Daily Anesthesiology Research Analysis
Analyzed 128 papers and selected 3 impactful papers.
Summary
Analyzed 128 papers and selected 3 impactful articles.
Selected Articles
1. Postoperative Urinary Retention After Reversal of Neuromuscular Block by Neostigmine versus Sugammadex in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Trial.
In a randomized trial of 235 laparoscopic cholecystectomy patients, sugammadex (2 mg/kg) reduced postoperative urinary retention compared with neostigmine plus glycopyrrolate, with an absolute difference of 12.8% and no major adverse events. This suggests reversal choice can meaningfully impact same-day discharge barriers.
Impact: High-quality RCT evidence links neuromuscular block reversal choice to a tangible recovery outcome (POUR), a modifiable barrier to enhanced recovery pathways.
Clinical Implications: Consider preferential use of sugammadex for rocuronium reversal in ambulatory laparoscopic cholecystectomy to reduce POUR and facilitate timely discharge, while integrating quantitative neuromuscular monitoring to guide dosing.
Key Findings
- Sugammadex reduced the incidence of postoperative urinary retention versus neostigmine by an absolute 12.8% (P < .001).
- No major adverse events were reported in either group.
- Standardized ultrasound bladder assessments and clear POUR criteria were applied.
Methodological Strengths
- Randomized controlled design with clearly defined primary endpoint
- Objective ultrasound-based bladder volume assessment
Limitations
- Single procedure type and setting may limit generalizability
- Blinding status not described; potential performance bias
Future Directions: Multicenter RCTs across procedures, cost-effectiveness analyses, and integration with quantitative neuromuscular monitoring and bladder protocols to confirm discharge and patient-centered benefits.
BACKGROUND: In an era of fast-track surgery and enhanced recovery protocols, postoperative urinary retention (POUR) remains a common barrier to same-day discharge, contributing to prolonged PACU stays, patient discomfort, and unplanned admissions. Although sugammadex has been associated with a reduced incidence of POUR, no prospective, randomized studies have compared neostigmine and sugammadex for neuromuscular blockade reversal in laparoscopic cholecystectomy. The objective of this study was to determine the incidence of postoperative urinary retention after the reversal of rocuronium-induced neuromuscular blockade with neostigmine versus sugammadex in patients undergoing laparoscopic cholecystectomy. METHODS: A total of 235 patients undergoing laparoscopic cholecystectomy were enrolled. Anesthesia was induced with rocuronium 0.6 mg/kg (ideal body weight, IBW) to facilitate intubation, and moderate neuromuscular blockade was maintained intraoperatively with 0.15 mg/kg (IBW) doses. At the end of surgery, patients received either sugammadex 2 mg/kg (total body weight, TBW) or neostigmine 50 to 70 µg/kg (IBW) with glycopyrrolate 8 to 10 µg/kg (IBW) for reversal. Bladder volumes were assessed via ultrasound before and after attempted voiding. Postoperative urinary retention (POUR) was defined as (1) inability to void with bladder volume ≥ 300 mL, (2) post-void residual ≥ 200 mL, or (3) need for catheterization. The incidence of POUR was recorded as the primary end point. RESULTS: The incidence of POUR was significantly lower with sugammadex compared with neostigmine, difference of 12.8% (95% CI of the difference 4% to 22%, P < .001). There were no major adverse events in either group. CONCLUSIONS: In patients undergoing laparoscopic cholecystectomy, neuromuscular blockade with rocuronium followed by reversal with sugammadex provides a significant reduction in postoperative urinary retention when compared to reversal with neostigmine, without any major adverse effects.
2. Oxygen reserve index monitoring reduced the incidence of low pulse oxygen saturation during deep sedation for hysteroscopy: a prospective randomized controlled trial.
In 400 patients undergoing deep sedation for hysteroscopy, ORI-guided management reduced the incidence of low pulse oximetry saturation compared with standard monitoring, likely by enabling earlier intervention before overt desaturation. Effects were observed across both face mask and nasopharyngeal airway oxygen delivery strategies.
Impact: Demonstrates that a physiologic index (ORI) can preempt hypoxemia during deep sedation, supporting proactive respiratory management beyond pulse oximetry alone.
Clinical Implications: In procedures using deep sedation with high risk of transient hypoventilation, incorporating ORI monitoring and predefined response algorithms may reduce desaturation events and improve safety.
Key Findings
- Randomized 4-arm design (ORI vs non-ORI; face mask vs nasopharyngeal airway) in 400 deep-sedation hysteroscopy patients.
- ORI-guided management reduced the incidence of low SpO2 compared with standard monitoring.
- Early clinician intervention triggered by ORI reaching zero likely mediated benefit.
Methodological Strengths
- Prospective randomized controlled design with 4-arm factorial structure
- Protocolized intervention thresholds (ORI=0 vs SpO2 drop) enabling mechanism-focused inference
Limitations
- Blinding of clinicians to ORI was not feasible, introducing performance bias
- Single-procedure context may limit generalizability to other sedation settings
Future Directions: Validate ORI-guided algorithms across diverse procedural sedation contexts, assess impact on clinically significant hypoxemia-related outcomes, and define cost-effectiveness.
OBJECTIVE: Low pulse oxygen saturation (SpO METHODS: Based on whether ORI monitoring was adopted or not, and the oxygen supply methods during procedure [through face mask (FM) or nasopharyngeal airway (NPA)], four hundred participants underwent hysteroscopy under deep sedation were randomly divided into ORI+FM group, ORI+NPA group, non-ORI+FM group, and non-ORI+NPA group in a 1:1:1:1 ratio. Assist ventilation was performed when ORI dropped to zero in ORI monitoring groups, it was performed when SpO RESULTS: Compared to non-ORI monitoring groups, the incidence of low SpO CONCLUSION: During deep sedation for hysteroscopy, ORI monitoring and the altered clinician behavior from it may related to the reducing of the incidence of low SpO CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/search?term=NCT05701839, identifier NCT05701839.
3. Comparison of the effect of neostigmine and sugammadex on postoperative delirium in surgical patients: A systematic review and meta-analysis.
Across 7 RCTs (n=759) and 5 NRCTs (n=50,115), sugammadex was associated with lower postoperative delirium incidence versus neostigmine in RCTs (RR 0.67; I2=0%), especially within 24 hours postoperatively, while NRCTs showed no difference. Cognitive test scores (MMSE) were similar between groups.
Impact: Synthesizes randomized evidence suggesting a neurocognitive benefit of sugammadex over neostigmine, informing reversal strategies in high-risk populations.
Clinical Implications: For older or cognitively vulnerable patients, opting for sugammadex may reduce early postoperative delirium risk; standardized delirium assessments should accompany future practice changes.
Key Findings
- In RCTs, sugammadex reduced postoperative delirium incidence versus neostigmine (RR 0.67; 95% CI 0.49–0.91; I2=0%).
- Benefit was most apparent within the first 24 hours after surgery.
- NRCTs showed no significant difference (RR 1.15; 95% CI 0.88–1.50; I2=82%), highlighting confounding risks.
- Perioperative MMSE scores were similar between groups.
Methodological Strengths
- Separate analyses of RCTs and NRCTs with low heterogeneity among RCTs
- Predefined subgroup analyses (early POD and anticholinergic coadministration)
Limitations
- Heterogeneity and potential bias in NRCTs (I2=82%)
- Variability and non-standardized delirium assessment across studies
Future Directions: Conduct large, CONSORT/PRISMA-adherent multicenter RCTs with standardized delirium diagnostics to confirm effect sizes and identify subgroups most likely to benefit.
BACKGROUND: Postoperative delirium (POD) frequently occurs in elderly surgical patients and is associated with adverse outcomes. This review aimed to evaluate whether sugammadex, a selective neuromuscular blockade reversal agent, reduces postoperative delirium-incidence (POD-I) compared with neostigmine. METHODS: PubMed, EMBASE, and Cochrane CENTRAL were searched up to May 2025 for randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) comparing sugammadex and neostigmine regarding to POD-I. Primary outcome was POD-I, with subgroup analyses according to postoperative period (within 24 hours vs after postoperative 1 day) and the type of anticholinergic coadministered with neostigmine (atropine vs glycopyrrolate). Secondary outcome was perioperative changes in Mini-Mental State Examination scores (preoperative vs postoperative). Analyses were performed separately for RCTs and NRCTs using RevMan 5.4. RESULTS: Twelve studies (7 RCTs, n = 759; 5 NRCTs, n = 50,115) were included. In RCTs, sugammadex significantly reduced POD-I compared with neostigmine (risk ratio (RR), 0.67; 95% confidence interval (CI), 0.49-0.91; I2 = 0%; P = .008). Subgroup analysis of RCTs on POD-I within the 1st 24 hours postoperatively showed a significantly lower incidence in the sugammadex group (RR, 0.64; 95% CI, -0.45 to 0.90; P = .010). Subgroup analysis of RCTs by coadministered anticholinergics did not significantly influence POD-I (atropine: RR, 0.67; P = .06; glycopyrrolate: RR, 0.66; P = .06). In contrast, subgroup analysis of NRCTs on POD-I showed no significant difference between the groups (RR, 1.15; 95% CI, 0.88-1.50; I2 = 82%; P = .33). Preoperative and postoperative Mini-Mental State Examination scores in RCTs were similar between groups (preoperative: mean difference 0.03, P = .78; postoperative: mean difference 0.75, P = .12). CONCLUSION: Sugammadex is associated with a reduced incidence of POD compared to neostigmine, particularly within the 1st 24 hours after surgery, based on consistent findings from RCTs. This benefit was not observed in NRCTs. Further well-designed RCTs using standardized delirium assessments are required.