Daily Anesthesiology Research Analysis

BACKGROUND: The pectoral nerve (PecS) II block is a recently introduced technique utilized for surgical anesthesia and postoperative analgesia during breast surgery. This study aims to investigate the impact of ultrasound-guided PecS II block on the incidence of chronic postmastectomy pain in patients following radical mastectomy. METHODS: Ninety-eight patients undergoing selective radical mastectomy were included in this study. Based on whether the ultrasound-guided PecS II block was performed, the patients were randomly divided into the PecS II block group (group P) and the control group (group C). The primary outcomes included the incidence of chronic pain at 12 weeks after surgery, and the secondary outcomes included intraoperative dosage of remifentanil, the amount of oxycodone used in 48 h after surgery, time for the first analgesia administration, postoperative acute pain score 48 h after surgery, and HADS score at 48 h and 12 weeks after surgery. The presence or absence of pain in the previous week was recorded every 7 days after surgery (beginning on the 8 RESULTS: Compared with group C, the incidence of chronic pain in group P at 12 weeks after surgery was significantly decreased by 14.13% (20.65% vs. 34.78%, CONCLUSIONS: PecS II block can reduce the incidence of chronic postmastectomy pain after radical mastectomy, reduce perioperative opioid consumption, provide better analgesia, and improve the degree of anxiety and depression of patients. TRIAL REGISTRATION: ChiCTR2200066968, 22/12/2022.

BACKGROUND: Propofol is a widely used anesthetic for total IV anesthesia. Although it is generally safe, rare but serious complications can occur in vulnerable groups, such as critically ill patients and children. Clinicians often rely on surrogate measures ( e.g. , predicted effect-site concentrations or Bispectral Index), yet more direct indicators of anesthetic exposure and metabolic stress would be valuable. The authors hypothesized that pharmacometabolomics via breath analysis could yield real-time insights into propofol concentrations as well as accompanying metabolic responses to surgery. METHODS: In this pilot study, 10 pediatric patients (median age, 5.9 yr; interquartile range, 4.3 to 6.6) undergoing propofol anesthesia contributed 47 breath samples (10 preinduction, 37 postinduction) and 37 blood samples. All samples were analyzed by high-resolution mass spectrometry. Linear mixed-effects models examined associations between exhaled compounds and serum propofol concentrations while accounting for repeated measures in individual patients. Volcano plots were used to identify differential changes in metabolites after propofol induction. RESULTS: Propofol, its metabolites, and endogenous metabolites were readily detected in exhaled breath, demonstrating strong correlations with serum propofol concentrations (partial R ² ≥ 0.65; adjusted P < 0.001). Differential analysis showed significant upregulation of endogenous fatty aldehydes (log 2 [postinduction/preinduction] ≥ 1; adjusted P ≤ 0.05), suggestive of lipid peroxidation and oxidative stress. Exogenous compounds, including benzene and phenols, were also observed, reflecting propofol metabolism in vivo . CONCLUSIONS: This pilot study highlights a robust breath-serum relationship for propofol and reveals surgery-associated shifts in metabolic pathways, including evidence of oxidative stress. These findings underscore the feasibility of exhaled-breath pharmacometabolomics for individualized anesthetic care. Further validation in larger cohorts is warranted to confirm clinical utility and to determine whether real-time breath analysis could ultimately serve as a useful adjunct for guiding anesthetic management and monitoring perioperative metabolic responses.

Heparinized saline is used to prevent catheter obstruction; however, it is associated with concerns regarding the incidence of heparin-induced thrombocytopenia and the accuracy of the blood test results. This study compared the impact of saline with and without heparin on central venous catheter occlusion rates in post-surgical intensive care unit patients using a prospective, double-blinded, randomized, controlled design. Patients aged 20-90 years planned to experience central venous catheter insertion and postoperative intensive care unit admission were enrolled and were randomly assigned to either the heparin group (administered normal saline with heparin) or the control group (administered normal saline alone), based on a 1:1 ratio. Nurses blinded to patient allocation performed the occlusion assessment (every 24 h). The Kaplan-Meier curve was used to assess the time to occlusion or removal of each catheter. Central venous catheter insertion results of 136 patients showed no significant variation in occlusion rates between the heparin and control groups within the first 3 days. There was no significant difference between normal saline with and without heparin in preventing central venous occlusion in the intensive care unit up to 3 days post-surgery. The results of this study suggest that it is not necessary to use normal saline with heparin in the management of central venous catheter occlusion, at least when moving from the operating room to the intensive care unit.