Background The Global Leadership Initiative on Malnutrition (GLIM) is an international nutritional assessment approach, but its evaluation for reduced muscle mass and inflammation criteria remain undefined in critically ill patients. We hypothesize that the phase angle derived from a bioelectrical impedance analysis (BIA) may be used as a GLIM inflammation criterion. Methods ICU patients expected to require >= 48 h of mechanical ventilation were stratified by the median phase angle. The primary outcomes were in-hospital mortality and the Barthel Index at discharge. Phase angle cut-off values were calculated for in-hospital death and the composite outcome of death or discharge with a Barthel Index < 70. Outcomes were compared between groups using the BIA-based GLIM (phase angle and skeletal muscle index) and the GLIM assessed by C-reactive protein (CRP) and computed tomography (CT). Results Fifty-three patients were included. The phase angle was significantly associated with hospital stay and mechanical ventilation duration. The areas under the ROC curve of the phase angle for mortality and a Barthel Index < 70 were higher than those for SOFA, APACHE II and maximum CRP. The BIA-based GLIM identified malnourished patients with significantly poorer prognoses than CRP/CT-based GLIM. With phase angle thresholds of 2.67 and 4.03, the GLIM malnutrition showed a longer hospital stay, lower grip strength at discharge. Conclusion The phase angle might be a suitable indicator for inflammation in the GLIM criteria, and appropriate BIA equipment providing both the phase angle and SMI might allow the initial assessment to be completed in a single step.
Some parturients experience discomfort, pain, and nausea/vomiting during cesarean delivery under neuraxial anesthesia. We evaluated whether intravenous dexmedetomidine administered after fetal delivery and cord clamping improved maternal intraoperative experience. In this prospective, triple-blind, placebo-controlled trial, women aged 20–45 years undergoing elective cesarean delivery under combined spinal–epidural anesthesia were randomized 1:1 to dexmedetomidine or saline. Dexmedetomidine was administered after cord clamping as a loading dose of 1 μg/kg over 10 min, followed by 0.4 μg/kg/hr until peritoneal closure; controls received equivalent-volume saline. The primary outcome was satisfaction with intraoperative sedation/analgesia, assessed on postoperative day 1 using a 7-point verbal rating scale. Secondary outcomes were Quality of Recovery-40 score, maximum intraoperative pain score, intraoperative nausea/vomiting, and motor recovery time. Eighty-three participants were randomized; 81 contributed to the available-case analysis. Satisfaction scores were higher with dexmedetomidine than saline (Hodges–Lehmann location shift, 1.0 point; 95 https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000029334 ).
Anesthetic management in general surgery poses substantial risks in elderly patients because age-related physiologic decline and preexisting comorbidities increase vulnerability to peri-operative complications. Older adults have reduced physiological reserve, impaired organ function, and slower recovery from surgical and anesthetic stress, placing them at increased risk for postoperative delirium and early postoperative cognitive impairment. Dexmedetomidine, a selective α2-adrenergic receptor agonist, has sedative, anti-inflammatory, and opioid-sparing properties that may influence early postoperative cognitive outcomes without significant respiratory depression. This systematic review and meta-analysis evaluated the association between dexmedetomidine and 24-h postoperative delirium/early postoperative cognitive impairment in elderly patients undergoing general surgery. Four studies involving 479 patients met the inclusion criteria. Across the included studies, dexmedetomidine was generally administered as a 1 µg/kg loading dose followed by continuous intraoperative maintenance infusion of 0.2–0.7 µg/kg/h. Pooled analysis showed that dexmedetomidine was associated with significantly lower odds of 24-h postoperative delirium/early postoperative cognitive impairment compared with control treatment (pooled OR 0.38, 95
