Daily Anesthesiology Research Analysis

BACKGROUND: Older adults aged 65 years and older considering major surgery often prioritise functional and cognitive outcomes over survival. Therefore, we conducted a prospective cohort study that aimed to characterise the incidence, effect, and predictors of new postoperative disability in older adults. METHODS: The Functional Improvement Trajectories After Surgery multicentre prospective cohort study enrolled older adults (ie, those aged ≥65 years) undergoing major elective non-cardiac surgery at 17 hospitals across Canada. Endovascular, joint replacement, intra-cranial, and palliative procedures were excluded. The WHO Disability Assessment Schedule was used to assess disability preoperatively and at 1, 3, 6, 9, and 12 months postoperatively. The primary outcome was 6-month significant new disability or death. The secondary outcome was this composite outcome at 12 months. Multivariable logistic regression models were used to estimate associations of baseline characteristics with outcomes. FINDINGS: Between Dec 16, 2019, and April 26, 2023, we enrolled 2007 patients (median age 72 years [IQR 68-76]; 853 [42·5%] were female), of whom 1988 (99·1%) lived at home and 868 (43·3%) lived with frailty. By 6 months after surgery, 16·5% patients had significant new disability and death, increasing to 20·7% by 1 year. Patients with new disability at 6 months had higher risks of concurrent depression (risk difference 36·7%, 95% CI 31·9-41·6) and decisional regret (9·9%, 5·1-14·7). At 12 months, the higher risks of depression (33·6%, 28·2-39·0) and decisional regret (12·9%, 7·9-17·8) persisted. Multivariable modelling identified baseline frailty, cognitive impairment, mobility aids, open surgery, smoking, and possibly unmet social supports as associated with increased risks of postoperative new disability or death. INTERPRETATION: One in six older adults in this cohort experienced new disability or death at 6 months following major surgery, increasing to one in five patients by 1 year. Preoperative assessment of frailty, cognitive status, and social supports could enhance shared decision making, care planning, and functional recovery. FUNDING: Canadian Institutes of Health Research, PSI Foundation, Ontario Ministry of Health Innovation Fund, and the Elizabeth A and Richard J Currie, OC Chair in Translational Anesthesia Research at St Michael's Hospital and the University of Toronto.

BACKGROUND: This study aimed to compare the efficacy and safety of lidocaine-based patient-controlled intravenous analgesia (PCIA) with sufentanil-based PCIA for managing postoperative pain in patients undergoing laparoscopic colorectal cancer surgery. METHODS: A total of 126 patients were randomly assigned in a 1:1 ratio to lidocaine group (group L, n = 63) or the sufentanil group (group S, n = 63). The primary endpoint was visual analogue scale (VAS) pain score during movement at 24 h after surgery. Secondary endpoints included VAS pain scores at rest and during movement at 6, 12, 36, and 48 h after surgery, the time of first flatus and defecation after the surgery, postoperative hospitalization time and total hospitalization costs, patient satisfaction scores, and the incidence of adverse events. RESULTS: There was no significant difference between the two groups in VAS pain scores at rest and during movement at 6, 12, 24, 36, and 48 h after surgery (all p > 0.05). The time to first flatus and defecation, as well as postoperative hospitalization time and total hospitalization expenses, were also similar between the two groups (all p > 0.05). However, satisfaction score was significantly higher in group L compared to group S (p < 0.05), and the incidence of postoperative nausea and vomiting (PONV) was significantly lower in group L than in group S (p < 0.05). CONCLUSIONS: Lidocaine-based PCIA can effectively relieve postoperative pain, decrease the incidence of PONV, and improve patient satisfaction in patients undergoing laparoscopic colorectal cancer surgery. TRIALS REGISTRATION: The study was registered on the Chinese Clinical Trial Registry (ChiCTR) with the registration number ChiCTR2300068854, with the registration date being March 1, 2023.

Electrical impedance tomography (EIT)-guided positive end-expiratory pressure (PEEP) titration may optimize ventilation and reduce ventilator-induced lung injury in acute respiratory distress syndrome (ARDS). We compared EIT-guided PEEP with low PEEP/FiO₂ strategy in patients with moderate-to-severe ARDS. In this randomized controlled trial, 108 patients with PaO₂/FiO₂ below 200 mmHg were allocated to EIT-guided PEEP after a recruitment maneuver (n = 56) or low PEEP/FiO₂ strategy (n = 52). Patients in the EIT group underwent PEEP titration guided by the intersection point between alveolar overdistension and collapse during a decremental PEEP trial. Primary outcomes were oxygenation (PaO₂/FiO₂) and static compliance. Secondary outcomes included mortality, ventilator-free days, ICU stay, barotrauma, rescue therapies, and sequential organ failure assessment (SOFA) score changes. On day 1, oxygenation was higher with EIT (mean PaO₂/FiO₂ 180 vs. 159 mmHg; p = 0.036). Static compliance was greater at both day 1 (26 vs. 23 mL/cmH₂O; p = 0.016) and day 2 (27 vs. 24 mL/cmH₂O; p = 0.029). Driving pressure was lower with EIT at day 1 (16 vs. 17 cmH₂O; p < 0.001) and day 2 (15 vs. 17 cmH₂O; p = 0.005). SOFA scores improved more in the EIT group (day 1: - 1 vs. 0, p = 0.013; day 2: - 1 vs. - 0.5, p = 0.015). Twenty-eight-day mortality was lower with EIT (29 vs. 44%), although not statistically significant (p = 0.090). ICU stay, ventilation duration, barotrauma, ECMO use, and rescue therapies were similar. Benefits were most pronounced in patients with severe ARDS. EIT-guided PEEP improved oxygenation, lung mechanics, and reduced organ dysfunction in moderate-to-severe ARDS, particularly in severe cases. It showed a trend toward reduced mortality and may serve as a practical bedside tool for lung-protective ventilation. Larger multicenter trials are needed to confirm its clinical benefits.Trial registration: ClinicalTrials, NCT06733168. Registered on 13/12/2024, https://clinicaltrials.gov/study/NCT06733168.