Daily Anesthesiology Research Analysis

BACKGROUND: Opioid-free anesthesia (OFA) is increasingly being adopted to provide effective analgesia and reduce opioid-related adverse events. However, existing literature on OFA remains contentious, and its impact on postoperative recovery following thyroidectomy has not been evaluated. Therefore, we examined the hypothesis that OFA enhances the early quality of recovery in patients undergoing thyroid surgery. METHODS: In this randomized controlled trial, 204 adult patients undergoing thyroidectomy were randomly assigned to receive either OFA (esketamine, dexmedetomidine, and bilateral superficial cervical plexus blocks) or opioid-based anesthesia (OBA, sufentanil and remifentanil). The primary outcome was the quality of recovery on the first postoperative day, assessed using the quality of recovery-15 scale. Secondary outcomes included sleep quality score, area under the curve of pain intensity. Anesthesia-related complications were also recorded. RESULTS: On the first postoperative day, the OFA group had a significantly higher quality of recovery-15 score versus the OBA group (137.6 [5.6] vs 128.2 [10.5], mean difference = 9.4, 95% CI, 7.0-11.7, CONCLUSION: We showed that with a pre-emptive and preventive analgesia effect, OFA improved quality of recovery, sleep quality, pain, and postoperative nausea and vomiting after thyroidectomy. However, a prolonged emergence recovery was observed when patients receiving OFA strategy, warranting further investigation to optimize agent design and monitoring method to balance the intraoperative anesthesia depth. NAME OF TRIAL REGISTRY: Chinese Clinical Trial Registry. REGISTRATION NUMBER: ChiCTR2300070794; URL: https://www.chictr.org.cn/showproj.html?proj=196152. Thyroid surgery is increasingly performed as day case procedures. With the goal of enhanced recovery, it is important to assess outcomes from the patient’s perspective. This double blind, randomized controlled trial aimed to examine the effect of opioid-free anesthesia (OFA) on subjective quality of recovery (QoR) in patients undergoing thyroid surgery compared to those receiving opioid-based anesthesia. Importantly, we found that OFA improved QoR, sleep quality, pain, and postoperative nausea and vomiting after thyroid surgery, although it was associated with an increased risk of prolonged emergence recovery. Although cumulative effects of OFA has been shown to potentially enhance the overall postoperative QoR after different surgeries, such as orthopedic and thoracoscopic surgeries, our results showed that the advantages of OFA for QoR, particularly for thyroid surgery, remains limited and contentious. It warrants further investigation to optimize agent design of OFA.

INTRODUCTION: Lung-protective ventilation is essential for preventing postoperative pulmonary complications. While maintaining a low driving pressure and optimising PEEP is of importance, the ideal strategy remains contentious. This study evaluated whether adjusting PEEP based on BMI, compared with standard PEEP, could reduce driving pressure and peri-operative loss of lung aeration. METHODS: We conducted a randomised controlled, patient-blinded, single-centre superiority trial with two parallel groups. Adult patients undergoing surgery with general anaesthesia who required tracheal intubation were assigned randomly to either standardised PEEP (PEEP = 5 cmH RESULTS: Sixty patients were enrolled and allocated randomly. Adjustment of PEEP according to BMI/3 was associated with a significantly lower driving pressure, with a median (IQR [range]) of 8.9 (7.1-10.4 [5.2-14.9]) cmH DISCUSSION: In patients without major pulmonary disease who were undergoing non-cardiothoracic surgeries with tracheal intubation, adjusting PEEP based on a calculation of BMI/3 improved lung mechanics and reduced postoperative loss of lung aeration. This approach provides a straightforward and pragmatic method for individualising PEEP in patients undergoing general anaesthesia. Protecting the lungs during surgery is important to stop problems with breathing afterwards. One way to do this is by using the right air pressure when helping someone breathe with a machine. But doctors don't all agree on the best way to do this. This study looked at whether using air pressure based on a person's body size (BMI) is better than using the same air pressure for everyone. We did a study with two groups of adult patients who were having surgery and needed help breathing with a tube and machine. Some patients got the same air pressure (5 cmH

BACKGROUND: The aim of this study was to investigate the effect of esketamine on emergence delirium in pediatric patients. METHODS: We searched Pubmed, Cochrane Controlled Register of Trials, and Embase from inception to December 2024. Studies were independently evaluated for inclusion criteria and exclusion criteria by two reviewers. The primary outcome was the incidence of emergence delirium during the post-anesthesia period. The secondary outcomes were the PAED scores, FLACC scores, PACU stay time, and the incidence of nausea and vomiting. RESULTS: Ten studies including 853 children were eligible for this meta-analysis. The pooled data revealed that esketamine administration significantly reduced the incidence of emergence delirium in pediatric patients (RR: 0.40, 95% CI: 0.30-0.53, P < 0.00001, I CONCLUSION: The administration of esketamine can reduce the incidence of emergence delirium without prolonging PACU stay time and increasing the risk of nausea and vomiting in pediatric patients. Subgroup analysis indicated that a single bolus esketamine before anesthesia induction or at the end of surgery would better reduce the risk of ED than intraoperative continuous infusion. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024623667.