Daily Anesthesiology Research Analysis
Three anesthesia-focused randomized trials stand out today. Albumin added to cardiopulmonary bypass priming did not reduce cardiac surgery-associated acute kidney injury, while balanced opioid-free anesthesia reduced postoperative nausea and vomiting after video-assisted thoracic surgery, and continuous intravenous lidocaine lowered postoperative sore throat after laryngeal mask airway use.
Summary
Three anesthesia-focused randomized trials stand out today. Albumin added to cardiopulmonary bypass priming did not reduce cardiac surgery-associated acute kidney injury, while balanced opioid-free anesthesia reduced postoperative nausea and vomiting after video-assisted thoracic surgery, and continuous intravenous lidocaine lowered postoperative sore throat after laryngeal mask airway use.
Research Themes
- Perioperative organ protection in cardiac anesthesia
- Opioid-sparing anesthesia and PONV reduction
- Airway-related symptom control after laryngeal mask use
Selected Articles
1. The Potential Role of Albumin in Reducing Cardiac Surgery-Associated Acute Kidney Injury: A Randomized Controlled Trial.
In a double-blind single-center RCT of 248 patients undergoing CPB, adding 4% albumin to the priming solution did not reduce CSA-AKI within 5 days versus crystalloid alone. A post-hoc signal suggested potential benefit in those with baseline eGFR 60–70 mL/min/1.73 m², warranting targeted trials.
Impact: This rigorously designed RCT challenges the practice of routine albumin priming in CPB by providing negative evidence and identifies a plausible subgroup for future investigation.
Clinical Implications: Routine addition of albumin to CPB priming should not be adopted for patients with normal renal function; consider enrolling patients with mildly reduced eGFR in future targeted trials rather than changing current practice.
Key Findings
- No significant reduction in CSA-AKI with albumin priming vs crystalloid alone (29.3% vs 31.2%; OR 0.91, 95% CI 0.53–1.58).
- Post-hoc subgroup with baseline eGFR 60–70 mL/min/1.73 m² showed a trend toward lower CSA-AKI with albumin (35.7% vs 57.6%; OR 0.41, 95% CI 0.16–1.03).
- No differences in hemodynamic support needs, shock incidence, bleeding, transfusion, or nephrotoxin exposure between groups.
Methodological Strengths
- Double-blind randomized controlled design with standardized KDIGO AKI criteria.
- Balanced baseline characteristics and predefined primary endpoint within a clinically relevant timeframe.
Limitations
- Single-center study may limit generalizability.
- Post-hoc subgroup finding by eGFR is hypothesis-generating and underpowered for definitive conclusions.
Future Directions: Conduct multicenter, adequately powered RCTs targeting patients with impaired baseline eGFR to test albumin priming, and explore dose/concentration effects and mechanistic renal endpoints.
2. Effects of balanced opioid-free anesthesia on post-operative nausea and vomiting in patients undergoing video-assisted thoracic surgery: a randomized trial.
In 168 adults undergoing VATS, balanced opioid-free anesthesia halved PONV compared with opioid-based anesthesia (14.6% vs 30.1%) without worsening pain, recovery metrics, or patient-reported quality of life during the first 24 hours.
Impact: Provides randomized evidence supporting an opioid-sparing anesthetic strategy to reduce PONV in thoracic surgery without compromising recovery.
Clinical Implications: Balanced OFA can be considered for VATS patients at risk for PONV, with attention to institutional protocols and monitoring, as it reduces PONV without affecting early recovery or pain control.
Key Findings
- Lower PONV incidence with OFA vs OBA (14.6% vs 30.1%; P=0.017).
- Reduced time-to-event risk of PONV within 24 h with OFA (HR 0.44; 95% CI 0.22–0.87).
- No differences in pain scores, quality of recovery, 6-minute walk distance, or SF-36; overall postoperative complications were lower in OFA (19.5% vs 33.7%; P=0.039).
Methodological Strengths
- Randomized parallel-group design with trial registration (NCT05411159).
- Use of a validated PONV impact scale and comprehensive recovery outcomes.
Limitations
- Blinding is not described and may be challenging, risking assessment bias.
- Single-center design and 24-hour follow-up limit generalizability and longer-term effects.
Future Directions: Confirm findings in multicenter, blinded trials with standardized OFA regimens and extended follow-up, and assess safety hemodynamics and antiemetic-sparing effects.
3. Efficacy of continuous intravenous infusion of lidocaine on postoperative sore throat after laryngeal mask insertion: a randomized controlled trial.
In a four-arm randomized trial of 160 LMA cases, continuous IV lidocaine (bolus 1.5 mg/kg then 2 mg/kg/h) reduced postoperative sore throat at all time points up to 24 hours and lowered early hoarseness and cough, outperforming single bolus or gel application.
Impact: Addresses a common, patient-centered postoperative complaint with a pragmatic and scalable intervention, providing comparative data across multiple lidocaine strategies.
Clinical Implications: Consider continuous IV lidocaine intraoperatively for LMA cases to reduce postoperative sore throat and early airway symptoms, with appropriate monitoring for systemic toxicity; avoid routine gel use given increased transient tongue numbness.
Key Findings
- Continuous IV lidocaine reduced POST incidence and severity vs placebo at all time points up to 24 h.
- Continuous IV lidocaine lowered hoarseness and cough at T1–T2 compared with placebo; single bolus benefited only at T1.
- Lidocaine gel increased tongue numbness at T1 vs placebo, with no other sustained benefits.
Methodological Strengths
- Prospective randomized multi-arm design enabling head-to-head comparison of strategies.
- Pre-registered trial with multiple clinically relevant time-point assessments.
Limitations
- Blinding status is unclear; subjective outcomes like sore throat may be susceptible to bias.
- No pharmacokinetic monitoring of lidocaine levels; safety assessment limited to clinical adverse effects.
Future Directions: Validate in multicenter settings; define optimal dosing and duration; incorporate serum lidocaine monitoring and patient-reported outcomes; compare with other POST-preventive measures (e.g., cuff pressure control).