Daily Anesthesiology Research Analysis
Three studies stand out for anesthesiology: a multicenter randomized trial shows liposomal bupivacaine markedly improves pain control after hemorrhoidectomy vs ropivacaine; a prospective multicenter study demonstrates infratentorial ICP monitoring provides superior prognostic information in cerebellar stroke and proposes a simple predictive score; and a large prospective AI study enables real-time handheld ultrasound identification of cricothyrotomy landmarks, advancing airway safety.
Summary
Three studies stand out for anesthesiology: a multicenter randomized trial shows liposomal bupivacaine markedly improves pain control after hemorrhoidectomy vs ropivacaine; a prospective multicenter study demonstrates infratentorial ICP monitoring provides superior prognostic information in cerebellar stroke and proposes a simple predictive score; and a large prospective AI study enables real-time handheld ultrasound identification of cricothyrotomy landmarks, advancing airway safety.
Research Themes
- Perioperative analgesia optimization
- Neurocritical care monitoring advancements
- AI-assisted airway management
Selected Articles
1. Liposomal bupivacaine versus ropivacaine perianal infiltration for postoperative analgesia of haemorrhoidectomy: a multicentre, randomised controlled trial.
In 264 patients undergoing mixed hemorrhoid surgery, perianal infiltration with liposomal bupivacaine provided significantly lower resting and exercise NRS pain scores at all time points up to 72 hours postoperatively compared with ropivacaine. Fewer patients required rescue analgesics, and safety/adverse event rates were comparable between groups. Patient comfort during ambulation and defecation was improved with liposomal bupivacaine.
Impact: This well-designed multicenter RCT offers actionable evidence for postoperative analgesia, demonstrating clinically meaningful pain reductions and reduced rescue analgesic use with a long-acting local anesthetic formulation.
Clinical Implications: For hemorrhoidectomy enhanced recovery pathways, liposomal bupivacaine perianal infiltration can improve early postoperative pain, reduce rescue analgesics, and enhance ambulation/defecation comfort without added safety concerns. Institutions should weigh benefits against costs and consider protocolized adoption.
Key Findings
- Resting NRS pain scores were significantly lower with liposomal bupivacaine at 1–72 hours (median 0–2 vs 2–4; p<0.001).
- Exercise NRS scores were significantly lower across all time points (median 0–2 vs 2–5; p<0.001).
- Fewer patients required rescue analgesics (43.9% vs 83.3%; p<0.001), with improved ambulation and defecation pain.
- Adverse event rates and incision assessments were comparable between groups.
Methodological Strengths
- Prospective multicenter randomized controlled design with adequate sample size.
- Comprehensive pain assessments at multiple postoperative time points with prespecified outcomes and trial registration.
Limitations
- Blinding status is not specified; potential performance/detection bias.
- Single-country study in China limits generalizability; cost-effectiveness not assessed.
Future Directions: Conduct blinded, multinational RCTs, include cost-effectiveness analyses, and evaluate comparative effectiveness across diverse surgeries and patient populations.
OBJECTIVES: To evaluate whether liposomal bupivacaine provides superior postoperative analgesia compared with ropivacaine following haemorrhoidectomy, reduces the need for rescue analgesics in patients with mixed haemorrhoids and maintains a comparable safety profile. DESIGN: Prospective, randomised controlled multicentre trial. SETTING: Three grade 3A general hospitals in Guangxi, China, conducted between September 2023 and July 2024. PARTICIPANTS: Eligible patients were aged 18-75 years undergoing elective external dissection and internal ligation for mixed haemorrhoids (grade III and IV mixed haemorrhoids). Key exclusion criteria were severe systemic diseases, history of substance abuse or known allergies to local anaesthetics. A total of 264 patients (male, n=162; mean age, 43.1±12.2 years) were enrolled and completed the study, with 132 randomised to each group. INTERVENTIONS: Patients received either ropivacaine (100 mg in 20 mL) or liposomal bupivacaine (226 mg in 20 mL) through local infiltration at the end of surgery. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were the resting numerical rating scale (NRS) pain scores (0-10) at postoperative 1, 5, 7, 9, 11, 24, 36, 48 and 72 hours.
2. Infratentorial Pressure Monitoring in Cerebellar Stroke: Feasibility and Prognostic Utility.
In 35 patients with cerebellar stroke undergoing decompression and EVD, infratentorial ICP was consistently higher than supratentorial ICP and correlated with worse functional outcomes. A novel prognostic score—age (years) + 4 × mean infratentorial ICP (mmHg)—predicted unfavorable outcomes with AUC 0.88–0.89; a cutoff of 115 stratified risk. The monitoring approach was feasible with a high technical success rate.
Impact: The study addresses a key gap by directly measuring infratentorial pressures, revealing clinically relevant gradients undetected by standard supratentorial monitoring and offering a simple, pragmatic prognostic tool.
Clinical Implications: For posterior fossa pathologies, consider infratentorial ICP monitoring to capture compartment-specific pressure dynamics and refine prognostication. The age+4×infratentorial ICP score may guide triage and intensity of neurocritical care, pending external validation.
Key Findings
- Infratentorial ICP exceeded supratentorial ICP (11.9 vs 8.8 mmHg; P<0.001).
- Higher infratentorial ICP associated with unfavorable outcomes at 6 months (13.1 vs 9.5 mmHg; P=0.042).
- A prognostic score (age + 4 × mean infratentorial ICP) predicted poor outcomes with AUC 0.88–0.89; cutoff 115.
- Infratentorial monitoring achieved a 94% technical success rate.
Methodological Strengths
- Prospective multicenter cohort with simultaneous supra- and infratentorial ICP monitoring.
- Predefined functional outcomes assessed at discharge and 6 months.
Limitations
- Small sample size (n=35) limits precision and generalizability.
- Specialized monitoring setup; potential selection bias to surgically managed cases.
Future Directions: Larger, multicenter validation of the prognostic score; determination of actionable ICP thresholds; interventional trials to test management guided by infratentorial ICP.
BACKGROUND: Although supratentorial intracranial pressure (ICP) monitoring represents the current standard in neurocritical care, its validity for assessing infratentorial pathologies remains uncertain. This multicenter, prospective study aimd to (1) evaluate the feasibility and clinical utility of infratentorial ICP monitoring in acute posterior fossa pathologies and (2) develop a prognostic model for functional outcomes based on infratentorial pressure dynamics. METHODS: We conducted a prospective cohort study across three tertiary neurovascular centers in Germany (2021-2024), enrolling 35 consecutive patients with cerebellar stroke requiring surgical decompression and external ventricular drainage. All participants underwent simultaneous supratentorial and infratentorial ICP monitoring for seven posteroperative days. Functional outcomes were assessed using the modified Rankin scale at discharge and at six-month follow-up (FU). The primary end point was the comparison of ICP gradients between compartments; secondary analyses evaluated the association between infratentorial ICP and functional outcomes. RESULTS: The mean infratentorial ICP was significantly higher than the supratentorial ICP (11.9 mm Hg [95% confidence interval (CI) 10.5-13.3] vs. 8.8 mm Hg [95% CI 7.4-10.1], P < 0.001). Patients with unfavorable outcomes had significantly higher infratentorial ICP values compared with those with favorable outcomes at FU (13.1 mm Hg [95% CI 11.1-15.1] vs. 9.5 mm Hg [95% CI 6.8-12.1], P = 0.042).
3. Real-Time Identification of Cricothyrotomy Landmarks in Emergency Care and Obstetric Patients Using Wireless Handheld Ultrasound and Edge-Computing Artificial Intelligence: A Prospective Observational Study.
Across 608 female patients and 117,094 ultrasound frames, YOLOv8n/v10n running on a handheld device achieved high AUC (>0.88) for detecting cricoid cartilage, thyroid cartilage, and the cricothyroid membrane, with real-time throughput (~14 fps). Intersection-over-union was strong for CC/TC (~0.70–0.72) but lower for CTM (~0.36). The study demonstrates on-device feasibility for real-time airway landmark identification.
Impact: Real-time, handheld AI ultrasound for eFONA-relevant landmarks could standardize preprocedural marking and improve success in time-critical airway rescue, especially in challenging anatomy.
Clinical Implications: Integrate AI-assisted handheld ultrasound for preprocedural landmarking and training in emergency and obstetric settings; prioritize algorithmic improvements for CTM localization; evaluate impact on eFONA success and time-to-airway in clinical and simulation studies.
Key Findings
- High detection performance for CC, TC, and CTM (AUC > 0.88) across all YOLO variants.
- Real-time deployment on handheld ultrasound achieved ~13.8–14.1 fps (YOLOv8n/v10n).
- Localization accuracy: IOU ~0.71 for CC and ~0.70 for TC; lower IOU for CTM (~0.36).
- Large prospective dataset: 608 participants yielding 117,094 frames.
Methodological Strengths
- Prospective design with a large frame-level dataset spanning emergency and obstetric cohorts.
- On-device benchmarking of multiple YOLO variants demonstrating real-time feasibility.
Limitations
- Female-only cohort; generalizability to males and diverse anatomies is uncertain.
- Lower CTM localization accuracy; no evaluation of clinical outcomes (e.g., procedure success, time-to-airway).
Future Directions: Expand to mixed-sex, diverse BMI cohorts; optimize CTM segmentation/localization; randomized or pragmatic trials to assess effects on eFONA performance and training outcomes.
This study aimed to develop machine learning-based algorithms to assist physicians in ultrasound-guided localization of the cricoid cartilage (CC), thyroid cartilage (TC), and cricothyroid membrane (CTM) for cricothyroidotomy. Adult female participants presenting to the emergency department with dyspnea or to the obstetrics and gynecology department for a scheduled cesarean section between August 2022 and July 2024 were prospectively recruited. Ultrasonographic images were collected using a wireless handheld ultrasound device connected to an edge computing tablet. Three You Only Look Once (YOLO) model variants-v5n6, v8n, and v10n-were selected for development and evaluation. A total of 608 participants (median age: 58.0 years, interquartile range [IQR]: 40.0-73.0; median body mass index: 23.2 kg/m², IQR: 20.2-26.5) contributed 117,094 ultrasonographic frames. All three YOLO-based models demonstrated high accuracy in detecting CC, TC, and CTM, with area under the receiver operating characteristic curve values exceeding 0.88. In correctly identified frames, the models effectively localized CC (IOU values: YOLOv5n6, 0.713 [95% confidence interval (CI): 0.698-0.726]; YOLOv8n, 0.718 [95% CI: 0.702-0.733]; YOLOv10n, 0.718 [95% CI: 0.701-0.734]; p value: 0.03) and TC (YOLOv5n6, 0.700 [95% CI: 0.683-0.717]; YOLOv8n, 0.706 [95% CI: 0.687-0.725]; YOLOv10n, 0.703 [95% CI: 0.783-0.721] ; p value: 0.037), though localization accuracy was lower for CTM (YOLOv5n6, 0.364 [95% CI: 0.333-0.394]; YOLOv8n, 0.363 [95% CI: 0.331-0.394]; YOLOv10n, 0.354 [95% CI: 0.325-0.381] ; p value: 0.053). The mean frames per second for YOLOv5n6, YOLOv8n, and YOLOv10n were 3.67, 13.83, and 14.13, respectively, when deployed on the handheld ultrasound platform. YOLO-based models demonstrated high accuracy in detecting and localizing CC, TC, and CTM. YOLOv8n and YOLOv10n achieved clinically acceptable real-time imaging performance when deployed on a wireless handheld ultrasound device with an edge computing tablet. Further studies are needed to assess whether this favorable performance translates into actual clinical benefits.