Daily Anesthesiology Research Analysis
Analyzed 106 papers and selected 3 impactful papers.
Summary
Analyzed 106 papers and selected 3 impactful articles.
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.
Using life-cycle assessment and local pricing across 11,909 cases, TIVA generated 26.5–61.8 times less CO2e than sevoflurane and was less expensive per 1,000 procedures. Even minimal-flow sevoflurane emitted vastly more CO2e than TIVA, challenging perceptions that TIVA is costlier.
Impact: Provides quantitative, directly actionable evidence for decarbonizing anesthesia while reducing cost, supporting system-level protocol change.
Clinical Implications: Hospitals can reduce carbon emissions and costs by prioritizing TIVA over sevoflurane for maintenance, particularly avoiding high fresh gas flows. Implementation can be integrated into Green Theater/ESG initiatives.
Key Findings
- Per 1,000 procedures, TIVA emitted 963 kg CO2e vs 25,562 kg with minimal‑flow sevoflurane and 59,483 kg with 2 L/min FGF sevoflurane.
- TIVA cost €4,300 per 1,000 procedures vs €6,772 (minimal‑flow sevoflurane) and €11,933 (2 L/min sevoflurane).
- Sevoflurane emitted 26.5× (minimal‑flow) to 61.8× (2 L/min) more CO2e than TIVA.
Methodological Strengths
- Large consecutive case base (n=11,909) enabling realistic scenario modeling.
- Comprehensive life-cycle assessment using local tender prices and materials accounting.
Limitations
- Single-center simulation without prospective implementation outcomes.
- Focused on sevoflurane vs propofol; generalizability to other volatiles and health systems requires confirmation.
Future Directions: Prospective multicenter implementation with real-time carbon accounting dashboards; extend LCA to other volatiles/adjuncts; evaluate training and adoption strategies.
2. Effect of Oliceridine on Sufentanil-Induced Cough During General Anesthesia: A Prospective Randomized Controlled Clinical Study.
In a randomized, double-blind trial (n=286), pre-induction oliceridine 2 mg reduced sufentanil-induced cough from 42.7% to 0% without significant changes in blood pressure or heart rate. The effect was large and immediate, with no safety signal detected.
Impact: Demonstrates a simple, high-yield intervention to eliminate a common and potentially hazardous induction complication.
Clinical Implications: Consider oliceridine 2 mg pretreatment in patients at risk of SIC (e.g., neurosurgical, ophthalmic, full stomach) to improve airway safety during induction, pending local availability and stewardship.
Key Findings
- SIC incidence fell from 42.66% (saline) to 0% with oliceridine 2 mg (P<0.001; 95% upper confidence bound ≈ 2.6%).
- Cough severities (mild/moderate/severe) in controls were 12.59%/26.57%/3.50%; none occurred with oliceridine.
- No significant differences in systolic/diastolic blood pressure or heart rate; no significant adverse events noted.
Methodological Strengths
- Prospective, randomized, double-blind, placebo-controlled design with adequate sample size.
- Clinically meaningful primary endpoint with clear effect size.
Limitations
- Short-term peri-induction outcomes; durability and broader perioperative effects not assessed.
- Generalizability may depend on local availability/regulation of oliceridine and concomitant anesthetic regimens.
Future Directions: Head-to-head comparisons with other antitussive strategies, dose–response and timing studies, and evaluation in high-risk populations (e.g., intracranial pressure risks).
3. Reversal of neuromuscular blockade after coronary artery bypass grafting: a randomized control trial.
In a randomized trial (n≈71), sugammadex shortened time to extubation (6 vs 10.4 minutes), reduced early extubation failures (1 vs 4) and re-intubations (0 vs 2) compared with neostigmine after CABG. Functional dysphasia screen failures were lower with sugammadex.
Impact: Links neuromuscular reversal choice to faster extubation and fewer airway interventions in cardiac surgery, supporting ERACS pathways.
Clinical Implications: Prefer sugammadex over neostigmine for CABG if early extubation is targeted; anticipate more consistent recovery of muscle strength and potentially fewer airway complications.
Key Findings
- Time to extubation: 6.0 vs 10.4 minutes (sugammadex vs neostigmine; p=0.001).
- Early extubation failure: 1 (sugammadex) vs 4 (neostigmine); re-intubations: 0 vs 2 within 24 h.
- Functional dysphasia screen failures: 14% (sugammadex) vs 30% (neostigmine); ICU stay numerically shorter with sugammadex.
Methodological Strengths
- Randomized design with standardized perioperative protocol and pre-registered trial (NCT03939923).
- Multiple clinically relevant endpoints including extubation timing and airway events.
Limitations
- Single-center study with relatively small sample size; blinding not specified.
- Hemodynamic differences at specific time points suggest possible confounding requiring replication.
Future Directions: Larger multicenter RCTs with cost-effectiveness analysis and standardized extubation protocols; assess aspiration risk, esophageal motility, and long-term outcomes.