clinical myocardial stress or altered autonomic regulation in the post-term period. Although no overt arrhythmias were observed, subtle changes in P-wave morphology and QT dispersion were more prevalent in the post-term group. Conclusions: Prolonged QRS duration and an increased f(QRS-T) angle in post-term pregnancies can reflect the underlying changes in cardiac electrophysiology related to prolonged gestation. These ECG parameters may serve as non-invasive indicators of sub-clinical cardiac stress, which could be relevant for anaesthetic risk assessment and perinatal management.

PMID:40428877 | PMC:PMC12112964 | DOI:10.3390/medicina61050919

Medicina (Kaunas). 2025 May 9;61(5):870. doi: 10.3390/medicina61050870.

ABSTRACT

Background and Objectives: In coronary artery bypass grafting (CABG) surgeries, monitoring intracranial pressure (ICP) is crucial due to neurological risks. Although pulsatile flow (PF) during cardiopulmonary bypass (CPB) is considered more physiological than non-pulsatile flow (NPF), its impact on ICP remains unclear. This study aimed to compare preoperative and postoperative optic nerve sheath diameter (ONSD) measurements between PF and NPF techniques to evaluate their effect on ICP changes. Materials and Methods: Sixty patients undergoing elective CABG (aged 45-75 years, ASA II-III-IV) were enrolled and divided into two groups depending on the cardiopulmonary bypass technique determined by the surgeon: PF (Group P, n = 30) and NPF (Group NP, n = 30). ONSD measurements were performed with ultrasound before surgery (Tpreop) and after surgery (Tpostop). Hemodynamic parameters and jugular and carotid vessel diameters were also recorded. Statistical analysis included t-tests, Mann-Whitney U-tests, chi-square tests, and Pearson correlation. Results: Both groups demonstrated significant increases in ONSD postoperatively compared to preoperative values (p < 0.001). However, no statistically significant difference in the magnitude of ONSD change was observed between the PF and NPF groups (p > 0.05). Group P showed lower ejection fractions and higher total inotrope requirements compared to Group NP (p < 0.01), but these factors did not translate into differences in postoperative ICP dynamics. Conclusions: ONSD measurements increased significantly after CABG surgery, regardless of perfusion type. PF and NPF strategies were comparable in terms of their effects on ICP as reflected by ONSD changes. ONSD ultrasonography appears to be a simple, rapid, and non-invasive tool for perioperative ICP monitoring in cardiac surgery. Further studies are needed to confirm these findings with dynamic intraoperative monitoring and neurocognitive assessments.

PMID:40428828 | PMC:PMC12113333 | DOI:10.3390/medicina61050870

Medicina (Kaunas). 2025 Apr 23;61(5):783. doi: 10.3390/medicina61050783.

ABSTRACT

Background and Objectives: Dexmedetomidine is a potent selective α2 receptor agonist with analgesic and sedative effects. Many reports indicate that compared to fentanyl, the combination of dexmedetomidine with propofol provides comparably acceptable conditions for a laryngeal mask airway (LMA). However, no study has evaluated the effectiveness of combined dexmedetomidine and thiopental in LMA insertions compared to that of combined dexmedetomidine and propofol. This prospective, randomized, double-blind study aimed to compare the effects of dexmedetomidine with thiopental or propofol on LMA insertion conditions, hemodynamic responses, and pharyngolaryngeal morbidity, which in this study was defined as the presence of postoperative sore throat, dysphagia, or visible blood in the airway following a laryngeal mask airway (LMA) insertion. Materials and Methods: A total of 80 premedicated ASA I-II patients aged 18-65 years were randomized to the propofol group (Group P, n = 40) or thiopental group (Group T, n = 40). Anesthesia was induced by infusing 1 μg·kg-1 dexmedetomidine over 10 min followed by 2.5 mg·kg-1 propofol or 5 mg·kg-1 thiopental. LMA insertion conditions were evaluated on a scale assessing six variables. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and bispectral index values were recorded at baseline; 1 min before; and at 1, 2, 3, 4, and 5 min after an LMA insertion. The baseline values for the systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and bispectral index (BIS) values were recorded before dexmedetomidine infusion. Measurements for all patients were then taken 1 min before and at 1, 2, 3, 4, and 5 min after the LMA insertion Results: Demographic data were similar between the groups. In Group P, the time to loss of eyelash reflex and LMA insertion time were significantly shorter, the apnea duration was significantly longer, and the rates of full jaw opening and optimal LMA insertion conditions were significantly higher when compared with those of Group T (p < 0.05). Group P showed a significantly greater percentage decrease in HR compared to that of Group T at 1 min before and 1, 2, and 3 min after the LMA insertion (p < 0.05). Group T had a greater decrease in SAP and MAP at 1 min before insertion, while the SAP decrease was lower in Group T at 3, 4, and 5 min after insertion. The MAP and DAP values after the LMA insertion showed a greater decrease in Group P compared to in Group T (p < 0.05). The incidence of bradycardia was significantly (p < 0.05) higher in Group P than in Group T. There was no significant difference between the groups in terms of the frequency of hypotension, sore throat, presence of blood, or dysphagia at discharge from the recovery unit (p > 0.05). Conclusions: This study showed that the use of dexmedetomidine with thiopental provided comparably acceptable LMA insertion conditions with more stable hemodynamics compared to propofol.

PMID:40428741 | PMC:PMC12113334 | DOI:10.3390/medicina61050783

J ECT. 2025 May 20. doi: 10.1097/YCT.0000000000001161. Online ahead of print.

ABSTRACT

OBJECTIVES: Electroconvulsive therapy (ECT) is an important treatment method that is widely used in psychiatric conditions resistant to pharmacological treatments.

METHODS: This prospective, randomized study included 100 patients undergoing ECT. Group D received dexmedetomidine and propofol, while group R received remifentanil and propofol. In this study, key parameters such as seizure duration, hemodynamic changes, and recovery time were analyzed.

RESULTS: The investigation revealed no statistically significant differences between the groups with regard to mean age, gender distribution, or seizure duration (P > 0.05). Subsequent to induction, group R exhibited statistically significantly lower systolic blood pressure, diastolic blood pressure, and mean arterial pressures in comparison to group D (P < 0.05). Conversely, heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure levels in group R were found to be statistically significantly higher than in group D (P < 0.05). The recovery time in group D was found to be statistically significantly longer than in group R (P < 0.05).

CONCLUSIONS: Dexmedetomidine provides superior hemodynamic stability, while remifentanil ensures faster recovery. Dexmedetomidine has been shown to be more advantageous in terms of hemodynamic stability, while remifentanil has been demonstrated to result in shorter recovery times. Clinicians should tailor anesthetic choices based on patient profiles and therapeutic goals.

PMID:40424541 | DOI:10.1097/YCT.0000000000001161

Crit Care. 2025 May 16;29(1):195. doi: 10.1186/s13054-025-05437-0.

ABSTRACT

RATIONALE: The significance of the Recruitment to Inflation (R/I) ratio in identifying PEEP recruiters in patients undergoing ultra-protective lung ventilation during venovenous ECMO is not well established.

OBJECTIVES: To compare the concordance of the R/I ratio and Electrical Impedance Tomography (EIT) in determining optimum PEEP settings in severe ARDS patients on ECMO and ventilated with very low tidal volumes.

METHODS: Initially, a low-flow insufflation was performed to detect and measure the airway opening pressure (AOP). Subsequently, the R/I ratio was calculated from PEEP 15-5 cmH2O, followed by a decremental PEEP trial (20-6 cmH2O in 2 cmH2O steps) monitored by EIT. The optimum EIT-based PEEP was defined as the intersection of the collapse and overdistension curves.

MAIN RESULTS: Among 54 ECMO patients (tidal volume: 4.8 [3.0-6.0] mL/kg), 13 (24%) exhibited an airway opening pressure (AOP) of 11 (8-14) cmH2O. The cohort's median R/I ratio was 0.43 (0.28-0.61). A tertile-based analysis of the R/I ratio (≤ 0.34; 0.34-0.54; > 0.54) revealed median optimum EIT-based PEEP of 8 [8-10], 10 [8-14], and 14 [12-16] cmH2O, respectively. The R/I ratio demonstrated weak inverse correlations with lung overdistension (R2 = 0.19) and positive correlations with lung collapse (R2 = 0.26) measured by EIT (p < 0.01).

CONCLUSION: The R/I ratio is feasible during ultra-protective ventilation and provides valuable indications for guiding PEEP titration. Specifically, an R/I ratio > 0.34 may help identify patients likely to benefit from further individualized PEEP optimization using EIT. In contrast, when the R/I ratio is ≤ 0.34, a moderate PEEP level (8-10 cmH₂O) may suffice.

PMID:40380232 | PMC:PMC12084998 | DOI:10.1186/s13054-025-05437-0

Med Sci Monit. 2025 May 15;31:e948186. doi: 10.12659/MSM.948186.

ABSTRACT

BACKGROUND Propofol is the most commonly used hypnotic for laryngeal mask airway (LMA) insertion but requires high doses when used alone, potentially causing cardiorespiratory depression. Muscle relaxants are recommended, yet no study has assessed the effects of remifentanil and dexmedetomidine before propofol induction on LMA insertion conditions. This prospective study aimed to compare the outcomes of propofol administered with remifentanil versus dexmedetomidine during short-duration operations requiring LMA placement. MATERIAL AND METHODS Eighty premedicated ASA I-II patients (age 18-65 years) were randomized to receive dexmedetomidine (Group D=40) or remifentanil (Group R=40) before propofol induction. Group D received a 10-minute infusion (1 μg.kg), while Group R received remifentanil (2 μg.kg) over 60 seconds. Baseline systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and bispectral index (BIS) values were recorded before induction and at intervals up to 5 minutes after LMA placement. RESULTS Group R had significantly shorter eyelash reflex loss and LMA insertion times, but longer apnea duration. Ideal LMA insertion conditions, full chin opening, and no movement were more frequent in Group R (p<0.05). In Group D, HR was significantly lower than in Group R 1 minute before and after LMA insertion, but significantly higher in the 4th and 5th minutes after insertion (p<0.05). MAP in Group R was significantly lower than in Group D at 1 minute before and all times after LMA insertion (p<0.05). CONCLUSIONS Administration of 2 μg/kg remifentanil before 2.5 mg/kg propofol induction resulted in better hemodynamics, faster LMA insertion, and higher rates of optimal conditions compared to 1 μg/kg dexmedetomidine.

PMID:40369863 | PMC:PMC12094127 | DOI:10.12659/MSM.948186

Reg Anesth Pain Med. 2025 May 7:rapm-2025-106591. doi: 10.1136/rapm-2025-106591. Online ahead of print.

ABSTRACT

BACKGROUND: The effects of the erector spinae plane (ESP) block on chronic postsurgical pain (CPSP) after cardiac surgery remain unclear. This study evaluated the efficacy of bilateral ESP block in reducing the incidence and severity of CPSP after cardiac surgery.

METHODS: This prospective, randomized, controlled, single-blind trial included 63 patients aged 18-80 years with American Society of Anesthesiologists physical status II-III, scheduled for elective cardiac surgery via median sternotomy. Participants received a bilateral ultrasound-guided ESP block or standard care without regional anesthesia. The primary outcome was the Brief Pain Inventory (BPI) score at 3 months postoperatively. Secondary outcomes included morphine consumption in the first 24 hours; Numerical Rating Scale (NRS) scores during rest/activity at 0, 3, 6, 12, and 24 hours; BPI scores at 6 months postoperatively; and Douleur Neuropathique 4 (DN4) and Hospital Anxiety and Depression Scale (HADS) scores at 3 and 6 months postoperatively.

RESULTS: The BPI scores of the two groups did not differ significantly at 3 months postoperatively (median (IQR): 0(26) vs 12 (31), p=0.166). However, 24 hours postoperative morphine consumption (8 mg vs 10.5 mg, p<0.001) and NRS scores at multiple time points were significantly lower in the ESP block group. No significant differences were observed between the groups in terms of the BPI, DN4, or HADS scores at three or 6 months.

CONCLUSIONS: The ESP block effectively reduced acute pain and opioid consumption; however, it had no significant effect on the incidence or severity of CPSP at 3 and 6 months.

PMID:40341013 | DOI:10.1136/rapm-2025-106591

Lancet Respir Med. 2025 May 5:S2213-2600(25)00084-0. doi: 10.1016/S2213-2600(25)00084-0. Online ahead of print.

ABSTRACT

Despite substantial advancements in the management of cardiogenic shock, mortality rates remain greater than 40%. Trials have shown that increasing survival rates in cardiogenic shock is challenging. Even the most successful trials show 5-15% reductions in mortality, and gains have been restricted to acute myocardial infarction cardiogenic shock, representing approximately 5% of the population with cardiogenic shock. Trials studying pharmacological strategies in all populations with cardiogenic shock have been consistently neutral or negative. The reasons are complex and include heterogeneity in cardiogenic shock phenotypes, timing of patient inclusion, high prevalence of multiorgan failure and cardiac arrest, and unrealistic estimated treatment effects that restrict sample size with sometimes inadequate funding leading to underpowered trials. In June, 2024, international experts from the fields of cardiology, anaesthesiology, critical care medicine, biostatistics, government regulation of trials, and patient advocacy convened at the sixth Critical Care Clinical Trialists Workshop to reflect on how to improve the design of future randomised clinical trials in cardiogenic shock. This Position Paper summarises the results of discussions regarding what an optimal randomised controlled trial on cardiogenic shock should entail in terms of population selection, primary objectives, statistical analysis, and incorporation of the patient's perspective.

PMID:40339587 | DOI:10.1016/S2213-2600(25)00084-0

Iran J Microbiol. 2025 Feb;17(1):122-127. doi: 10.18502/ijm.v17i1.17809.

ABSTRACT

BACKGROUND AND OBJECTIVES: SARS CoV2 has tropism for various tissues, including the respiratory tract, brain, endothelium, heart, kidney and liver. Neurological symptoms can also be seen in the clinical course of the disease, and anosmia is the most common. The main objective of our study was to examine the urinary amino acid profiles of moderately severe patients diagnosed with COVID-19 with a positive RT-PCR test and try to find metabolic changes associated with the infection. Also, it was aimed to investigate the neuroinhibitory Gamma-Aminobutyric acid (GABA) levels in order to examine the physiopathology.

MATERIALS AND METHODS: Thirty adult cases who were followed up in the infection clinic with positive SARS CoV 2 RT-PCR and diagnosed with COVID 19 disease were included in the study with consent. The amino acid profile of these patients' urine samples, 30 different amino acid levels and creatine levels were examined using the liquid chromatography-mass spectrometry (LCMS) method on the SCIEX QTRAP 4500 device.

RESULTS: The mean age of the patients is 40 ± 5. Elevated GABA in 28/30 cases, high hydroxylysine amino acid in 27/30 cases, low glycine in 30/30 cases were detected in the urine. The creatinine levels of the patients were found to be normal.

CONCLUSION: It has been thought that the height of GABA may be due to bacteria producing GABA as a result of the change in microbiota due to lactic acidosis, as well as that the virus may directly affect the brain and cause an increase in GABA.

PMID:40330059 | PMC:PMC12049756 | DOI:10.18502/ijm.v17i1.17809

Ann Intensive Care. 2025 May 6;15(1):61. doi: 10.1186/s13613-025-01462-y.

ABSTRACT

BACKGROUND: This post-hoc analysis of a multinational, multicenter study aimed to describe and compare clinical characteristics, microbiology, and outcomes between immunosuppressed and non-immunosuppressed patients with nosocomial lower respiratory tract infections (nLRTI). The study utilized data from the European Network for ICU-related Respiratory Infections, including 1,060 adult ICU patients diagnosed with nLRTI. Descriptive statistics were used to compare baseline characteristics and pathogen distribution between groups. A Cox proportional hazards model stratified by immunosuppression status was applied to assess 28-day mortality risk, adjusting for disease severity and key clinical variables.

RESULTS: Immunosuppression was observed in 24.9% (264/1060) of the patients, and oncological conditions were the most common etiology of immunosuppression. Chronic pulmonary and cardiovascular diseases were the most frequent comorbidities. In both groups, Pseudomonas aeruginosa was the predominant microorganism, particularly affecting patients with immunosuppression (25.3% vs. 16.7%, p = 0.032). Cox regression model adjusted for disease severity (SAPS II), polytraumatized status, altered consciousness, and postoperative status, SAPS II remained a strong independent predictor of mortality, with each one-point increase associated with a 2.3% higher risk of death (HR: 1.023, 95% CI 1.017-1.030, p < 0.001). The analysis also revealed significant heterogeneity in mortality risk among immunosuppressed patients, with hematological malignancies, recent chemotherapy, and bone marrow transplantation associated with the highest mortality.

CONCLUSIONS: Immunosuppressed patients had a lower adjusted survival probability compared to non-immunosuppressed patients. Moreover, P. aeruginosa was the most frequently identified etiological pathogen in immunosuppressed patients.

PMID:40328994 | PMC:PMC12055687 | DOI:10.1186/s13613-025-01462-y

Turk Gogus Kalp Damar Cerrahisi Derg. 2024 Dec 31;32(4 Suppl 2):068-68. doi: 10.5606/tgkdc.dergisi.2024.msb-43. eCollection 2024 Nov.

ABSTRACT

OBJECTIVE: This study aimed to share the early results of the pulmonary endarterectomy program recently implemented in our clinic in the treatment of chronic thromboembolic pulmonary hypertension.

METHODS: Eighteen patients (10 females, 8 males; mean age: 46 years) who underwent pulmonary endarterectomy between October 2022 and August 2024 were included in the retrospective study. Perioperative and follow-up data, including age, in-hospital mortality, and the length of intensive care unit and hospital stays after pulmonary endarterectomy, were evaluated.

RESULTS: The majority of the patients (n=16) were New York Heart Association class III or IV before surgery. According to the University of California, San Diego level classification, almost all patients had at least level 1 and 2 lesions in one or more pulmonary artery (n=17). Cardiopulmonary bypass time, cross-clamp time, and total circulatory arrest time were 174.8±16.6, 34.7±12.2, and 21,7±6.2 min, respectively. The in-hospital mortality rate was 5.5% (n=1), and the morbidity rate was 16.6% (n=3). Extracorporeal membrane oxygenation was performed on two patients (one venoarterial, one venovenous). Both patients were successfully weaned off ECMO. However, the patient who received venoarterial ECMO died due to multiorgan failure in the second postoperative month. After pulmonary endarterectomy, the durations of mechanical ventilation, intensive care stay, and hospital stay before discharge were 6.1±13.1, 17.8±14.7, and 20.01±13.9 days, respectively. The systolic and mean pulmonary artery pressure fell from 97.6±22.6 and 63.1±18.1 mmHg before surgery to 42.5±12.8 and 25.7±6.1 mmHg after surgery.

CONCLUSION: Pulmonary endarterectomy is a highly effective treatment for chronic thromboembolic pulmonary hypertension, providing dramatic clinical improvement in the early term with acceptable mortality and morbidity rates.

PMID:40322154 | PMC:PMC12045168 | DOI:10.5606/tgkdc.dergisi.2024.msb-43

Anaesth Crit Care Pain Med. 2025 Apr 30;44(4):101539. doi: 10.1016/j.accpm.2025.101539. Online ahead of print.

NO ABSTRACT

PMID:40315993 | DOI:10.1016/j.accpm.2025.101539

Diagnostics (Basel). 2025 Apr 10;15(8):961. doi: 10.3390/diagnostics15080961.

ABSTRACT

Background/Objectives: Myocarditis is a major cause of morbidity and mortality in children and can lead to long-term heart failure, dilated cardiomyopathy, the need for heart transplantation, or death. New systemic inflammatory indices that combine lymphocyte, neutrophil, and platelet counts have been recently used as strong prognostic markers of some inflammatory diseases and adverse outcomes of neoplasms. This study aimed to investigate the use of new systemic indices as early predictive markers for adverse outcomes in patients with pediatric myocarditis. Methods: This study retrospectively examined patients between the ages of >1 month and <18 years who were monitored in our clinic with a diagnosis of myocarditis between 1 January 2022 and 31 December 2024. The cases were divided into two groups: fulminant myocarditis (requiring the use of inotropes or extracorporeal membrane oxygenation due to hemodynamic disturbance) and non-fulminant myocarditis. The systemic inflammatory index values of these groups (calculated in the first 6 h) were compared, and the results were statistically analyzed. Results: The study included 122 pediatric myocarditis cases treated during the study period (80 boys; median age: 11 (IQR: 8-14) years). Twenty-six of these patients (21.3%) developed fulminant myocarditis. The median systemic immune-inflammation index (SII) value in the group with fulminant myocarditis was 1300 (IQR: 1000-1600), while this value was 500 (IQR: 350-650) for the non-fulminant group (p < 0.05). The median systemic inflammatory response index (SIRI) values were 2.9 (IQR: 2.5-3.2) in the fulminant myocarditis group and 1.5 (IQR: 1.2-1.8) in the non-fulminant group (p < 0.05). The cut-off values for fulminant myocarditis were found to be 1050 for the SII, with an AUC value of 0.76 (95% confidence interval: 0.80-0.96; p < 0.001), and 1.9 for the SIRI, with an AUC value of 0.64. Conclusions: The SII and SIRI may independently predict adverse myocarditis prognoses in children. These new biomarkers are easy to calculate using routine blood parameters.

PMID:40310387 | PMC:PMC12025616 | DOI:10.3390/diagnostics15080961

Medicina (Kaunas). 2025 Mar 25;61(4):589. doi: 10.3390/medicina61040589.

ABSTRACT

Background and Objective: Probiotics have been shown to be effective in controlling various adverse health conditions such as antibiotic-associated diarrhea, inflammatory bowel disease, obesity, and neurological diseases. However, to our knowledge, there is no research on the preventive effect of probiotics on heart damage caused by infections. This study examined the preventive benefits of probiotics against sepsis-related heart injury using a rat model caused by lipopolysaccharide (LPS). Materials and Methods: Four groups of twenty-four male Wistar albino rats, each with six rats, were set up. For 14 days, Group 1 (Sham Group) was given oral normal saline, intraperitoneal Escherichia coli O111-B4 lipopolysaccharide (LPS Group) was given to Group 2, and oral probiotics were given to Group 3 (Probiotic Group). Escherichia coli O111-B4 lipopolysaccharide was injected intraperitoneally after Group 4 (Probiotic + LPS) received oral probiotics containing Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12 (109 CFU/day). Blood samples were taken twenty-four hours following the administration of LPS. The animals were then euthanized by cervical dislocation, and samples of cardiac tissue were taken in order to assess any damage to the heart. The following serum values were measured: C-reactive protein (CRP), creatine kinase-myocardial band (CK-MB), cardiac troponin subunit I (cTn-I), tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6). The TNF-α, IL-1β, IL-6, glutathione (GSH), malondialdehyde (MDA), Total Oxidant Status (TOS), Total Antioxidant Status (TAS), Oxidative Stress Index (OSI), CRP, CK-MB, and cTn-I levels were assessed in tissue samples. Additionally, staining techniques were used to analyze histopathological alterations in tissues. Results: With the exception of serum IL-6 (p = 0.111), tissue and serum cytokine levels were considerably greater in the sepsis group (Group 2) than in the other groups (p < 0.05 to <0.001). The TAS, GSH, and SOD levels were significantly lower (p < 0.05 to <0.001) in septic rats, although the tissue levels of TOS, OSI, and MDA were significantly higher. With the exception of serum CRP in Group 3 (p = 0.328), the CK-MB, CRP, and cTn-I levels were considerably higher in Group 2 than in the other groups (p < 0.01 to <0.001). When compared to the other groups, histopathological examination showed significant alterations in the LPS group. Conclusions: Probiotics showed positive effects on oxidative stress markers and dramatically decreased sepsis-induced cardiac damage in the LPS-induced sepsis model. These results imply that probiotics could be used as a therapeutic approach to lessen the cardiac damage brought on by sepsis.

PMID:40282880 | PMC:PMC12029071 | DOI:10.3390/medicina61040589

Pain Ther. 2025 Jun;14(3):913-930. doi: 10.1007/s40122-025-00739-1. Epub 2025 Apr 24.

ABSTRACT

Compared with conventional sternotomy, minimally invasive cardiac surgery (MICS) is associated with significant advantages such as reduced tissue trauma, faster recovery, and shorter hospital stay. However, the management of postoperative pain caused by intercostal nerve injury, pleural irritation, and tissue retraction remains a major challenge. Despite the less invasive nature of MICS, patients often report experiencing pain similar to that experienced following conventional cardiac surgery, particularly during the acute postoperative period. Effective pain management is essential for optimizing recovery, reducing the consumption of opioids, and preventing the transition to chronic postsurgical pain. Regional anesthesia techniques play a key role in multimodal analgesia for MICS. Thoracic epidural analgesia exhibits strong analgesic efficacy; nevertheless, it remains underutilized owing to concerns regarding anticoagulation-related complications and hemodynamic instability. The thoracic paravertebral block is a safer alternative that provides comparable pain relief with fewer side effects. Similarly, ultrasound-guided fascial plane blocks, such as serratus anterior, parasternal intercostal, interpectoral + pectoserratus, and erector spinae plane blocks, have gained popularity owing to their safety and feasibility; however, the effectiveness of these blocks varies according to the surgical approach and type of incision. Systemic analgesia is an integral component of multimodal pain management in MICS. Despite the efficacy of opioids, a shift toward opioid-sparing strategies has been observed given the significant adverse effects associated with the use of opioids. Intravenous adjuncts such as dexmedetomidine, ketamine, and non-steroidal anti-inflammatory drugs can reduce opioid consumption and improve postoperative pain control. Despite advances in pain management, a single approach that can provide comprehensive analgesia for MICS remains to be established. A multimodal strategy that combines systemic and regional techniques must be developed to optimize pain management and long-term outcomes.

PMID:40272720 | PMC:PMC12085451 | DOI:10.1007/s40122-025-00739-1

Eur J Anaesthesiol. 2025 Jun 1;42(6):500-507. doi: 10.1097/EJA.0000000000002142. Epub 2025 Feb 21.

ABSTRACT

BACKGROUND: The predictability of severe and refractory postpartum haemorrhage (PPH) remains a challenge for clinicians and researchers.

OBJECTIVE: We aimed to evaluate the ability of the shock index to predict refractory PPH.

DESIGN: This study was a secondary analysis of a multicentre, prospective, observational study investigating the association between severe postpartum haemorrhage (PPH) and the subsequent development of mental disorders.

SETTING: Participants were patients who experienced severe PPH, characterised by blood loss of at least 1500 ml requiring the administration of sulprostone. The shock index, defined as the ratio of heart rate to SBP, was recorded at two time points: at the start of sulprostone infusion (T0) and at the time of the most severe symptoms after enrolment but before the occurrence of refractory PPH (T1). Refractory PPH was defined by the need for four or more blood products, interventional radiology, or laparotomy (excluding caesarean section).

THE MAIN OUTCOME: The predictive ability of the shock index was assessed using univariate and multivariate logistic regression and area under the receiver operating characteristic curve (AUROC).

RESULTS: From November 2014 to November 2016, 332 patients experienced severe PPH, of which 316 were included in the final analysis. The prevalence of refractory PPH was 35.4% (112/316). We found that high shock index levels at T0 were independently associated with the occurrence of refractory PPH: odds ratio (OR) 3.07 [95% confidence interval (CI), 1.22 to 7.89, P = 0.017]. In addition, high shock index levels at T1 were also independently associated with the occurrence of refractory PPH: OR 5.28 (95% CI, 2.25 to 12.8), P < 0.001. The AUROC of shock index levels measured at T0 and T1 were 0.614 (95% CI, 0.549 to 0.678) and 0.681 (95% CI, 0.616 to 0.746), respectively.

CONCLUSION: The shock index measured at the start of sulprostone infusion and at the worst time after enrolment, has poor discriminative power to predict this event.

PMID:40265724 | DOI:10.1097/EJA.0000000000002142

Saudi J Anaesth. 2025 Apr-Jun;19(2):181-189. doi: 10.4103/sja.sja_829_24. Epub 2025 Mar 25.

ABSTRACT

Chronic postsurgical pain (CPSP) is a prevalent and debilitating sequela of cardiac surgery, exerting a profound impact on patients' quality of life, functional recovery, and healthcare systems. Its pathophysiology includes complex mechanisms, including peripheral and central sensitization, neuroplastic alterations, and inflammatory pathways, influenced by demographic, psychological, and perioperative factors. Inadequate management of acute pain is a critical contributor to its development. This review examines the etiology of CPSP, presents key risk factors, and critically evaluates pharmacological and nonpharmacological interventions. Particular attention is devoted to the role of regional anesthesia techniques and emerging preventive and therapeutic strategies, highlighting the necessity of multidisciplinary, evidence-informed approaches to address this persistent clinical challenge.

PMID:40255354 | PMC:PMC12007855 | DOI:10.4103/sja.sja_829_24

Curr J Neurol. 2024 Jul 5;23(3):197-198. doi: 10.18502/cjn.v23i3.17629.

NO ABSTRACT

PMID:40231035 | PMC:PMC11994065 | DOI:10.18502/cjn.v23i3.17629

Am J Transl Res. 2025 Mar 15;17(3):1985-1995. doi: 10.62347/HZWL9608. eCollection 2025.

ABSTRACT

OBJECTIVES: In this study, we evaluated perioperative pain management using the Analgesia Nociception Index (ANI) monitoring in high-risk ASA III-IV patients scheduled for hip surgery. Specifically, we examined the lumbar plexus (LP), sacral plexus (SP), and supra-inguinal fascia iliaca compartment blocks (SIFIB), as well as combinations of SP blocks.

METHODS: In this prospective observational study, we included 74 patients who were assigned to one of two groups: Group L, which received LP and SP blocks, and Group F, which received SIFIB and SP blocks. Surgery was performed after confirming the sensory block with the pinprick test and applying the sedation protocol. Sedation levels were evaluated using the BIS monitor whereas analgesic requirements were assessed using the ANI monitor. Demographic data, including age, sex, ASA score, SpO2, heart rate (HR), mean arterial pressure (MAP), duration of sensorimotor block, type and duration of surgery, time to first analgesic use, and total analgesic consumption, were recorded. Visual analog scale (VAS) scores at 0, 6, 12, and 24 h additional analgesic requirements, and satisfaction ratings from patients and surgeons were also evaluated.

RESULTS: Compared to Group F, Group L presented significantly greater ANI values at 30, 60, 90 min intraoperatively, as well as at 6 and 12 h postoperatively. The VAS scores were consistently higher in Group F than in Group L at all measurement times.

CONCLUSION: Group L provided better analgesia, required fewer sedatives during surgery, and had greater satisfaction among patients and surgeons. A negative correlation was found between the VAS score and ANI for assessing patient pain.

PMID:40225986 | PMC:PMC11982881 | DOI:10.62347/HZWL9608