Journal of Clinical Medicine

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Posterior Arytenoid Cartilage Dislocation Despite Optimal Intubation During Prolonged Steep Trendelenburg Robotic Prostatectomy: A Potential Biomechanical Contributor

by Seong Hyeok Lee and Hyun Jung Koh

J. Clin. Med. 2026, 15(7), 2652; https://doi.org/10.3390/jcm15072652 - 31 Mar 2026

Viewed by 387

Abstract

Background: Arytenoid cartilage dislocation (ACD) is a rare but clinically significant complication of endotracheal intubation that may be misdiagnosed as transient vocal cord paralysis. The potential role of prolonged surgical positioning in ACD remains underrecognized. Methods: A 63-year-old male developed left [...] Read more.

Background: Arytenoid cartilage dislocation (ACD) is a rare but clinically significant complication of endotracheal intubation that may be misdiagnosed as transient vocal cord paralysis. The potential role of prolonged surgical positioning in ACD remains underrecognized. Methods: A 63-year-old male developed left posterior ACD following robot-assisted radical prostatectomy (RARP) performed in a steep Trendelenburg position for 3.5 h. Intubation was successfully achieved on the first attempt using a video laryngoscope with full glottic visualization and no apparent airway trauma. Postoperatively, the patient developed persistent dysphonia, dysphagia, aspiration, and tongue deviation. Initial flexible laryngoscopy suggested left vocal cord paralysis, whereas direct laryngoscopy on postoperative day 6 confirmed posterior arytenoid dislocation. Urgent closed reduction was performed, followed by structured voice therapy, which resulted in substantial functional recovery. Discussion: This case illustrates that ACD may occur despite technically optimal and atraumatic intubation and should be interpreted as reflecting a temporal association rather than a definitive causal relationship. Prolonged steep Trendelenburg positioning and extended operative duration may be considered potential contributing biomechanical factors, possibly mediated by venous congestion, mucosal edema, altered endotracheal tube dynamics, and cumulative shear stress on the cricoarytenoid joint. However, these mechanisms remain interpretive and hypothesis-generating. Conclusions: Prolonged steep Trendelenburg positioning and extended operative duration may represent possible contributing biomechanical factors in ACD, even in the setting of atraumatic intubation. Early laryngeal evaluation and timely reduction remain essential for optimal functional recovery. Full article

(This article belongs to the Special Issue Advances in Clinical Anesthesia and Analgesia: Novel Approaches for Optimal Patient Safety and Comfort)

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14 pages, 976 KB

Open AccessArticle

The Association Between Early Postoperative Temperature Trajectories and Severe Acute Kidney Injury After Valvular Heart Surgery: A Retrospective Cohort Study

by Jin Sun Cho, Sungmin Suh, Jae-Kwang Shim, Hye Sun Lee, Hee Won Choi, Hyejin Yang and Young-Lan Kwak

J. Clin. Med. 2026, 15(5), 1887; https://doi.org/10.3390/jcm15051887 - 1 Mar 2026

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Abstract

Background/Objectives: Postoperative body temperature abnormalities are common yet underrecognized, and their association with acute kidney injury (AKI) remains unclear. In this study, we aimed to identify early postoperative temperature trajectories and evaluate their associations with AKI. Methods: This retrospective cohort study included [...] Read more.

Background/Objectives: Postoperative body temperature abnormalities are common yet underrecognized, and their association with acute kidney injury (AKI) remains unclear. In this study, we aimed to identify early postoperative temperature trajectories and evaluate their associations with AKI. Methods: This retrospective cohort study included 3274 adults undergoing valvular heart surgery with cardiopulmonary bypass. The patients’ temperatures were continuously measured using a pulmonary artery catheter for 12 postoperative hours, and temperature trajectories were identified using data-driven latrend class modeling. The primary outcome was severe AKI (KDIGO stage ≥ 2), and the secondary outcome was non-recovery AKI (≥72 h). Multivariable logistic regression and E-value sensitivity analysis were performed. Results: Four distinct temperature trajectories were identified: Class 1 (32.8%), initial normothermia progressing to mild hyperthermia (37.5–38.0 °C); Class 2 (27.4%), mild hypothermia (36.0–36.5 °C) with rapid normalization; Class 3 (24.4%), stable normothermia; and Class 4 (15.4%), lower-range mild hypothermia (35.5–36.0 °C) with delayed recovery. Severe AKI and non-recovery AKI occurred most frequently in Class 4 patients (15.1% vs. 2.9%, 3.9%, and 4.8% in Classes 1–3, p < 0.001; 15.1% vs. 1.7%, 4.0%, and 4.4%, p < 0.001, respectively). After adjusting for key clinical variables, Class 4 remained independently associated with severe AKI (OR 2.44, 95% CI: 1.69–3.57; E-value 4.33) and non-recovery AKI (OR 2.78, 95% CI: 1.89–4.00; E-value 4.97). Conclusions: Early postoperative temperature trajectories were significantly associated with severe AKI, with the highest risks in patients exhibiting lower-range mild hypothermia with delayed recovery. These findings suggest that early postoperative temperature patterns may be useful for risk stratification for severe AKI after cardiac surgery. Full article

(This article belongs to the Special Issue Advances in Clinical Anesthesia and Analgesia: Novel Approaches for Optimal Patient Safety and Comfort)

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12 pages, 1395 KB

Open AccessArticle

The Effect of Preoperative Visual Explanation on Anxiety in Children: A Randomized Controlled Trial

by Hülya Tosun Söner, Süleyman Kızıldağ, Osman Uzundere, Fatma Acil, Meral Erdal Erbatur, Selen Topalel, Ayhan Kaydu, Cem K. Kaçar, Erhan Gökçek, Enes Sırma, Ömer Erdağ and Sedat Kaya

J. Clin. Med. 2026, 15(3), 1041; https://doi.org/10.3390/jcm15031041 - 28 Jan 2026

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Abstract

Background/Objectives: This study aimed to investigate the effects of explaining the perioperative process to pediatric patients scheduled for adenotonsillectomy using pictures on their anxiety levels. Methods: A prospective, randomized controlled trial was conducted, enrolling 58 patients. The patients were divided into [...] Read more.

Background/Objectives: This study aimed to investigate the effects of explaining the perioperative process to pediatric patients scheduled for adenotonsillectomy using pictures on their anxiety levels. Methods: A prospective, randomized controlled trial was conducted, enrolling 58 patients. The patients were divided into two groups: Group 1 (n = 29), where the perioperative process was explained using pictures, and Group 2 (n = 29), the control group, where no pictures were used. Child anxiety was assessed using the modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF) at five observation time points before anesthesia induction. Parents’ anxiety was measured using the Visual Analog Scale for Anxiety. Results: Patients in Group 1 had significantly lower heart rates during induction and the intraoperative period compared to Group 2 (p = 0.031, p = 0.025, respectively). In terms of anxiety and RSAS scores, patients in Group 1 had significantly lower mYPAS-SF scores at time points t2, t3, t4, and t5 compared to Group 2 (t2: p = 0.001; t3–t5: p < 0.001). No significant difference was observed at t1 (p = 0.068). The mean RSAS scores were also significantly lower in Group 1 (p = 0.029). Parents’ anxiety was significantly lower in Group 1 at all three time points (t1: p = 0.017; t2: p = 0.006; t3: p = 0.036). Conclusions: Our study results demonstrate that illustrating the perioperative process to children undergoing adenotonsillectomy can significantly reduce preoperative anxiety and prevent awakening agitation. Given its ease of implementation, we believe that using visual aids to explain the perioperative process to pediatric patients can facilitate process management for patients, parents, and physicians. Full article

(This article belongs to the Special Issue Advances in Clinical Anesthesia and Analgesia: Novel Approaches for Optimal Patient Safety and Comfort)

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13 pages, 509 KB

Open AccessArticle

What Is the Most Effective Strategy for Acute Postoperative Pain in Total Knee Arthroplasty—Retrospective Observational Study

by Jin Joo, Man Soo Kim, Jeha Lee and Hyun Jung Koh

J. Clin. Med. 2025, 14(22), 8138; https://doi.org/10.3390/jcm14228138 - 17 Nov 2025

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Abstract

Background and Objectives: Effective early postoperative pain control is essential for optimal recovery following total knee arthroplasty (TKA). In addition to pharmacological pain management, the choice of anesthetic agents and surgical technique can significantly impact postoperative outcomes. Remimazolam and robotic-assisted TKA (RA-TKA) have [...] Read more.

Background and Objectives: Effective early postoperative pain control is essential for optimal recovery following total knee arthroplasty (TKA). In addition to pharmacological pain management, the choice of anesthetic agents and surgical technique can significantly impact postoperative outcomes. Remimazolam and robotic-assisted TKA (RA-TKA) have recently gained attention due to their potential advantages. This study aims to evaluate the effects of remimazolam and RA-TKA on acute postoperative pain compared with conventional TKA (C-TKA) and standard anesthetic protocols. Materials and Methods: In this retrospective observational study, 460 patients undergoing elective unilateral TKA were divided in to four groups based on surgical technique and anesthetic agents; RA-TKA with remimazolam (Group RR, n = 115), C-TKA with remimazolam (Group CR, n = 134), RA-TKA with conventional anesthesia (Group RC, n = 79), and C-TKA with conventional anesthesia (Group CC, n = 152). Remimazolam was administered at 6 mg/kg/h for induction and 1 mg/kg/h for maintenance, whereas conventional anesthesia was induced with propofol (1.5 mg/kg) and maintained with sevoflurane (1.5~2.0 vol%). The primary endpoint was acute postoperative pain, assessed via patient-controlled analgesia (PCA) consumption and supplemental analgesic use on the day of surgery. Secondary endpoints included total PCA consumption and additional analgesic use during the first 72 h, recovery room stay, discharge scores, and the incidence of postoperative nausea and vomiting (PONV). Results: Group RR required significantly fewer additional analgesics on the day of surgery than the other groups. Although group RR and group CR exhibited prolonged recovery room stay and lower discharge scores, these outcomes were not correlated with PCA consumption or supplementary analgesic use. RA-TKA was associated with approximately a 31% reduction in additional analgesic use compared with C-TKA, indicating a major contribution of the surgical technique to early postoperative pain control. Remimazolam alone did not demonstrate an independent effect on acute pain management. Conclusions: RA-TKA combined with remimazolam significantly reduced the need for additional analgesics on the day of surgery, highlighting a synergistic effect of the anesthetic and surgical approach. These findings support RA-TKA with remimazolam as an effective strategy for managing early postoperative pain following TKA. Full article

(This article belongs to the Special Issue Advances in Clinical Anesthesia and Analgesia: Novel Approaches for Optimal Patient Safety and Comfort)

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9 pages, 561 KB

Open AccessArticle

Apnoeic Oxygenation Using High-Flow Oxygen: Effects on Partial Pressure of Carbon Dioxide in Rigid Bronchoscopy

by Bon-Sung Koo, Yang-Hoon Chung, Misoon Lee, Sung-Hwan Cho and Jaewoong Jung

J. Clin. Med. 2025, 14(22), 8064; https://doi.org/10.3390/jcm14228064 - 14 Nov 2025

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Abstract

Background/Objectives: Rigid bronchoscopy poses safety challenges due to airway leakage. Although apnoeic oxygenation is a potential strategy, concerns over carbon dioxide (CO₂) retention have limited its adoption. The introduction of high-flow nasal cannula (HFNC) has renewed interest by potentially mitigating [...] Read more.

Background/Objectives: Rigid bronchoscopy poses safety challenges due to airway leakage. Although apnoeic oxygenation is a potential strategy, concerns over carbon dioxide (CO₂) retention have limited its adoption. The introduction of high-flow nasal cannula (HFNC) has renewed interest by potentially mitigating CO₂ accumulation during prolonged apnoea. This study investigated changes in the arterial partial pressure of CO₂ (PaCO₂) during apnoeic oxygenation using Optiflow™. Methods: We retrospectively analysed patients undergoing rigid bronchoscopy with HFNC (70 L·min⁻¹) from 2020 to 2022. The apnoeic period was defined from the onset of apnoeic oxygenation to ventilation resumption. Arterial blood gas levels and complications, including arrhythmia and desaturation, were evaluated. Regression analysis was used to evaluate changes over time. Results: Apnoeic oxygenation was performed in 10 male patients (mean age 65 ± 14 years; body mass index 24.75 ± 4.18 kg·m⁻²). The mean duration of apnoea was 33.7 ± 13.7 min, with PaCO₂ rising linearly at 1.50 mmHg/min. No interventions were required to maintain SpO₂ above 91% for all patients. Except for one case of atrial fibrillation that occurred during emergence rather than the apnoeic period, no significant complications were observed. Conclusions: The observed increase in PaCO₂ was lower than in previously reported studies using HFNC via the nares, suggesting that direct delivery of oxygen to the distal airway via bronchoscopy may enhance CO₂ clearance through more effective washout. Apnoeic oxygenation with HFNC could potentially overcome airway leakage for selected patients, but vigilant monitoring remains essential throughout the apnoeic period. Further research is warranted to enhance patient safety. Full article

(This article belongs to the Special Issue Advances in Clinical Anesthesia and Analgesia: Novel Approaches for Optimal Patient Safety and Comfort)

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10 pages, 871 KB

Open AccessArticle

Efficiency of 80% vs. 100% Oxygen for Preoxygenation: A Randomized Study on Duration of Apnoea Without Desaturation

by Jaewoong Jung, Yang-Hoon Chung, Bon-Sung Koo, Sang-Hyun Kim, Hee-Chul Jin and Won Seok Chae

J. Clin. Med. 2025, 14(21), 7647; https://doi.org/10.3390/jcm14217647 - 28 Oct 2025

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Abstract

Background/Objectives: Preoxygenation with 100% oxygen is commonly used but poses risks such as hyperoxia and atelectasis. Using 80% oxygen may reduce these effects but shortens duration of apnoea without desaturation (DAWD). This study compared preoxygenation efficiency between 80% and 100% oxygen and [...] Read more.

Background/Objectives: Preoxygenation with 100% oxygen is commonly used but poses risks such as hyperoxia and atelectasis. Using 80% oxygen may reduce these effects but shortens duration of apnoea without desaturation (DAWD). This study compared preoxygenation efficiency between 80% and 100% oxygen and evaluated changes in the Oxygen Reserve Index™ (ORi™). Methods: Patients undergoing elective laparoscopic cholecystectomy were randomized to preoxygenation with 80% or 100% oxygen. Adequate preoxygenation was defined as a ≤10% difference between fraction of inspired oxygen and end-tidal oxygen (EtCO₂). The primary outcome was DAWD, the interval from apnoea onset to peripheral oxygen saturation (SpO₂) of 93%. Secondary outcomes included time to adequate preoxygenation and additional warning time from ORi™ zero to SpO₂ 97%. Results: Thirty patients were randomised to 80% (n = 15) or 100% oxygen (n = 15) oxygen groups. One patient in the 100% group was excluded due to spontaneous breathing before SpO₂ 93%, leaving 29 for DAWD analysis. DAWD was 345 ± 136 s (80%) and 430 ± 163 s (100%) with a mean difference of 86 s (p = 0.135). No significant differences were observed in tie to adequate preoxygenation or additional warning time. Conclusions: Preoxygenation with 80% oxygen resulted in a numerically shorter DAWD compared with 100% oxygen, without a significant difference in ORi™. These findings may suggest the potential feasibility of using 80% oxygen for preoxygenation. However, given the limited sample size and uncertain clinical relevance, further large-scale studies are warranted to clarify the safety and clinical implications of lower oxygen concentration during anaesthesia induction. Full article

(This article belongs to the Special Issue Advances in Clinical Anesthesia and Analgesia: Novel Approaches for Optimal Patient Safety and Comfort)

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10 pages, 716 KB

Open AccessArticle

Assessing Artificial Intelligence-Powered Responses to Common Patient Questions on Radiofrequency Ablation and Cryoanalgesia for Chronic Pain

by Giuliano Lo Bianco, Marco Cascella, Silvia Natoli, Francesco Paolo D’Angelo, Emanuele Sinagra, Maurizio Marchesini, Emanuele Piraccini, Andrea Tinnirello, Felice Occhigrossi, Cesare Gregoretti and Christopher L. Robinson

J. Clin. Med. 2025, 14(19), 6814; https://doi.org/10.3390/jcm14196814 - 26 Sep 2025

Cited by 3 | Viewed by 1259 | Correction

Abstract

Background: Radiofrequency ablation (RFA) and cryoanalgesia are minimally invasive procedures used when conservative medical management fails and there are positive diagnostic blocks. Although both radiofrequency ablation (RFA) and cryoanalgesia are straightforward techniques, the increasing workload of physicians is leading to less time available [...] Read more.

Background: Radiofrequency ablation (RFA) and cryoanalgesia are minimally invasive procedures used when conservative medical management fails and there are positive diagnostic blocks. Although both radiofrequency ablation (RFA) and cryoanalgesia are straightforward techniques, the increasing workload of physicians is leading to less time available for patient interaction, including addressing questions about indications, feasibility, long-term effectiveness, and potential complications. Generative artificial intelligence (AI) chatbots, such as ChatGPT, have the potential to reduce physician burden and enhance patient education. Methods: An expert panel compiled thirteen frequently asked questions about RFA and cryoanalgesia, which were subsequently submitted to ChatGPT-4.0. The AI-generated responses were evaluated by 41 participants, including pain physicians, healthcare professionals, and non-healthcare individuals. The Likert scale was used for evaluating the responses, focusing on reliability, accuracy, and comprehensibility using predefined acceptability thresholds. Results: Across all 13 questions, ChatGPT’s responses demonstrated high overall reliability, with a mean score of 4.9 ± 0.7. The mean accuracy score was 2.6 ± 0.3, suggesting alignment with evidence-based standards. Comprehensibility was rated at 2.7 ± 0.2 on average. Pre-procedural questions achieved the highest scores, while post-procedural questions posed more challenges for ChatGPT. Conclusions: ChatGPT demonstrated potential as an adjunct tool for patient education on RFA and cryoanalgesia. Improvements in procedural specificity and medical accuracy are needed before routine clinical implementation. Full article

(This article belongs to the Special Issue Advances in Clinical Anesthesia and Analgesia: Novel Approaches for Optimal Patient Safety and Comfort)

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10 pages, 420 KB

Open AccessArticle

Comparison of Conscious and Deep Sedation Methods in Terms of Pulmonary Complications in ERCP Procedures of Patients with Billroth II Gastrectomy: A Retrospective Study

by Ayse Lafci, Mehmet Sahap, Gokhan Erdem and Bulent Odemis

J. Clin. Med. 2025, 14(14), 5099; https://doi.org/10.3390/jcm14145099 - 17 Jul 2025

Cited by 1 | Viewed by 1213

Abstract

Background/Objective: Patients who have undergone Billroth II gastrectomy may develop gastroparesis, hypomotility, and reflux esophagitis. These patients are at risk of aspiration of gastric contents into the lungs when subsequently sedated for Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures. The aim of this study [...] Read more.

Background/Objective: Patients who have undergone Billroth II gastrectomy may develop gastroparesis, hypomotility, and reflux esophagitis. These patients are at risk of aspiration of gastric contents into the lungs when subsequently sedated for Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures. The aim of this study was to compare conscious sedation and deep sedation in terms of pulmonary complications in this selected cohort. Methods: Patients who had previously undergone Billroth II surgery and underwent ERCP procedure with sedation for gallstones or biliary tract strictures in a tertiary hospital between January 2020 and September 2023 were studied. Patient records were retrospectively obtained from the hospital information system. All the patients were divided into two groups as conscious sedation (Group CS) and deep sedation (Group DS). The groups were compared statistically in terms of pulmonary complications. Results: A total of 63 ERCP procedures were performed on 28 patients who had undergone Billroth II gastrectomy. There were 37 procedures involving conscious sedation (Group CS) and 26 involving deep sedation (Group DS). No statistically significant difference was found regarding pulmonary aspiration (p = 0.297) and other respiratory complications such as laryngospasm or desaturation between the two groups. In Group DS, it was observed that vomiting incidence was higher (p = 0.012), and airway maneuver requirements were increased (p = 0.007). Conclusions: In patients who have undergone Billroth II gastrectomy, both conscious sedation and deep sedation techniques can be used effectively during ERCP procedures. The complication rates and patient outcomes of the two techniques are comparable. The occurrence of respiratory complications leading to adverse post-procedural outcomes requires careful monitoring and meticulous follow-up for these patients. Full article

(This article belongs to the Special Issue Advances in Clinical Anesthesia and Analgesia: Novel Approaches for Optimal Patient Safety and Comfort)

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13 pages, 1135 KB

Open AccessArticle

The Relationship Between Neuromuscular Block Depth and Airway Retroglossal Area: A Prospective, Nonrandomized, Observational Clinical Trial

by László Asztalos, Mena Boktor, Miklós Kukuly, Dorka Sólyom, Adrienn Pongrácz, Sorin J. Brull and Béla Fülesdi

J. Clin. Med. 2025, 14(12), 4374; https://doi.org/10.3390/jcm14124374 - 19 Jun 2025

Cited by 4 | Viewed by 1548

Abstract

Background: Tracheal intubation and mechanical ventilation are facilitated by neuromuscular blocking agents. We investigated the effectiveness of subjective clinical evaluation of neuromuscular function on retroglossal area size, since it determines spontaneous ventilation adequacy following tracheal extubation. Secondarily, we correlated changes in retroglossal [...] Read more.

Background: Tracheal intubation and mechanical ventilation are facilitated by neuromuscular blocking agents. We investigated the effectiveness of subjective clinical evaluation of neuromuscular function on retroglossal area size, since it determines spontaneous ventilation adequacy following tracheal extubation. Secondarily, we correlated changes in retroglossal area and depth of neuromuscular block assessed during both respiratory phases using quantitative neuromuscular monitoring. Methods: Once mechanical ventilation was no longer needed, antagonists were used to reverse the neuromuscular block in 21 consenting patients; adequacy of reversal was assessed subjectively by delivering a sequence of four rapid (2 Hz) electrical stimuli (train-of-four, TOF) to a peripheral nerve and assessing attainment of four equal muscle contractions (TOF ratio = 1.0), signifying normal neuromuscular function. Retroglossal area during both inhalation and exhalation were measured pharyngoscopically at various phases of neuromuscular recovery, including at baseline after anesthesia induction but before neuromuscular block onset and at recovery before tracheal extubation; area changes were correlated with depth of quantitatively measured neuromuscular block. Results: Clinicians’ subjective evaluation of readiness for tracheal extubation failed to identify significant residual block in most patients who required rescue antagonism. Markedly decreased retroglossal areas (inhalation: 39.5% of baseline; exhalation: 20.1% of baseline) were present at extubation, and 11 out of 21 (52.4%) patients needed rescue antagonism. In contrast, in patients with neuromuscular recovery to the currently recommended threshold determined quantitatively (TOF ratio > 0.90), retroglossal areas were only 80% recovered but returned to near baseline values when the TOF ratio ≥ 0.95. Conclusions: Quantitative monitoring should guide the timing of tracheal extubation. Current definitions of the minimal threshold for adequate neuromuscular recovery (TOF ratio > 0.90) after mechanical ventilation in postoperative patients should be re-evaluated. A TOF ratio > 0.95 better correlates with return to normal (baseline) retroglossal area during both inhalation and exhalation. Full article

(This article belongs to the Special Issue Advances in Clinical Anesthesia and Analgesia: Novel Approaches for Optimal Patient Safety and Comfort)

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Review

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11 pages, 231 KB

Open AccessReview

Use of Intra-Operative EEG Monitoring for Nociception Balance Quantification—A Narrative Review

by Crina-Elena Leahu, Sonia Luka, Cristina Petrisor, Sebastian Tranca, Simona Cocu and George Calin Dindelegan

J. Clin. Med. 2026, 15(5), 2072; https://doi.org/10.3390/jcm15052072 - 9 Mar 2026

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Abstract

Introduction: Balancing hypnosis and antinociception during general anesthesia remains challenging, as traditional clinical and hemodynamic signs incompletely reflect cortical and nociceptive processing. Electroencephalogram (EEG)-derived indices such as qCON (hypnosis) and qNOX (nociception probability) (Quantium Medical, Barcelona, Spain), as well as their predecessors [...] Read more.

Introduction: Balancing hypnosis and antinociception during general anesthesia remains challenging, as traditional clinical and hemodynamic signs incompletely reflect cortical and nociceptive processing. Electroencephalogram (EEG)-derived indices such as qCON (hypnosis) and qNOX (nociception probability) (Quantium Medical, Barcelona, Spain), as well as their predecessors IoC1 (Index of consciousness) and IoC2 (Angel-6000 A multi-parameter Anesthesia Monitor, Shenzen Weihao Kang Medical Technology Co., Ltd., Shenzen, Guangdong, China), have been developed to provide a dual assessment of anesthetic state. Their clinical role, technical limitations, and impact on drug titration, however, remain incompletely defined. Methods: A structured narrative review was conducted based on studies investigating IoC/qCON and qNOX in the context of anesthetic depth or nociception monitoring. Studies were grouped into three thematic domains: (1) validation against clinical or EEG standards, (2) use in guiding anesthetic or opioid administration, and (3) technical characteristics, including signal delay and pharmacodynamic modeling implications. Results: Sixteen studies met inclusion criteria. Eight validation studies demonstrated that IoC/qCON correlates strongly with clinical sedation scales and established EEG-derived indices such as BIS and entropy. Five interventional studies evaluating drug titration found limited impact of qCON-guided hypnosis control on anesthetic consumption but more consistent effects of qNOX/IoC2 guidance on opioid dosing and intraoperative stability. Three technical investigations showed that qCON exhibits processing delays on the order of tens of seconds that can be accounted for by incorporating monitor lag into pharmacodynamic analyses. Conclusions: qCON and qNOX provide complementary EEG-based indices of hypnosis and cortical nociceptive responsiveness. Evidence supports their validity as indicators of anesthetic brain state but highlights technical limitations, such as processing delay and susceptibility to physiologic factors. Their optimal clinical use lies in multimodal monitoring strategies that integrate EEG besides classic clinical and monitoring parameters. Full article

(This article belongs to the Special Issue Advances in Clinical Anesthesia and Analgesia: Novel Approaches for Optimal Patient Safety and Comfort)

Other

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1 pages, 149 KB

Open AccessCorrection

Correction: Lo Bianco et al. Assessing Artificial Intelligence-Powered Responses to Common Patient Questions on Radiofrequency Ablation and Cryoanalgesia for Chronic Pain. J. Clin. Med. 2025, 14, 6814

by Giuliano Lo Bianco, Marco Cascella, Silvia Natoli, Francesco Paolo D’Angelo, Emanuele Sinagra, Maurizio Marchesini, Emanuele Piraccini, Andrea Tinnirello, Felice Occhigrossi, Cesare Gregoretti and Christopher L. Robinson

J. Clin. Med. 2025, 14(22), 8157; https://doi.org/10.3390/jcm14228157 - 18 Nov 2025

Cited by 1 | Viewed by 376

Abstract

Additional Affiliations [...] Full article

(This article belongs to the Special Issue Advances in Clinical Anesthesia and Analgesia: Novel Approaches for Optimal Patient Safety and Comfort)

21 pages, 2319 KB

Open AccessSystematic Review

The Effect of Thermal-Softened Endotracheal Tubes on Postoperative Sore Throat and Other Complications—A Systematic Review and Meta-Analysis

by Hui-Zen Hee, Chen-Hsi Chiu and Cheng-Wei Lu

J. Clin. Med. 2025, 14(11), 3620; https://doi.org/10.3390/jcm14113620 - 22 May 2025

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Abstract

Background: Endotracheal tube (ETT) intubation during general anesthesia (GA) is commonly associated with postoperative sore throat. This study aimed to evaluate whether thermal-softened ETTs reduce the postoperative sore throat incidence in patients undergoing elective surgery under GA. Methods: We conducted a [...] Read more.

Background: Endotracheal tube (ETT) intubation during general anesthesia (GA) is commonly associated with postoperative sore throat. This study aimed to evaluate whether thermal-softened ETTs reduce the postoperative sore throat incidence in patients undergoing elective surgery under GA. Methods: We conducted a comprehensive search of the literature across PubMed, Cochrane Library, and EMBASE to identify randomized controlled trials (RCTs) evaluating the effect of thermal-softened ETTs on postoperative sore throat in patients undergoing elective surgeries under GA. The primary outcome was postoperative sore throat incidence, while secondary outcomes included hoarseness, vocal cord lesions, and time to intubation. Data were extracted independently by two authors, and the risk of bias was assessed using the Revised Cochrane risk of bias tool (version 2.0). A meta-analysis was then performed using the random-effects model, with the results expressed as risk ratios (RRs) and mean difference (MDs). Results: Eight studies, with a total of 970 participants, were included. Thermal-softened ETTs significantly reduced postoperative sore throat incidence (RR: 0.60, 95% CI: 0.44 to 0.82, p = 0.001). Subgroup analysis showed no difference for single-lumen tubes (RR: 0.76, 95% CI: 0.45 to 1.26, p = 0.28), but remained significant for double-lumen tubes (RR: 0.5, 95% CI: 0.39 to 0.65, p < 0.00001). No significant difference was found in hoarseness (RR: 0.86, 95% CI: 0.64 to 1.17, p = 0.34), but a lower incidence of vocal cord lesions (RR: 0.52, 95% CI: 0.40 to 0.68, p < 0.00001) was observed. No difference was found in the time to intubation (MD: −6.51, 95% CI: −20.04 to 7.02, p = 0.35). Conclusions: Thermal-softened ETTs may reduce the incidence of postoperative sore throat and vocal cord lesions but have no significant effect on hoarseness or intubation time. Full article

(This article belongs to the Special Issue Advances in Clinical Anesthesia and Analgesia: Novel Approaches for Optimal Patient Safety and Comfort)

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