This research aimed to investigate the correlation between perioperative respiratory adverse events (PRAE) and postoperative serum SNHG4 levels, and preliminarily explore the potential regulatory mechanism of SNHG4 in an inflammatory lung injury cell model. Among the children undergoing general anesthesia surgery, this study included 122 children with PRAE. 104 patients without PRAE were assigned to the control group. RT-qPCR was employed to quantify the level of SNHG4 in serum. Receiver operating characteristic (ROC) curve and binary logistic regression were performed to preliminarily assess the association between PRAE occurrence and postoperative SNHG4 level. In vitro, human pulmonary microvascular endothelial cells (HPMECs) were treated with lipopolysaccharide (LPS). CCK-8 assay and flow cytometry were conducted to detect cell viability and apoptosis, respectively, and ELISA was applied to quantify the secretion of inflammatory cytokines. The level of SNHG4 in the PRAE group was significantly lower than that in the control group. Postoperative serum SNHG4 level was significantly correlated with the occurrence of PRAE. In LPS-stimulated HPMECs, restoring SNHG4 expression significantly enhanced cell viability, decreased the apoptotic rate, and reduced the secretion of pro-inflammatory cytokines. Dual-luciferase reporter assays confirmed the targeting relationship between SNHG4 and miR-449c-5p. Rescue experiments further demonstrated that overexpression of miR-449c-5p could partially reverse the biological effects of SNHG4 overexpression on LPS-induced HPMECs. A statistically significant association was observed between PRAE and postoperative serum SNHG4 level. In injured pulmonary endothelial cells, SNHG4 shows a significant correlation with inflammatory responses, which is linked to its targeting effect on miR-449c-5p.
Metabolic acidosis is a common and clinically important acid–base disorder in critically ill patients and is associated with poor outcomes. Although arterial blood gas analysis is routinely used to evaluate acid–base status, the prognostic value of early metabolic changes during the first 24 h of intensive care unit (ICU) admission remains unclear. This study aimed to evaluate the association between 24-hour arterial blood gas dynamics and mortality in critically ill patients with metabolic acidosis. This retrospective study included 357 adult patients with metabolic acidosis admitted to the tertiary care ICU. Patients were classified as survivors and non-survivors. Arterial blood gas measurements taken at admission and 24 h later were analysed. pH, PaCO₂, bicarbonate (HCO₃⁻), base excess, lactate were recorded and the corrected anion gap was calculated. The prognostic performance of these dynamic parameters in predicting mortality was assessed using receiver operating characteristic (ROC) analysis, and independent associations were examined using multivariate logistic regression. Overall mortality was 39.5
Retrosternal goiter can cause tracheal deviation, airway compression, and recurrent laryngeal nerve dysfunction, posing challenges for perioperative airway management. Evidence guiding airway management strategies is largely derived from high-resource settings, with limited data from low- and middle-income countries. To evaluate airway management strategies and perioperative outcomes in patients undergoing retrosternal goiter surgery in Vietnam. We retrospectively reviewed 40 consecutive patients who underwent resection of retrosternal goiter between 2021 and 2025. Preoperative airway assessment combined symptom evaluation, bedside airway examination and cervicothoracic computed tomography, and airway management followed a stepwise multidisciplinary institutional approach in which the tracheal tube was downsized according to the degree of narrowing and adequate mask ventilation was confirmed before neuromuscular blockade. Data included preoperative clinical presentation, imaging, laryngoscopy and/or bronchoscopy, intraoperative anesthetic and surgical techniques, and postoperative complications. The primary outcome was successful endotracheal intubation. Secondary outcomes included airway-related and perioperative complications, post-anesthesia care unit time, and hospital length of stay. The median age was 62.0 years (interquartile range [IQR] 52.3–68.3), and 37.5
Surgical resection is central to colorectal cancer management, but surgery and anesthesia can induce perioperative immunosuppression. Opioids, a mainstay of perioperative analgesia, may impair cellular immunity, including disruption of Th1/Th2 immune equilibrium. This randomized controlled trial evaluated whether opioid-free anesthesia (OFA) better preserves perioperative immune function than opioid-based anesthesia. Sixty patients scheduled for elective laparoscopic colorectal cancer resection were randomly allocated to OFA (dexmedetomidine, esketamine, lidocaine) or opioid-based anesthesia (sufentanil, remifentanil). Peripheral blood was sampled before induction and on postoperative days 1 and 5 to measure Th1/Th2 ratio, CD4⁺/CD8⁺ ratio and natural killer (NK)-cell counts. Serum cortisol, measures of postoperative pain and complications, including postoperative nausea and vomiting (PONV), were documented. On postoperative day 5, the Th1/Th2 ratio was markedly reduced in patients given OFA relative to the control (C) group (1.14 ± 0.40 vs. 1.57 ± 0.89, P = 0.017); in the C group it had returned to baseline, whereas it remained suppressed with OFA. CD4⁺/CD8⁺ ratios and NK-cell counts showed no between-group differences at any point. Cortisol levels at the end of surgery and Numeric Rating Scale pain scores on day 1 were significantly lower with opioid-based anesthesia, while PONV incidence was lower with OFA. In laparoscopic colorectal cancer surgery, the OFA regimen used in this trial was associated with sustained postoperative reduction of the Th1/Th2 ratio compared with opioid-based anesthesia. Although OFA reduced PONV, its potential to prolong Th1/Th2 suppression warrants caution when selecting anesthetic strategies for these patients. This trial was retrospectively registered with the Chinese Clinical Trial Registry under ChiCTR2500101735 (registered April 29, 2025).
Aplasia cutis congenita (ACC) is a rare congenital anomaly characterized by absence of skin and in some cases, underlying bone in the newborn. Although ACC is well described in the plastic surgery and neurosurgery literature, anesthesiology-focused reports remain limited. As a result, practical guidance addressing perioperative anesthetic management in these physiologically vulnerable infants is lacking. We present two neonates with severe aplasia cutis congenita requiring urgent surgical intervention within the first few days of life. We contrast the two presentations of ACC, one with isolated disease and the other presenting as part of a syndrome with associated congenital heart disease. These cases illustrate key perioperative considerations, including airway management, risk of significant blood loss, and the need for careful positioning. They also demonstrate how comorbid conditions may influence anesthetic planning and intraoperative management. Perioperative management of neonates with ACC requires meticulous preoperative assessment, anticipation of significant blood loss, and coordinated multidisciplinary care. This case series proposes a structured perioperative anesthetic framework for neonates with ACC that may facilitate standardized care in this high-risk population.
Anaphylactic shock is a life-threatening event characterized by severe inflammatory response and profound hemodynamic instability, which can progress to cardiac arrest. Cardiopulmonary resuscitation (CPR) is a life-saving intervention in the event of cardiac arrest but may cause severe mechanical injury. Coronary artery injury is a rare complication which is not fully discussed in literatures. We present a case of a 64-year-old male who suffered anaphylactic shock to 4
Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. At present, there is insufficient evidence regarding the relationship between mechanical power and mortality in patients with acute brain injury (ABI). We aimed to investigate the association between mechanical power and 28-day mortality, ventilator-free days, duration of mechanical ventilation, and ICU length of stay (LOS) in mechanically ventilated patients with ABI. We conducted a retrospective study involving 950 participants with brain injuries receiving mechanical ventilation. Demographic, clinical, and ventilation parameters were collected. Associations between the first 24 h of MP and 28-day mortality were analyzed using multivariable Cox proportional-hazards models, with sequential adjustment for demographics, illness severity and comorbidities. Secondary outcomes (ventilator-free days through day 28 (VFDs), duration of ventilation, and ICU length of stay) were analyzed using multivariable linear regression. Non-survivors had significantly higher baseline MP compared to survivors (13.8 ± 4.5 vs. 10.8 ± 3.4 J/min, p < 0.001). In Cox regression, higher MP was consistently associated with increased mortality risk across all models. In the fully adjusted model, a per-unit increment in MP (J/min) was associated with an 18.5
Post-extubation respiratory deterioration remains a concern in adult cardiac surgery patients requiring prolonged postoperative mechanical ventilation, even after a successful spontaneous breathing trial (SBT). We evaluated the association between pre-extubation lung ultrasound score (LUS) and escalation to non-invasive ventilation (NIV) within 48 h after extubation. This single-center prospective observational study included adult cardiac surgery patients who required invasive mechanical ventilation for > 24 h and successfully completed an SBT. LUS was assessed after the SBT and before extubation using a standardized 12-zone protocol, with a total score ranging from 0 to 36. The primary outcome was NIV escalation within 48 h after extubation. LUS was analyzed primarily as a continuous variable using logistic regression, and its discriminative performance was assessed using receiver operating characteristic (ROC) analysis. Prespecified LUS strata (< 11, 11–14, and > 14) were used for descriptive analyses. Among 120 patients, 32 (26.7
Postoperative sleep disturbance (PSD) is common and may impair recovery. Sleep quality during the first postoperative night is important in early recovery and offers an immediate opportunity for symptom-directed care. Several PSD prediction models have been reported, but most predict sleep disturbance at 1 week or within 7 days after surgery. We developed and internally validated a pre-sleep model for first-night PSD using variables available before the first postoperative night. This single-center prospective cohort study included 205 adults undergoing elective surgery. First-night PSD was assessed on the morning of postoperative day 1 and defined as an Athens Insomnia Scale (AIS) score ≥ 6. After exclusion of patients with missing primary outcome data, patients were randomly divided in a 7:3 ratio into a training cohort (n = 143) and an internal testing cohort (n = 62). Candidate predictors available before the first postoperative night were selected using LASSO regression and entered into multivariable logistic regression to construct the prediction model and nomogram. Model performance was assessed using receiver operating characteristic (ROC) curves, calibration analysis, decision curve analysis (DCA), and bootstrap internal validation. First-night PSD occurred in 135 patients (65.9
Postoperative sleep disturbance is common after thyroid cancer surgery and may delay recovery. Stellate ganglion block (SGB) can regulate sympathetic activity, but single local anesthetic blockade has limited duration. This trial aimed to evaluate whether perineural addition of dexmedetomidine to ropivacaine in right-sided SGB could improve early postoperative sleep quality among thyroid cancer patients. This randomized, double-blind controlled trial included 60 patients in the per-protocol efficacy analysis (n = 30 per group); safety and recovery outcomes were assessed in all 62 treated participants. Before anesthesia induction, patients received ultrasound-guided right-sided SGB with a 6-mL injectate: 0.2
Airway management in adults with special healthcare needs undergoing dental treatment under general anesthesia may be challenging because of limited cooperation, heterogeneous diagnoses, and difficulties in awake airway assessment. The Percentage of Glottic Opening (POGO) score quantifies glottic visualization, but its relationship with nasotracheal tube advancement in this population remains unclear. This study aimed to describe videolaryngoscopic glottic visualization, total nasotracheal intubation duration, nasotracheal tube-advancement techniques, and airway-related events during nasotracheal intubation. This prospective descriptive observational study included 100 adults with special healthcare needs undergoing dental treatment under general anesthesia. Videolaryngoscopic nasotracheal intubation was performed in all patients. POGO score, modified Cormack–Lehane grade, Han mask ventilation grade, total nasotracheal intubation duration, first-attempt success, airway optimization maneuvers, nasotracheal tube-advancement techniques, and airway-related complications were prospectively recorded. Total nasotracheal intubation duration was analyzed as a continuous variable and categorized as ≤ 30 s, 31–60 s, and > 60 s; >60 s was defined as prolonged nasotracheal intubation. Spearman correlation, Mann–Whitney U, Chi-square, and Fisher’s exact tests were used as appropriate. The median POGO score was 100 [75–100], and first-attempt intubation success was achieved in all patients. The median total nasotracheal intubation duration was 38.0 [28.0–49.3] seconds. Intubation was completed within 30 s in 40 patients (40.0
Ophthalmic draping during cataract surgery creates an isolated surgical field but may lead to carbon dioxide (CO₂) accumulation beneath the drape. Elevated CO₂ can cause hypercapnia, cerebral vasodilation, and increased intracranial pressure, potentially reflected by changes in cerebral oximetry and optic nerve sheath diameter (ONSD). Patients with a history of COVID-19 pneumonia may exhibit residual pulmonary dysfunction that influences these parameters during surgery. This study aimed to investigate the effects of ophthalmic draping on end-tidal CO₂, cerebral oximetry, and ONSD in patients undergoing cataract surgery and to determine whether these effects differ between patients with and without a history of COVID-19 pneumonia. This prospective comparative study included 80 ASA I–III patients aged > 18 years with and without a history of COVID-19 pneumonia who underwent unilateral phacoemulsification under local anesthesia. Participants were divided into two main groups: those with (Group A, n = 40) and without (Group B, n = 40) a history of COVID-19 pneumonia. Within each predefined COVID-19 history stratum, patients were randomly allocated by block randomization to receive either 2 L/min (A-2, B-2) or 4 L/min (A-4, B-4) oxygen insufflation beneath the surgical drape. End-tidal CO₂ and hemodynamic parameters were continuously monitored, while cerebral oximetry parameters (rSO₂, ΔO₂Hb, ΔHHb, ΔcHb) were measured bilaterally every five minutes. ONSD was assessed ultrasonographically before and after surgery. ETCO₂ values showed no significant group-by-time differences. Postoperative ONSD values were significantly higher than preoperative values within both main groups and all oxygen-flow subgroups; however, the between-group comparisons were not statistically significant. Right frontal relative deoxyhemoglobin changes (ΔHHb-right) differed significantly between Groups A and B at the 10th minute (p = 0.003), while the other cerebral oximetry parameters demonstrated no significant group- or time-dependent differences. No patient developed hypoxia or neurological deterioration. In patients undergoing short-duration unilateral phacoemulsification under local anesthesia with supplemental oxygen at 2–4 L/min, ophthalmic draping was not associated with clinically meaningful differences in ETCO₂ or ONSD, regardless of the history of COVID-19 pneumonia. Although selected cerebral oximetry parameters showed statistically significant differences between groups, all measured respiratory, hemodynamic, and cerebral physiological variables remained within physiological limits throughout the procedure. These findings should be interpreted within the context of the specific clinical settings studied. ClinicalTrials.gov, NCT05571683. Retrospectively registered on 7 October 2022.
Burnout disproportionately affects healthcare professionals, particularly critical care specialists. The ongoing conflict in Ukraine has placed a significant strain on healthcare resources, with the added burden of the recent COVID-19 pandemic further intensifying the risk of burnout among Ukrainian critical care physicians. This study aimed to evaluate the prevalence of burnout and identify associated risk factors to guide targeted interventions. A cross-sectional survey was conducted from September 2022 to February 2023 among Ukrainian critical care providers recruited via secure messaging Viber™ group chat and the CERTAIN educational platform. The survey captured demographic and practice-related data and employed the Ukrainian-translated Maslach Burnout Inventory (MBI). Statistical analysis comprised descriptive statistics, exact permutation tests, and comparisons to recent European burnout data using risk differences (RDs). Of the 412 individuals who accessed the survey link, 105 critical care physicians submitted survey responses. The prevalence of burnout was 71.4
The impact of labor epidural analgesia (LEA) on breastfeeding success remains uncertain. This study aimed to identify whether LEA affects lactation onset and breastfeeding continuation postpartum. In this prospective observational cohort study, 305 healthy term singleton mothers planning vaginal delivery were enrolled. They were allocated to the LEA (n = 154) or non-LEA (n = 151) group based on their own preferences for LEA. The primary outcome was lactation onset, assessed within 48 h postpartum. Secondary outcomes were exclusive breastfeeding or breastfeeding rates at 3 days, 6 weeks and 3 months (assessed via interview or telephone). Inverse probability of treatment weighting (IPTW) using propensity scores was applied to enable homogeneous comparisons between the groups. After IPTW adjustment and regression analysis, LEA was not significantly associated with lactation onset as assessed within 48 h postpartum and the rate in two groups was comparable (58.5
To investigate the relationship between serum levels of S100 calcium-binding protein A6 (S100A6), intercellular adhesion molecule-1 (ICAM-1), and S100 calcium-binding protein B (S100B) and the development of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) in children undergoing tonsillectomy and adenoidectomy under sevoflurane anesthesia. A total of 300 children scheduled for tonsillectomy and adenoidectomy under sevoflurane anesthesia were prospectively enrolled. The Cornell Assessment of Pediatric Delirium (CAPD) was used to assess POD, and the Wechsler Preschool and Primary Scale of Intelligence or the Wechsler Intelligence Scale for Children-Revised was used to evaluate POCD. Serum levels of S100A6, ICAM-1, and S100B were measured 24 h post-surgery. The marker levels were compared between the POD and non-POD groups, and between the POCD and non-POCD groups. Correlations between the markers and CAPD scores/cognitive function z-scores were analyzed. Restricted cubic spline models were used to assess dose-response relationships, and multivariate logistic regression models were constructed to evaluate the independent associations and combined discriminatory power of the three biomarkers. Among the 300 children, 62 (20.7
The aim of this study was to compare the analgesic efficacy of a combination of serratus plane block (SPB) and transversus thoracic plane (TTP) block with pectoral nerve block (PECS) 2 in patients undergoing modified radical mastectomy (MRM) surgery. Sixty patients in the ASA I-III classification, aged between 18 and 75 years, who agreed to participate in the study and would undergo MRM surgery, were included in the study. The patients were divided into two groups. Before the surgery, PECS 2 block (30mL, 0.25
Ultrasound–CT fusion may improve anatomical orientation during lumbar nerve root block, but its comparative clinical value is uncertain. We compared peri-procedural pain trajectories and workflow between fusion guidance and ultrasound guidance alone in patients with multilevel lumbar disc herniation. This retrospective cohort screened 163 potential patients from January 2023 to June 2024. Of 120 patients who entered a guidance attempt, 115 completed the planned procedure and entered the comparison. All received a unilateral single-target lumbar nerve root block using 3 mL of 1
Hepatic insufficiency within a week of orthotopic liver transplantation (OLT), termed early allograft dysfunction (EAD), occurs in 20–25
Controlled hypotension is a widely adopted anesthetic method in shoulder arthroscopy to improve visual clarity. However, hypotension-related hypoperfusion may lead to postoperative acute kidney injury (AKI). The renal resistive index (RRI) is considered an effective and reliable parameter for identifying prerenal AKI. This study aimed to evaluate perioperative changes in RRI during shoulder arthroscopy with controlled hypotension. Following ethics committee approval, 90 adult patients undergoing elective shoulder arthroscopy were prospectively assessed. Controlled hypotension was achieved by adjusting the intravenous remifentanil infusion (0.01–0.2 µg/kg/min). RRI was measured pre- and postoperatively in pain-free, hemodynamically and respiratory stable patients. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Data from 65 patients were analyzed. The postoperative RRI values (mean ± SD: 0.683 ± 0.085) were significantly higher than the preoperative values (mean ± SD: 0.648 ± 0.077) (p < 0.001). The mean change in RRI (delta RRI), calculated as (postoperative RRI − preoperative RRI) / preoperative RRI, was 5.6
