To identify risk factors and characteristics associated with left ventricular diastolic dysfunction and investigate its correlation with mortality in sepsis patients. A prospective cohort study was performed in sepsis patients between December 2022 and October 2023. Baseline characteristics, laboratory tests, treatments, echocardiographic results, and 28-day mortality were documented. Univariate and multivariate logistic regression analyses were conducted and a nomogram was constructed. Association between left ventricular diastolic dysfunction and 28-day mortality was analyzed. In total, 117 patients with a mean age of 58.3 ± 16.5years old and 63.3% men (74) were included. There were 75 (64.1%) and 42 (36.9%) patients with abnormal and normal diastolic dysfunction, respectively. Pneumonia, hematocrit, the ratio of E-wave peak velocity to A-wave peak velocity (E/A), ventricular septal early diastolic peak velocity of the mitral valve annulus (e'), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were associated with ventricular diastolic dysfunction (P < 0.05). The nomogram constructed with these variables demonstrated high accuracy in predicting the occurrence of left ventricular diastolic dysfunction (area under the curve 0.938, sensitivity 83.8%, specificity 97.6%, Youden index 0.814). Left ventricular diastolic dysfunction could cause an increased 28-day mortality, with grade III diastolic dysfunction having the highest mortality rate (40.0%). In sepsis patients, a nomogram based on pneumonia, hematocrit, E/A, ventricular septal e', and NT-proBNP levels could accurately assess left ventricular diastolic dysfunction. Left ventricular diastolic dysfunction was associated with a high 28-day mortality, warranting further studies on the association between dysfunction severity and mortality risk.

We previously reported that administering local anesthetic into the space between the endothoracic fascia, diaphragm, and costodiaphragmatic recess (SEDIC) at the 10th intercostal space via the re-modified thoracoabdominal nerves block through the perichondrial approach (RM-TAPA) effectively anesthetizes the lower abdomen (T9-T12). However, the analgesic area obtained by RM-TAPA was distinct from prior reports of M-TAPA, which achieved broader analgesic effects from T4 to L1. The aim of this study was to verify the range of analgesic effects when local anesthetics are administered into the SEDIC at the 9th intercostal space, which was estimated to be close to the needle tip of the M-TAPA, in ten healthy volunteers. Each volunteer received 20mL of 0.2% ropivacaine into the SEDIC at the 9th intercostal space, and sensory blockade was assessed 1h post-injection using a pinprick test. RM-TAPA performed at the 9th intercostal space provided adequate analgesia from T6 to T10. The analgesic effect on the lateral cutaneous branches was more pronounced on the right side than on the left. These findings imply that optimizing needle position and injection site in RM-TAPA, tailored to specific surgical needs, represents a refinement in perioperative pain management strategies.

PurposeDesflurane and sevoflurane are widely used for general anesthesia; however, it remains uncertain if sevoflurane might be preferable for patients with chronic respiratory inflammatory diseases. This study compared postoperative outcomes of desflurane and sevoflurane following gastrointestinal cancer surgery in patients with chronic obstructive pulmonary disease (COPD) or asthma.MethodsWe conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database (April 2011–March 2022), identifying patients with COPD or asthma who underwent gastrointestinal cancer surgery. The primary outcome was postoperative pulmonary complications, including pneumonia, respiratory failure, mechanical ventilation > 24 h, and unplanned reintubation within 7 days after surgery. Secondary outcomes were in-hospital mortality and postoperative stay. We conducted propensity score overlap weighting and instrumental variable analyses adjusted for confounders.ResultsWe identified 24,243 COPD and 16,199 asthma patients. Propensity score overlap weighting showed no significant association between desflurane and increased postoperative pulmonary complications in COPD [adjusted risk difference (aRD) − 0.57%; 99% confidence interval (CI), − 1.8% to 0.60%] or asthma (aRD, − 0.62%; 99% CI, − 1.8% to 0.59%). In-hospital mortality did not differ significantly between groups in COPD (aRD, − 0.24%; 99% CI, − 0.76% to 0.29%) or asthma (aRD, 0.07%; 99% CI, − 0.45% to 0.59%). The postoperative stay also showed no significant association between the desflurane and sevoflurane groups.ConclusionsDesflurane-based anesthesia was not associated with increased postoperative pulmonary complications and mortality compared to sevoflurane in patients with chronic respiratory diseases undergoing gastrointestinal cancer surgery. However, further studies using reliable diagnostic criteria to assess COPD or asthma are warranted.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00540-025-03548-0.

This study aimed to quantitatively evaluate the characteristics of patients with chronic pain and differences in their responses to different treatment approaches. A retrospective review was performed regarding patients with chronic pain who visited an interdisciplinary pain treatment centre between January 1, 2018, and March 31, 2023. The patients were categorised into four groups based on the treatment received: a conventional therapy group treated by medical doctors, an exercise therapy group received additional exercise therapy, a psychotherapy group received additional psychotherapy, and an interdisciplinary treatment group received additional exercise therapy and psychotherapy. Responses to pain-related and psychosocial questionnaire results were compared between baseline and six months post-treatment. Of the 1,967 initial participants, 239 patients met the eligibility criteria and their data were included in the analysis. In the Conventional therapy group, the indicators showed improvement in pain symptoms, excluding the Pain Self-Efficacy Questionnaire (PSEQ) and Hospital Anxiety and Depression Scale-Depression (HADS-D) scores. In the Exercise therapy group, significant improvements in PSEQ (from 28.15 to 33.34, p < 0.001) and HADS-D (from 7.17 to 6.35, p = 0.035) scores were documented. HADS-Anxiety scores decreased in the Psychotherapy group from 10.36 to 7.91 (p = 0.028). The Interdisciplinary treatment group showed a significant reduction in pain catastrophizing scale scores (from 35.15 to 26.31, p = 0.038). This study indicated that exercise therapy, psychotherapy, and interdisciplinary approaches might contribute to improvements in psychosocial outcomes amongst patients with chronic pain. Although the effects of exercise therapy were more consistent, psychotherapy and interdisciplinary treatment demonstrated potential benefits.

Postoperative pain management is critical for psychological and physical patient outcomes. In April 2022, the Japanese government introduced a new Acute Pain Service (APS) fee addition into the health care reimbursement system to promote structured APS implementation. This study aims to describe the current status of APS addition and explore its association with patient and hospital outcomes. We conducted a retrospective study using a nationwide claims database. Patients who underwent surgery with general anesthesia from April 2022 to June 2023 were included. Surgical procedures were categorized into 15 departments or classified as "mixed," and APS addition claim frequency was summarized. Propensity score matching and multivariable regression analyses were performed. A total of 14,022 patients with APS addition and 551,315 without were included. The relative frequency of APS addition was 2.48%, with the highest in esophageal surgery (11.8%). APS addition claims gradually increased over time. Propensity score matching showed no apparent differences in total hospitalization costs or length of stay between groups. However, significant interactions were observed between APS addition and patient age. Among 90-year-old patients, the estimated mean cost reduction [95% confidence interval (CI)] was 4.6% [2.1%, 7.0%] for males and 4.7% [2.4%, 6.9%] for females, while the estimated mean [95% CI] reduction in length of stay was 6.7% [3.0%, 10.3%] and 8.9% [5.6%, 12.1%], respectively. Although the overall effects of APS addition were minimal, age-stratified analyses suggest that it may be associated with improved outcomes among older patients. These exploratory findings warrant further investigation.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by core symptoms of impaired social communication and stereotyped behaviors. While early-life exposure to anesthetics may increase the risk of ASD, anesthetics can also have therapeutic effects on ASD, potentially through mechanisms involving the N-methyl-D-aspartate (NMDA) receptor, gamma-aminobutyric acid (GABA)ergic, and µ-opioid receptor signaling pathways. Given that individuals with ASD often exhibit high levels of non-cooperation and poor communication abilities, they typically require deeper sedation during medical examinations, making the choice of anesthetics particularly critical. This article provides an overview about the effects and underlying mechanisms of various anesthetics with ASD, aiming to assist anesthesiologists in implementing anesthesia management for ASD patients more scientifically.