Daily Anesthesiology Research Analysis

INTRODUCTION: Postoperative pulmonary complications are common after lung cancer surgery in older adults. Individualised positive end-expiratory pressure may optimise intra-operative lung mechanics, but its effect on postoperative pulmonary complications is uncertain. We hypothesised that individualised positive end-expiratory pressure would reduce the incidence of postoperative pulmonary complications compared with a fixed positive end-expiratory pressure in older patients (age ≥ 60 years) undergoing lung cancer surgery. METHODS: In total, 400 patients were allocated randomly to individualised positive end-expiratory pressure (PEEP RESULTS: Median (IQR [range]) individualised positive end-expiratory pressure was 11 (9-11 [3-13]) cmH DISCUSSION: Electrical impedance tomography-guided individualised positive end-expiratory pressure reduced driving pressures and improved intra-operative oxygenation but did not decrease the incidence of postoperative pulmonary complications in older adults undergoing lung cancer surgery. WHAT WE DID: We studied 400 older people (aged 60 and over) who were having surgery for lung cancer. During their operations, they were put into two groups: one group had their breathing machine set to a pressure chosen specially for them and the other group used the same fixed pressure used for everyone. We then checked how well their lungs worked during surgery and whether they had breathing problems after surgery. WHY DID WE DO IT: People often have lung problems after lung cancer surgery, especially older adults. Doctors thought that choosing a breathing pressure that is right for each person might help protect the lungs and stop problems after surgery. We wanted to see if this personalised pressure really made a difference. WHAT WE FOUND: We found that the personalised pressure helped lungs work better during the operation and increased the amount of oxygen in the blood during surgery. However, people in both groups had about the same number of lung problems (such as pneumonia) after surgery. This means that, while personalised breathing pressure helped during the operation, it did not reduce lung problems after surgery in older patients.

BACKGROUND: Effective interventions for postoperative delirium (POD) remain unclear. Research indicates that light and sound stimulation may enhance the functional connectivity of the medial visual network, while olfactory stimulation improves cognitive function. This study aims to address POD by integrating auditory, olfactory and visual stimuli to develop a multisensory virtual reality device. OBJECTIVE: To assess the effect of multisensory virtual reality on reducing POD in patients undergoing laparoscopic gastrointestinal surgery. DESIGN: Randomised controlled trial. SETTING: Single-centre tertiary hospital in China between September 2023 and July 2024. PARTICIPANTS: A total of 342 patients aged 60 years or older, undergoing elective laparoscopic gastrointestinal surgery. INTERVENTION: Participants were randomly assigned to either a multisensory virtual reality group, who received standard care along with a 20-min virtual reality session featuring a biophilic environment infused with juniper essential oil, or a standard care group, who received standard care alone for 20 min pre-operatively. MAIN OUTCOME MEASURES: The primary outcome was the incidence of POD, assessed twice daily using the Confusion Assessment Method (CAM) for the three postoperative days. Secondary outcomes included pre-operative mean arterial pressure (MAP), heart rate (HR) and assessments of delirium severity, duration, anxiety levels and pain scores during the same postoperative period. RESULTS: The incidence of POD during the three postoperative days was lower in patients assigned to the multisensory virtual reality group (9.4%, 16 of 170 patients) than in those assigned to the standard care group (19.2%, 33 of 172 patients), P = 0.010. Multisensory virtual reality reduced preoperative anxiety scores and anxiety scores during the three postoperative days, P = 0.001 for all. No serious adverse events occurred during the intervention. CONCLUSIONS: The pre-operative use of multisensory virtual reality as a preventive measure may significantly reduce the incidence of POD during the first three postoperative 3 days after elective laparoscopic gastrointestinal abdominal surgery. CLINICAL TRIAL NUMBER AND REGISTRY: Chinese Clinical Trials Registry, ChiCTR2300075624.

BACKGROUND: This randomized trial compared ultrasound-guided interscalene block (ISB) and combined infraclavicular (ICB)-anterior suprascapular nerve block (SSNB) for arthroscopic shoulder surgery. We hypothesized that combined ICB-anterior SSNB provides equivalent analgesia to ISB 30 min after surgery. METHODS: Fifty subjects were randomized to ISB or combined ICB-anterior SSNB. Twenty mL of bupivacaine 0.5% with epinephrine 5 µg/mL was used for ISB. For ICB and anterior SSNB, we administered 20 mL and 3 mL of bupivacaine 0.5% with epinephrine 5 µg/mL, respectively. Subsequently, all patients underwent general anesthesia.The primary outcome was the pain score at 30 min in the post-anesthesia care unit. Secondary outcomes included the rate of complete sensorimotor blockade (assessed after the performance of the blocks using a 14-point composite scale), postoperative pain scores at 0.5, 1, 3, 6, 12, 24, 36, and 48 hours, the presence of hemidiaphragmatic paralysis at 30 min after the performance of the blocks and in the post-anesthesia care unit, consumption of intraoperative and postoperative narcotics, opioid-related side effects, and patient satisfaction at 24 hours. RESULTS: No intergroup differences were found in postoperative pain scores, proportion of patients with complete sensorimotor blockade, intraoperative/postoperative opioid consumption, side effects, and patient satisfaction at 24 hours. Compared with combined ICB-SSNB, ISB resulted in a higher incidence of hemidiaphragmatic paralysis 30 min after the block and in the post-anesthesia care unit (68% vs 0%; and 88% vs 0%, respectively; both p<0.001). CONCLUSION: Compared with ISB, combined ICB-anterior SSNB results in equivalent postoperative analgesia while circumventing the risk of hemidiaphragmatic paralysis. Further confirmatory trials are required. Future studies should also investigate whether combined ICB- anterior SSNB can provide surgical anesthesia for shoulder surgery. TRIAL REGISTRATION NUMBER: NCT05444517.