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Search Results (868)

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15 pages, 1389 KiB  
Article
Predicting the Body Weight of Tilapia Fingerlings from Images Using Computer Vision
by Lessandro do Carmo Lima, Adriano Carvalho Costa, Heyde Francielle do Carmo França, Alene Santos Souza, Gidélia Araújo Ferreira de Melo, Brenno Muller Vitorino, Vitória de Vasconcelos Kretschmer, Suzana Maria Loures de Oliveira Marcionilio, Rafael Vilhena Reis Neto, Pedro Henrique Viadanna, Gabriel Rinaldi Lattanzi, Luciana Maria da Silva and Kátia Aparecida de Pinho Costa
Fishes 2025, 10(8), 371; https://doi.org/10.3390/fishes10080371 (registering DOI) - 2 Aug 2025
Abstract
The aim of this study was to develop a mathematical model to predict the body weight of tilapia fingerlings using variables obtained through computer vision. A total of 2092 tilapia fingerlings and juveniles, weighing between 10 and 100 g, were fasted for 12 [...] Read more.
The aim of this study was to develop a mathematical model to predict the body weight of tilapia fingerlings using variables obtained through computer vision. A total of 2092 tilapia fingerlings and juveniles, weighing between 10 and 100 g, were fasted for 12 h, anesthetized, weighed, and photographed using an iPhone 12 Pro Max at 33 cm height in a closed container with different bottom colors. Images were segmented using Roboflow’s instance segmentation model, achieving 99.5% mean average precision, 99.9% precision, and 100% recall. From the segmented images, area, perimeter, major axis (MA), minor axis (SA), X and Y centroids, compactness, eccentricity, and the MA/SA ratio were extracted. Seventy percent of the data was used to build the model, and 30% for validation. Stepwise multiple regression (backward selection) was performed, using body weight as the dependent variable. The prediction model was: −17.7677 + 0.0007539(area) – 0.0848303 (MA) – 0.108338(SA) + 0.0034496(CX). The validation model showed similar coefficients and R2 = 0.99. The second validation, using observed versus predicted values, also yielded an R2 of 0.99 and a mean absolute error of 1.57 g. Correlation and principal component analyses revealed strong positive associations among body weight, area, axes, and predicted values. Computer vision proved effective for predicting tilapia fingerlings’ weight. Full article
(This article belongs to the Special Issue Application of Artificial Intelligence in Aquaculture)
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15 pages, 203 KiB  
Case Report
Is Spinal Analgesia or Anesthesia Safe After Labor Epidural Analgesia? Reporting Two Cases of High Neuraxial Block and Mini-Review of the Literature
by Arsen Uvelin, Marijana Cavrić-Dragičević, Borislava Pujić, Lidija Jovanović, Teodora Tubić and Radmila Popović
Reports 2025, 8(3), 129; https://doi.org/10.3390/reports8030129 (registering DOI) - 1 Aug 2025
Viewed by 52
Abstract
Background and Clinical significance: Single-shot spinal anesthesia for intrapartum Cesarean section has recently been incriminated in carrying a high risk of high neuraxial block (HNB) occurrence in parturients receiving labor epidural analgesia. The so-called volume effect of the epidurally injected solution causes a [...] Read more.
Background and Clinical significance: Single-shot spinal anesthesia for intrapartum Cesarean section has recently been incriminated in carrying a high risk of high neuraxial block (HNB) occurrence in parturients receiving labor epidural analgesia. The so-called volume effect of the epidurally injected solution causes a contraction of the dural sack and unexpected HNB. Case presentation: We present two cases of HNB in parturients receiving epidural analgesia. The first case describes the 36-year-old patient G3P2, who was administered a repeated rescue analgesia single-shot spinal injection with low-dose local anesthetic (levobupivacaine, 3 mg) following non-functional combined spinal–epidural analgesia. The second case describes the 28-year-old parturient G1P0, who experienced HNB after single-shot spinal anesthesia with hyperbaric bupivacaine (7.5 mg) following labor epidural analgesia. Conclusions: Intrathecal administration of local anesthetic for the purpose of spinal analgesia or anesthesia in a parturient with epidural analgesia can cause unexpected HNB and could occur even at low doses of intrathecally administered medications. The interplay of numerous variables and circumstances in the specific case can result in the occurrence of HNB. We assume that in our first case, the volume effect and repeated dural puncture, and in the second case, the low height of the parturient coupled with the volume effect, played significant role in the occurrence of HNB. Full article
(This article belongs to the Section Anaesthesia)
13 pages, 250 KiB  
Article
Evaluation of Depth of Anesthesia Sleep Quality in Swine Undergoing Hernia Repair: Effects of Romifidine/Ketamine-Diazepam Protocols with and Without Tramadol and the Potential Role of Serotonin as a Biomarker
by Fabio Bruno, Fabio Leonardi, Filippo Spadola, Giuseppe Bruschetta, Patrizia Licata, Veronica Cristina Neve and Giovanna Lucrezia Costa
Vet. Sci. 2025, 12(8), 722; https://doi.org/10.3390/vetsci12080722 (registering DOI) - 31 Jul 2025
Viewed by 136
Abstract
Sedation and anesthesia are essential for ensuring animal welfare during surgical procedures such as hernia repair in swine. However, the number of sedative and anesthetic agents officially approved for livestock use remained limited. This study evaluated the sedative efficacy and serotonergic effects of [...] Read more.
Sedation and anesthesia are essential for ensuring animal welfare during surgical procedures such as hernia repair in swine. However, the number of sedative and anesthetic agents officially approved for livestock use remained limited. This study evaluated the sedative efficacy and serotonergic effects of a romifidine/ketamine/diazepam protocol, with and without the addition of tramadol, in swine undergoing umbilical hernia repair. Sixty-six crossbred Large White swine were randomly allocated to three groups: LL (lidocaine 4 mg/kg by infiltration), LT (lidocaine 2 mg/kg by infiltration + tramadol 2 mg/kg intraperitoneally), and TT (lidocaine2 mg/kg by infiltration + tramadol 4 mg/kg intraperitoneally). The physiological parameters heart rate, arterial pressure, oxygen saturation, rectal body temperature, and respiratory rate were assessed. The depth of intraoperative anesthesia and postoperative sedation was assessed using an ordinal scoring system (0–3). Plasma serotonin (5-HT) concentration was measured at baseline and 24 h post-surgery. Physiological parameters remained within species-specific reference ranges throughout the procedure. Anesthesia depth scores significantly decreased over time in all groups (p ≤ 0.001), with the tramadol-treated groups (LT and TT) showing more prolonged deeper anesthesia. Postoperative sedation was significantly higher in the TT group (p ≤ 0.001). Serotonin concentration decreased in LL, increased in LT, and remained stable in TT. These findings suggest that tramadol may enhance sedation and recovery, potentially through serotonergic modulation. Moreover, serotonin could serve as a physiological marker warranting further investigation in future studies of anesthetic protocols in veterinary medicine. Full article
(This article belongs to the Special Issue Anesthesia and Pain Management in Large Animals)
14 pages, 875 KiB  
Article
A Comparative Study of Brain Injury Biomarker S100β During General and Spinal Anesthesia for Caesarean Delivery: A Prospective Study
by Mungun Banzar, Nasantogtokh Erdenebileg, Tulgaa Surjavkhlan, Enkhtsetseg Jamsranjav, Munkhtsetseg Janlav and Ganbold Lundeg
Medicina 2025, 61(8), 1382; https://doi.org/10.3390/medicina61081382 - 30 Jul 2025
Viewed by 602
Abstract
Background and Objectives: Anesthetic agents may influence brain function, and emerging evidence suggests possible neurotoxicity under certain conditions. S100β is a well-established biomarker of brain injury and blood–brain barrier disruption, and its prolonged elevation beyond 6–12 h, despite a short half-life, may [...] Read more.
Background and Objectives: Anesthetic agents may influence brain function, and emerging evidence suggests possible neurotoxicity under certain conditions. S100β is a well-established biomarker of brain injury and blood–brain barrier disruption, and its prolonged elevation beyond 6–12 h, despite a short half-life, may indicate ongoing neuronal injury. Its use in cesarean section (C-section) remains limited, despite the potential neurological implications of both surgical stress and anesthetic technique. This study evaluates potential brain injury during caesarean section by comparing maternal and neonatal S100β levels under general and spinal anesthesia. Materials and Methods: This observational prospective study compared changes in the S100β brain damage biomarker in maternal (pre- and post-surgery) and umbilical artery blood during elective c-sections under general or spinal anesthesia. The 60 parturient women who underwent a C-section from 1 July 2021 to 30 December 2023 were evenly distributed into 2 groups: General anesthesia (GA) (n = 30) and Spinal anesthesia (SA) group (n = 30). It included healthy term pregnant women aged 18–40, ASA I–II and excluded those with major comorbidities or emergency conditions. Results: S100β concentrations slightly increased once the C-section was over in both the SA and GA groups, but without notable differences. In the SA and GA groups, preoperative S100β concentration in maternal blood was 195.1 ± 36.2 ng/L, 193.0 ± 54.3 ng/L, then increased to 200.9 ± 42.9 ng/L, 197.0 ± 42.7 at the end of operation. There was no statistically significant difference in S100β concentrations between the spinal and general anesthesia groups (p = 0.86). Conclusions: S100β concentrations slightly increased after C-section in both groups. The form of anesthesia seems to be irrelevant for the S100β level. However, further research is needed to confirm these findings and fully evaluate any potential long-term effects. Full article
(This article belongs to the Special Issue Advanced Research on Anesthesiology and Pain Management)
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11 pages, 220 KiB  
Review
Superficial Cervical Plexus Block for Postoperative Pain Management in Occipital Craniotomies: A Narrative Review
by Shahab Ahmadzadeh, Bennett M. Ford, Alex V. Hollander, Mary Kathleen Luetkemeier, Tomasina Q. Parker-Actlis and Sahar Shekoohi
Med. Sci. 2025, 13(3), 101; https://doi.org/10.3390/medsci13030101 - 28 Jul 2025
Viewed by 349
Abstract
Post-craniotomy pain is common yet often sub-optimally managed because systemic opioids can obscure postoperative neurologic examinations. The superficial cervical plexus block (SCPB) has, therefore, emerged as a targeted regional anesthesia option for occipital craniotomies. The SCPB targets the C2–C4 nerves to anesthetize the [...] Read more.
Post-craniotomy pain is common yet often sub-optimally managed because systemic opioids can obscure postoperative neurologic examinations. The superficial cervical plexus block (SCPB) has, therefore, emerged as a targeted regional anesthesia option for occipital craniotomies. The SCPB targets the C2–C4 nerves to anesthetize the occipital scalp region, covering the lesser occipital nerve territory that lies within typical posterior scalp incisions. Clinical evidence shows the block is effective in reducing acute postoperative pain after occipital craniotomy and diminishes opioid requirements. Studies have demonstrated successful and long-lasting analgesia, reductions in 24-h opioid consumption, and a lower incidence of severe pain. Moreover, the technique exhibits a low complication rate and is safer than a deep cervical plexus block because the injection remains superficial and avoids critical vascular and neural structures. When delivered under ultrasound guidance, major adverse events are exceedingly rare. By reducing opioid use, the SCPB can help reduce postoperative complications, allowing earlier neurological assessments and fewer opioid-related side effects. Incorporation of the SCPB into multimodal analgesia regimens can, therefore, accelerate postoperative recovery by providing regionally focused, opioid-sparing pain control without clinically significant sedation. Overall, current data support the SCPB as a dependable, well-tolerated, and clinically practical approach for managing post-craniotomy pain in patients undergoing occipital approaches. In this narrative review, we will discuss the mechanism of action and anatomy, the clinical application, safety and tolerability, patient outcomes, and emerging future directions of the superficial cervical plexus block and how it mitigates post-occipital craniotomy pain. Full article
14 pages, 2806 KiB  
Article
Pilot Study on Resuscitation Volume’s Effect on Perfusion and Inflammatory Cytokine Expression in Peri-Burn Skin: Implications for Burn Conversion
by Tamer R. Hage, Edward J. Kelly, Eriks Ziedins, Babita Parajuli, Cameron S. D’Orio, David M. Burmeister, Lauren Moffatt, Jeffrey W. Shupp and Bonnie C. Carney
Eur. Burn J. 2025, 6(3), 42; https://doi.org/10.3390/ebj6030042 - 28 Jul 2025
Viewed by 176
Abstract
Fluid resuscitation after thermal injury is paramount to avoid burn shock and restore organ perfusion. Both over- and under-resuscitation can lead to unintended consequences affecting patient outcomes. While many studies have examined systemic effects, limited data exist on how fluid resuscitation impacts burn [...] Read more.
Fluid resuscitation after thermal injury is paramount to avoid burn shock and restore organ perfusion. Both over- and under-resuscitation can lead to unintended consequences affecting patient outcomes. While many studies have examined systemic effects, limited data exist on how fluid resuscitation impacts burn wound progression in the acute period. Furthermore, the mechanisms underlying burn wound progression remain not fully understood. This study used a swine model to investigate how varying resuscitation levels affect peri-burn wound dynamics. Twenty-seven female Yorkshire pigs were anesthetized, subjected to 40% total body surface area burn and 15% hemorrhage, then randomized (n = 9) to receive decision-support-driven (adequate, 2–4 mL/kg/%TBSA), fluid-withholding (under, <1 mL/kg/%TBSA), or high-constant-rate (over, >>4 mL/kg/%TBSA) resuscitation. Pigs were monitored for 24 h in an intensive care setting prior to necropsy. Laser Doppler Imaging (LDI) was conducted pre-burn and at 2, 6, 12, and 24 h post burn to assess perfusion. Biopsies were taken from burn, peri-burn (within 2 cm), and normal skin. RNA was isolated at 24 h for the qRT-PCR analysis of IL-6, CXCL8, and IFN-γ. At hour 2, LDI revealed increased peri-burn perfusion in over-resuscitated animals vs. under-resuscitated animals (p = 0.0499). At hour 24, IL-6 (p = 0.0220) and IFN-γ (p = 0.0253) were elevated in over-resuscitated peri-burn skin. CXCL8 showed no significant change. TUNEL staining revealed increased apoptosis in over- and under-resuscitated peri-burn skin. Differences in perfusion and cytokine expression based on resuscitation strategy suggest that fluid levels may influence burn wound progression. Full article
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18 pages, 1352 KiB  
Study Protocol
Effects of Hydrodilatation at Different Volumes on Adhesive Capsulitis in Phases 1 and 2: Clinical Trial Protocol HYCAFVOL
by Javier Muñoz-Paz, Ana Belén Jiménez-Jiménez, Francisco Espinosa-Rueda, Amin Wahab-Albañil, María Nieves Muñoz-Alcaraz, José Peña-Amaro and Fernando Jesús Mayordomo-Riera
Clin. Pract. 2025, 15(8), 141; https://doi.org/10.3390/clinpract15080141 - 26 Jul 2025
Viewed by 271
Abstract
Background: Adhesive capsulitis (AC) causes a global limitation of both active and passive range of motion (ROM) in the shoulder, with or without pain, and no specific radiographic findings. Its course is self-limiting and progresses through three or four stages. The diagnosis [...] Read more.
Background: Adhesive capsulitis (AC) causes a global limitation of both active and passive range of motion (ROM) in the shoulder, with or without pain, and no specific radiographic findings. Its course is self-limiting and progresses through three or four stages. The diagnosis is primarily clinical, since imaging tests are nonspecific. Treatment options include physical therapy (PT), intra-articular corticosteroid injections, suprascapular nerve block (SSNB), and hydrodilatation (HD). The latter is useful for expanding and reducing inflammation of the joint capsule through the insufflation of saline solution, anesthetics, and corticosteroids. Objectives: To compare whether patients with AC, stratified by phase 1 and 2, who receive high-volume HD as treatment achieve better outcomes in terms of shoulder pain and function compared to patients who receive low-volume HD. To compare whether there are differences in PT times and to determine mean axillary recess (AR) values. Methods: A randomized, parallel-block, triple-blind clinical trial will be conducted in 64 patients with AC in phases 1 and 2, aged 30 to 70 years, with limited active and passive ROM in two planes, and shoulder pain lasting more than 3 months. HD will be administered with volumes of 20 mL or 40 mL, followed by a conventional rehabilitation program. Outcomes will be reviewed at the 1st, 3rd, and 6th months of HD. Variables collected will include Shoulder Pain and Disability Index (SPADI), Visual Analog Scale (VAS), Range of motion (ROM), Lattinen index (LI), AR size, and time to completion of PT. Results: HD has been gaining clinical relevance in interventional rehabilitation as a treatment for AC, although its medium- and long-term efficacy remains a matter of debate. The variability in the volumes used for capsular expansion, with studies ranging from 18 mL to 47 mL, is compounded by the fact that most of these studies do not differentiate between AC stages. This could influence treatment effectiveness. Furthermore, diagnosis remains a challenge since valid and specific diagnostic parameters are lacking. Conclusions: Understanding the differences between HD techniques, considering the influence of certain factors such as the volume used or the stages of AC, as well as improving diagnosis and the coordination of scientific work. This could facilitate the development of protocols for the use of HD in AC. Full article
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23 pages, 1118 KiB  
Systematic Review
Management of Preoperative Anxiety via Virtual Reality Technology: A Systematic Review
by Elina Christiana Alimonaki, Anastasia Bothou, Athina Diamanti, Anna Deltsidou, Styliani Paliatsiou, Grigorios Karampas and Giannoula Kyrkou
Nurs. Rep. 2025, 15(8), 268; https://doi.org/10.3390/nursrep15080268 - 25 Jul 2025
Viewed by 194
Abstract
Background: Perioperative care is an integral part of the procedure of a surgical operation, with strictly defined rules. The need to upgrade and improve some individual long-term processes aims at optimal patient care and the provision of high-level health services. Therefore, preoperative care [...] Read more.
Background: Perioperative care is an integral part of the procedure of a surgical operation, with strictly defined rules. The need to upgrade and improve some individual long-term processes aims at optimal patient care and the provision of high-level health services. Therefore, preoperative care is drawn up with new data resulting from the evolution of technology to upgrade the procedures that need improvement. According to the international literature, a factor considered to be of major importance is high preoperative anxiety and its effects on the patient’s postoperative course. High preoperative anxiety is postoperatively responsible for prolonged hospital stays, increased postoperative pain, decreased effect of anesthetic agents, increased amounts of analgesics, delayed healing of surgical wounds, and increased risk of infections. The use of Virtual Reality technology appears as a new method of managing preoperative anxiety. Objective: This study investigates the effect and effectiveness of Virtual Reality (VR) technology in managing preoperative anxiety in adult patients. Methods: A literature review was performed on 193 articles, published between 2017 and 2024, sourced from the scientific databases PubMed and Cochrane, as well as the trial registry ClinicalTrials, with a screening and exclusion process to meet the criterion of investigating VR technology’s effectiveness in managing preoperative anxiety in adult patients. This systematic review was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Results: Out of the 193 articles, 29 were selected. All articles examined the efficacy of VR in adult patients (≥18) undergoing various types of surgery. The studies represent a total of 2.354 participants from 15 countries. There are two types of VR applications: distraction therapy and patient education. From the studies, 14 (48%) used the distraction VR intervention, 14 (48%) used the training VR intervention, and 1 (4%) used both VR interventions, using a range of validated anxiety scales such as the STAI, VAS-A, APAIS, and HADS. Among the 29 studies reviewed, 25 (86%) demonstrated statistically significant reductions in preoperative anxiety levels following the implementation of VR interventions. VR technology appears to manage preoperative anxiety effectively. It is a non-invasive and non-pharmacological intervention with minimal side effects. Conclusions: Based on the review, the management of preoperative anxiety with VR technology shows good levels of effectiveness. Further investigation of the efficacy by more studies and randomized controlled trials, with a larger patient population, is recommended to establish and universally apply VR technology in the preoperative care process as an effective method of managing preoperative anxiety. Full article
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13 pages, 1538 KiB  
Article
Respiratory and Cardiovascular Activity of LENART01, an Analgesic Dermorphin–Ranatensin Hybrid Peptide, in Anesthetized Rats
by Piotr Wojciechowski, Dominika Zając, Adrian Górski, Wojciech Kamysz, Patrycja Kleczkowska and Katarzyna Kaczyńska
Int. J. Mol. Sci. 2025, 26(15), 7188; https://doi.org/10.3390/ijms26157188 - 25 Jul 2025
Viewed by 161
Abstract
Opioids are among the most effective drugs for treating moderate to severe pain. Unfortunately, opioid use, even short-term, can lead to addiction, tolerance, overdose, and respiratory depression. Therefore, efforts to design and develop novel compounds that would retain analgesic activity while reducing side [...] Read more.
Opioids are among the most effective drugs for treating moderate to severe pain. Unfortunately, opioid use, even short-term, can lead to addiction, tolerance, overdose, and respiratory depression. Therefore, efforts to design and develop novel compounds that would retain analgesic activity while reducing side effects continue unabated. The present study was designed to investigate the respiratory and cardiovascular effects of the hybrid peptide LENART01, which has evidenced potent antinociceptive and antimicrobial activity. This hybrid peptide, composed of N-terminally located dermorphin and C-terminal modified ranatensin pharmacophore, was tested in vivo in anesthetized rats. The main effect of LENART01 was apnea in 70% of examined animals, sighing, and a significant increase in blood pressure. Interestingly, the hybrid induced sighs less frequently than ranatensin, and apnea dependent on vagus nerve mu opioid receptor activation much less frequently and less intensely than dermorphin itself. This shows that LENART01 is a safer opioid system-related agent as compared to dermorphin for its prospective use in the treatment of pain. Full article
(This article belongs to the Special Issue Recent Progress of Opioid Research, 2nd Edition)
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13 pages, 2208 KiB  
Article
Electrophysiological Characterization of Sex-Dependent Hypnosis by an Endogenous Neuroactive Steroid Epipregnanolone
by Tamara Timic Stamenic, Ian Coulter, Douglas F. Covey and Slobodan M. Todorovic
Biomolecules 2025, 15(7), 1033; https://doi.org/10.3390/biom15071033 - 17 Jul 2025
Viewed by 412
Abstract
Neuroactive steroids (NAS) have long been recognized for their hypnotic and anesthetic properties in both clinical and preclinical settings. While sex differences in NAS sensitivity are acknowledged, the underlying mechanisms remain poorly understood. Here, we examined sex-specific responses to an endogenous NAS epipregnanolone [...] Read more.
Neuroactive steroids (NAS) have long been recognized for their hypnotic and anesthetic properties in both clinical and preclinical settings. While sex differences in NAS sensitivity are acknowledged, the underlying mechanisms remain poorly understood. Here, we examined sex-specific responses to an endogenous NAS epipregnanolone (EpiP) in wild-type mice using behavioral assessment of hypnosis (loss of righting reflex, LORR) and in vivo electrophysiological recordings. Specifically, local field potentials (LFPs) were recorded from the central medial thalamus (CMT) and electroencephalogram (EEG) signals were recorded from the barrel cortex. We found that EpiP-induced LORR exhibited clear sex differences, with females showing increased sensitivity. Spectral power analysis and thalamocortical (TC) and corticocortical (CC) phase synchronization further supported enhanced hypnotic susceptibility in female mice. Our findings reveal characteristic sex-dependent effects of EpiP on the synchronized electrical activity in both thalamus and cortex. These results support renewed exploration of endogenous NAS as clinically relevant anesthetic agents. Full article
(This article belongs to the Special Issue Role of Neuroactive Steroids in Health and Disease: 2nd Edition)
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19 pages, 1773 KiB  
Systematic Review
Immunomodulatory Effects of Anesthetic Techniques in Lung Cancer Surgery: A Systematic Review and Meta-Analysis
by Georgios Konstantis, Ilias Katsadouros, Georgia Tsaousi, Vasileios Grosomanidis and Chryssa Pourzitaki
Medicina 2025, 61(7), 1263; https://doi.org/10.3390/medicina61071263 - 12 Jul 2025
Viewed by 249
Abstract
Background and Objectives: Lung cancer represents one of the principal causes of cancer-associated mortality worldwide. Despite the numerous novel therapeutic agents, surgical resection remains, in many cases, the mainstay treatment. A growing body of evidence indicates that the anesthetic technique of choice [...] Read more.
Background and Objectives: Lung cancer represents one of the principal causes of cancer-associated mortality worldwide. Despite the numerous novel therapeutic agents, surgical resection remains, in many cases, the mainstay treatment. A growing body of evidence indicates that the anesthetic technique of choice contributes to perioperative immunosuppression, thus having an impact on cancer recurrence and prognosis. The aim of this systematic review is to provide a thorough summary of the current literature regarding the modulation of the immune response induced by the various anesthetic techniques that are used in lung cancer surgery, with a particular emphasis on cellular immunity. Materials and Methods: PubMed, Scopus, and the Cochrane databases were systematically searched from November 2023 up to March 2024 to identify randomized controlled trials (RCTs) that met the eligibility criteria. Results: A total of seven RCTs were included. Four of the RCTs compared the administration of general anesthesia alone versus general anesthesia combined with epidural anesthesia. The subsequent meta-analysis showed that the combination of general and epidural anesthesia exerted a positive impact on the cell counts of the CD3+ cells (SMD −0.42, 95% Cl −0.70 to −0.13 24 h postoperatively and SMD −0.86 95% Cl −1.48 to −0.23 72 h postoperatively), the CD4+ cells (SMD −0.41 95% Cl −0.69 to −0.12 at the end of surgery and SMD −0.56 95% Cl −0.85 to −0.27 72 h later), and the CD4+/CD8+ ratio (SMD −0.31 95% Cl −0.59 to −0.02 immediately after surgery, SMD −0.50 95% Cl −0.86 to −0.14 24 h postoperatively, and SMD −0.60 95% Cl −0.89 to −0.31 72 h later). The pooled results regarding CD8+ and NK cell counts were inconclusive. The remaining three studies compared volatile-based anesthesia with total intravenous anesthesia (TIVA). Due to disparities between these studies, qualitative analysis was inconclusive, whereas quantitative analysis was not feasible. Conclusions: The supplementation of general anesthesia with epidural anesthesia favorably impacts CD3+ and CD4+ cell counts, as well as the CD4+/CD8+ ratio. The present results and the effects of anesthetic technique on other immune cells must be consolidated with further high-quality studies. Full article
(This article belongs to the Section Pharmacology)
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16 pages, 970 KiB  
Systematic Review
Review of the Safety and Clinical Considerations of Vasoconstrictor Agents in Dental Anesthesia During Pregnancy
by Andrei Urîtu, Victor Bogdan Buciu, Ciprian Roi, Doina Chioran, Denis Mihai Serban, Nicolae Nicoleta, Elena Lavinia Rusu, Mihai Ionac, Mircea Riviș and Sebastian Ciurescu
J. Clin. Med. 2025, 14(13), 4773; https://doi.org/10.3390/jcm14134773 - 6 Jul 2025
Viewed by 538
Abstract
Background: The use of vasoconstrictors in dental anesthesia during pregnancy raises clinical concerns due to their potential effects on uteroplacental blood flow and fetal well-being. Despite widespread use, the safety profiles of agents such as epinephrine, levonordefrin, and felypressin remain insufficiently reviewed, [...] Read more.
Background: The use of vasoconstrictors in dental anesthesia during pregnancy raises clinical concerns due to their potential effects on uteroplacental blood flow and fetal well-being. Despite widespread use, the safety profiles of agents such as epinephrine, levonordefrin, and felypressin remain insufficiently reviewed, particularly in isolation from local anesthetics. Methods: A systematic literature search was conducted using PubMed (MEDLINE) for studies published between January 2000 and May 2025, following PRISMA 2020 guidelines. Included studies assessed the use, pharmacokinetics, or outcomes of vasoconstrictor agents used in dental procedures during pregnancy. Articles were selected based on predefined inclusion criteria and synthesized narratively. Results: Out of 95 screened records, only six narrative reviews and three clinical guidelines met eligibility criteria. Epinephrine was the most frequently described agent, generally regarded as safe at low dental doses (1:100,000–1:200,000) when properly administered. Levonordefrin showed insufficient safety data and was associated with potential uterine vasoconstriction. Felypressin was contraindicated due to its oxytocic properties and high risk of inducing uterine contractions. Conclusions: Among vasoconstrictors, epinephrine remains the only agent with an acceptable safety profile in pregnancy when used correctly. Levonordefrin lacks adequate evidence, and felypressin poses clear risks. Until further clinical trials are available, individualized risk assessment and adherence to obstetric and dental guidelines are critical for ensuring maternal and fetal safety. Full article
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25 pages, 1036 KiB  
Systematic Review
Anesthetic Management for Patients with Placenta Accreta Spectrum: A Scoping Review
by Tomasz Jasinski, Aleksander Remesz, Rafal Resko, Aleksandra Budynko and Katarzyna Majdylo
J. Clin. Med. 2025, 14(13), 4738; https://doi.org/10.3390/jcm14134738 - 4 Jul 2025
Viewed by 356
Abstract
Background: Placenta accreta spectrum (PAS) is a condition in which villous tissue pathologically adheres to or invades the uterine wall, which may result in massive bleeding with substantial maternal morbidity and mortality. Despite the constantly increasing prevalence of this condition, an optimal [...] Read more.
Background: Placenta accreta spectrum (PAS) is a condition in which villous tissue pathologically adheres to or invades the uterine wall, which may result in massive bleeding with substantial maternal morbidity and mortality. Despite the constantly increasing prevalence of this condition, an optimal anesthetic management method for this condition has not been fully established. A scoping review of the literature was performed to evaluate current anesthetic management strategies for PAS. Methods: This review was conducted using the Joanna Briggs Institute (JBI) methodology for scoping reviews. A search of five databases (MEDLINE, EMBASE, CINAHL Complete, Scopus, and Web of Science) was conducted to identify articles containing data on seven prespecified aspects of PAS anesthetic management. Studies that described the management of miscarriage and abortion procedures were excluded. Results: One hundred thirty articles encompassing numerous approaches to PAS management were included in the final review. Data were mostly extracted from case reports (n = 56) and observational studies (n = 64). The most commonly adopted strategy (n = 62) was the creation of a multidisciplinary team comprising various specialists, including anesthesiologists. Conclusions: Due to the limited number of interventional studies, the most effective methods of anesthetic management for this condition could not be fully established. However, the safe and effective anesthetic management of PAS patients is feasible. Future research in this field should focus on resolving the identified knowledge gaps and increasing the quality of published studies. Full article
(This article belongs to the Section Anesthesiology)
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9 pages, 1006 KiB  
Case Report
The Potential Advantages of Remimazolam for Awakening in Deep Brain Stimulation Surgery: A Retrospective Analysis of Cases
by Sung-Hye Byun, Jinsong Yeo and Sou-Hyun Lee
J. Clin. Med. 2025, 14(13), 4724; https://doi.org/10.3390/jcm14134724 - 3 Jul 2025
Viewed by 357
Abstract
Background and Objectives: Deep brain stimulation (DBS) requires sedation strategies that enable rapid and reliable awakening during intraoperative electrophysiological testing. Although propofol and dexmedetomidine are commonly used, their lack of pharmacological antagonists might delay recovery. In this retrospective case series, we assessed the [...] Read more.
Background and Objectives: Deep brain stimulation (DBS) requires sedation strategies that enable rapid and reliable awakening during intraoperative electrophysiological testing. Although propofol and dexmedetomidine are commonly used, their lack of pharmacological antagonists might delay recovery. In this retrospective case series, we assessed the effects of using remimazolam, a short-acting benzodiazepine that is reversible with flumazenil. No existing research has determined whether this may represent a clinically advantageous alternative. Materials and Methods: Six patients who underwent DBS surgery with monitored anesthetic care between May and August 2024 were included. Two patients received dexmedetomidine and propofol combined, whereas four received remimazolam for initial sedation. The time from sedation discontinuation to intraoperative electrophysiological examination, postoperative hospital stays, and perioperative complications were evaluated. Results: Patients who received remimazolam had shorter awakening intervals (median 17 min) compared to those who received dexmedetomidine and propofol (median 50 min), with a large effect size difference (Cliff’s delta −1.00). In all cases of remimazolam, patients were administered flumazenil to facilitate awakening, and transient hypertension requiring nicardipine was observed in some patients. Among the patients who underwent unilateral DBS, those who received remimazolam had shorter postoperative hospital stays (5–7 days) than the patient who received dexmedetomidine and propofol (9 days). No patient had complications. Conclusions: This small retrospective case series indicated that remimazolam, when reversed with flumazenil, was associated with rapid awakening compared with dexmedetomidine and propofol in patients undergoing DBS surgery. However, these findings require validation in larger prospective studies due to the small sample size. Full article
(This article belongs to the Section Anesthesiology)
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Article
Comparison of Two Initial Effect-Site Concentrations of Remifentanil with Propofol During Percutaneous Vertebroplasty Under Monitored Anesthesia Care: A Randomized Controlled Study with Titration-Based Adjustment
by Shih-Syuan Lin, Zhi-Fu Wu, Hou-Chuan Lai, Ching-Lung Ko, Ting-Yi Sun, Kun-Ting Hong, Kai-Li Lo, Tzu-Hsuan Yeh and Wei-Cheng Tseng
J. Clin. Med. 2025, 14(13), 4669; https://doi.org/10.3390/jcm14134669 - 1 Jul 2025
Viewed by 352
Abstract
Background: Percutaneous vertebroplasty (PVP) is often performed under monitored anesthesia care (MAC) using a combination of propofol and remifentanil. However, the effects of different remifentanil effect-site concentrations (Ce) combined with propofol on perioperative outcomes in this procedure have not been reported. Methods: In [...] Read more.
Background: Percutaneous vertebroplasty (PVP) is often performed under monitored anesthesia care (MAC) using a combination of propofol and remifentanil. However, the effects of different remifentanil effect-site concentrations (Ce) combined with propofol on perioperative outcomes in this procedure have not been reported. Methods: In this prospective, randomized controlled study, 80 patients scheduled for single-level PVP under MAC were enrolled. Participants were randomly assigned to receive propofol (Ce: 2.0 mcg/mL) combined with either a low (1.0 ng/mL; Group 1) or high (2.0 ng/mL; Group 2) remifentanil Ce. The primary outcome was the incidence of intraoperative patient movement; secondary outcomes included hemodynamic stability, perioperative adverse events, anesthetic consumption, frequency of dose adjustments, postoperative recovery, and anesthesia satisfaction. Results: Group 2 exhibited significantly fewer episodes of patient movement during the procedure and better intraoperative hemodynamic stability. Additionally, fewer upward adjustments in remifentanil infusion were observed in Group 2. Although the total propofol consumption was similar between the groups, Group 2 required a significantly lower propofol Ce to achieve adequate sedation. Surgeon satisfaction with anesthesia was also significantly higher in Group 2. Conclusions: Using a higher remifentanil Ce (2.0 ng/mL) in combination with propofol during PVP under MAC reduces patient movement and improves intraoperative hemodynamic stability without increasing adverse events. This regimen may thereby enhance procedural efficiency and surgeon satisfaction during vertebral interventions. Full article
(This article belongs to the Section Anesthesiology)
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