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This study presents, for the first time, an ultrasound method combining focused and single plane wave transmissions to achieve single calibration, non-invasive, cuffless blood pressure monitoring. High-quality echo signals obtained from focused transmissions were first used to identify the optimal segment of the radial artery wall. Then, single plane wave signals were utilized to track this segment frame-by-frame and calculate local pulse wave velocity (PWV). Finally, the M-K equation was applied to estimate systolic and diastolic blood pressures. To validate the effectiveness of the proposed algorithm, 25 volunteers participated in the study. Data were collected using both an oscillometric cuff-based blood pressure monitor and our ultrasound system in four states: morning, evening, pre-exercise, and post-exercise. A total of 300 sets of comparative data were obtained. The overall mean deviation for systolic blood pressure was $2.2~\pm ~2.1$ mmHg, and for diastolic blood pressure, it was $2.1~\pm ~2.2$ mmHg. To our knowledge, this is the first study to achieve real-time blood pressure calculation within seconds using a single-array ultrasound transducer. Compared to existing non-invasive continuous blood pressure monitoring methods, this approach is faster and provides more accurate vascular wall information. Significance: Combined with affordable hardware, this method holds significant potential for the development of wearable devices for real-time cardiovascular health monitoring.

Background: Accurate blood pressure monitoring is essential in many clinical scenarios for adults and children and, when continuous measurement is critical, necessitates the insertion of an arterial line. A novel continuous non-invasive arterial pressure monitoring device using a pulse contour algorithm (Pulse Decomposition Analysis), Vitalstream™, is approved by the United States Food and Drug Administration for use in adults. In this study the performance and accuracy of the device compared to intraarterial blood pressure monitoring were assessed in children ages 2-17 undergoing major surgeries. We report the results using comparison to aspects of the recently published ISO 81060-3:2022 standard for continuous automated blood pressure measurement., Methods: 31 children ages 2-17 years scheduled for major surgery requiring invasive arterial blood pressure monitoring were consented to participate. Systolic, diastolic, and mean arterial blood pressure readings were obtained from both systems during at least thirty minutes of simultaneous monitoring during hemodynamically stable periods of the surgical procedure and statistically compared., Results: The correlations of systolic and, diastolic, and mean arterial pressures were, respectively, 0.77, 0.68 and 0.7. The Bland-Altman comparisons yielded bias of -3.79 (9.74) mmHg, 1.72 (8.45) mmHg and 2.41 (8.75) mmHg respectively, for systolic, diastolic, and mean arterial pressures, (p < 0.001 for all comparisons). Concordances for systole, diastole and MAP were, respectively, 0.82, 0.85 and 0.83., Conclusions: Most values fell within +/-20mmhg of the corresponding arterial line values. While this meets the basic requirement for such devices published by professional societies, clinicians will need to be aware of the potential variances and make clinical decisions accordingly. The Vitalstream™ may offer low risk, accurate continuous pressure monitoring in children ages 2-17., Clinical Trials: gov: NCT04817137 The trial was registered at clinicaltrials.gov (NCT048I7173)., Competing Interests: Declaration of competing interest Karen Boretsky, Vivian Nasr, and Douglas Atkinson declare no conflict of interest. Martin Baruch declares his involvement as co-founder and CTO of the manufacturer of the Vitalstream™ device used in this study, Caretaker Medical, Charlottesville, VA. To address any conflict of interest between the investigators and the manufacturer, the investigators relied on our good impression of the company's integrity and the clinicians' feelings that the results are true and that Vitalstream™ agrees with the invasive BP reference., (Copyright © 2024. Published by Elsevier Inc.)

This study aimed to analyze whether oscillometric blood pressure devices validated for the general population may be considered approved under Universal Standard criteria. A systematic review was conducted, with searches in nine databases, up to September 2023, including 32 validation studies of noninvasive arm cuff devices for self-measurement. The British Hypertension Society protocol was most common (68%), followed by the Association for the Advancement of Medical Instrumentation (40%). Most devices met Universal Standard criterion 1, but only 17 (53%) met criterion 2. Few studies contained details about the choice of cuffs, the number of participants by arm circumference, or the differences between methods by cuff subgroup. Due to the considerable differences between validation protocols, 53% of the devices analyzed were approved under the Universal Standard. The study contributes to expanding the validated pool of self-measurement devices under the Universal Standard., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Aims: The femoral nerve (FN) is commonly blocked using ropivacaine to provide postoperative analgesia after knee surgery. However, the minimal required concentration has not yet been defined. The aim of this study was to estimate the minimal ropivacaine concentration required to achieve adequate analgesic FN block in 90% of cases (EC90). Methods: This study included 50 patients who were scheduled for knee ligament reconstruction under combined nerve block and general anaesthesia. The FN block was performed using 15 mL of ropivacaine with varying concentrations and considered adequate when associated with pain-free recovery. The sciatic, obturator, and lateral femoral cutaneous nerves were blocked to negate other knee pain generators, and their block success was confirmed. We used the biased-coin design up–down sequential method where the adequacy of an FN block altered the ropivacaine concentration used for the next block. The adequacy of the analgesic block or lack of it was analysed to calculate the analgesic EC90. The quadriceps motor power and morphine requirement were also recorded. Results: The recommended analgesic ropivacaine EC90 was 0.05% w/v. The associated quadriceps weakness and morphine requirement were minimal. Conclusion: FN block using ropivacaine 0.05% w/v may provide adequate analgesia in 90% of patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Post-dural puncture headache is a complication of spinal anaesthesia, theorised to be triggered by a lowering in intracranial pressure due to the cerebrospinal fluid leak through the dural puncture. Our objective was to evaluate whether there is a decrease in optic nerve sheath diameter (ONSD) with a reduction in intracranial pressure after spinal anaesthesia. Methods: Patients were randomised by a computer-generated randomisation table to receive spinal anaesthesia (Group S) or peripheral nerve block (Group P) after assessing their eligibility for the anaesthesia procedure as per the protocol. The ONSD was measured in the preoperative period and again at 4 h and 24 h after the anaesthetic, both in the supine and sitting positions, along with haemodynamic parameters. Continuous variables such as age, height, weight, mean arterial pressures, and ONSD were expressed as mean [standard deviation (SD)] [95% confidence interval (CI)] and compared using the student's t -test. Repeated measure ANOVA and Bonferroni were used to compare intra-group parameters. Results: The mean decrease in the ONSD from a baseline mean of 3.95 (SD: 0.17) (95%CI: 3.87, 4.02) to 3.89 (SD: 0.26) (95%CI: 3.78, 4.007) mm at 4 h and 3.94 (SD: 0.12) (95%CI: 3.89, 4.0) mm at 24 h after spinal anaesthesia was statistically significant. The changes in the ONSD measurements in Group P were not statistically significant. Headache was not reported at 24 h or in the follow-up at postoperative day 5. Conclusion: Measurement of ONSD is an easy, economical method for identifying decreased intracranial pressure after spinal anaesthesia. Further research could identify cut-off values to prognosticate PDPH in high-risk individuals. [ABSTRACT FROM AUTHOR]

Background and Aims: Current views on oxycodone's effects on immunity are inconsistent. Our objective was to compare the effects of perioperative oxycodone as the sole opioid in a multi-modal analgesia regimen with conventional opioid regimens on immunity in cervical cancer. Methods: In this randomised controlled trial (RCT), patients scheduled for laparoscopic radical hysterectomy for cervical cancer were randomised to receive either oxycodone (Group O) or conventional opioid regimens (Group C). The primary outcome was the CD4+/CD8+ ratios postoperatively at 24 and 48 h. Student's t -test was used for normally distributed variables, the non-parametric Wilcoxon test for non-normally distributed variables, and Chi-square/Fisher's exact test for qualitative variables, with differences significant set at P < 0.05. Results: We included 56 patients in the final analysis. The postoperative CD4+/CD8+ ratios were comparable between groups. However, the mean arterial pressures (MAPs) at extubation and 5 minutes thereafter were lower in Group O than in Group C (both P < 0.001), as were the heart rates (HRs) (P = 0.001 and 0.018, respectively). Within 24 h postoperatively, the visual analogue scale (VAS) scores for resting and movement-evoked pain were lower in Group O than in Group C (all P < 0.001), and the same was observed at 48 h postoperatively (both P = 0.002), as was the incidence of catheter-related bladder discomfort (P = 0.001). The VASs for postoperative analgesia satisfaction were higher in Group O than in Group C (P = 0.006). Conclusion: In laparoscopic surgery for cervical cancer, perioperative oxycodone as the sole opioid within a multi-modal analgesia framework does not yield anticipated benefits in immunopreservation compared to conventional opioid regimens but improves postoperative pain management and haemodynamic stability. [ABSTRACT FROM AUTHOR]

Background: Goal directed fluid therapy (GDFT) may be a rational approach to adopt in neurosurgical patients, in whom intravascular volume optimization is of utmost importance. Most of the parameters used to guide GDFT are derived invasively. We postulated that the total volume of intraoperative intravenous fluid administered during elective craniotomy for supratentorial brain tumours would be comparable between two groups receiving GDFT guided either by the non-invasively derived plethysmography variability index (PVI) or by stroke volume variation (SVV). Methods: 60 ASA category 1, 2 and 3 patients between 18 and 70 years of age were randomized to receive intraoperative fluid guided either by SVV (SVV group; n = 31) or PVI (PVI group; n = 29). The total volume of fluid administered intraoperatively was recorded. Serum creatinine was measured before the surgery, at the end of the surgery, 24 h after surgery and on the fifth post-operative day. Arterial cannulation was performed before induction in all patients. Serum lactate was measured before induction, once in 2 h intraoperatively, at the end of the surgery and 24 h after the surgery. Brain relaxation score was assessed by the surgeon during dural opening and dural closure. Patients were followed up till discharge or death. The duration of mechanical ventilation and the duration of hospital stay was noted for all patients. Results: The volume of fluid given intraoperatively was significantly higher in the SVV group (p = 0.005). The two groups were comparable with respect to serum lactate and serum creatinine measured at pre-determined time intervals. Brain relaxation score was also comparable between the groups. SVV and PVI displayed moderate to strong correlation intraoperatively. The duration of mechanical ventilation and the length of the hospital stay were comparable between the two groups. Conclusions: PVI and SVV are equally effective in guiding GDFT in adults undergoing elective craniotomy for supratentorial brain tumours. [ABSTRACT FROM AUTHOR]

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Background: This study aimed to compare the effectiveness of the NoSAS, STOP-Bang, and Berlin scoring systems, which are utilized to predict obstructive sleep apnea syndrome (OSAS), in forecasting difficult airway management. Additionally, the study sought to determine which of these scoring systems is the most practical and effective for this purpose. Methods: Following the ethics committee approval, preoperative NoSAS, STOP-Bang, and Berlin scores were calculated for 420 patients aged 18 years and older who were scheduled for tracheal intubation. Mask ventilation and intubation were performed by research assistant with a minimum of two years of experience. Detailed examinations and recordings were conducted, including demographic data, neck circumference, OSAS diagnosis, history of difficult intubation, comorbidities, ASA classification, Mallampati classification, and Cormack-Lehane grade. Subsequently, the predictive efficacy of these three scoring systems for difficult mask ventilation and difficult intubation was compared. Results: In our study, 83 patients (19.8%) were classified as having difficult mask ventilation, and 101 patients (24.0%) were classified as having difficult intubation. The NoSAS score demonstrated a higher predictive power compared to the other scoring systems for difficult mask ventilation and difficult intubation. The cut-off value for the NoSAS score was determined to be 6.5 for predicting difficult mask ventilation and 7.5 for predicting difficult intubation. Conclusion: The routine implementation of the NoSAS score, an easy-to-use, rapid and objective tool primarily developed for OSAS screening, is likely to be effective in preoperatively identifying difficult airways in patients undergoing general anesthesia. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing general anesthesia are more frequently monitored for depth of anesthesia using processed electroencephalography. Opioid-free anesthesia is nowadays an accepted modality for general anesthesia, however it is unclear how to interpret data from processed electroencephalography when using a mixture of non-opioid anesthetic drugs. Our objective was to describe density spectral array patterns and compare processed encephalographic data indices between opioid-free and routine opioid based anesthesia. Methods: This prospective observational cohort study was conducted on 30 adult patients undergoing laparoscopic surgery in a non-tertiary regional hospital. The patients underwent general anesthesia with three different methods and were monitored for anesthesia depth using processed encephalography and density spectral array. Primary outcome is a group-derived mean difference in patient state index and spectral edge frequency. As a secondary outcome a descriptive comparison of the spectral power, derived from the density spectral array, was done between groups. Results: The opioid-free anesthesia group had significantly higher patient state index and spectral edge frequency compared to routine anesthesia. Density spectral array patterns were also different, most notably lacking the high power in alpha frequency spectrum seen in the other routine anesthesia methods. Conclusions: Processed electroencephalography monitoring can be used in opioid-free anesthesia, however clinicians should expect higher values in monitoring indices. The density spectral array pattern using a common protocol for opioid-free anesthesia, with mainly sevoflurane combined with low doses of dexmedetomidine and esketamine, differs from well described opioid and GABA-ergic anesthesia methods. These findings should be further validated using other protocols for opioid-free anesthesia in order to safely monitor anesthesia depth. Trial registration: Clinicaltrials.gov registration number NCT06227143, registration date; 26th of January 2024. [ABSTRACT FROM AUTHOR]

This study developed and evaluated a model for assessing pain during the surgical period using photoplethysmogram data from 242 patients. Pain levels were measured at 2 min intervals using a numerical rating scale or clinical criteria: preoperative, before and after intubation, before and after skin incision, and postoperative. Key features from the photoplethysmography waveform were extracted to build XGBoost-based models for intraoperative and postoperative pain assessment. The combined perioperative model was compared with a commercial surgical pain index, yielding area under the receiver operating characteristics curve scores of 0.819 and 0.927 for intraoperative and postoperative periods, respectively, compared to the commercial index's scores of 0.829 and 0.577. These results highlight the models' effectiveness in pain assessment throughout the surgical process, identifying waveform skewness and diastolic phase rate decrease as critical for intraoperative pain assessment and systolic phase area or baseline fluctuation as significant for postoperative pain assessment. Clinical trial registration: Registration name: Clinical Research Information Service (CRIS). Registration site: http://cris.nih.go.kr. Number: KCT0005840. Principal Investigator: Dr. Byung-Moon Choi. Date of registration: January 28, 2021 [ABSTRACT FROM AUTHOR]

Background: There is no established treatment for the acute exacerbation of trigeminal neuralgia. We aimed to investigate the efficacy and safety of intravenous fosphenytoin for this disease. Methods: We conducted a retrospective observational study of data from 41 patients with trigeminal neuralgia who received intravenous fosphenytoin therapy. Fosphenytoin diluted with physiological saline was administered intravenously at a loading dose of 9.8–20.7 mg/kg or at a dose of 7.5–9.5 mg/kg when maintenance therapy was needed. Pain was evaluated using a numerical rating scale (NRS), assessed immediately before administration (baseline) and at 2, 12, and 24 h after administration. Results: The mean (± standard deviation) NRS score was 9.85 ± 0.69, 0.49 ± 1.47, 1.60 ± 2.19, and 3.46 ± 3.19 at baseline, 2, 12, and 24 h after administration, respectively (p < 0.001). Intravenous fosphenytoin therapy was effective for the acute exacerbation of trigeminal neuralgia regardless of whether it was administered during the perioperative period of microvascular decompression (MVD) or the type of drugs used concomitantly. Fosphenytoin was effective when re-administered (n = 14) or at a maintenance dose (n = 2). The adverse drug reactions observed were mild dizziness in six patients, abnormal auditory perception and thirst in three patients each, and somnolence, decreased SpO2, and drug eruption in one patient each, all of which were transient. Conclusions: Intravenous fosphenytoin therapy can immediately eliminate pain during acute exacerbation of trigeminal neuralgia and can be a useful therapeutic drug in emergency response or until elective treatment, such as MVD, is performed. [ABSTRACT FROM AUTHOR]

Background: Postoperative visceral pain is a common complication after endoscopic retrograde cholangiopancreatography (ERCP). In this study, we compared the analgesic and anti-inflammatory effects of oxycodone and fentanyl in children undergoing ERCP. Methods: A single-center, randomized, double-blind study was conducted at a tertiary care hospital affiliated with Shanghai Jiao Tong University. Eighty-two pediatric patients aged 2–18 years who were scheduled for elective ERCP were randomly assigned to receive either oxycodone (0.2 mg/kg) or fentanyl (2 μg/kg). The postoperative pain was evaluated after 10 min, 20 min, and 30 min in the post-anesthesia care unit (PACU) as well as 6 h and 24 h in the ward following ERCP. Additionally, inflammatory cytokines in the serum, including tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 were examined by blood sampling at baseline, 6 h, and 24 h after ERCP. Results: Compared to fentanyl, children receiving oxycodone had significantly lower pain scores at 30 min, 6 h, and 24 h after ERCP, while the scores at 10 and 20 min were similar in both groups. We also found that fewer patients had pain scores ≥3 at 6 h and 24 h after the procedure in the oxycodone group [36.6% (15/41) vs. 61.0% (25/41) at 6 h, 34.1% (14/41) vs. 58.5% (24/41) at 24 h, p = 0.027 for both cases]. Furthermore, fewer children in the oxycodone group had elevated inflammatory cytokines (IL-6 at 6 h and TNF-α at 24 h after ERCP) compared to the fentanyl group. The incidence of postoperative vomiting was also lower among children receiving oxycodone [14.1% (7/41) vs. 24.4% (10/41), p = 0.032]. Conclusion: Oxycodone (0.2 mg kg−1) can provide effective analgesia and stable hemodynamics in children undergoing ERCP. This analgesic characteristic may be related to amelioration of inflammation after ERCP. Clinical Trial Registration: www.chictr.org.cn, identifier ChiCTR2300074473. [ABSTRACT FROM AUTHOR]

Objective: Remimazolam besylate and Ciprofol are newer sedatives used in minor surgeries. Propofol is a classic drug mainly used for short surgeries. This trial was conducted to compare the efficacy and safety of remimazolam besylate, ciprofol, and propofol during hysteroscopic surgeries. Methods: Patients undergoing hysteroscopy were randomly assigned to receive remimazolam besylate (Group R), ciprofol (Group C), or propofol (Group P). A total of 194 patients were assessed for eligibility. One patient in Group P was excluded because the operation had timed out of 60 min. Patients all in Group R、Group C and Group P received an induction dose of 0.2 mg/kg remimazolam besylate、0.4 mg/kg ciprofol、2.0 mg/kg propofol seperately over 30 s. A corresponding dosage of 1 mg/kg/h、0.6–1.2 mg/kg/h and 3.0–6.0 mg/kg/h was given by continuous intravenous infusion to maintain a BIS of 40–60 till the end of the surgery. The incidence rates of body movement, respiratory depression, and adverse effects were compared among the groups. Results: The incidence of injection pain was much higher in Group P (64.1%) than that in Group R (3.4%) and Group C (3.2%, both P < 0.001). The onset time was significantly shorter in Group P than that in Group R and Group C (both P < 0.01). The awakening time (MOAA/S score = 3) was longest in Group R, followed by Groups C and Group P (P < 0.01). The time to complete recovery (MOAA/S score = 5) has no significantly difference between Group C and Group P, whereas the onset time was significantly shorter in Group R (P < 0.01). The number of body movements was significantly higher in Group R than that in Group C and Group P (P < 0.01). The incidence of hypotension was significantly lower in Group R than that in Group C and Group P (both P < 0.01). The rate of respiratory inhibition was significantly lower in Group R and Group C than that in Group P (both P < 0.05). Conclusion: Considering jointly the safety and efficacy, ciprofol seems to be the best choice for sedation. [ABSTRACT FROM AUTHOR]

Background: The combined technique of programmed intermittent epidural boluses (PIEB) and dural puncture epidural (DPE) is currently considered a more effective mode for labor analgesia. We investigated the optimal interval time for PIEB administration with different concentrations of ropivacaine combined with the DPE for labor analgesia. Methods: Ninety patients with cervical dilation of <5 cm and a VAS score >5 were randomly assigned to receive labor analgesia with ropivacaine at concentrations of 0.075% (0.075% group), 0.1% (0.1% group), and 0.125% (0.125% group). In each group, an initial administration of a combination of ropivacaine 12 mL and sufentanil 0.3 μg/mL was followed by an additional dose of ropivacaine 10 mL and sufentanil 0.3 μg/mL after 30 min. The initial PIEB interval time was set at 40 min for the first patient in each group, and subsequent interval times for the following patients were adjusted based on meeting analgesic needs (VAS score ≤1) with a gradient of 10 min. The primary outcome was the ED90 of interval time required to achieve analgesic needs during PIEB with different concentrations of ropivacaine, employing an up-and-down sequential allocation method. Results: The optimal PIEB interval times for ropivacaine concentrations of 0.075%, 0.1%, and 0.125% were determined to be 40.9 (95% CI, 35.3–45.8), 45.3 (95% CI, 39.3–51.5), and 52.9 (95% CI, 46.8–59.3) minutes respectively, while comparable maternal and neonatal outcomes were observed across all groups. Conclusion: When PIEB is combined with DPE for labor analgesia, the optimal PIEB interval times for ropivacaine concentrations of 0.075%, 0.1%, and 0.125% were determined to be 41, 45, and 53 min respectively. [ABSTRACT FROM AUTHOR]

Background: Proper anesthesia management is required to maintain immobilization and stable breathing of the patient to improve catheter contact and stability during catheter ablation for PVI. However, it remains unclear whether the depth of neuromuscular blockade affects the results of RFCA under general anesthesia. Methods: The patients were randomly assigned to either the moderate neuromuscular blockade group (Group M, train-of-four 1 to 2) or the deep neuromuscular blockade group (Group D, posttetanic count 1–2). The primary outcome was the 12-month AF recurrence rate using confirmed electrocardiographic diagnosis after the ablation procedure at two different neuromuscular blockade depths. Results: Total 94 patients (47 in each group) were included in the analysis. Recurrence of AF during the A 12-month follow-up was 12 (25%) in group D and 22 (46%) in group M. The AF recurrence rate was significantly higher in group M (p = 0.03). The relative risk (RR) for the risk of 12-month AF recurrence was 0.545 in group D. AF symptom recurrence was observed during the A 12-month follow-up in 12 (25%) and 26 (54%) patients in groups D and M, respectively. Conclusions: Compared to moderate neuromuscular blockade, deep neuromuscular blockade while performing RFCA under general anesthesia reduced 12-month AF recurrence rate. Deep neuromuscular blockade under general anesthesia is thought to increase the success rate by providing a stable surgical environment during the RFCA procedure. Trial registration: Clinical trials of Korea KCT 0003371 [ABSTRACT FROM AUTHOR]

Objective: This study aims to explore the analgesic effects and safety of periarticular injections of methylene blue (MB) combined with a cocktail formulation following total knee arthroplasty (TKA). Methods: A total of 70 patients undergoing total knee arthroplasty were selected and divided into two groups based on the cocktail formula used for periarticular infiltration, including the methylene blue group (M group, n = 35) and the control group (C group, n = 35). Both groups underwent spinal anesthesia. At the end of the surgery, the M group received a 0.05% methylene blue combined cocktail for periarticular infiltration block, while the C group received a conventional cocktail infiltration block. Postoperatively, both groups used intravenous patient-controlled analgesia. Then, the rest and movement Numeric Rating Scale (NRS) scores, postoperative sufentanil consumption, postoperative inflammatory markers, and the occurrence of adverse reactions such as wound infection and poor wound healing were compared after postoperative 24 h, 48 h, 72 h, and 7-day, 14-day, 28-day between the two groups. Results: The rest and during movement, NRS scores at postoperative 24 h, 48 h, 72 h, 7-day, 14-day, and 28-day were significantly lower in the C group compared with the M group (P < 0.05). The total sufentanil consumption at postoperative 72 h was less in the M group (98.9 ± 11.3 µg) compared to the C group (129.1 ± 12.3 µg) (P < 0.01). It also showed a lower IL-6 in the M group at postoperative 24 h and 72 h (P < 0.05). However, there were no significant differences in CRP levels between the two groups at 24 h and 72 h post-surgery (P > 0.05), and neither group experienced complications such as wound infection or poor wound healing. Conclusion: Methylene blue combined with a cocktail can be safely used for local infiltration after knee arthroplasty, which reduces postoperative opioid consumption and suppresses the release of inflammatory factors. Moreover, it synergistically enhanced the local anesthetic analgesia and provided sustained pain relief for at least 4 weeks. [ABSTRACT FROM AUTHOR]

Introduction: Haemodynamic atrioventricular delay (AVD) optimisation has primarily focussed on signals that are not easy to acquire from a pacing system itself, such as invasive left ventricular catheterisation or arterial blood pressure (ABP). In this study, standard clinical central venous pressure (CVP) signals are tested as a potential alternative. Methods: Sixteen patients with a temporary pacemaker after cardiac surgery were studied. AV delay optimisation was performed by alternating between a reference AVD of 120ms and tested settings ranging from 40 to 280ms, with 8 replicates for each setting. Alongside (a) the raw data, three methods of correcting for respiration were tested: (b) limiting analysis to a respiratory cycle, (c) asymmetric least squares (ALS) and (d) discrete wavelet transform (DWT). The utility of a quality control step was tested. Results: CVP signals were a mirror image of the systolic ABP signals: The four R values were -0.674, -0.692, -0.631, -0.671 respectively (all p<0.001). With quality control, the mirror image was best for DWT (R = -0.76, p<0.001), with the CVP and ABP optima agreeing well (R = 0.78, p<0.001). The automated quality control signal correctly predicted the gap between the AVD optima calculated from ABP and CVP (R = 0.8, p<0.001). Conclusions: Central venous pressure signals could be used to optimise AVD, because they have a reliable inverse relationship with ABP when pacemaker settings undergo protocolised testing. However, protocols need careful design to circumvent spontaneous biological variability. [ABSTRACT FROM AUTHOR]

Background: Thoracic outlet syndrome (TOS) is an uncommon condition defined by the compression of neurovascular structures within the thoracic outlet. When conservative management strategies fail to alleviate symptoms, surgical decompression becomes necessary. The purpose of this study is to evaluate and compare the efficacy and safety of regional anesthesia (RA) using spontaneous breathing in contrast to general anesthesia (GA) for patients undergoing surgical intervention for TOS. Methods: We conducted a retrospective comparative study involving 68 patients who underwent trans-axillary first rib resection for TOS. The patient cohort was divided into two groups: 29 patients in the GA group and 39 patients in the RA group. The RA technique employed consisted of supraclavicular brachial plexus (SBP) and pectoral nerve (PECS II) blocks, accompanied by deep sedation. Key outcome measures such as pain scores, opioid consumption, and various perioperative parameters were systematically analyzed. Results: Postoperative pain levels recorded in the recovery room were significantly lower in the RA group, with a median numerical rating scale (NRS) score of zero compared to two in the GA group (p = 0.0443). Additionally, both intraoperative and postoperative opioid consumption showed a marked reduction in the RA group, with p-values of less than 0.001 and 0.0418, respectively. The RA approach was associated with shorter surgical durations (p = 0.0008), a decrease in the incidence of postoperative nausea and vomiting (PONV) (p = 0.0312), and a lower occurrence of intraoperative lung injuries (p < 0.0001). Furthermore, the length of hospital stay was significantly reduced for patients in the RA group. Conclusions: Although both groups reported low postoperative pain scores, the regional anesthesia approach exhibited distinct advantages in terms of opioid consumption, surgical duration, and overall perioperative outcomes. The utilization of SBP and PECS II blocks facilitated surgical procedures and mitigated complications, thereby positively influencing the postoperative recovery trajectory. Future prospective studies are essential to validate these findings further and to investigate long-term outcomes associated with the use of regional anesthesia in TOS surgery. [ABSTRACT FROM AUTHOR]

Background: Lung ultrasound-guided alveolar recruitment manoeuvres (RMs) may reduce the lung ultrasound score. However, whether the use of this strategy can reduce the incidence of postoperative pulmonary complications (PPCs) in the adult obese population has not yet been tested. Methods/design: This is a single-centre, two-arm, prospective, randomised controlled trial. A total number of 476 obese patients scheduled for bariatric surgeries will be enrolled. They will be randomly assigned to receive either lung ultrasound-guided RMs (intervention group) or conventional RMs (control group) intraoperatively. The occurrence of PPCs will be recorded as the primary outcome. Discussion: To the best of our knowledge, this is the first trial to test the effect of lung ultrasound-guided RMs on PPCs. The results of this trial will support the anaesthesiologists in choosing a potentially more efficient method to perform RMs for bariatric surgery patients. Trial registration: www.chictr.org.cn ChiCTR2400080203. Registered on 23 January 2024. [ABSTRACT FROM AUTHOR]

Background: Literature regarding the advantages of HFNC in infants for ensuring oxygen supply after non-cardiac surgery is insufficient. The purpose of our study is to compare COT vs. HFNC on postoperative outcomes in infants undergoing non-cardiac surgery. We hypothesize that prophylactic use of HFNC after non-cardiac surgery in infants would reduce the incidence of post-anesthesia hypoxemia and could also be adapted as first-line oxygen therapy after non-cardiac surgery. Methods: This is a superior, single-blind, randomized controlled study. A total of 394 infants undergoing general anesthesia will be randomly assigned to accept COT or HFNC in a 1:1 ratio. The primary outcome is the rate of desaturation post-extubation. Secondary outcomes include the rate of mild upper airway obstruction, the rate of severe respiratory depression, the rate of transfer to PICU, duration of oxygen therapy, length of PACU stay, the time to reach full enteral feeding, and postoperative adverse events, including nasal injury, agitation, vomiting, and unplanned secondary surgery related to the initial surgery. Discussion: This is the first randomized controlled trial to explore the advantages of HFNC in infants to ensure oxygen supply after non-cardiac surgery. If favorable evidence is obtained, HFNC could be adopted as first-line oxygen therapy for infants following non-cardiac surgery. Trial registration: The trial was registered at https://www.chictr.org.cn (Registration number: ChiCTR2400081600, Date: March 6, 2024). [ABSTRACT FROM AUTHOR]

Background: Laparoscopic radical gastrectomy has been reported to be associated with substantial trauma and pain. This study compared the impact of ultrasound-(US)-guided, bilateral, double-injection intertransverse process block (ITPB) on postoperative analgesia with subcostal transversus abdominis plane block (TAPB) in patients who were undergoing laparoscopic radical gastrectomy. Methods: Sixty-two patients who were undergoing laparoscopic radical gastrectomy surgery under general anesthesia were included. These patients were randomized to either the ITPB group or the TAPB group. Patients in the ITPB group received a double-shot US-guided bilateral ITPB at the thoracic level T6/7 and T9/10 level using ropivacaine (0.3%, 15 mL). Patients in the TAPB group received bilateral subcostal TAPB one injection per side using ropivacaine (0.3%, 30 mL). All patients used a BIS-guided combined intravenous and inhalation anesthesia. The primary outcome was defined as postoperative morphine-equivalent consumption during the first 24 h. Results: The study recruited 62 patients (31 in each group) for the analysis. A comparatively less postoperative opioid consumption was observed in the ITPB group compared with the subcostal TAPB group within the first 24 h postoperatively (mean [standard deviation-(SD)] morphine-equivalent dose): 27.8 (5.7) mg vs 31.2 (4.4) mg, P < 0.001. The ITPB group showed lower intraoperative opioid use, and statistical significantly lower scores at rest and coughing at 6, 24 h postoperatively. The time to first requiring rescue analgesia was longer in the ITPB group than the subcostal TAPB group (median [IQR]): 8.0 [8.0] vs 6.0 [6.0] h, P = 0.009. The patients in the ITPB group exhibited earlier independent movement, lower incidence of postoperative complications and higher levels of satisfaction (P = 0.021). Conclusion: This study showed that the double-shot bilateral ITPB could reduce opioids consumption and achieve longer and better pain relief. Additionally, it promoted early postoperative activity and improved patient satisfaction. Trial registration: ChiCTR2300072986. Registered 29 June 2023. [ABSTRACT FROM AUTHOR]

Wearable piezoelectric sensors, as an emerging tool for blood pressure measurement, have attracted much attention at the forefront of medical physics and have broad application prospects due to their portability, real-time monitoring and low interference with human activities. However, the development of piezoelectric materials is currently a key factor restricting the development of wearable piezoelectric sensors. In order to continuously improve the accuracy and speed of blood pressure measurements by wearable piezoelectric sensors, new measurement methods need to be designed in addition to the development of high-performance piezoelectric materials. We present the advantages and disadvantages of different types of piezoelectric materials for wearable piezoelectric sensors, illustrate their future development directions, and discuss the current new strategies and the latest applied research of piezoelectric sensors applied to blood pressure measurement. In addition, the challenges and future prospects of wearable piezoelectric sensors for blood pressure measurement are revealed, providing new ideas for future applications of high-performance wearable piezoelectric sensors for health monitoring. [ABSTRACT FROM AUTHOR]

Interest in the concept of a virtual human model that can encompass human physiology and anatomy on a biophysical (mechanistic) basis, and can assist with the clinical diagnosis and treatment of disease, appears to be growing rapidly around the globe. When such models are personalised and coupled with continual diagnostic measurements, they are called ‘digital twins’. We argue here that the most useful form of virtual human model will be one that is constrained by the laws of physics, contains a comprehensive knowledge graph of all human physiology and anatomy, is multiscale in the sense of linking systems physiology down to protein function, and can to some extent be personalized and linked directly with clinical records. We discuss current progress from the IUPS Physiome Project and the requirements for a framework to achieve such a model. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) progressively impairs the memory and thinking skills of patients, resulting in a significant global economic and social burden each year. However, diagnosis of this neurodegenerative disorder can be challenging, particularly in the early stages of developing cognitive decline. Current clinical techniques are expensive, laborious, and invasive, which hinders comprehensive studies on Alzheimer's biomarkers and the development of efficient devices for Point-of-Care testing (POCT) applications. To address these limitations, researchers have been investigating various biosensing techniques. Unfortunately, these methods have not been commercialized due to several drawbacks, such as low efficiency, reproducibility, and the lack of accurate identification of AD markers. In this review, we present diverse promising hallmarks of Alzheimer's disease identified in various biofluids and body behaviors. Additionally, we thoroughly discuss different biosensing mechanisms and the associated challenges in disease diagnosis. In each context, we highlight the potential of realizing new biosensors to study various features of the disease, facilitating its early diagnosis in POCT. This comprehensive study, focusing on recent efforts for different aspects of the disease and representing promising opportunities, aims to conduct the future trend toward developing a new generation of compact multipurpose devices that can address the challenges in the early detection of AD. [ABSTRACT FROM AUTHOR]

Background/Objectives: Eversion carotid endarterectomy (CEA) in awake patients is performed using cervical plexus blocks (CPBs) with or without carotid artery sheath infiltration (CASI) under ultrasound guidance. Although adequacy of anesthesia (AoA) guidance monitors nociception/antinociception balance, its impact on intraoperative analgesia quality and perioperative outcomes in awake CEA remains unexplored. Existing literature lacks evidence on whether AoA-guided anesthesia enhances clinical outcomes over standard techniques. This study aimed to assess the role of AoA guidance in improving intraoperative analgesia and perioperative outcomes in patients undergoing CEA with CPBs alone or with CASI compared to standard practice. Methods: A randomized controlled trial included 184 patients divided into three groups: CPBs with intravenous rescue fentanyl (IRF) and lidocaine (LID) guided by hemodynamic observation (C group), AoA-guided IRF and LID (AoA group), and AoA-guided IRF, LID, and CASI (AoA-CASI group). Primary outcomes included perioperative adverse events, and secondary outcomes assessed rescue medication demand and hemodynamic stability. Results: Analysis of 172 patients revealed no significant differences between groups in perioperative adverse events or hemodynamic parameters (p > 0.05). However, the AoA-CASI group demonstrated significantly reduced IRF and LID usage compared to the C and AoA groups (p < 0.001). No significant advantage was observed between the AoA and C groups regarding adverse events (p = 0.1). Conclusions: AoA-guided anesthesia with or without CASI does not significantly reduce perioperative adverse events or improve hemodynamic stability in awake CEA. Clinical implications suggest that focusing on surgical technique optimization may yield greater benefits in reducing adverse events compared to advanced anesthetic monitoring. Further studies are warranted to explore alternative approaches to enhance clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: The safety and efficacy of electrophysiological (EP) procedures using ultrasound (US) guidance are being increasingly studied. We investigated if a systematic workflow with ultrasound guidance (the US4ABL), comprising four steps (transesophageal echocardiography (TEE) for left atrial thrombus exclusion, US of the groin vessels to guide femoral access, TEE-aided transseptal puncture, and transthoracic echocardiography (TTE) for exclusion of pericardial tamponade after the procedure), reduces the number of complications and fluoroscopy duration and dose. Methods: A total of 212 consecutive patients underwent left-sided ablations using the US4ABL workflow and were compared to a group of 299 patients who underwent the same type of ablations using post-procedural TTE to exclude tamponade (standard group: venous and/or arterial access by palpation and fluoroscopy, and pressure guided transseptal puncture). Complications, procedural duration, fluoroscopy duration, and dose were compared. Results: The cohort included 511 patients (42% female); 43.8% of patients suffered from paroxysmal atrial fibrillation (AF), 35.4% presented with persistent AF, 10.7% underwent the procedure was for atrial tachycardia, and 10% of patients had premature ventricular contractions. The complication rate in the US4ABL group was lower compared to the standard group: 0 complications vs. 11 complications (3.7%, mainly vascular and pericardial), respectively (p = 0.005). The procedure times were lower in the US4ABL group (p < 0.01), whereas the fluoroscopy time and dose did not differ significantly. Conclusions: A fully ultrasound-guided (US4ABL) workflow for left atrial and ventricular electrophysiology procedures reduces the complication rate and the procedure time. [ABSTRACT FROM AUTHOR]

Background: Propofol as an intravenous (IV) induction agent frequently causes significant hypotension and requires monitoring and prompt intervention. The plethysmographic waveform, obtained from a pulse oximeter, relies on two components of light absorption-red and infrared, representing changes in blood volume and cardiovascular status of the patient. Aims and Objectives: The current study aimed to obtain a baseline value and positive predictive value (PPV) of plethysmographic variability index (PVI) to predict hypotension and also compare the PPV of PVI and perfusion index (PI) to predict hypotension induced by propofol. Materials and Methods: Seventy patients posted for elective surgery were first given IV crystalloids 2 h before surgery and then induced with propofol IV. Hemodynamic parameters, PI and PVI were recorded from baseline until 3 min post-intubation. Hypotension was defined as a fall in systolic blood pressure >30% or mean arterial pressure (MAP) <60 mmHg. Patients were then grouped into those who developed hypotension (Group H) and those who did not (Group NH). Statistical analysis of MAP, PVI, and PI was done. Receiver operating characteristic (ROC) curves were plotted and analyzed. The PPV of PVI and PI was calculated and compared. Results: Hypotension occurred in 56 patients. The mean baseline MAP was lower in Group H (91.3±10.54 mmHg vs. 99.93±3.36 mmHg). The fall in MAP was highest at 3 min post-induction (Group H 59.38±7.09, Group NH 79.36±8.05). The difference in baseline PVI was not statistically significant (Group H 15.59±3.67, Group NH 15.43±5.65). PVI peaked in Group H when MAP was minimum (59.38±7.09 mmHg) at 3 min post-induction. The difference in baseline PI was not significant at any time point (Group H 1.13±1.02, Group NH 0.92±0.47) Area under the ROC curve of 0.534 for PVI and 0.559 for PI were not statistically significant hence showing no correlation between baseline PVI and PI and propofol-induced hypotension. Conclusion: Baseline PVI and PI can serve as screening tools and not diagnostic tools for predicting hypotension. Baseline PVI =19 is more accurate to predict post-induction hypotension than the values mentioned in previous studies. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy is a minimally invasive surgery which most often is associated with post-operative pain. Pre-emptive administration of ketamine and diclofenac in combination reduces post-operative pain. Aims and Objectives: In patients undergoing laparoscopic cholecystectomy, the aim of this study was to evaluate the efficacy of preemptively administered ketamine and diclofenac and their combination on post-operative pain. Materials and Methods: A total of 90 patients, with American Society of Anesthesiologists physical grading I and II, were recruited for the study. Patients were allocated randomly into the following groups: Group I was administered 100 mL isotonic saline intravenous (IV) 20 min before the induction of anesthesia and 0.15 mg/kg ketamine IV diluted in 5-mL isotonic saline before skin incision; Group II received diclofenac in the dose of 1 mg/kg diluted in 100-mL isotonic saline IV 20 min before the induction of anesthesia and 5-mL isotonic saline IV before skin incision; Group III was administered a combination of diclofenac 1 mg/kg diluted in 100-mL isotonic saline IV 20 min before the induction of anesthesia and 0.15 mg/kg ketamine diluted in 5-mL isotonic saline IV before skin incision. Time for rescue analgesia, post-operative Visual Analog Scale score, hemodynamic changes, and adverse effects were evaluated. Results: Post-operative analgesia was longer in Group III as compared to Group II and Group I at 2, 4, and 6 h (P<0.05). The mean time to receive rescue analgesia was significantly higher in Group III (6.950±0.6208) and Group II (5.633±0.7184) as compared to Group I (2.833±0.6205). Significantly higher heart rate and blood pressure were noted in Group I as compared to Group II and Group III at 2, 4, and 6 h postoperatively. Conclusion: Administration of ketamine and diclofenac preemptively in the patients undergoing laparoscopic cholecystectomy has a definitive role in providing postoperative analgesia without any adverse side effects whereas ketamine alone when given preemptively did not produce any benefit in post-operative pain relief. [ABSTRACT FROM AUTHOR]

Background: Shivering is a commonly encountered post-anesthesia event. Tramadol is an easily available drug that is often used to prevent shivering. However, its side effects like nausea have prompted the search for better dugs that could prevent shivering with minimal side effects. Aims and Objectives: Our study aimed at comparing the efficacy of tramadol, dexmedetomidine, and dexamethasone in preventing post-spinal shivering in lower limb orthopedic surgeries. Materials and Methods: A total of 90 patients were enrolled for this study and divided into three groups - group Dx-received 1 µg/kg of dexmedetomidine, group De-received 0.1 mg/kg of dexamethasone, and group T-received 0.5 mg/kg of tramadol. Incidence of shivering was the primary outcome. Secondary outcomes were-shivering score, sedation score, hemodynamic parameters, and adverse effects, if any. One-way analysis of variance was employed for comparing continuous variables and the Chisquare test for categorical variables. Results: Incidence of shivering and shivering score was the least in dexmedetomidine group, followed by tramadol and dexamethasone. Sedation score was higher with dexmedetomidine than tramadol and dexamethasone. Conclusion: Dexmedetomidine is most effective in preventing post-spinal shivering in patients. The sedation it caused added comfort to the patients for the duration of surgery and did not cause any significant adverse effect in post-operative period. [ABSTRACT FROM AUTHOR]

With shifts in lifestyle and dietary patterns, obesity has become an increasing health issue among younger demographics, particularly affecting young adults. This trend is strongly associated with a heightened risk of developing chronic diseases, especially cardiovascular conditions. However, conventional health monitoring systems are often limited to basic parameters such as heart rate, pulse pressure (PP), and systolic blood pressure (SBP), which may not provide a comprehensive assessment of cardiac health. This study introduces an intelligent heart health monitoring system that leverages the Internet of Things (IoT) and advanced sensor technologies. By incorporating IoT-based sensors, this system aims to improve the early detection and continuous monitoring of cardiac function in young obese women. The research employed a TERUMO ES-P2000 to measure blood pressure and a PhysioFlow device to assess noninvasive cardiac hemodynamic parameters. Through precise sensor data collection, the study identified key indicators for monitoring cardiovascular health. Machine learning models and big data analysis were utilized to predict cardiac index (CI) values based on the sensor-derived inputs. The findings indicated that young obese women showed significant deviations in blood pressure (SBP and PP) and cardiac hemodynamic metrics (SVI, EDV, and ESV) at an early stage. The implementation of signal processing techniques and IoT sensors enhanced the CI prediction accuracy from 33% (using basic parameters like heart rate, PP, and SBP) to 66%. Moreover, the integration of extra sensor-based parameters, such as Stroke Volume Index (SVI) and Cardiac Output (CO), along with the use of color space transformations, successfully improved the prediction accuracy of the original data by 36.68%, increasing from 53.33% to 90.01%. This represents a significant improvement of 30.01% compared to the existing technology's accuracy of 60%. These results underscore the importance of utilizing sensor-derived parameters as critical early indicators of cardiac function in young obese women. This research advances smart healthcare through early cardiovascular risk assessment using AI and noninvasive sensors. [ABSTRACT FROM AUTHOR]

Noise pollution is a known health risk factor and evidence for cardiovascular diseases associated with traffic noise is growing. At least 20% of the European Union's population lives in noise-polluted areas with exposure levels exceeding the recommended limits of the World Health Organization, which is considered unhealthy by the European Environment Agency. This results in the annual loss of 1.6 million healthy life years. Here, we investigated the protective effects of cardiovascular drug interventions against aircraft noise-mediated cardiovascular complications such as elevated oxidative stress or endothelial dysfunction. Using our established mouse exposure model, we applied mean sound pressure levels of 72 dB(A) for 4 d. C57BL/6 mice were treated with the beta-blocker propranolol (15 mg/kg/d s.c. for 5 d) or the alpha-blocker phenoxybenzamine (1.5 mg/kg/d s.c. for 5 d) and noise-exposed for the last 4 d of the drug administration. Short-term noise exposure caused hypertension (measured by tail-cuff blood pressure monitoring) and impaired endothelial function (measured by isometric tension recording in the aorta and video microscopy in cerebral arterioles in response to acetylcholine). Noise also increased markers of oxidative stress and inflammation. Treatment of mice with propranolol and phenoxybenzamine prevented endothelial and microvascular dysfunction, which was supported by a decrease in markers of inflammation and oxidative stress in heart tissue and the brain. Amelioration of noise-induced hypertension (systolic blood pressure) was not observed, whereas pulse pressure was lowered by trend. This study provides a novel perspective mitigating the adverse effects of noise pollution, especially in vulnerable groups with medication, a rationale for further pharmacological human studies. [ABSTRACT FROM AUTHOR]

Background and Objectives: Neuromuscular blocking agents are essential to ensure optimal surgical conditions during general anesthesia. Sugammadex, a selective binding agent, is widely used to reverse neuromuscular blockade. While weight-based dosing (2 mg/kg for moderate blockade) is recommended, many clinicians administer a fixed dose of 200 mg in clinical practice, potentially leading to overdosing. This study aimed to compare the efficacy and recovery profiles of weight-based and fixed-dose sugammadex in patients undergoing general anesthesia. Materials and Methods: In this randomized controlled trial, 20 patients were divided into two groups: the recommended dose group (R group, 2 mg/kg) and the fixed dose group (F group, 200 mg). Primary outcomes included time to achieve a normalized train-of-four (TOF) ratio of 0.9. Secondary outcomes included recovery time, time to spontaneous respiration, response to verbal commands and extubation, and adverse events. Results: The median time to achieve a normalized TOF ratio of 0.9 was 2.3 min in the R group and 2.0 min in the F group (p = 0.529). Secondary outcomes, including recovery time and time to extubation showed no significant differences. Adverse events were minimal and comparable between groups. Conclusions: The fixed-dose sugammadex (200 mg) demonstrated similar efficacy and safety to weight-based dosing (2 mg/kg) in reversing moderate neuromuscular blockade. These findings do not allow abandoning the recommendation of adjustment for body weight, particularly in patients with low body weight or comorbidities. [ABSTRACT FROM AUTHOR]

Background/Objectives: Acute pulmonary embolism (PE) is a leading cause of cardiovascular mortality, characterized by nonspecific symptoms and variable clinical presentations. Accurate risk stratification is essential for effective management. While conventional tools like the simplified pulmonary embolism severity index (sPESI) and imaging modalities are widely used, they are often costly and have limitations in predictive accuracy. Inflammatory and coagulative markers, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean-platelet-volume-to-lymphocyte ratio (MPVLR), have shown promise in thrombotic conditions. This study explores their prognostic value in PE, focusing on their associations with risk stratification and clinical outcomes. Methods: This retrospective study included 231 adult patients diagnosed with PE at a tertiary care center. Exclusion criteria included recent infection, autoimmune diseases, or immunosuppressive therapy. Laboratory data, clinical parameters, and outcomes (e.g., hospitalization duration, complications, and mortality) were analyzed. Ratios were calculated from routine blood counts, and statistical comparisons were conducted between low- and high-risk groups based on sPESI. Results: High-risk patients (n = 203) exhibited significantly higher troponin, blood urea nitrogen, aspartate aminotransferase, lactate, the NLR (median 4.9 vs. 2.7, p = 0.005), and the MPVLR (median 7.1 vs. 3.9, p = 0.001) compared to low-risk patients. The PLR showed no significant difference between risk groups (p = 0.233). An elevated NLR, PLR, and MPVLR correlated with ICU admission, intubation, and mortality (p < 0.001, p < 0.007, and p < 0.001, respectively). The NLR was the most consistently associated with hospitalization duration and mortality, while the MPVLR and PLR were less predictive of overall hospitalization. Conclusions: The NLR, MPVLR, and PLR are cost-effective, easily calculable markers with the potential for improving risk stratification in PE patients. Among these, the NLR showed the strongest prognostic value, correlating with multiple clinical outcomes. Multicenter studies are needed to validate these findings further and establish clinical utility. [ABSTRACT FROM AUTHOR]

Regional anesthesia is a popular method for surgical anesthesia in clavicular surgery. Selective blocking of the cervical 3, 4, and 5 nerve roots shows promise in clavicle surgery, with its fast onset, good anesthesia and less complications, necessitating evaluation of its impact on diaphragmatic function. The purpose of this study is to examine the safety of C3, 4, and 5 nerve root block for its application in clavicle surgery. We conducted a pragmatic, randomized trial to evaluate the effect of C3, 4, and 5 nerve root block as compared with interscalene with intermediate cervical plexus block in diaphragmatic motion. This study involved forty patients undergoing right clavicle surgery. Patients were assigned in a 1:1 ratio to either a C345 nerve root block (administered with 2, 3, and 5 ml of 0.5% ropivacaine) or an interscalene with intermediate cervical plexus block (ISB + ICPB, each receiving 10 ml of 0.5% ropivacaine). Diaphragmatic kinetics were quantitatively assessed using sonographic techniques. The primary outcome was the incidence of complete hemi-diaphragmatic paralysis, observed at 30 min post-blockade. Secondary outcomes included the rate of complete hemi-diaphragmatic paralysis at 15 min and the degree of diaphragmatic motion restoration at 2, 4, 6, and 8 h post-blockade, onset time of block, motor block score in upper extremity, and adverse events. Results showed that only one patient (5%) in the C345 group vs. fifteen (75%) in the ISB + ICPB group experienced complete hemi-diaphragmatic paralysis at 30 min during deep breathing (P = 0.001). No patients in the C345 group, compared to five (25%) in the ISB + ICPB group exhibited paradoxical movement at 30 min during voluntary sniffing (P = 0.0471). Additionally, the C345 group demonstrated significantly greater diaphragmatic motion and upper limb strength restoration at all measured intervals post-blockade. Moreover, faster onset time and less adverse events were observed in the C345 group vs. in the ISB + ICPB group. Benefit from low volume of local anesthetics, the C345 nerve root block not only significantly reduces the incidence of complete hemi-diaphragmatic paralysis but also facilitates better recovery from diaphragmatic paralysis compared to the ISB + ICPB. It can be inferred that C345 is a more beneficial anesthesia method for early recovery of clavicular patients. Trial registration number: ChiCTR2300078283 04/12/2023. [ABSTRACT FROM AUTHOR]

In this review, we have amalgamated the literature, taking a multimodal neuroimaging approach to quantify the relationship between neuronal firing and haemodynamics during a task paradigm (i.e., neurovascular coupling response), while considering confounding physiological influences. Original research articles that used concurrent neuronal and haemodynamic quantification in humans (n ≥ 10) during a task paradigm were included from PubMed, Scopus, Web of Science, EMBASE and PsychINFO. Articles published before 31 July 2023 were considered for eligibility. Rapid screening was completed by the first author. Two authors completed the title/abstract and full‐text screening. Article quality was assessed using a modified version of the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. A total of 364 articles were included following title/abstract and full‐text screening. The most common combination was EEG/functional MRI (68.7%), with cognitive (48.1%) and visual (27.5%) tasks being the most common. The majority of studies displayed an absence/minimal control of blood pressure, arterial gas concentrations and/or heart rate (92.9%), and only 1.3% monitored these factors. A minority of studies restricted or collected data pertaining to caffeine (7.4%), exercise (0.8%), food (0.5%), nicotine (2.7%), the menstrual cycle (0.3%) or cardiorespiratory fitness levels (0.5%). The cerebrovasculature is sensitive to numerous factors; thus, to understand the neurovascular coupling response fully, better control for confounding physiological influences of blood pressure and respiratory metrics is imperative during study‐design formulation. Moreover, further work should continue to examine sex‐based differences, the influence of sex steroid hormone concentrations and cardiorespiratory fitness. What is the topic of this review?This review examines literature using simultaneous multimodal neuroimaging to measure the relationship between neuronal firing and haemodynamics during task paradigms (i.e., neurovascular coupling). This review focuses on the control of physiological, psychological and lifestyle factors of the included articles.What advances does it highlight?The review underscores the critical need for improved control of physiological and lifestyle confounders, such as blood pressure, carbon dioxide levels, caffeine intake, exercise, menstrual cycle phase and sex comparisons, in study designs to ensure more accurate and reliable findings in neurovascular coupling research. [ABSTRACT FROM AUTHOR]

Background: Monitoring core temperature is important for patients under anesthesia. Esophageal and pulmonary artery blood temperatures can be used for measuring core temperature during general anesthesia. However, these methods pose challenges, especially when the placement of an esophageal thermometer and pulmonary artery catheter (PAC) is either impractical or not the preferred approach. An endotracheal tube (ETT) with a thermometer on the cuff allows for the measurement of tracheal temperature, providing a suitable alternative to core temperature measurement. This study aimed to assess the clinical reliability and accuracy of the thermometer in the ETT in comparison to the core temperature measured using a PAC. Methods: Eleven patients who underwent coronary artery bypass graft (CABG) surgery were enrolled in this study. The patients were intubated using an ETT equipped with a thermometer on the cuff, and a PAC was inserted. Temperature measurements of both the trachea and pulmonary artery blood were recorded at 5-minute intervals for 1 hour before starting cardiopulmonary bypass. The agreement between the two temperature measurement methods was investigated using the Bland-Altman plot with multiple measurements per subject, and the correlation was evaluated using the concordance correlation coefficient (CCC). Results: Eleven patients with a total of 143 pairs of data were included for analysis. The mean difference between the tracheal and pulmonary artery temperatures was −0.10°C. The 95% limit of agreement (LoA), calculated as ± 1.96 standard deviation, ranged from −0.35°C to 0.15°C. The 95% confidence interval for the lower and upper LoA was −0.51°C to −0.27°C and 0.07°C to 0.31°C, respectively. The maximum allowed difference (Δ) was set at 0.5°C. The majority of temperature differences fell within the LoA and were well below the maximum allowed difference. The CCC was 0.95, which indicates a substantial strength of agreement. Conclusions: The agreement between the tracheal and pulmonary artery temperature measurements using the ETT thermometer and pulmonary artery catheter, respectively, was found to be clinically reliable and accurate. Therefore, the tracheal temperature measurement can effectively represent the core temperature of the patients. Employing an ETT equipped with a thermometer on the cuff can serve as a reliable and independent method for measuring core temperature. Trial registration: Clinical trial registration number:NCT05595616. [ABSTRACT FROM AUTHOR]

Copyright of Saudi Journal of Anaesthesia is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Saudi Journal of Anaesthesia is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Saudi Journal of Anaesthesia is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Using neuromuscular blocking agents (NMBA) in pediatric induction protocol is a challenging matter. Therefore, in this study, we aimed to find a safer way for anesthesia in children. We compared the effects of dexmedetomidine with atracurium on intubation conditions in children aged 6–12 years under general anesthesia. If dexmedetomidine has the similar effect as atracurium, we can use it for intubation and anesthesia of children in situations where the use of atracurium is challenging for any reason. Methods: This clinical trial was carried out on children between 6 and 12 years in Mashhad University of Medical Sciences, Mashhad, Iran between January 2018 and February 2020. Participants candidates for tracheal intubation and general anesthesia were enrolled. Patients were distributed into two groups: Patients received Dexmedetomidine (Group D) and patients received Atracurium (Group A). Results: We enrolled 25 patients in each group. Most of them were male. The intubation quality score consists of 5 items including laryngoscopy, vocal cord, coughing, jaw relaxation and limb movement was assessed between two groups. This score had no statistically significant difference between study groups. Immediately after induction and one minute after it, heart rate was statistically significant higher in group A than group D (P < 0.001 & P = 0.04 respectively). All of the intubations in our study were successful. More coughing was seen in group A compared with group D (P = 0.01). Conclusion: In children aged 6–12 years, the administration of intravenous dexmedetomidine 1mcg/kg over a period of 10 min before the induction of anesthesia with sufentanil 0.3 µg/kg and propofol 3 mg/kg showed no statistically significant difference in quality of intubation score when compared to the use of 0.5 mg/kg atracurium to facilitate intubation. Decreased heart rate and less coughing were observed when using dexmedetomidine. This trial was registered retrospectively in the Iranian Clinical Trials Registry at 2021-24-05 (https://www.irct.ir/), and its registration number is IRCT20201028049177N1. [ABSTRACT FROM AUTHOR]

Background: Central venous oxygen saturation (ScvO2) obtained from a central venous catheter (CVC) is often used to approximate oxygen delivery in critically ill patients. Despite their importance in administering medications and monitoring oxygen delivery, the use of CVCs can be associated with significant complications. Midline catheters are inserted via a peripheral vein above the antecubital fossa and provide a safe alternative to CVCs. This study aimed to determine the equivalence of ScvO2 and midline catheter oxygen saturation (SmO2) in critically ill patients. Methods: This was a single-center observational study of critically ill adult patients who had concurrently placed CVCs (internal jugular and subclavian) and midline catheters as part of standard ICU care. Venous oxygen saturation and lactate levels were measured from both catheters using the Abbott point-of-care i-STAT analyzer. Demographic and ICU admission data were collected. Continuous variables were compared using the paired t-test. Pearson's correlation was used to evaluate the linear correlation between ScvO2 and SmO2. The systematic error (bias) was calculated using Bland-Altman analysis. Receiver operating characteristic curves were constructed to evaluate the sensitivities and specificities for different values of SmO2 to predict ScvO2. Results: Forty-eight patients (n = 48) were enrolled in the study. The mean ScvO2 and SmO2 were 65.5% +/- 11.2% and 62.7% +/- 17.6% respectively (p = 0.1197). In the Bland-Altman analysis, the mean bias between ScvO2 and SmO2 was 2.8% +/- 12.3% with 95% limits of agreement of −21.3% to 26.9%. More than 60% of the ScvO2 and SmO2 values diverged by ≥ 5%. Conclusions: The difference between the mean SmO2 and ScvO2 was not statistically significant and the mean bias between SmO2 and ScvO2 is low. Despite this, the substantially large standard deviation and limits of agreement preclude the use of SmO2 as a direct surrogate of ScvO2. [ABSTRACT FROM AUTHOR]