Daily Anesthesiology Research Analysis

BACKGROUND: Inadequate neuromuscular blockade (NMB) reversal can cause residual NMB (RNMB) and hypoventilation, but the incidence after sugammadex or neostigmine for kidney transplantation is unknown. We compared hypoventilation for up to three days after neostigmine or sugammadex for kidney transplantation, adjusting for RNMB, opioids, and other confounders. METHODS: This single-center double-blind trial randomized adults undergoing renal transplantation with rocuronium-based NMB and reversal with neostigmine at train-of-four count (TOFC) ≥ 2 or sugammadex at post-tetanic count PTC ≥ 1 following institutional practices. We identified postoperative quantitative TOF ratio (TOFR) < 0.9 events, and ≥ 1-min-long hypoventilation episodes (minute ventilation <40% of predicted for each patient) using continuous non-invasive bioimpedance ventilation monitoring in the post-anesthesia care unit (PACU) (primary outcome) and ward for up to three days. Logistic regression compared the incidence of hypoventilation, adjusting for TOFR<0.9, opioids, and other factors. We also analyzed patient-reported dyspnea scores, outcomes, and hospital resources utilization for two postoperative weeks. RESULTS: The intention-to-treat analysis included 84 patients: 52(62%) males, age 49(15) years. 42(50%) patients received sugammadex or neostigmine. Sugammadex patients had similar TOFR<0.9 events, normalized to patient's baseline, in PACU (40% vs. 60%, p = 0.127) and the ward (17% vs. 26%, p = 0.425). Hypoventilation incidence was similar in PACU (sugammadex 55% vs. neostigmine 58%, p = 1.000) and the ward (69% vs. 67%, p = 1.000) before or after adjusting for RNMB, opioids received, and other covariates. CONCLUSIONS: Sugammadex was non-inferior to neostigmine on the incidence of RNMB and hypoventilation, even after adjusting for RNMB, opioids, and other covariates, in PACU and up to three days after kidney transplantation. TRIAL REGISTRATION: ClinicalTrial.govNCT03923556https://clinicaltrials.gov/ct2/show/NCT03923556.

PURPOSE: To develop a method for detecting respiratory phases and their onset during intra-arrest ventilation with ongoing chest compressions based on explicit definitions for respiratory phase onsets, enabling automated processing at scale. METHODS: An algorithm was developed that uses the product of airflow and airway pressure, and the product of flow and airway pressure slope. For experimental validation of the algorithm, ventilatory recordings from 13 pigs with mechanical ventilation were used. For each animal, 20 ventilations before induction of cardiac arrest (regular ventilation) and 20 ventilations during ongoing chest compressions with asynchronous ventilation (intra-arrest ventilation) were selected. Algorithm performance was analysed against investigator-validated annotations of respiratory phase onsets. RESULTS: The proposed algorithm yielded perfect classification of inspiratory and expiratory phases during regular and intra-arrest ventilation. For the determination of the exact timestamp of respiratory phase onsets, the algorithm had an F1-score of 1 in regular ventilation and 0.971 during intra-arrest ventilation. CONCLUSIONS: We propose an algorithm to detect respiratory phases and their exact onsets robust to chest compressions, which exhibits excellent results on a validation dataset. The concept incorporates the inherent relationship of airflow and airway pressure to differentiate between airflow due to artificial ventilations and airflow due to chest compressions.

Background and aim Hip fractures are associated with significant pain and functional limitations in the perioperative period. Conventional regional anesthesia techniques, such as femoral nerve block (FNB) and fascia iliaca compartment block (FICB), provide analgesia but may cause quadriceps weakness. The pericapsular nerve group (PENG) block, a newer motor-sparing technique, may offer improved outcomes. This study aimed to compare the analgesic efficacy and functional outcomes of PENG + lateral femoral cutaneous nerve (LFCN) block with FICB and FNB + LFCN in patients undergoing hip fracture surgery. Methods In this randomized, assessor-blinded clinical trial, 180 patients with proximal femur fractures were assigned to PENG + LFCN, supra-inguinal FICB, or FNB + LFCN (n = 60 each). Blocks were performed under ultrasound guidance using standardized doses of ropivacaine and dexamethasone. The primary outcome was the median reduction in Visual Analog Scale (VAS) score during movement at 30 minutes post-block. Secondary outcomes included ease of spinal positioning, postoperative VAS scores, time to first rescue analgesia, 24-hour opioid consumption, quadriceps strength, patient satisfaction, and complications. Data were analyzed using the Kruskal-Wallis test, with post hoc pairwise comparisons performed using the Dwass-Steel-Critchlow-Fligner procedure. Results The median reduction in post-block VAS at 30 minutes was greatest in the PENG group (7.0 points), followed by the FICB group (5.0 points) and the FNB group (3.0 points) (p < 0.001). Post hoc analysis showed that PENG provided superior analgesia compared with both FICB and FNB (p < 0.0001), and FICB was also superior to FNB (p < 0.0001). The PENG group also had a longer median time to first rescue analgesia (24 hours; IQR: 12-24) and lower 24-hour median opioid consumption (5 mg morphine equivalent; IQR: 0-5) compared with the FICB and FNB groups (p < 0.001 for both). Patients in the PENG group demonstrated minimal quadriceps weakness and higher satisfaction (p < 0.001 for both). No major complications occurred. Conclusions The PENG + LFCN block provided superior analgesia, facilitated spinal anesthesia positioning, reduced opioid requirements, and better preserved quadriceps strength compared with FICB and FNB + LFCN. These findings support the PENG block as an effective motor-sparing alternative for perioperative analgesia in hip fracture surgery.