Daily Anesthesiology Research Analysis

BACKGROUND: Intraoperative neuromonitoring (IONM) is a critical adjunct in thyroid surgery to preserve recurrent laryngeal nerve (RLN) function. This study aims to evaluate whether tracheal intubation in the thyroid surgical position enhances IONM signal quality compared to the standard supine position. METHODS: In this dual-centre, parallel-group, randomised trial, 184 adults scheduled for elective thyroidectomy requiring IONM were allocated 1:1 to intubation in either the thyroid surgical position or the conventional supine position. The modified intention-to-treat cohort comprised 167 participants (85 vs 82) with an assessable baseline vagus response (V1). The primary outcome was the incidence of satisfactory electromyography (EMG) signals, defined as an initial vagus nerve EMG amplitude exceeding 500 μV when stimulated at 1.0 mA. Secondary outcomes included EMG signal amplitude, intubation-related metrics (e.g., Cormack-Lehane grades, intubation difficulty scale scores, intubation time, and depth of intubation), postoperative complications (e.g., lip lesions, dental injury, postoperative nausea and vomiting, dizziness, and headache), and clinician satisfaction with patient positioning and mask ventilation. RESULTS: Satisfactory V1 signals occurred in 82/85 patients (96.47 %) in the thyroid-surgical-position group versus 70/82 (85.37 %) in the supine group (relative risk 1.13; 95 % CI 1.03-1.24; P = 0.0145). Intubation time and Cormack-Lehane grades did not differ significantly, but the Thyroid Surgical Position Group required deeper EMG tube insertion (22 cm [21-23] vs. 22 cm [21-22]; median differences 1.1, 95% CI 0-1; P = 0.046). Postoperative complications did not differ significantly between groups (all P > 0.05). Clinician satisfaction scores were significantly higher in the Thyroid Surgical Position Group (median 9 vs. 5; median differences 4, 95% CI 3-4; P < 0.0001). Mask ventilation satisfaction was also rated higher in the Thyroid Surgical Position Group (median 9 vs. 8; median differences 1, 95% CI 0-1 P < 0.0001). CONCLUSIONS: Tracheal intubation in the thyroid surgical position significantly improves IONM signal quality and clinician satisfaction without increasing intubation difficulty or postoperative complications. Adopting this simple positioning strategy can optimise EMG tube placement and enhance the reliability of IONM during thyroid surgery.

BACKGROUND: Effective pain management during peripherally inserted central catheter placement in neonates and pediatric patients remains challenging, often leading to procedural distress and suboptimal outcomes. AIM: This randomized controlled trial aimed to evaluate the analgesic efficacy of brachial plexus block compared to local infiltration anesthesia during peripherally inserted central catheter placement. METHODS: Seventy patients were randomized into two groups: brachial plexus block (Group B) and local infiltration anesthesia (Group C). Procedural pain was assessed using the Comfort Neo Scale at T = 0 min (puncture) and T = 30 min (30 min after the procedure). Secondary outcomes included the first-attempt success rate, procedure time, number of puncture attempts, and rescue analgesic use. All interventions were performed under ultrasonographic guidance. Continuous data are expressed as medians [interquartile range (IQR)]. RESULTS: The median Comfort Neo Scale scores at T = 0 were significantly lower in Group B (6 [6-6]) than in Group C (30 [30-30]; difference: -24, 95% CI: -24 to -24, p < 0.0001). At T = 30, the scores remained lower in Group B (6 [6-6]) than in Group C (22 [12-30]; difference: -16, 95% CI: -19 to -10, p < 0.0001). Group B also demonstrated shorter procedure times (30 [20-30] vs. 40 [30-50] min; difference: -10 min, 95% CI: -20 to -10, p < 0.0001), higher first-attempt success rates (61% vs. 38%; odds ratio: 0.08, 95% CI: 0.03-0.26, p < 0.0001), and fewer puncture attempts (1 [1-2] vs. 2 [1-3]; difference: -1, 95% CI: -2 to 0, p < 0.001). Rescue analgesic use and pain-related movements were significantly reduced in Group B (odds ratio for pain-related movement: ∞, 95% CI: 109-∞, p < 0.0001). CONCLUSIONS: Brachial plexus block provides superior pain relief and procedural outcomes compared to local infiltration anesthesia during peripherally inserted central catheter placement in neonates and pediatric patients. Its adoption as a standard pain management approach can enhance patient comfort, improve efficiency, and reduce procedural distress. Future studies should explore the broad applicability and long-term benefits of this approach. TRIAL REGISTRATION: Japan Registry of Clinical Trials (jRCT): jRCT1010220045.

PURPOSE: To evaluate whether combining ciprofol and remimazolam offers superior safety and efficacy compared to propofol or ciprofol monotherapy for sedation during painless gastroscopy. We hypothesize improved hemodynamic and respiratory stability with the combination. METHODS: A total of 641 patients undergoing gastroscopy were randomly assigned to one of three groups. Group P (Propofol) received an intravenous bolus of propofol at a dose of 1.5 mg/kg. Group CR (Ciprofol + Remimazolam) received an initial intravenous dose of remimazolam (0.08 mg/kg), followed by ciprofol (0.25 mg/kg). Group C (Ciprofol) received an intravenous bolus of ciprofol at a dose of 0.4 mg/kg. Sedation depth was maintained within the target range (Bispectral Index 40-60) through the administration of supplemental doses: propofol (10-20 mg boluses) in Group P, and ciprofol (2.5-5 mg boluses) in Groups CR and C. RESULTS: Compared with group P, groups CR and C demonstrated significantly lower incidences of hypotension (CR: 7.8% vs P: 21.6%; C: 12.3% vs P: 21.6%; all CONCLUSION: The combination of ciprofol and remimazolam exerts a lesser impact on the respiration and circulation of patients undergoing gastroscopy, and demonstrates superior safety and efficacy compared to the use of propofol or ciprofol alone.