Daily Anesthesiology Research Analysis
Today’s top anesthesiology research includes: a multicenter stepped-wedge randomized trial showing targeted normoxemia safely reduces hyperoxemia without increasing hypoxemia in burn units; a double-blind RCT identifying a balanced remimazolam–remifentanil regimen for awake fiberoptic intubation; and a randomized trial demonstrating a motion sickness patch halves PONV risk in female thyroid surgery despite dual antiemetic prophylaxis.
Summary
Today’s top anesthesiology research includes: a multicenter stepped-wedge randomized trial showing targeted normoxemia safely reduces hyperoxemia without increasing hypoxemia in burn units; a double-blind RCT identifying a balanced remimazolam–remifentanil regimen for awake fiberoptic intubation; and a randomized trial demonstrating a motion sickness patch halves PONV risk in female thyroid surgery despite dual antiemetic prophylaxis.
Research Themes
- Perioperative oxygen management and safety
- Sedation strategies for awake fiberoptic intubation
- Enhanced PONV prevention in high-risk thyroid surgery
Selected Articles
1. Effect of targeting normoxemia on supplemental oxygen-free days for adults with acute thermal burns: A stepped wedge cluster randomized clinical trial.
In a multicenter stepped-wedge RCT across six US burn centers (n=1,437), targeting SpO2 90–96% increased time in normoxemia (77%→81%), reduced hyperoxemia (22%→17%), and did not increase hypoxemia (0.7% vs 0.8%). The strategy did not significantly increase oxygen-free days by day 28 but maintained safety and slightly improved hospital-free days to day 90.
Impact: This is a large, pragmatic, multicenter randomized evaluation of oxygen titration strategy specific to burn care, addressing a ubiquitous yet under-tested practice with safety endpoints.
Clinical Implications: Adopting a normoxemia target (SpO2 90–96%) in burn ICUs appears safe, reduces hyperoxemia exposure, and can be implemented without increasing hypoxemia; protocols should emphasize de-escalating FiO2 when SpO2 exceeds 96%.
Key Findings
- Time in normoxemia increased from 77% (usual care) to 81% (targeted normoxemia).
- Hyperoxemia exposure decreased from 22% to 17%; hypoxemia remained similar (0.7% vs 0.8%).
- No significant increase in supplemental oxygen–free days by day 28 (aMD 0.90 days; 95% CI -0.77 to 2.57; p=0.29).
- Hospital-free days to day 90 improved (aMD 3.47 days; 95% CI 0.19–6.76) with maintained safety.
Methodological Strengths
- Multicenter stepped-wedge cluster randomized design with pragmatic implementation
- Large sample size (n=1,437) with prespecified safety outcomes
Limitations
- Primary outcome (oxygen-free days) not significantly improved
- Potential for temporal and cluster effects inherent to stepped-wedge design; blinding not feasible
Future Directions: Evaluate patient-centered outcomes (e.g., wound healing, pulmonary complications), protocol adherence metrics, and cost-effectiveness; test normoxemia targeting in broader surgical/ICU populations.
2. Efficacy and safety of remimazolam combined with remifentanil for sedation during awake fiberoptic intubation: a randomized controlled trial.
In a five-arm, double-blind RCT (n=150), remimazolam (0.2–0.6 mg/kg/h) plus remifentanil 0.05 mcg/kg/min provided effective AFOI sedation in patients with normal airways. Deep sedation occurred with remimazolam alone and higher remimazolam combination doses (0.4–0.6 mg/kg/h), supporting 0.2 mg/kg/h as the optimal balance between efficacy and safety.
Impact: Provides dose-ranging, controlled evidence for a rapidly adopted sedative (remimazolam) in the high-stakes setting of awake fiberoptic intubation, informing safety thresholds.
Clinical Implications: For AFOI, consider remimazolam 0.2 mg/kg/h plus remifentanil 0.05 mcg/kg/min to minimize deep sedation while maintaining procedural conditions; avoid higher remimazolam infusion rates that increase oversedation risk.
Key Findings
- Five-arm double-blind RCT with 150 patients compared remimazolam and remifentanil dosing for AFOI.
- Deep sedation occurred in remimazolam alone and higher-dose combinations: 3.3% (Rm), 17.2% (RR0.4), 50.0% (RR0.6).
- Remimazolam 0.2 mg/kg/h plus remifentanil 0.05 mcg/kg/min balanced efficacy and safety best.
Methodological Strengths
- Prospective, double-blind randomized controlled design
- Dose-ranging, multi-arm comparison with standardized topical anesthesia
Limitations
- Population limited to patients with normal airways; generalizability to difficult airways is uncertain
- Primary outcome focused on depth of sedation; limited reporting on procedural success metrics
Future Directions: Assess performance in difficult airways, incorporate patient-centered outcomes (comfort, recall), and compare against alternative regimens (e.g., dexmedetomidine-based protocols).
3. Effects of motion sickness patch on postoperative nausea and vomiting in female patients undergoing thyroid surgery: a randomized clinical trial.
In 162 female thyroid surgery patients receiving standard antiemetic prophylaxis, adding a motion sickness patch reduced 24-hour PONV from 34.6% to 18.5% (RR 0.536; 95% CI 0.310–0.925). This supports multimodal PONV prophylaxis that includes a transdermal anticholinergic-type intervention in high-risk settings.
Impact: Demonstrates incremental benefit of a motion sickness patch on top of dual prophylaxis in a homogeneous, high-risk surgical population, providing directly actionable prevention data.
Clinical Implications: For high-risk female thyroidectomy patients, consider adding a motion sickness patch to dexamethasone and palonosetron to further reduce PONV within 24 hours.
Key Findings
- Randomized trial in 162 female thyroid surgery patients on standard dual antiemetic prophylaxis.
- PONV within 24 hours reduced from 34.6% (control) to 18.5% (patch); RR 0.536 (95% CI 0.310–0.925; p=0.021).
- Secondary outcomes were collected (QoR-15, pain, sedation, GI recovery, adverse events), supporting comprehensive assessment.
Methodological Strengths
- Randomized allocation with standardized baseline prophylaxis
- Clinically meaningful, prespecified primary endpoint (24-hour PONV incidence)
Limitations
- Single surgical population (female thyroidectomy) may limit generalizability
- Limited reporting of secondary outcomes and adverse event profiles in the abstract
Future Directions: Validate in mixed-sex, diverse surgical populations; assess optimal timing and duration of patch use and interaction with other antiemetics; evaluate cost-effectiveness.