Daily Anesthesiology Research Analysis
Analyzed 106 papers and selected 3 impactful papers.
Summary
Today’s most impactful anesthesiology research spans sustainability, airway safety, and fast-track cardiac anesthesia. A simulation study of 11,909 cases shows total intravenous anesthesia dramatically reduces carbon emissions and costs versus sevoflurane. Two randomized controlled trials report that sugammadex accelerates extubation after CABG and that oliceridine essentially abolishes sufentanil-induced cough without hemodynamic instability.
Research Themes
- Sustainable anesthesia and cost-effectiveness
- Airway safety during induction
- Enhanced recovery and fast-track cardiac anesthesia
Selected Articles
1. Environmental and economic impacts of anaesthesia: A simulation study comparing total intravenous anaesthesia versus sevoflurane for maintenance of anaesthesia in 11 909 adult patients of a Belgian tertiary hospital.
In a simulation using 11,909 cases, TIVA produced 26.5–61.8 times less CO2e than sevoflurane-based maintenance and also cost substantially less per 1000 procedures. These results challenge assumptions that TIVA is more expensive and support its adoption for environmental stewardship and cost savings.
Impact: Quantifies both carbon and economic impacts of anesthetic choice at scale and demonstrates dual environmental and cost advantages for TIVA over sevoflurane.
Clinical Implications: Hospitals can reduce perioperative carbon emissions and drug costs by favoring TIVA maintenance where clinically appropriate, reinforcing low-flow strategies when volatiles are used.
Key Findings
- Per 1000 procedures, TIVA emitted 963 kg CO2e and cost €4300.
- Minimal-flow sevoflurane emitted 25,562 kg CO2e and cost €6772; at 2 L/min FGF, 59,483 kg CO2e and €11,933.
- Sevoflurane produced 26.5–61.8 times more CO2e than TIVA; TIVA cost 36–63% of sevoflurane maintenance.
Methodological Strengths
- Large institutional dataset (11,909 consecutive cases) with lifecycle assessment of drugs and disposables
- Scenario-based economic modeling using local tender prices and explicit fresh gas flow comparisons
Limitations
- Single-center retrospective simulation; real-world practice variability may limit generalizability
- Clinical outcomes were not assessed; environmental and cost endpoints only
Future Directions: Prospective multi-center implementation studies linking environmental/cost metrics with patient outcomes and operational feasibility; inclusion of drug waste and infusion hardware footprints.
BACKGROUND: Total intravenous anaesthesia (TIVA) is widely recognised as a less environmentally harmful alternative to volatile anaesthesia. However, TIVA is often perceived as a more expensive technique, raising questions about its cost-effectiveness in routine practice. OBJECTIVE: This study models the environmental impact and cost-effectiveness of TIVA versus sevoflurane anaesthesia. DESIGN: Retrospective simulation-based observational study. PATIENTS: Surgical cases of 11 909 consecutive patients, older than 5 years, observed in a tertiary Belgian hospital. INTERVENTION: The economic cost and carbon dioxide equivalent (CO2e) emissions of maintenance using sevoflurane versus propofol of anaesthesia were calculated, using local tender prices and the lifecycle assessment for all drugs and disposable materials involved in each scenario. MAIN OUTCOME MEASURE: The economic cost and CO2e emissions of different scenarios for maintenance of anaesthesia. RESULTS: For every 1000 procedures, CO2e emissions and costs were: TIVA - 963 kg at a cost of €4300; minimal-flow sevoflurane - 25 562 kg at a cost of €6772; sevoflurane [2 l min-1 fresh gas flow (FGF)] - 59 483 kg at a cost of €11 933. CONCLUSION: Our simulations indicate that minimal flow sevoflurane produces 26.5 times more CO2e than TIVA, rising to 61.8 times more at 2 l min-1 FGF. TIVA also costs significantly less, at 36% and 63% of sevoflurane anaesthesia costs with minimal flow and 2 l min-1 FGF, respectively.These findings highlight not only TIVA's marked superiority in reducing carbon emissions but also its notable cost advantages over traditional volatile anaesthetic methods. The stark contrast in emissions - where TIVA produces just a fraction of the CO2e compared to even the most environmentally conscious sevoflurane protocols - underscores the critical role anaesthetic choice plays in healthcare sustainability. Moreover, the substantial difference in costs challenges the prevailing perception that TIVA is prohibitively expensive. As hospitals worldwide face mounting pressure to align clinical practices with environmental stewardship, these results advocate for a critical reassessment of routine anaesthetic protocols.
2. Reversal of neuromuscular blockade after coronary artery bypass grafting: a randomized control trial.
In CABG patients, sugammadex shortened time to extubation (6 vs 10.4 minutes) and reduced dysphagia screening failures, with fewer airway interventions compared with neostigmine. Findings support sugammadex for fast-track extubation after cardiac surgery.
Impact: Directly informs neuromuscular reversal strategy to enable early extubation in cardiac anesthesia, a key ERAS target with patient safety implications.
Clinical Implications: Consider sugammadex to facilitate in-OR extubation after CABG, potentially reducing re-intubations and dysphagia risk; monitor hemodynamics given slightly higher HR/SBP post-reversal.
Key Findings
- Time to extubation was shorter with sugammadex vs neostigmine (6.0 vs 10.4 minutes; p=0.001).
- Functional dysphasia screen failures were lower with sugammadex (14%) vs neostigmine (30%).
- Airway interventions occurred only in the neostigmine group (2 re-intubations, 1 NIPPV).
Methodological Strengths
- Randomized controlled design with standardized anesthetic protocol targeting in-OR extubation
- Multiple clinically relevant secondary outcomes including dysphagia screen and airway events; trial registration provided
Limitations
- Single-center study with modest sample size (n=71), limiting generalizability
- Blinding procedures are not detailed; potential performance bias cannot be excluded
Future Directions: Larger multicenter RCTs to assess extubation success, re-intubation, aspiration, and resource utilization; stratify by CPB duration and residual paralysis depth.
BACKGROUND: Early extubation in cardiac surgery improves recovery and outcomes. Extubation of the airway after cardiac surgery in the operating room or in the immediate postoperative period is a key component of the optimization of outcomes in cardiac surgical patients. Specific objectives of this study included measuring time to extubation with secondary outcomes of post-extubation vital signs, lung function, and esophageal motility. Exploratory parameters included ICU stay and re-intubation in 24 h. METHODS: In this study, we compare two groups of patients undergoing coronary bypass grafting surgery (CABG) under general anesthesia with muscle relaxation. Reversal of neuromuscular blockade randomized to group 1: neostigmine and group 2: sugammadex. A standard anesthetic protocol was followed throughout the perioperative period in each of these patients with the goal of in-operating room extubation. A two-sample t-test and/or linear model was used in the data analysis. RESULTS: 4 subjects were not extubated in the neostigmine group versus 1 subject in the sugammadex group. The average time to extubation in the neostigmine group was 10.4 min, (STDEV: 5.9 min) and sugammadex was 6 min, (STDEV: 4.7 min). p = 0.001 (ANOVA). Significant secondary outcome measures included patients who received sugammadex had higher heart rates at the second measurement (85.0) vs. neostigmine (79.5) p = 0.047 and higher systolic blood pressures at the second measurement point for sugammadex (111.7) vs. neostigmine (103.9) p = 0.023. 11/36 (30%) failed the Functional Dysphasia Screen in the neostigmine group versus 5/35 (14%) in the sugammadex. Subjects in the neostigmine group had an average ICU stay of 40.1 +/- 32.4 h versus 35.6 +/- 15.8 in the sugammadex group. 2 patients in the neostigmine group were re-intubated and 1 patient was placed on non-invasive positive pressure ventilation vs. no airway interventions in the sugammadex group. CONCLUSIONS: Based on the results of this study, utilizing sugammadex for reversal of neuromuscular blockade after CABG may increase early extubation in the operating room, decrease the re-intubation rates, provide a very consistent level of muscle strength for lung function, and may improve postoperative esophageal dysmotility. TRIAL REGISTRATION: ClinicalTrials.gov NCT03939923, Registration date of Feb 2, 2019.
3. Effect of Oliceridine on Sufentanil-Induced Cough During General Anesthesia: A Prospective Randomized Controlled Clinical Study.
Oliceridine 2 mg given before sufentanil completely prevented sufentanil-induced cough (0% vs 42.7%) without significant changes in blood pressure or heart rate. This suggests a practical, safe prophylaxis option for SIC during induction.
Impact: Large, double-blind RCT demonstrates a dramatic, clinically meaningful reduction of a common induction complication with a mechanistically plausible agent.
Clinical Implications: Consider oliceridine pretreatment to eliminate SIC in high-risk inductions (e.g., neurosurgery, ocular surgery, elevated ICP), with attention to formulary access and opioid stewardship.
Key Findings
- SIC incidence was 0% with oliceridine vs 42.66% with placebo (p<0.001).
- Cough severity distribution in controls: mild 12.59%, moderate 26.57%, severe 3.50%.
- No significant differences in systolic/diastolic blood pressure or heart rate between groups.
Methodological Strengths
- Prospective, randomized, double-blind, placebo-controlled design with adequate sample size
- Clear primary endpoint (SIC incidence) and assessment of hemodynamic safety
Limitations
- Single-agent, single-dose strategy; dose-response and comparisons with other antitussive measures not assessed
- Generalizability to emergency or high-acuity induction settings remains to be established
Future Directions: Head-to-head comparisons with other SIC-preventive strategies, evaluation across diverse surgical populations, and assessment of downstream complications (e.g., ICP spikes, wound dehiscence).
BACKGROUND: Sufentanil-induced cough (SIC) frequently occurs during the induction of general anesthesia and may result in serious clinical complications, occasionally posing life-threatening risks. In clinical practice, we observed that oliceridine-a G protein-biased μ-opioid receptor agonist-demonstrates a potent suppressive effect on SIC. This study aimed to evaluate the efficacy of oliceridine in preventing SIC and to assess any associated adverse events. METHODS: In this prospective, randomized, double-blind, placebo-controlled trial, 286 adult patients undergoing elective surgery under general anesthesia were enrolled and randomly assigned to receive either 2 mg oliceridine (OS group) or an equal volume of normal saline (SS group) before intravenous administration of sufentanil. The primary outcome was the incidence of SIC. Secondary outcomes included the severity of cough, vital sign changes, and adverse events. RESULTS: The incidence of SIC was 42.66% in the SS group and 0% in the OS group (95% upper confidence bound ≈ 2.6%; P < 0.001). Among the SS group, mild, moderate, and severe cough occurred in 12.59%, 26.57%, and 3.50% of patients, respectively. No significant differences were observed in systolic or diastolic blood pressure, heart rate, or SpO CONCLUSION: Pretreatment with 2 mg oliceridine demonstrated favorable effevtiveness in suppressing SIC without significant adverse effects. Oliceridine appears to be a safe and effective prophylactic strategy for preventing SIC and may have valuable clinical utility in anesthesia practice.