Daily Anesthesiology Research Analysis

BACKGROUND: The co-administration of intravenous dexamethasone and dexmedetomidine is reported to prolong the duration of analgesia after single-shot interscalene brachial plexus block. The most effective dose with minimal side effects remains undetermined. OBJECTIVES: To evaluate the difference in time to first analgesic request in patients receiving different doses of intravenous dexmedetomidine after an interscalene brachial plexus block undergoing arthroscopic shoulder surgery. DESIGN: A double-blind, randomised controlled study. SETTING: A single-centre study from November 2021 to December 2023. PATIENTS: Two hundred and eighteen patients undergoing arthroscopic shoulder surgery were included. INTERVENTIONS: Patients were randomly assigned to one of four groups using blocked randomisation: intravenous 0.9% saline (group 1) or intravenous dexmedetomidine: 1.0 (group 2), 1.5 (group 3) and 2.0 (group 4) μg kg -1 . MAIN OUTCOME MEASURES: The primary outcome was the time to first analgesic request in hours. RESULTS: There was no significant difference in the time to first analgesic request: group 1 (18.8 ± 6.3 h), group 2 (18.7 ± 5.1 h), group 3 (17.7 ± 5.6 h) and group 4 (19.5 ± 5.0 h). There was no significant difference in postoperative nausea and vomiting, patient satisfaction and quality of sleep in the first 24 h. There were significant differences in the incidences of intra-operative hypotension and bradycardia between the control group and all the dexmedetomidine groups combined; however, this study was not powered for this analysis. The time to extubation was statistically significantly higher in group 4 with a prolonged time to extubation (>14 min) when the duration of surgery was shorter (OR 0.98, 95% CI 0.96 to 0.99). CONCLUSIONS: Administering high doses of intravenous dexmedetomidine may not yield additional analgesic benefits after single-shot interscalene brachial plexus block while potentially increasing haemodynamic risks and prolonging time to extubation. TRIAL REGISTRATION: EudraCT 2021-004686-12.

BACKGROUND: Postoperative delirium (POD) remains a significant complication following cardiopulmonary bypass (CPB) surgery, particularly in middle-aged patients who constitute the majority of this surgical population. While intranasal insulin (INI) has shown neuroprotective potential in aging cohorts, its efficacy in younger surgical patients and its underlying mechanisms remain under explored. This study investigates whether INI mitigates POD through sleep-wake cycle modulation. METHOD: It is a single-center prospective randomized, double-blinded controlled trial from March 4, 2024 to October 18, 2024. 76 middle-aged patients (45-65 years) undergoing elective CPB surgery were randomized to receive INI (20 IU) or placebo preoperatively and on postoperative days 1-2. The primary outcome was POD incidence (CAM-ICU criteria). Secondary outcomes included Mini-Mental State Examination (MMSE) scores, actigraphy-derived sleep metrics (sleep efficiency [SE], total sleep time [TST]). Analyses followed intention-to-treat principles. RESULTS: INI significantly reduced POD incidence (17.1 % vs. 38.9 %, RR = 3.45, p = 0.037) and improved cognitive recovery, as evidenced by higher MMSE scores at postoperative day 5 with a difference of 1.71 (95 % CI, 0.19 to 3.23; p = 0.027). Sleep analysis revealed robust improvements in the INI group: SE increased by 21.3 % (78.2 ± 12.1 % vs. 64.5 ± 15.3 %, p = 0.031), and TST extended by 27.1 % (6.1 ± 1.2h vs. 4.8 ± 1.5h, p = 0.033) on postoperative day 1. No significant differences were observed in hospital length of stay (p = 0.893), highlighting the specificity of INI's sleep-mediated effects. CONCLUSION: This trial demonstrates that INI stabilizes postoperative sleep architecture, leading to reduced POD incidence and enhanced cognitive recovery in middle-aged CPB patients. These findings position INI as a targeted intervention for perioperative neurocognitive protection, particularly in populations vulnerable to circadian disruption. CLINICAL TRIAL REGISTRATION: ChiCTR 2400081444. Registered March 1, 2024, http://www.chictr.org.cn.

BACKGROUND: Airway management in critically ill obese patients is potentially associated with a higher risk of adverse events due to a constellation of physiological and anatomical challenges. Data from international prospective studies on peri-intubation adverse events in obese critically ill patients are lacking. METHODS: INTUBE (International Observational Study to Understand the Impact and Best Practices of Airway Management In Critically Ill Patients) was an international multicentre prospective cohort study enrolling critically ill adult patients undergoing in-hospital tracheal intubation in 197 sites from 29 countries worldwide from October 1, 2018, to July 31, 2019. This secondary analysis compares airway management practices and outcomes between obese (body mass index-BMI RESULTS: A total of 2946 patients met inclusion criteria for this secondary analysis, 639 (21.7%) obese and 2307 (78.3%) non-obese. Severe peri-intubation hypoxemia was more frequently reported in obese compared to non-obese patients (12.1% vs 8.6% respectively, p = 0.01). Variables independently associated with a higher risk of peri-intubation hypoxemia were baseline SpO CONCLUSIONS: Compared to non-obese patients, obese critically ill exhibit a higher incidence of peri-intubation severe hypoxemia. In this population, worse baseline oxygenation and first-pass intubation failure significantly increase the risk of peri-intubation severe hypoxemia. As obesity is linked to a higher likelihood of first-pass intubation failure, likely driven by more challenging airway features, in this high-risk population first attempt should be performed by an expert operator to minimize peri-intubation complications. TRIAL REGISTRATION: Clinicaltrials.gov NCT03616054 . Registered 3 August 2018.