Search Results (56)

Acute pain is the most common presentation in the emergency department (ED), accounting for approximately 78% of visits and highlighting the need for rapid and effective pain management. Ketamine is a well-established analgesic that can serve as an alternative when opioids are contraindicated. Recently, low-dose ketamine (LDK), also known as sub-dissociative or subanesthetic ketamine, has emerged as a potential option for acute pain control in ED settings; however, evidence regarding its efficacy and safety remains inconsistent. This systematic review aimed to evaluate the effectiveness and safety of LDK for acute pain management in the emergency department. A comprehensive search of SCOPUS, PubMed, and Web of Science was conducted using predefined keywords related to ketamine, acute pain, and emergency care. Peer-reviewed randomized controlled trials (RCTs) published in English between 2015 and 2025 involving adults aged ≥ 18 years were included, and the risk of bias was assessed using the Cochrane Risk of Bias 2 (ROB-2) tool. Sixteen RCTs including 1908 adult patients met the inclusion criteria. The findings were heterogeneous: several studies demonstrated that LDK provided effective pain reduction within 30 min compared with commonly used analgesics such as morphine, ketorolac, and fentanyl, whereas others found no significant superiority, including one placebo-controlled trial. The analgesic effect appeared dose- and administration-dependent, with short intravenous infusions showing better tolerability than bolus dosing. Transient neuropsychiatric adverse effects were reported, but no serious adverse events were identified. Larger multicenter studies are needed to further clarify optimal dosing strategies and confirm the safety profile of LDK in ED pain management. Full article

Background: Inherited Epidermolysis Bullosa (EB) is a wide group of rare genetic disorders characterized by mucocutaneous fragility and blister formation. In neonates with EB, pain control is particularly complex because painful skin lesions coexist with developmental vulnerability, repeated handling, and the need for frequent wound care. Traditional opioid use carries a risk of adverse effects such as respiratory depression. Tramadol, a centrally acting weak opioid with a dual mechanism of action, may offer a safer alternative. Methods: This retrospective observational study analyzed neonates with different EB subtypes admitted to our tertiary neonatal care center between January 2020 and October 2022. Genetic diagnosis was confirmed via next-generation sequencing. Pain was assessed using the Neonatal Infant Pain Scale (NIPS). Tramadol was administered intravenously (1–2 mg/kg bolus or 0.1–0.2 mg/kg/h infusion) before daily wound dressings, then transitioned to oral dosing when appropriate. Pain scores before and after tramadol administration were compared. Results: Six neonates with various EB subtypes were included. All patients received tramadol for procedural pain control. No significant differences in NIPS scores were observed before and after tramadol administration (p = 0.997), indicating adequate pain control, although baseline pain scores were low, limiting interpretation of analgesic efficacy. No immediate adverse events were observed during hospitalization or reported during follow-up. Conclusions: Scheduled tramadol administration appears to be a safe and effective option for pain management in neonates with EB, with no observed hemodynamic or respiratory complications. Given the scarcity of data in this population, our findings highlight the need for multicenter studies to establish standardized analgesia protocols for EB neonates. Full article

Perioperative anaphylaxis, though rare, is a potentially life-threatening complication. While antibiotics and neuromuscular blocking agents are common triggers, benzodiazepine-induced reactions have been considered uncommon. Remimazolam, a novel benzodiazepine sedative, has gained widespread use in Korea due to its rapid onset, short recovery, hemodynamic stability, and availability of flumazenil. However, increasing utilization has coincided with rising reports of hypersensitivity. We report the case of a 62-year-old female undergoing contralateral total knee replacement under spinal anesthesia. Continuous remimazolam infusion was initiated, but within ten minutes the patient developed chest discomfort followed by abrupt hypotension and oxygen desaturation, requiring urgent conversion to general anesthesia. Following a remimazolam bolus and rocuronium administration, sudden cardiac arrest occurred. Return of spontaneous circulation (ROSC) was achieved after approximately 28 min of cardiopulmonary resuscitation with a cumulative intravenous epinephrine dose of approximately 17 mg, and veno-arterial extracorporeal membrane oxygenation (ECMO) was required. Post-ROSC transesophageal echocardiography demonstrated a transient anteroseptal regional wall motion abnormality; subsequent coronary angiography demonstrated no significant coronary disease, and computed tomography pulmonary angiography was negative for embolism, leaving acute hypersensitivity as the most plausible mechanism. Acute serum tryptase was elevated at 11.6 µg/L and normalized to 3.4 µg/L (the patient’s individual baseline) prior to discharge, satisfying the World Allergy Organization (WAO) criterion. A skin prick test performed four weeks later was positive for remimazolam and negative for rocuronium and the other coadministered agents. An expanded multi-database literature review identified 16 prior cases of remimazolam-induced anaphylaxis. Most described cardiovascular collapse as the predominant manifestation. To our knowledge, based on available literature, this is among the first reports of remimazolam-induced anaphylaxis occurring in the setting of high spinal anesthesia with sympathetic blockade. Vigilance and adherence to established anaphylaxis management guidelines are essential. Full article

Maropitant has been proposed as an adjunct for pain relief in dogs undergoing surgeries like ovariohysterectomy (OVH), but its effectiveness has not yet been definitively proven. This study aimed to assess the intraoperative analgesic effect of intravenously administered maropitant citrate at a constant rate infusion through monitoring parasympathetic tone activity in female dogs undergoing OVH. Thirty healthy females of various breeds, with an average age of 3.8 ± 2.7 years, an average weight of 16.75 ± 10.68 kg, were randomly assigned to two treatment groups. The group receiving maropitant (G_Maro, n = 15) was given a 1 mg kg⁻¹ maropitant bolus intravenously (IV), followed by a continuous infusion of 100 mcg kg⁻¹ min⁻¹. The lidocaine group (G_Lido, n = 15) received a 2 mg/kg lidocaine IV bolus, with subsequent infusion at 50 mcg kg⁻¹ min⁻¹. Cardiorespiratory variables and the PTA index were evaluated at 11 anesthetic time points. Overall, cardiovascular variables such as Heart Rate (HR) and systolic arterial pressure (SAP) significantly decreased during anesthesia induction in the G_Maro (p = 0.0001; p = 0.01, respectively) and in G_Lido (p = 0.01). Differences between groups during induction were observed in HR (p = 0.03), SAP (p = 0.04), and mean arterial pressure (MAP) (p = 0.03). MAP showed significant changes from baseline at the start of surgery and during clamping in both G_Maro (p = 0.03) and G_Lido (p = 0.003). Regarding ventilatory variables—pulse oximetry (SpO₂), respiratory rate (RR), inspired oxygen fraction (FiO₂), end-tidal CO₂ (EtCO₂)—no group differences were found, but RR (G_Maro; p = 0.001, G_Lido; p = 0.0001) and SpO₂ (G_Maro; p = 0.004, G_Lido; p = 0.04) differed significantly from baseline due to the controlled clinical setting. During anesthesia maintenance, end-tidal isoflurane (ET_Iso) increased significantly in the G_Lido (p = 0.009), with no difference between groups (p = 0.94). Finally, only the PTA energy variable showed a significant decrease in the G_Maro (p = 0.0006), and a significant difference in this parameter was observed during right ovarian pedicle manipulation between groups (p = 0.02). In conclusion, continuous intravenous infusion of maropitant citrate at 100 mcg kg⁻¹ h⁻¹ effectively reduced the sympathetic response related to nociception, similar to lidocaine, in healthy female dogs undergoing OVH. Full article

Background: Magnesium sulfate (MgSO₄) has been investigated as an adjuvant in perioperative analgesia because of its antagonistic effects on the N-methyl-D-aspartate receptor (NMDA receptor) and its potential to attenuate central sensitization. However, clinical findings regarding its analgesic efficacy remain inconsistent across surgical procedures. Lumbar microdiscectomy is a common spinal procedure in which effective early postoperative pain control is important for patient comfort and early mobilization. This study aimed to evaluate the effect of intraoperative MgSO₄ administration on early postoperative analgesia and perioperative outcomes in patients undergoing lumbar microdiscectomy. Methods: This retrospective single-center cohort study included thirty-eight patients with American Society of Anesthesiologists (ASA) physical status I–II who underwent elective single-level lumbar microdiscectomy under general anesthesia. Patients were divided into two groups according to intraoperative magnesium administration: a control group receiving standard anesthesia without MgSO₄ (n = 19) and an MgSO₄ group receiving an intravenous MgSO₄ bolus of 30 mg/kg followed by a continuous infusion of 10 mg/kg/h until skin closure (n = 19). Postoperative pain intensity was assessed using the Numeric Rating Scale (NRS) at 0, 5, 10, 15, and 30 min after admission to the post-anesthesia care unit. Secondary outcomes included intraoperative remifentanil consumption, extubation time, and time to first mobilization. Complementary in silico analyses included molecular docking and protein–protein interaction (PPI) network analysis. Results: Postoperative NRS scores were numerically lower in the MgSO₄ group; however, between-group differences were not statistically significant. Mean intraoperative remifentanil consumption was numerically lower in the MgSO₄ group (236 ± 166 µg) compared with the control group (319 ± 298 µg), without statistical significance (p = 0.27). Repeated-measures analysis demonstrated the significant effect of time on postoperative NRS scores, whereas the overall group effect was not significant. Molecular analyses indicated stable morphine binding to opioid receptors and highlighted glutamatergic signaling components as central nodes within the interaction network. Conclusions: Intraoperative MgSO₄ administration was not associated with significant improvements in early postoperative pain scores or perioperative recovery parameters following lumbar microdiscectomy. Molecular analyses provide exploratory in silico insights and should be interpreted cautiously given the retrospective design and the in silico nature of these findings. Full article

Background and Clinical Significance: Sickle cell vaso-occlusive crisis (VOC) may present with severe refractory pain that is difficult to control despite guideline-directed multimodal therapy and high-dose opioids. Case Presentation: We report an adult with VOC and severe, opioid-refractory anterior thigh and leg pain who was treated with bilateral, ultrasound-guided continuous femoral nerve catheters (0.5% bupivacaine bolus per side followed by infusion of 0.2% ropivacaine at 5 mL/h each). Twenty-four-hour opioid use decreased by 76% from 44 mg intravenous hydromorphone (880 MME) before block placement to 10.4 mg (208 MME) after catheter initiation. Pain scores declined significantly from 10/10 to 3/10, facilitating mobilization and expediting discharge of the patient. No local anesthetic systemic toxicity occurred, and transient quadriceps weakness was managed with fall-risk precautions. IRB approval for this case report was waived per our institution policy. Conclusions: In select adults with VOC and predominant anterior thigh/leg pain, bilateral continuous femoral nerve catheters may provide rapid analgesia and substantial opioid-sparing benefits as part of multidisciplinary care. These findings are hypothesis-generating and support prospective evaluation of continuous peripheral nerve block strategies in VOC. Full article

Background/Objectives: Hemodynamic and neurohormonal factors, including renal perfusion and venous pressure, may affect diuretic response, which may be modulated by body position. This study aimed to assess whether supine versus upright positioning influences diuretic efficacy and neurohormonal activation during early decongestion in patients with AHF and reduced ejection fraction (HFrEF). Methods: This single-center, prospective, pilot randomized study enrolled 12 hospitalized patients with decompensated HFrEF receiving guideline-directed medical therapy. Participants were randomized (1:1) to remain in either the supine or upright/seated position during intravenous furosemide administration (1 mg/kg: half of the dose administered as a bolus, half as a 2-h infusion). Serial measurements of urine volume, electrolyte excretion, and neurohormonal biomarkers (renin, aldosterone, catecholamines) were performed at baseline, 2, and 6 h after diuretic administration. Results: No significant differences were found between supine and upright groups in total urine output, urine dilution, sodium excretion, or weight change after 6 h. There were no statistically significant differences in renin and aldosterone levels across subsequent timepoints; however, renin concentration tended to be higher in upright than in supine individuals. Interestingly, supine participants demonstrated greater urinary adrenaline concentration after furosemide administration, alone and after adjustment for urinary creatinine. Conclusions: No clinically meaningful differences were found between supine versus upright position patients with AHF, receiving neurohormonal blockade. Full article

Standing sedation in horses provides immobilization and analgesia for surgery while avoiding the high risks of general anesthesia. Ketamine at subanesthetic doses may enhance sedation and reduce xylazine requirements, but evidence in clinical settings is limited. In a randomized blinded trial, we evaluated whether adding a low-dose ketamine infusion could reduce the xylazine dose required for effective sedation during standing ventriculocordectomy and laryngoplasty. Fifty-one horses were randomly assigned to sedation with xylazine alone (SX group) or xylazine plus ketamine (KX group) in a continuous rate infusion. The ketamine group received ketamine (0.25 mg/kg intravenous (IV) bolus followed by 0.5 mg/kg/h infusion), while xylazine was administered in both groups via a titrated infusion to effect according to the Ghent Sedation Algorithm. Sedation depth, ataxia, surgical condition scores, and cardiorespiratory parameters were recorded. Data are presented as median (25th–75th percentiles) and estimated effect with 95% confidence intervals (CI). Statistical significance was set at p < 0.05 and at 95% CIs excluding zero. The addition of ketamine did not significantly reduce xylazine requirements (0.9 (0.7–1.3) vs. 0.8 (0.5–1.1) mg/kg/h for SX and KX, respectively; p = 0.139). However, horses receiving ketamine (KX) achieved deeper sedation (Estimate = 2.74; 95% CI: 0.95 to 4.63) with no differences in ataxia or surgical conditions. Cardiorespiratory variables remained stable in both groups, and no adverse events occurred. In conclusion, adding a subanesthetic ketamine infusion improved sedation depth without adverse effects but did not significantly reduce the xylazine requirement. Full article

Background and Objectives: Surgical stress during robotic-assisted radical prostatectomy (RARP) elicits a measurable systemic inflammatory response despite the minimally invasive approach. Intravenous lidocaine has been increasingly investigated for its potential anti-inflammatory, analgesic, and immunomodulatory benefits, but evidence in robotic urologic oncology remains limited. This study aimed to evaluate whether intraoperative lidocaine infusion attenuates postoperative inflammation, improves analgesic outcomes, and accelerates early recovery following RARP. Materials and Methods: This prospective non-randomized observational study included 80 patients undergoing elective RARP, divided into a Lidocaine Group (n = 40) receiving an intraoperative bolus and continuous infusion, and a Control Group (n = 40) receiving standard anesthesia without lidocaine. Serum IL-6, TNF-α, CRP, and fibrinogen were measured at baseline, end of surgery, and 24 h postoperatively. Postoperative pain scores, opioid consumption, gastrointestinal recovery, ambulation, and length of stay were recorded. Statistical analyses included repeated-measures ANOVA, correlation testing, and between-group comparisons. Results: Baseline characteristics were similar between groups. At 24 h postoperatively, lidocaine administration was associated with a significantly attenuated inflammatory response, with lower levels of IL-6 (45.7 ± 10.8 vs. 68.9 ± 12.6 pg/mL, p < 0.01) and TNF-α (20.5 ± 5.1 vs. 27.2 ± 6.4 pg/mL, p < 0.01) compared with controls. Patients receiving lidocaine reported lower postoperative pain scores and required significantly less opioid analgesia, with a total 24 h consumption of 8.9 ± 3.4 vs. 14.8 ± 5.2 mg morphine milligram equivalents (p < 0.001). Lidocaine was also associated with faster recovery, including earlier oral intake and a shorter length of hospital stay (2.9 ± 0.7 vs. 3.6 ± 0.9 days, p = 0.003). No lidocaine-related adverse events were observed. Conclusions: In this prospective observational study, intraoperative intravenous lidocaine was associated with attenuated early postoperative inflammation, improved analgesic outcomes, and enhanced early recovery following RARP. These findings support the potential role of intravenous lidocaine as a safe adjunct in multimodal perioperative management; however, given the non-randomized observational design, causal inferences should be interpreted with caution. Further randomized controlled trials are warranted to confirm causality and to validate long-term clinical and mechanistic effects. Potential residual confounding inherent to the observational design should be considered when interpreting these findings. Full article

Vitamin B1 (thiamine) is a water-soluble B vitamin. As a cofactor of many enzymes, it is essential for the proper functioning of many body systems and organs, including metabolic and energy metabolism. In extreme cases, vitamin B1 deficiency causes neurodegenerative disorders, including beri-beri, or cognitive impairment resulting from encephalopathy. B1 avitaminosis may result from increased demand, dietary errors, malabsorption, or excessive loss. Thiamine supplementation is used in cases of vitamin B1 deficiency or for preventative measures in situations of increased demand. Vitamin B1 can be administered enterally or parenterally (intravenously, intramuscularly, subcutaneously). The route and dose depend on the individual patient’s clinical situation. Hypersensitivity to vitamin B1 is rare and appears to be primarily associated with rapid intravenous infusion of large doses of thiamine hydrochloride over a short period (intravenous bolus). Hypersensitivity to thiamine administered by routes other than intravenous or intramuscular injection appears to be an incidental phenomenon. Thiamine should also be considered as an occupational allergen. The mechanism of thiamine hypersensitivity has not been clearly elucidated. However, considering the clinical nature and dynamics of the reaction, the most likely reaction seems to be an immediate type of hypersensitivity reaction (immunoglobulin E (IgE)-dependent), in which thiamine (but not its metabolites) acts as a hapten. Diagnosing hypersensitivity to vitamin B1 is difficult due to the lack of validated tests for additional testing. In individuals requiring thiamine supplementation who have experienced hypersensitivity to intramuscular or intravenous administration of this vitamin, switching to oral administration may be considered (provided this does not reduce treatment efficacy). This form of supplementation is usually well tolerated by individuals allergic to parenteral thiamine. However, if enteral supplementation does not guarantee the maintenance of therapeutic potential, thiamine desensitization may be considered, which seems to be an effective therapeutic method in such a clinical situation. Full article

Background and Objectives: Effective perioperative pain management remains a key goal of enhanced recovery protocols, especially in minimally invasive urologic surgery, where optimizing comfort while limiting opioid exposure is essential. Intravenous lidocaine has gained attention for its multimodal analgesic and anti-inflammatory properties, yet evidence in robotic prostatectomy remains limited. This study evaluated whether intraoperative lidocaine infusion was associated with lower early postoperative pain scores and reduced opioid use in patients undergoing robotic-assisted radical prostatectomy. Materials and Methods: A retrospective, single-center analysis was conducted at Pelican Clinical Hospital, Oradea, Romania, including 112 patients operated on between January 2020 and December 2023. All procedures were performed by the same surgical and anesthetic teams using standardized ERAS-based protocols. Patients were divided into two groups: the Lidocaine Group (LG, n = 51), who received a bolus of 1.5 mg/kg lidocaine followed by an infusion of 1.5 mg/kg/h during surgery, and the Control Group (CG, n = 61), who received standard anesthesia without lidocaine. Postoperative pain was measured using the visual analog scale (VAS) at 0, 4, 12, and 24 h, and opioid use was converted into morphine milligram equivalents (MME). Secondary outcomes included time to ambulation, gastrointestinal recovery, oral intake, hospital stay, and complications. Results: Pain intensity was significantly lower in the lidocaine group at 4 h postoperatively (VAS 3.5 ± 1.1 vs. 4.3 ± 1.3; p = 0.01), with similar scores later. Total opioid use was reduced by about 18% in the lidocaine group (25.7 ± 9.4 vs. 31.2 ± 10.5 MME; p = 0.03). Recovery parameters and complication rates were comparable between groups, and no lidocaine-related adverse events were recorded. Conclusions: Intraoperative intravenous lidocaine was associated with lower early postoperative pain scores and reduced opioid requirements after robotic-assisted radical prostatectomy without affecting recovery or safety. Its favorable profile and low cost support its inclusion as a practical adjunct in multimodal analgesia within ERAS pathways. Full article

Ischemia/reperfusion (I/R) injury is a major complication in lung transplantation. Recent evidence suggests that mitogen-activated protein kinases (MAPKs) such as p-38 mitogen-activated protein kinase (p-38 MAPK) and extracellular signal-regulated kinase (ERK), along with functionally related kinases like phosphoinositide 3-kinase (PI3K) and protein kinase B (AKT), contribute to I/R pathophysiology by mediating inflammatory and stress-response signaling. MicroRNAs (miRNAs) also play a regulatory role in these processes. Lidocaine has demonstrated anti-inflammatory activity in several tissues; however, its ability to modulate miRNA expression and kinase activation in the lung is not yet fully understood. This study investigated the involvement of these signaling molecules in lung I/R injury and evaluated the modulatory effect of intravenous lidocaine in a porcine lung auto-transplantation model. Eighteen large white pigs were assigned to sham-operated (n = 6), control (lung auto-transplantation, n = 6), or lidocaine-treated (n = 6) groups. Lidocaine was administered as a 1.5 mg/kg bolus followed by a continuous infusion (1.5 mg·kg⁻¹·h⁻¹). Lung biopsies were collected before ischemia, before reperfusion, and at 30- and 60-min post-reperfusion to assess total and phosphorylated levels of p-38 MAPK, ERK, PI3K, and AKT (Thr308, Ser473), along with miR-126, miR-142-5p, miR-152, and miR-155 expression. I/R increased p-38 MAPK and AKT, and enhanced phosphorylation of all four kinases. miRNA levels were also upregulated. Lidocaine partially or completely attenuated these changes. These findings support a role for these molecular pathways in lung I/R injury and suggest that lidocaine may offer protective effects through their modulation. Full article

Overexpression of αvβ3 integrin is found in a diverse group of tumors originating from glial cells in the brain, making this transmembrane receptor a promising biomarker for molecular MRI diagnosis. In the study, we conjugated a monoclonal antibody against the β3 subunit (CD61) of the αvβ3 integrin receptor with carbon-encapsulated iron nanoparticles to yield Fe@C-(CH₂)₂-CONH-anti-CD61 bioconjugates that were used in dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI). Wistar rats bearing C6 gliomas were injected as a single bolus (0.5 mL) through the tail vain with a suspension of Fe@C-(CH₂)₂-CONH-anti-CD61 nanoparticles (200 μg mL⁻¹) and the animals were imaged using the T2*-weighted echo planar imaging (T2* EPI) technique. Results showed that intravenously infused nanoparticles targeting αvβ3 integrin receptors provide strong contrast in rat glioma tissues. No such effects were observed in other rat organs, although some post-contrast effects were also noted in the liver and kidney. The study shows that the as-developed nanoparticles decorated with anti-CD61 monoclonal antibodies might be considered as a novel contrast candidate for noninvasive DSC-MRI diagnosis in CD61-positive gliomas. Full article

Endotoxemia often leads to microcirculatory derangement. In six sevoflurane anaesthetized Beagle dogs, we investigated the effects of 1 mg/kg of Escherichia coli lipopolysaccharide endotoxin intravenous and blood pressure (mean arterial pressure of 65 mmHg versus 85 mmHg) on microcirculation assessed on buccal mucosa using side stream dark field microscopy. Dogs were afterwards resuscitated with fluids and noradrenaline. We investigated dose requirements of noradrenaline with or without dexmedetomidine. Microcirculatory parameters, and markers of sepsis (cardiac output, mixed venous oxygen saturation, carbon dioxide gap, and lactate) were analysed before endotoxemia, after endotoxemia, after a 30 mL/kg of Ringer’s acetate fluid bolus, and during noradrenaline +/− dexmedetomidine infusion, after a second fluid bolus, and a second time after vasopressor treatment in a cross-over fashion. Endotoxemia and mean arterial pressure had no statistically significant effect on microcirculation; however, endotoxemia resulted in a decrease in cardiac output. Dexmedetomidine neither improved microcirculation nor reduced noradrenaline requirements. Full article

Background and Objectives: After transcatheter aortic valve implantation (TAVI), transvalvular gradients increase immediately following the procedure up to 24 h afterward. While factors such as anesthesia type and fluid status have been suggested as potential contributors, the underlying cause remains unclear. With advancements in TAVI techniques, there has been a shift in anesthesia protocols from general anesthesia (GA) to monitored anesthesia care (MAC). This study aimed to assess the impact of GA and MAC on the increase in transvalvular gradients observed 24 h post-TAVI. Methods: A retrospective, single-center analysis was conducted on patients who underwent TAVI at our institution between 2011 and 2023 (n = 744, males = 421). The patients were divided into two groups: those who received GA (n = 201) and those who received MAC (n = 543). The GA group received either inhaled anesthetics, with or without propofol infusions, or propofol infusions at a rate of ≥100 mcg/kg/min. The MAC group received bolus doses and continuous infusions of dexmedetomidine. Transvalvular gradients were compared between immediate and 24 h post-procedure echocardiograms. Results: The average age of patients in the GA group (78 years [IQR 71–83]) was similar to that of the MAC group (77 years [IQR 71–83]). The GA group had a higher prevalence of comorbidities at baseline. Both groups exhibited stable, normotensive blood pressure levels during the procedure, though the GA group required more vasopressors and intravenous fluid. The GA group showed a 24 h post-TAVI mean transvalvular gradient change of +5.1 mmHg [IQR 3–8.1], while the MAC group had a 24 h mean transvalvular gradient change of +5.8 mmHg [IQR 3.2–9], with no significant difference between the groups (p = 0.139). Conclusions: Despite the greater cardiovascular depressive effects and increased need for vasopressors and fluid resuscitation in the GA group, there was no significant difference in the increase in transvalvular gradients between the GA and MAC groups at 24 h post-TAVI. Further research is needed to fully understand the reasons behind the increase in gradients observed after TAVI. Full article