Daily Anesthesiology Research Analysis

BACKGROUND: Tonsillectomy in children is a common procedure to treat obstructive sleep apnea and other respiratory conditions. However, it is associated with postoperative complications, including bleeding, pain, and postoperative nausea and vomiting. Non-steroidal anti-inflammatory drugs are often used for pain management, but their effects on postoperative bleeding risk remains controversial. This meta-analysis aims to evaluate the impact of NSAIDs on postoperative bleeding and PONV in children undergoing tonsillectomy by synthesizing evidence from RCTs. MATERIALS AND METHODS: This study was conducted strictly in accordance with the PRISMA guidelines. After a thorough search of databases such as CNKI, Wanfang, Sinomed, PubMed, Embase, and the Cochrane Library, 26 randomized controlled trials were eventually included. Meta-analysis was performed using STATA software, and the impact on postoperative bleeding and postoperative nausea and vomiting was evaluated by relative risk (RR) and 95% confidence interval (CI). RESULTS: A total of 26 randomized controlled trials were included in the meta-analysis, involving 2717 pediatric patients. The risk of total postoperative bleeding [1.19, 95% CI (0.9, 1.58)], primary bleeding [RR = 1.13, 95% CI (0.77-1.65)], and secondary bleeding [RR = 1.36, 95% CI (0.86-2.14)] was not significantly affected by the use of NSAIDs during the perioperative period. Subgroup analysis showed that different types of NSAIDs and administration methods did not significantly increase the risk of postoperative bleeding. In addition, NSAIDs significantly reduced the incidence of PONV [RR = 0.78, 95% CI (0.67-0.92)]. CONCLUSION: In conclusion, this study has not identified any correlation between the application of NSAIDs and an elevated risk of bleeding after tonsillectomy in children. It lends support to the notion that these drugs can serve as an effective alternative for analgesia after tonsillectomy in children, which helps to cut down the usage of opioid drugs and consequently mitigate their associated adverse effects. However, more high-quality RCTs are necessary to further confirm these results and refine postoperative management guidelines.

Tranexamic acid (TXA) is used for the treatment and occasionally prevention of postpartum hemorrhage (PPH); however, questions still remain regarding dosing regimen optimization. This study evaluated TXA pharmacokinetic (PK) data from four clinical trials (NCT: 04274335, 03287336, 00872469, and 02797119) conducted in pregnant participants receiving intravenous, intramuscular, or oral TXA to prevent or treat PPH. The goal of this analysis was to comprehensively characterize TXA PK in a large, heterogeneous population of pregnant individuals to (1) assess the need for weight-based dosing and (2) compare exposure target attainment for alternative routes of administration. A population PK analysis was performed using nonlinear mixed-effects modeling in Pumas, and a stepwise approach was implemented to select the structural model and identify significant covariates. A total of 211 pregnant participants who received between 0.35 and 4 g of TXA intravenously, orally, or intramuscularly offered 1303 TXA plasma concentrations for model development. A two-compartment model with first-order elimination and first-order absorption for both intramuscular and oral administration best described the disposition of TXA. Actual body weight was the only statistically significant covariate identified, but inclusion into the model did not explain a substantial amount of the observed variability. Simulations of virtual pregnant individuals indicated minimal differences in TXA exposure between fixed and weight-based dosing regimens, supporting the use of fixed dosing. Intramuscular TXA was additionally found to be a viable alternative to intravenous administration, achieving similar target exposure metrics.

BACKGROUND: Cardiac surgery often results in significant postoperative pain, which can lead to complications and prolonged recovery. Pain and depression are closely linked, with effective pain management potentially reducing the risk of depression. Combining sufentanil, an opioid, with esketamine, a medication with both analgesic and antidepressant effects, may improve pain control and mood in postoperative patients. While promising in other surgeries, their effects in cardiac surgery remain unclear. This study explores how sufentanil and esketamine work together to manage pain and reduce depression after cardiac surgery. METHODS: A randomized controlled clinical trial was conducted from January 2021 to December 2023, involving 104 patients who underwent cardiac surgery. Patients [aged 61-64 years, body mass index (BMI) <30 kg/m RESULTS: The experimental group had significantly fewer PCIA pump button presses (2.41±0.72) than the control group (6.20±1.31) (P<0.001). Visual analog pain scores were lower in the experimental group at multiple postoperative time points (P<0.05). Hamilton Depression Rating Scale (HAMD) scores were significantly lower in the experimental group (7.52±4.24) compared to the control group (13.84±2.76) (P<0.05), as were Hamilton Anxiety Rating Scale (HAMA) scores (8.84±2.13 CONCLUSIONS: The combined administration of sufentanil and esketamine effectively managed pain and significantly reduced depressive symptoms in post-cardiac surgery patients. The experimental group demonstrated reduced PCIA usage and improved clinical indicators. These findings provide valuable insights for enhancing postoperative recovery and addressing both pain management and psychological well-being. TRIAL REGISTRATION: Chinese Clinical Trial Registry; identifier: ChiCTR2400092428.