Daily Anesthesiology Research Analysis
A multicenter randomized trial showed a nasal mask oxygen kit significantly reduced hypoxia during sedated gastrointestinal endoscopy compared with a standard nasal cannula. A national US cohort (>5.5 million cases) linked postoperative delirium in older adults to markedly higher 30-day mortality and major complications, with substantial hospital-level variation. A propensity-matched registry study suggested perioperative dexmedetomidine use may be associated with increased locoregional recurren
Summary
A multicenter randomized trial showed a nasal mask oxygen kit significantly reduced hypoxia during sedated gastrointestinal endoscopy compared with a standard nasal cannula. A national US cohort (>5.5 million cases) linked postoperative delirium in older adults to markedly higher 30-day mortality and major complications, with substantial hospital-level variation. A propensity-matched registry study suggested perioperative dexmedetomidine use may be associated with increased locoregional recurrence and distant metastasis in oral cavity squamous cell carcinoma.
Research Themes
- Perioperative respiratory safety and monitoring
- Delirium and perioperative brain health quality improvement
- Oncologic implications of anesthetic drug choices
Selected Articles
1. Efficacy of a nasal mask oxygen kit versus regular nasal cannula in sedated gastrointestinal endoscopy: a multicentre, randomised clinical trial.
In 1,197 sedated endoscopy patients, a nasal mask oxygen kit significantly reduced hypoxia (12.5% vs 7.4%), subclinical respiratory depression, and overall adverse events compared with a nasal cannula, without increasing severe hypoxia. Findings support nasal mask oxygen delivery for ASA I/II patients receiving propofol–fentanyl sedation.
Impact: Large multicenter randomized data address a common and clinically important safety issue in procedural sedation, demonstrating a simple, implementable intervention that reduces hypoxia.
Clinical Implications: Consider adopting nasal mask oxygen delivery in sedated gastrointestinal endoscopy to reduce hypoxia and adverse events, especially in ASA I/II patients under propofol–fentanyl sedation. Incorporate device availability and staff training into endoscopy suite protocols.
Key Findings
- Hypoxia incidence reduced from 12.5% (nasal cannula) to 7.4% (nasal mask oxygen kit), p=0.003.
- Subclinical respiratory depression decreased (13% vs 9.4%, p=0.047).
- Total adverse events were lower with the nasal mask (27.5% vs 18.6%, p<0.001) without an increase in severe hypoxia.
Methodological Strengths
- Multicenter randomized design with a large sample size (n=1,197).
- Objective primary outcome (pulse oximetry-defined hypoxia).
Limitations
- Open-label design may introduce performance bias.
- Generalizability limited to ASA I/II patients and propofol–fentanyl sedation; device specifics may influence results.
Future Directions: Evaluate effectiveness in higher-risk populations (ASA III/IV), other sedation regimens, and cost-effectiveness; assess integration into endoscopy quality metrics.
OBJECTIVE: The incidence of hypoxia in painless gastrointestinal endoscopy is not negligible. A nasal mask oxygen kit may reduce the incidence of hypoxia compared with a regular nasal cannula. METHODS: This multi-centre, randomised, open-label clinical trial took place from 1 September 2022 to 6 June 2023 in three Chinese teaching hospitals. Participants were randomly assigned 1:1 to either the intervention or the control group. Before induction of anaesthesia, a nasal cannula was used in the control group, and a nasal mask oxygen kit was used in the intervention group. The primary outcome was hypoxia (peripheral capillary oxygen saturation (SpO RESULTS: Among the 1204 initially enrolled patients, 1197 completed the study, with 597 randomised to the nasal mask oxygen kit group and 600 to the control group. Compared with the control group, the nasal mask oxygen kit significantly reduced the incidence of hypoxia during gastrointestinal endoscopy under sedation (12.5% vs 7.4%; rate difference (RD) = 0.051; 95% CI 0.018 to 0.085; p=0.003), subclinical respiratory depression (13% vs 9.4%; RD = 0.036; 95% CI 0.0005 to 0.072; p=0.047) and total adverse events (27.5% vs 18.6%; RD = 0.089; 95% CI 0.042 to 0.137; p<0.001). There was no difference in the incidence of severe hypoxia (1.17% vs 0.7%; RD = 0.005; 95% CI -0.006 to 0.016; p>0.05). CONCLUSIONS: The nasal mask oxygen kit can decrease the incidence of hypoxia in patients with American Society of Anesthesiologists class I/II undergoing gastrointestinal endoscopy under propofol and fentanyl sedation. TRIAL REGISTRATION NUMBER: NCT05405530.
2. Postoperative Delirium in Older Adults Undergoing Noncardiac Surgery.
In >5.5 million noncardiac surgical admissions for patients ≥65 years, postoperative delirium occurred in 3.6% and was associated with 3.5-fold higher odds of death or major complications and 2.8-fold higher odds of 30-day mortality. Substantial hospital-level variation persisted after risk adjustment, identifying delirium as a quality improvement target.
Impact: Provides definitive, risk-adjusted national estimates linking delirium to mortality and complications at scale and reveals modifiable hospital-level variation, directly informing perioperative brain health initiatives.
Clinical Implications: Prioritize standardized delirium screening, prevention bundles, and accurate coding; benchmark hospital performance and incorporate delirium metrics into perioperative quality programs for older adults.
Key Findings
- Postoperative delirium incidence was 3.6% across 5,530,054 admissions.
- Delirium associated with higher odds of death or major complications (aOR 3.47) and 30-day mortality (aOR 2.77).
- Significant hospital-level variation in delirium incidence persisted after adjustment (median OR 1.53).
Methodological Strengths
- Extraordinary sample size with national coverage across 3,169 hospitals.
- Advanced multivariable and multilevel modeling to assess patient-level outcomes and hospital-level variation.
Limitations
- Retrospective design vulnerable to residual confounding.
- Reliance on screening/coding accuracy may misclassify delirium.
Future Directions: Prospective validation of delirium prevention pathways and hospital-level interventions; improve delirium detection and coding fidelity; evaluate resource allocation based on risk-adjusted benchmarks.
IMPORTANCE: Understanding the association of postoperative delirium with adverse outcomes and the hospital-level variation of postoperative delirium is important for efforts to improve perioperative brain health. OBJECTIVE: To examine (1) the association of postoperative delirium with 30-day mortality and complications and (2) hospital-level variation in postoperative delirium. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study examined hospitalizations among patients aged 65 years and older who underwent noncardiac surgery in US hospitals between January 1, 2017, and December 31, 2020. Data were analyzed between August 28, 2024, and April 10, 2025. EXPOSURE: Postoperative delirium. MAIN OUTCOMES AND MEASURES: The association of the composite of death and major complications with postoperative delirium was examined using multivariable logistic regression. Variability in the hospital incidence of postoperative delirium was evaluated using multilevel logistic regression analysis. RESULTS: Among 5 530 054 inpatient admissions for major noncardiac surgery in 3169 hospitals, the mean (SD) patient age was 74.7 (7.0) years, and 3 161 054 admissions (57.2%) were of female patients. The incidence of postoperative delirium was 3.6% (197 921 admissions). Compared with patients without postoperative delirium, patients with postoperative delirium were more likely to experience death or major complications (adjusted OR [aOR], 3.47; 95% CI, 3.41-3.53; P < .001), 30-day mortality (aOR, 2.77; 95% CI, 2.71-2.83; P < .001), and nonhome discharges (aOR, 3.96; 95% CI, 3.88-4.04; P < .001). Controlling for patient characteristics, the odds of postoperative delirium were higher for patients undergoing surgery in hospitals with a higher rate of postoperative delirium compared with hospitals with lower rates of postoperative delirium (median OR, 1.53; 95% CI, 1.50-1.56). CONCLUSIONS AND RELEVANCE: In this national retrospective cohort study of more than 5.5 million hospitalizations, older individuals undergoing major noncardiac surgery who experienced postoperative delirium had 3.5-fold higher odds of death or major complications, 2.8-fold higher odds of death, and 4.0-fold higher odds of nonhome discharge. There was substantial variation in the hospital rate of postoperative delirium after accounting for patient risk, which suggests that this complication may be an appropriate target for hospital efforts to improve perioperative brain health, provided that delirium screening and coding accuracy are improved.
3. Impact of perioperative dexmedetomidine on recurrence and survival outcomes in oral cavity squamous cell carcinoma.
In a propensity-matched cohort of 8,024 OCSCC patients, perioperative dexmedetomidine use was associated with higher risks of locoregional recurrence (aHR 1.67) and distant metastasis (aHR 1.30). While mechanistic pathways remain speculative, findings warrant caution and prospective validation.
Impact: Raises an important safety signal regarding a commonly used anesthetic adjunct in cancer surgery, potentially informing drug selection and perioperative oncologic strategies.
Clinical Implications: Exercise caution with routine perioperative DEX in OCSCC surgery; discuss alternatives and individualize use pending prospective trials. Multidisciplinary teams should consider potential oncologic risks when designing anesthetic plans.
Key Findings
- After 1:1 propensity score matching (n=8024), DEX exposure associated with increased locoregional recurrence (aHR 1.67, 95% CI 1.55–1.80).
- DEX exposure associated with increased distant metastasis (aHR 1.30, 95% CI 1.19–1.42).
- Associations persisted in multivariable Cox and competing risk analyses.
Methodological Strengths
- Large nationwide registry with rigorous 1:1 propensity score matching.
- Use of multivariable Cox models and competing risk analyses.
Limitations
- Observational design precludes causal inference; residual confounding possible.
- Details on dosing, timing, and concomitant anesthetic/oncologic therapies may be limited.
Future Directions: Prospective randomized trials to evaluate DEX’s oncologic safety; mechanistic studies on immune modulation and metastasis; stratified analyses to identify high-risk subgroups.
OBJECTIVES: To investigate the association between perioperative dexmedetomidine (DEX) use and oncological outcomes-including locoregional recurrence (LRR) and distant metastasis (DM)-in patients undergoing curative surgery for oral cavity squamous cell carcinoma (OCSCC). METHODS: This retrospective cohort study used data from the Taiwan Cancer Registry Database and included patients with stage I-IVB OCSCC who underwent curative surgery between 2007 and 2019. Patients were categorised by DEX exposure status and matched 1:1 using propensity score matching (PSM) based on key clinical and demographic variables. Cox proportional hazards models and competing risk analyses were used to estimate the association between DEX use and oncological outcomes. RESULTS: After PSM, 8024 patients (4012 per group) were included. Multivariable Cox regression showed that perioperative DEX use was significantly associated with increased risks of LRR (adjusted HR (aHR) 1.67; 95% CI 1.55 to 1.80; p<0.001) and DM (aHR 1.30; 95% CI 1.19 to 1.42; p<0.001). DISCUSSION: These findings suggest a potential oncological risk associated with perioperative DEX administration. Possible mechanisms include immune modulation and enhanced metastatic potential, as reported in preclinical studies. Further investigation is needed to clarify causal pathways and identify patient subgroups most affected. CONCLUSIONS: Perioperative DEX use is independently associated with increased risks of LRR and DM in OCSCC patients. These results underscore the importance of cautious perioperative management and the need for prospective validation in randomised clinical trials.