Background Airway management in the prone position remains a major challenge in anesthesia, particularly during short urologic procedures. Although endotracheal intubation (ETT) is considered the standard technique, the Classic laryngeal mask airway (LMA) has emerged as a less invasive alternative in patients without an anticipated difficult airway. This study aimed to compare the efficacy and safety of Classic LMA versus ETT for airway management in prone‐position urologic surgeries. Methods In this randomized clinical trial, 70 patients undergoing prone‐position urologic surgery with an operative duration of ≤ 90 min were assigned to either the Classic LMA group or ETT group ( n = 35 each). Primary outcomes included intraoperative ventilatory performance assessed by peak airway pressure (Ppeak), need for conversion of airway technique, and airway‐related complications. Secondary outcomes included intraoperative hemodynamic and respiratory parameters, including heart rate (HR), systolic and diastolic blood pressure (SBP/DBP), oxygen saturation (SpO 2 ), end‐tidal carbon dioxide (ETCO 2 ), Ppeak, minute ventilation (VE), and postoperative complications. Results Baseline demographic and perioperative characteristics were comparable between groups. No significant differences were observed between the Classic LMA and ETT groups regarding intraoperative hemodynamic variables, SpO 2 , ETCO 2 , or VE. Ppeak was significantly higher in the ETT group ( p < 0.001). During recovery, significant time‐related changes were observed in hemodynamic and respiratory parameters in both groups, although no clinically significant intergroup differences were identified. Postoperative complications, including sore throat and laryngospasm, were infrequent and comparable between groups. Conclusion Classic LMA provided airway maintenance and ventilation comparable to ETT in short prone‐position urologic surgeries and may be considered as a feasible airway device in patients meeting appropriate airway assessment criteria. Trial Registration: Iranian Registry of Clinical Trials (IRCT): IRCT20250729066688N1
Objective Arterial serum was generally used to uncover shifts in the metabolic profile induced by surgery and anaesthesia. The specific perioperative metabolic alterations in the brain remain largely unknown. We aimed to detect perioperative changes in cerebral metabolism by arteriovenous gradients of circulating metabolites across the brain using liquid chromatography–tandem mass spectrometry (LC‐MS) analysis. Methods The prospective study was conducted at Sichuan Provincial People’s Hospital, China. Twenty patients with unilateral pulmonary lesion were recruited. Patients undergoing thoracic surgery were randomised to receive general anaesthesia with sevoflurane or propofol. Blood samples from radial artery and jugular bulb were collected before and after first anaesthetic administration, at the end of 60 min of maintenance of anaesthesia and 60 min after patients regained consciousness. LC‐MS‐based untargeted metabolomics strategies were used to determine the difference in abundance of circulating metabolites between artery and jugular bulb. Results A total of 3900 metabolites were detected. Potential critical alterations of metabolites including phosphatidylcholine (PC), phosphatidylethanolamine (PE), choline, isocitrate and lactate and pathways were identified. Brain took up PC and PE in group sevoflurane but secreted these compounds in group propofol. Additionally, propofol was associated with the release of choline and isocitrate from brain. In both groups, lactic acid entered brain intraoperatively. Conclusion This work may offer a comprehensive mapping of perioperative alterations of cerebral metabolism in patients under general anaesthesia and a new direction for further studies in pharmacology of general anaesthetics and pathogenesis of perioperative brain dysfunction. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2500111204
Background Propofol sedation (PS) administered by nonanesthesiologists has been demonstrated as safe across various medical disciplines, yet its in‐office use in urology remains limited. Prostate biopsies are typically performed either under local anesthesia or anesthesiologists‐administered anesthesia, including sedation and general anesthesia. Both approaches are associated with well‐recognized limitations such as patient discomfort and substantial resource requirements, contributing to the slow transition from the transrectal to the transperineal approach for prostate biopsy. PS administered directly by urologists could potentially overcome these barriers. Methods In this study, a standardized, urologically performed and supervised PS workflow for prostate biopsies was established and interdisciplinarily implemented. Consecutive patients undergoing MRI/ultrasound fusion‐guided prostate biopsy were retrospectively analyzed. Procedures were initially performed transrectally and subsequently expanded to the transperineal approach. Outcomes include descriptive analysis of sedation‐ and biopsy‐related complications and patient‐reported outcome measures (PROMs), biopsy access route, and utilization of anesthesia and operating room resources. Results A total of 205 consecutive biopsies were performed under PS. No propofol‐associated complications occurred. Biopsy‐related complications were rare and limited to urinary retention (< 1%) and febrile urinary tract infection (< 2%). PROMs demonstrated excellent tolerability and comfort with this sedation method, with strong preferences for PS in the event of repeat biopsies. Following PS implementation, the proportion of transperineal biopsies substantially increased from initially 34% to 74%, while the use of general anesthesia and operating room resources was reduced from up to 45% to 17%. Conclusion In‐office administration of PS by urologists is safe and associated with excellent patient acceptance. Through simpler workflows and reduced need of anesthesiology and operating room resources, PS facilitates the implementation of the transperineal approach for prostate biopsy.
Postdural puncture headache (PDPH) is a recognized complication of neuraxial anesthesia that follows unintentional dural puncture during epidural techniques or intentional dural puncture during spinal anesthesia and other neuraxial procedures. It has traditionally been managed with a period of mandatory supine bed rest and pillow restriction, a practice grounded in the historical belief that recumbency limits ongoing cerebrospinal fluid (CSF) leakage, thereby preventing headaches. This “no-pillow” instruction remains widely taught and practiced, including among clinicians, despite an absence of literature support and evidence suggesting the opposite may be true. This review synthesizes the current literature, including randomized controlled trials, Cochrane systematic reviews, and multisociety clinical guidance, to critically examine whether pillow restriction after dural puncture reduces PDPH incidence. Evidence indicates that neither prolonged bed rest nor pillow avoidance reduces PDPH incidence and that enforced postural restriction instead increases patient discomfort, back and neck pain, and the risk of complications associated with prolonged immobilization. This review advocates the revision of institutional protocols to permit pillow use and early postoperative mobilization, as tolerated.
Background Postspinal shivering is a frequent complication of spinal anesthesia (SA) and is particularly relevant in urological procedures, where perioperative heat loss can be exacerbated by irrigation fluids. Modifying the temperature of the intrathecal local anesthetic may affect thermoregulatory responses and the properties of the blockade. Methods This prospective, randomized, double‐blind, controlled trial was conducted in 96 patients (ASA I–II, aged 18–60 years) undergoing elective urological procedures under SA. Participants received intrathecal hyperbaric bupivacaine 0.5% (15 mg) combined with fentanyl 25 μg at one of three temperatures: 4°C (cold; n = 32), 24°C (room; n = 32), or 37°C (warm; n = 32). Shivering was graded using the validated Crossley and Mahajan scale. The primary endpoint was the incidence of clinically significant shivering (Grade ≥ 3) throughout the observation period, evaluated at 10‐min intervals. Results Cold bupivacaine demonstrated a significantly higher incidence of clinically significant shivering (Grade ≥ 3) (81.3%) compared with the room‐temperature (34.4%) and warm (25%) groups ( p < 0.001). The post hoc analysis showed that the difference between the room‐temperature and warm groups was not significant. Pharmacological intervention requirements were substantially elevated in the cold group (43.8%, 15.6%, 15.6%; p = 0.01). Warm bupivacaine accelerated sensory and motor block onset ( p = 0.001) while reducing residual motor blockade. Conclusion Warmed intrathecal bupivacaine significantly reduces PSS incidence and severity while optimizing block characteristics without compromising safety in urological patients. Trial Registration: ClinicalTrials.gov identifier: NCT07081516.
