The external oblique intercostal block (EOIB) is a novel regional anesthesia technique for upper abdominal surgery. However, its efficacy and safety compared to other analgesic strategies remain uncertain. This study aimed to evaluate the impact of EOIB on postoperative analgesia and recovery in adults undergoing upper abdominal surgery. PubMed, Web of Science, and the Cochrane Library were searched from inception until August 2025 for randomized controlled trials comparing EOIB to placebo, no block, or other regional techniques. Primary outcomes were 24-h postoperative opioid consumption and pain scores (rest/movement). Secondary outcomes included rescue analgesia requirement, opioid-related adverse effects, block-related complications, and recovery parameters. EOIB significantly reduced postoperative opioid consumption when compared with control at 24 h (SMD - 0.45; P < 0.001) and 48 h (SMD - 1.38, 95% confidence intervals [CI] -2.60 to - 0.16; P = 0.03). At rest, postoperative pain scores at 2, 4, 6, 12 and 24 h were all significantly lower (all P ≤ 0.03). Likewise, the reductions in pain during movement were only observed at 6, 12, and 24 h (all P ≤ 0.03). EOIB prolonged the duration until first rescue analgesia was initiated with a mean difference of 1.62 h (P < 0.001) and reduced the incidence of postoperative nausea and vomiting (OR 0.21, 95% CI 0.07-0.068). No significant differences were observed in overall rescue analgesia use. Overall, EOlB effectively reduces postoperative opioid consumption in upper abdominal surgery, particularly within the first 12 h with a favorable safety profile.
Background:While the transversus abdominis plane block (TAPB) is commonly used for postoperative analgesia after abdominal procedures, the erector spinae plane block (ESPB) has recently gained attention as an alternative regional anesthesia technique with potential advantages in managing visceral pain. We aimed to conduct a systematic review and meta-analysis to assess the analgesic efficacy of ESPB compared to TAPB under ultrasound guidance following hysterectomy. Materials and Methods:A comprehensive search was conducted across PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus to identify randomized controlled trials (RCTs) comparing ESPB versus TAPB for pain relief in patients undergoing hysterectomy through January 2026. Meta-analysis was conducted using RevMan software: Review Manager (RevMan), version 5.4.0, The Cochrane Collaboration, Copenhagen, Denmark. The primary outcome was postoperative pain intensity assessed by the 10-cm visual analog scale (VAS), with clinical significance evaluated using minimal clinically important difference (MCID) analysis (threshold 1.0 cm). Secondary outcomes included postoperative opioid consumption and incidence of nausea and vomiting. Results:Six RCTs involving 447 patients were included. ESPB demonstrated significantly lower VAS pain scores compared to TAPB at 2, 4, 6, 12, and 24 h postoperatively (P < 0.001). MCID analysis revealed that clinical benefit was most pronounced in the early postoperative period, particularly at 2 h. Patients receiving ESPB had significantly lower 24-h opioid consumption (P < 0.001) and reduced incidence of postoperative nausea and vomiting (PONV) (P = 0.004). Conclusion:ESPB demonstrates superior analgesia compared to TAPB following hysterectomy, particularly in the early postoperative period, with reduced opioid consumption and PONV incidence. Further research with standardized protocols is warranted.
Preoperative fasting was historically introduced to reduce pulmonary aspiration during anesthesia; however, contemporary evidence increasingly challenges the assumption that "longer is safer." Aspiration is a rare event and is primarily determined by patient- and procedure-related risk factors rather than fasting duration alone, whereas prolonged fasting is consistently associated with patient discomfort and adverse physiological consequences. Risk assessment has become more complex with emerging clinical factors, most notably the widespread use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which may delay gastric emptying and lead to residual solid gastric contents despite adherence to guideline-recommended fasting intervals. International recommendations for perioperative GLP-1 RA management remain heterogeneous, underscoring the need for pragmatic, risk-stratified strategies that balance aspiration risk mitigation with metabolic stability. Point-of-care gastric ultrasound is increasingly recognized as a valuable bedside decision-support tool, enabling qualitative and quantitative assessment of gastric contents in uncertain or high-risk scenarios and informing airway management and procedural timing. This review synthesizes the current evidence supporting liberal preoperative intake of clear liquids and highlights the transition from rigid, time-based rules toward individualized, physiology-informed approaches to perioperative hydration and nutrition.
Obesity, an ever-evolving global epidemic, continues to offer some of the most controversial and at times, polarizing debates in the modern-day medicine; whether it is for the formers' ethnic intricacies, or for that matter, its potential outcome associations. Given the far-reaching implications of obesity however, the recent developments in characterization of the same, are of special interest to an anesthesiologist caring for this predilected cohort of patients. The expert propositions, in this regard, outline the much-required need to think beyond the body mass index (BMI), traditionally used to define obesity. To that effect, motivated by the understanding of obesity as an adiposity-based chronic disease, visceral obesity has gained particular attention with the cost-effective and adaptable anthropometric measures: waist circumference, waist-to-hip ratio, and of late waist-to-height ratio, outperforming the isolated predictive and prognostic utility of BMI in the corresponding literature. Moreover, it is for the concept of visceral obesity that may aid in the distinction of metabolically unhealthy obesity from the metabolically healthy obesity. Hence, focusing the evolving updates on visceral obesity, the index narrative review comprehensively discusses the topic, underlining the points relevant to anesthesiologists, such as cardiometabolic risk profiling, relationship to metabolic syndrome, metabolic inflammation, operative outcomes, the perplexity surrounding "obesity paradox," and the useful insights provided by critical care medicine and the viral pandemic.
Intrathecal morphine (ITM) remains the benchmark for post-cesarean analgesia but is frequently associated with opioid-related adverse effects. Regional analgesia techniques such as transversus abdominis plane block (TAPB) are increasingly used as an opioid-sparing alternative. Multiple systematic reviews and meta-analyses (SRMAs) have evaluated TAPB efficacy, yet findings remain fragmented, heterogeneous, and methodologically inconsistent. This umbrella review synthesizes and critically appraises the highest-level evidence on the analgesic efficacy and safety of TAPB after cesarean delivery (CD). A PROSPERO-registered umbrella review was conducted according to PRISMA 2020 and PRIOR guidelines. SRMAs of randomized controlled trials (RCTs) evaluating TAPB for post-cesarean analgesia were systematically searched across major databases until October 31, 2025. Methodological quality was assessed using AMSTAR-2, overlap quantified via corrected covered area (CCA), and pooled findings reanalyzed using the metaUmbrella platform. Evidence credibility was evaluated using Ioannidis' criteria and certainty using GRADE. Fourteen SRMAs encompassing 125 RCTs (60 unique) were included. Study overlap was moderate (CCA 8.33%). AMSTAR-2 ratings revealed variable quality: four high-quality, eight low-quality, and two critically low-quality reviews. Reanalysis demonstrated that TAPB provided small but statistically significant reductions in 24-hour pain at rest (SMD - 0.11), pain on movement (SMD - 0.12), and opioid consumption (SMD - 0.19). All achieved Class IV (weak) evidence with low GRADE certainty. No significant differences were observed in early (6-12-hour) pain or time-to-rescue analgesia. TAPB showed a favorable trend toward reduced postoperative nausea and vomiting, though with high heterogeneity. ITM offered modestly superior early analgesia, but differences were below minimal clinically important thresholds and accompanied by more opioid-related side effects. Despite extensive literature, the overall credibility and certainty of evidence supporting TAPB after CD remain weak due to heterogeneity, methodological limitations, and review redundancy. TAPB provides modest analgesic benefit and improved tolerability, supporting its role when neuraxial opioids are omitted, contraindicated, or declined. High-quality RCTs, standardized TAPB techniques, and core outcome sets are needed to refine clinical recommendations.
Crisis resource management (CRM) training focuses on developing these high-stakes, unexpected event-handling skills. The abilities under non-technical skills (NTS) are not directly connected to technical competence but are still vital for preserving patient safety, collaboration, the environment, facilities, and all ICU members. This scoping review article aimed to demonstrate how to manage a crisis in an intensive care unit using non-technical skills. This review article presented crisis resource management (CRM) training and major components of crisis management including leadership, effective communication, anticipation and planning, resource utilization, workload distribution, situational awareness and triage, and prioritization. This review identified non-technical skills used for crisis management in the ICU for patient safety and favorable outcomes. Uncorrected crisis management could lead to unintended patient outcomes that impact morbidity and mortality. Crisis resource management (CRM) training focuses on developing these high-stakes, unexpected event-handling skills. Non-technical skills application with well-evident different approaches of crisis management usually leads to the least side effects and complications.
Patients with Madelung’s Disease often present with diffuse deposition and thickening of adipose tissue in the neck, nape, anterior chest wall, and shoulder-back region, making airway management extremely challenging. Currently, successful case reports of endotracheal intubation after general anesthesia induction in such patients are rare. This case involves a patient with Madelung’s Disease in his 60s who underwent pulmonary wedge resection. The surgery was successfully completed using endotracheal intubation after general anesthesia induction. For patients with Madelung’s Disease, thorough airway assessment and preparation for difficult airway management are crucial to ensure perioperative safety.
A 47-year-old man was diagnosed with a tracheal mass with a narrowed airway at the level of vertebrae thoracalis 2-4 (T2 - T4). He was scheduled for sternotomy. The patient's clinical condition was considered ASA III. We used fiberoptic bronchoscopy (FOI) to visualize the tumor's location and employed double endotracheal tubes to manage the airway difficulties. The first endotracheal tube was inserted orally into the trachea until it passed the tumor to provide primary airway control. Once the ventilator was connected, the second tube was repositioned below the tumor to maintain airway patency. After the surgery, the patient was transferred to the intensive care unit (ICU) for close monitoring of maintaining respiratory stability and preventing complications. The patient recovered well with stable vital signs and effective pain control.
Background: Tracheal intubation is essential for securing the airway during general anesthesia but often results in postoperative sore throat (POST), hoarseness, and coughing, with reported incidences reaching ~65%, ~55%, and ~96%, respectively. These complications arise mainly from irritation, inflammation, and mechanical trauma caused by the endotracheal tube, particularly during prone-position procedures. Their severity depends on factors such as tube size, cuff pressure, and intubation duration. Preventive approaches include optimizing cuff pressure and using anti-inflammatory or local anesthetic agents. This study evaluated whether intracuff dexmedetomidine offers an advantage over alkalinized lidocaine in reducing POST during prolonged prone-position surgeries. Patients and Methods: In this prospective randomized study, 100 adult patients (aged 18–65 years, American Society of Anesthesiologists I–II) undergoing thoracolumbar spine surgery under general anesthesia between March and October 2025 were allocated to two groups: Group D received 4 mL of intracuff dexmedetomidine (4 µg/mL), and Group AL received 4 mL of 2% alkalinized lidocaine. Primary outcomes included the incidence and severity of POST, hoarseness, and pain assessed in the Post-Anesthesia Care Unit, and at 2 and 24 h postsurgery. Secondary outcomes included hemodynamic and procedural parameters. Results: Both groups were comparable in demographic and clinical variables. No statistically significant differences were found in POST incidence, hoarseness, pain scores, or hemodynamic measures, though dexmedetomidine showed a slight trend toward better symptom prevention. Conclusion: Intracuff dexmedetomidine provided a modest improvement over alkalinized lidocaine in reducing postextubation sore throat, hoarseness, and postoperative pain during prolonged prone-position spine surgery.
Background: An increasing number of articles have been published on sevoflurane. However, a quantitative evaluation of sevoflurane-related publications that are frequently cited has not been performed. This study aimed to determine how interest in sevoflurane has changed among the authors of academic journals over the past 50 years. Methods: Sevoflurane-related studies were retrieved from the Web of Science Core Collection. The 100 most frequently cited original studies were identified via manual screening and analyzed. Document metrology software programs were used to perform visual analysis. Results: The citation frequency of the 10 most frequently cited articles ranged from 293 to 576, with an average citation frequency of 379.2. Five of the 10 most cited articles involved studies of sevoflurane-related neuropsychiatric complications. Among the 10 articles, the first three were related to neuropsychiatric complications. Only two articles on the effects of general anesthesia with sevoflurane were included. These articles originated from 17 countries, with more than half being from the United States and Japan. Harvard University was the most cited university. The three core journals were Anesthesiology, Anaesthesia and Analgesia, and the British Journal of Anaesthesia. Anesthesiology is the academic journal that publishes the most sevoflurane-related research. Fifteen of the 55 articles focused on neuropsychiatric complications, and 10 focused on the mechanisms of sevoflurane anesthesia. Conclusion: This study shows that the research focus has shifted from the anesthetic mechanisms of sevoflurane to its neuropsychiatric complications, highlighting the need for clinicians to carefully weigh its benefits against potential neurological risks, particularly in pediatric and elderly populations.
Background: This study aimed to compare erector spinae plane block (ESPB), serratus anterior plane block (SAPB), and serratus posterior superior intercostal plane block (SPSIPB) to determine the most suitable technique for maintaining postoperative analgesia in video-assisted thoracoscopic surgeries (VATS). Materials and Methods: Forty-five adult patients scheduled for elective VATS were included. Patients were randomly allocated into three groups: ESPB, SAPB, and SPSIPB. All patients received postoperative paracetamol and dexketoprofen, and intravenous tramadol hydrochloride. Postoperative static and dynamic visual analogue scale (VAS) scores, total tramadol consumption, side effects were recorded at regular intervals. Results: Static VAS scores at 0, 1, 6, 12, and 18 hours were significantly higher in the ESPB group than in the SAPB and SPSIPB groups (P < 0.05). In the SAPB group, static and dynamic VAS scores at 0 and 1 hour were lower compared to the SPSIPB group (P < 0.05). During the first 24 postoperative hours, tramadol consumption was significantly higher in the ESPB group compared to the other two groups (P < 0.05). No significant difference in tramadol consumption was observed between the SAPB and SPSIPB groups (P > 0.05). Conclusion: In patients undergoing VATS, SAPB was associated with lower VAS scores compared to both ESPB and SPSIPB, while ESPB resulted in higher VAS scores and greater tramadol consumption than the other two groups. These findings suggest that SAPB may be a more effective analgesic technique following thoracoscopic surgery, though confirmation with larger patient populations is recommended.
