BMC anesthesiology
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Randomized Controlled Trial
Effect of different doses of ciprofol on hemodynamics induced by general anesthesia in elderly diabetic patients undergoing spinal surgery: a double-blind, randomized, controlled study.
To evaluate the safety and efficacy of different doses of ciprofol for the induction of general anesthesia in elderly patients with diabetes undergoing spinal surgery. ⋯ The incidence of hypotension in Group C (46.4%) was significantly higher than that in Groups A (7.4%) and B (14.8%) (P < 0.05). The area under the time-mean arterial pressure curve (AUTMAP) was significantly greater in Group C (176.39 ± 33.83 mmHg·min) than in Group B (158.44 ± 26.55 mmHg·min) and Group A (143.59 ± 19.52 mmHg·min) (P < 0.05). The incidence of intubation response was highest in Group A (77.8%, P < 0.05). Significant differences in bispectral index (BIS) values were observed at 3, 4, and 5 min post-administration among the groups CONCLUSIONS: The induction regimen of 0.3 mg/kg ciprofol combined with 0.4 µg/kg sufentanil and 0.7 mg/kg rocuronium provided superior hemodynamic stability and reduced the need for vasoactive drugs in elderly diabetic patients. This regimen was found to be more favorable compared to the 0.2 mg/kg and 0.4 mg/kg ciprofol dosing groups, demonstrating an optimal balance of safety and efficacy during anesthesia induction in this high-risk population. This trial was registered in the Chinese Clinical Trial Registry on February 26, 2024 (Registration Number: ChiCTR2400081164).
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Randomized Controlled Trial
The efficacy and safety of patient-controlled intravenous analgesia with esketamine after total hip arthroplasty: a randomized controlled trial.
To evaluate the efficacy and safety of esketamine-based patient-controlled intravenous analgesia following total hip arthroplasty. ⋯ Patient-controlled intravenous analgesia with esketamine has the potential to provide good postoperative analgesia for total hip arthroplasty patients, reduce the incidence of adverse reactions after the operation, improve the satisfaction of patients and surgeons, and significantly improve patients' postoperative mood.
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Observational Study
Anesthesia for pregnant patients with symptomatic neurological disease: 13 years' experience from a tertiary care center.
Improvements in diagnostics and clinical care have allowed more women of childbearing age, suffering from neurological diseases, to safely have pregnancy, reducing peripartum complications. However, these patients remain at risk and are a constant challenge for anesthesiologists in the delivery room. ⋯ In our experience, when neuraxial anesthesia was feasible, it proved to be a safe option for pregnant patients with symptomatic neurological disease, resulting in uncommon maternal complications.
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Given the prevalence of cardiovascular disease, encountering difficult airways in this patient population is quite common. The challenge for anesthesiologists lies not only in establishing the airway but also in managing the hemodynamic instability caused by sympathetic activation during intubation. The purpose of this report is to describe the anesthetic experience of this patient with severe mitral and tricuspid regurgitation, atrial fibrillation with rapid ventricular response, and moderate pulmonary hypertension with an anticipated difficult airway. ⋯ This case highlights the importance of considering both airway safety and maintaining hemodynamic stability when cardiac surgery patients encounter an anticipated difficult airway. Awake intubation is not the only option, and intubation after general anesthesia may be considered when the benefits are evaluated to outweigh the risks.
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Postcardiotomy cardiogenic shock (PCCS) in cardiac surgery is associated with a high rate of morbidity and mortality. Beside other therapeutic measures (e.g. intraaortic balloon pump (IABP)), extracorporeal life support is being increasingly used in this particular form of shock. Objectives of this meta-analysis were to determine mortality and complications of extracorporeal life support treatment (ECLS) in cardiac surgery patients, and if outcomes were influenced by a preexisting cardiovascular risk profile. ⋯ Extracorporeal life support for PCCS is associated with a substantial mortality and complication rate. Diabetes mellitus and obesity seem to be independent risk factors. Therefore, until future work has elucidated which patients benefit at all, the risks of ECLS-treatment must be critically weighed up against a possible benefit.