Daily Anesthesiology Research Analysis

BACKGROUND: Procedural sedation and analgesia is crucial for gastrointestinal endoscopy to improve patient comfort and facilitate procedural success. However, pharmacological agents differ in their efficacy and safety profiles, and the optimal agent to balance these outcomes remains uncertain, creating challenges in clinical decision-making. Therefore, we conducted a network meta-analysis to comprehensively evaluate and compare the efficacy and safety of various pharmacological agents. METHODS: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to April 10, 2025. Randomised controlled trials (RCTs) comparing at least two intravenous pharmacological agents in adult patients undergoing gastrointestinal endoscopy were included. Evidence quality was assessed using the Cochrane Risk of Bias 2.0 tool. Efficacy outcomes included sedation success rate and induction time; safety outcomes included time to full alertness, recovery time, and adverse events (hypoxia, hypotension, bradycardia, and postoperative nausea and vomiting [PONV]). A random-effects network meta-analysis was performed. Risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes were calculated, with 95% confidence intervals (CIs). Treatment rankings were presented using surface under the cumulative ranking (SUCRA) curves. The study protocol was registered with PROSPERO (CRD42024572207). FINDINGS: The network meta-analysis included 152 RCTs with 26,527 patients, evaluating 37 interventions. No regimen demonstrated statistically significant superiority over propofol-opioids in terms of sedation success, which remained the reference standard. However, Etomidate-opioids achieved the highest SUCRA ranking for sedation success (SUCRA = 84.5%) and performed favorably in bradycardia (SUCRA = 79.4%), time to full alertness (SUCRA = 65.3%), and recovery time (SUCRA = 82.8%). Notably, etomidate-opioids significantly reduced the risk of hypoxia compared with propofol-opioids (RR = 0.35, 95% CI 0.16, 0.79; SUCRA = 55.0%), but showed no significant differences in hypotension (SUCRA = 45.5%), bradycardia (SUCRA = 79.4%), time to full alertness (SUCRA = 65.3%), or recovery time (SUCRA = 82.8%). It was, however, associated with an increased the risk of PONV (RR = 2.61, 95% CI 1.13, 6.07, SUCRA = 29.4%). Esketamine-remimazolam demonstrated an excellent safety profile, significantly reducing the risk of hypotension (RR = 0.12, 95% CI 0.06, 0.27; SUCRA = 95.6%) and bradycardia (RR = 0.19, 95% CI 0.06, 0.55; SUCRA = 88.3%) and shortening time to full alertness compared with propofol-opioids (MD = -6.05 min, 95% CI -11.85, -0.24; SUCRA = 92.7%). However, its SUCRA ranking for sedation success was lower than that of etomidate-opioids (63.4% vs. 84.5%), with no statistically significant difference observed between esketamine-remimazolam and etomidate-opioids (RR = 1.29, 95% CI 0.68, 2.45). INTERPRETATION: Although no pharmacological regimen demonstrates superior sedation success compared with propofol-opioids, which serve as the standard comparator, etomidate-opioids regimens offer a favorable balance between sedation efficacy and safety, though they warrant attention due to an increased risk of PONV. Esketamine-remimazolam demonstrates superior hemodynamic stability and faster recovery but may be less effective in achieving sedation success. Midazolam-based regimens demonstrate lower efficacy and prolonged recovery and are therefore not recommended. FUNDING: None.

BACKGROUND: The risk of postoperative pulmonary complications is significantly increased in patients undergoing video-assisted thoracic surgical lobectomy. Individualized positive end-expiratory pressure (PEEP) is extensively employed to optimize respiratory mechanics and enhance oxygenation during one-lung ventilation (OLV). However, there is no consensus regarding the optimal level of positive end-expiratory pressure and its effects during OLV. Therefore, we designed a randomized controlled trial to assess whether titrating PEEP to the maximum dynamic lung compliance in patients undergoing lung resection surgery impacts the occurrence of postoperative pulmonary complications (PPCs). METHODS: In this randomized controlled trial, patients undergoing thoracoscopic lobectomy were randomly assigned to either a dynamic lung compliance group that received individualized PEEP guided by the maximum dynamic pulmonary compliance or a conventional ventilation group with a fixed PEEP of 5 cm H RESULTS: One hundred patients were enrolled. The optimal PEEP obtained in the dynamic lung compliance group was 9.04 ± 1.83 cm H CONCLUSIONS: In patients undergoing video-assisted thoracoscopic lobectomy for lung resection with maximum dynamic compliance-guided positive end-expiratory pressure (PEEP), the incidence of postoperative pulmonary complications (PPCs) within 7 days was significantly lower compared to those receiving a PEEP of 5 cm H TRIAL REGISTRATION: This study was registered at the Chinese Clinical Trials Registry on 04/07/2021 with registration number ChiCTR2100048201. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-025-03183-y.

OBJECTIVE: To examine whether regional anaesthesia (RA) versus general anaesthesia (GA) is associated with the one-year postoperative mortality among the older surgical patients. METHODS: We conducted a single-center retrospective cohort study from 2012 to 2016. Patients aged 70 years or older who underwent surgery were included, and those who underwent transplantation, burn surgery, or minor procedures were excluded. The primary exposure was anaesthesia type (RA vs. GA); the main outcome was one-year all-cause mortality, which was verified through hospital records and a national registry. Demographic, clinical, and laboratory variables were included as covariates. Multivariable-adjusted logistic regression models were used to evaluate the independent effect of anaesthesia methods on one-year mortality. Kaplan-Meier curves assessed survival rates by anaesthesia method, with log-rank tests comparing the curves. MAIN RESULTS: Among 16,599 older adults, 29.7% received RA. The one-year mortality rate was lower in the RA group (6.44%) than in the GA group (9.52%), yielding an adjusted odds ratio of 0.72 (95% CI, 0.63-0.82). K‒M analyses revealed improved survival in the RA group (log-rank P < 0.05). Propensity score matching and inverse probability weighting analyses corroborated these findings. The E-value of 2.12 demonstrates the robustness of the results against unmeasured confounding. CONCLUSIONS: Regional anaesthesia may be linked to better one-year survival in older patients. Although other confounding factors cannot be excluded, these findings underscore the need for multicenter, prospective investigations to inform perioperative decisions in geriatric populations.