Daily Anesthesiology Research Analysis

BACKGROUND: Intermittent Valsalva maneuver (VM) is commonly used to facilitate high-intensity focused ultrasound (HIFU) ablation. However, the optimal duration of a VM in terms of adverse impacts on brain function is unknown. This prospective study explored the impact of different VM durations on brain function in patients undergoing HIFU ablation surgery for hepatic cancer. METHODS: Adult patients scheduled for HIFU ablation for liver cancer under general anaesthesia were randomized into control group, ≤ 5.2 minutes per VM episode (short VM group), or > 5.2 minutes per VM episode (long VM group). Four-channel electroencephalogram was conducted using SedLine® to record brain electrical parameters (e.g., power spectral density, entropy values, and cross-frequency domain coupling). The primary endpoint was burst suppression in the intent-to-treat population that included all enrolled subjects. Key secondary endpoints included postoperative delirium, emergence agitation, and postoperative recovery quality. RESULTS: A total of 156 subjects were screened, and 153 were randomized: 50, 52, and 51 subjects in the control, short VM, and long VM groups, respectively. The rate of burst suppression was 2.0% (1/50), 30.8% (16/52), and 66.7% (34/51) in the control, short VM, and long VM groups, respectively (p < 0.001). The long VM group also had lower alpha and beta band power spectral density, and higher permutation entropy compared to the control group. The rate of postoperative delirium was 0.0% (0/48), 0.0% (0/49) and 6.1% (3/49) in the control, short VM, and long VM groups, respectively (p = 0.107). The long VM group had the highest rate of emergence agitation (64.7% vs 2.0% in the control group and 28.8% in the short VM group, p < 0.001), and the lowest Quality of recovery-15 (QoR-15) scores [106 (100-109) vs 110 (107-118) in the control group and 110 (102-114) in the short VM group, p < 0.001]. CONCLUSIONS: A VM lasting for > 5.2 minutes per episode resulted in substantial increases in the rates of burst suppression in adult patients undergoing HIFU ablation for liver cancer. Based on these findings, it is recommended that the VM should be limited to ≤ 5.2 minutes per episode if possible.

BACKGROUND: The concept of tubeless anesthesia has emerged as a transformative approach in modern anesthesiology, particularly within the framework of enhanced recovery after surgery (ERAS). However, research regarding the application of tubeless anesthesia in the context of thoracoscopic wedge resection remains limited, particularly with respect to comparative studies of different anesthesia techniques, such as the use of a laryngeal mask airway (LMA) combined with various nerve block approaches. This prospective study evaluated the feasibility and safety of tubeless anesthesia in thoracoscopic wedge resection and its impact on rapid postoperative recovery, providing more evidence for clinical practice. METHODS: Ninety patients scheduled for thoracoscopic wedge resection were randomized into three groups, with 30 patients in each group: double-lumen endotracheal intubation (Group A), LMA + intercostal nerve block (Group B), and LMA + paravertebral nerve block (Group C). Satisfaction with the surgical field, operation time, hospitalization duration, anesthesia costs, hospitalization costs, postoperative feeding time, and ambulation time were recorded. Intraoperative and postoperative adverse events, perioperative anesthesia-related parameters, hemodynamic variables at five time points [pre-intubation (T0), 3 min post-intubation (T1), at surgery initiation (T2), at surgery completion (T3), and post-extubation (T4)], and arterial blood gas (ABG) indices at four time points [pre-intubation (T0'), 3 min post-intubation (T1'), 45 min post-intubation (T2'), and 1 hour post-surgery (T3')] were analyzed. RESULTS: Compared with Group A, Groups B and C presented significantly shorter postoperative feeding times, earlier ambulation, shorter hospitalization durations, and lower anesthesia/hospitalization costs (P<0.05). The incidence of postoperative cough, sore throat, and hoarseness was lower in Groups B and C than in Group A (P<0.05). Compared with those in Group A, the total intubation time, extubation time, and recovery time in Groups B and C were significantly shorter (P<0.05). At T1 and T4, the mean arterial pressure (MAP) and heart rate (HR) were lower in Groups B and C than in Group A (P<0.05). At T2 and T3, the end-tidal CO CONCLUSIONS: Tubeless anesthesia with preserved spontaneous breathing is safe and effective in selected low-risk patients undergoing short-duration thoracoscopic wedge resection, reducing postoperative complications and promoting enhanced recovery. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2300073484.

BACKGROUND: Lacking preoperative CPSP risk factors that cover all surgical modalities, are based on large-scale databases, and are free from patients' subjective elements and compliance. MATERIALS AND METHODS: This study utilised the UK Biobank, whose baseline assessment was conducted between 2006 and 2010. It centred on participants who responded to the CPSP questionnaire during January to February 2019. In conjunction with previous reviews, 67 potential risk factors were identified and categorised into 10 domains. The Cox proportional hazards regression model was employed to analyse the relationships between these factors and CPSP. Finally, interaction and sensitivity analyses were performed to mitigate biases arising from potential reverse causalities among the risk factors, as well as the matching of the operation time with the CPSP occurrence time and data imputation. RESULTS: Of 125,939 included participants with 74,046 (58.8%) women and 56.8 years mean age at baseline, 3609 incident CPSP cases were observed. After stepwise Cox regression, 21 factors were significantly associated with a higher CPSP risk. Among them, 15 factors demonstrated a significant association with increased CPSP risk (P < 0.001). These factors include older age, obesity, lower educational attainment, lower income, a higher surgery times before baseline, elevated PRS, insufficient sleep, smoking, longer time spent outdoors in summer or winter, maternal smoking around birth, chronic condition or disability, regular analgesic use, elevated cystatin C and gamma glutamyl transferase. Additionally, high-sodium diets, higher mismatched count, hypertension, and related hematological indicators such as increased mean corpuscular hemoglobin concentration, red cell distribution width, and monocyte count were also found to significantly elevate the risk of CPSP (P < 0.05). CONCLUSIONS: Our findings contribute to a more comprehensive understanding of CPSP risk factors and pathogenesis, which hold significant implications for developing targeted preventive strategies, optimizing perioperative pain management, and improving the allocation of healthcare resources.