Dow International Medical College

Ultrasound-guided regional anesthesia (UGRA) has changed how we manage pain by allowing doctors to visualize nerves and other structures in real time, making the process more accurate, effective, and safe while also reducing risk. This narrative review examines the latest advancements in UGRA techniques, evaluating their efficacy and safety, particularly for peripheral nerve and truncal plane blocks, their potential to diminish opioid consumption, and their clinical applications in perioperative care. This review followed the Scale for the Assessment of Narrative Review Articles (SANRA) quality assessment guidelines and searched six databases for studies published from January 2015 to October 2025, including trials, meta-analyses, cohort studies, reviews, and technical reports. This review aims to give doctors, anesthesia experts, and researchers the newest information and methods about UGRA, focusing on better ways to see needles and use additives like dexamethasone and dexmedetomidine to make regional anesthesia more effective and last longer, which can help lower opioid use and speed up recovery after surgery, while ultrasound guidance makes these techniques safer and more accurate. Another important finding is that real-time imaging and protocols help reduce safety concerns like toxicity, nerve damage, and infection. Artificial intelligence (AI) and robotics in UGRA enhance precision, safety, and recovery, paving the way for further standardization and accessibility.

Venous thromboembolism (VTE) remains a leading cause of preventable morbidity and mortality among hospitalized patients. Although pharmacological thromboprophylaxis is well established in inpatient care, initiation is frequently delayed until after hospital admission. The emergency department represents the first point of contact for many high-risk patients and a potential opportunity for earlier prevention. This systematic review and meta-analysis evaluated the effectiveness of emergency department-initiated thromboprophylaxis protocols in preventing VTE among high-risk adult patients. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review was conducted using MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to the most recent update. Eligible studies included randomized controlled trials and observational or quasi-experimental studies evaluating thromboprophylaxis initiated in, or directly facilitated by, the emergency department. Outcomes of interest included incidence of VTE, bleeding complications, mortality, length of stay, and process measures such as prophylaxis utilization and timeliness. Risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool for randomized trials and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool for non-randomized studies. Due to substantial clinical and methodological heterogeneity, quantitative pooling was limited, and a structured narrative synthesis was performed. The review identified a heterogeneous body of evidence comprising prospective and retrospective cohorts, before-and-after implementation studies, and health information technology interventions. Emergency department-initiated or emergency department-facilitated protocols consistently increased appropriate thromboprophylaxis use and reduced delays to the first dose. In a subset of large protocol implementation studies, earlier initiation was associated with lower rates of symptomatic VTE without a corresponding increase in major bleeding. Mortality and length of stay outcomes were inconsistently reported, precluding definitive conclusions. The overall certainty of evidence was limited by observational designs, variability in patient populations, and inconsistent outcome definitions. Emergency department-initiated thromboprophylaxis protocols improve the timeliness and appropriateness of VTE prevention and may reduce symptomatic events without increasing bleeding risk in selected high-risk populations. These findings support the integration of structured thromboprophylaxis pathways into emergency care, while highlighting the need for high-quality prospective trials to define their impact on patient-centered outcomes.

Background: Catheter ablation is a cornerstone in arrhythmia management, but its safety profile in patients with congenital heart disease (CHD) remains underexplored on a national scale. Objectives: To evaluate the utilization and in-hospital complication rates of catheter ablation among patients with CHD and arrhythmias, using data from a large, nationally representative inpatient database. Methods: We analyzed data from the 2018–2020 National Inpatient Sample (NIS) to identify hospitalizations involving catheter ablation for arrhythmias in adult CHD patients. Patient characteristics, in-hospital outcomes, and resource utilization were examined. Multivariable logistic regression was used to identify predictors of complications. Results: Between 2018 and 2020, 2370 adult hospitalizations for CHD involved catheter ablation for cardiac arrhythmias. Most patients were aged 60–74 years (41%), male (61%), and White (80%). Atrial fibrillation (44%) and atrial flutter (34%) were the most common indications. In-hospital mortality was low at 0.6%. Median length of stay was 3.0 days (IQR: 2.0–6.0), and the median inflation-adjusted total charge was $138 056 (IQR:$99 076–$202 284). Twelve percent of patients experienced at least one complication, most commonly pericardial, vascular, and cardiac complications. In multivariate analysis, ablation for atrial flutter was associated with increased odds of at least one complication (OR: 3.32 [1.44–7.62]; P = 0.005). Age ≥75 years was associated with lower odds compared with age 18–44 years (OR: 0.22 [0.05–0.94]; P = 0.042). Gender, race, insurance, income, and comorbidities were not significantly associated with in-hospital complications. Conclusion: In this nationally representative cohort of adults with CHD undergoing catheter ablation, in-hospital mortality and complication rates were low. However, complication risk varied by arrhythmia type and age, reiterating the need for individual risk assessment and continued evaluation of procedural safety. The lower complication rate in the oldest age group likely reflects selection bias rather than greater intrinsic procedural safety. CHD complexity, surgical-scar-related arrhythmia substrates, and chromosomal abnormalities are underexplored but clinically meaningful determinants of ablation outcomes that warrant dedicated investigation in future registry-based studies.

Introduction: The association between sarcopenia and many postoperative outcomes is not well-established. Aims: This meta-analysis aims to clarify the potential of sarcopenia to predict these postoperative outcomes. Methods: A search of PubMed, EMBASE, and Cochrane CENTRAK databases was performed until November 2023 in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Studies that met the inclusion criteria were extracted and their quality assessment was done using the Newcastle–Ottawa Scale. The pooled analysis was done using a random-effects model with dichotomous outcomes expressed as odds ratio (OR) and continuous as weighted mean differences with 95% confidence intervals (CIs). Results: Seventeen studies met the inclusion criteria with a total of 5879 patients, with 1690 diagnosed with sarcopenia. Sarcopenia was shown to be significantly associated with increased risk of inpatient mortality (OR = 5.18, 95% CI: 1.04–25.68; P = 0.04), 30-day mortality (OR = 3.32, 95% CI: 2.02–5.46; P < 0.00001), 90-day mortality (OR = 4.24, 95% CI: 1.19–15.12; P = 0.03) and 1-year mortality (OR = 2.53, 95% CI: 1.25–5.12; P = 0.01). Sarcopenic was also associated with an increased risk of severe complications, cardiac complications, pulmonary complications, renal complications, postoperative infections, intensive care unit and hospital length of stay and the risk of unfavorable discharge. There was no significant association between sarcopenia and risk of leakage. Conclusion: Our meta-analysis provided insights into sarcopenia and postoperative outcomes of emergency surgeries. We demonstrated the significant association between the presence of sarcopenia and the presentation of postoperative adverse outcomes and markers of worsened quality of recovery.