Daily Anesthesiology Research Analysis
A multicenter randomized trial found that an ACT target ≥400 s during cardiopulmonary bypass is equivalent to ≥480 s for transfusion, with slightly less early bleeding and no increase in thromboembolism. An international consensus defined core outcome sets for pediatric perioperative research to standardize patient-centered outcomes. A randomized non-inferiority trial showed the intertruncal supraclavicular block did not meet non-inferiority versus the classical approach and had more hemidiaphra
Summary
A multicenter randomized trial found that an ACT target ≥400 s during cardiopulmonary bypass is equivalent to ≥480 s for transfusion, with slightly less early bleeding and no increase in thromboembolism. An international consensus defined core outcome sets for pediatric perioperative research to standardize patient-centered outcomes. A randomized non-inferiority trial showed the intertruncal supraclavicular block did not meet non-inferiority versus the classical approach and had more hemidiaphragmatic paresis.
Research Themes
- Perioperative anticoagulation targets during cardiopulmonary bypass
- Standardization of pediatric perioperative outcomes
- Comparative effectiveness of regional anesthesia techniques
Selected Articles
1. Comparison of Two Activated Clotting Time Targets During Cardiac Surgery With Cardiopulmonary Bypass: A Prospective Multicenter Randomized Controlled Trial.
In a multicenter equivalence RCT (n=1,021), targeting ACT ≥400 s during CPB was equivalent to ≥480 s for intra/postoperative PRBC transfusions. The lower ACT group had modestly less blood loss at 6 and 24 hours and slightly higher early hemoglobin without clinically meaningful differences; thromboembolic events were similar.
Impact: Defines a lower, equally safe anticoagulation target during CPB with potential to reduce bleeding without increasing thrombotic risk, informing perfusion and anesthesia protocols.
Clinical Implications: Programs can consider adopting an ACT target ≥400 s during CPB to potentially reduce early bleeding while maintaining safety, with local validation and oversight by cardiac anesthesia-perfusion teams.
Key Findings
- PRBC transfusion rates were equivalent between ACT ≥400 s and ≥480 s groups (19.1% vs 17.2%).
- Lower ACT was associated with reduced blood loss at 6 h (median 260 vs 300 mL, p=0.003) and 24 h (480 vs 550 mL, p=0.007).
- Early postoperative hemoglobin was slightly higher in the lower ACT group without clear clinical relevance.
- Thromboembolic event rates were similar in both groups.
Methodological Strengths
- Prospective multicenter randomized single-blind equivalence design with large sample size (n=1,021).
- Predefined clinically relevant secondary endpoints with standardized measurements.
Limitations
- Single-blind design; potential performance bias cannot be fully excluded.
- Small absolute differences in bleeding and hemoglobin limit clinical interpretability for individual patients.
Future Directions: Evaluate protocolized heparin management incorporating ACT ≥400 s across diverse populations and centers, and explore cost-effectiveness and interactions with antifibrinolytic strategies.
2. Core Outcome Sets for Pediatric Perioperative Research: An International Stakeholder Engagement Exercise and Consensus Report from the Pediatric Perioperative Outcomes Group.
Through international stakeholder surveys (n=1,178) and a Delphi consensus (n=67), core outcome sets were established for neonates, infants, children, and adolescents in perioperative research. Common core outcomes included cardiovascular/respiratory adverse events, pain and its relief assessment, and unplanned medical attention; quality of recovery (except neonates) and return to normal function (adolescents) were also identified.
Impact: Provides a standardized, patient-centered framework for outcome reporting in pediatric perioperative trials, improving comparability and relevance of future research.
Clinical Implications: Investigators should incorporate these core outcomes into trial designs and registries to ensure comparability and patient-relevant reporting, alongside condition-specific endpoints.
Key Findings
- International survey included 1,178 stakeholders across 9 countries (patients, parents/guardians, and clinicians).
- Two-round Delphi with 67 expert stakeholders achieved unanimous agreement on core sets for 4 pediatric age groups.
- Core outcomes across all ages: cardiovascular/respiratory adverse events, pain, assessment of pain relief, and unplanned medical attention.
- Quality of recovery was included for all but neonates; return to normal function was included for adolescents.
Methodological Strengths
- COMET-guided, multi-stakeholder international process with both public and professional input.
- Structured Delphi methodology with consensus confirmation via face-to-face virtual meetings.
Limitations
- Representativeness may be limited by regional recruitment and stakeholder composition.
- Adoption and implementation across diverse healthcare systems remain to be demonstrated.
Future Directions: Prospective validation of core outcome feasibility across settings, development of age-appropriate measurement instruments, and integration into registries and trial protocols.
3. Intertruncal versus classical approach to supraclavicular brachial plexus block on sensory-motor blockade for upper extremity surgery: a randomized controlled non-inferiority trial.
In a randomized non-inferiority trial (n=122), the intertruncal supraclavicular block did not achieve non-inferiority to the classical approach for complete sensory blockade at 20 minutes. IA-SCB had inferior musculocutaneous blockade, longer performance time, and higher hemidiaphragmatic paresis.
Impact: Clarifies limitations and potential respiratory side effects of the intertruncal approach, guiding technique selection and training for supraclavicular blocks.
Clinical Implications: Prefer the classical supraclavicular approach when rapid, reliable onset and minimizing hemidiaphragmatic paresis are priorities; if using IA-SCB, anticipate longer setup and consider diaphragmatic function.
Key Findings
- Complete sensory blockade at 20 min: 79.3% (CA-SCB) vs 72.7% (IA-SCB); non-inferiority not met (margin −5%, estimate −6.6%).
- IA-SCB resulted in inferior musculocutaneous nerve blockade.
- IA-SCB had longer performance time than CA-SCB.
- Higher incidence of hemidiaphragmatic paresis with IA-SCB.
Methodological Strengths
- Randomized controlled non-inferiority design with standardized local anesthetic dosing and assessment intervals.
- Comprehensive evaluation across terminal nerves and diaphragmatic function.
Limitations
- Single-center design and modest sample size may limit power for non-inferiority margins.
- Assessment limited to 30 minutes post-block; longer-term block quality and analgesia were not studied.
Future Directions: Larger multicenter trials with patient-centered outcomes (e.g., analgesia duration, respiratory function) and technique refinements to reduce diaphragmatic paresis in IA-SCB.