Daily Anesthesiology Research Analysis
Across three rigorous trials, perioperative and pain management practices are directly informed. A multicenter RCT in Lancet found no benefit of evolocumab for 24‑month saphenous vein graft patency after CABG despite substantial LDL-C lowering. A double-blind RCT optimized pulsed radiofrequency duration at the dorsal root ganglion for lumbar radicular pain, and a randomized trial in cardiac surgery supports remimazolam as an effective sedative alternative to propofol.
Summary
Across three rigorous trials, perioperative and pain management practices are directly informed. A multicenter RCT in Lancet found no benefit of evolocumab for 24‑month saphenous vein graft patency after CABG despite substantial LDL-C lowering. A double-blind RCT optimized pulsed radiofrequency duration at the dorsal root ganglion for lumbar radicular pain, and a randomized trial in cardiac surgery supports remimazolam as an effective sedative alternative to propofol.
Research Themes
- Perioperative cardiovascular therapy and graft outcomes after CABG
- Optimization of neuromodulation parameters for chronic radicular pain
- Sedation strategy and safety in cardiac anesthesia
Selected Articles
1. Effect of evolocumab on saphenous vein graft patency after coronary artery bypass surgery (NEWTON-CABG CardioLink-5): an international, randomised, double-blind, placebo-controlled trial.
In 782 randomized CABG patients, evolocumab achieved a ~48% placebo-adjusted LDL-C reduction at 24 months but did not reduce the saphenous vein graft disease rate compared with placebo (21.7% vs 19.7%; p=0.44). The therapy was well tolerated. These findings indicate further LDL-C lowering does not meaningfully influence mechanisms driving early SVG failure.
Impact: A large multicenter double-blind RCT directly challenges the assumption that more intensive LDL lowering improves early SVG outcomes after CABG.
Clinical Implications: Do not expect early evolocumab initiation after CABG to improve 24‑month saphenous vein graft patency; prioritize other graft-protective strategies (surgical technique, conduit choice, antiplatelet therapy).
Key Findings
- Placebo-adjusted LDL-C reduction of 48.4% at 24 months with evolocumab.
- No reduction in 24‑month vein graft disease rate: 21.7% (evolocumab) vs 19.7% (placebo); p=0.44.
- Adverse event profiles were similar, indicating good tolerability.
Methodological Strengths
- International, multicenter, randomized double-blind, placebo-controlled design
- Objective imaging-based endpoint (CCTA or invasive angiography) with prespecified analysis
Limitations
- Primary outcome data available in a subset of randomized participants (modified ITT analysis)
- Trial powered for graft disease rate, not for clinical events
Future Directions: Investigate non-lipid mechanisms of early SVG failure (e.g., intimal hyperplasia, thrombosis, graft handling) and evaluate targeted interventions beyond LDL lowering.
2. Efficacy of pulsed radiofrequency treatment duration to the lumbar dorsal root ganglion in lumbar radicular pain: a double-blind randomized controlled trial.
In 60 patients with unilateral lumbar radicular pain, 6-minute DRG pulsed radiofrequency produced the most consistent, statistically significant pain and disability improvements versus 4 minutes at 6 months. Eight minutes showed additional subjective benefits (GPE) and per-protocol pain advantages. PRF was safe and well tolerated.
Impact: Provides parameter-level optimization from a double-blind RCT, directly translatable to procedural pain practice.
Clinical Implications: Adopt a 6-minute PRF duration for DRG targeting in lumbar radicular pain as a clinical standard; consider 8 minutes in selected patients prioritizing subjective benefit while balancing procedure time.
Key Findings
- Six-minute PRF reduced pain more than 4 minutes at 6 months (mean difference −1.35 NRS; p=0.031).
- All groups improved over time in NRS and ODI; 8 minutes showed lowest ODI and significant GPE improvement within-group.
- Per-protocol analysis confirmed superior pain reduction for 6 and 8 minutes versus 4 minutes.
Methodological Strengths
- Double-blind randomized controlled design with ITT and per-protocol analyses
- Multiple clinically relevant endpoints (pain, disability, global perceived effect) with 6-month follow-up
Limitations
- Modest sample size limits subgroup analyses and precision
- Single-condition focus; generalizability to other radicular levels or etiologies uncertain
Future Directions: Evaluate durability beyond 6 months, cost-effectiveness, and patient selection criteria for choosing 6 vs 8 minutes (e.g., baseline pain severity, sensory profiles).
3. Remimazolam besylate versus propofol as sedative agents in cardiac surgery: A randomized noninferiority clinical trial.
In 318 analyzed elective cardiac surgery patients on CPB, remimazolam achieved a significantly higher protocol-defined sedation success rate than propofol (99.4% vs 82.3%; absolute difference 17.1%, p<0.001), meeting noninferiority. Recovery metrics and ICU/hospital length of stay were comparable.
Impact: First randomized evidence in cardiac anesthesia indicating remimazolam can reliably maintain intraoperative sedation targets with high success.
Clinical Implications: Remimazolam is a viable alternative to propofol for CPB cardiac surgery sedation, potentially offering more consistent target BIS maintenance without prolonging extubation or LOS.
Key Findings
- Protocol-defined sedation success was higher with remimazolam (99.4%) vs propofol (82.3%); absolute difference 17.1% (95% CI 11.6–23.9), p<0.001.
- No significant differences in time to BIS <60, extubation time, ICU stay, or hospital stay.
- Vasoactive use during induction and BIS variation after withdrawal were similar.
Methodological Strengths
- Randomized noninferiority design with prespecified BIS-targeted primary endpoint
- Complete trial completion with high analyzable rate (318/320)
Limitations
- Single-country, relatively short perioperative follow-up limits assessment of rare adverse events
- Sedation success defined by BIS may not capture all clinically relevant aspects (e.g., hemodynamic stability, awareness)
Future Directions: Compare hemodynamic profiles and safety (e.g., hypotension, bradycardia) head-to-head; evaluate outcomes in higher-risk subgroups and assess cost-effectiveness.