Daily Anesthesiology Research Analysis

BACKGROUND: Gastrointestinal function is mediated by the cholinergic pathway, which is impacted by neostigmine and glycopyrrolate, but not sugammadex. We hypothesized that sugammadex is associated with earlier gastric emptying in adults undergoing colorectal surgery, compared to neostigmine-glycopyrrolate. METHODS: Patients were enrolled in a pragmatic, single-center, patient and assessor-blinded, randomized, controlled trial. At skin closure, subjects were randomized to sugammadex 2 mg/kg or neostigmine 0.07 mg/kg and glycopyrrolate (0.2 mg per 1 mg of neostigmine). The primary end point, gastric emptying, was assessed with the paracetamol absorption test, with greater area under the curve representing faster gastric emptying. Secondary end points included time to first bowel movement, time to achieve adequate reversal (train-of-four ratio ≥0.9), gastrointestinal complications, hospital length of stay, and postanesthesia care unit recovery time. The analysis was intention-to-treat. RESULTS: All 60 patients randomized to sugammadex received the allocated intervention. Of 60 patients randomized to neostigmine-glycopyrrolate, 56 received neostigmine-glycopyrrolate, 2 received sugammadex, and 2 received both agents. Gastric emptying did not differ significantly between sugammadex (mean [standard deviation {SD}] area under the curve {AUC} 1118 [122]) and neostigmine (AUC 1130 [117], P = .58). Sugammadex treatment was associated with shorter time to first bowel movement (44.3 hours [33.8] vs 61.0 hours [43.0]; difference = 16.7 hours, 95% confidence interval {CI}, [2.3-31.1], P = .02) and time to adequate reversal (5.2 minutes [6.3] vs 17.5 minutes [10.1]; difference = 12.3 minutes, 95% CI, [9.2-15.4], P < .001). Neostigmine-glycopyrrolate treatment was not associated with a significant increase in gastrointestinal complications (32% vs 17%; OR = 2.3, 95% CI, [0.9-6.2], P = .09), a longer hospital length of stay (7.8 days [19.8] vs 4.8 days [4.9]; difference = 3 days, 95% CI, [ - 2.2 to 8.3], P = .27), or a difference in postanesthesia care unit recovery time (108 minutes [56.4] vs 115 minutes [50.3]; difference= -6.9 minutes, 95% CI, [ - 26.4 to 12.6], P = .48). Adverse events were similar between groups. CONCLUSIONS: Sugammadex treatment was not associated with faster gastric emptying (primary end point). Regarding prespecified secondary end points, sugammadex treatment was associated with a 12.3-minute shorter time to adequate reversal in real-life practice conditions, but it did not benefit the proportion of subjects with a gastrointestinal complication, hospital length of stay, or postanesthesia care unit recovery time. Further studies are needed to confirm our finding that sugammadex is associated with a clinically significant 16.7-hour shorter time to first bowel movement, and to establish the role of sugammadex in colorectal surgery enhanced recovery protocols.

The iliopsoas plane block (IPB) is a novel analgesic technique that has been demonstrated to be effective for hip fracture and hip replacement surgery. This study aimed to assess the effect of IPB on postoperative quality of recovery following elective hip arthroplasty compared with femoral nerve block (FNB). One hundred patients underwent elective hip arthroplasty were randomly assigned to the IPB or FNB groups. The primary outcome was the quality of recovery 24 h after surgery. Secondary outcomes included the quality of recovery at 48 and 72 h after surgery, pain scores, quadriceps strength, first time out of bed, total opioid consumption, patient satisfaction, and complications. Compared with participants in the FNB group, Quality of recovery-15 score at 24-h was significantly higher in the IPB group (127 [123-130] vs. 117.5 [113.7-120.2]), with a median difference of 9 (95% CI, 7-11; P < 0.001). Moreover, the QoR-15 score of the IPB group was higher than that of the FNB group at 48 and 72 h after surgery (P < 0.001). However, there were no clinically significant differences between the two groups. Quadriceps strength was superior in the IPB group than that in the FNB group (P < 0.001). The first time out of bed was shorter in the IPB group than that in the FNB group (P < 0.001). This study found that IPB enhanced the quality of recovery in the first 24 h following hip arthroplasty compared with FNB.Trial registration Chinese Clinical Trial Registry ChiCTR2200055289.

BACKGROUND: Processed electroencephalography parameters are used to guide anesthesia to adequate levels for surgical procedures. Despite known spectral differences between anesthetics, studies often assume similar anesthetic states when titrating to the same target values, presupposing a reductive one-size-fits-all approach for all anesthetic agents. We hypothesize this may introduce bias and aim to characterize the differences using conventional and new approaches. METHODS: For this retrospective study, we included 108 patients undergoing surgery under general anesthesia with either fluranes or propofol. We analyzed steady-state frontal electroencephalography during surgery. Conventional approaches were compared with "fitting oscillations & one-over-f" and "variational mode decomposition" at clinically guided hypnotic and analgesic levels. After comparing the hypnotic drugs at the group level, we used 2 distinct ranges of spectral edge frequency (SEF) for further analyses (8-15 Hz vs 15-21 Hz). RESULTS: Sevoflurane and desflurane ("flurane") demonstrated similar spectral patterns using both conventional methods and "fitting oscillations & one-over-f" and "variational mode decomposition." "Variational mode decomposition" presented a 1.5 Hz higher central frequency (area under the receiver operating characteristic [AUC]: 0.88, 95% confidence interval [CI], 0.81-0.94, P < .001) in the propofol group (10.8 Hz [10.4-11.6]), compared to the flurane group (9.26 Hz [8.51-9.41]). "Fitting oscillations & one-over-f" produced a 2.04 Hz higher center frequency (AUC: 0.82, 95% CI, 0.72-0.91, P < .001) in the propofol group (10.6 [9.8-11.3]) compared to the flurane group (8.56 [8.02-9.69]). The exponent was 0.26 Hz-1 lower (AUC: 0.76, 95% CI, 0.67-0.85, P < .001) in the propofol group (2.45 Hz-1 [2.45-2.71]) compared to the flurane group (2.71 Hz-1 [2.50-2.93]). At the lower SEF range, "variational mode decomposition" presented a 1.5 Hz higher central frequency (AUC: 0.83, 95% CI, 0.70-0.94, P < .001) in the propofol group (10.4 Hz [9.7-10.9]), compared to the flurane group (8.92 Hz [8.03-9.45]). "Fitting oscillations & one-over-f" produced a 1.5 Hz higher center frequency (AUC: 0.83, 95% CI, 0.68-0.95, P = .002) in the propofol group (10.3 [10.0-10.8]) compared to the flurane group (8.78 [7.63-9.66]). The exponent was 0.31 Hz-1 lower (AUC: 0.79, 95% CI, 0.65-0.91, P = .002) in the propofol group (2.57 Hz-1 [2.44-2.70]) compared to the flurane group (2.88 Hz-1 [2.66-3.05]). Similar differences were found in the higher SEF group. However, no significant difference was found in the exponent between the groups. CONCLUSIONS: Differences between the electroencephalographic (EEG) spectral patterns under propofol anesthesia compared to anesthesia using fluranes were sensitively captured by 2 recent approaches to EEG analysis. This could potentially lead to establishing agent-specific anesthetic indices.