Daily Anesthesiology Research Analysis
A double-blind crossover RCT showed opioid-free anesthesia substantially reduced postoperative nausea and vomiting after lower-extremity wound surgery. A European consensus process synthesized 101 patient-centered perioperative safety recommendations. A randomized trial found propofol enables the fastest recovery from intraoperative sedation compared with remimazolam and dexmedetomidine under brachial plexus blockade.
Summary
A double-blind crossover RCT showed opioid-free anesthesia substantially reduced postoperative nausea and vomiting after lower-extremity wound surgery. A European consensus process synthesized 101 patient-centered perioperative safety recommendations. A randomized trial found propofol enables the fastest recovery from intraoperative sedation compared with remimazolam and dexmedetomidine under brachial plexus blockade.
Research Themes
- Opioid-sparing anesthesia and PONV prevention
- Perioperative patient safety consensus and implementation
- Sedation pharmacology and recovery optimization
Selected Articles
1. Opioid-free anaesthesia to reduce postoperative nausea and vomiting after lower extremity wound surgery: a randomised double-blind crossover trial.
In a randomized double-blind crossover trial of 66 adults undergoing two lower-extremity wound procedures, opioid-free anesthesia (lidocaine, esketamine, dexmedetomidine, propofol) reduced 48-hour PONV incidence versus opioid-inclusive anesthesia (5% vs 23%; OR 0.13). The within-patient design strengthens causal inference for PONV reduction with OFA.
Impact: Provides rigorous within-subject evidence supporting OFA as an effective PONV prevention strategy, a high-priority perioperative outcome. May influence anesthetic maintenance choices to minimize PONV risk.
Clinical Implications: Consider OFA protocols to reduce PONV in suitable surgical populations, alongside standard multimodal antiemetic prophylaxis and careful hemodynamic monitoring.
Key Findings
- OFA reduced 0–48 h PONV incidence versus opioid-inclusive anesthesia (5% vs 23%; OR 0.13, 95% CI 0.03–0.55).
- Crossover, double-blind design with a median 9-day washout minimized interindividual variability and temporal confounding.
- Both anesthetic regimens achieved surgical anesthesia with general anesthesia for lower-extremity wound procedures.
Methodological Strengths
- Randomized, double-blind, crossover design with within-patient comparisons.
- Prospective registration and clearly defined primary and secondary endpoints.
Limitations
- Single surgical context (lower-extremity wound surgeries) with modest sample size (n=66).
- Potential carryover effects despite a median 9-day washout were not fully explored.
Future Directions: Validate OFA’s PONV benefit across diverse surgeries and risk profiles; assess interactions with standardized antiemetic bundles and evaluate safety profiles (hemodynamics, analgesia) in larger multicenter RCTs.
BACKGROUND: Postoperative nausea and vomiting (PONV) are common complications after surgery. Opioid use is a significant risk factor. We utilised a crossover design to test this hypothesis in the same individuals that opioid-free anaesthesia (OFA) compared with opioid-inclusive anaesthesia reduces PONV. METHODS: This randomised double-blind crossover trial included adult patients undergoing two surgical procedures for lower extremity wounds under general anaesthesia. Each patient received both OFA (i.v. lidocaine, esketamine, dexmedetomidine and propofol) and opioid-inclusive anaesthesia (sufentanil and propofol); which came first was determined by randomisation. The primary outcome was the incidence of PONV during the first 48 h postoperatively. Secondary outcomes were the severity of PONV, use of rescue antiemetics, postoperative pain, need for rescue analgesia, adverse events, time to extubation, and length of recovery room stay. RESULTS: Sixty-six patients completed this study (mean age 53 years, 36% female). The median washout period was 9 days. Compared with opioid-inclusive anaesthesia, OFA reduced the incidence of PONV 0-48 h postoperatively (5% vs. 23%, odds ratio [OR] = 0.13, 95% CI: 0.03-0.55, CONCLUSION: This crossover trial demonstrates that OFA reduced PONV following lower extremity wound surgery, providing compelling evidence for the administration of OFA to enhance perioperative care. REGISTRATION: ChiCTR2200061511 (https://www.chictr.org.cn).
2. Multidisciplinary, evidence-based, patient-centred perioperative patient safety recommendations: a European consensus study
Through a systematic review of 267 guidelines and a two-round modified Delphi process with 66 experts from 19 countries, the panel synthesized 101 evidence-based, patient-centered perioperative safety practices. The process balanced expert diversity and included patient representatives to strengthen feasibility and patient relevance.
Impact: Provides a comprehensive, consensus-based framework to standardize perioperative safety across Europe, filling a major gap and guiding implementation efforts.
Clinical Implications: Hospitals and perioperative teams can adopt or benchmark against the 101 practices to prioritize high-impact safety interventions and inform local protocols.
Key Findings
- Systematic review extracted 4,666 safety recommendations from 267 guidelines.
- A two-round modified Delphi with 66 experts (19 countries) achieved consensus on 101 practices.
- Consensus definition required ≥70% rating 7–9 for importance and feasibility on a 9-point Likert scale.
Methodological Strengths
- Comprehensive systematic guideline review with transparent synthesis steps.
- Structured, predefined consensus thresholds with multidisciplinary and patient representation.
Limitations
- Consensus does not substitute for interventional validation; implementation impact not tested.
- Heterogeneity of source guidelines may affect consistency and generalizability.
Future Directions: Prioritize implementation science studies to evaluate clinical impact, feasibility, and cost-effectiveness of key practices; develop toolkits and metrics for benchmarking.
BACKGROUND: Surgery-related adverse events are among the most common adverse events in-hospital. However, no comprehensive, multidisciplinary perioperative guidelines exist at the European level. The aim of this study is to describe the process and results in achieving European multidisciplinary consensus on perioperative patient safety recommendations. METHODS: This multimethod study included: (1) a systematic review of guidelines; (2) selection and synthesis of recommendations; and (3) a two-round modified Delphi technique including a 2-day face-to-face consensus conference. We recruited a panel of two expert groups balanced in terms of gender, geographical origin, and professional background, with meaningful participation from patient representatives. Consensus was defined as at least 70% of the panel rating a recommendation 7-9 on a 9-point Likert scale for importance to patient safety and feasibility of implementation. RESULTS: The systematic review included 267 guidelines, from which 4666 patient safety recommendations were identified and extracted. After four synthesis rounds, 99 recommendations were presented for the Delphi survey, detailing their strength of recommendation, level of evidence, and methodological quality of the cited guidelines. An expert group, composed of 66 multidisciplinary experts from 19 European countries, participated with a response rate of 80.3%. After the two Delphi rounds and the consensus conference, the panel agreed on a final set of 101 recommended perioperative patient safety practices. CONCLUSIONS: A set of 101 comprehensive, evidence-based, patient-centred perioperative patient safety practices was developed through a European consensus process to improve the quality of care in healthcare facilities across Europe and beyond.
3. Comparison of the recovery profiles of propofol, dexmedetomidine, and remimazolam for intraoperative sedation in patients undergoing upper limb surgery under brachial plexus blockade: a randomized controlled trial.
In 119 patients undergoing upper-limb surgery under brachial plexus block, recovery from intraoperative sedation was fastest with propofol (12 min), intermediate with remimazolam (17 min), and slowest with dexmedetomidine (19 min). No significant differences were observed in length of stay, quality of recovery, or Aldrete scores.
Impact: Direct, head-to-head RCT informs sedative selection under regional anesthesia by quantifying recovery profiles, a key factor for ambulatory throughput and patient experience.
Clinical Implications: When rapid emergence is prioritized under regional anesthesia, propofol may be preferred; remimazolam and dexmedetomidine offer acceptable recovery with potential benefits in other domains that warrant individualized selection.
Key Findings
- Recovery time: propofol 12 min (95% CI 10–13), remimazolam 17 min (95% CI 15–19), dexmedetomidine 19 min (95% CI 16–22); P<0.001 overall.
- Remimazolam recovery was significantly longer than propofol (mean difference 5 min; 95% CI 3–8; Bonferroni-adjusted P<0.001).
- No significant differences in length of stay, quality of recovery, or Aldrete scores among groups.
Methodological Strengths
- Prospective randomized controlled design with three active comparators.
- Pre-registered study with clearly defined primary and secondary outcomes.
Limitations
- Conducted under regional anesthesia for upper-limb surgery; generalizability to other contexts (e.g., general anesthesia) is uncertain.
- Sample size may be underpowered to detect small differences in secondary outcomes.
Future Directions: Compare safety profiles (e.g., hemodynamics, respiratory events) and patient-centered outcomes across sedatives in diverse procedures; assess cost and throughput implications.
PURPOSE: The ideal sedative should have a rapid onset, short duration, and quick and predictable recovery. Despite the increasing use of the recently developed sedative remimazolam for intraoperative sedation, there is a paucity of research on its comparative recovery profile. Our aim was to compare the recovery profiles of intraoperative sedation with propofol, dexmedetomidine, and remimazolam in patients undergoing surgery under regional anesthesia. METHODS: We included 119 patients scheduled to undergo upper limb surgery under brachial plexus blockade in a randomized controlled trial. We randomized patients to receiving intraoperative sedation with propofol, dexmedetomidine, or remimazolam. The primary outcome was the recovery time (from the completion of infusion to attaining a Modified Observer's Assessment of Alertness and Sedation score of 5). As secondary outcomes, we assessed other recovery profiles, including length of stay, quality of recovery, and the Aldrete score. RESULTS: The mean (95% confidence interval [CI]) recovery time was 19 min (95% CI, 16 to 22) for patients in the dexmedetomidine group, 17 min (95% CI, 15 to 19) for the remimazolam group, and 12 min (95% CI, 10 to 13) for the propofol group (P < 0.001). Post hoc analysis revealed that the recovery time in the remimazolam group was longer compared to that in the propofol group (mean difference, 5 min; 95% CI, 3 to 8; Bonferroni adjusted P < 0.001). We found no significant differences among the three groups in the recovery-related secondary outcomes (all P > 0.05). CONCLUSIONS: Patients in the propofol group exhibited the most rapid recovery time from intraoperative sedation under regional anesthesia, followed by those in the remimazolam and dexmedetomidine groups. We found no differences in the recovery-related secondary outcomes. STUDY REGISTRATION: ClinicalTrials.gov ( NCT05688345 ); first submitted 30 December 2022.