Daily Anesthesiology Research Analysis
Across anesthesiology and perioperative care, three studies stand out: a systematic review on acute pain management for people with opioid use disorder supports continuing buprenorphine and highlights key evidence gaps; a randomized trial shows a brief continuous low-dose propofol infusion markedly reduces emergence agitation in preschool children; and a nationwide trauma analysis links discretionary single-unit transfusions to higher mortality, infection, and thromboembolism.
Summary
Across anesthesiology and perioperative care, three studies stand out: a systematic review on acute pain management for people with opioid use disorder supports continuing buprenorphine and highlights key evidence gaps; a randomized trial shows a brief continuous low-dose propofol infusion markedly reduces emergence agitation in preschool children; and a nationwide trauma analysis links discretionary single-unit transfusions to higher mortality, infection, and thromboembolism.
Research Themes
- Perioperative pain management in opioid use disorder
- Pediatric anesthesia—emergence agitation prevention
- Trauma transfusion practices and outcome risk
Selected Articles
1. Acute Pain Management in People With Opioid Use Disorder : A Systematic Review.
This preregistered systematic review (115 studies) suggests that continuing buprenorphine during acute pain—often perioperatively—yields similar or improved pain outcomes compared with discontinuation. Limited RCT evidence indicates clonidine, haloperidol plus midazolam with IV morphine, and intraoperative IV lidocaine may improve acute pain outcomes; effects on OUD outcomes remain largely unstudied.
Impact: Guides perioperative strategies for patients with OUD, a population at the center of the opioid epidemic, and identifies high-priority evidence gaps that can reframe clinical protocols.
Clinical Implications: Perioperative teams should consider continuing buprenorphine during acute pain episodes and evaluate multimodal adjuncts (e.g., clonidine, intraoperative IV lidocaine) while recognizing the paucity of data on methadone and long-term OUD outcomes.
Key Findings
- Across cohort studies, continuing buprenorphine during acute pain was associated with similar or improved pain outcomes versus discontinuation.
- Single RCTs suggest oral clonidine, IM haloperidol plus midazolam with IV morphine, and intraoperative IV lidocaine can improve acute pain outcomes.
- Evidence on methadone and on the impact of acute pain interventions on OUD outcomes is scarce, highlighting critical research gaps.
Methodological Strengths
- A priori protocol registration on OSF
- Comprehensive multi-database search with dual screening and risk-of-bias assessment
Limitations
- Most included studies were observational with confounding risk
- Settings largely ED/hospital and pre–high-potency synthetic opioid era or non-U.S. opium-using populations
Future Directions: Conduct pragmatic RCTs in contemporary perioperative settings (including methadone-treated patients) and measure both pain and OUD outcomes, including relapse and treatment retention.
2. Comparing different administration methods of subanaesthetic propofol to mitigate emergence agitation in preschool children undergoing day surgery: a double-blind, randomised controlled study.
In 160 preschool children undergoing day-case laparoscopic inguinal hernia repair with sevoflurane, a 3-minute continuous infusion of propofol 1 mg/kg at case end reduced emergence agitation to 5% versus 30–65% with other strategies, without prolonging extubation or emergence times. Peak PAED scores were lowest with continuous infusion.
Impact: Provides a simple, implementable dosing strategy that substantially reduces emergence agitation in a high-risk pediatric population without delaying recovery.
Clinical Implications: For preschool children anesthetized with sevoflurane, consider a 3-minute continuous infusion of propofol 1 mg/kg at the end of surgery to minimize emergence agitation without impacting time to extubation.
Key Findings
- Emergence agitation incidence dropped to 5% with 3-minute continuous infusion of propofol 1 mg/kg versus 30–65% in control or bolus groups.
- Peak PAED scores were significantly lower in the continuous infusion group.
- Extubation and emergence times did not differ among groups, indicating no recovery delay.
Methodological Strengths
- Double-blind randomized controlled design
- Clearly defined primary and secondary outcomes with validated scales (PAED, Watcha)
Limitations
- Single procedure type and single anesthetic (sevoflurane) in a single-center study
- Short-term outcomes without behavioral follow-up beyond early recovery
Future Directions: Replicate across procedures, anesthetic regimens, and settings; evaluate dose–response, safety in higher-risk children, and longer-term behavioral outcomes.
3. Has the pendulum swung too far? Discretionary single-unit red blood cell transfusion in trauma is associated with infection, thromboembolic events, and mortality.
In a propensity-weighted analysis of 649,841 trauma admissions, a single early RBC unit (with no further transfusion) was associated with higher odds of mortality (aOR 2.11), infection (aOR 3.92), and thromboembolic events (aOR 2.02). Findings challenge discretionary single-unit transfusion in borderline indications.
Impact: Massive real-world dataset with robust adjustment shows potential harm from a common practice, likely informing trauma/anesthesia transfusion protocols.
Clinical Implications: Avoid routine discretionary single-unit RBC transfusions in trauma patients with equivocal hemorrhage; emphasize restrictive, goal-directed strategies and reassessment before additional units.
Key Findings
- Single-unit RBC transfusion within 4 hours (no subsequent transfusion) increased adjusted odds of mortality (aOR 2.11).
- Risk of infection (aOR 3.92) and thromboembolic events (aOR 2.02) was significantly higher after single-unit transfusion.
- Findings persisted after inverse probability-weighted propensity matching with regression adjustment.
Methodological Strengths
- Very large multicenter dataset (ACS-TQIP) with rigorous propensity weighting and regression adjustment
- Clear exposure definition (single early unit, no subsequent transfusion) and clinically relevant composite outcomes
Limitations
- Observational design with residual confounding possible despite adjustment
- Indication bias and unmeasured clinician decision factors cannot be fully excluded
Future Directions: Prospective studies to define hemodynamic/biomarker thresholds for transfusion and trials comparing restrictive vs. discretionary early single-unit strategies.