Rethinking phototherapy: Why skin color matters for infant jaundice

Jaundice is one of the most common medical issues in newborns, affecting nearly 80% of full-term infants in their first days of life. The condition occurs when excess bilirubin, a yellow pigment formed as red blood cells break down, builds up in the body. While mildcases usually resolve on their own, dangerously high bilirubin levels can cause brain damage or even death. The standard treatment, phototherapy, uses blue light to break bilirubin down into forms the body can excrete.

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Lymphoma itself, not just treatment, can trigger rapid immune system and tissue aging

A new study led by a team of researchers at Moffitt Cancer Center reveals that lymphoma can accelerate the biological aging of the immune system and other tissues, providing new insight into how cancer reshapes the body beyond tumor growth.

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New cancer drug boosts effectiveness of chemotherapy-even in resistant tumours: Study

A groundbreaking cancer drug could enhance how patients respond to chemotherapy even in treatment-resistant tumours.

The drug works by disarming a key defence mechanism that tumours use to protect themselves from treatment. In preclinical models, it has already shown promise in making chemotherapy-resistant cancers more responsive to therapy.

Chemotherapy is one of the most widely used cancer treatments, but it doesn’t always work as effectively as hoped. One major reason is that a specific group of the body’s own immune cells act as a barrier around tumours. These white blood cells known as macrophages surround the blood vessels inside tumours and act like gatekeepers, blocking helpful immune cells from entering and doing their job in supporting the responses to chemotherapy.

The King’s College London scientists, who have launched a spinout company Aethox Therapeutics, found that these macrophages make a protein called heme oxygenase-1 (HO-1), which helps shield the tumour from the immune system and block the effects of chemotherapy. The new drug, KCL-HO-1i, targets this protein.

Professor James Arnold, Head of Tumour Immunology Group, King’s College London, said: “We discovered that these macrophages in cancer play a key role in blocking chemotherapy. By targeting the enzyme they produce using KCL-HO-1i, we were able to help beneficial immune cells and chemotherapy drugs become significantly more effective. In laboratory models, even chemotherapy-resistant tumours became responsive to treatment, which is a really exciting step forward.”

Unlike many cancer treatments that require hospital visits, KCL-HO1i is designed to be taken at home as a tablet between chemotherapy sessions. This makes it easier for patients to incorporate into their treatment plans without adding extra hospital burdens.

In early tests using mouse models of breast cancer, supported by funding by Cancer Research UK and Medical Research Council (MRC), the drug made tumours more responsive to a range of commonly used chemotherapies. These promising results suggest it could be used across a wide variety of cancer types and chemotherapy treatments.

The researchers hope that with funding, clinical trials on breast and other cancers could begin within two years.

Professor James Spicer, Professor of Experimental Cancer Medicine, King’s College London, said: “Chemotherapy remains a key part of treatment for many patients with cancer, but too often it is not as effective or long-lasting as we might like. This research has identified a key reason for these limitations, and discovered a drug that we are keen to test in the clinic alongside established chemotherapy drugs”.

This breakthrough is the result of a multidisciplinary collaboration between researchers including Professors James Arnold, James Spicer, and Miraz Rahman and their research teams at King’s College London.

Professor Miraz Rahman, Professor of Medicinal Chemistry, King’s College London, said: “If human trials are successful, KCL-HO-1i could become a valuable companion drug to existing cancer therapies – helping more patients to benefit from the treatments that are already available and reduce the need for more aggressive cancer therapies in the future.”

Tanya Hollands, Research Information Manager at Cancer Research UK, added: “Researchers are increasingly learning how to make better use of existing cancer treatments, whether it’s using them differently or in combination with new medicines, like this work suggests. Using combination therapies can help bring improved treatment options to patients more quickly, safely and affordably, because some components of the treatment have already been tested and used in the clinic.

While early stage, it’s exciting to see this potential new way to disarm cancer’s ability to avoid detection by the immune system with a new drug, while also boosting the effectiveness of chemotherapy, and we look forward to seeing how this work progresses.”

Reference:

 Meriem Bahri et al, An oral heme oxygenase inhibitor targets immunosuppressive perivascular macrophages in preclinical models of cancer, Science Translational Medicine (2025). DOI: 10.1126/scitranslmed.ads3085

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Midwives willing to adopt alternative labour positions if they trust their safety and effectiveness: Study

Upright positions and mobility during labor are pivotal for improved maternal and fetal outcomes; however, such practices remain underutilized, particularly in low-income settings like Uganda. Despite recommendations from the World Health Organization for varied upright positions such as sitting, squatting, and walking during labor, cultural inertia often results in women being confined to supine positions. Midwives serve as key facilitators in labor, and their practices heavily influence women’s choices and experiences during childbirth. Recent study sought to explore midwives’ viewpoints and the rationale behind their selection of birthing positions during labor.

Historical Context of Labor Positions

Historically, numerous labor positions existed that allowed women to customize their birthing experience, emphasizing comfort and empowerment. However, the shift to institutionalized births introduced norms that often prioritize supine deliveries, reflecting a biomedically-centric approach. Research evidences the benefits of active and upright positions, including increased control for the birthing woman, decreased cesarean rates, and improved fetal conditions, yet limiting beliefs and institutional practices present substantial barriers to their adoption.

Challenges in Uganda’s Birthing Practices

In Uganda, the ongoing reinforcement of traditional practices—often led by midwives—while acknowledging women’s preferences for alternative birthing positions is crucial for enhancing maternal care. As cited, a high percentage of women prefer positions other than lying on their backs, indicating a disconnect between practice and preference. Yet, midwives often feel bound by institutional norms, fearing complications or a lack of resources to effectively support non-supine positions.

Midwives’ Perspectives and Institutional Barriers

A model employing qualitative thematic analysis of midwives’ perspectives reveals a complex interplay of professional responsibility, established norms, and individual agency. Midwives exhibit varying degrees of comfort with upright positions, often defaulting to supine due to fears regarding safety and efficacy, particularly during the second stage of labor. Their clinical practices reflect a risk-averse mentality shaped by institutional protocols that prioritize standardized procedures. Importantly, while midwives expressed a desire to respect women’s birthing choices, they frequently hesitated to advocate for these due to uncertainties around potential complications.

Recommendations for Enhancing Midwifery Education

The discussion underscores the need for enhanced midwifery education focused on various birthing positions and addressing common misconceptions about risks associated with upright labor. By fostering a systemic approach to overcome resource limitations and facilitating continued professional development, stakeholders can empower midwives to promote a more woman-centered care paradigm reflective of women’s preferences. The historical context of colonialism and its lasting impacts on birthing practices also highlight the importance of integrating traditional knowledge and practices into modern clinical care. Establishing a supportive environment, where midwives can empower women’s choices while ensuring safety, is critical to transforming labor experiences in Uganda.

Key Points

– Mobility and upright positions during labor are crucial for enhancing maternal and fetal outcomes, yet many women in low-income settings, such as Uganda, remain confined to supine positions due to cultural inertia despite WHO recommendations.

– Historically, diverse labor positions provided women opportunities for personalized and empowering birthing experiences, yet modern medical practices have largely shifted towards supine deliveries, which are often rooted in a biomedically-centric approach despite evidence supporting the benefits of active labor positions.

– In Uganda, a significant proportion of women express preference for laboring in upright positions rather than lying supine; however, midwives often reinforce traditional practices, feeling constrained by institutional norms and a lack of resources to support these preferences.

– Thematic analysis of midwives’ perspectives indicates a complex dynamic where professional responsibility, established norms, and personal agency influence their practice, resulting in a tendency towards risk-averse behavior that defaults to supine positions, primarily due to safety concerns.

– Recommendations for midwifery education highlight the urgent need to address misconceptions around upright labor, enhance knowledge of diverse birthing positions, and foster continuous professional development to empower midwives in championing women-centered practices.

– The discourse connects the historical context of colonialism with current birthing practices, emphasizing the importance of integrating traditional knowledge into modern healthcare frameworks to create supportive environments in which midwives can encourage women’s choices while maintaining safety.

Reference –

Z. H. Fatma et al. (2025). ‘This Is Like Tradition, Lie On Your Back, Hold Your Leg, And Push’: Understanding Midwives’ Perspectives On Their Choice Of Labour Positions In A Ugandan Hospital. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07657-2.

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Meclizine May Ease Dizziness but Raises Chances of Injurious Falls, Study Shows

USA: A large U.S. cohort study found meclizine, a common vestibular suppressant for dizziness, is linked to a significantly higher risk of injurious falls in both younger and older adults. The findings, from Dr. Meredith E. Adams and colleagues at the University of Minnesota, were published in JAMA Otolaryngology–Head & Neck Surgery.

Meclizine, an antihistamine with anticholinergic effects, provides short-term relief from vertigo and dizziness. However, routine use is questioned due to sedative properties and potential to impair balance and cognition, which increase fall risk. The new analysis highlights safety concerns when prescribing meclizine, especially for patients vulnerable to falls.
Researchers reviewed data from over 805,000 adults diagnosed with dizziness (2006–2015). Of these, 62,000 (8%) filled a meclizine prescription within 30 days. Outcomes were compared between those who did and did not receive meclizine.
The study led to the following findings:
  • 9% of meclizine users experienced an injurious fall within 60 days of prescription, compared with 4% of patients who did not receive the drug.
  • After adjusting for sociodemographic and clinical factors, meclizine use was linked to a nearly threefold higher risk of injurious falls among adults aged 18 to 64 years (HR, 2.94).
  • Patients aged 65 years and older had a 2.5-fold higher risk of injurious falls associated with meclizine use (HR, 2.54).
  • The elevated risk was observed across both younger and older adults, indicating that the harms are not limited to older populations.
  • While older adults are already prone to balance issues and falls, younger adults with dizziness were also significantly affected.
“Although meclizine may offer immediate symptom relief, our findings indicate that its use is inconsistent with evidence-based guidelines for common vestibular disorders and may expose patients to unnecessary harm,” the authors noted.
The study highlights the importance of re-evaluating prescribing practices for dizziness. Falls are a major cause of morbidity, hospitalization, and loss of independence in both older and middle-aged adults. The inappropriate use of vestibular suppressants such as meclizine may therefore contribute to preventable adverse outcomes.
The researchers suggest that prospective clinical trials and mechanistic studies are needed to better understand the relationship between vestibular suppressant medications and fall risk. They also emphasized the need for future clinical guidelines that discourage routine meclizine prescriptions for dizziness and instead promote safer, evidence-based management strategies.
“While meclizine has been widely used for decades to treat dizziness, this large-scale study highlights a significant safety trade-off. Clinicians are encouraged to weigh the short-term symptomatic benefits against the long-term risks of falls, and to consider alternative approaches that align with best practice recommendations,’ the authors concluded.
Reference:
Adams ME, Karaca-Mandic P, Marmor S. Meclizine Use and Subsequent Falls Among Patients With Dizziness. JAMA Otolaryngol Head Neck Surg. Published online July 24, 2025. doi:10.1001/jamaoto.2025.2052

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Children Born Small for Gestational Age Face Higher Risk of Neurodevelopmental Disability by Age 5: Hokkaido Study

 Children born small for their gestational age (SGA) are more likely to experience neurodevelopmental difficulties by the age of five, even if they are delivered at full term, according to a new study published in Pediatrics International.

The research, led by Dr. Satoshi Suyama and colleagues from the Funded Research Division of Child and Adolescent Psychiatry, Hokkaido University Hospital, sheds light on the long-term implications of restricted fetal growth on early childhood development.
Low birth weight has long been recognized as a factor contributing to delayed growth and developmental challenges. SGA, a clinical measure used to define infants whose weight falls below the expected range for their gestational age, has been associated with a range of neurodevelopmental disorders. However, the impact of being born SGA at full term (term-SGA) has been less clear.
To explore this, the investigators utilized data from the Hokkaido Study on Environment and Children’s Health, a large prospective birth cohort. The study targeted 4,851 children who reached the age of five between April 2008 and November 2011. Mothers were asked to complete questionnaires, including the widely used Strengths and Difficulties Questionnaire (SDQ), which evaluates behavioral and emotional challenges in children. Information on birth weights was cross-referenced with data from the Japan Pediatric Society to classify children as SGA or term-SGA. Out of the invited participants, 3,484 families responded.
The analysis revealed the following findings:
  • Children born small for gestational age (SGA) showed notable differences compared to those with normal birth weight.
  • Univariate analysis revealed significant variations in hyperactivity/inattention scores and overall Total Difficulties Scores (TDS).
  • Multivariate analysis indicated that both SGA and term-SGA status were strongly linked to higher odds of neurodevelopmental disability, even after adjusting for sex and household income.
  • Children with SGA status had a 75% greater risk of elevated TDS (OR = 1.75).
  • Children born term-SGA had a 72% higher risk of elevated TDS (OR = 1.72).
  • No significant association was found between SGA status and hyperactivity or inattention scores when assessed independently.
The findings highlight that being born small for gestational age, regardless of whether a child is preterm or full term, can have lasting implications on neurodevelopment. “Our results suggest that SGA, even at term, may predispose children to difficulties in emotional and behavioral development, as reflected in the SDQ scores,” the authors noted.
The study highlights the importance of early monitoring and interventions for children born SGA, to help mitigate potential developmental challenges during the crucial early years of growth. Given the rising global focus on child health and developmental outcomes, the researchers emphasize that identifying at-risk children at birth could play a critical role in ensuring timely support and improved long-term well-being.
Reference:
Suyama, S., Itoh, M., Tamura, N., Iwata, H., Yamaguchi, T., Kobayashi, S., Miyashita, C., Saito, T., & Kishi, R. (2024). Association between small for gestational age and neurodevelopmental disability at 5 years in the Hokkaido study. Pediatrics International, 67(1), e70137. https://doi.org/10.1111/ped.70137

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Inhaled Molgramostim Promising for Autoimmune Pulmonary Alveolar Proteinosis: Phase 3 Trial Shows

USA: A phase 3 study published in the New England Journal of Medicine has highlighted encouraging results for inhaled molgramostim, a recombinant human granulocyte–macrophage colony-stimulating factor (GM-CSF), in patients with autoimmune pulmonary alveolar proteinosis (aPAP). The research was led by Dr. Bruce C. Trapnell from the Translational Pulmonary Science Center, Cincinnati Children’s Hospital Medical Center, and colleagues. 

Autoimmune pulmonary alveolar proteinosis is a rare lung disease characterized by the accumulation of surfactant within the alveoli, resulting in impaired oxygen exchange and progressive hypoxemia. The underlying cause involves autoantibodies directed against GM-CSF, a protein essential for the function of alveolar macrophages in clearing surfactant. Currently, therapeutic options remain limited, with whole lung lavage being the standard intervention.
To evaluate the efficacy and safety of inhaled molgramostim, the investigators conducted a multicenter, double-blind, placebo-controlled phase 3 trial. A total of 164 patients with confirmed aPAP were randomized to receive either molgramostim at a daily dose of 300 μg or placebo for 48 weeks. The primary endpoint assessed was the change from baseline to 24 weeks in the diffusing capacity of the lungs for carbon monoxide (DLCO), adjusted for hemoglobin and expressed as a percentage of the predicted value. Secondary endpoints included DLCO changes at 48 weeks, health-related quality of life scores measured by the St. George’s Respiratory Questionnaire (SGRQ), and exercise capacity.
Key Findings
  • At 24 weeks, patients treated with molgramostim showed a mean improvement of 9.8 percentage points in DLCO compared with 3.8 points in the placebo group. This translated into a treatment difference of 6 percentage points (95% CI, 2.5–9.4; P<0.001).
  • At 48 weeks, the molgramostim group continued to demonstrate benefit with an average DLCO increase of 11.6 percentage points versus 4.7 points in the placebo group (P<0.001).
  • Quality of life also improved, with the St. George’s Respiratory Questionnaire total score decreasing by −11.5 points at 24 weeks compared with −4.9 points in the placebo group (P=0.007).
  • No significant improvement was seen in the SGRQ activity score at 24 weeks, and therefore, no further statistical testing was conducted for subsequent secondary outcomes.
  • Safety outcomes were reassuring, with adverse events and serious adverse events occurring at similar rates in both treatment and placebo arms.
The authors concluded that once-daily inhaled molgramostim significantly improved pulmonary gas exchange compared with placebo and was well tolerated in patients with aPAP.
This trial provides the strongest evidence to date supporting inhaled GM-CSF therapy as a potential new treatment pathway for patients with autoimmune pulmonary alveolar proteinosis, a condition that currently lacks effective pharmacological options.
Reference: https://www.nejm.org/doi/abs/10.1056/NEJMoa2410542

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Low-Dose Oral Minoxidil for Hair Loss Not Linked to Tachycardia, Large Study Suggests

USA: A new retrospective study published in the Journal of the American Academy of Dermatology (JAAD) reports that low-dose oral minoxidil (LDOM), widely used off-label for nonscarring alopecia, does not increase the risk of tachycardia in patients without pre-existing cardiac conditions.

Researchers from Thomas Jefferson University’s Sidney Kimmel Medical College, led by Zachary J.K. Neubauer and colleagues, analyzed data from more than half a million patients with androgenic alopecia or other forms of nonscarring hair loss, drawn from the TriNetX database spanning 2004 to 2024. Importantly, individuals with a prior history of hypertension, tachycardia, or arrhythmia were excluded from the study.
The analysis included 524,522 patients, of which 9,267 received LDOM (≤ 5 mg/day) and the rest served as minoxidil-naïve controls. The LDOM group tended to be older (average age 45.5 years versus 39.8 years in controls) and had a higher proportion of men (33% vs. 19%). The primary outcome assessed was the incidence of tachycardia.
The key findings of the study were as follows:
  • Among those on LDOM, 126 patients (7.7%) developed tachycardia, with a median time to onset of approximately 245 days.
  • When compared to controls, the risk difference was statistically insignificant.
  • The hazard ratio (HR) for tachycardia in the LDOM group was 0.90, and after adjustments, it remained nonsignificant at 0.92.
  • Men had a 36% lower risk of developing tachycardia compared with women (HR, 0.64).
  • Asian patients also demonstrated reduced risk (HR, 0.81).
  • Conversely, White individuals were more likely to experience tachycardia compared to other groups (HR, 1.29).
  • Black individuals were also more likely to experience tachycardia compared to other groups (HR, 1.19).
According to the authors, these findings reinforce the safety of LDOM for patients without underlying cardiac issues. They noted that co-administration of beta-blockers—a practice sometimes considered to mitigate potential cardiovascular effects—is not warranted based on this evidence.
“This study represents the largest analysis to date evaluating the relationship between LDOM and tachycardia risk in nonscarring alopecia, and it is the only investigation to include a control group,” the researchers stated. However, they emphasized the need for prospective studies to validate these observations.
The findings provide reassurance for dermatologists and patients using LDOM for hair restoration, highlighting that the therapy does not appear to pose an additional risk for tachycardia when prescribed to individuals without cardiac risk factors.
Reference:
Neubauer ZJK, Lipner HI, Lipner SR. No association between low-dose oral minoxidil and tachycardia in a large retrospective cohort study of non-scarring alopecia patients. J Am Acad Dermatol. 2025 Aug 8:S0190-9622(25)02587-3. doi: 10.1016/j.jaad.2025.07.065. Epub ahead of print. PMID: 40784566.

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Keeping It Warm: A Comprehensive Study on Postoperative Hypothermia in Non-Cardiac Surgery

Postoperative hypothermia is a prevalent issue among non-cardiac surgery patients that can have serious consequences but often goes unaddressed. To address this problem, a study was conducted to identify risk factors for postoperative hypothermia in this patient population. Recently published study analyzed various factors contributing to postoperative hypothermia, focusing on age, BMI, ASA classification, type of surgery, blood loss, fluid administration, blood transfusion, anesthesia and surgery duration as potential risk factors.

Risk Factors for Postoperative Hypothermia

The analysis revealed that age over 60 years, BMI less than 18.5 kg/m², ASA III-IV classification, endoscopic surgery, blood loss exceeding 100 ml, intravenous fluid administration over 1000 ml, blood transfusion, anesthesia time longer than 60 minutes, and surgery time exceeding 60 minutes were associated with an increased risk of postoperative hypothermia. Elderly patients are particularly vulnerable due to reduced subcutaneous fat and thermoregulatory function. Patients with high body fat are at a lower risk due to increased metabolic rate, while those with low BMI are more prone to hypothermia. The study emphasized the importance of proper temperature management for elderly and high-risk patients. It highlighted the impact of longer anesthesia and surgery times on hypothermia risk, suggesting that prolonged exposure to anesthetic drugs and low-temperature environments can lead to heat loss. Endoscopic surgeries were found to increase the risk of hypothermia due to continuous insufflation and irrigation, leading to heat loss. Fluid rehydration exceeding 1000 ml and blood loss over 100 ml were also identified as significant predictors of hypothermia. Despite the comprehensive analysis, the study acknowledged limitations such as potential language bias, incomplete data, and a focus on adult non-cardiac surgery patients. The findings emphasize the need for tailored interventions and proactive measures to prevent postoperative hypothermia in at-risk populations. The quality of evidence for identified risk factors varied from very low to low, with intraoperative blood loss emerging as a key predictor. The study underscores the importance of early identification and management of high-risk individuals to mitigate complications and enhance patient outcomes following non-cardiac surgeries.

Conclusion

In conclusion, this research provides valuable insights into risk factors for postoperative hypothermia in non-cardiac surgery patients, offering a foundation for developing effective management protocols. Recognizing and addressing these risk factors early on can significantly improve patient outcomes and reduce the incidence of postoperative hypothermia in this population.

Key Points

– Age over 60 years, BMI less than 18.5 kg/m², ASA III-IV classification, endoscopic surgery, blood loss exceeding 100 ml, intravenous fluid administration over 1000 ml, blood transfusion, anesthesia time longer than 60 minutes, and surgery time exceeding 60 minutes were identified as risk factors for postoperative hypothermia.

– Elderly patients are more vulnerable to hypothermia due to reduced subcutaneous fat and thermoregulatory function, while patients with high body fat have a lower risk because of an increased metabolic rate.

– Prolonged anesthesia and surgery times contribute to hypothermia risk by exposing patients to heat loss in low-temperature environments.

– Endoscopic surgeries increase the risk of hypothermia through continuous insufflation and irrigation, leading to heat loss. – Factors like fluid rehydration exceeding 1000 ml and blood loss over 100 ml were significant predictors of postoperative hypothermia.

– The study highlights the importance of tailored interventions and proactive measures to prevent postoperative hypothermia in high-risk populations, emphasizing the need for early identification and management of at-risk individuals to enhance patient outcomes following non-cardiac surgeries.

Reference –

Ruyi Tan et al. (2025). Risk Factors For Postoperative Hypothermia In Non-Cardiac Surgery Patients: A Systematic Review And Meta-Analysis. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03089-9.

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Pediatric Pain Relief: The Role of Regional Anesthesia in Renal Disease Management, study finds

Renal disease in pediatric patients presents significant challenges, particularly in anesthetic management, due to its association with high morbidity and mortality rates. Achieving effective perioperative pain management is crucial, and pediatric regional anesthesia emerges as a valuable strategy to enhance pain control. Recent study explores the impact of ultrasound-guided supraclavicular brachial plexus block (BPB) as an adjunct to sevoflurane anesthesia during brachiobasilic arteriovenous fistula (AVF) operations in children with end-stage renal disease (ESRD).

Challenges in AVF Creation and the Role of BPB

The creation of AVF is critical for hemodialysis access, yet the procedure faces complications, including a high primary failure rate largely attributed to inadequate vessel dilation and sympathetic overflow-induced vasospasm. The implementation of BPB can induce sympathetic blockade, leading to vessel dilation and improved blood flow—key factors in ensuring successful AVF maturation.

Study Design and Objectives

In a randomized controlled trial, 60 pediatric patients with ESRD participated, divided into two groups receiving either general anesthesia with BPB or general anesthesia with saline injection. The study aimed to measure the time to AVF maturation, hemodynamic stability during surgery, the incidence of emergence agitation, and postoperative analgesia.

Results and Clinical Implications

Results indicated that patients receiving BPB demonstrated significantly improved outcomes: faster maturation of the AVF (mean of 12 weeks compared to 15 weeks in the control group) and enhanced hemodynamics, manifested as lower mean arterial pressure (MAP) reduction and heart rates post-block. Notably, the basilic vein diameter post-block was greater in the BPB group, suggesting improved conditions for AVF creation and maturation. Additionally, instances of emergence agitation were reduced from 66% in the control group to 20% in the BPB group, indicating a smoother recovery phase. Pain scores at varying time intervals after surgery were also significantly lower for those receiving BPB, demonstrating effective analgesia.

Conclusion and Future Directions

This trial underscores the role of regional anesthesia as a feasible approach in pediatric patients undergoing AVF surgery. By fostering vasodilation and facilitating adequate blood flow, BPB not only reduces the chances of AVF failure but also enhances the overall surgical experience through better hemodynamic management and reduced perioperative discomfort. The findings advocate for the integration of ultrasound-guided regional anesthesia techniques into the standard anesthetic regimen for pediatric patients with ESRD, aiming for improved surgical outcomes and patient comfort. Future research is encouraged to further explore long-term effects and validate these findings across larger cohorts.

Key Points

– Pediatric renal disease complicates anesthetic management due to increased morbidity and mortality, necessitating effective perioperative pain control strategies, such as pediatric regional anesthesia.

– The study focuses on ultrasound-guided supraclavicular brachial plexus block (BPB) as an adjunct to sevoflurane anesthesia for improving outcomes during brachiobasilic arteriovenous fistula (AVF) surgeries in children with end-stage renal disease (ESRD).

– In a randomized controlled trial involving 60 pediatric ESRD patients, two groups underwent either general anesthesia with BPB or with saline injection, assessing AVF maturation time, hemodynamic stability, emergence agitation, and postoperative analgesia.

– BPB was associated with significantly faster AVF maturation (12 weeks vs. 15 weeks in the control group), better hemodynamic parameters, and a larger basilic vein diameter, which are vital for successful AVF creation.

– Emergence agitation was markedly reduced in the BPB group (20%) compared to the control group (66%), indicating improved recovery experiences, along with significantly lower pain scores at various postoperative intervals.

– The findings support the use of regional anesthesia techniques like BPB in pediatric patients with ESRD undergoing AVF surgery, emphasizing potential benefits in surgical outcomes and patient comfort while highlighting the need for further research to confirm these results in larger populations.

Reference –

S. Elsawy et al. (2025). Ultrasound-Guided Supraclavicular Brachial Plexus Block As An Additive To Sevoflurane Anesthesia In Pediatrics Undergoing Brachiobasilic Arteriovenous Fistula Operation: Randomized Controlled Clinical Trial. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03091-1.

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