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.
OBJECTIVES: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication with high morbidity and mortality. This study was designed to determine whether adding human albumin to the cardiopulmonary bypass (CPB) priming solution reduces the incidence of CSA-AKI. DESIGN: A double-blind, randomized controlled trial (RCT) involving 248 patients scheduled for cardiac surgery with CPB. SETTING: A single-center tertiary university hospital. PARTICIPANTS: Adults with a baseline estimated glomerular filtration rate (eGFR) of ≥60 mL/min/1.73 m INTERVENTIONS: Patients were randomized to receive either a crystalloid priming solution (Plasma-Lyte) plus 4% albumin (intervention group, n = 126) or a crystalloid solution alone (control group, n = 122) for CPB. MEASUREMENTS AND MAIN RESULTS: Data analyses were performed using the Chi-square test and Student's t-test, or their nonparametric equivalent. The primary outcome was the incidence of CSA-AKI, as defined by the Kidney Disease Improving Global Outcomes criteria, within 5 days postoperatively. Both cohorts were comparable in baseline and perioperative characteristics, including preoperative albumin levels. The incidence of CSA-AKI was 29.3% (n = 37) in the intervention group compared with 31.2% (n = 38) in the control group (odds ratio: 0.91, 95% confidence interval: 0.53-1.58). The observed difference in CSA-AKI incidence between the groups was not statistically significant. A post-hoc subgroup analysis of patients with a baseline eGFR of 60 to 70 mL/min/1.73 m² indicated a trend toward a reduced incidence of CSA-AKI in the intervention group compared with the control group (35.7% v 57.6%; odds ratio: 0.41, 95% confidence interval: 0.16-1.03). This trend was not observed in patients with an eGFR greater than 70 mL/min/1.73 m². No significant differences were observed between groups for the need for inotropes or vasoconstrictors, incidence of cardiogenic or distributive shock, bleeding, need for transfusion, or use of nephrotoxic drugs. CONCLUSIONS: Adding albumin to the CPB priming solution did not decrease the incidence of CSA-AKI in patients with normal preoperative renal function. These findings suggest that albumin might benefit patients with impaired renal function, warranting further investigation.
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.
OBJECTIVES: Postoperative nausea and vomiting (PONV) is common after video-assisted thoracic surgery, which may be associated with the use of intraoperative opioids. We tested the hypothesis that balanced opioid-free anesthesia (OFA) might reduce the incidence of PONV after video-assisted thoracic surgery. METHODS: One hundred and sixty-eight adults undergoing video-assisted thoracic assisted surgery were randomly assigned to receive balanced opioid-free anesthesia or balanced opioid-based anesthesia (OBA). The primary outcome was the incidence of PONV, which was assessed with the Myles's simplified PONV impact scale during the initial 24 h after surgery. RESULTS: Compared with OBA group, the overall incidence of PONV in OFA group was significant reduced (14.6% vs. 30.1%, P = 0.017), and OFA reduced the risk of PONV events within 24 h of surgery (HR, 0.44; 95%CI: 0.22-0.87, P = 0.018). The incidence of other postoperative complications in OFA group was lower than that in OBA group (19.5% vs. 33.7%, P = 0.039). The quality of recovery, distance of 6-minute walk test, pain scores, and 36-item short form survey were comparable at each time points. CONCLUSION: In patients undergoing video-assisted thoracic surgery, the use of balanced OFA anesthesia can help reduce the incidence of PONV events. This anesthetic regimen has shown good feasibility without significantly increasing the patient's pain score and complications. CLINICAL TRIAL REGISTRATION NUMBER: Clinicaltrials.gov, Identifier: NCT05411159. First posted date: 9 Jun, 2022.
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).
BACKGROUND: This randomized controlled trial was performed to explore efficacy of continuous intravenous infusion of lidocaine on postoperative sore throat after laryngeal mask insertion. METHODS: In this prospective trial one hundred and sixty general anesthesia surgery patients (20 to 60 years) using laryngeal mask airway were randomly divided into control group (Group C, saline as placebo), lidocaine gel group (Group LG, lidocaine gel applied to the surface of the laryngeal mask), single intravenous lidocaine group (Group SL, intravenous lidocaine 1.5 mg/kg at induction of anesthesia) and continuous infusion of lidocaine group (Group CL, a bolus of 1.5 mg/kg, followed by an infusion of 2 mg/kg/h until the end of the surgical). The primary outcomes were the incidence and severity of POST at the time of laryngeal mask removal (T1), 2 h (T2), 6 h (T3), and 24 h (T4) after removal. The secondary outcomes included the incidence of adverse events such as hoarseness, cough, and tongue numbness. RESULT: Within 24 h after extubation, the incidence and severity of POST was significantly lower in group CL than that in group C at all time points. In contrast, compared with group C, the incidence and severity of POST in group SL was lower only at T1. The incidence of hoarseness and cough in group CL were significantly lower than that in group C at T1 and T2. In group SL, the incidence of hoarseness and cough was lower than that in the group C only at T1. In group LG, the incidence of tongue numbness was significantly higher than that in group C only at T1, and there were no significant difference in the four groups at the other time points. CONCLUSION: Continuous infusion of lidocaine is effective in reducing the incidence and severity of POST after laryngeal mask ventilation, as well as reducing the incidence of adverse effects such as hoarseness and cough. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2300070339,04/10/2023).