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Music therapy is a nonpharmacologic, patient-centered intervention increasingly used in perioperative settings to improve the surgical experience for patients and their families. Despite growing evidence, music therapy's integration into anesthesia care remains variable, highlighting a need to synthesize the current landscape of music therapy in this clinical context. This scoping review aimed to map the primary characteristics and impacts of live interactive music therapy delivered by a certified music therapist across the perioperative continuum and identify gaps in the literature to guide future research and practice in perioperative settings. Following PRISMA-ScR guidance, database searches were conducted October 2024 to June 2025 using key medical subject headings (MeSH) terms. Inclusion criteria specified (1) live or recorded music therapy delivered by a certified music therapist and (2) intervention timing within 24 hours pre- to 72 hours post-operation. The initial search yielded 2095 articles. After abstract screening, 1049 remained and underwent full-text review. 25 articles met criteria and were included in data extraction. The 25 articles included 1821 patients aged 9-months- to 94-years-old across diverse surgical specialties. Music therapy was delivered preoperatively (n = 17), intraoperatively (n = 8), and postoperatively (n = 15), with inclusion of flexible and protocolized approaches. Pediatric music therapy was more frequently delivered preoperatively, emphasizing play-based, active engagement. Adult music therapy was more evenly distributed across perioperative timepoints, emphasizing introspective, emotion-focused approaches. Selected outcome measures reflected these differences, with pediatric effects captured through behavioral observation (e.g, modified-Yale Perioperative Anxiety Scale [m-YPAS]), whereas adult outcomes relied more heavily on self-reporting (eg, visual analog scale [VAS]). Postoperatively, pediatric and adult music therapy approaches were more aligned across age groups given both used relaxation-based approaches. Perioperative music therapy is a feasible, low-risk adjunct that may complement existing pharmacologic strategies to support anxiety, mood, and pain with minimal interruption to patient care for teams with access to this resource. Limitations including small sample sizes, expectancy effects, inconsistent music therapy intervention reporting, and lack of therapist-contact controls prompt cautious interpretation. Future research should explore intraoperative delivery logistics, dose-response relationships, integration of multimodal outcomes, and anesthesia team perspectives to guide practical integration of music therapy into the anesthesia armamentarium.

Due to multiple factors, patients will experience significant postoperative pain following laparoscopic total hysterectomy (TLH), predominantly manifesting as visceral pain. For the first time, we compared the analgesic effects of intertransverse process block (ITPB) and erector spinae plane block (ESPB) in patients undergoing TLH. We hypothesized that ITPB would further reduce the perioperative opioid dosage and improve visceral pain in TLH patients when compared with ESPB. This research included 66 patients (18-65&#x202f;years-of-age) undergoing TLH under general anesthesia. Patients were assigned by randomization to either an ITPB or ESPB group. Ultrasound-guided bilateral intertransverse process blocks at T10-11 were performed for patients in the ITPB group, with 0.375% (20&#x202f;mL) ropivacaine per side. For the ESPB group, we performed bilateral ultrasound-guided ESPB at the T10 level with 0.375% ropivacaine (20&#x202f;mL) per side. All patients received total intravenous anesthesia guided by the bi-spectral index (BIS). The primary outcome included total opioid use, expressed as morphine equivalents, within the first 24&#x202f;h following surgery. Patients in the ITPB group required significantly lower intraoperative remifentanil doses (mean difference: -328.0&#x202f;&#x3bc;g, 95% CI: -395.2 to -260.9, p&#x202f;<&#x202f;0.001) and exhibited reduced cumulative opioid consumption within 24&#x202f;h postoperatively (mean difference: -2.5&#x202f;mg morphine equivalents, 95% CI: -3.85 to -1.15, p&#x202f;<&#x202f;0.001) when compared to the ESPB group. The ITPB group also exhibited significantly lower Numerical Rating Scale (NRS) scores for visceral pain upon awakening and at 2, 4, 6, 8, and 24&#x202f;h after surgery when compared to the ESPB group (p&#x202f;<&#x202f;0.001). Similarly, NRS scores for incisional pain were significantly lower in the ITPB group immediately after awakening and at 4, 6, and 8&#x202f;h postoperatively (p&#x202f;<&#x202f;0.05). Compared with ESPB, ITPB more effectively reduced perioperative opioid consumption and provided superior and sustained postoperative visceral analgesia for patients undergoing total laparoscopic hysterectomy. In addition, ITPB was associated with improved short-term postoperative recovery quality. In future, studies need to elucidate the underlying mechanisms of ITPB and optimize the volume and concentration of local anesthesia for administration.

Stroke during pregnancy is uncommon but poses a significant threat to both mother and fetus, requiring rapid, carefully balanced interventions. We describe a 46-year-old woman at 24 weeks' gestation who presented with sudden speech difficulties, facial droop, and weakness on one side of her body. Imaging revealed an acute right middle cerebral artery occlusion, and extensive evaluation ruled out cardioembolic, thrombophilia, and vascular causes. She underwent urgent mechanical thrombectomy under monitored anesthesia care, achieving partial revascularization without complications. Her neurological function improved progressively, and both maternal and fetal outcomes were favorable. This case highlights the complexity of managing acute stroke in pregnancy, where timely decision-making must integrate standard stroke protocols with pregnancy-specific considerations, including imaging, anesthesia, and multidisciplinary care. Sharing such experiences is essential to expand knowledge on the safety and effectiveness of endovascular interventions in this rare but critical setting.

Hepatic transarterial chemoembolization (TACE) is a palliative treatment option for unresectable hepatic tumors in dogs. Accurate identification of tumor-feeding arteries, including extrahepatic collaterals, is essential for therapeutic efficacy but remains challenging with conventional digital subtraction angiography (cDSA). This study evaluated the feasibility and clinical utility of intraoperative C-arm cone-beam computed tomography (CBCT) during hepatic TACE in dogs compared with conventional mobile C-arm fluoroscopy. This retrospective study included 36 client-owned dogs undergoing hepatic TACE. Dogs were divided into two groups: the CBCT group (n = 18), treated using a ceiling-mounted angiography system with intraoperative CBCT, and the control group (n = 18), treated using a conventional mobile C-arm system. Procedure time, anesthesia time, radiation dose parameters [dose-area product (DAP), air kerma (AK)], contrast medium volume, and the identification of tumor-feeding arteries were compared between the groups. Technical success was achieved in all procedures. There were no significant differences in median anesthesia or procedure times between the groups. The median DAP per body weight was significantly lower in the CBCT group than in the control group (p < 0.001), although AK and fluoroscopy time did not differ significantly. While the total contrast medium volume was similar between groups, the volume of contrast medium used specifically for angiography was significantly lower in the CBCT group (p = 0.043). Intraoperative CBCT identified extrahepatic collateral feeding arteries in eight dogs; notably, these vessels were not visualized on preoperative computed tomography in five of these cases. Intraoperative C-arm CBCT is a feasible and effective technique for hepatic TACE in dogs. The use of CBCT-derived 3D roadmap guidance enhanced the visualization of vascular anatomy and detection of small extrahepatic collateral vessels while significantly reducing the radiation dose and angiographic contrast medium volume.

Reliable identification of the thoracic duct (TD) is critical during esophagectomy to prevent clinically significant chylothorax. Although various fat-loading and imaging techniques exist, many require specialized equipment or large-volume administration. We standardized a protocol using a small dose of high-fat ice cream administered three hours before anesthesia induction to facilitate lymphatic opacification. In our experience, this protocol was well-tolerated, without anesthesia-related adverse events, and achieved successful TD visualization in all cases without specialized imaging systems such as indocyanine-green fluorescence. Several practical lessons emerged from this decade-long experience. First, combined with thoracoscopic magnification, this approach enables reliable visualization down to the TD branches. This not only prevents inadvertent injury but also allows for the immediate identification and secure repair of any leakage. Second, preserving a clearly visualized TD was associated with fewer clinically relevant chyle leaks, even within a perioperative pathway incorporating very early enteral feeding. Third, TD preservation under direct visualization did not appear to compromise oncologic adequacy, with comparable survival and recurrence patterns in appropriately selected cases. In conclusion, safe intraoperative TD management may depend less on routine en bloc resection than on strategic preservation enabled by reliable visualization. This simple, widely accessible fat-loading protocol facilitates consistent TD identification, and supports selective preservation guided by oncologic considerations without increasing technical complexity. This practical framework enhances surgical safety and optimizes perioperative outcomes in modern esophageal surgery.

This study aims to evaluate and compare the efficacy of articaine buccal infiltration for the extraction of deciduous maxillary molars, assessing its effectiveness as a potential alternative to conventional local anesthesia techniques in pediatric dentistry. A randomized clinical trial was conducted involving children aged 6-12 years requiring extraction of primary maxillary molars. Bilateral extraction was done in children, with one side receiving buccal infiltration with 4% articaine and the other side undergoing traditional infiltration with lidocaine. Pain perception during injection and extraction, onset and duration of anesthesia, and any adverse effects were recorded and analyzed using validated pain scales and statistical methods. There was no statistically significant difference in pain intensity between the two groups for pain on administration of the local anesthetic agent. Intraoperative pain rating was similar in both groups. Articaine buccal infiltration appears to be equally effective as traditional infiltration with lidocaine and can be used as an alternative for the extraction of deciduous maxillary molars in children. Ragulakollu RK, Namineni S, Cheruku S. Efficacy of Articaine with Single Buccal Infiltration in Extraction of Maxillary Molars in Pediatric Patients. Int J Clin Pediatr Dent 2026;19(3):324-330.

Disorders of sex development (DSD) are rare congenital conditions characterized by discordance among chromosomal, gonadal, and phenotypic sex. Adult presentation of ambiguous genitalia is not uncommon, particularly in low-resource settings where delayed diagnosis, limited access to specialized care, sociocultural stigma, and financial barriers constrain evaluation and management. We present two adults with remarkably comparable external genital appearances but profoundly different gender identities, social roles, treatment interests, and therapeutic goals. The two patients, both aged 25 years,&#xa0;presented to our institution with comparable ambiguous external genitalia but different gender roles and concerns. Case one is a&#xa0;phenotypic female presenting with an enlarged clitoris and partially obstructed vaginal introitus, causing her&#xa0;severe psychosocial distress and inability to engage in sexual intercourse. She had normal female secondary sexual characteristics and regular menstruation. Imaging demonstrated normal internal female reproductive organs. Due to financial limitations, karyotyping was not performed. She desired vaginal opening and removal of the penile-like structure. She underwent examination under anesthesia, introital reconstruction, and clitoral reduction surgery, with good postoperative functional and psychological outcomes. Case two is an&#xa0;individual raised and socially recognized as male who presented with progressive abdominal distension and chronic pelvic pain. Despite a masculine gender identity and virilized phenotype, the patient reported menstruation since adolescence. Imaging demonstrated multiple abdominal masses suspicious for malignancy. He was desirous of the removal of the uterus to eliminate menstruation, which was a major source of his distress, irrespective of whether he would sexually perform as a male or not. Exploratory laparotomy revealed large intra-abdominal tumors, and histopathology confirmed dysgerminoma. The patient is currently undergoing chemotherapy. These cases highlight the complexity of adult DSD presentation in resource-constrained settings and underscore the importance of individualized, patient-centered management that prioritizes gender identity, psychosocial well-being, reproductive goals, and informed consent. The report further emphasizes the ethical and clinical challenges posed by limited diagnostic capacity and delayed presentation.

The impact of different mechanical ventilation modes on pulmonary outcomes following laparoscopic surgery in the Trendelenburg position remains unclear. This study aimed to compare the effects of two common ventilation modes on postoperative pulmonary complications (PPCs) in elderly patients undergoing such procedures. Elderly patients scheduled for laparoscopic surgery in the Trendelenburg position were randomly allocated to receive either pressure-controlled ventilation (PCV) or volume-controlled ventilation (VCV). Both groups were managed with a lung-protective ventilation strategy. The primary outcome was the incidence of PPCs within the first three postoperative days. Airway pressures, details enabling the calculation of respiratory system dynamic compliance (Cdyn) and arterial blood gas levels were also recorded at predetermined intraoperative time points: before anesthesia induction (T0); 10&#xa0;min after tracheal intubation in the supine position without pneumoperitoneum (T1); 30&#xa0;min (T2) and 60&#xa0;min (T3) after establishing pneumoperitoneum and the Trendelenburg position; and at the end of surgery after returning to the supine position (T4). Compared with the VCV group (32.1%), the PCV group exhibited a significantly lower incidence of PPCs (13.0%; &#x3c7;2&#x2009;=&#x2009;5.758, P&#x2009;=&#x2009;0.016) (RR&#x2009;=&#x2009;0.403, 95% CI: 0.183-0.888). Furthermore, patients managed with PCV exhibited significantly lower intraoperative airway pressures-including peak airway pressure (Ppeak), plateau pressure (Pplat), and driving pressure (&#x394;P)-as well as reduced dead space fraction (VD/VT) and arterial partial pressure of carbon dioxide (PaCO&#x2082;). Cdyn was higher in the PCV group. In elderly patients undergoing laparoscopic surgery in the Trendelenburg position, pressure-controlled ventilation was shown to improve Cdyn and was associated with a lower composite rate of postoperative pulmonary complications than volume-controlled ventilation. Whether these physiological advantages translate into clinically meaningful benefit requires confirmation in larger studies.

We report an urgent transfemoral transcatheter aortic valve replacement (TAVR) performed under local anesthesia in a patient with acute heparin-induced thrombocytopenia (HIT) and severe thrombocytopenia complicated by recent gastrointestinal bleeding. Argatroban was used as the periprocedural anticoagulant, and a crossover technique enabled complete hemostasis despite a critically low platelet count. This case demonstrates that a fully percutaneous TAVR strategy using argatroban can be safely performed during acute HIT and provides a practical approach for structural heart interventions in patients at high bleeding risk.

Postoperative nausea and vomiting (PONV) is a prevalent adverse event following bimaxillary orthognathic surgery, with opioids being a significant contributing factor. Oliceridine, a G protein-biased &#x3bc;-opioid receptor agonist, reduces activation of the &#x3b2;-arrestin pathway and may decrease gastrointestinal adverse events relative to traditional opioids. This study aimed to evaluate the efficacy and safety of oliceridine relative to sufentanil for postoperative patient-controlled intravenous analgesia (PCIA) in this population, with a particular emphasis on PONV. This prospective, double-blind, randomized controlled exploratory trial was conducted at the Peking University School and Hospital of Stomatology from March to August 2025. A total of 100 eligible patients (ASAI-II, BMI 18-24&#x202f;kg/m2, aged 18-60&#x202f;years) were randomly assigned in a 1:1 ratio to receive either oliceridine (0.25&#x202f;mg/kg combined with tropisetron 10&#x202f;mg, designated as Group O) or sufentanil (1.25&#x202f;&#x3bc;g/kg combined with tropisetron 10&#x202f;mg, designated as Group S) via patient-controlled intravenous analgesia (PCIA), which included a 2&#x202f;mL/h background infusion, 0.5&#x202f;mL bolus, 15-min lockout interval. All participants were administered multimodal antiemetic prophylaxis and standardized general anesthesia. The primary outcome measure was the incidence of PONV within 72&#x202f;h. Secondary outcome measures included the severity of PONV, the use of rescue antiemetics, postoperative pain scores assessed using an 11-point numerical rating scale (NRS), and the occurrence of adverse events. Statistical analyses were conducted using SPSS version 26.0, with a significance threshold set at p <&#x202f;0.05. The baseline characteristics were comparable between the groups. The incidence of PONV within 72&#x202f;h was lower in Group O compared to Group S (40.0% vs. 50.0%; odds ratio [OR]&#x202f;=&#x202f;0.67, 95% confidence interval [CI]: 0.30-1.47; p&#x202f;= 0.315). Similarly, the incidences of moderate-to-severe PONV (26.0% vs. 36.0%; OR&#x202f;=&#x202f;0.59, 95% CI: 0.28-1.25; p =&#x202f;0.108) and the requirement for rescue antiemetics (20.0% vs. 34.0%; OR&#x202f;=&#x202f;0.49, 95% CI: 0.20-1.20; p&#x202f;= 0.115) were lower in Group O. However, none of these differences reached statistically significance. A repeated-measures analysis of variance (ANOVA) for moderate-to-severe postoperative pain revealed a significant effect of time (F =&#x202f;17.189, p <&#x202f;0.001) but no significant group-time interaction (p =&#x202f;0.142). No serious adverse events, such as respiratory depression or hypotension, were reported in either group, and the incidence of dizziness was similar between the groups (22% vs. 24%, p&#x202f;>&#x202f;0.05). Oliceridine demonstrated comparable analgesic efficacy and safety to sufentanil, exhibiting numerically lower, albeit not statistically significant, differences in postoperative nausea and vomiting (PONV) and the use of rescue antiemetics. Considering the exploratory nature of this study and the determination of the sample size based primarily on clinical feasibility rather than statistical power, these findings should be regarded as preliminary. Further validation in larger, adequately powered trials incorporating dose-optimization designs is necessary. https://www.chictr.org.cn/showproj.html?proj=257554, Identifier: ChiCTR2500096345.

Budd-Chiari syndrome (BCS) is a rare hepatic vascular disorder frequently associated with prothrombotic conditions such as myeloproliferative neoplasms. Pregnancy and assisted reproductive technologies further increase thrombotic and portal-hypertensive risk. We report a successful in vitro fertilization-conceived pregnancy in a 35-year-old woman with chronic BCS secondary to JAK2-positive polycythemia vera. The pregnancy was complicated by ovarian hyperstimulation syndrome and severe intrahepatic cholestasis of pregnancy. Progressive portal hypertension with worsening esophageal varices prompted planned preterm delivery at 34 weeks' gestation. A multidisciplinary team performed cesarean delivery under epidural anesthesia with prophylactic perioperative terlipressin administration and thromboprophylaxis. Maternal and neonatal outcomes were favorable. With careful multidisciplinary management, pregnancy in women with stable BCS is feasible.

Different distraction techniques have been used in dentistry and have shown great results in managing anxious pediatric patients, especially during local anesthesia (LA) administration. Various physiological parameters are used to measure anxiety, among which peripheral perfusion index (PI) provides information about vascular tone and fluid status by interpreting the data obtained from pulse oximetry. In the present study, we aimed to evaluate the relationship between anxiety and PI values and also compare different distraction techniques in single-visit pulpectomy. Healthy, cooperative 5-7 years old participants were selected for single-visit pulpectomy. Four groups were formed by simple random sampling. Group I (control), group II (illumination cap), group III (laser light), and group IV [audiovisual (AV)]. Two physiological parameters are recorded [pulse rate (PR), PI] at three intervals: (1) baseline-when the patient sat on the dental chair, (2) second reading-5 minutes after introduction of the distraction technique during LA administration, and (3) third reading-25 minutes after the second reading. Intergroup comparison and post hoc analysis are done for all the groups with two key parameters. It has been found that the illumination cap group was most effective in reducing anxiety, followed by laser light, AV, and the control group (p-value < 0.05). PI can be used as an important parameter for assessing anxiety, and use of the illumination cap as a distraction tool can show promising results in reducing anxiety. Payak R, Gangwar A, Gangwar C, et al. Comparing Two Distraction Techniques with Illumination Caps for Assessing Dental Anxiety in Pediatric Patients during Single-visit Pulpectomies Based on the Perfusion Index Parameter. Int J Clin Pediatr Dent 2026;19(3):331-336.

Transient RNA-labeling tools can reveal transcriptional dynamics with high temporal precision, yet most approaches remain largely confined to cell culture. Here, we report a 5-fluorouridine (5-FUd)-based transient transcriptomics method, 5FU-seq, that surpasses standard strategies by enabling higher metabolic incorporation, greater sensitivity, and robust detection across a broad spectrum of transcripts. Applying 5FU-seq to the murine brain uncovered stimulus-dependent transcriptional networks and revealed a dynamic regulatory program associated with Nrf2 regulation in the hippocampus during anesthesia-induced unconsciousness. We further engineered a transgenic mouse line for cell type-specific transient transcriptomics in situ, enabling simultaneous mapping of gene expression and active enhancer activity with high spatiotemporal resolution. Benchmarking in myeloid cells responding to inflammatory cues against FACS-based RNA-seq and ATAC-seq confirmed the robustness of this dual chemical-genetic toolkit. Together, this work establishes a broadly applicable platform for integrated transcriptomic and epigenetic profiling in complex tissues.