Daily Anesthesiology Research Analysis
Analyzed 130 papers and selected 3 impactful papers.
Summary
A multicenter randomized trial shows ciprofol sedation reduces hypoxia events compared with propofol in overweight patients undergoing GI endoscopy. Two large meta-analyses report that erector spinae plane blocks reduce postoperative nausea and vomiting and that transcutaneous electrical acupoint stimulation lowers postoperative delirium risk in older adults. Together, these studies support safer sedation choices and multimodal, non-pharmacological strategies to improve perioperative outcomes.
Research Themes
- Sedation safety and hypoxia prevention in endoscopy
- Regional anesthesia and reduction of postoperative nausea and vomiting
- Non-pharmacological neuromodulation to prevent postoperative delirium in older adults
Selected Articles
1. Ciprofol Versus Propofol for the Prevention of Hypoxia During Gastrointestinal Endoscopy Procedures in Overweight Patients: A Multicenter, Randomized, Controlled Trial.
In overweight patients undergoing GI endoscopy, ciprofol sedation reduced the combined incidence of hypoxia and severe hypoxia compared with propofol. Secondary outcomes favored ciprofol, including less injection pain and fewer corrective measures for hypoxia, while endoscopy success was comparable.
Impact: This large multicenter RCT directly informs sedative selection in a high-volume procedural setting, demonstrating a clinically meaningful reduction in hypoxia with ciprofol.
Clinical Implications: For overweight patients undergoing GI endoscopy, ciprofol may be preferred over propofol to lower hypoxia risk, with similar procedural success. Institutions should consider updating sedation protocols and monitoring workflows accordingly.
Key Findings
- Ciprofol reduced the total incidence of hypoxia and severe hypoxia versus propofol in overweight patients during GI endoscopy.
- Secondary outcomes supported ciprofol with lower injection pain and fewer corrective hypoxia interventions.
- Endoscopy success rates were comparable between groups.
Methodological Strengths
- Multicenter randomized controlled design with over 1000 participants
- Pre-specified primary and secondary outcomes with trial registration (NCT05518929)
Limitations
- Abstract does not report exact event rates or effect sizes in the public summary
- Conducted in a single country; generalizability to other populations requires caution
Future Directions: Head-to-head trials in diverse populations, mechanistic studies on respiratory physiology under ciprofol, and cost-effectiveness analyses to guide formulary adoption.
BACKGROUND AND AIMS: To compare the incidence of hypoxia and other sedation-related adverse events (AEs) in overweight patients undergoing gastrointestinal (GI) endoscopy who were sedated using ciprofol or propofol. METHODS: A randomized, controlled trial was conducted in five hospitals in China between September 2022 and August 2023. Patients were randomized into either ciprofol or propofol sedation. The primary outcome was the total incidence of hypoxia and severe hypoxia. The secondary outcomes were hypoxia incidence, severe hypoxia incidence, subclinical respiratory depression incidence, endoscopy success rate, injection pain incidence, and corrective hypoxic measures proportion. RESULTS: A total of 1018 patients were randomized into either ciprofol group (n = 506) or propofol group (n = 512). The mean BMI was 26.23 kg/m CONCLUSIONS: During GI endoscopy, overweight patients are significantly less prone to hypoxia when sedated with ciprofol than with propofol, offering a safer alternative. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05518929).
2. Erector spinae plane block reduces postoperative nausea and vomiting: a systematic review and meta-analysis of 44 randomized trials.
Across 44 RCTs with 2,830 patients, ESPB significantly reduced postoperative nausea (RD −0.16) and vomiting (RD −0.12), alongside lower opioid consumption and improved 24-hour pain scores. GRADE rated evidence for nausea as high and for vomiting as moderate; trial sequential analysis suggested adequate information size.
Impact: This synthesis shifts ESPB from an analgesia-only perspective to a broader recovery-enhancing technique by demonstrating robust PONV reduction across surgeries.
Clinical Implications: Consider ESPB as part of multimodal PONV prophylaxis, particularly where opioid-sparing is prioritized. Protocols should integrate ESPB with standard antiemetic strategies in ERAS pathways.
Key Findings
- ESPB reduced postoperative nausea (RD −0.16, 95% CI −0.21 to −0.12) and vomiting (RD −0.12, 95% CI −0.17 to −0.07).
- Opioid consumption decreased (morphine SMD −0.86; fentanyl SMD −2.96; tramadol SMD −1.43) with ESPB versus controls.
- Pain on movement at 24 h was lower (SMD −1.58), with GRADE indicating high to moderate certainty for PONV outcomes.
Methodological Strengths
- Comprehensive meta-analysis of 44 randomized trials with trial sequential analysis
- PROSPERO-registered protocol and GRADE assessment of certainty
Limitations
- Heterogeneity across surgical procedures and ESPB techniques
- Some outcomes showed wide confidence intervals and potential small-study effects
Future Directions: Standardize ESPB technique and dermatomal targets; conduct head-to-head comparisons with other regional techniques for PONV; evaluate cost-effectiveness within ERAS.
BACKGROUND: Postoperative nausea and vomiting (PONV) is a prevalent complication and remains a significant clinical challenge. The erector spinae plane (ESPB) block has been shown to offer significant pain relief during and after surgical procedures, positioning it as a potentially beneficial anesthetic technique. However, limited evidence currently supports its effectiveness in reducing nausea and vomiting specifically. This meta-analysis aims to examine the impact of ESPB on PONV rates, assessing whether the block offers measurable benefits for this common postoperative issue, in addition to its recognized analgesic effects. METHODS: Two researchers conducted a comprehensive search across three databases-PubMed, Embase, and the Cochrane Central Register of Controlled Trials-using keywords such as "erector spinae plane block, meta-analysis, nausea, and vomiting" to identify all relevant literature. The data obtained from these studies were then analyzed through meta-analysis, utilizing Review Manager software to synthesize findings and assess overall outcomes. RESULTS: In this meta-analysis, 44 trials involving 2,830 patients were analyzed. The ESPB was found to significantly decrease the incidence of nausea (risk difference (RD) = -0.16, 95% confidence interval (CI): -0.21-0.12) and vomiting (RD = -0.12, 95% CI: -0.17-0.07) compared to no ESPB. Additionally, ESPB decreased the dosage of morphine [standardized mean difference (SMD) = -0.86, 95% CI: -1.54 to -0.18], fentanyl (SMD = -2.96, 95% CI: -5.13 to -0.79), and tramadol (SMD = -1.43, 95% CI: -2.32 to -0.55) when compared to no ESPB. It also reduced VAS movement at 24 h (SMD = -1.58, 95% CI: -3.04 to -0.13) and lowered the occurrence of dizziness (RR = 0.43, 95% CI: 0.18-1.02), while prolonging the likelihood of itching (RR = 0.39, 95% CI: 0.25-0.61). We assessed the outcomes of nausea and vomiting with GRADE, and they were high to moderately certain, respectively. In addition, our analysis of trial sequences found adequate sample sizes for reductions in the incidence of nausea and vomiting. CONCLUSION: Our meta-analysis found that ESPB may be able to reduce the incidence of nausea and vomiting and improve the quality of patients' postoperative recovery and trial sequential analysis confirmed an adequate sample size for this conclusion. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024604805.
3. Transcutaneous electrical acupoint stimulation for preventing postoperative delirium in elderly patients: a systematic review and meta-analysis.
Across 20 RCTs (n=2,290), TEAS reduced postoperative delirium from 17.0% to 5.6% (RR 0.34). TEAS also lowered propofol consumption, pain scores, CAM scores, and improved QoR-15 without serious adverse events, supporting a safe, non-pharmacological delirium prevention strategy.
Impact: Provides high-quality evidence that a scalable, low-risk intervention significantly reduces postoperative delirium in older adults, a major driver of morbidity and resource use.
Clinical Implications: Integrate TEAS into perioperative care pathways for older adults at risk of delirium, alongside standard multicomponent prevention strategies; consider resource-light implementations in PACU and wards.
Key Findings
- TEAS reduced postoperative delirium (5.6% vs 17.0%; RR 0.34, 95% CI 0.26–0.45).
- TEAS decreased propofol consumption (MD −35.59 mg) and pain (MD −0.60), and improved QoR-15 (MD 23.76).
- No serious adverse events were reported across included trials.
Methodological Strengths
- Randomized trials only with comprehensive meta-analytic methods
- Pre-registered protocol and GRADE assessment of evidence quality
Limitations
- Variability in TEAS timing, acupoint selection, and stimulation parameters
- Potential publication bias toward positive RCTs in complementary therapies
Future Directions: Standardize TEAS protocols, identify high-benefit subgroups, and compare TEAS against other non-pharmacologic delirium prevention components in pragmatic trials.
OBJECTIVE: To systematically evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) in preventing postoperative delirium (POD) in elderly patients undergoing various surgical procedures. METHODS: A comprehensive literature search was conducted across multiple electronic databases to identify randomized controlled trials (RCTs) comparing TEAS with control interventions (sham or no stimulation) in patients aged >60 years undergoing surgery. The primary outcome was the incidence of POD within the first seven postoperative days. Meta-analysis was performed using RevMan software, calculating risk ratios (RR), mean differences (MD), or standard MD with 95% confidence intervals (CIs). The quality of evidence was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: Twenty RCTs involving 2,290 patients (aged >60 years) were included. The overall incidence of POD was 5.6% in the TEAS group compared to 17.0% in the control group (RR 0.34, 95% CI 0.26-0.45). TEAS also significantly reduced CAM score (MD -1.01, 95% CI -1.98 to -0.04), propofol consumption (MD -35.59 mg, 95% CI -65.75 to -5.42), postoperative pain score (MD -0.60, 95% CI -1.02 to -0.18), and improved recovery quality (QoR-15 score: MD 23.76, 95% CI 21.72-25.80). The intervention appeared safe with no serious adverse events reported. CONCLUSION: Perioperative TEAS application significantly reduces the risk of POD in elderly surgical patients. Its protective effects are potentially mediated through anti-inflammatory effects. TEAS represents a promising non-pharmacological intervention for POD prevention within enhanced recovery protocols. SYSTEMATIC REVIEW REGISTRATION: CRD420251128976.