While esketamine has shown promise in enhancing the quality of anesthesia recovery, its effect on a critical recovery endpoint-extubation time-has yielded inconsistent results across clinical studies. Therefore, this study investigated the effect of esketamine on extubation time in patients undergoing general anesthesia. In this single-center, randomized, double-blind, placebo-controlled trial (RCT), we enrolled 154 patients scheduled for elective laparoscopic hysterectomy. Patients were randomly assigned to receive either intravenous esketamine (a bolus of 0.2 mg/kg at induction, followed by a continuous infusion of 0.125 mg/kg/h) or an equivalent volume of normal saline as placebo. For all patients, a transversus abdominis plane (TAP) block was performed with 0.25% ropivacaine at the end of surgery. The primary analysis was conducted according to a modified intention-to-treat (mITT) principle, including all randomized patients who received the allocated intervention and had the primary outcome assessed. The sample size was calculated to provide 90% power to detect a 4-minute difference in extubation time. The primary outcome was the time to extubation in the post-anesthesia care unit (PACU). The Bonferroni correction was applied to secondary outcomes to adjust for multiple comparisons. A total of 141 patients completed the study (Esketamine group: n=70; Control group: n=71). Compared to the control group, the esketamine group had a significantly shorter extubation time (23.2 ± 5.2 minutes vs. 28.5 ± 5.3 minutes; mean difference -5.3 minutes, 95% CI: -7.1 to -3.5; P<0.001). PACU stay duration was also reduced (60.2 ± 7.3 minutes vs. 65.8 ± 6.9 minutes; P<0.001). Furthermore, patients receiving esketamine reported lower postoperative pain scores and required less opioid consumption, with no significant increase in adverse effects. Adjunctive low-dose esketamine during propofol-based total intravenous anesthesia significantly shortens extubation time and PACU stay, reduces intraoperative opioid consumption, and no significant increase in adverse effects was observed in this cohort. The reduction in postoperative pain scores did not remain significant after Bonferroni correction and requires further confirmation.
Opioid-free anesthesia (OFA) is becoming increasingly common, yet its effects on early postoperative recovery remain unclear. Our study assessed the effect of OFA on postoperative recovery compared to opioid-based anesthesia (OBA). Systematic review and meta-analysis. We searched MEDLINE, the Cochrane Library, Embase, BIOSIS, and Web of Science concluding on December 19, 2024, for randomized controlled trials comparing OFA and OBA in adults (≥ 18 years). Data were extracted, and risk of bias was assessed using the Cochrane RoB 2.0 tool (The Nordic Cochrane Centre for The Cochrane Collaboration). The primary outcome was recovery quality at postoperative 24 hours. Random-effects meta-analyses were conducted. Evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Our meta-analysis was registered with PROSPERO (ID CRD42024621490). Sixteen trials with a total of 1,968 patients were included in our meta-analysis. OFA was statistically significance associatedwith an improved Quality of Recovery (QoR)-40 score (mean difference 6.33; 95% CI, 3.48-9.17; very low certainty) and QoR-15 score at postoperative 24 hours (mean difference 10; 95% CI, 2.25-17.74; low certainty) compared to OBA. OFA was a statistical significance associated with a reduced risk of postoperative nausea and vomiting, as well as a shorter stay in the postanesthesia care unit. OFA did not reduce postoperative pain and extubation time. Our meta-analysis has high heterogeneity, with a predominance of women and middle-aged populations in the included studies. Additionally, side effects related to OFA were not analyzed. Our systematic review and meta-analysis concluded that it is uncertain whether OFA is superior to OBA in improving postoperative recovery quality. However, OFA leads to a statistically significant reduction in the incidence of postoperative nausea and vomiting. The evidence was primarily drawn from small trials involving elective surgeries. While our results support using OFA, larger and high-quality studies are needed to validate its effect on postoperative recovery quality.
Percutaneous endoscopic lumbar discectomy (PELD) is a widely used minimally invasive spinal procedure. Rare but life-threatening complications related to irrigation-induced intraspinal hypertension have been reported, but cases under general anesthesia combined with metabolic acidosis and acute pulmonary edema are extremely rare and easily misdiagnosed. This case highlights a rare fatal complication and its clinical features to improve perioperative recognition and management. A 56-year-old ASA II woman without hypertension or heart disease underwent elective PELD for L5-S1 disc herniation. Intraoperatively, persistent tachycardia and hypertension occurred despite adequate anesthesia depth. Postoperatively, she developed agitation, severe lactic acidosis, acute pulmonary edema, and required re-intubation and ICU treatment, complicated by stress cardiomyopathy. After systematic supportive therapy, she recovered and was discharged on postoperative day 12, with no sequelae at 1-month follow-up. Spinal cord-like hypertension syndrome is a rare but catastrophic complication of PELD, especially under general anesthesia. Early warning signs include unexplained intraoperative tachycardia and hypertension. Perioperative strategies such as reducing irrigation volume/pressure, close surgeon-anesthesiologist communication, and early intervention can improve patient safety and prognosis.
Transcatheter aortic valve implantation (TAVI) is increasingly performed under monitored anesthesia care (MAC); however, its use in patients with morbid obesity and obstructive sleep apnea (OSA) remains challenging because of the risk of hypoventilation and airway compromise. Prophylactic planned intraoperative non-invasive ventilation may offer a strategy to safely extend MAC to this high-risk population, but evidence in this setting remains scarce. We report a case of transfemoral TAVI successfully performed under MAC in a 67-year-old morbidly obese patient with severe OSA using bi-level non-invasive positive pressure ventilation (NIPPV), dexmedetomidine-based sedation, and regional analgesia. NIPPV was applied perioperatively to support spontaneous ventilation and optimize oxygenation, allowing the completion of the procedure without airway intervention or conversion to general anesthesia. The patient had an uneventful recovery and was discharged on the fourth postoperative day. This case demonstrates that prophylactic bilevel non-invasive positive pressure ventilation (NIPPV) can facilitate the safe use of monitored anesthesia care during TAVI in selected high-risk patients, supporting a physiology-driven strategy to maintain spontaneous ventilation while avoiding general anesthesia.
The pericapsular nerve group (PENG) block is a novel regional technique that provides adequate postoperative analgesia without producing motor weakness during hip surgery. We sought to compare the postoperative analgesic effectiveness of the PENG block with varying concentrations of local anesthetic in total hip arthroplasty. Prospective, randomized, double-blind trial registered with the ClinicalTrials.gov (NCT04900116). Department of Anesthesiology, Istanbul University Faculty of Medicine, Istanbul, Turkey. Ninety-one patients aged 18-80 with an American Society of Anesthesiologists Physical Status Classification of I-III undergoing total hip arthroplasty under spinal anesthesia with a PENG block were included in this study. Patients were divided into 4 groups: Group One received 20 mL of 0.5% bupivacaine; Group 2 received 20 mL of 0.25% bupivacaine; Group 3 received 20 mL of 0.125% bupivacaine; and Group 4 received 20 mL of saline as a control. Visual Analog Scale pain scores, morphine consumption, nausea, vomiting, and quadriceps weakness were evaluated at postoperative hours 0 (the end of surgery), 6, 12, 24, and 48. In addition, we recorded the first ambulation time; breakthrough morphine need; hospitalization duration; patient and surgeon satisfaction; preoperative and postoperative first month Beck-depression scores; and any complications. Groups One and 2 had significantly lower Visual Analog Scale scores and morphine consumption than the control group (P = 0.001 and P = 0.001, respectively). Quadriceps weakness was significantly higher in Group One at postoperative hour 0 (P = 0.011). Nausea and vomiting were significantly lower in Group One than in the other groups at postoperative hours 12 and 24 (P = 0.007 and P = 0.027, respectively). The length of hospital stay was significantly shorter in Group One than in the control group (P = 0.048). This was a single-center study with no standardized quantitative measurement method for assessing quadriceps weakness. The PENG block with 20 mL of 0.5% bupivacaine in total hip arthroplasty provides effective postoperative analgesia by reducing opioid side effects and hospital stay, as evidenced by low pain scores and morphine consumption.
This study was conducted to assess the efficacy of intravenous nitroglycerin versus dexmedetomidine in achieving controlled hypotension in patients with chronic rhinosinusitis during functional endoscopic sinus surgery (FESS), and to compare the effects of these drugs on hemodynamics, intraoperative analgesic requirement, surgical field quality, and recovery characteristics. This randomized study was conducted on 50 patients, randomly assigned into two groups: Group D (dexmedetomidine) and Group N (nitroglycerin). Mean arterial pressure (MAP) was maintained between 50 and 65 mmHg. Intraoperative hemodynamics, fentanyl requirement, extubation time, and surgical field (Boezaart scale) were recorded and statistically analyzed. Group D showed significantly lower mean heart rates (P < 0.001) and reduced fentanyl requirement (P < 0.0001). Group N achieved the target MAP faster and demonstrated shorter extubation times (P < 0.0001). The quality of the surgical field and the duration of the surgery were comparable. Both the drugs used in our study are effective for controlling hypotension during FESS. Dexmedetomidine offers added analgesic-sparing benefits, while nitroglycerin allows faster recovery, making it preferable in cases requiring early extubation. Résumé Contexte:Cette étude a été menée afin d’évaluer l’efficacité de la nitroglycérine intraveineuse versus la dexmédétomidine pour obtenir une hypotension contrôlée chez des patients atteints de rhinosinusite chronique subissant une chirurgie endoscopique fonctionnelle des sinus (FESS). Les effets de ces médicaments sur les paramètres hémodynamiques, les besoins analgésiques peropératoires, la qualité du champ opératoire et les caractéristiques de récupération ont également été comparés.Méthodologie:Cette étude randomisée a inclus 50 patients répartis aléatoirement en deux groupes: Groupe D (dexmédétomidine) et Groupe N (nitroglycérine). La pression artérielle moyenne (PAM) a été maintenue entre 50 et 65 mmHg pendant l’intervention. Les paramètres hémodynamiques peropératoires, les besoins en fentanyl, le temps d’extubation et la qualité du champ opératoire évaluée par l’échelle de Boezaart ont été enregistrés et analysés statistiquement.Résultats:Le Groupe D a présenté une fréquence cardiaque moyenne significativement plus basse (P < 0,001) ainsi qu’une réduction des besoins en fentanyl (P < 0,0001) par rapport au Groupe N. Le Groupe N a atteint la PAM cible plus rapidement et a montré des temps d’extubation significativement plus courts (P < 0,0001). La qualité du champ opératoire et la durée de l’intervention étaient comparables entre les deux groupes.Conclusions:La dexmédétomidine et la nitroglycérine se sont toutes deux révélées efficaces pour obtenir une hypotension contrôlée pendant la FESS. La dexmédétomidine a offert des bénéfices supplémentaires en réduisant les besoins analgésiques, tandis que la nitroglycérine a permis une récupération plus rapide et une extubation précoce, ce qui la rend préférable lorsque la rapidité de récupération postopératoire est souhaitée.
Inadvertent Perioperative Hypothermia (IPH) remains a common clinical problem. This study aimed to evaluate the efficacy of a multimodal temperature management strategy versus passive insulation in reducing the incidence of IPH among patients undergoing general anesthesia. This was a single-center, randomized, assessor-blinded randomized trial conducted at our hospital from November to December 2025. This study enrolled 206 patients scheduled for 4-8 h surgeries. They were randomly assigned to either a multimodal group (preoperative warming, forced-air warming blanket, fluid warming, increased ambient temperature, pharmacological intervention) or a control group (passive insulation with cotton quilts). Core body temperature was monitored at multiple perioperative time points. The primary outcome was the incidence of intraoperative hypothermia (core temperature < 36 °C). Secondary outcomes included inflammatory markers, blood gas parameters, fluid balance, pain scores, postoperative complications, and hospital length of stay. Compared with the control group, the multimodal group had a significantly lower incidence of intraoperative hypothermia starting at 90 min after surgery initiation (T5: control 60.6% vs. multimodal 48.0%; adjusted OR 0.37, 95% CI 0.15-0.93) and continuing to the end of surgery (T11: control 69.2% vs. multimodal 27.5%; adjusted OR 0.08, 95% CI 0.03-0.23). The multimodal intervention also reduced the incidence of hypothermia at operating room discharge (28% vs. 72%; adjusted OR 0.12, 95% CI 0.06-0.24) and suggest a potential reduction in the risk of postoperative cardiac adverse events (0% vs. 3.85%; P = 0.045). The multimodal group showed a greater increase in inflammatory markers (TNF-α, NLR, PLR), less pain at 48 h postoperatively, and a smaller reduction in pH. This multimodal temperature management bundle significantly lowers the incidence of perioperative hypothermia in patients undergoing prolonged surgery under general anesthesia, with benefits starting at 90 min and strengthening over time. It stabilizes metabolic parameters and may reduce cardiac complications and pain at 48 h postoperatively. https://www.chictr.org.cnChiCTR2500112554.Registered17/11/2025, first recruitment 20/11/2025.
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This retrospective study aimed to evaluate anesthesia management, intraoperative support strategies, and 60-day clinical outcomes in patients requiring surgical intervention, including fasciotomy and/or amputation, due to crush and compartment syndrome following the February 6, 2023, Kahramanmaraş earthquakes. The study also sought to identify predictors of mortality and contribute to the field of disaster medicine. This single-center study reviewed the data of 64 patients who underwent emergency surgery between February 6 and April 6, 2023. Retrospectively collected and analyzed data included patient demographics, ASA (American Society of Anesthesiologists) physical status classification, anesthesia techniques used, intraoperative support provided, and 60-day follow-up clinical outcomes, including mortality, renal function, and muscle necrosis markers. Most patients (93.8%) underwent surgery under general anesthesia due to systemic instability. This finding highlights the critical role of the systemic effects of traumatic injuries and crush syndrome in the choice of anesthesia. The 60-day mortality rate was 11.1%. Significant decreases in muscle necrosis markers, such as CK, AST, and ALT, were observed after fasciotomy. This finding suggests that even delayed fasciotomy may be effective in reducing the systemic toxic load. A key finding was that the preoperative albumin/lactate ratio was identified as a strong and independent predictor of mortality. This ratio may serve as a practical biomarker for patient risk stratification and prognosis. In cases of crush and compartment syndrome following an earthquake, general anesthesia was widely preferred over regional techniques because of patients' severe systemic instability. The data show that surgical interventions, such as fasciotomy, can successfully reduce the systemic toxic load and improve patient outcomes. Furthermore, a simple biomarker, such as the preoperative albumin/lactate ratio, could be a critical tool for predicting patient risk and mortality, especially in resource-limited settings following a disaster. This study provides important information for planning anesthesia and surgical management strategies in similar disaster situations.
Evidence from experimental and clinical studies suggests that anesthetic drugs may modulate tumor biology by influencing immune regulation, inflammation and intracellular calcium signaling. However, the extent to which sevoflurane or propofol alters calcium-related molecular expression in human breast cancer tissue remains unclear. This study aimed to compare the effects of sevoflurane- versus propofol-based anesthesia on calcium signaling pathway-related gene and protein expression in breast cancer tissues and to evaluate their association with early -postoperative recovery and short-term oncologic outcomes. A total of 38 female patients undergoing breast cancer surgery were prospectively randomized to the sevoflurane group (S group, n=19) or the propofol group (P group, n=19). Paired tumor and adjacent normal tissues were collected intra-operatively. mRNA expression of RYR2 and CALML5 was quantified using RT-qPCR and protein levels were assessed by Western blotting. Postoperative pain was evaluated using the 24-hour resting numerical rating scale (NRS), recovery quality using the quality of recovery-15 (QoR-15) on post-operative day 1 and incision pain at post-operative months 3 and 6. Tumor recurrence or metastasis was monitored for 6 months. Compared with the propofol group, sevoflurane anesthesia demonstrated a nonsignificant upward trend in RYR2 mRNA and protein expression (P>0.05), whereas CALML5 expression showed a significant increase under sevoflurane (P<0.001). No significant intergroup differences were detected in 24-hour NRS scores, post-operative QoR-15, chronic incision pain at 3 or 6 months, or 6-month recurrence/metastasis rates (all P>0.05). Sevoflurane anesthesia induced a selective increase in CALML5 expression compared with propofol, suggesting potential differential modulation of calcium-associated molecular pathways. However, these molecular changes did not translate into measurable differences in early recovery, post-operative pain, or short-term oncologic prognosis. The findings support the clinical non-inferiority of sevoflurane compared with propofol and provide preliminary molecular evidence to guide future mechanism-based perioperative investigations.
This study aimed to evaluate the effects of the scalp nerve block (SNB) on surgical outcomes and postoperative complications in the subthalamic nucleus (STN) deep brain stimulation (DBS) surgery. This retrospective cohort study analyzed data from 121 adult patients (≥18 years) who underwent STN-DBS surgery at a tertiary teaching hospital in Fuzhou, China, between November 2, 2017, and April 4, 2024. Patients were divided chronologically into two groups: local anesthesia (LA) alone (2017-2020, n=50) and LA combined with SNB (2020-2024, n=71). The primary outcome was the incidence of pulmonary infection within 7 days post-surgery. Secondary outcomes included other complications, microelectrode recordings, and anesthesia and surgery time parameters. Data were analyzed using univariate and multivariate logistic regression. Compared with the LA group, the LA+SNB group had a significantly shorter intracranial electrode implantation duration (123.97 ± 39.76 min vs. 181.74 ± 53.57 min, p < 0.001) and a lower rate of postoperative pulmonary infection (11.3% vs. 32.0%, p = 0.005). In univariate analysis, SNB was associated with a lower risk of pulmonary infection (OR = 0.262, 95% CI: 0.102-0.675, p = 0.006). However, in multivariate analysis adjusting for anesthetic method, duration of DBS, and tracheal extubation time, the association between SNB and pulmonary infection was no longer statistically significant (OR = 0.426, 95% CI: 0.138-1.315, p = 0.138), whereas tracheal extubation time remained an independent predictor (OR = 1.026 per minute, 95% CI: 1.009-1.045, p = 0.004). LA+SNB was associated with improved perioperative outcomes during STN-DBS surgery, including shorter operative time, reduced PACU stay, lower unadjusted pulmonary infection rates, and decreased intracranial air volume. However, only tracheal extubation time, rather than SNB itself, remained an independent predictor of pulmonary infection in multivariate analysis. Temporal confounding and selection bias are inherent limitations.
Background Tonsillectomy is a common pediatric procedure requiring effective perioperative pain management to minimize complications and promote recovery. In resource-limited settings, standardized protocols are often challenged by infrastructural constraints and variable adherence to multimodal analgesia guidelines, risking suboptimal pain control and delayed discharge. Objective To evaluate a standardized acetaminophen-based pain management protocol and its impact on postoperative outcomes in children aged seven to 14 years undergoing tonsillectomy at the Lady Reading Hospital, a tertiary care hospital in Peshawar, Khyber Pakhtunkhwa, Pakistan. Methods A prospective observational study was conducted at Lady Reading Hospital, Peshawar, between October 2024 and July 2025. Data from 99 consecutively enrolled patients were collected using a structured proforma, capturing demographics, perioperative medications, pain scores (Numeric Rating Scale 0-10 or Wong-Baker Faces scale), discharge status, oral intake tolerance, and pain at discharge. The analgesic protocol was primarily acetaminophen-based. Patients received intraoperative acetaminophen, with ibuprofen administered postoperatively as needed for breakthrough pain. A single dose of tramadol was given at induction as part of the standard anesthesia protocol. Descriptive statistics were analyzed using SPSS version 25. Ethical approval was obtained from the hospital research committee. Results All 99 patients (100%) received uniform intra-/post-operative acetaminophen (15 mg/kg). Adjunct ibuprofen, as rescue analgesia (PRN), was administered to only six out 99 (6.1%) of patients, whose pain did not subside. Postoperative pain scores revealed that 73.7% (73/99) of the patients reported mild pain (score=3 on the 0-10 pain scale), while 20.2% (20/99) of the patients reported moderate pain (score=5 on the 0-10 pain scale), with the latter predominantly observed in younger children (seven to nine years). All patients 99/99 (100%) tolerated cold liquids orally. Although no patient (0/99) reported pain at discharge (assessed as a binary Yes/No field by nursing staff at time of discharge; not a formal repeated pain score), while 73.7% (73/99) were discharged home after 24 hours, with retention rates peaking among 26/99 (26.3%) patients aged 11-year-olds. Conclusion A standardized perioperative acetaminophen-based monotherapy was associated with generally low pain scores and favorable recovery outcomes, including high rates of oral intake tolerance and minimal pain at discharge in this cohort. However, a proportion of patients still experienced moderate pain, which may be related to the limited use of ibuprofen. Given the observational design and absence of a control group, these findings should be interpreted with caution. Further controlled studies are needed to compare analgesic strategies and to determine the optimal role of adjuncts such as ibuprofen and age-specific dosing. Additionally, system-level factors influencing timely discharge warrant further investigation.
Traumatic brain injury (TBI) leads to immune dysregulation, which predisposes patients to infections. We hypothesized that TBI leads to poor lung bacterial clearance, due at least in part to dysfunctional neutrophil (PMN) responses. In this study, we characterized both murine and porcine models of TBI plus lung bacterial inoculation to evaluate the effects of TBI on bacterial clearance, and tested the effects of plasma harvested from human TBI patients on PMN function. C57BL6 mice or Yucatan mini swine underwent sham (anesthesia only) or a mild TBI using standardized methods. Four hours later, mice were inoculated with Staphylococcus aureus. Pigs were inoculated with Actinobacter pleuropneumoniae immediately after TBI. At prespecified timepoints after inoculation (24 hr for mice and 72 hr for pigs), animals were euthanized and bronchoalveolar lavage (BAL) and blood were collected, and lung was harvested for further analyses. Plasma from TBI patients was used to perform in vitro assessment of PMN function. C57BL6 mice, Yucatan mini swine, healthy volunteers, and TBI patients. None. In both animal models, TBI predisposed to poor pulmonary bacterial clearance despite significantly increased PMNs in BAL and blood. In vitro, treatment of PMNs with plasma or plasma-derived extracellular vesicles (EVs) from TBI patients led to increased nondirectional chemokinesis, less reactive oxygen species production, and decreased ability to phagocytose. TBI leads to decreased bacterial clearance in the lung in models of TBI + bacterial lung infection, despite increased PMN counts in lung and blood. This is secondary to inappropriate PMN function after TBI, which we demonstrated in vitro via multiple functional assays to be caused, in part, by systemic factors in the plasma, including EVs. Further studies are required to understand the link between TBI and PMN dysfunction that leads to increased susceptibility to bacterial lung infection.
This study aimed to redefine the precise morphology and relationships of the temporal fasciae using high resolution sectioned images and three dimensional (3D) models. In the temporal region, fascial layers are difficult to distinguish by cadaveric dissection, which has contributed to inconsistent anatomical terminology. Therefore, we undertook this study to investigate and clarify these fasciae. Using the sectioned images with true color and high resolution, fascial, muscular, and vascular structures in the temporal region were traced, segmented, and reconstructed into surface models using MATLAB and Slicer. Maya scripts integrated these models with the sectioned images for 3D visualization. Three fascial layers (the temporoparietal fascia, the superficial layer of the deep temporal fascia, and the deep layer of the deep temporal fascia) were clearly distinguished. The deep temporal fascia presented as a single layer posteriorly but divided into two layers anteriorly. Distinct fat pads were consistently identified between each fascial layer and between the deep fascia and temporal muscle. The courses of the superficial temporal artery and middle temporal vein were precisely visualized. This study provides a clarified, 3D anatomical framework of the temporal fascia, resolving discrepancies in traditional descriptions. High fidelity, artifact free image data offer a reliable basis for safer surgical approaches, flap elevation, filler injections, and regional anesthesia in the temporal region.
Pain management following total knee arthroplasty (TKA) is critical for enhancing outcomes such as minimizing opioid consumption and hospital stay, overall function, and rehabilitation. To evaluate the effectiveness of combined intrathecal dexmedetomidine (ITD) and adductor canal block (ACB) in relieving post TKA pain. Double-blind, randomized controlled trial. KafrElsheikh University, Kafrelsheikh, Arab Republic of Egypt. A total of 75 patients, aged 18 to 75, who underwent TKA under spinal anesthesia participated in this double-blind, randomized controlled trial.. Three equal sets of patients were formed. Group ITD patients received 15 mg of hyperbaric bupivacaine in 3 mL via intrathecal injection, with 5 μg of dexmedetomidine (DEX) in 0.5 mL (total volume 3.5 mL) and an ACB with 20 mL of 0.9% saline. Group ACB patients received an intrathecal injection containing 15 mg of hyperbaric bupivacaine along with 0.5 mL of saline and an ACB with 20 mL of 0.25% bupivacaine. Group ITD+ACB patients received 15 mg of hyperbaric bupivacaine in 3 mL via intrathecal injection, with 5 μg in 0.5 mL of DEX and an ACB using 20 mL of 0.25% bupivacaine. The amount of morphine taken in the first postoperative 48 hours was the primary outcome. Compared to Group ITD and Group ACB, the total amount of morphine needed in the first postoperative 24 and 48 hours was significantly lower in Group ITD+ACB, and in group ACB compared to group ITD (P < 0.05). Visual Analog Scale pain scores were markedly reduced in Group ITD+ACB and in Group ACB than in Group ITD at postoperative 4 hours (P = 0.018 and P = 0.041, respectively); in Group ITD+ACB than in Group ITD and Group ACB at postoperative 8 hours (P = 0.005 and P = 0.011, respectively); and in Group ITD+ACB compared to Group ITD at postoperative 12 hours (P = 0.005). The time to the first rescue analgesic was notably longer in Group ITD+ACB compared to Group ITD and Group ACB (P value < 0.05)and in Group ACB compared to Group ITD (P < 0.001). Side effects were similar in all 3 groups. Our trial had a relatively limited sample size and was conducted at a single center. Combined ITD and ACB were superior in TKA postoperative pain management and required decreased postoperative analgesia without significant side effects compared to ACB alone or ITD alone.
To identify the factors affecting hospital cost associated with primary arthroscopic stabilization for recurrent shoulder anterior instability. The clinical data of patients with symptoms of recurrent glenohumeral anterior stability who underwent arthroscopic stabilization at a single institution between January 2020 and April 2022 were collected retrospectively. Surgical information and patient characteristics were recorded. Variations in hospital hospitalization expenses were identified and extracted from the medical and billing record keeping system at the hospital. Sixty-one cases of recurrent anterior instability of the glenohumeral joint were identified in 59 patients during the study period. There were no significant differences in hospitalization expenses between the Arthroscopic Bankart repair and Arthroscopic Latarjet groups (P = .624), nor across the different periods (P = .54). However, compared with the minority group, the majority group required a higher number of surgical procedures (1 [1, 1.5] vs 2 [1, 2], P = .011) and had longer operative durations (120.00 [107.00, 135.00] minutes vs 162.50 [130.00, 222.50] minutes, P = .001). Total hospitalization expenses were significantly higher in the majority group (10,144.23 ± 1795.78 United States dollar [USD]) than in the minority group (9042.87 ± 943.22 USD) (P = .003), driven by increased costs for implants (3848.84 ± 855.72 USD vs 4623.81 ± 1175.04 USD, P = .005), consumables (6886.56 ± 1013.82 USD vs 7649.36 ± 1620.16 USD, P = .028), anesthesia (371.98 [357.98, 379.40] USD vs 400.82 [371.98, 429.66] USD, P = .001), medications (524.45 [427.86, 631.29] USD vs 623.39 [515.35, 824.74] USD, P = .02), and anesthetics (168.83 ± 44.55 USD vs 213.83 ± 66.82 USD, P = .003). No significant differences were observed between the minority and majority groups in operation expenses, non-implanted consumables, perioperative drug costs, nursing and examination fees, or days of hospitalization (all P > .05). Patients who experienced 3 or more recurrent dislocations prior to primary arthroscopic stabilization incurred significantly higher hospitalization expenses, driven by increased implant use and prolonged operative time. These findings suggest that earlier surgical intervention in patients with recurrent anterior shoulder instability may help reduce procedural complexity and associated costs.
BackgroundPerioperative neurocognitive disorders (PND) encompass delayed neurocognitive recovery (dNCR; ≤30 days) and postoperative neurocognitive disorder (NCD; >30 days). While the HMGB1-TLR4/NF-κB axis drives acute neuroinflammation, the temporal dynamics of this signaling beyond the acute phase and distinct contributions of HMGB1 versus TLR4 to dNCR-to-NCD transition remain elusive. This study investigated whether glycyrrhizin attenuates sevoflurane-surgery-induced recognition memory deficit via modulation of HMGB1-TLR4 signaling.MethodsEight-month-old male C57BL/6J mice underwent right common carotid artery dissection under prolonged sevoflurane anesthesia (3%, 2 h) with or without glycyrrhizin pretreatment (30 mg/kg, i.p., 1 h preoperatively; n = 15/group for Batch 1, n = 7/group for Batch 2). Cognitive function was assessed via open field, novel object recognition, Y-maze, and Morris water maze. Hippocampal neuroinflammation (cytokines, microglia/astrocyte activation), HMGB1-TLR4-NF-κB signaling, synaptic proteins (synaptophysin, PSD-95), and histological alterations (Nissl staining) were evaluated at postoperative day 7 and day 20.ResultsProlonged sevoflurane exposure combined with surgical trauma induced recognition memory impairment and reduced platform crossings in the Morris water maze, both attenuated by glycyrrhizin. While peripheral IL-6 normalized by day 7, hippocampal cytokines (IL-6, IL-1β, TNF-α) and glial activation persisted through day 20. At the molecular level, HMGB1 was elevated at day 7 but normalized by day 20, whereas TLR4/NF-κB remained elevated at both time points; glycyrrhizin suppressed this cascade. Synaptic proteins were reduced and CA3/dentate gyrus exhibited Nissl staining reductions at days 7 and 20, protected by glycyrrhizin, whereas CA1 Nissl staining showed no significant alterations at either time point.ConclusionsThese findings demonstrate a temporal dissociation between HMGB1 normalization and sustained TLR4/NF-κB activation following sevoflurane-surgery in middle-aged mice. Prophylactic glycyrrhizin attenuates recognition memory deficits and suppresses hippocampal neuroinflammation, though mechanistic inferences remain speculative and require rigorous validation.
Genetic polymorphism may influence the efficacy of analgesia during labor anesthesia. This study employed a retrospective case-control study design and aimed to investigate the potential influence of the miR-124 rs531564 polymorphism on the efficacy of labor analgesia in primiparous women. 100 primiparas were enrolled as study participants, all of whom received epidural sufentanil for analgesia. Genotyping was performed using the PCR-LDR, while RT-qPCR was employed to measure the miR-124 expression. The analgesic efficacy (assessed by VAS score), plasma concentration of sufentanil, and incidence of adverse reactions were compared among parturients with different genotypes. In this study, the CC genotype was observed in 53% of participants, the CG genotype in 36%, and the GG genotype in 11%. Individuals with the CC genotype exhibited a higher VAS score at 1-hour post-administration (indicating a poorer analgesic response) and lower 1-minute Apgar scores. Primiparas carrying the CC genotype had reduced miR-124 expression, suggesting that the C allele might contribute to the physiological mechanisms of labor analgesia through down-regulation of miR-124. Moreover, individuals with the CC genotype showed lower sufentanil blood concentrations during the mid-phase of administration (15-20 minutes), which could be attributed to faster drug metabolism or clearance, leading to suboptimal plasma levels - possibly explaining the observed diminished analgesic effect (as indicated by the elevated VAS score at 1 hour). In contrast, primiparas carrying the G allele demonstrated higher sufentanil concentrations at the same time point, correlating with improved analgesic outcomes. The miR-124 rs531564 polymorphism may influence the efficacy of labor analgesia.
This study aimed to evaluate perioperative changes in optic nerve sheath diameter (ONSD) and regional cerebral oxygen saturation (rSO₂) using noninvasive monitoring techniques during laparoscopic abdominal surgery, and to assess their association with postoperative cognitive dysfunction (POCD). This prospective observational study included 50 ASA I-III patients aged 20-60 years undergoing laparoscopic abdominal surgery under general anesthesia. Bilateral ONSD and rSO₂ were measured at five time points: before induction (T0), 5 min after induction (T1), 5 min after CO₂ pneumoperitoneum (T2), 30 min after pneumoperitoneum (T3), and 5 min after desufflation (T4). IAP was assessed using intravesical measurements and insufflator readings. Cognitive function was evaluated with the Mini-Mental State Examination (MMSE) preoperatively and 24 h postoperatively. Hemodynamic and airway parameters were recorded concurrently. ONSD increased significantly following pneumoperitoneum, peaking at 30 min, and returned toward baseline after desufflation. In contrast, rSO₂ demonstrated a non-synchronous pattern, increasing after induction, decreasing transiently after pneumoperitoneum, and subsequently recovering toward post-induction levels, suggesting preserved cerebral oxygenation despite intraoperative physiological changes. No significant correlation was observed between ONSD and rSO₂. Intravesical intra-abdominal pressure (IAP) measurements were consistently higher than insufflator-derived values. No significant differences were found between preoperative and postoperative MMSE scores. CO₂ pneumoperitoneum induces transient increases in intracranial pressure (ICP) surrogates and reversible changes in cerebral oxygenation without affecting early postoperative cognitive function. These findings support the use of multimodal monitoring rather than reliance on single parameters. The study was retrospectively registered at ClinicalTrials.gov. gov identifier: NCT07264764. Registered on 24 November 2025.
In situ simulation (ISS) enables healthcare teams to test systems, identify safety threats, and strengthen interprofessional practice. Compared with off-site simulation (OSS), ISS may promote greater fidelity and transfer of learning. Cross-training, where participants adopt roles outside their profession, is widely used in healthcare education but remains controversial, with little evidence on how participants perceive its impact. We conducted a qualitative study in a Danish teaching hospital intensive care unit, using ethnographic observations, field notes, and semi-structured interviews. Sixteen interviews with physicians and nurses, supported by audio recordings of debriefings, were thematically analysed using a phenomenological-hermeneutic approach with consensus coding. Four themes were identified: fidelity, psychological safety, transfer, and cross-training. Participants described fidelity as multidimensional, including environmental, team, scenario, time, and resource aspects. ISS was perceived as more realistic and immersive than OSS, supporting deeper engagement and learning. PS was enhanced by familiarity with colleagues and environment, limited observation, and absence of cross-training. Facilitator competence at facilitating politely and creating room for all participants to speak up strongly influenced PS. ISS was viewed as promoting greater transfer of technical and social-cognitive skills to clinical practice, with some learning leading to organisational change. Cross-training was met with mixed reactions. Most participants, especially junior staff, preferred training in authentic roles, citing negative effects on PS and learning. More experienced clinicians occasionally valued cross-training for its reflective potential, though often only in less advanced roles. In situ simulation promotes learning by aligning fidelity, psychological safety, and transfer within participants' authentic clinical roles and environments. Cross-training was frequently perceived as undermining both learning and psychological safety, particularly among less experienced staff, suggesting a misalignment between role substitution and learners' developmental needs. Careful scenario design emphasising authentic roles, realistic fidelity, and skilled facilitation may optimise simulation learning outcome, Cross-training should be applied selectively, with explicit attention to learners' experience levels, role authenticity, and potential impacts on psychological safety.