Daily Anesthesiology Research Analysis
Three high-impact anesthesiology studies stand out: a dual-centre randomized trial shows that intubation in the thyroid surgical position significantly improves intraoperative neuromonitoring reliability in thyroidectomy; a double-blind pediatric RCT demonstrates brachial plexus block markedly reduces pain and improves procedural efficiency during PICC placement; and a large randomized trial indicates ciprofol plus remimazolam yields safer hemodynamics than propofol for gastroscopy sedation.
Summary
Three high-impact anesthesiology studies stand out: a dual-centre randomized trial shows that intubation in the thyroid surgical position significantly improves intraoperative neuromonitoring reliability in thyroidectomy; a double-blind pediatric RCT demonstrates brachial plexus block markedly reduces pain and improves procedural efficiency during PICC placement; and a large randomized trial indicates ciprofol plus remimazolam yields safer hemodynamics than propofol for gastroscopy sedation.
Research Themes
- Airway and neuromonitoring optimization in thyroid surgery
- Pediatric regional anesthesia for procedural pain control
- Sedation pharmacology: hemodynamic safety of novel agent combinations
Selected Articles
1. Tracheal intubation in the thyroid surgical position improves recurrent laryngeal nerve monitoring: a dual-centre randomised trial.
Intubating patients in the thyroid surgical position increased the proportion of satisfactory vagus nerve EMG signals (>500 μV) compared with standard supine intubation, without added complications or intubation difficulty. Clinician satisfaction and mask ventilation ratings were higher, suggesting a simple, scalable change to improve IONM reliability.
Impact: This pragmatic RCT provides actionable evidence that a minor positioning change enhances neuromonitoring fidelity in thyroidectomy, potentially reducing recurrent laryngeal nerve injury risk.
Clinical Implications: Adopt thyroid surgical positioning before EMG-tube intubation in thyroidectomy to improve IONM signal adequacy, with no trade-off in safety or intubation difficulty.
Key Findings
- Satisfactory V1 EMG signals were higher in the thyroid-position group: 96.47% vs 85.37% (RR 1.13; 95% CI 1.03–1.24; P=0.0145).
- No significant differences in intubation time or Cormack–Lehane grade between groups.
- Slightly deeper EMG tube insertion was required in the thyroid-position group; postoperative complications were similar.
- Clinician and mask ventilation satisfaction were significantly higher in the thyroid-position group.
Methodological Strengths
- Dual-centre, randomised, parallel-group design with modified intention-to-treat analysis.
- Predefined, objective EMG amplitude threshold for satisfactory signal; comprehensive perioperative outcomes.
Limitations
- Blinding was not feasible, potentially introducing performance bias.
- Generalizability may be limited to centres using standardized EMG tubes and IONM protocols.
Future Directions: Evaluate impacts on RLN injury rates and voice outcomes, and assess applicability across diverse devices and surgical teams in multicentre pragmatic trials.
2. Brachial Plexus Block Reduces Pain Scores During Peripherally Inserted Central Catheter Placement in Neonates and Pediatric Patients Compared to Local Infiltration Anesthesia: A Randomized, Double-Blind, Single-Center Study.
In a double-blind pediatric RCT, brachial plexus block dramatically reduced procedural pain during PICC placement versus local infiltration, with better first-pass success, fewer punctures, and shorter procedure time. Ultrasound guidance supported high efficacy and safety.
Impact: Provides high-quality evidence for adopting regional anesthesia to improve pain control and procedural outcomes for a common pediatric procedure.
Clinical Implications: Consider brachial plexus block (ultrasound-guided) as standard analgesia for pediatric PICC placement to reduce distress and enhance efficiency, with appropriate expertise and monitoring.
Key Findings
- Comfort Neo pain scores markedly lower with brachial plexus block at puncture (median 6 vs 30) and at 30 minutes (6 vs 22), both p<0.0001.
- Higher first-attempt success (61% vs 38%) and fewer puncture attempts (median 1 vs 2).
- Shorter procedure time (median 30 vs 40 minutes) and reduced rescue analgesic use and pain-related movement.
Methodological Strengths
- Randomized, double-blind design with clear primary and secondary outcomes.
- Ultrasound-guided techniques standardize block placement and enhance reproducibility.
Limitations
- Single-center study with modest sample size may limit generalizability.
- Short-term outcomes; long-term safety and feasibility across diverse settings not assessed.
Future Directions: Multicentre trials to confirm efficacy, assess block-related complications, and evaluate implementation frameworks in neonatal and pediatric settings.
3. Intravenous Anesthesia with Ciprofol and Remimazolam Besylate for Painless Gastroscopy: A Prospective, Single-Center, Randomized Controlled Trial.
Among 641 randomized patients, ciprofol plus remimazolam reduced hypotension compared with propofol, and ciprofol alone also showed benefit. BIS-guided sedation was achieved with fewer hemodynamic perturbations, suggesting a safer profile for endoscopic sedation.
Impact: Novel combination of two newer agents demonstrates improved hemodynamic safety over propofol for a ubiquitous procedure, supporting broader adoption of safer sedation regimens.
Clinical Implications: For routine gastroscopy, consider ciprofol plus remimazolam to mitigate hypotension while maintaining adequate sedation, particularly in patients at risk of hemodynamic instability.
Key Findings
- Ciprofol + remimazolam lowered hypotension incidence versus propofol (7.8% vs 21.6%); ciprofol alone also reduced hypotension (12.3% vs 21.6%).
- Target BIS 40–60 achieved with supplemental dosing while maintaining better hemodynamic stability.
- Safety and efficacy favored the combination over either monotherapy for painless gastroscopy.
Methodological Strengths
- Large randomized controlled trial (n=641) with BIS-guided sedation across three arms.
- Direct head-to-head comparison with propofol, the current standard, enhances clinical interpretability.
Limitations
- Single-center study; blinding status not clearly reported in the abstract.
- Abstract truncation limits visibility of full safety and respiratory outcomes.
Future Directions: Multicentre, blinded trials with comprehensive respiratory endpoints and high-risk subgroups to confirm safety and generalizability.