Daily Anesthesiology Research Analysis

OBJECTIVE: To determine whether high flow nasal cannula (HFNC) oxygenation can reduce the incidence of hypoxia during sedated gastrointestinal endoscopy in patients with obesity. DESIGN: Multicentre, randomised, parallel group trial. SETTING: Three tertiary hospitals in Shanghai, China. PARTICIPANTS: 1000 adult patients with obesity (body mass index ≥28) who were scheduled for gastrointestinal endoscopy. INTERVENTIONS: Participants were randomly allocated to receive regular nasal cannula oxygenation or HFNC oxygenation during a sedated procedure with propofol and low dose sufentanil. MAIN OUTCOME MEASURES: The primary outcome was the incidence of hypoxia (75%≤SpO RESULTS: From 6 May 2021 to 26 May 2023, 984 patients (mean age 49.2 years; 36.9% (n=363) female) completed the study and were analysed. Compared with regular nasal cannula oxygenation, HFNC oxygenation reduced the incidence of hypoxia from 21.2% (103/487) to 2.0% (10/497) (difference -19.14, 95% confidence interval -23.09 to -15.36; P<0.001), subclinical respiratory depression from 36.3% (177/487) to 5.6% (28/497) (difference -30.71, -35.40 to -25.92; P<0.001), and severe hypoxia from 4.1% (20/487) to 0% (0/497) (difference -4.11%, -6.26 to -2.48; P<0.001). Other sedation related adverse events did not differ between the two groups. CONCLUSIONS: In patients with obesity, oxygenation via HFNC during sedated gastrointestinal endoscopy significantly reduced the incidences of hypoxia, subclinical respiratory depression, and severe hypoxia without increasing other adverse events. TRIAL REGISTRATION: ClinicalTrials.gov NCT04500392.

BACKGROUND: Breast surgery is frequently associated with significant acute postoperative pain, necessitating effective pain management strategies. Both thoracic paravertebral block (PVB) and interpectoral plane and pectoserratus plane (IP+PS) blocks have been used to relieve pain after breast surgery. OBJECTIVE: In this systematic review and meta-analysis with trial sequential analysis, we aimed to identify the optimal analgesic technique for achieving effective pain relief in breast surgery. The primary outcome of this study was postoperative opioid consumption expressed as morphine milligram equivalent (MME) at 24 h. Secondary outcomes included resting and movement pain scores at 0, 6, 12 and 24 h, postoperative nausea and vomiting (PONV), and rescue analgesic requirements within the first 24 h. DESIGN: A meta-analysis of randomised controlled trials (RCTs) with meta-regression and trial sequential analysis (TSA). DATA SEARCH: We systematically searched Pubmed, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar, Medline (from inception to until 1 October 2024). ELIGIBILITY CRITERIA: RCTs that include patients undergoing breast surgery with PVB or IP+PS block, with no language restriction. RESULTS: Eighteen RCTs with 924 patients were included. No significant difference in MME consumption at 24 h was observed between the two techniques; mean difference (MD) -1.94 (95% confidence interval (CI) -4.27 to 0.38, P = 0.101). Subgroup analyses revealed a minor advantage for IP+PS in patients without axillary involvement; MD -2.42 (95% CI -3.56 to -1.29, P  < 0.001), though below the threshold of clinical significance. Secondary outcomes, including pain scores, PONV incidence and rescue analgesic requirements were comparable. Trial sequential analysis (TSA) confirmed sufficient sample size, suggesting further studies may not alter conclusions. CONCLUSION: PVB and IP+PS blocks offer comparable analgesic efficacy and opioid-sparing effects after breast surgery, with no meaningful differences in 24-h MME consumption, pain scores, or PONV incidence.

OBJECTIVES: Managing severe pneumonia remains a challenge. Rapid diagnostic tests, such as multiplex polymerase chain reaction (mPCR), facilitate quick microorganism identification and may enable timely and appropriate antimicrobial therapy. However, studies from low-income countries are scarce. This study aimed to evaluate the diagnostic characteristics of mPCR and its impact on antibiotic therapy and outcomes in critically ill patients with pneumonia. DESIGN: Multicenter observational study. SETTING: Twelve ICUs across Morocco. PATIENTS: Adult patients with pneumonia requiring invasive mechanical ventilation, including community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Respiratory samples were analyzed using both mPCR and conventional microbiological methods. The diagnostic performance of mPCR was evaluated, including its sensitivity and specificity. Additionally, the appropriateness of mPCR-induced modifications in empiric antibiotic therapy and their impact on patient outcomes were assessed. A total of 210 patients were included, with a median age of 50 years (range, 33-67 yr), of whom 66.2% were male. Pneumonia types were distributed as 30% CAP, 58% VAP, and 12% HAP. mPCR demonstrated a sensitivity of 96.9% (95% CI, 92.3-99.2%) and a specificity of 92% (95% CI, 91-93%). Following mPCR, antibiotic therapy modifications were observed in 58% of patients (n = 122), including de-escalation or cessation in 11% (n = 23), escalation in 26.5% (n = 56), adequacy adjustments in 7.5% (n = 16), and initiation of antibiotics in 13% (n = 27). The appropriateness of antibiotic therapy increased significantly from 38.7% (n = 83) to 67% (n = 141; difference, 27.5%; 95% CI, 18.3-36.7; p < 0.0001). Generalized mixed model analysis revealed that appropriate post-mPCR antibiotic therapy was associated with reduced mortality (adjusted odds ratio, 0.37; 95% CI, 0.15-0.93; p = 0.038). CONCLUSIONS: Our findings suggest that the use of mPCR is associated with a significant improvement in the appropriateness of empiric antibiotic therapy and is also associated with a positive impact on the outcome of patients with pneumonia.