Article: Comparison of high flow nasal cannula versus procedural oxygen mask for hypoxemia prevention during endoscopic retrograde cholangiopancreatography: a randomized parallel-group trial - Minerva Anestesiologica 2025 Nov 20 - Minerva Medica - Journals

To compare mechanical power (MP) levels among flow-controlled ventilation (FCV), volume-controlled ventilation (VCV), and pressure-controlled volume-guaranteed ventilation (PCV-VG) during laparoscopic surgery and to test the hypothesis that the stable flow dynamics of FCV would reduce MP. Patients were divided into three groups according to the mechanical ventilation modes applied during laparoscopic surgery: PCV-VG (n=15), VCV (n=14), and FCV (n=15). MP was calculated at four timepoints: baseline (T1), post-induction (T2), during CO₂ insufflation (T3), and post-insufflation (T4). The primary outcome of the study was the comparison of MP in the FCV mode with MP in the other groups during insufflation. Driving pressure (DP), plateau pressure, and peak airway pressure were also analyzed. Baseline MP was highest in PCV-VG (6.9 J/min vs. 5.0 J/min in VCV and 5.1 J/min in FCV; p=0.002). During insufflation (T3), MP increased to a similar extent across groups (PCV-VG: 9.4 J/min, VCV: 8.7 J/min, FCV: 8.6 J/min), with PCV-VG showing the smallest relative rise (p<0.001). DP and plateau pressures increased during pneumoperitoneum, but Bonferroni-adjusted comparisons revealed that these were not statistically significant. PCV-VG maintained higher positive end-expiratory pressure (5 vs. 4 cmH₂O, p<0.001); however, it did not significantly affect peak pressures. Contrary to our hypothesis, FCV did not reduce MP more effectively than either VCV or PCV-VG. However, PCV-VG demonstrated better mitigation of insufflation-induced increases in MP, suggesting potential advantages for lung protection during laparoscopy. Further prospective studies are needed to assess clinical outcomes.

This study aimed to evaluate the effects of low-pressure (10 mmHg) and standard-pressure (14 mmHg) pneumoperitoneum on upper airway dimensions during lapar

Background: This study aimed to determine whether the duration or the magnitude of intraoperative BIS suppression has a greater impact on postoperative recovery. Methods: In this observational study, 141 patients were monitored for BIS values, suppression ratio (SR), maximum suppression ratio (SRmax), and total suppression time (SRT) during the perioperative period. Recovery phenotypes were assessed using the Richmond Agitation-Sedation Scale (RASS). Statistical analyses evaluated the relationship between BIS suppression parameters (SR, SRmax, SRT) and postoperative sedation or emergence agitation. Optimal thresholds for clinically significant suppression were determined. Results: Patients classified into the sedation group according to RASS scores exhibited significantly higher intraoperative SRmax values (p: 0.038) and prolonged SRT (p: 0.001) compared to the agitated group. An SRT ≥ 7.5 min predicted sedated recovery with 86.7% sensitivity and 39.4% specificity (AUC = 0.651, 95% CI: 0.561–0.742, p: 0.002). Similarly, an SRmax ≥ 19.5 was associated with sedated recovery (85.3% sensitivity, 53.0% specificity; AUC = 0.683, 95% CI: 0.592–0.775, p: 0.001). No significant association was found between BIS suppression and emergence agitation. Conclusions: Prolonged intraoperative BIS suppression and higher SRmax values are comparably predictive of postoperative sedation but not agitation. Monitoring these parameters may aid in anticipating recovery patterns.