Anestesia y reanimación cardiovascular

Diagnostics (Basel). 2025 Jul 22;15(15):1839. doi: 10.3390/diagnostics15151839.

ABSTRACT

Background: Down syndrome (DS) is associated with unique anatomical and physiological characteristics that complicate the perioperative management of infants undergoing cardiac surgery. While ventricular septal defect (VSD) repair is commonly performed in this population, detailed data comparing perioperative outcomes in DS versus non-syndromic infants remain limited. Methods: This retrospective matched study analysed 100 infants (50 with DS and 50 without DS) who underwent isolated VSD closure between January 2021 and January 2025. Patients were matched by age and surgical date. Intraoperative anesthetic management, complications, postoperative outcomes, and mortality were compared between groups. Results: DS patients had lower age, weight, and height at surgery. They required significantly smaller endotracheal tube sizes, more intubation and vascular access attempts. The DS group had significantly lower rates of extubation in the operating room and experienced longer durations of mechanical ventilation and ICU stay. However, no significant differences were observed in total hospital stay or mortality between groups. Conclusions: Although DS infants present with increased anesthetic complexity and respiratory challenges, they do not exhibit higher surgical mortality following isolated VSD closure. Tailored perioperative strategies may improve respiratory outcomes in this high-risk group.

PMID:40804803 | PMC:PMC12346779 | DOI:10.3390/diagnostics15151839

Anesthesiology. 2025 Sep 1;143(3):518-532. doi: 10.1097/ALN.0000000000005559. Epub 2025 Aug 12.

ABSTRACT

Cardiac output is a key cardiovascular variable quantifying global blood flow. The measurement performance of cardiac output monitoring methods is investigated in validation studies, which are method comparison studies determining the agreement between cardiac output values measured with a test method and those measured with a reference method. The StatistiCal analysis and repOrting of cardiac output Method comPARison studiEs (COMPARE) statement provides a framework for designing, performing, and reporting cardiac output method comparison studies and includes a checklist of 29 items that are essential for reporting of those studies. Considering and reporting the items specified in the COMPARE checklist will help standardize cardiac output method comparison studies and increase the external validity of the results.

PMID:40793805 | DOI:10.1097/ALN.0000000000005559

Resusc Plus. 2025 Jun 24;25:101017. doi: 10.1016/j.resplu.2025.101017. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a major public health problem. This study aims to describe the international variations in the practices related to the initiation, termination, and refraining from resuscitation of adult patients (≥18 years) with a non-traumatic OHCA.

METHODS: An exploratory descriptive study was conducted using a cross-sectional online survey. The respondents were recruited using snowball sampling technique. Framework analysis was used to identify key themes in responses, with descriptive statistics summarising data trends.

RESULTS: The study collected responses from 59 countries. Our findings reveal that respondents from 59.3% of countries reported that they initiate resuscitation in all cases where the patients do not show obvious signs of irreversible death or do not have confirmed advance directives. Respondents from 15.3% of countries reported that once started, prehospital resuscitation attempts are not terminated. Prehospitally respondents from 20.3% of the countries reported that they rely exclusively on specific criteria to decide when to terminate resuscitation efforts while in 45.8%, these decisions are made at the discretion of the provider. Respondents from most countries (91.5%) reported that they refrain from resuscitation in the presence of obvious signs of irreversible death. Respondents from 57.6% of countries, reported that they refrained from resuscitation if the patient had a confirmed do-not-attempt-cardiopulmonaryresuscitation (DNACPR), while 15.3% mentioned staff safety as a reason to abstain from attempting resuscitation.

CONCLUSION: This study reveals global variation in EMS resuscitation practices, reflecting disparities in resources, healthcare infrastructure, EMS system design, community acceptability given cultural and societal norms, and legislation.

PMID:40777886 | PMC:PMC12329125 | DOI:10.1016/j.resplu.2025.101017

J Anesth Analg Crit Care. 2025 Aug 6;5(1):50. doi: 10.1186/s44158-025-00271-w.

ABSTRACT

BACKGROUND: Perineural dexamethasone is widely used as an adjuvant to local anesthetics in regional anesthesia to prolong analgesia. However, concerns persist regarding its potential neurotoxic effects, particularly when administered perineurally. This systematic review aims to synthesize preclinical evidence evaluating the neurotoxicity or neuroprotective properties of perineural dexamethasone.

METHODS: A systematic search of PubMed, CENTRAL, Scopus, and Embase was conducted through May 22, 2025. Eligible studies included in vivo or in vitro preclinical models assessing the neurotoxic or neuroprotective effects of perineural dexamethasone compared to control conditions. Risk of bias was assessed using the SYRCLE tool for in vivo studies and a narrative evaluation for in vitro studies. A total of 14 studies (11 in vivo, 3 in vitro) met inclusion criteria.

RESULTS: In vitro studies showed that dexamethasone alone was not neurotoxic at clinically relevant doses but could enhance cytotoxicity when combined with local anesthetics at higher concentrations. In vivo models generally demonstrated no significant long-term nerve inflammation, degeneration or demyelination, with some early protective effects observed in perineural dexamethasone groups. However, all in vivo studies were rated at high risk of bias. In nerve injury models, dexamethasone reduced apoptotic and inflammatory markers when administered immediately post-injury, with limited effect when delayed.

CONCLUSIONS: Preclinical evidence supports the general safety of low-dose, preservative-free perineural dexamethasone. Nonetheless, high-dose use, additives, and application in patients with neuropathies may pose risks. Given the high risk of bias in existing studies and minimal added benefit over systemic administration, clinical caution is advised.

PMID:40770367 | PMC:PMC12329900 | DOI:10.1186/s44158-025-00271-w

Intensive Care Med. 2025 Sep;51(9):1674-1686. doi: 10.1007/s00134-025-08070-1. Epub 2025 Aug 6.

ABSTRACT

Extracorporeal Life Support (ECLS), including venovenous (VV) extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R) is a temporary support option for patients with severe respiratory failure. Current data and recent guidelines support the use of VV ECMO for select patients with very severe respiratory failure as this technique might improve survival in appropriately selected patients. Patient selection criteria, timing of ECMO initiation and optimal management of mechanical ventilation and anticoagulation, and other adjunctive treatment options are a matter of ongoing research.

PMID:40768066 | DOI:10.1007/s00134-025-08070-1

Front Med (Lausanne). 2025 Jul 18;12:1649654. doi: 10.3389/fmed.2025.1649654. eCollection 2025.

NO ABSTRACT

PMID:40757198 | PMC:PMC12313688 | DOI:10.3389/fmed.2025.1649654

Br J Anaesth. 2025 Oct;135(4):1119-1121. doi: 10.1016/j.bja.2025.06.035. Epub 2025 Aug 5.

NO ABSTRACT

PMID:40753004 | DOI:10.1016/j.bja.2025.06.035

J Cardiothorac Vasc Anesth. 2025 Oct;39(10):2677-2684. doi: 10.1053/j.jvca.2025.07.008. Epub 2025 Jul 11.

ABSTRACT

OBJECTIVES: To compare the efficacy of single-level and two-level deep parasternal intercostal plane (DPIP) blocks in managing postoperative pain in cardiac surgery patients undergoing median sternotomy.

DESIGN: A prospective, randomized controlled study.

SETTING: A cardiac surgery unit in a tertiary hospital, conducted under institutional ethical approval.

PARTICIPANTS: Adult patients (≥18 years) undergoing elective coronary artery bypass grafting (CABG), valve surgery, or combined CABG + valve procedures. Exclusion criteria included allergies to local anesthetics, emergency surgeries, reoperations, chronic pain, and major comorbidities.

INTERVENTIONS: Single-level DPIP block: 10 mL of 0.25% bupivacaine bilaterally at the T4/5 intercostal space. Two-level DPIP block: 5 mL bilaterally at T2/3 and T5/6 intercostal spaces. All blocks were administered preoperatively under ultrasound guidance.

MEASUREMENTS AND MAIN RESULTS: Both techniques provided effective analgesia. However, single-level blocks yielded significantly lower pain scores at 4, 6, and 8 hours, particularly during movement and in patients undergoing CABG. Differences decreased at 12 hours and disappeared by 24 hours. Pain scores were inversely correlated with age. No block-related complications were observed.

CONCLUSIONS: Single-level DPIP blocks demonstrated more consistent early analgesia and were technically simpler to perform. Given their efficacy, safety, and efficiency, single-level blocks may serve as a practical alternative for routine use in cardiac surgery. Further research is warranted to optimize block level, volume, and concentration based on patient and surgical characteristics.

PMID:40750549 | DOI:10.1053/j.jvca.2025.07.008

Crit Care. 2025 Jul 31;29(1):340. doi: 10.1186/s13054-025-05545-x.

ABSTRACT

Circulating dipeptidyl peptidase 3 is a new biomarker linked to circulatory failure prognosis and pathophysiology and is a potential actionable therapeutic target. In this short review intended for the clinician, a question-and-answer format provides key insights on the nature of this biomarker and the therapeutical potential of its targeted inhibition in critically ill patients.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-025-05545-x.

PMID:40745610 | PMC:PMC12315211 | DOI:10.1186/s13054-025-05545-x

Crit Care. 2025 Jul 31;29(1):339. doi: 10.1186/s13054-025-05526-0.

ABSTRACT

Monitoring inspiratory drive and effort may aid proper selection and setting of respiratory support in patients with acute respiratory failure (ARF), whether they are intubated or not. Although diaphragmatic electrical activity (EAdi) and esophageal manometry can be considered the reference methods for assessing respiratory drive and inspiratory effort, respectively, various alternative techniques exist, each with distinct advantages and limitations. This narrative review provides a comprehensive overview of bedside methods to assess respiratory drive and effort, with a primary focus on patients with ARF. First, EAdi and esophageal manometry are described and discussed as reference techniques. Then, alternative methods are categorized along the neuromechanical pathway from inspiratory drive to muscular effort into three groups: (1) techniques assessing the respiratory drive: airway occlusion pressure (P0.1), mean inspiratory flow (Vt/Ti) and respiratory muscle surface electromyography (sEMG); (2) techniques assessing the respiratory muscle effort: whole-breath occlusion pressure (ΔPocc), pressure-muscle index (PMI), nasal pressure swing (ΔPnose), diaphragm ultrasonography (USdi), central venous pressure swing (ΔCVP), breathing effort (BREF) models, and flow index; (3) techniques and clinical parameters assessing the consequences of effort: tidal volume (Vt), electrical impedance tomography (EIT), dyspnea. For each, we summarize the physiological rationale, measurement methodology, interpretation of results, and key limitations.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-025-05526-0.

PMID:40745324 | PMC:PMC12315345 | DOI:10.1186/s13054-025-05526-0

Medicina (Kaunas). 2025 Jul 18;61(7):1298. doi: 10.3390/medicina61071298.

ABSTRACT

Objective: This study aimed to investigate the cardioprotective effects of bosentan, an endothelin receptor antagonist, in a rat model of lung ischemia-reperfusion (I/R) injury, with a focus on myocardial tissue involvement. Methods: Twenty-four male Wistar rats were randomly assigned to four groups: sham, bosentan, I/R, and I/R + bosentan. Lung I/R injury was induced by hilar clamping for 45 min, followed by 60 min of reperfusion. Bosentan (30 mg/kg) was administered intraperitoneally 30 min prior to the procedure. Myocardial tissue was evaluated histopathologically for structural disorganization, inflammation, fibrosis, and edema. TGF-β1 protein levels in myocardial tissue were compared across the groups using β-actin as the loading control. ELISA was used to quantify ET-1, NF-κB, and p53 levels, while spectrophotometric analysis was employed to assess MDA levels and the activities of SOD and CAT enzymes in heart tissue. Results: The I/R group exhibited significant myocardial disorganization, inflammation, and interstitial edema compared to the sham and bosentan groups. Bosentan treatment markedly ameliorated these histopathological alterations. Additionally, the I/R group showed elevated levels of ET-1, NF-κB, p53, and MDA, along with reduced SOD and CAT activities; these changes were significantly attenuated by bosentan administration. Bosentan treatment significantly reduced myocardial ET-1 levels (from 136.88 ± 5.02 to 120.18 ± 2.67 nmol/g, p = 0.003), NF-κB levels (from 0.87 ± 0.04 to 0.51 ± 0.03 ng/mg, p = 0.002), and TGF-β1 expression (from 1.72 ± 0.10 to 0.91 ± 0.08 relative units, p = 0.001). Moreover, bosentan increased antioxidant enzyme activities, elevating SOD levels from 21.45 ± 1.23 to 32.67 ± 1.45 U/mg protein (p = 0.001) and CAT levels from 15.22 ± 0.98 to 25.36 ± 1.12 U/mg protein (p = 0.002). Conclusions: Bosentan exerts cardioprotective effects in rats subjected to lung I/R injury by reducing myocardial damage, inflammation, and oxidative stress. These findings suggest that bosentan may serve as a potential therapeutic agent for preventing remote organ injury associated with pulmonary I/R.

PMID:40731929 | PMC:PMC12299891 | DOI:10.3390/medicina61071298

Braz J Cardiovasc Surg. 2025 Jul 24;40(4):e20240325. doi: 10.21470/1678-9741-2024-0325.

ABSTRACT

INTRODUCTION: Previous studies suggest that the location of coronary artery disease cannot independently predict atrial fibrillation after coronary artery bypass grafting, but with little information, it has also been thought that simultaneous right coronary endarterectomy may cause this rhythm problem.

OBJECTIVE: In this study, we aimed to evaluate the effect of right coronary artery bypass grafting on early postoperative atrial fibrillation.

METHODS: Patients who underwent elective on-pump coronary artery bypass grafting operations in our hospital were included in the study, and patients who underwent a different open-heart surgery or those who had previously undergone open-heart surgery were not included. Patients included in the study were divided into Group 1 (patients who developed postoperative atrial fibrillation) and Group 2 (patients who did not develop postoperative atrial fibrillation) and compared in terms of right coronary artery bypass grafting and other follow-up parameters.

RESULTS: The mean age of a total of 158 patients included in the study was determined as 63.25 ± 10.07 years (range 44 - 85 years), 120 were male, and 96% of them had hypertension. Postoperative atrial fibrillation developed in 43 patients, and right coronary artery bypass grafting was performed in 123 patients.

CONCLUSION: We think that the frequency of postoperative atrial fibrillation development may be higher in cases where right coronary artery bypass grafting is performed, as it may play a role in processes related to the conduction system and right ventricular dysfunction, and multicenter studies with a large number of patients would be beneficial on this subject.

PMID:40705943 | DOI:10.21470/1678-9741-2024-0325

Intensive Care Med. 2025 Aug;51(8):1476-1489. doi: 10.1007/s00134-025-08036-3. Epub 2025 Jul 24.

ABSTRACT

BACKGROUND: Noninvasive respiratory supports are routinely applied in critically ill patients with acute respiratory failure to avoid intubation and invasive mechanical ventilation, thereby reducing the risk of related complications, and to facilitate successful weaning from mechanical ventilation after extubation. They are also applied during the intubation procedure for preoxygenation with the aim of enhancing oxygenation and ensuring the safety of the procedure.

MAIN BODY: High-flow nasal oxygen decreases airway dead space, provides a stable concentration of inspired oxygen, generates low level of flow-dependent positive airway pressure, and optimizes comfort. Positive-pressure noninvasive supports include continuous positive-airway pressure and noninvasive ventilation and enable providing higher end-expiratory pressure, thereby further improving oxygenation. Noninvasive ventilation, but not continuous positive-airway pressure, better decreases inspiratory effort, and increases tidal volume and transpulmonary driving pressure.

CONCLUSION: High-flow nasal oxygen has become the first-line therapy in acute hypoxemic respiratory failure, while noninvasive ventilation remains the reference treatment during exacerbations of chronic obstructive pulmonary disease, in patients with respiratory acidosis. In patients requiring intubation, noninvasive ventilation is the optimal technique for preoxygenation to decrease the risk of hypoxemia, while high-flow nasal oxygen is an alternative option for non-hypoxemic patients or those with contraindications to noninvasive ventilation. After extubation in patients at high risk of reintubation, prophylactic noninvasive ventilation, eventually alternating with high-flow nasal oxygen, improves weaning outcome compared to other strategies; high-flow nasal oxygen alone outperforms conventional oxygen in low-risk patients.

PMID:40705073 | DOI:10.1007/s00134-025-08036-3

J Clin Anesth. 2025 Sep;106:111939. doi: 10.1016/j.jclinane.2025.111939. Epub 2025 Jul 22.

NO ABSTRACT

PMID:40700889 | DOI:10.1016/j.jclinane.2025.111939

CJC Open. 2025 Apr 21;7(7):860-870. doi: 10.1016/j.cjco.2025.04.008. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: To determine, among patients who underwent major noncardiac thoracic surgery, the association between smoking and perioperative atrial fibrillation (AF) and myocardial injury after noncardiac surgery (MINS), and whether the effect of colchicine use on these outcomes varied by smoking status.

METHODS: This study is a subgroup analysis of the Colchicine for the Prevention of Perioperative Atrial Fibrillation (COP-AF) randomized clinical trial. A total of 3209 participants who underwent major noncardiac thoracic surgery were randomized to receive colchicine, 0.5 mg twice daily, or identical placebo, for 10 days starting 2-4 hours before surgery. The co-primary outcomes were clinically significant perioperative AF and MINS during the 14-day follow-up.

RESULTS: A total of 687 (21.4%) were current smokers, 1577 (49.1%) were former smokers, and 945 (29.5%) were never smokers. AF occurred in 7.7%, 7.6%, and 5.3%, and MINS occurred in 21.0%, 19.7%, and 17.6% of current, former, and never smokers, respectively. Compared to never smokers, the adjusted hazard ratio for AF was 1.72 (95% confidence interval [CI] 1.07-2.77, P = 0.02) in current smokers and 1.46 (95% CI 0.99-2.16, P = 0.06) in former smokers, and the adjusted hazard ratio for MINS was 1.16 (95% CI 0.87-1.54, P = 0.32) in current smokers and 1.02 (95% CI 0.81-1.28, P = 0.88) in former smokers. No interaction occurred between smoking status and colchicine allocation for AF (interaction P, 0.82) or MINS (interaction P, 0.08).

CONCLUSIONS: Current smoking was associated with a small but increased risk of perioperative AF but not MINS after thoracic surgery. The effect of colchicine use on either outcome was not modified by smoking status.

CLINICAL TRIAL REGISTRATION: NCT03310125.

PMID:40698308 | PMC:PMC12277807 | DOI:10.1016/j.cjco.2025.04.008

J Cardiothorac Vasc Anesth. 2025 Oct;39(10):2660-2669. doi: 10.1053/j.jvca.2025.06.053. Epub 2025 Jun 28.

ABSTRACT

OBJECTIVE: This study was designed to compare the hemodynamic effects of acute normovolemic hemodilution (ANH) and norepinephrine infusion during autologous blood donation, with a particular focus on cardiac cycle efficiency (CCE), an energy-based parameter of cardiovascular performance.

DESIGN: A prospective, randomized clinical trial.

SETTINGS: Single-center, academic hospital.

PARTICIPANTS: Forty patients undergoing coronary artery bypass graft surgery.

INTERVENTIONS: In the ANH group, a crystalloid solution was administered simultaneously to the contralateral upper extremity. The volume of replacement fluid was calculated at a 3:1 ratio relative to the volume of blood withdrawn. In the norepinephrine infusion (NA) group, no fluid was administered during the donation process. Instead, norepinephrine infusion was administered at a rate of 0.05 µg/kg/min.

MEASUREMENTS AND MAIN RESULTS: Hemodynamic parameters were monitored at three time points during the blood donation process. The primary outcome was the comparison of CCE changes between groups. Secondary outcomes included other advanced hemodynamic variables, metabolic indicators, and short-term postoperative clinical results. Changes in CCE during autologous blood donation were comparable between groups (ANH: 0.20 ± 0.51, NA: 0.5 ± 0.57, p = 0.373). Hemodynamic stability was achieved in both groups, with no relevant differences in cardiac index, stroke volume index, or metabolic markers (p > 0.05). Dynamic preload parameters showed expected physiological patterns in the norepinephrine group, consistent with volume-sparing circulatory support. None of the patients experienced acute kidney injury. There was no difference between the groups in terms of intensive care unit or hospital length of stay.

CONCLUSIONS: Norepinephrine infusion demonstrated hemodynamic equivalence to ANH in the setting of autologous blood donation during coronary artery bypass graft surgery. Its ability to preserve circulatory function without fluid administration suggests it may serve as a viable alternative to ANH, particularly in patients requiring careful volume management.

PMID:40695683 | DOI:10.1053/j.jvca.2025.06.053

Intensive Care Med. 2025 Jul;51(7):1240-1255. doi: 10.1007/s00134-025-08012-x. Epub 2025 Jul 16.

ABSTRACT

Post-cardiac arrest brain injury (PCABI) emanates from the injurious pathophysiologic sequelae that take place during and after resuscitation from cardiac arrest. Regrettably, identification of efficacious management strategies to mitigate PCABI has been disappointing with numerous well-conducted randomized control trials yielding neutral results. The reasons for this observation are likely multifactorial, however, increasingly patient and disease-specific heterogeneity is recognized as a crucial factor in clinical decision-making. Traditionally, PCABI has been stratified based upon simple historical characteristics (e.g. location of cardiac arrest, initial rhythm, witnessed vs. unwitnessed) that inadequately reflect in vivo PCABI severity or responses to clinical interventions within individual patients. It is therefore increasingly clear that this approach to PCABI is insufficient. In other syndromes, such as sepsis or acute respiratory distress syndrome, attempts to identify early "phenotypes" of patients reflect growing recognition of considerable between-patient heterogeneity in the disease mechanisms and response to therapeutic interventions. A similar approach should be taken with PCABI. In this review, we described the clinical heterogeneity and phenotypes of PCABI as related to the underlying pathophysiology, selective anatomical vulnerability and electrographic patterns. The overarching aim of the review is the propose a shift to expeditious phenotyping of PCABI severity that focuses on assessing in vivo severity and patterns of injury that could be used for future targeted therapies. We will also discuss potential causes of heterogeneous clinical responses to interventions and highlight future research areas for PCABI that focus on phenotyping and incorporating these considerations into clinical trials.

PMID:40668231 | PMC:PMC12283859 | DOI:10.1007/s00134-025-08012-x

Ann Intensive Care. 2025 Jul 15;15(1):99. doi: 10.1186/s13613-025-01509-0.

ABSTRACT

The objective of this work was to develop guidelines for nutritional support in critically ill adults and children (excluding neonates and burn patients) unable to maintain an adequate oral intake. We aimed to provide up-to-date recommendations based on high-level evidence including the results of recent landmark randomized controlled trials. Experts from the French Intensive Care Society (SRLF), the French Society of Clinical Nutrition and Metabolism (SFNCM), and the French-Speaking Group of Pediatric Emergency Physicians and Intensivists (GFRUP) used the GRADE methodology to develop the guidelines. Twenty-four Patient Intervention Comparator Outcome (PICO) questions were identified, resulting in 34 adult and 29 pediatric recommendations. Of the 34 recommendations for adults, three were based on high-level evidence, 12 on moderate-level evidence, and 19 on expert opinion. The corresponding numbers for the 29 pediatric recommendations were one, five, and 23. All recommendations achieved strong agreement among the experts. These guidelines emphasize the importance of individualized nutritional support strategies that incorporate recent high-quality evidence to optimize the outcomes of critically ill patients.

PMID:40665004 | PMC:PMC12263543 | DOI:10.1186/s13613-025-01509-0

Saudi J Anaesth. 2025 Jul-Sep;19(3):363-367. doi: 10.4103/sja.sja_810_24. Epub 2025 Jun 16.

ABSTRACT

BACKGROUND: This study aimed to investigate the protective effects of intravenous lipid emulsion (ILE) against bupivacaine-induced cardiac toxicity, using histopathological analyses.

METHODS: Twenty-eight adult male Wistar-Albino rats were divided into four groups: Sham (Group A), ILE (Group B), Bupivacaine (Group C), and Bupivacaine + ILE (Group D). Neurotoxicity was induced in Groups C and D with continuous bupivacaine infusion. ILE was administered to Groups B and D. Histological examination of brain tissues, and apoptotic index were evaluated.

RESULTS: The apoptotic index was significantly higher in Group C, but ILE administration in Group D markedly decreased these parameters (P < 0.05). Histopathological analysis revealed that ILE reduced edema and neuronal degeneration in Group D.

CONCLUSION: ILE demonstrated a neuroprotective effect against bupivacaine-induced cardiac toxicity by improving hemodynamic stability and reducing cellular damage. This suggests a potential therapeutic role of ILE in managing local anesthetic systemic toxicity.

PMID:40642616 | PMC:PMC12240504 | DOI:10.4103/sja.sja_810_24

Reg Anesth Pain Med. 2025 Jul 10:rapm-2025-106901. doi: 10.1136/rapm-2025-106901. Online ahead of print.

NO ABSTRACT

PMID:40639952 | DOI:10.1136/rapm-2025-106901