Daily Anesthesiology Research Analysis

BACKGROUND: Remimazolam recently became available as a sedative. The comparison of the respiratory suppression effects of remimazolam and propofol under deep sedation for colonoscopy was not thoroughly unclear, particularly with regard to the novel metric of time to first airway intervention. The goal of this study was to systemically compare the respiration profiles of the patients sedated with remimazolam and propofol at the comparable sedation level in the patients undergoing colonoscopy. METHODS: Four hundred-fifty outpatients were randomly assigned to remimazolam (Group Rem, n = 225) and propofol (Group Pro, n = 225). The target sedation level was the modified Observer's Assessment of Alertness/Sedation ≤ 2. The primary outcome was elapsed time from anesthesia induction to first airway intervention. Secondary outcomes included incidence and severity of hypoxia and apnea, minute ventilation (MV), tidal volume (TV), and respiratory rate (RR). RESULTS: The elapsed time from induction to the first airway intervention was 11 ± 8 min in Group Rem (n = 208) vs. 5 ± 6 min in Group Pro (n = 208, P < 0.001). Patients in Group Rem required less frequent airway intervention and had a lower incidence of and shorter duration of apnea than patients in Group Pro (all P < 0.001). MV at 1 min, 2 min, 4 min post-induction, and at the end of the procedure were higher in Group Rem than those in Group Pro (P < 0.001). CONCLUSIONS: Patients sedated with remimazolam vs. propofol during colonoscopy maintain improved respiration and require less frequent airway intervention, and have lower incidence of adverse events.

INTRODUCTION: Hospital-acquired bloodstream infections (HA-BSIs) are severe and require antibiotic therapy. In non-complicated BSIs, shortened therapy reduces side effects without compromising efficacy. The impact of shortened antibiotic therapy in HA-BSI critically ill patients without indication of prolonged therapy requires further evaluation. METHODS: Using the international prospective EUROBACT-2 cohort, we compared shortened (7-10 days) versus long (14-21 days) treatment durations in ICU patients eligible for shortened therapy. Patients without antibiotic therapy within 3 days after HA-BSI occurrence or requiring prolonged therapy (due to infection source, microorganism, or clinical deterioration) were excluded. Treatment failure, defined as death, persistent infection, or subsequent infectious complications by Day 28, was assessed using an inverse-probability of treatment weighted (IPTW) logistic regression. RESULTS: Among 2600 patients, 550 were eligible for shortened treatment, 213 received short, and 337 received long treatment. The most common infection source was intravascular catheters (33%), most common microorganisms were Enterobacterales (39%). Patients with long treatment were more frequently infected with Staphylococcus aureus (11% vs. 5.6%, p = 0.025) or difficult-to-treat microorganisms (23% vs. 7%, p < 0.001), and received more commonly combination therapy (46% vs. 30%, p < 0.001). Short treatment was associated with reduced 28-day treatment failure (OR 0.64, 95% CI 0.44-0.93, p = 0.019), mainly due to reduction in subsequent infectious complications (OR 0.58, 95% CI 0.37-0.91, p = 0.018). Mortality (OR 0.92 [95% CI 0.59, 1.43], p = 0.7) and persistent infection rates (OR 0.47 [95% CI 0.17, 1.14], p = 0.12) were similar. CONCLUSIONS: In selected ICU patients with HA-BSI, shortened antibiotic treatment might be considered.

IMPORTANCE: Chronic low back pain (CLBP) can necessitate opioid therapy. Effective approaches to reduce CLBP's symptoms and opioid-related harms are needed. Cognitive behavioral (CBT) and mindfulness-based (MBT) therapies may be useful but have not been well-studied for opioid-treated CLBP. OBJECTIVE: To compare the effectiveness of MBT vs CBT in opioid-treated CLBP, hypothesizing MBT's superiority. DESIGN, SETTING, AND PARTICIPANTS: In this 12-month community partner-informed, partially masked, multisite, randomized clinical trial, participants at primary and specialty care clinics and community settings were randomly assigned (1:1) to MBT or CBT groups. Participants included English-fluent adults (21 years or older), without prior MBT or CBT training, and with moderate-to-severe CLBP (average score ≥3 on the Brief Pain Inventory [BPI]; functional limitation score ≥20 on the Oswestry Disability Index [ODI]), treated with an opioid dosage of at least 15 mg/d of morphine milligram equivalents (MME) for at least 3 months. Outcome data were collected from July 1, 2017, to November 23, 2022. Analysis used the intention-to-treat approach. INTERVENTIONS: Manual-based MBT or CBT interventions consisting of 8 weekly therapist-led group sessions and at-home practice. OUTCOMES AND MEASURES: Self-reported coprimary (average pain severity, 0-10 [BPI]; functional limitations, 0-100 [ODI]) and secondary (mental and physical health-related quality of life [QOL] on the Medical Outcomes Study 12-Item Short Form Health Survey and opioid dose in MME per day, Timeline Followback) outcomes compared at 6 and 12 months. RESULTS: Among 6024 screened individuals, 2926 were ineligible, 2328 were eligible, and 770 were enrolled, including 385 in the MBT and 385 in the CBT groups. ... Over time, each group significantly improved their outcomes, without serious adverse effects. The intention-to-treat linear mixed-effects model analysis did not detect significant between-group differences at 6 and 12 months for pain ... and function ... and indicated MBT's noninferiority relative to CBT on primary outcomes.