Daily Anesthesiology Research Analysis
Analyzed 26 papers and selected 3 impactful papers.
Summary
Three high-impact anesthesiology papers advance perioperative care. A large RCT shows subanesthetic S-ketamine markedly reduces postoperative delirium and systemic inflammation after hip fracture surgery. A double-blind RCT demonstrates that combining flurbiprofen axetil with ultrasound-guided intercostal nerve block yields superior analgesia and respiratory metrics in multiple rib fractures, while a PRISMA-compliant review outlines safe sedation/GA strategies and urgent standardization needs in pediatric radiotherapy.
Research Themes
- Perioperative delirium prevention and neuroinflammation modulation
- Multimodal analgesia and regional anesthesia optimization
- Pediatric radiotherapy anesthesia safety and protocol standardization
Selected Articles
1. Subanesthetic S-ketamine prevents postoperative delirium and reduces inflammatory cytokines in older patients receiving hip fracture surgery: a randomized, controlled study.
In a randomized controlled trial of 356 older adults undergoing hip fracture surgery, subanesthetic S-ketamine (0.3 mg/kg loading, 0.2 mg/kg/h infusion) reduced postoperative delirium from 29.8% to 9.6% within 7 days and improved sleep quality. It also suppressed proinflammatory cytokines (IL-1β, IL-6, TNF-α) without altering pain scores or opioid consumption through 48 hours, and reduced nausea/vomiting.
Impact: This trial provides robust evidence that S-ketamine prophylaxis can substantially lower postoperative delirium in a high-risk surgical population, linking clinical benefit to reductions in systemic inflammation.
Clinical Implications: Perioperative S-ketamine at subanesthetic doses may be integrated into multimodal strategies for delirium prevention in older hip fracture patients, with monitoring for known ketamine-related effects.
Key Findings
- Postoperative delirium incidence reduced to 9.6% vs 29.8% within 7 days (P<0.001).
- Improved sleep quality (lower PSQI) from day of surgery through day 3 (all P<0.001).
- Lower IL-1β, IL-6, and TNF-α from D0 to D3 (all P<0.01), with reduced nausea/vomiting (6.7% vs 28.1%, P<0.001).
- No differences in rest/movement pain scores through D2 or analgesic use within 48 h.
Methodological Strengths
- Randomized controlled parallel-group design with adequate sample size (N=356).
- Objective clinical endpoint (POD) and biomarker assessment (IL-1β, IL-6, TNF-α).
Limitations
- Single-condition surgical cohort limits generalizability beyond hip fracture surgery.
- Blinding and trial registration details are not fully specified in the abstract.
Future Directions: Replicate findings across surgical populations, define optimal dosing/timing, and assess long-term cognitive outcomes and health economics.
The preventive effect of S-ketamine on postoperative delirium (POD) in older patients receiving elective surgery is controversial. This randomized, controlled study aimed to evaluate the effect of subanesthetic S-ketamine on the incidence of POD in older patients receiving hip fracture surgery. Three hundred and fifty-six older patients scheduled for elective hip fracture surgery were randomized to S-ketamine group (N = 178, received S-ketamine 0.3 mg/kg loading, 0.2 mg/kg/h infusion) and control group (N = 178, received normal saline with an equal volume). The S-ketamine group showed a lower incidence of POD within 7 days than the placebo group (9.6% versus 29.8%, P < 0.001). Compared with the control group, the S-ketamine group had a lower Pittsburgh Sleep Quality Index score from the surgery day (D0) to day (D)3 after surgery (all P < 0.001). However, pain at rest and at motion (assessed by numerical rating scale) until D2, as well as patient-controlled intravenous analgesic bolus and rescue analgesic within 48 h, were not different between groups. Additionally, the S-ketamine group showed lower proinflammatory cytokines from D0 to D3, including interleukin-1β, interleukin-6, and tumor necrosis factor-α, compared with the control group (all P < 0.01). Moreover, the S-ketamine group disclosed a lower incidence of nausea and vomiting than the placebo group (6.7% versus 28.1%, P < 0.001); the other adverse reactions were comparable between the two groups. S-ketamine at a subanesthetic dose effectively prevents POD and improves sleep quality, with a good safety profile in older patients receiving hip fracture surgery.
2. Flurbiprofen Axetil Combined with Ultrasound-Guided Intercostal Nerve Block for Preoperative Analgesia in Patients with Traumatic Multiple Rib Fractures: A Randomized Controlled Trial.
In a three-arm, double-blind RCT of 150 patients with multiple rib fractures, combining flurbiprofen axetil with ultrasound-guided ropivacaine ICNB significantly improved 30-minute VAS at rest, reduced rescue analgesia, eliminated the need for rescue paravertebral block in the combination group, and improved respiratory parameters and satisfaction.
Impact: This trial operationalizes multimodal analgesia by demonstrating additive benefits of systemic NSAID and regional block for rib fractures, with clinically meaningful reductions in pain and rescue interventions.
Clinical Implications: For traumatic rib fractures, combining flurbiprofen axetil with ultrasound-guided ICNB can be considered to enhance early analgesia, reduce rescue blocks/medications, and support respiratory function while maintaining safety.
Key Findings
- Combination group (flurbiprofen axetil + ropivacaine ICNB) had lower 30-min VAS vs other groups (p<0.001).
- Rescue analgesia was reduced across most intervals; 0 patients required rescue paravertebral block vs 8 in flurbiprofen-alone group (p<0.001).
- Improved respiratory function metrics and higher patient satisfaction with favorable safety profile.
- Trial was prospectively registered (ChiCTR2500105786).
Methodological Strengths
- Randomized, double-blind, three-arm controlled design with adequate sample size (N=150).
- Prospective trial registration and clinically relevant outcomes including respiratory metrics.
Limitations
- Single-center design may limit generalizability.
- Some reported secondary outcomes are truncated in the abstract (e.g., SPID details).
Future Directions: Multicenter trials to confirm external validity, dose–response optimization of ICNB and NSAID co-administration, and evaluation of long-term pulmonary outcomes.
INTRODUCTION: Given the limitations of single-modality analgesia for rib fractures, this study aimed to determine whether combining systemic flurbiprofen axetil with a regional intercostal nerve block (ICNB) yields more effective and sustained preoperative pain relief than either technique used alone. METHODS: In this single-center, randomized, double-blind, controlled trial, 150 patients scheduled for surgery were allocated to one of three groups: Group F (flurbiprofen axetil + saline ICNB), Group FB (flurbiprofen axetil + ropivacaine ICNB), and Group B (saline + ropivacaine ICNB). The primary outcome was the Visual Analog Scale (VAS) score at quiet breathing 30 min post-intervention. Secondary outcomes included VAS scores at 6, 12, 18, and 24 h, rescue analgesia requirements, diaphragmatic excursion, arterial blood gas parameters, adverse events, and patient satisfaction. RESULTS: The FB group demonstrated significantly lower VAS scores at 30 min than the other groups (p < 0.001), along with significantly reduced rescue analgesia requirements across most time intervals (p < 0.05). No patients in the FB group required rescue thoracic paravertebral block versus eight in Group F (p < 0.001). The FB group also showed a significantly higher sum of pain intensity difference over 0-24 h (SPID CONCLUSION: The combination of flurbiprofen axetil and ultrasound-guided ICNB provided superior preoperative analgesia than either agent alone, reduced rescue medication needs, improved respiratory function, and enhanced patient satisfaction, with a favorable safety profile in patients with traumatic multiple rib fractures. TRIAL REGISTRATION: The study protocol was registered at the Chinese Clinical Trial Registry with registration no. ChiCTR2500105786 ( https://www.chictr.org.cn ).
3. Anesthesia in Pediatric Radiotherapy: A Systematic Literature Review by the SIOP Europe Working Group on Pediatric Anesthesia in Radiation Therapy.
This PRISMA-guided systematic review of 39 studies on anesthesia/sedation for pediatric radiotherapy found frequent use of propofol-based sedation with favorable safety under expert delivery, but substantial heterogeneity in practice and poorly characterized complications. The authors call for standardized protocols and prospective studies focusing on safety, long-term neurocognition, and resource needs.
Impact: By consolidating scattered evidence and identifying gaps, this review provides a foundation for practice recommendations and future research to improve safety and consistency in pediatric RT anesthesia.
Clinical Implications: Centers should consider protocolizing sedation/GA for pediatric RT, emphasizing expert staffing, monitoring standards, and risk–benefit discussions regarding potential neurodevelopmental impacts.
Key Findings
- Thirty-nine studies included; most were retrospective with low-to-moderate quality and high heterogeneity in techniques, staffing, and monitoring.
- Propofol-based sedation was most commonly used and generally safe when delivered by experienced pediatric anesthetists.
- Complication rates varied and were often poorly defined; concerns include long-term neurocognitive impact, vascular access, and procedural burden.
- Urgent need for standardized protocols and prospective studies to clarify safety and staffing requirements.
Methodological Strengths
- PRISMA-compliant systematic search and synthesis across Medline and Embase.
- Focus on clinically relevant outcomes and practice variability in pediatric RT anesthesia.
Limitations
- Evidence base largely retrospective with inconsistent definitions and reporting.
- No meta-analysis due to heterogeneity; generalizability across settings may vary.
Future Directions: Develop standardized anesthesia pathways for pediatric RT and conduct multicenter prospective studies assessing acute and long-term neurocognitive outcomes, staffing models, and resource utilization.
Radiotherapy (RT) is essential in pediatric cancer treatment and often requires complete immobility. In younger or noncompliant children, this is typically achieved through sedation or general anesthesia (GA), which raises concerns about acute complications and potential long-term neurodevelopmental effects. Despite widespread use, standardized anesthesia protocols for pediatric RT are lacking. To support the development of practice recommendations, the SIOPE Working Group on Pediatric Anesthesia in Radiation Therapy conducted a systematic literature review. Studies from Medline and Embase were reviewed (March-September 2024) according to PRISMA guidelines, focusing on sedation and GA in pediatric RT. Thirty-nine studies were included, mostly retrospective and of low to moderate quality. Considerable heterogeneity was observed in anesthetic techniques, staffing, and monitoring. Propofol-based sedation was most frequently reported, with favorable safety when delivered by experienced pediatric anesthetists. Complication rates varied widely and were often poorly defined. Additional concerns included long-term neurocognitive impact, vascular access, and procedural burden, especially in resource-limited settings. Evidence supports the safe use of sedation/GA in pediatric RT, but current literature is limited and inconsistent. Standardized protocols and prospective studies are urgently needed to better define safety, long-term outcomes, and staffing requirements.