To compare efficacy of oliceridine versus sufentanil given during general‑anesthesia induction in patients undergoing strabismus‑correction surgery. 288 patients scheduled for elective strabismus correction under general anesthesia were enrolled. Inclusion criteria had no age or sex restrictions, with ASA Ⅰ‑Ⅱ. Due to scarcity of adult strabismus surgeries, all participants were aged 3‑19 years, and were randomized to group S (sufentanil) or group A (oliceridine). All patients received routine general anesthesia induction and maintenance. The induction regimen consisted of midazolam 0.05 mg/kg, cisatracurium 0.2 mg/kg, propofol 1.5–2.0 mg/kg, combined with sufentanil 0.4 μg/kg or oliceridine 0.08 mg/kg. Anesthesia was maintained with continuous infusion of propofol and remifentanil. Infusion rates were adjusted according to blood pressure and heart rate, and additional boluses of propofol or remifentanil were administered when necessary. No study‑assigned opioids (oliceridine or sufentanil given at induction) were re‑administered in either group. All patients were transferred to the post-anesthesia care unit (PACU) after surgery. The primary outcome was the adequate intraoperative analgesia rate, defined as the percentage of patients with adequate intraoperative analgesia among all patients who received anesthesia induction and completed surgery. Adequate intraoperative analgesia was defined as heart rate and blood pressure fluctuations less than 20
Hypotension is a common consequence of spinal anesthesia and is mainly related to sympathetic blockade, venous pooling, and reduced venous return. We investigated whether the preoperative right internal jugular vein collapsibility index (RIJV-CI) could help identify patients at risk of hypotension after spinal anesthesia during transurethral resection surgery. This prospective observational study included 60 patients aged 18–65 years with ASA physical status I–II who underwent elective transurethral resection surgery (TUR-P and TUR-M) under spinal anesthesia. Before intravenous fluid administration and spinal anesthesia, inspiratory (dI) and expiratory (dE) diameters of the right internal jugular vein were measured using M-mode ultrasonography during spontaneous breathing. RIJV-CI was calculated as [(dE − dI) / dE] × 100. Hypotension was defined as a ≥20
Effective analgesia is essential in multiple rib fractures to preserve respiratory function. Thoracic paravertebral block (TPVB) is effective but may be limited by technical difficulty and complications. Rhomboid intercostal–subserratus (RISS) plane block is a newer ultrasound-guided alternative. To compare the analgesic efficacy and pulmonary function recovery associated with ultrasound-guided RISS block and TPVB in patients with traumatic multiple rib fractures. In this prospective, randomized, blinded trial conducted in an emergency ICU, 50 adults aged 18–60 years with unilateral traumatic fractures of three or more ribs were randomized 1:1 to receive continuous ultrasound-guided TPVB or RISS block with catheter infusion in addition to standardized systemic analgesia. The primary endpoint was pulmonary function at 24 h, assessed using forced expiratory volume in one second (FEV1). Secondary outcomes included pain scores at rest and during coughing, pulmonary function, diaphragmatic excursion, rescue opioid consumption, adverse events, and ICU and post-ICU ward stay. Fifty patients were randomized, with 25 patients in each group. At 24 h, FEV1 increased from 56.2 ± 3.2
The impact of the COVID-19 pandemic on patient-centred outcomes remains unclear. We evaluated Days Alive and Out of Hospital at 90 days (DAOH-90) in cardiac surgery patients, and assessed outcome differences based on sex, income, and rurality before and after the first local directive to postpone elective surgery. This was a retrospective cohort study including adults (≥ 18 years) at Toronto General Hospital and the University of Ottawa Heart Institute from March 15, 2018 to March 15, 2022. Analyses were conducted separately for coronary artery bypass grafting (CABG), isolated valve, and complex surgery (CABG with ≥ 1 valve or multivalve surgery without CABG). March 15, 2020, the date of the first Ontario directive to postpone elective surgery, was specified as the interruption in procedure-specific interrupted time-series (ITS) models of monthly DAOH-90. In an exploratory analysis, patient-level zero-inflated beta-binomial models model the association of sex, rurality, and neighbourhood income with the outcome. We included 5,630 patients [2549 (45
