Search Results (649)

Background/Objectives: This study aimed to explore potential associations between gut microbiota and the in vivo tissue exposure profiles of bioactive constituents derived from Gastrodia elata in spontaneously hypertensive rats (SHRs). Methods: Fecal microbiota transplantation (FMT), high-performance liquid chromatography (HPLC) tissue quantification, and 16S rRNA gene sequencing were applied in the present work. Results: Distinct tissue exposure patterns of Gastrodia elata-derived gastrodin (GAS) and gastrodigenin (HBA) were observed following gut microbiota remodeling. Noticeable shifts in the relative abundance of specific intestinal bacterial taxa were detected between hypertensive SHRs and normotensive Wistar rats, and these taxonomic alterations showed correlation with tissue levels of the target herbal components. Conclusions: It should be noted that the FMT experimental design in this study cannot fully decouple microbiota-related effects from drug treatment confounders; hence, our findings represent preliminary correlative observations rather than definitive causal evidence. This work provides experimental clues for understanding host–microbe–herb interplay under hypertensive conditions and may offer reference information for optimizing administration strategies of natural hypotensive compounds. Full article

Background/Objectives: Peripheral nerve blocks offer the option of targeted pain relief localized to the injured areas while minimizing potential systemic side effects of opioids such as hypotension and respiratory depression. However, there is often hesitancy in the acute setting to perform these procedures. The objective of this study was to describe the technical performance and recorded complications of archived ultrasound-guided and ultrasound-assisted peripheral nerve blocks performed by Emergency Medicine trainees in the emergency department (ED). Methods: A retrospective review of patients presenting at two urban academic EDs who underwent ultrasound-guided peripheral nerve blocks. Data were collected from the ED ultrasound image archiving system and electronic medical record and included age, gender, level of provider training, and ultrasound image data. The primary outcome was technical performance, including needle-tip visualization and visualization of anesthetic infiltration. Secondary outcomes included recorded complications and technical outcomes by level of trainee experience. Results: A total of 72 patients were included in the final analysis. Ulnar nerve blocks were the most common procedure performed at 33%. No major complications were documented in the available records; one patient had documented paresthesia. On ultrasound image review, the needle tip was clearly visualized in 47/72 (65%) of blocks and infiltration of anesthetic was seen in real time in 79% of subjects. Conclusions: Among archived trainee-performed ultrasound-guided peripheral nerve blocks, needle-tip visualization and anesthetic-infiltration visualization varied across procedures and levels of training, and few complications were recorded. These findings provide descriptive data regarding the technical performance of trainee-performed ultrasound-guided nerve blocks but should not be interpreted as establishing their overall safety or clinical effectiveness. Full article

Emergency laparotomy is frequently performed in dogs with cardiovascular compromise, making perioperative anesthesia and nociceptive management particularly challenging. Although ultrasound-guided regional anesthesia techniques have demonstrated opioid-sparing effects during elective procedures, evidence supporting their use in emergency surgery remains limited. Medical records of 61 client-owned dogs were reviewed, and 41 met the inclusion criteria. Dogs were retrospectively allocated to one of four groups according to the analgesic technique received: thoracic paravertebral (TPV, n = 12), erector spinae plane (ESP, n = 11), quadratus lumborum (QL, n = 7), or no regional anesthesia (comparison group, n = 11). All regional blocks were performed using ropivacaine. Total intraoperative fentanyl consumption differed significantly among groups (p < 0.0001), with all regional anesthesia groups requiring less fentanyl than dogs managed without a regional block. Block execution time also differed significantly, with the ESP block requiring the shortest execution time. No significant differences were observed in block-related complications. Intraoperative hypotension did not differ significantly among the regional anesthesia groups; however, significant differences were observed between the control group and both the TPV and ESP groups. Ultrasound-guided TPV, ESP, and QL blocks were associated with lower intraoperative rescue fentanyl requirements than systemic analgesia alone, while block-related technical complications were uncommon. These techniques may represent useful components of multimodal anesthesia for selected dogs undergoing emergency laparotomy, providing opioid-sparing effects without increasing the incidence of intraoperative hypotension compared with systemic opioid analgesia alone. Full article

Background: Maintaining hemodynamic stability is crucial during coil embolization of unruptured intracranial aneurysms. Remimazolam has been suggested to exert less cardiovascular depression than propofol and may therefore provide more stable hemodynamic conditions. This study compared the hemodynamic effects of remimazolam and propofol when used for anesthesia induction and maintenance in patients undergoing coil embolization with I-gel airway management. Methods: In this single-center, randomized study, adults undergoing elective coil embolization for unruptured intracranial aneurysms were assigned to remimazolam or propofol induction followed by I-gel insertion. The primary outcome was the peak-to-nadir systolic blood pressure difference during the peri-induction period. Secondary outcomes included the peak-to-nadir mean arterial pressure difference, lowest systolic and mean arterial pressures, the incidence of hypotension, vasoactive drug requirements, and recovery outcomes. Results: Of the 50 patients randomized, 46 were included in the analysis, including 22 in the remimazolam group and 24 in the propofol group. The peri-induction peak-to-nadir systolic blood pressure difference was smaller with remimazolam than with propofol (38.2 ± 13.2 vs. 51.7 ± 13.4 mmHg, p = 0.001). The peak-to-nadir mean arterial pressure difference was also smaller, while the lowest systolic and mean arterial pressures were higher, with remimazolam. The incidence of hypotension was lower with remimazolam (40.9% vs. 87.5%, p = 0.002), with correspondingly lower requirements for ephedrine and norepinephrine. Conclusions: Remimazolam-based anesthesia was associated with a smaller peri-induction peak-to-nadir systolic blood pressure difference, a lower incidence of hypotension, and less frequent vasoactive drug use than propofol during I-gel-facilitated anesthesia for unruptured intracranial aneurysm coil embolization. These findings suggest a favorable hemodynamic profile in this setting and support further evaluation in larger trials. Full article

Background/Objectives: Bisoprolol fumarate (BF) is a cardioselective beta-blocker used to treat pediatric heart failure and certain tachyarrhythmias. Currently, it is administered mainly as extemporaneously prepared suspensions from crushed tablets, which may cause issues with dose accuracy, stability, and palatability. Orodispersible minitablets (MODTs) may facilitate administration and individualized dosing, while prolonged release could potentially reduce peak-to-trough fluctuations and, thus, minimize adverse effects such as hypotension or bradycardia. This proof-of-concept study aimed to develop spray-dried prolonged-release microparticles containing BF, incorporate them into MODTs, and evaluate the effect of compression on drug release. Methods: Microparticles were prepared by spray drying ethanolic solutions of BF and ethylcellulose at 40 °C, 50 °C, and 60 °C. Their characterization included scanning electron microscopy, X-ray diffraction, differential scanning calorimetry, thermogravimetric analysis and dissolution studies. Selected microparticles were compressed into 3 mm MODTs, which were evaluated for mechanical properties, disintegration, and BF release. Results: Formulations containing 10% BF and 90% ethylcellulose released from 52.6% to 73% of BF after 2 h, increasing to 84.8–90.0% after 8 h and reaching 96% after 24 h. Solid-state analyses indicated complete amorphization of the drug in these microparticles. The spray-drying temperature affected process efficiency but did not significantly impacted morphology or dissolution behavior. The optimized MODTs disintegrated in less than 30 s and had a tensile strength of up to 2.62 MPa. Importantly, compression increased the initial BF release from 26.4% for the microparticles to 43.9% for the MODTs at 0.5 h, resulting in f₂ values of 45.04–48.46. Despite the higher initial BF release, the moderately prolonged-release profile was maintained in the case of MODTs. Conclusions: These findings demonstrate the feasibility of combining prolonged-release microparticles with orodispersible minitablets as a proof-of-concept for a pediatric drug delivery approach. Full article

Ephedrine is used as a vasopressor in cats, but the hemodynamic effects of intravenous (IV) administration have not been characterized. This study evaluated the hemodynamic effects of IV ephedrine in 10 cats that developed hypotension during anesthesia. Cats received either saline (SE) or atropine (AE) before ephedrine for hypotension (mean arterial pressure < 60 mmHg). Hemodynamic variables were analyzed using a linear mixed-effects model. No significant differences were observed between groups in the response rate (defined as mean arterial pressure ≥ 65 mmHg after ephedrine administration; SE, 70%; AE, 80%) or the duration of the pressor response (SE, 4 [1–10] min; AE, 3 [1–5] min). A significant main effect of ephedrine administration was identified for the systemic vascular resistance index, with increases observed in both groups, reaching statistical significance in the AE group. Significant interaction effects were observed for heart rate and cardiac index, both of which increased significantly in the AE group. These findings indicate that the pressor effect of IV ephedrine in anesthetized hypotensive cats is mediated primarily by increasing systemic vascular resistance index. Ephedrine provides a rapid and reliable pressor response and may be considered an early treatment option for anesthesia-induced hypotension in cats. Full article

Background and Objectives: Postoperative pain after major cancer surgery contributes to pulmonary, cardiovascular, metabolic, and functional complications. Thoracic epidural analgesia [TEA] has traditionally been considered the standard analgesic technique for open thoracic and upper abdominal oncologic surgery, although minimally invasive techniques and ERAS pathways have prompted a re-evaluation of its role. Methods: This narrative review summarizes evidence from PubMed and MEDLINE published between 1995 and June 2026, emphasizing randomized trials, systematic reviews, meta-analyses, large observational studies, and selected work by the authors. Results: TEA provides superior dynamic analgesia and reduces opioid consumption, facilitating early mobilization, respiratory recovery, and gastrointestinal function. By attenuating sympathetic and neuroendocrine stress responses, it may contribute to reductions in pulmonary complications, ileus, insulin resistance, and delirium, particularly in elderly, frail, sarcopenic, and high-risk patients. Limitations include hypotension, urinary retention, technical failure, and rare but potentially serious complications such as epidural hematoma. In minimally invasive surgery, alternative regional techniques and multimodal opioid-sparing analgesia often achieve comparable postoperative outcomes with fewer hemodynamic effects, supporting selective rather than routine TEA use. Although neuraxial techniques may have immunomodulatory effects and potentially preserve immune function, randomized studies have not demonstrated a reduction in cancer recurrence or an improvement in long-term survival. Conclusions: TEA remains an effective analgesic strategy for selected patients undergoing major open thoracic and upper abdominal cancer surgery. In contemporary perioperative practice, its use should be individualized according to surgical invasiveness, patient characteristics and expected postoperative pain. Current evidence supports TEA primarily as a perioperative analgesic and recovery strategy, with no established oncologic benefit. Full article

Background/Objectives: Congenital chylous ascites is a rare neonatal condition characterized by the accumulation of lymphatic fluid within the peritoneal cavity. The disorder can be difficult to manage, as many infants show limited response to standard conservative strategies such as dietary modification and supportive care. Currently, no universally accepted therapeutic guidelines exist. We report the successful use of propranolol in the management of refractory congenital chylous ascites. Methods: Clinical data were collected from a 35-week preterm male infant who had prenatal ultrasound evidence of fetal ascites from the 28th week of gestation. Postnatal management initially included fasting, total parenteral nutrition, and from day 9 of life, continuous infusion of octreotide. Due to the persistent ascites, oral propranolol was added to the therapy on the 31st day of life. Current literature was reviewed to compare our findings with those available. Results: Following the addition of propranolol to ongoing octreotide therapy, the infant demonstrated gradual clinical improvement with decreased abdominal distension and reduction of ascitic fluid; as propranolol and octreotide were administered concurrently for approximately 30 days, a causal effect could not be isolated to propranolol alone. Oral propranolol was administered at 0.5 mg/kg every 6 h (2 mg/kg/day total), with heart rate, blood pressure, and glucose monitored throughout treatment; no propranolol-related adverse events (bradycardia, hypotension, bronchospasm, hypoglycemia, or feeding intolerance) occurred. Ultrasonographic resolution of ascites was achieved by day 48, the peritoneal drainage catheter having already been removed on day 34; propranolol was subsequently tapered and discontinued by day 68, and the patient was discharged in stable condition on day 93, with no recurrence on serial ultrasound over the 45 days from resolution to discharge. A narrative review of the literature identified nine infants with lymphatic disorders successfully treated with propranolol. Conclusions: This case suggests a possible temporal association between propranolol administration and clinical improvement in a neonate with congenital chylous ascites refractory to conventional management; no propranolol-related adverse events were observed during treatment. Given the rarity of this condition and the absence of standardized treatment guidelines, further studies—potentially through multicenter registries or prospective case series—are warranted to establish optimal dosing strategies, evaluate long-term outcomes, and clarify the role of propranolol in this setting. Full article

Background: Intraoperative hypotension during major abdominal surgery is common and can result from changes in preload, afterload, or myocardial contractility. Recognising the underlying cause is essential for targeted haemodynamic management. Arterial dP/dt_max has been proposed as a surrogate marker for ventricular systolic function, but its behaviour during fluid and vasopressor administration under general anaesthesia remains not fully understood. This study evaluated changes in radial arterial dP/dt_max following protocol-guided fluid administration and norepinephrine boluses during intraoperative hypotension. Methods: This prospective observational study involved 88 adult patients undergoing elective major abdominal surgery with continuous radial arterial waveform monitoring. Hypotensive episodes were defined as a mean arterial pressure <65 mmHg persisting for at least 60 s and were managed according to a predefined algorithm based on stroke volume variation and dynamic arterial elastance. The primary outcome was the change in arterial dP/dt_max from baseline to 5 min after fluid administration. Linear mixed-effects models were used to account for repeated intervention episodes within patients. Results: A total of 502 protocol-guided intervention episodes contributed by 76 patients were included in the primary analysis: 228 fluid-treated episodes and 274 norepinephrine-treated episodes. Estimated mean arterial dP/dt_max increased from 517 mmHg·s⁻¹ (95% CI 477–557) at baseline to 631 mmHg·s⁻¹ (95% CI 591–671) at 5 min during fluid-treated episodes and from 575 mmHg·s⁻¹ (95% CI 536–615) to 647 mmHg·s⁻¹ (95% CI 608–686) during norepinephrine-treated episodes (both p < 0.001). A significant intervention-condition-by-time interaction was observed (F = 5.55, p = 0.019), indicating that temporal evolution of arterial dP/dt_max differed between the two algorithm-defined haemodynamic conditions. Conclusions: Radial arterial dP/dt_max increased after both fluid administration and norepinephrine, confirming its sensitivity to haemodynamic loading conditions. It should therefore be interpreted as an integrated haemodynamic variable influenced by ventricular performance, preload, and arterial properties rather than as a direct measure of intrinsic myocardial contractility. Full article

Background: Berberine, an isoquinoline alkaloid present in Berberis spp., Coptis chinensis and Hydrastis canadensis, is among the most widely consumed metabolic-health supplements, popularized as “nature’s Ozempic”. Concurrent, often undisclosed use with prescription drugs is common in older adults, yet berberine is far from inert. Objective: To synthesize the evidence on berberine as a perpetrator of supplement–drug interactions, propose a four-axis mechanistic taxonomy, with product quality treated separately as a modifier of exposure rather than as a mechanism, and derive a clinically actionable risk-stratification framework. Methods: Structured narrative review, prepared per the SANRA quality criteria; PubMed/MEDLINE, Scopus, Web of Science and Embase were searched up to May 2026. Results: Despite very low systemic exposure (oral bioavailability 0.68% in rats; low ng/mL plasma concentrations in humans), high luminal, enterocytic and hepatic concentrations generate interaction liability, documented in humans for a few pairs and mechanistic for most, along four mechanistic axes: inhibition, and transcriptional induction, of CYP3A4, with CYP2D6/CYP2C9 inhibition that is quasi-irreversible through a metabolite-intermediate complex; transporter modulation (P-glycoprotein, OCT1/OCT2, and MATE1); pharmacodynamic additivity (hypoglycemia, hypotension, and QT prolongation); and microbiome- and gut-barrier-mediated effects, the last of these being a candidate axis rather than a demonstrated one. Product-quality variability is treated separately, as a modifier of exposure. The clinical anchor is increased cyclosporine exposure in renal-transplant recipients (AUC +34.5%; trough 29.3% above control). These elements are integrated into a three-tier risk-stratification framework that combines perpetrator potency, victim-drug vulnerability, and patient vulnerability, with each tier being linked to a defined pharmacy action. Conclusions: In patients on multiple medications, and particularly when berberine is co-administered with drugs of narrow therapeutic index, it should be managed as an active pharmacological perpetrator rather than as an inert supplement. Unstandardized product quality and an unsettled European regulatory framework, under which national limits differ by more than an order of magnitude, further widen the uncertainty around the dose actually delivered. Berberine use should therefore be elicited routinely at medication reconciliation and stratified by mechanism, by victim-drug vulnerability, and by patient risk, with particular attention to metabolic self-medication in the GLP-1 era. Full article

Chimeric antigen receptor T-cell therapy and bispecific T-cell engagers have transformed treatment of relapsed and refractory hematologic malignancies, achieving unprecedented response rates. However, their clinical adoption has revealed a complex spectrum of cardiovascular toxicities, differing in frequency and pattern between the two technologies. Manifestations range from common hemodynamic perturbations—hypotension and tachycardia—to severe events, including malignant arrhythmias, left ventricular dysfunction, myocardial infarction, and cardiogenic shock. These complications seem to have different pathophysiological pathways that are yet to be completely understood: on the one hand, they are frequently intertwined with cytokine release syndrome, the hallmark immune complication of T-cell-redirecting therapies, as seen with chimeric antigen receptor T-cell therapy; on the other, a substantial proportion of cardiovascular events—particularly with bispecific T-cell engagers—occur independently of cytokine release syndrome. Proposed cardiotoxic mechanisms include on-target, off-tumor antigen recognition and consequent damage; interleukin-6-driven systemic inflammation; and off-target, off-tumor antigen cross-reactivity. Effective management requires proactive baseline risk stratification, serial cardiac biomarker monitoring, and timely immunosuppressive intervention—primarily tocilizumab—to mitigate cytokine release syndrome-driven injury. Despite rapid clinical expansion, critical gaps remain: long-term cardiovascular outcomes are poorly characterized, validated surveillance protocols are lacking, and cardiovascular endpoints are rarely included in pivotal trials. This narrative review appraises the pathophysiology, clinical spectrum, and management of cardiovascular toxicities associated with these therapies, aiming to define this emerging cardio-oncology frontier, inform multidisciplinary care frameworks and propose a clinical management algorithm. Full article

Taiwan has one of the highest dialysis prevalences worldwide, making safe and reliable hemodialysis monitoring a critical sensor-based healthcare challenge. Modern hemodialysis machines integrate heterogeneous multimodal sensors (pressure, flow, conductivity, temperature, and cardiovascular signals), but differences in machine brands, data formats, and privacy constraints hinder centralized learning and robust complication prediction. This work proposes a Medical IoT-oriented federated learning framework, PSOFed-HD, that performs dual-layer Particle Swarm Optimization (PSO) to enhance heterogeneous sensor fusion for predicting dialysis-related hypotension and discomfort events. The events are defined as abnormal blood-pressure states, defined as systolic blood pressure <90 mmHg. Each hemodialysis machine is paired with an edge gateway acting as an FL client, where local PSO optimizes CNN feature weights over non-IID sensor subsets, while the central server applies PSO-driven aggregation to adaptively weight client models according to validation performance. Experiments on real-world hemodialysis datasets with 17 most commonly seen HD physiological features demonstrate that standard FedAvg yields an accuracy of 65.24% and F1-score of 0.5318, server-side PSO improves accuracy to 75.11%, and client-side PSO further raises accuracy to 81.97%. The proposed dual-layer PSO framework achieves the best performance, with 90.56% accuracy and an F1-score of 0.8533, along with superior ROC characteristics (AUC = 0.908) and stable cross-validation across 11 folds. State-of-the-art federated learning techniques for non-IID data such as SCAFFOLD and FedProx are also examined using the same heterogeneous HD dataset. The performance is close to our client-only PSO techniques, proving the merits of our dual-layer PSO architecture. These results confirm that jointly optimizing local feature representations and global aggregation weights enables effective fusion of heterogeneous hemodialysis sensor data under privacy-preserving Medical IoT constraints, providing a practical decision-support approach for real-time complication prediction in dialysis units. Future work will incorporate temporal models such as LSTM or Transformer architectures to achieve early event prediction. Full article

Background/Objectives: High tibial osteotomy (HTO) is a joint-preserving procedure for selected patients with medial compartment knee osteoarthritis and varus malalignment. Postoperative pain after HTO may impair early mobilization and increase systemic opioid requirements. Periarticular infiltration analgesia is commonly used as part of multimodal analgesia; however, comparative evidence regarding opioid-containing and opioid-free infiltration protocols in HTO remains limited. This study compared postoperative pain, systemic opioid consumption, PCA demand, rescue analgesic requirement, and analgesia-related adverse events between a modified opioid-containing Ranawat cocktail and an opioid-free dexmedetomidine-based periarticular infiltration protocol. Methods: This single-center retrospective comparative cohort study included 80 patients who underwent medial opening-wedge HTO between March 2021 and March 2025. Patients were categorized according to the documented periarticular infiltration protocol: modified Ranawat cocktail (n = 40) or dexmedetomidine-based cocktail (n = 40). Postoperative VAS scores were recorded at 6, 12, 18, and 24 h and on postoperative days 7 and 14. Secondary outcomes included 24 h systemic opioid consumption expressed as morphine milligram equivalents, PCA demand count, rescue analgesic use, and analgesia-related adverse events. Longitudinal postoperative VAS trajectories were analyzed using unadjusted and adjusted linear mixed-effects models. The adjusted model included the available covariates of age, body mass index, preoperative VAS score, operative time, and tourniquet time. Results: Baseline demographic and perioperative variables were comparable between groups. The dexmedetomidine group demonstrated lower adjusted postoperative VAS scores during the early postoperative period, with statistically significant between-group differences at 12, 18, and 24 h, whereas pain trajectories converged by postoperative day 14. Twenty-four-hour systemic opioid consumption was lower in the dexmedetomidine group than in the modified Ranawat group (9.78 ± 1.99 vs. 13.92 ± 1.79 MME, p < 0.001). PCA demand was also lower in the dexmedetomidine group (6.30 ± 3.16 vs. 9.63 ± 2.92, p < 0.001). No significant between-group differences were observed in rescue NSAID use, rescue tramadol requirement, nausea/vomiting, hypotension, bradycardia, allergic reactions, or other recorded adverse events. Conclusions: In this retrospective cohort, dexmedetomidine-based opioid-free periarticular infiltration was associated with lower adjusted early postoperative VAS scores, reduced 24 h systemic opioid consumption, and fewer PCA demands compared with a modified opioid-containing Ranawat cocktail after medial opening-wedge HTO. However, because treatment allocation was not randomized and several potentially relevant confounders were not available for adjustment, these findings should be interpreted as associative and hypothesis-generating. Prospective adequately powered randomized studies are needed to confirm these findings and evaluate their effects on functional recovery and osteotomy healing. Full article

Introduction: Bispecific antibodies (BsAbs) are a promising and potent therapeutic intervention for relapsed or refractory (R/R) hematologic malignancies, including acute lymphoblastic leukemia (ALL), multiple myeloma (MM), and B-cell lymphomas. These recombinant molecules are designed to target two distinct antigens or epitopes. While BsAbs have shown significant efficacy in managing hematologic malignancies, toxicities must be carefully monitored and their safety profiles require further investigation. This meta-analysis investigates cardiovascular adverse effects associated with seven BsAbs across multiple clinical trials. Methods: A systematic literature review identified seven BsAbs, blinatumomab, elranatamab, epcoritamab, glofitamab, mosunetuzumab, talquetamab, and teclistamab, analyzing 25 clinical trials (Phase I–III) that included monotherapy regimens. The cardiovascular adverse events studied were arrhythmias, heart failure, blood pressure changes, and myocardial infarctions. A meta-analysis using the R meta package calculated proportions and 95% confidence intervals (CIs) and employed a random-effects model to assess heterogeneity. Results: Among 3215 patients, pooled analysis revealed significant findings with 13.6% cardiac arrhythmia (95% CI 10.1–18.2%, p = 0.05), 13.3% hypotension (95% CI 10–17.3%, p < 0.0001), 10.2% tachycardia (95% CI 7.6–13.5%, p = 0.0003), and 3.4% sudden death (95% CI 0–80%, p = 0.046). Less frequent events were hypertension (8%), acute myocardial infarction (1.5%), heart failure (1.4%), and atrial fibrillation (1.3%). Discussion: As BsAbs see increased use in R/R hematologic malignancies, cardiovascular complications must be closely monitored. This analysis highlights hypotension, cardiac arrhythmias, tachycardia, and sudden death as significant adverse effects. Although study heterogeneity and limited patient-level data may have influenced incidence estimates, these findings support routine cardiovascular monitoring and underscore the need for prospective studies to identify high-risk patients and optimize prevention and management strategies. Oncologists, cardiologists, and pharmacists should establish strategies for early detection and management to optimize patients’ outcomes. Full article

Background and Objectives: The Hypotension Prediction Index (HPI) is a predictive algorithm that enables proactive management of intraoperative hypotension (IOH) and has been integrated into finger cuff devices for practical use in obstetric settings. This study aims to evaluate the effectiveness of HPI in reducing IOH during elective cesarean sections (CS). Materials and Methods: This randomized controlled trial enrolled parturients undergoing elective CS under spinal anesthesia. The parturients were randomized to either the HPI or the control group using non-invasive blood pressure (NIBP) monitoring. The primary outcome was the time-weighted average mean arterial pressure below 65 mmHg (TWA-MAP < 65 mmHg). Secondary outcomes included maternal nausea and vomiting, intraoperative fluid and vasopressor requirements, incidences of hypertension and bradycardia, estimated blood loss, duration of high-dependency unit admission, fetal Apgar scores, umbilical cord pH, and length of neonatal intensive care unit (NICU) stay. Results: A total of 100 parturients were enrolled in the study, with 96 included in the analysis. Baseline demographic characteristics were similar between the groups. The TWA-MAP < 65 mmHg was significantly lower in the HPI group (0.24 [0, 0.70] vs. 1.67 [0.71, 2.57] mmHg; p < 0.001). The incidence of intraoperative and postoperative nausea and vomiting were significantly reduced in the HPI group (p < 0.01). Incidence of intraoperative hypertension and bradycardia, fetal Apgar scores, umbilical cord pH, and length of NICU stay did not differ between the two groups (p > 0.05). Conclusions: HPI-guided management was associated with a reduction in hypotension burden and perioperative nausea and vomiting. Full article