Daily Anesthesiology Research Analysis
Three studies with direct relevance to anesthesiology stand out today: a randomized non-inferiority trial shows remimazolam is comparable to propofol for postoperative delirium and early recovery in older gastrectomy patients; a meta-analysis of 26 RCTs suggests intravenous anesthesia reduces intraoperative bleeding and operative time in endoscopic sinus surgery; and a 155,604-encounter multicenter analysis quantifies pediatric induction anxiety patterns and the effect of premedication.
Summary
Three studies with direct relevance to anesthesiology stand out today: a randomized non-inferiority trial shows remimazolam is comparable to propofol for postoperative delirium and early recovery in older gastrectomy patients; a meta-analysis of 26 RCTs suggests intravenous anesthesia reduces intraoperative bleeding and operative time in endoscopic sinus surgery; and a 155,604-encounter multicenter analysis quantifies pediatric induction anxiety patterns and the effect of premedication.
Research Themes
- Perioperative neurocognition and hypnotic choice in older adults
- Anesthesia technique and surgical field bleeding in endoscopic sinus surgery
- Pediatric induction anxiety epidemiology and targeted anxiolysis
Selected Articles
1. Incidence of postoperative delirium and quality of recovery in older patients undergoing gastrectomy under general anaesthesia with remimazolam vs. propofol: a randomised non-inferiority study.
In older adults undergoing gastrectomy, remimazolam was non-inferior to propofol for postoperative delirium (7.9% in both groups) and 24-hour quality of recovery. Findings support remimazolam as a viable maintenance hypnotic alternative in this population.
Impact: High-quality randomized evidence directly informs hypnotic choice for older surgical patients, addressing delirium risk—a key perioperative outcome. It provides practice-ready data comparing a newer agent to standard care.
Clinical Implications: Remimazolam can be considered for maintenance anesthesia in older patients without increasing delirium risk, allowing clinicians to prioritize hemodynamic stability and workflow while expecting similar early recovery.
Key Findings
- Postoperative delirium incidence within 72 hours was identical with remimazolam and propofol (7.9% each; OR 1.00, 95% CI 0.50–2.02).
- Quality of recovery at 24 hours (QoR-15) was similar between groups (median 109 in both).
- No differences in postoperative nausea, retching, or vomiting were reported between groups.
Methodological Strengths
- Randomized, non-inferiority design with prespecified outcomes (CAM for delirium, QoR-15).
- Adequate sample size with balanced groups (n=216 per arm) and rigorous statistical analyses.
Limitations
- Single surgical category (gastrectomy) and single-country context may limit generalizability.
- Short follow-up (72-hour delirium, 24-hour QoR) without longer-term cognitive outcomes.
Future Directions: Assess broader surgical populations and longer-term neurocognitive outcomes; explore dosing strategies and hemodynamic benefits in frail and high-risk cohorts.
2. Effects of different anesthesia methods on bleeding and prognosis in endoscopic sinus surgery: a meta-analysis and systematic review of randomized controlled trials.
Across 26 RCTs (n=1472), intravenous anesthesia (commonly TIVA) was associated with reduced intraoperative bleeding and shorter operative time compared with inhalational anesthesia during endoscopic sinus surgery. Postoperative complications were broadly comparable, supporting individualized selection with consideration of surgical field quality.
Impact: Synthesizing randomized evidence on a common ENT procedure provides practical guidance on anesthesia technique to improve surgical field and efficiency.
Clinical Implications: Consider propofol-based TIVA to reduce bleeding and potentially improve visualization and efficiency in endoscopic sinus surgery, while tailoring to comorbidities and institutional protocols.
Key Findings
- Intravenous anesthesia reduced intraoperative blood loss versus inhalational anesthesia (SMD 0.69; 95% CI 0.21–1.18; P=0.005).
- Operation time favored intravenous anesthesia.
- Postoperative adverse events (nausea/vomiting/pain) were generally comparable between techniques.
Methodological Strengths
- Prospectively registered protocol (PROSPERO) and inclusion of only randomized controlled trials.
- Multiple databases searched with predefined outcomes and standardized effect estimates.
Limitations
- Heterogeneity across trials (e.g., anesthetic regimens, surgical techniques) likely high; exact I2 not fully reported in abstract.
- Potential publication bias and variability in outcome definitions across studies.
Future Directions: Head-to-head standardized TIVA versus specific inhalational protocols with surgeon-blinded bleeding scales and cost-effectiveness analyses.
3. Population-based incidence of anxiety-related behaviours during induction of general anaesthesia in children and efficacy of anxiolytic interventions: an international multicentre retrospective observational study.
In 155,604 pediatric anesthesia encounters, difficult induction occurred in 6.2% and anxiety behaviors in 22.2%, peaking in 1–3-year-olds. Premedication was associated with fewer difficult inductions, suggesting targeted anxiolysis for toddlers while recognizing many children proceed without intervention.
Impact: Provides real-world, population-scale estimates of induction anxiety and identifies high-risk age windows, informing resource allocation and targeted premedication strategies.
Clinical Implications: Prioritize non-pharmacologic support and consider premedication for toddlers (1–3 years), where anxiety and difficult mask acceptance are highest; tailor interventions rather than routine universal premedication.
Key Findings
- Difficult induction incidence 6.2% overall, peaking at 11.5% in children aged 1–3 years.
- Anxiety-related behaviors occurred in 22.2% overall, 40.8% in 1–3-year-olds.
- Premedication was associated with decreased difficult induction (adjusted OR 0.78; 95% CI 0.73–0.84).
Methodological Strengths
- Large multicenter dataset (n=155,604) with standardized behavioral assessment tools.
- Age-stratified analyses enabling identification of high-risk groups.
Limitations
- Retrospective design with potential confounding and documentation bias.
- Incomplete detail on specific pharmacologic regimens, dosing, and non-pharmacologic interventions.
Future Directions: Prospective studies to test tailored anxiolysis bundles (behavioral plus pharmacologic) in toddlers and evaluate downstream outcomes (PACU agitation, PACU length of stay).