Daily Anesthesiology Research Analysis
Analyzed 168 papers and selected 3 impactful papers.
Summary
A multicenter randomized clinical trial showed a wearable transcutaneous electrical acupoint stimulation (TEAS) device outperformed metoclopramide for moderate-to-severe postoperative nausea and vomiting. Two pediatric anesthesia studies advanced perioperative care: a network meta-analysis ranked medications effective for preventing emergence agitation after sevoflurane, and a prospective cohort defined a renal NIRS-derived metric that predicts postoperative AKI after cardiopulmonary bypass.
Research Themes
- Nonpharmacologic perioperative therapeutics
- Pediatric anesthesia risk prediction and monitoring
- Evidence synthesis for emergence agitation prevention
Selected Articles
1. Transcutaneous Electrical Acupoint Stimulation vs Metoclopramide for Moderate to Severe Postoperative Nausea and Vomiting: A Randomized Clinical Trial.
In a multicenter, double-dummy randomized trial of 232 women with moderate-to-severe PONV after thyroid or anterior cervical surgery, wearable TEAS at PC6 achieved higher 2-hour remission (77.6% vs 55.2%; P<.001) and lower 24-hour relapse (12.2% vs 56.3%; P<.001) than metoclopramide, with no adverse events. The design included rerandomization for nonresponders at 2 hours.
Impact: This rigorous RCT demonstrates a nonpharmacologic wearable therapy that outperforms a standard antiemetic for moderate-to-severe PONV, with excellent safety and potential to change antiemetic pathways.
Clinical Implications: TEAS at PC6 can be considered as an effective, well-tolerated rescue or adjunct for moderate-to-severe PONV, potentially reducing reliance on antiemetics and their adverse effects in enhanced recovery pathways.
Key Findings
- Higher 2-hour PONV remission with TEAS vs metoclopramide (77.6% vs 55.2%; P<.001).
- Lower 24-hour relapse with TEAS vs control (12.2% vs 56.3%; P<.001).
- No adverse events were reported in either group; double-dummy, blinded design across 4 centers.
- Rerandomization of nonresponders at 2 hours allowed cross-intervention evaluation.
Methodological Strengths
- Randomized, double-dummy, patient- and observer-blinded multicenter design.
- Active-controlled with prespecified rerandomization for nonresponders; trial registered (ChiCTR2400084329).
Limitations
- Per-protocol analysis (not clearly ITT) may introduce bias.
- All participants were female and limited to thyroid/anterior cervical procedures in China, limiting generalizability; comparator was metoclopramide only.
Future Directions: Replicate in mixed-sex, broader surgical populations, compare against 5-HT3 antagonists and multimodal regimens, and assess integration into ERAS with cost-effectiveness and long-term outcomes.
IMPORTANCE: Moderate to severe postoperative nausea and vomiting (PONV) significantly impedes recovery and is inadequately managed by current pharmacotherapy. OBJECTIVE: To evaluate the clinical efficacy of a novel wearable transcutaneous electrical acupoint stimulation (TEAS) device targeting the PC6 (Neiguan) acupoint in managing moderate to severe PONV. DESIGN, SETTING, AND PARTICIPANTS: This randomized, double-dummy, patient-blinded and observer-blinded, parallel-group, and active-controlled clinical trial was conducted at 4 hospit
2. Relationship between perioperative medications and risk of emergence agitation in children after sevoflurane anesthesia: a network meta-analysis.
This NMA of 70 trials (7617 children) compared 19 perioperative drugs for preventing emergence agitation after sevoflurane. Direct comparisons versus control showed significant risk reduction with dexmedetomidine, propofol, midazolam, fentanyl, nalbuphine, and ketamine; SUCRA rankings supported these findings and highlighted several additional agents.
Impact: Provides comparative effectiveness across a broad set of agents using network methods, offering practical rankings to guide pediatric anesthetic plans for emergence agitation prevention.
Clinical Implications: Dexmedetomidine, propofol, midazolam, fentanyl, nalbuphine, and ketamine can be prioritized for EA prevention after sevoflurane; selection should consider airway risk, hemodynamics, workflow, and PACU staffing.
Key Findings
- Across 70 trials (n=7617), six agents significantly reduced EA vs control: dexmedetomidine, propofol, midazolam, fentanyl, nalbuphine, ketamine.
- Effect sizes (log OR vs control): fentanyl −1.28, ketamine −1.77, dexmedetomidine −1.60, midazolam −0.96, propofol −1.34, nalbuphine −1.32 (all P<0.001).
- SUCRA rankings identified additional promising agents (e.g., esketamine, sufentanil, tropisetron) while confirming top performers.
- Frequentist common-effect Mantel–Haenszel model with P-scores enabled ranking amid indirect comparisons.
Methodological Strengths
- Comprehensive multi-database search and registered protocol (CRD42023470892).
- Network meta-analysis allowing indirect comparisons and ranking (SUCRA/P-scores); reported effect sizes vs control.
Limitations
- Common-effect model may under-account for heterogeneity; variability in definitions and dosing across trials.
- Limited pediatric adverse-event synthesis and potential publication bias; some agents with sparse comparisons.
Future Directions: Head-to-head pediatric RCTs among top-ranked agents, standardized EA definitions, dose–response studies, and safety endpoints to refine protocolized prevention bundles.
PURPOSE: To explore the efficacy of perioperative medications in preventing emergence agitation (EA) in children after sevoflurane anaesthesia. METHODS: This network meta-analysis used a frequency-analysis model. PubMed, Embase, Cochrane Library, Web of Science, Google Scholar and ClinicalTrials.gov databases were searched from inception to March 11, 2023. RESULTS: A total of 19 drugs were analysed in 70 studies involving 7617 participants. In the cumulative ranking area under the curve (SUCRA) analysis, sufentanil, esketamine, dexmedetomidine, nalbuphine, tropisetron, ketamine, magnesium sulphate, propofol, fentanyl, remifentanil, and midazolam showed significant EA-preventing effects. Further direct comparisons between the drugs and the control group revealed that fentanyl (Log OR = -1.28, 95% CI -1.76, -0.80, P < 0.001), ketamine (Log OR = -1.77, 95% CI -2.45, -1.10, P < 0.001), dexmedetomidine (Log OR = -1.60, 95% CI -1.88, -1.33, P < 0.001), midazolam (Log OR = -0.96, 95% CI -1.34, -0.57, P < 0.001), propofol (Log OR = -1.34, 95% CI -1.83, -0.85, P < 0.001), and nalbuphine (Log OR = -1.32, 95% CI -1.66, -0.98, P < 0.001) significantly reduced the incidence of EA in children. CONCLUSION: Dexmedetomidine, propofol, midazolam, fentanyl, nalbuphine, and ketamine showed favourable EA-preventing effects in children. REGISTRATION NUMBER: CRD42023470892. IMPACT: This review provides a detailed network meta-analysis comparing 19 perioperative medications, offering a ranked efficacy profile (via SUCRA analysis) for preventing emergence agitation (EA) in children after sevoflurane anaesthesia, which consolidates and expands upon previous pairwise comparisons. It identifies dexmedetomidine, propofol, midazolam, fentanyl, nalbuphine, and ketamine as the most effective drugs for EA prevention, supporting evidence-based decision-making in paediatric anaesthesia practice.
3. Renal regional oxygenation during pediatric cardiac surgery predicts acute kidney injury: a prospective cohort study with model comparisons.
In 120 children undergoing CPB, the cumulative burden of renal desaturation (AUC of rSO2 decrease ≥5% during CPB) best predicted postoperative AKI (C-index 0.854). Longer CPB time increased risk, while higher preoperative creatinine (reflecting more mature renal function) was protective; AKI was associated with prolonged ventilation and increased costs.
Impact: Defines an actionable intraoperative NIRS metric with strong discrimination for pediatric AKI, informing perfusion and hemodynamic targets during CPB.
Clinical Implications: Intraoperative renal NIRS monitoring with attention to the cumulative rSO2 desaturation (≥5% drop AUC) could guide interventions (e.g., perfusion adjustments, anemia management) to mitigate AKI risk.
Key Findings
- AKI incidence was 35.8%; the rSO2 ≥5% decrease AUC during CPB achieved the best model performance (C-index 0.854).
- Greater desaturation AUC increased AKI risk (OR 1.02 per unit; P=0.014); longer CPB time also increased risk.
- Higher preoperative serum creatinine was protective; AKI associated with prolonged ventilation and higher costs.
Methodological Strengths
- Prospective cohort with continuous intraoperative NIRS and predefined multivariable adjustment.
- Model comparison across multiple rSO2 metrics with discrimination (C-index) reporting.
Limitations
- Single-center observational study without external validation; AKI defined by pRIFLE may vary vs KDIGO.
- Predictive threshold not yet tested in interventional trials; sample size moderate.
Future Directions: External validation and interventional trials targeting rSO2 desaturation burden; integration with perfusion strategies and hemoglobin/oxygen delivery optimization.
BACKGROUND: Acute kidney injury (AKI) is a common complication after pediatric cardiac surgery using cardiopulmonary bypass (CPB). This study evaluated renal regional oxygen saturation (R-rSO₂), measured via near-infrared spectroscopy (NIRS), as an AKI predictor. METHODS: 120 pediatric patients undergoing CPB-assisted congenital heart surgery were prospectively enrolled. Continuous intraoperative R-rSO₂ monitoring was performed. Four multivariable logistic regression models (adjusted for age, pre-SCr, pre-hemoglobin, RACHS-2, cyanosis, and CPB time) assessed distinct R-rSO₂ metrics during CPB for predicting AKI (pRIFLE criteria). RESULTS: AKI incidence was 35.8% (n = 43). The model using the area under the curve (AUC) for R-rSO₂ decrease ≥5% during CPB showed superior predictive performance (C-index = 0.854) and fit. Within this model, a greater AUC for R-rSO₂ decrease ≥5% during CPB was independently associated with increased AKI risk (OR 1.02, 95% CI 1.00-1.03, P = 0.014). Prolonged CPB duration (OR 1.02, 95% CI 1.00-1.04, P = 0.028) and lower preoperative serum creatinine (OR 0.87, 95% CI 0.76-0.99, P = 0.031) were also significant predictors. AKI correlated with prolonged ventilation (P < 0.001) and higher costs (P < 0.001). CONCLUSION: Renal tissue desaturation during CPB, quantified as the AUC for R-rSO₂ decrease ≥5%, is significantly associated with postoperative AKI in children. Higher preoperative creatinine (mature function) was protective, while longer CPB time increased risk. IMPACT: The cumulative burden of renal desaturation specifically during CPB is the outstanding intraoperative predictor of postoperative AKI in children undergoing congenital heart surgery. This study defines a quantitative metric-the cumulative area under the curve for renal regional oxygen saturation decrease ≥5% during CPB-which demonstrates high specificity and provides a potential, actionable intraoperative monitoring threshold for predicting AKI risk.