Daily Anesthesiology Research Analysis
Across anesthesiology and perioperative medicine, a triple-blind RCT showed that preoperative intranasal dexmedetomidine meaningfully reduced postoperative delirium in older adults with sleep disorders. A systematic review of antibacterial pharmacokinetics in adult ECMO patients found variability is driven mainly by critical illness and renal function rather than ECMO circuitry, underscoring the role of therapeutic drug monitoring. A pragmatic quality-improvement study demonstrated that eliminat
Summary
Across anesthesiology and perioperative medicine, a triple-blind RCT showed that preoperative intranasal dexmedetomidine meaningfully reduced postoperative delirium in older adults with sleep disorders. A systematic review of antibacterial pharmacokinetics in adult ECMO patients found variability is driven mainly by critical illness and renal function rather than ECMO circuitry, underscoring the role of therapeutic drug monitoring. A pragmatic quality-improvement study demonstrated that eliminating routine preoperative ECGs for low-risk cataract surgery did not worsen outcomes, supporting de-implementation of low-value testing.
Research Themes
- Delirium prevention via preoperative sedation strategies
- Precision dosing and pharmacokinetics in ECMO critical care
- De-implementation of low-value preoperative testing
Selected Articles
1. Preventive Effect of Preoperative Intranasal Dexmedetomidine for Postoperative Delirium in Elderly Patients with Sleep Disorders Undergoing Major Noncardiac Surgery: A Randomized, Triple-Blind, Placebo-Controlled Trial.
In a triple-blind RCT of 348 older adults with sleep disorders, preoperative intranasal dexmedetomidine given the night before major noncardiac surgery reduced postoperative delirium versus placebo and improved preoperative sleep. Bradycardia occurred more frequently, necessitating monitoring.
Impact: This trial introduces a practical, noninvasive preoperative intervention that reduces delirium—a major driver of morbidity and cost—by targeting sleep quality the night before surgery.
Clinical Implications: Consider intranasal dexmedetomidine the night before surgery for older patients with sleep disorders at high delirium risk, embedded in delirium prevention bundles, with vigilant bradycardia monitoring and contraindication screening.
Key Findings
- Preoperative intranasal dexmedetomidine reduced POD incidence versus placebo (18.4% vs 32.8%; RR 0.56, 95% CI 0.38–0.82).
- Preoperative sleep quality improved with dexmedetomidine.
- Bradycardia was more frequent in the dexmedetomidine group, highlighting a safety consideration.
Methodological Strengths
- Randomized, triple-blind, placebo-controlled design
- Weight-based dosing regimen with prespecified administration window and rescue protocol
Limitations
- Adverse event signal of bradycardia requires careful monitoring and may limit generalizability.
- Population restricted to older adults with sleep disorders; applicability to broader surgical populations is uncertain.
Future Directions: Validate findings across diverse surgeries and risk profiles, define optimal dosing/timing, and integrate with multimodal delirium prevention (e.g., sleep hygiene, nonpharmacologic measures).
2. Antibacterial Pharmacokinetics in Critically Ill Patients Receiving Extracorporeal Membrane Oxygenation (ECMO): A Systematic Review of Population Pharmacokinetic Studies.
Across 31 population pharmacokinetic studies in adult ECMO patients, ECMO-specific parameters rarely drove antibacterial PK variability; renal function and critical illness factors predominated. The review recommends individualized dosing supported by therapeutic drug monitoring and standardized reporting of covariates and clinical endpoints.
Impact: Clarifies that dosing should focus on patient physiology rather than ECMO circuit attributes, informing anesthesiologist-intensivists’ antimicrobial strategies and stewardship in ECMO ICUs.
Clinical Implications: Prioritize renal function and renal replacement therapy status over ECMO settings when adjusting antibacterial dosing; embed therapeutic drug monitoring and model-informed precision dosing into ECMO care pathways.
Key Findings
- Thirty-one adult ECMO population PK studies were identified via systematic search.
- ECMO-specific variables (mode, flow rate, oxygenator type) generally did not significantly influence antibacterial PK.
- PK variability was primarily driven by renal function and renal replacement therapy related to critical illness.
- Therapeutic drug monitoring and individualized dosing were recurrent recommendations.
Methodological Strengths
- Comprehensive multi-database systematic search up to March 2025
- Focused extraction of PK model covariates and ECMO parameters across studies
Limitations
- Heterogeneity of PK models and covariate reporting limits quantitative synthesis and generalizability.
- Limited clinical endpoint data; PROSPERO registration occurred late relative to the search timeline.
Future Directions: Prospective, standardized popPK studies incorporating uniform ECMO descriptors, renal metrics, and linked clinical endpoints to enable dosing algorithms and decision support.
3. Discontinuing routine preoperative electrocardiogram testing in low-risk cataract surgery patients: the EliminECG quality improvement project.
In a 1,000-patient quality improvement project for cataract surgery, selective ECG based on standardized symptom/vital screening performed as safely as routine ECG, with similar cancellation rates and perioperative events. Findings support de-implementation of routine ECGs in asymptomatic, low-risk patients.
Impact: Provides pragmatic evidence to reduce low-value preoperative testing in a high-volume procedure, improving value-based care without compromising safety.
Clinical Implications: Adopt guideline-concordant screening to reserve pre-op ECGs for symptomatic or higher-risk cataract patients; streamline pre-assessment pathways to reduce delays and resource use.
Key Findings
- Among 1,000 cataract cases, routine ECG versus selective screening yielded similar surgery cancellation rates (4% vs 3.2%; P=0.79).
- No significant differences in intraoperative events or unplanned admissions between groups.
- Supports international guidelines discouraging routine pre-op ECG in asymptomatic, low-risk cataract patients.
Methodological Strengths
- Large real-world cohort with prospectively defined screening protocol
- Direct comparison of routine versus selective strategies aligned to international guidelines
Limitations
- Nonrandomized quality-improvement design susceptible to unmeasured confounding.
- Single health system and procedure type (low-risk cataract) may limit generalizability.
Future Directions: Extend de-implementation protocols to other low-risk procedures, evaluate cost savings and patient-reported outcomes, and explore digital screening tools.