Daily Anesthesiology Research Analysis

STUDY OBJECTIVE: Recruitment maneuver is pivotal for reducing the development of atelectasis but the optimal strategy is far from being established. This study hypothesized that the recruitment maneuver under ultrasound guidance compared with conventional technique, and that stepwise lung inflation compared with sustained inflation would reduce early postoperative atelectasis among intermediate- to high-risk patients undergoing abdominal surgery. DESIGN: A multicenter, 2 × 2 factorial, randomized clinical trial. SETTING: Six tertiary hospitals in China. PATIENTS: Adult patients who had an intermediate to high risk of pulmonary complications scheduled for abdominal surgery with an anticipated duration of 2 h or longer. INTERVENTIONS: Using a factorial design, patients receiving recruitment maneuver at end of surgery were allocated to ultrasound guidance or conventional technique without ultrasound guidance, combined with one of two lung inflation patterns (stepwise or sustained). All patients received lung-protective ventilation. MEASUREMENTS: The primary outcome was the incidence of early postoperative atelectasis, as assessed with lung ultrasound at 30 min after tracheal extubation. MAIN RESULTS: Between April 2024 and October 2024, 353 patients were enrolled and randomly assigned. The ultrasound guidance group had a significantly lower incidence of early postoperative atelectasis compared with conventional technique group (75 [41.9%] vs 107 [61.5%]; RR 0.67 [95% CI 0.53 to 0.83]; P < 0.001). There were significant differences favoring ultrasound guidance versus conventional technique for 5 prespecified secondary outcomes: early postoperative lung ultrasound score (median difference - 1 [95% CI -2 to 0]), incidence of hypoxemia (RR, 0.72; 95% CI, 0.58 to 0.88), oxygenation index (median difference 21.7 mmHg [95% CI 0.5 to 42.1]), incidence of pulmonary complications within 7 days postoperatively (RR 0.78 [95% CI 0.63 to 0.97]), and hospitalization cost (median difference - 3586 yuan [95% CI -7084 to -313]). For stepwise versus sustained inflation, there were no significant differences in primary and secondary outcomes. CONCLUSIONS: Among intermediate- to high-risk patients undergoing abdominal surgery, recruitment maneuver under ultrasound guidance significantly reduced early postoperative atelectasis versus conventional technique, while both stepwise and sustained lung inflation can be used alternatively for achieving a recruitment maneuver.

BACKGROUND: Postoperative delirium (POD), a common complication in older surgical patients, has an incidence between 20 and 50%, highlighting the importance of effective intervention methods. Preventive methods available so far mainly focus on the reduction of well-known perioperative risks to prevent POD onset. Esketamine, a newly added therapeutic agent, has also exhibited the potential for POD incidence reduction and the improvement of patient outcomes. Previous meta-analyses and systematic reviews primarily focused on general adult patient groups; thus, the purpose of the current meta-analysis was specifically to examine the efficacy and safety outcomes of esketamine administration in surgical operations among elderly patients. METHODS: This study was registered with PROSPERO (CRD420251151647). A literature search was conducted in the Cochrane Library, PubMed, Embase, Ovid, Scopus, and Web of Science databases until 1 October 2025. Eligible studies were English-language randomized controlled trials (RCTs) involving surgical patients aged ≥60 and reporting esketamine-related POD outcomes. Two reviewers independently selected studies and extracted data. The study quality was assessed using the Cochrane risk of bias (RoB) 2 tool. Data were pooled using fixed- or random-effects models and reported as risk ratios (RRs) or standardized mean differences (SMDs) with 95% CI. Heterogeneity was evaluated using I2 statistics, and publication bias was assessed using funnel plots and Egger's test. RESULTS: A total of 13 RCTs involving 1,581 elderly surgical patients were analyzed. Esketamine significantly reduced the incidence of POD (RR = 0.58, 95% CI: 0.43-0.79), postoperative nausea and vomiting (RR = 0.57, 95% CI: 0.44-0.74), perioperative hypotension (RR = 0.47, 95% CI: 0.27-0.81), and opioid consumption during anesthesia induction (SMD = -0.43, 95% CI: -0.59 to -0.26). However, it increased dizziness (RR = 1.29, 95% CI: 1.03-1.62) and perioperative hypertension (RR = 2.40, 95% CI: 1.16-4.97). No significant differences were found in pain scales [visual analog scale (VAS) and Numerical Rating Scale (NRS)], cognitive function [Mini-Mental State Examination (MMSE)], or psychological events (hallucinations and nightmares). CONCLUSION: Although perioperative esketamine exhibits benefits across multiple recovery outcomes, particularly in reducing intraoperative opioid consumption during induction, highlighting its potential for optimizing analgesic strategies, caution is warranted regarding the elevated risk of perioperative hypertension in elderly patients. The substantial heterogeneity observed in certain outcomes necessitates further validation. Therefore, current evidence does not yet support its routine clinical application. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251151647, identifier CRD420251151647.

BACKGROUND: Tracheal injury, vocal cord injury, sore throat, and hoarseness are common complications of double-lumen tube (DLT) intubation. We try to make efforts to minimize these complications. Our objective is to test whether the use of Safe Easy Endotracheal kit-flexible (SEEKflex)-assisted DLT intubation reduces complications. METHODS: We conducted a multicenter, non-blinded, randomized, parallel-group clinical trial with the aim of comparing the use of SEEKflex versus Stylet in DLT intubation under videolaryngoscopy. Between January 2023 and May 2024, patients aged 18-75 years who required a left-sided DLT to maintain pulmonary isolation during thoracic surgery. We randomly assigned 140 patients to two groups in a 1:1 ratio: SEEKflex combined with videolaryngoscopy group (SEEKflex group) and Stylet combined with videolaryngoscopy group (Stylet group). RESULTS: The incidence of sore throat and hoarseness at 24 h postoperatively was significantly higher in the Stylet group than in the SEEKflex group (sore throat, 33% vs 17%, P = 0.032, hoarseness, 41% vs 26%, P = 0.049); however, there was no significant difference in severity between the two groups. No patients developed new sore throat or hoarseness on postoperative day 2, and the incidence and severity of sore throat and hoarseness were similar between the two groups. The incidence of tracheal injury was higher in the Stylet group than in the SEEKflex group (24% vs 10%, P = 0.025). After examining all participants, 12 patients in the Stylet group and 4 patients in the SEEKflex group experienced vocal cord congestion or edema. The incidence of vocal cord injury was higher in the Stylet group compared to SEEKflex group (17% vs 6%, P = 0.034). CONCLUSIONS: SEEKflex-assisted DLT intubation reduces complications.