Anestesia y reanimación cardiovascular

Turk J Anaesthesiol Reanim. 2025 Jul 24;53(4):163-169. doi: 10.4274/TJAR.2025.241778. Epub 2025 Jul 9.

ABSTRACT

OBJECTIVE: In the present study, European Cardiac Operative Risk Assessment System II (EuroSCORE II) and the Society of Thoracic Surgery (STS) risk scoring systems were used to predict mortality in patients who underwent various types of open-heart surgery, including coronary artery bypass grafting, aortic valve replacement, mitral valve replacement, and combined valve surgery with coronary artery bypass grafting, in the cardiovascular surgery operating room. The aim was to compare risk assessment systems regarding their clinical applicability.

METHODS: A total of 469 patients, 141 (30.1%) female and 328 (69.9%) male, were included in the study. All risk factors were retrospectively recorded according to the EuroSCORE II and STS risk assessment systems. Statistical analysis was performed using the receiver operating characteristic (ROC) curve. Predicted and actual mortality rates were compared for each risk-scoring system.

RESULTS: When the ability of the EuroSCORE and STS risk classifications to predict mortality was analyzed using the ROC curve, the area under the curve for the EuroSCORE II risk score was 78.3% (P < 0.001), while the area under the curve for the STS risk score was 82.3% (P < 0.001). In our study, the STS scoring system was found to have a greater predictive value than EuroSCORE II. When the patients' observed and expected mortality rates were examined according to the EuroSCORE II and STS risk scores, no statistically significant relationship was found between the expected and observed mortality rates for each risk group.

CONCLUSION: In our study, the STS risk scoring system was found to be more accurate in predicting in-hospital mortality than the EuroSCORE. However, there was no statistically significant difference between the expected and observed mortality rates in either risk-scoring system. There is no consensus in the literature regarding which scoring system is more effective. More studies from different societies are needed.

PMID:40631722 | PMC:PMC12288423 | DOI:10.4274/TJAR.2025.241778

Genet Med. 2025 Sep;27(9):101514. doi: 10.1016/j.gim.2025.101514. Epub 2025 Jul 2.

ABSTRACT

PURPOSE: Collagen type 4 alpha 1 (COL4A1) and alpha 2 (COL4A2) chains, encoded by COL4A1 and COL4A2, are essential for basement membrane integrity, contributing to structural stability and cell regulation. Pathogenic variants in these genes cause a spectrum of autosomal dominant and, more rarely, autosomal recessive disorders, which are collectively known as COL4A1/A2-related disorders. These multisystem disorders can include neurologic, ophthalmologic, renal, and other organ system pathology and vary widely in symptoms, complicating diagnosis and management.

METHODS: Using a modified eDelphi method, we obtained consensus from international experts across medical subspecialties on the evaluation and management of COL4A1/A2-related disorders, with consensus set at ≥70% agreement.

RESULTS: Consensus was achieved on recommendations for evaluating and managing these conditions.

CONCLUSION: Genetic testing and counseling are advised for individuals showing symptoms of COL4A1/A2-related disorders and for at-risk relatives. Given the complexity and rarity of these disorders, management requires a multidisciplinary approach informed by current understanding of disease mechanisms. Recommended care includes neurological and ophthalmological imaging and monitoring of cardiovascular and renal function. Ongoing research is critical to uncover genotype-phenotype links and potential modifiers, with clinical research participation encouraged to advance knowledge and treatments.

PMID:40616396 | DOI:10.1016/j.gim.2025.101514

Crit Care. 2025 Jul 3;29(1):273. doi: 10.1186/s13054-025-05505-5.

ABSTRACT

BACKGROUND: Vasopressin is currently suggested as a second-line vasopressor in patients with septic shock and persistent arterial hypotension. This survey aimed to assess the current use of vasopressin and terlipressin in patients with septic shock.

METHODS: An international survey endorsed by the European Society of the Intensive Care Medicine. All items addressed the different areas of uncertainty and research identified from current international recommendations. RESULTS: 1919 intensivists from 124 countries responded to the survey: 1220(64%) worked in Europe, 1430(74%) in high and upper-middle income level countries and 916(48%) in academic ICUs. Vasopressin or terlipressin were available to 1830(95%) respondents. The main reported indications were refractory septic shock, catecholamine sparing in all types of refractory shock, refractory vasoplegic shock (other than septic) without reduced left ventricular systolic function and septic shock with high cardiac output and low systemic vascular resistance (73%,53%,51% and 49% of respondents, respectively). The main reported contraindications were non-occlusive mesenteric ischemia and digital or skin ischemia. Overall, 1506(78%) respondents used vasopressin or terlipressin, 93% of them as a second-line vasopressor after initial resuscitation, mainly to increase blood pressure and reduce the catecholamine load. The dose of norepinephrine alone or the duration of norepinephrine administration alone triggered vasopressin and terlipressin initiation for 98% and 53% of respondents, respectively: the most frequent dose of norepinephrine base was 0.25-0.50 µg/kg/min and the most frequent duration was > 2-6 h. The combination of the dose of norepinephrine base and the duration of its administration triggered vasopressin and terlipressin initiation for 78% of respondents, the most frequent combination being a norepinephrine base dose > 0.25 or > 0.50 µg/kg/min for > 2-6 h. An initial dose of vasopressin of 0.01 or 0.03 U/min was used by 50% of respondents. The mean arterial pressure level triggered the tapering of vasopressin or terlipressin for 88% of respondents. Discontinuation started after the dose of the first-line vasopressor had been lowered below a predefined threshold for 43% of respondents and was progressive for 89% of respondents.

CONCLUSIONS: Vasopressin is commonly used to treat patients with septic shock, but its handling (doses and discontinuation practices) remains heterogeneous, indicating the need for guidance in its clinical use.

PMID:40611266 | PMC:PMC12231731 | DOI:10.1186/s13054-025-05505-5

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