Daily Anesthesiology Research Analysis

BACKGROUND: Organ dysfunction after cardiac surgery may be reduced by dexmedetomidine. We evaluated whether perioperative dexmedetomidine reduces complications after cardiac surgery with cardiopulmonary bypass. METHODS: In this randomised, double-blind, placebo-controlled trial conducted in nine Chinese hospitals, adults scheduled for cardiac surgery with cardiopulmonary bypass were randomly assigned to receive i.v. dexmedetomidine (0.4 μg kg RESULTS: A total of 1073 participants (46% female; mean age: 54 yr [range: 47-63 yr]) completed the study after randomisation. Major complications occurred in 161/536 (30%) participants who received dexmedetomidine, compared with 169/537 (32%) who received saline (relative risk: 0.93 [95% confidence interval: 0.72-1.21]; P=0.66). In addition, 10/536 (1.9%) participants who received dexmedetomidine died in hospital, compared with 15/537 (2.8%) participants who received saline (odds ratio: 0.66 [95% confidence interval: 0.29-1.49]; P=0.32). Major complications, other than heart block, did not differ between participants who received dexmedetomidine, compared with participants who received saline. Safety outcomes and process measures did not differ between participants allocated to dexmedetomidine or saline. CONCLUSIONS: Perioperative use of dexmedetomidine did not reduce death, complications, or both in adults undergoing cardiopulmonary bypass-assisted cardiac surgery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT02237495).

OBJECTIVES: Postoperative delirium significantly worsens surgery prognosis. Here, the authors assessed the ability of comprehensive perianesthetic management to reduce the risk of delirium after thoracic surgery. DESIGN: This was a prospective, randomized, single-blind study. SETTING: The study was conducted at a tertiary care institution and university-level teaching hospital. PARTICIPANTS: A total of 508 patients scheduled to undergo elective thoracic surgeries with an expected anesthesia duration of at least 2 hours were enrolled. INTERVENTIONS: All eligible participants received routine pre- and postoperative nonpharmacologic interventions, and the intervention group also received comprehensive perianesthetic management, including perioperative pain control, rational medication, refined intraoperative management, and cognitive training. Delirium was assessed using the Confusion Assessment Method. MEASUREMENTS AND MAIN RESULTS: Of the 508 randomized patients, 497 were included in the final analysis. Postoperative delirium occurred in 9 of 247 patients (3.6%) in the intervention group and in 23 of 250 patients (9.2%) in the control group. Bundle perianesthetic management was associated with a significantly lower risk of delirium, both in per-protocol analysis (relative risk 0.40, 95% confidence interval 0.19-0.84, p = 0.012) and intention-to-treat analysis (relative risk 0.39, 95% confidence interval 0.19-0.84, p = 0.011). No significant differences were observed between the groups in terms of delirium duration, postoperative pain, ability to perform activities of daily living, hospitalization duration, or hospital-related costs. CONCLUSIONS: The findings support integrating this bundle into perioperative pathways to reduce the risk of delirium after thoracic surgery. Further studies are warranted to evaluate its feasibility, generalizability, and safety in broader clinical settings.

BACKGROUND: Gabapentinoids, including gabapentin and pregabalin, are increasingly used in perioperative settings to manage postoperative pain. Despite their widespread use, the clinical evidence regarding the treatment of gabapentinoids in terms of improvement of pain, reduction of opioid consumption and the enhancement of functional recovery is inconclusive. This systematic review and meta-analysis aimed at evaluating the efficacy of gabapentinoids in orthopedic surgeries, with a focus on their role as standalone interventions without the influence of other analgesic modalities like spinal anesthesia or nerve blocks. METHODS: We conducted a search of electronic databases, including PubMed, Scopus, and Web of Science, to identify randomized controlled trials (RCTs) to identify randomized controlled trials (RCTs) evaluating the use of gabapentinoids in orthopedic surgeries. Fourteen RCTs which met the inclusion criteria were included in the meta-analysis mean differences (WMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for continuous and binary outcomes, respectively. Data on postoperative pain reduction, opioid-sparing effects, and adverse events were extracted and analyzed using a random-effects model. Weighted mean differences (WMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for continuous and binary outcomes, respectively. Heterogeneity was assessed using the I RESULTS: The meta-analysis revealed that gabapentinoids significantly reduced postoperative pain intensity at 24 hours (WMD: -0.57). Although statistically significant, the mean reductions in the mean reductions in pain intensity did not exceed the minimal clinically important difference (MCID) of 1.0 point on a 0–10 numeric rating scale, indicating limited clinical relevance. Gabapentinoids were also followed by a lower risk of nausea (RR: 0.68) but an increased likelihood of dizziness (RR: 1.25). Heterogeneity was high in the category of pain (I CONCLUSION: While gabapentinoids demonstrate statistically significant benefits by reducing post-operative pain and opioid use in orthopedic surgeries, their clinical effect is still limited. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-025-03291-9.