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Intranasal Dexmedetomidine Is More Effective than Intranasal Midazolam in Reducing Preoperative Anxiety in Children

A systematic review and meta-analysis published in BMC Anesthesiology evaluated the efficacy and safety of intranasal dexmedetomidine as compared to intranasal or oral midazolam in reducing preoperative anxiety in pediatric surgical patients. The review included 19 RCTs comprising 1475 pediatric patients. The pooled analysis revealed that intranasal dexmedetomidine was associated with significantly lower anxiety scores at or before induction (SMD = –1.10; 95% CI, –1.68 to –0.53; P = 0.0002), parental separation anxiety (SMD = –0.56; 95% CI, –0.99 to –0.12; P = 0.01), and mean heart rate (MD = –6.60 beats/min; 95% CI, –10.56 to –2.64; P = 0.001) compared to intranasal midazolam. No statistically significant difference was detected between intranasal dexmedetomidine and oral midazolam.

Higher Ventilatory Ratio Values Are Associated with Increased Mortality Risk in Patients with ARDS

A systematic review and meta-analysis published in Respiratory Medicine assessed the association between ventilatory ratio (VR) and mortality in patients with ARDS. Seventeen observational studies were included in the meta-analysis. The meta-analysis demonstrated an increase in the odds of mortality in patients with ARDS who had higher VR values (OR = 1.55; 95% CI, 1.27-1.96). Most studies in the analysis were rated as low quality due to the study design and heterogeneity (I2 = 71.9%). VR may represent a complementary prognostic marker, but future prospective studies are needed to validate its performance.

Prophylactic Propranolol Is a Promising New Strategy to Prevent Paroxysmal Sympathetic Hyperactivity in Adults with TBI

An RCT published in BMC Anesthesiology investigated whether prophylactic use of propranolol reduces the incidence of paroxysmal sympathetic hyperactivity (PSH) in 90 adults with a moderate-to-severe TBI. Participants were randomized to standard care (Group I, n = 30); standard care plus propranolol (40 mg/12 h; Group II, n = 30); or standard care plus propranolol (40 mg/12 h) plus gabapentin (100 mg/8 h; Group III, n = 30). PSH incidence was lowest in Group III (10%) versus Group II (33.3%) and Group I (60%) (P < 0.001). Although the addition of gabapentin further reduced PSH, it prolonged the recovery time, suggesting a trade-off between efficacy and sedative effects. The results should be confirmed in larger multicenter trials.

AKI Consistently Associated with Increased Short-Term and Long-Term Neurocognitive Risk

A systematic review and meta-analysis published in Neurology evaluated associations between AKI and subsequent risk of stroke, delirium, and dementia. The review identified 49 studies comprising 11,253,825 participants. Individuals with AKI were at increased risk of stroke (hazard ratio [HR] = 1.35; 95% CI, 1.20-1.52), delirium (OR = 1.76; 95% CI, 1.42-2.17), and dementia (HR = 1.64; 95% CI, 1.41-1.89). A gradient of risk across increasing AKI stages was demonstrated for stroke (stage 1: HR = 1.11; 95% CI, 1.00-1.23 and combined stages 2 and 3: HR = 1.57; 95% CI, 1.35-1.81). AKI was also associated with higher in-hospital and 90-day mortality poststroke (HR = 2.13; 95% CI, 1.56-2.90 and HR = 4.81; 95% CI, 2.55-9.08, respectively) and with 90-day disability (OR = 1.47; 95% CI, 1.22-1.76). These findings suggest that AKI may identify individuals vulnerable to both acute and chronic brain injuries. Future studies are needed to clarify mechanisms that link AKI to brain injury and to mitigate neurocognitive risk in this high-risk population.

Systematic Screening Improves DVT Detection Rate in the ICU Compared with Clinically Suspected Diagnosis

A systematic review and meta-analysis published in Thrombosis Journal identified independent risk factors for ICU-DVT, providing a basis for evidence-based, risk-stratified prevention. The review included 186 studies comprising 203,880 ICU patients. The overall incidence of DVT was 10.4% (95% CI, 8.9-12.0). Systematic screening significantly improved DVT detection rates compared with clinically suspected diagnosis (14.6% vs 7.9%). Meta-analysis findings revealed that central venous catheterization, a history of DVT, use of vasoactive agents, mechanical ventilation, prolonged ICU stay, and malignancy were associated with increased odds of DVT. Future large-scale studies are warranted to validate causal relationships and enable the development of risk prediction tools for precision prevention.

Stellate Ganglion Block May Alleviate Early Postoperative Pain

A systematic review and meta-analysis published in BMC Anesthesiology assessed the efficacy and safety of stellate ganglion block (SGB) to manage postoperative pain in ICU patients. A total of 33 RCTs comprising 2231 participants were included. SGB may help alleviate early pain (6, 12, and 24 hours) postoperatively. It also shortens hospital and ICU stays to –1.04 days (95% CI, –1.74 to –0.34) and –0.37 days (95% CI, –1.56 to –0.20), respectively. Although SGB reduces the incidence of nausea and vomiting (RR = 0.55; 95% CI, 0.40-0.77), it increases the incidence of upper eyelid ptosis (RR = 31.67; 95% CI, 6.43-155.90). Future high-quality, large-sample RCTs are needed to confirm and expand upon the efficacy and safety of SGB.

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