Daily Anesthesiology Research Analysis

OBJECTIVES: The present study was designed to investigate the equivalence of two target activated clotting time (ACT) values with regard to packed red blood cell (PRBC) transfusion in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Secondary endpoints include postoperative blood loss, transfusion of other blood products, and postoperative laboratory parameters, including renal function, intensive care unit length of stay, postoperative thrombotic events, and other adverse events. DESIGN: Multicenter, randomized, single-blind, controlled equivalence trial. Patients were randomized to a lower target ACT of ≥400 seconds or a higher target ACT of ≥480 seconds. SETTING: Three tertiary and one university medical center in the Netherlands. PARTICIPANTS: 1,021 patients ≥18 years of age scheduled for first-time elective cardiac surgery with CPB between November 2019 and December 2023. MEASUREMENTS AND MAIN RESULTS: PRBC transfusion was equivalent in both ACT groups (19.1% v 17.2% risk difference -0.029; 0.066). In the low ACT group, blood loss at 6 and 24 hours postoperative was significantly lower (median [interquartile range], 260 [245] v 300 [250] mL, p = 0.003 and 480 [363] v 550 [410] mL, p = 0.007) and the hemoglobin level at 6 hours and 1 day after surgery significantly higher (mean [95% confidence interval], 11.8 [11.6-11.9] v 11.6 [11.3-11.8] g/dL, p = 0.017 and 11.4 [11.1-11.6] v 11.1 [11.0-11.4] g/dL, p = 0.045) compared with the high ACT group, but lacking clinical relevance. The frequency of thromboembolic events was similar in both groups. CONCLUSIONS: This study showed that a target ACT of ≥400 seconds is equivalent to a target ACT of ≥480 seconds in terms of intraoperative and postoperative PRBC transfusion rates in the modern cardiac surgery setting. This target range is considered comparable regarding the outcomes of patients undergoing cardiac surgery with CPB.

BACKGROUND: Identifying the outcomes that matter in clinical research is important, especially those that matter to patients and their parents/guardians. Consistency in outcome reporting enables meaningful assessments of interventions and facilitates comparison of results across trials. The aim of this study was to develop core outcome sets for pediatric perioperative research. METHODS: The authors determined core outcome sets through extensive stakeholder engagement, following a stepwise process as recommended by the Core Outcome Measures in Effectiveness Trials (COMET) initiative. They surveyed patients, parents/guardians, and healthcare providers to elicit views on the importance of perioperative outcomes. These results informed a subsequent Delphi process of expert stakeholder representatives. Final core outcome sets were agreed to after virtual face-to-face meetings of the investigators. RESULTS: A total of 1,178 total subjects were included in the international stakeholder survey: 81 patients ages 8 to 12 yr, 99 patients ages 13 to 17 yr, 587 parents/guardians, and 411 healthcare providers (128 nurses, 147 anesthesiologists, and 136 surgeons). Subjects were recruited in Australia, Canada, China, Colombia, the Netherlands, New Zealand, South Africa, Switzerland, and the United States. Sixty-seven expert stakeholders completed a two-round Delphi, including 7 patient family representatives, 9 surgeons, 7 nurses, and 44 anesthesiologists. Proposed core outcome sets were voted on and unanimously agreed to after the virtual face-to-face meetings for the following populations: neonates, infants, children ages 1 to 12 yr, and adolescents ages 13 to 17 yr. Core outcomes for all populations included cardiovascular or respiratory adverse events, pain, assessment of pain relief, and unplanned medical attention. Quality of recovery was included in all but the neonate population, while return to normal function was also included in the adolescent population. CONCLUSIONS: The authors identified perioperative core outcome sets for four age-based pediatric populations. Researchers should include these outcomes in their studies whenever appropriate, in addition to the outcomes specific to their research question.

BACKGROUND: As the characteristics of the intertruncal approach to the supraclavicular block (IA-SCB) are uncertain, we aimed to compare its effect on sensory-motor blockade with that of the classical approach (CA) within 30 min post-block. METHODS: In total, 122 patients undergoing elbow, forearm, wrist, or hand surgery were randomly assigned to receive CA-SCB or IA-SCB. Both groups received identical local anesthetic agents (1% lidocaine and 0.5% ropivacaine) in 25 ml total. The IA-SCB group received 15 ml between the middle and inferior trunks and 10 ml between the superior and middle trunks, while the CA-SCB group received 15 ml in the corner pocket and 10 ml in the center of the neural clusters. Sensory-motor blockade of all four terminal nerves was assessed every 5 min for 30 min. The non-inferiority threshold aimed to exclude the possibility that the IA-SCB was > 5% inferior to the CA-SCB in terms of the proportion of patients with complete sensory blockade at 20 min post-block. RESULTS: Complete sensory blockade at 20 min post-block was 79.3% and 72.7% with the CA-SCB and IA-SCB, respectively, exceeding the non-inferiority margin of -5% (-6.6%, 95% CI [-22.3% to 9.1%]; P value for non-inferiority = 0.206). Additionally, the IA-SCB showed an inferior musculocutaneous nerve blockade, longer performance time, and higher incidence of hemidiaphragmatic paresis. CONCLUSIONS: Our findings do not confirm the non-inferiority of the IA-SCB to the CA-SCB in achieving complete sensory blockade at 20 min post-block. Further research may be necessary to establish its efficacy in regional anesthesia.