Ir J Med Sci. 2025 Oct 7. doi: 10.1007/s11845-025-04102-3. Online ahead of print.
ABSTRACT
BACKGROUND: Preoperative anxiety adversely affects anesthetic management, hemodynamic stability, and recovery. Among modifiable perioperative variables, the impact of preoperative waiting time on anxiety and postoperative outcomes has been insufficiently explored.
AIM: To assess the relationship between waiting time and perioperative anxiety, hemodynamic responses, intraoperative opioid use, and postoperative analgesic requirements in adults undergoing elective surgery under general anesthesia.
METHODS: In this prospective observational study, 130 ASA I-II adults were evaluated in the preoperative waiting area. The Amsterdam Preoperative Anxiety and Information Scale (APAIS), systolic blood pressure, and heart rate were measured on arrival and immediately pre-induction. Waiting time was the interval between these assessments. Intraoperative fentanyl/remifentanil doses and postoperative tramadol consumption were recorded. Pearson correlation and linear regression were used (p < 0.05).
RESULTS: Longer waiting times were associated with higher pre-induction APAIS scores (r = 0.339, p < 0.001) and greater postoperative tramadol use (r = 0.333, p < 0.001). Waiting time inversely correlated with preoperative systolic blood pressure (r = - 0.253, p = 0.004). Associations with intraoperative opioid doses were not significant. Female sex, lower education, prior surgery, and negative surgical experiences were associated with higher anxiety. Midazolam premedication did not prevent anxiety escalation in patients with extended waiting times.
CONCLUSION: Preoperative waiting time is a modifiable, hospital-based factor that meaningfully influences perioperative anxiety and postoperative analgesic demand. Reducing unnecessary delays through individualized perioperative planning may enhance patient comfort, support hemodynamic stability, and reduce postoperative analgesic requirements.
PMID:41055853 | DOI:10.1007/s11845-025-04102-3
Medicine (Baltimore). 2025 Oct 3;104(40):e44919. doi: 10.1097/MD.0000000000044919.
ABSTRACT
BACKGROUND: In our study, we aimed to evaluate the frequency of early postoperative sepsis, the factors affecting it and the outcomes of sepsis in patients treated in a postoperative intensive care unit (PICU).
METHODS: Postoperative patients treated in PICU between July 15, 2021 to July 14, 2022 were included in our prospective study. Patient data, demographic characteristics, operation, and anesthesia method characteristics were recorded and analyzed.
RESULTS: Eleven percent of the 1123 cases were infected, 6.4% had sepsis, and 5.3% had septic shock. It was determined that emergency operation, male gender, increased American Society of Anesthesiologists class, immunosuppression, increased frequency of peroperative blood product and colloid use, acute physiology and chronic health examination II, sequential organ failure assessment, CCI scores, blood urea nitrogen, creatinine, alanine aminotransferase, aspartate aminotransferase, C-reactive protein, Na, Cl, Ca, bilirubin, INR, albumin, platelet levels were associated with infection, sepsis, and septic shock (P < .05). In patients with sepsis and septic shock, the need and duration of invasive mechanical ventilation in PICU, the need for renal replacement therapy, steroid, sedation, muscle relaxant, blood product, albumin requirement, cardiac complications, PICU, intensive care unit, and hospital mortality were found to be high (P < .05). In multivariate logistic regression analysis for mortality, acute physiology and chronic health examination II score (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.04-1.32, P = .006), sequential organ failure assessment score (OR, 1.32; 95% CI, 1.06-1.64, P = .010), body mass index (OR, 0.85; 95% CI, 0.79-0.91, P < .001), blood urea nitrogen (OR, 1.05; 95% CI, 1.02-1.07, P < .001), creatinine (OR, 0.30; 95% CI, 0.15-0.60, P = .001), K (OR, 1.98; 95% CI, 1.14-3.46, P = .015), and platelet (OR, 0.996; 95% CI, 0.993-0.999, P = .006) were independent risk factors for mortality.
CONCLUSION: In light of the results of our study, we believe that sepsis cases and mortality can be prevented through widespread quality improvement programs such as shortening the duration of mechanical ventilation in postoperative surgical patients, effective treatment of some metabolic, electrolyte and coagulation disorders during intensive care stay, and regulation of blood product and colloid use.
PMID:41054073 | DOI:10.1097/MD.0000000000044919
J Clin Anesth. 2025 Oct 3;107:112030. doi: 10.1016/j.jclinane.2025.112030. Online ahead of print.
NO ABSTRACT
PMID:41045717 | DOI:10.1016/j.jclinane.2025.112030
J Clin Anesth. 2025 Oct 1;107:112027. doi: 10.1016/j.jclinane.2025.112027. Online ahead of print.
ABSTRACT
INTRODUCTION: Postoperative diaphragmatic dysfunction (PDD) is a common complication following major surgeries, contributing to adverse clinical outcomes. Ultrasound-based assessment has emerged as the preferred method for evaluating PDD. We aimed to assess the association between PDD and postoperative pulmonary complications (PPCs) and their relationship with pneumonia.
METHODS: We systematically searched PubMed, Scopus, and Embase for clinical studies assessing PDD via ultrasound. The inclusion period ranged from January 10th, 2025, to March 20th, 2025. Two authors independently selected the investigations according to the following criteria: [1] observational study or randomized clinical trials enrolling adult patients undergoing cardiac, thoracic, or abdominal surgery [2] evaluation of PDD using diaphragmatic excursion (DE) or diaphragmatic thickening fraction (DTF) after surgery, and [3] report an association between PDD and PPCs or pneumonia as clinical outcomes. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. Two authors independently performed data extraction. The Methodological Index for Nonrandomized Studies (MINORS) assessed study quality. The primary outcome was the association between PDD and PPCs. The secondary outcomes evaluated prevalence of PDD and pneumonia as an individual component of PPCs when it was reported separately, and its association with PDD.
RESULTS: The systematic review included 19 studies, and six studies met the criteria for meta-analysis. PDD was significantly associated with higher odds of PPCs (OR 2.99, 95 % CI: 2.01-4.45) and pneumonia (OR 5.41, 95 % CI: 2.36-12.42). No significant publication bias was detected. Heterogeneity was low for both outcomes.
CONCLUSION: Ultrasound-assessed postoperative diaphragmatic dysfunction is significantly associated with higher odds of postoperative pulmonary complications, including pneumonia, highlighting its clinical relevance at the bedside. PDD, assessed via ultrasound, is strongly associated with an increased risk of PPCs and pneumonia in postoperative patients. These findings underscore the importance of routine postoperative diaphragmatic assessment and the potential for targeted interventions to mitigate PDD-related complications. However, the current evidence is constrained by methodological variability and the absence of standardized diagnostic criteria. Future studies should focus on establishing consensus definitions for PDD and ensuring consistent assessment of key clinical outcomes.
PMID:41037871 | DOI:10.1016/j.jclinane.2025.112027
Sci Rep. 2025 Oct 1;15(1):34277. doi: 10.1038/s41598-025-16552-x.
ABSTRACT
We aimed to evaluate the prognostic value of octanoyl-carnitine in patients undergoing surgical myocardial revascularization for coronary artery disease. We conducted a retrospective analysis of an existing prospective cohort aimed at studying risk factors for vasoplegia in patients undergoing cardiac surgery with cardiopulmonary bypass. We conducted our study exclusively on patients included in the prospective cohort at Dijon University Hospital in 2021. We included 42 adult patients undergoing coronary artery bypass grafting, either alone or combined with another surgical procedure. We collected plasma samples for each patient from EDTA-anticoagulated tubes, taken as part of routine biological check-ups according to the department protocol, at three time points: preoperatively, immediately postoperatively in the intensive care unit, and on the first postoperative day. Liquid chromatography coupled with tandem mass spectrometry was used to determine plasma levels of acyl-carnitines, including octanoyl-carnitine. The primary endpoint was the occurrence of major postoperative complications (stroke, atrial fibrillation, acute kidney injury, and/or death). Fourteen patients (33%) had major postoperative complications. Octanoyl-carnitine plasma concentration significantly increased during the perioperative period and was significantly associated with major postoperative complications at all three time points in coronary artery bypass grafting patients (T1: 14.2 [11.6; 18.6] vs 21.1 [14.8; 28.0], T2: 20.9 [16.4;27.9] vs 34.8 [21.2;37.2], T3: 22.8 [13.7;30.9] vs 34.4 [30.2;41.2]; p < 0.05; in nmol/l). At baseline, octanoyl-carnitine levels were higher in patients with complications, while other acyl-carnitines showed no significant differences. Octanoyl-carnitine is associated with mitochondrial metabolism and could be evaluated alone or in conjunction with clinical scores.
PMID:41034608 | PMC:PMC12488848 | DOI:10.1038/s41598-025-16552-x
Sci Rep. 2025 Sep 30;15(1):33802. doi: 10.1038/s41598-025-04047-8.
ABSTRACT
We aimed to determine the postoperative gastrointestinal tract dysfunction and intraoperative hemodynamic effects of ultrasound-guided retrolaminar block in patients undergoing percutaneous nephrolithotomy. Fifty-eight adult patients were randomly divided into 2 groups preoperatively: Group RLB (n = 28) underwent ultrasound-guided retrolaminar block with 20 mL 0.5% bupivacaine. Group Control (n = 30) patients without block application. Primary outcome measure was abdominal Perlas score by ultrasound. Secondary outcome measures were time to first oral feeding, flatus, defecation, mobilization; duration of hospital stay; I-FEED (intake, feeling nauseated, emesis, physical examination, duration of symptoms) Score values; Patient Satisfaction Score; duration of postoperative rescue analgesia; Visual Analog Scale scores; intraoperative heart rate and mean arterial pressures. Patients in Group RLB exhibited significantly lower intraoperative opioid consumption (61.11 ± 21.18 µg, p < 0.001) and a prolonged time to rescue analgesia (13.35 ± 4.06 min). VAS scores were consistently lower postoperatively, and patient satisfaction was high. Additionally, the Group RLB demonstrated reduced gastric content volume at 6 h postoperatively (p = 0.004) and a lower I-FEED score (2.35 ± 0.91, p < 0.05), indicating improved gastrointestinal function. Heart rate and mean arterial pressure were also significantly reduced in Group RLB. Retrolaminar block has shown positive effects on postoperative pain management, gastrointestinal tract function and hemodynamic stability in PCNL. Lower opioid consumption, faster bowel movements and longer-lasting analgesic effect improved patient satisfaction and provided adequate postoperative pain control. These findings support the use of RLB as a safe and effective analgesic method in PCNL surgery.
PMID:41027977 | PMC:PMC12484968 | DOI:10.1038/s41598-025-04047-8
Anaesth Crit Care Pain Med. 2025 Sep 27:101614. doi: 10.1016/j.accpm.2025.101614. Online ahead of print.
ABSTRACT
BACKGROUND: Anaesthesia is crucial in ensuring patient comfort and safety during surgical procedures by inducing a temporary loss of sensation, memory, and consciousness. However, its multifaceted nature presents challenges in defining its aims and expected outcomes. This study aimed to establish a consensus on anaesthesia's definition and core aims using a structured Delphi process.
METHODS: We conducted a modified three-round eDelphi method involving 23 international experts. Participants engaged in iterative online surveys to refine a consensus definition and aims. Consensus was predefined as achieving ≥80% agreement. The process included external expert reviews to enhance objectivity and validity. Statistical analyses included median, interquartile range (IQR), and agreement percentages.
RESULTS: The Delphi process resulted in consensus on 49 aims and a refined definition of anaesthesia. The final definition emphasises safe, effective, individualised, patient-centred, and empathetic care, ensuring optimal surgical conditions while enhancing patient outcomes. Key aims included preoperative optimisation, stress and pain reduction, organ function preservation, prompt emergence and recovery, interdisciplinary teamwork, continuous outcome assessment, and sustainability in anaesthesia practices. The final agreement rate for the updated definition was 82.6% (median: 10, IQR: 9-10). Additionally, environmental sustainability was recognised as an integral aim.
CONCLUSION: The consensus developed in this study provides a structured framework for defining anaesthesia's objectives, improving patient-centred care, guiding clinical practice, and fostering research. By incorporating sustainability and long-term patient outcomes, the consensus supports the evolution of precision anaesthesia. Future research will validate these defined aims in various perioperative settings and refine the consensus based on real-world applications.
PMID:41022202 | DOI:10.1016/j.accpm.2025.101614
Anaesth Crit Care Pain Med. 2025 Sep 26:101617. doi: 10.1016/j.accpm.2025.101617. Online ahead of print.
ABSTRACT
BACKGROUND: New-onset atrial fibrillation (NOAF) occurs in 10% of intensive care unit (ICU) stays and worsens clinical outcomes. Despite its significance, no specific guidelines exist for the general ICU population. Our study investigates potential therapeutic approaches to NOAF, focusing on the rhythmic and haemodynamic outcomes associated with dedicated strategies.
METHODS: In our prospective multicentre cohort study, we included adult patients admitted to 33 ICUs in France, exhibiting at least one episode of NOAF. Exclusions included permanent and post-cardiac/thoracic surgery AF. Data on demographics, clinical history, haemodynamic monitoring, and treatment choice for NOAF episodes were prospectively recorded. Heart rate, blood pressure, and rhythm status were assessed immediately before, at +5, +30, +60 minutes, and +24 hours after NOAF onset.
RESULTS: Between May and December 2019, 453 ICU patients with 735 NOAF episodes were included. Therapeutic approaches included wait-and-see (n = 159 (22%)), IV fluid (n = 338 (46%)), magnesium (n = 299 (41%)), amiodarone (n = 295 (40%)), and beta blockers (n = 73 (10%)); alone or combined in 354 episodes (61%). Electric cardioversion, preferred for poor haemodynamic tolerance, was most effective for sinus rhythm conversion at +1 h (n = 17/30 (57%)). Heart rate and rhythm control were achieved at 87% (n = 588/674) and 80% (n = 259/654) at +24 h, with no significant difference between the strategies. On ICU discharge, 48 (13%) patients remained in AF; independent predictors included age, obesity, prior stroke, and hypercholesterolemia.
CONCLUSIONS: Therapeutic approaches for NOAF in ICU patients were heterogeneous, with nearly a quarter managed by a wait-and-see approach. Most strategies achieved rhythm and rate control within 24 hours. These findings highlight the frequent transient nature of NOAF episodes and support the need for individualized treatment decisions, particularly in unstable patients and those at risk for persistent AF. Trial registration ClinicalTrials.gov NCT03977883 (https://clinicaltrials.gov/study/NCT03977883?term=NCT03977883&rank=1).
PMID:41016469 | DOI:10.1016/j.accpm.2025.101617
Medicina (Kaunas). 2025 Aug 22;61(9):1510. doi: 10.3390/medicina61091510.
ABSTRACT
Objectives: Sex-based disparities in COVID-19 outcomes are well-documented, with men experiencing greater acute severity and women showing increased vulnerability to post-viral syndromes. However, longitudinal immunometabolic trajectories in vaccinated individuals remain underexplored. In this study, sex-based differences in long-term metabolic, endocrine, renal, cardiovascular, and inflammatory responses were investigated among vaccinated individuals recovering from SARS-CoV-2 infection. Methods: This retrospective single-center cohort study included 426 adults (199 females, 227 males) with PCR-confirmed symptomatic COVID-19 and at least two vaccine doses. Serial assessments were conducted at baseline, 18-, 24-, and 30-month post-infection. Parameters included fasting glucose, HbA1c, lipid profile, thyroid function, renal markers, CRP, D-dimer, fibrinogen, troponin, and hematologic indices. Statistical analyses assessed longitudinal changes and sex-stratified correlations. Results: Fasting glucose and HbA1c levels significantly declined over time, more prominently in males. Glucose correlated with age and BMI only in females. Lipid levels remained largely unchanged, although males had higher baseline triglycerides. Females showed rising TSH levels and persistently lower free T3; males exhibited higher creatinine, urea, and troponin levels throughout. Inflammatory markers declined significantly in both sexes, with males displaying higher CRP and troponin, and females showing sustained fibrinogen elevation and a temporary lymphocyte surge. D-dimer was elevated in females at the 30-month point. Conclusions: Sex-specific physiological recovery patterns were evident among vaccinated COVID-19 survivors. Males exhibited earlier metabolic and cardiac alterations, while females had more persistent endocrine and inflammatory shifts. These findings underscore the need for sex-tailored long-term monitoring strategies prioritizing early metabolic and cardiac screening in men and prolonged immunoendocrine surveillance in women.
PMID:41010901 | PMC:PMC12471504 | DOI:10.3390/medicina61091510
Medicina (Kaunas). 2025 Aug 22;61(9):1506. doi: 10.3390/medicina61091506.
ABSTRACT
Background and Objectives: Acute normovolemic hemodilution (ANH) is commonly used to minimize perioperative blood loss and transfusion requirements. While it is considered safe, the molecular effects of ANH on vital organs remain unclear. Aquaporins (AQPs), the principal cellular water transporters, may play a role in tissue adaptation or injury under hemodilution stress. This study aimed to evaluate the impact of ANH on AQP1, AQP3, and AQP4 expression profiles and their association with apoptotic and inflammatory markers in the aorta, heart, kidney, and liver. Materials and Methods: Male Hannover-Sprague Dawley rats (6 months old) were assigned to control (no procedure), sham (anesthesia only), and hemodilution (anesthesia and ANH) groups. ANH was induced using balanced crystalloid infusion. Physiological parameters, blood gases, electrolytes, and metabolic profiles were monitored. At 24 h post-ANH, tissues were harvested for immunoblot analysis of AQPs, as well as apoptotic and inflammatory markers. Results: At 24 h post-ANH, changes in potassium, calcium, and glucose levels, decreased hematocrit, increased lactate, decreased pH, base excess, and PaCO2 were detected, indicating mild metabolic acidosis due to tissue hypoxia and impaired oxygen delivery. Apoptotic and inflammatory responses were observed across all tissues, but AQP alterations were organ-specific. In the heart, AQP1 downregulation correlated inversely with NF-κB and TNF-α levels, while AQP3 upregulation positively correlated with apoptosis. The aorta showed the opposite pattern. In the kidney, AQP4 downregulation was strongly associated with apoptosis and inflammation. Furthermore, ANH selectively increased the AQP3 expression without affecting AQP1 or AQP4 in the liver. Conclusion: ANH induces differential aquaporin expression patterns in major organs, with tissue-specific associations with apoptosis and inflammation. These findings highlight a potential mechanistic role for AQPs, particularly AQP1 and AQP3, in modulating tissue response to hemodilution. These molecular adaptations may serve as early indicators of tissue stress, suggesting clinical relevance for perioperative fluid strategies.
PMID:41010898 | PMC:PMC12471857 | DOI:10.3390/medicina61091506
Crit Care. 2025 Sep 25;29(1):404. doi: 10.1186/s13054-025-05636-9.
ABSTRACT
BACKGROUND: ECMO outcomes in COVID-19-related respiratory failure among solid organ transplant (SOT) and hematopoietic stem-cell transplant recipients (HSCT) are poorly described. We investigated: (1) whether transplant patients (SOT/HSCT) with COVID-19 have worse outcomes than non-immunocompromised (IC) COVID-19 patients, and (2) whether among transplant recipients (SOT/HSCT), those with COVID-19 have worse outcomes than those with non-COVID-19-related respiratory failure. Additionally, we aimed to identify factors independently associated with mortality among COVID-19 transplants.
METHODS: Retrospective analyses of the Extracorporeal Life Support Organization Registry from 1/1/2017 to 31/07/2023. Two comparisons were made: (1) transplant COVID-19 versus non-IC COVID-19, and (2) transplant COVID-19 versus transplant non-COVID-19 patients. Outcomes were analyzed using propensity score (PS)-adjusted, multivariable, and PS-matched analyses, adjusting for a priori identified confounders. Primary outcome was in-hospital mortality.
RESULTS: Among 38,270 runs, 146 transplant COVID-19, 12,552 non-IC-COVID-19 and 886 transplant non-COVID-19 runs were identified. In-hospital mortality in transplant COVID-19 patients was 75.3% and the risk was invariably increased compared to non-IC-COVID-19 (PS-adjusted OR: 2.36 [95%CI:1.61-3.46], p < 0.001, multivariable OR:2.35 [95%CI:1.59-3.49], p < 0.001, and PS-matched analysis OR: 1.89 [95%CI:1.21-2.95], p < 0.005) and transplant non-COVID-19 patients (PS-adjusted OR: 4.20 [95%CI:2.74-6.44], p < 0.001, multivariable OR: 3.79 [95%CI:2.51-5.74], p < 0.001, and PS-matched analyses OR: 3.17 [95%CI:1.90-5.28], p < 0.001). Mortality difference remained stable over time. Older age independently associated with higher mortality. This was accompanied by higher need for renal replacement therapy compared to non-IC-COVID-19 patients. Compared to transplant non-COVID-19 patients, ECMO runs and time-to-live discharge were invariably prolonged. Hemorrhagic, metabolic, pulmonary and infectious complications consistently occurred more frequently.
CONCLUSIONS: Mortality was high in COVID-19 transplant ECMO patients, warranting cautious use of ECMO in this population.
PMID:40999467 | PMC:PMC12465718 | DOI:10.1186/s13054-025-05636-9
Anesthesiology. 2025 Sep 25. doi: 10.1097/ALN.0000000000005776. Online ahead of print.
ABSTRACT
BACKGROUND: Randomized controlled trials (RCTs) are designed to achieve balanced distribution of baseline characteristics across study arms through random allocation, rendering null-hypothesis significance testing on these characteristics unnecessary and potentially misleading. Despite longstanding guidance discouraging this practice, its prevalence and patterns within anesthesiology and pain medicine literature remain unclear.
METHODS: We conducted a meta-research study of parallel-group RCTs published from 1996 to 2025 across 101 journals indexed under the "Anesthesiology and Pain Medicine" category in Scopus. Data extraction included study characteristics, reporting of baseline testing, number of variables tested, and statistical significance. Multivariable logistic regression was used to identify factors associated with baseline testing, and a binomial test assessed whether the observed rate of significant findings exceeded the expected false-positive rate under the null hypothesis.
RESULTS: Of 2453 eligible RCTs, 1186 (48.3%) reported statistical testing of baseline characteristics. Among studies performing such testing, 228 (19.2%) reported at least one statistically significant difference, and 58 (25.4%) discussed it as a study limitation. A total of 11516 variables were tested, with 424 (3.7%) reported as statistically significant-below the 5% expected by chance (p < 0.001). Larger author teams were associated with lower odds of baseline testing (OR 0.95; 95% CI 0.93-0.97), while a higher number of variables tested increased the odds of finding at least one significant difference (OR 1.10; 95% CI 1.07-1.12).
CONCLUSIONS: Despite methodological guidance and CONSORT recommendations, statistical testing of baseline characteristics remains common in anesthesiology RCTs and has not declined over time. This practice likely reflects persistent misunderstanding of randomization and may lead to misinterpretation of study validity. Education and stronger editorial policies are needed to align reporting behavior with best practices and improve trial transparency.
PMID:40997084 | DOI:10.1097/ALN.0000000000005776
Saudi J Anaesth. 2025 Oct-Dec;19(4):643-645. doi: 10.4103/sja.sja_38_25. Epub 2025 Sep 3.
ABSTRACT
This case report presents the significant enlargement of the left internal jugular vein (IJV) detected during ultrasound (US)-guided central venous catheterization (CVC) in an adult patient undergoing cardiac surgery. An 81-year-old female patient who had severe mitral valve regurgitation, severe tricuspid valve regurgitation, and pulmonary hypertension was scheduled for Mitral Valve Replacement and DeVega Tricuspidoplasty. The patient had many comorbidities, so she was on antihypertensive (nebivolol), antithrombotic (rivaroxaban), and antidiabetic (insulin) medications. After anesthesia induction, the patient was positioned for CVC. Ultasound guidance showed that the anteroposterior diameter of the right IJV was small and the degree of overlapping of carotid artery (CA) was high. Left side was evaluated before starting the procedure. Marked enlargement of the left IJV and less overlapping of CA was observed. Left IJV catheterization was decided and performed without any complication. The surgery lasted for 3 hours and was completed uneventfully. Although right IJV is usually preferred for CVC where central intravenous access is required, it is advisable to evaluate the left IJV when the right one has a small diameter and there is a significant overlapping of right CA. In these cases, the choice for CVC side should be based on the data which is obtained from both sides.
PMID:40994495 | PMC:PMC12456641 | DOI:10.4103/sja.sja_38_25
Turk J Anaesthesiol Reanim. 2025 Sep 23. doi: 10.4274/TJAR.2025.251940. Online ahead of print.
ABSTRACT
OBJECTIVE: This descriptive survey study aims to evaluate the knowledge, attitudes, and practices of anaesthesiology specialists and residents in Türkiye regarding advanced hemodynamic monitoring in high-risk surgical patients.
METHODS: The survey, comprising 25 questions, was distributed to 960 anaesthesia professionals, with 713 completing the questionnaire.
RESULTS: The study reveals that while invasive blood pressure monitoring is widely used (96.3%), the adoption of advanced hemodynamic monitoring techniques, such as cardiac output monitoring, remains limited (12.6%). For awake high-risk surgical patients under regional anaesthesia, a significant proportion of respondents (15.1% and 37.1%) considered non-invasive blood pressure monitoring to be insufficient. Additionally, 41.1% of participants believed that stroke volume variation, pulse pressure variation, and systolic pressure variation parameters could be used to assess fluid deficits in awake patients.
CONCLUSION: High costs, technical complexity, and lack of training are identified as major barriers. The findings highlight the need for enhanced educational programs and practical training to improve the utilization of advanced hemodynamic monitoring, ultimately aiming to reduce perioperative morbidity and mortality. The study underscores the importance of integrating advanced hemodynamic monitoring into routine clinical practice and suggests the development of nationwide algorithms to standardize practices.
PMID:40984788 | DOI:10.4274/TJAR.2025.251940
Ann Transplant. 2025 Sep 23;30:e949664. doi: 10.12659/AOT.949664.
ABSTRACT
BACKGROUND Patients with chronic kidney disease (CKD) have a markedly increased cardiovascular risk, largely due to persistent endothelial dysfunction (ED). Kidney transplantation improves cardiovascular status, but whether transplant type-living donor (LDT) or cadaver donor transplantation (CDT)-differentially affects coronary endothelial function remains unclear. MATERIAL AND METHODS In this prospective observational study, 75 kidney transplant recipients (LDT: n=50; CDT: n=25) and 25 healthy controls (HC) underwent CFVR measurement at baseline (CFVR-1) and 6 months post-transplantation (CFVR-2). Left ventricular ejection fraction (LV-EF), diameters, and NT-proBNP were also assessed. Group comparisons and pre-/post-transplant changes were analyzed. RESULTS Baseline CFVR was higher in HC than in transplant groups (p0.05), but CFVR-1 0.05). A ≥10% EF increase occurred in 36% of patients in each group. CONCLUSIONS Kidney transplantation improves coronary endothelial function and cardiac performance regardless of donor type, though severe baseline CFVR impairment is more common in cadaveric recipients.
PMID:40984640 | PMC:PMC12476130 | DOI:10.12659/AOT.949664
Intensive Care Med. 2025 Sep 22. doi: 10.1007/s00134-025-08111-9. Online ahead of print.
ABSTRACT
Mechanical ventilation is a life-sustaining treatment needed in patients with acute brain injury to maintain airway permeability, optimize gas exchange, and prevent secondary brain damage. Positive end-expiratory pressure (PEEP), a key component of mechanical ventilation, helps prevent atelectasis, improve oxygenation, and stabilize alveolar recruitment, offering potential benefits in terms of lung protection. However, neurological tolerance of PEEP can be poor in brain-injured patients. The variability in lung and chest-wall elastance, lung recruitability, cardiac function, and fluid status, as well as the integrity of cerebral autoregulation, further complicates the recommendations for the safe range of PEEP in this patient population. This review aims to explore the physiological effects of PEEP on the brain-heart-lung interplay, focusing on the direct and indirect influences of PEEP on intracranial and cerebral perfusion pressures, as well as cerebral perfusion. We also discuss the need for individualized mechanical ventilation settings to balance the respiratory benefits of PEEP against its potential adverse effects on cerebral perfusion.
PMID:40982016 | DOI:10.1007/s00134-025-08111-9
BMJ Open. 2025 Sep 16;15(9):e099044. doi: 10.1136/bmjopen-2025-099044.
ABSTRACT
INTRODUCTION: Early and balanced replacement of blood products appears to be the key factor in improving outcomes of major bleeding patients including acute trauma, cardiac, obstetric and transplant surgery patients. Definitive clinical guidance regarding the optimal ratio of blood products, including those containing fibrinogen, is still lacking. Therefore, we tested the hypothesis that increasing the fibrinogen content to erythrocyte suspension ratio improves the mortality and functional outcomes of patients undergoing surgeries with expected major bleeding.
METHODS AND ANALYSIS: The Approximate Dose-Equivalent of Fibrinogen-to-Erythrocyte Suspension (ADEFES) ratio is a multicentre, prospective, observational, cohort study of patients undergoing major surgical procedures with expected major perioperative bleeding (ie, requiring packed red blood cells (PRBC)>4U/24 hours). For 5U of cryoprecipitate and 1.5 U of fresh frozen plasma (FFP), the approximate dose-equivalent for fibrinogen is considered as 1 gram of fibrinogen. Association of the ADEFES ratio at 24 hours will be assessed on the primary objective, which will consist of the composite of 30-day all-cause mortality, 30-day bleeding-specific mortality and the 'highly-dependent scores' of Katz index of independence in activities of daily living.
ETHICS AND DISSEMINATION: The study protocol was approved by the Ethics Committee of Ankara Bilkent City Hospital (approval no. E2-23-4265, dated 07 June 2023; Chair: Prof. Dr. F.E. Canpolat) and by the institutional review boards of all participating centres. The study will be conducted in accordance with the principles of the Declaration of Helsinki and the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, as well as in compliance with national regulations on data protection and Good Clinical Practice standards. Written informed consent will be obtained from all participants prior to inclusion in the study.The results of this study will be disseminated through peer-reviewed scientific journals, presentations at national and international conferences, and communication with relevant stakeholders including clinical practitioners and healthcare institutions. If applicable, study outcomes will also be shared via institutional newsletters and digital platforms to reach a broader audience in the medical community.
TRIAL REGISTRATION NUMBER: NCT06021184.
PMID:40962355 | PMC:PMC12443187 | DOI:10.1136/bmjopen-2025-099044
Korean J Pain. 2025 Oct 1;38(4):437-448. doi: 10.3344/kjp.25149. Epub 2025 Sep 17.
ABSTRACT
BACKGROUND: The erector spinae plane (ESP) block has gained attention as a regional anesthesia technique for pain management in vertebral surgeries. This umbrella review synthesizes data from systematic reviews (SRs) and meta-analyses to evaluate the effectiveness of the ESP block in reducing postoperative opioid consumption, pain, and postoperative nausea and vomiting (PONV) in patients undergoing vertebral surgeries.
METHODS: A search was conducted in CENTRAL, Embase, PubMed Central, and Scopus from 2016 to 2025. The authors included SRs and meta-analyses that investigated the use of the ESP block in vertebral surgeries. Primary outcomes were opioid consumption at 24 postoperative hours (measured as milligrams of morphine equivalent), pain scores at 12 and 24 hours, PONV incidence, and the need for additional analgesics. Quality was assessed using the AMSTAR 2 tool.
RESULTS: Thirteen SRs were included. The ESP block reduced opioid consumption at 24 postoperative hours (mean morphine equivalents difference, -8.70 to -18.69), although high heterogeneity was observed. Pain reduction at 12 and 24 hours was statistically significant but clinically modest, with most SRs reporting reductions of less than one point in Numeric Rating Scale or Visual Analog Scale pain scales. The ESP block also significantly reduced PONV and additional analgesic use. However, most SRs were rated as low quality due to inadequate pre-registration and justification for excluding studies.
CONCLUSIONS: The ESP block demonstrates potential as a multimodal analgesia component in vertebral surgeries, reducing opioid consumption, pain intensity, and PONV. However, high heterogeneity and low methodological quality highlight the need for further research.
PMID:40957865 | PMC:PMC12485463 | DOI:10.3344/kjp.25149
J ECT. 2025 Sep 16. doi: 10.1097/YCT.0000000000001187. Online ahead of print.
ABSTRACT
OBJECTIVES: Electroconvulsive therapy (ECT), which is applied by producing a seizure with an electrical current under general anesthesia, is an effective and reliable method in the treatment of most psychiatric diseases. Nevertheless, how the treatment affects intracranial pressure and other neuronal mechanisms is uncertain. This prospective observational study evaluated the effects of ECT on intracranial pressure by measuring the optic nerve sheath diameter (ONSD) using ultrasonography.
METHODS: Thirty-nine patients undergoing their first ECT session were included in the study, and ONSD measurements were performed on all patients at 4 time points: before and after anesthesia induction, after ECT (post-ictal), and during the recovery phase. Age, weight, height, psychiatric diagnoses, medications and comorbidities, blood pressure and heart rate values, and motor seizure durations were recorded.
RESULTS: Post-ictal ONSD (5.47 ± 0.40 mm) was significantly higher than preinduction (4.89 ± 0.33 mm), postinduction (4.90 ± 0.35 mm), and recovery (4.96 ± 0.38 mm) measurements (P < 0.001). The change in ONSD during ECT was significantly higher in patients with preexisting hypertension (P = 0.001) and correlated positively with blood pressure.
CONCLUSIONS: In patients with an indication for ECT and without an intracranial space-occupying lesion, ECT procedure may cause a transient increase in intracranial pressure (ICP). This change in ICP may be more pronounced in patients with a diagnosis of hypertension. These findings highlight the need for careful monitoring of ICP in hypertensive patients undergoing ECT.
PMID:40956101 | DOI:10.1097/YCT.0000000000001187
Ultrasound. 2025 Sep 11:1742271X251353722. doi: 10.1177/1742271X251353722. Online ahead of print.
ABSTRACT
BACKGROUND: Bedside ultrasound of inferior vena cava is used by clinician sonographers in intensive care units. Its data can impact clinical decision-making. Subcostal view is a standard view for this issue. A significant proportion of the intensive care unit patients have very difficult approach to this view. In these patients, an alternative view is a transhepatic view, feasible in nearly every intensive care unit patient. Limited data on the ultrasound technique exist in literature.
AIM: In this review, we discuss in detail the technical aspects of the inferior vena cava ultrasound technique assessed from the transhepatic view, ultrasound tips, and pitfalls.
METHODS: A search was performed using PubMed, Google Scholar, EMBASE, and Scopus databases with the terms "inferior vena cava ultrasound," "transhepatic view," "right mid-axillary view," "right lateral intercostal view," "ultrasound technique," "inferior vena cava pitfalls," and inferior vena cava ultrasound tips," "intensive care unit." The latest articles were reviewed and this review was written using the most current information.
DISCUSSION: A standardised ultrasound approach from mid-axillary line provides optimal image acquisition. When there are difficulties finding inferior vena cava or in obesity alternative approaches should be used. Potential pitfalls during acquisition are: misidentifying the inferior vena cava; technical issues in inferior vena cava measurements; utility of the inferior vena cava data in isolation.
CONCLUSION: Mastering the ultrasound technique from the transhepatic view offers clinicians the opportunity to perform inferior vena cava ultrasound, even in the most challenging patients. Awareness of potential pitfalls and knowledge how to avoid them is important to intensive care unit clinicians to avoid wrong decisions at the bedside.
PMID:40951908 | PMC:PMC12425945 | DOI:10.1177/1742271X251353722