Daily Anesthesiology Research Analysis

BACKGROUND: Pediatric laparoscopic surgery often induces atelectasis due to pneumoperitoneum, postural changes, and immature respiratory physiology, increasing postoperative pulmonary complications (PPCs). Fixed PEEP may fail to address perioperative variability. This study evaluated whether dynamic PEEP adjustment reduces atelectasis and improves oxygenation. METHODS: Children at moderate or high risk of PPCs undergoing elective laparoscopic surgery were randomized into two groups. Group A had driving pressure-guided individualized PEEP titration at three specified time points: after intubation, before pneumoperitoneum initiation, and after pneumoperitoneum completion. Group B had individualized PEEP titration only after intubation, with this PEEP maintained until the end of ventilation. Both groups received alveolar recruitment maneuvers (ARMs). Observations were conducted at 5 min after tracheal intubation (T1), 20 min post-pneumoperitoneum (T2), 60 min post-pneumoperitoneum (T3), at the end of surgery (T4), and at extubation (T5). The primary outcome were intraoperative lung ultrasound score. Secondary outcomes included incidence of atelectasis, oxygenation index, peak airway pressure, plateau pressure, PEEP, driving pressure, dynamic lung compliance, mean arterial pressure, and heart rate. RESULTS: At T4 and T5, Group A showed significantly lower subpleural consolidation scores, total lung ultrasound scores, and atelectasis rates versus Group B ( CONCLUSION: Driving pressure-guided dynamic PEEP titration reduces postoperative lung ultrasound abnormalities and atelectasis while improving oxygenation and respiratory mechanics in pediatric laparoscopy, without compromising hemodynamic stability. This strategy supports personalized PEEP optimization. TRIAL REGISTRATION: This trial was registered on Clinical Trials.gov (Registration No. ChiCTR2300070193, Registration date: 2023-04-04). The trial was retrospectively registered as enrollment began prior to registration. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-025-03274-w. UNLABELLED: • Compared to static PEEP strategies, driving pressure-guided dynamic PEEP titration during pediatric laparoscopic surgery significantly reduces intraoperative atelectasis, improves oxygenation, and shortens postoperative extubation time. • Driving pressure-guided dynamic PEEP titration optimizes respiratory mechanics under pneumoperitoneum, offering a feasible non-invasive approach to personalized lung protection in children. • The driving pressure-guided dynamic PEEP titration demonstrated robust safety by maintaining hemodynamic stability while enhancing pulmonary compliance and minimizing ventilator-induced lung injury. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-025-03274-w.

OBJECTIVE: To compare the analgesic efficacy of anesthesiologist-performed ultrasound-guided superficial parasternal intercostal plane block (SPIPB) and surgeon-performed deep parasternal intercostal plane block (DPIPB) in patients undergoing coronary artery bypass grafting (CABG) via median sternotomy. DESIGN: A prospective, randomized, single-blind clinical trial. SETTING: A single, tertiary care university hospital. PARTICIPANTS: Seventy-five participants (aged 45-80 years, ASA III-IV) scheduled for elective isolated CABG surgery. INTERVENTIONS: Participants were randomly assigned to the SPIPB, DPIPB, or control groups. Regional blocks were performed either under ultrasound guidance after sternal closure and sterilization of the surgical site (SPIPB) or intraoperatively under direct vision (DPIPB). Postoperative pain was managed with multimodal analgesia protocols. MEASUREMENTS AND MAIN RESULTS: Outcomes included pain scores and tramadol administration at the 1st, 4th, 12th, and 24th postoperative hours, as well as after extubation. The cumulative 24-hour tramadol administration (primary outcome) was significantly lower in the DPIPB group (95 ± 44 mg) compared with the SPIPB (141 ± 58 mg) and control groups (176 ± 61 mg) (p < 0.001). Compared with the control group, the DPIPB group had a significantly reduced likelihood of requiring high-dose tramadol (odds ratio [OR]: 0.18, 95% confidence interval [CI]: 0.06-0.56, p = 0.003). The SPIPB group showed an intermediate effect compared with control (OR: 0.52, 95% CI: 0.23-1.18, p = 0.095). When directly compared, DPIPB was associated with significantly lower tramadol use than SPIPB (OR: 0.34, 95% CI: 0.16-0.72, p < 0.001). Pain scores at all time points were significantly lower in both block groups compared with control (p < 0.05), with DPIPB showing the most pronounced effect. No block-related complications were observed. CONCLUSIONS: Both parasternal intercostal blocks improved postoperative analgesia compared with standard care. The SPIPB was performed under ultrasound guidance, whereas the DPIPB was applied under direct vision by the surgeon. The DPIPB demonstrated superior opioid-sparing effects and improved dynamic pain control. These findings support the use of parasternal fascial plane blocks, whether performed under ultrasound guidance or direct vision, as effective components of multimodal analgesia in cardiac surgery.

BACKGROUND: Use of tobacco poses significant health risks, particularly in surgical patients, where smoking is a well-established risk factor for postoperative complications. Patients are often seen in the pre-assessment clinic 2-4 weeks prior to surgery, presenting a window of opportunity to intervene. The objective of our systematic review and meta-analysis is to explore the impact of short-term smoking cessation on postoperative outcomes, focusing on the critical 2-4-week period preceding surgery. DESIGN: Systematic review and meta-analysis. SETTING: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. PATIENTS: Adults undergoing surgical procedures with a defined smoking cessation pre-operative smoking cessation interval. MEASUREMENT: Post-operative complications including pulmonary complications, surgical site infection, wound complication, bleeding, mortality, and composite complications. RESULTS: Fifty-five studies were included in the systematic review and meta-analysis. Pulmonary complications were more prevalent in former smokers compared to non-smokers, even after cessation. Progressively longer smoking cessation periods showed improved outcomes. Compared to active smokers, preoperative cessation reduced pulmonary complications by 27 % at ≥2 weeks (RR 0.73, 95 % CI 0.60-0.89), 29 % at ≥4 weeks (RR 0.71, 95 % CI 0.61-0.82), and 37 % at ≥8 weeks (RR 0.63, 95 % CI 0.41-0.95). With ≥4 weeks of cessation, there was a 33 % lower risk of wound complications (RR 0.67, 95 % CI 0.47-0.94), 31 % lower risk of composite complications (RR 0.69, 95 %CI 0.63-0.76), and 14 % lower risk of mortality (RR 0.86, 95 % CI 0.77-0.97). Short term cessation did not seem to have a significant impact on surgical site infections or bleeding. CONCLUSIONS: Short term cessation of at least 2-4 weeks demonstrates benefits in reducing post-operative complications.