Daily Anesthesiology Research Analysis

OBJECTIVES: To compare the incidence of surgical site infection (SSI) between patients receiving cefoxitin via target-controlled infusion (TCI) and those receiving standard dosing during colorectal surgery, and to evaluate differences in intraoperative antibiotic exposure and postoperative safety outcomes. METHODS: In this single-center, parallel-arm randomized clinical trial, 2,494 adults undergoing elective colorectal surgery between April 2022 and July 2025 were assigned to receive cefoxitin via TCI or the standard dosing method. The TCI group received cefoxitin through a pharmacokinetic model-driven infusion pump targeting a plasma concentration of 80 μg/mL until the end of surgery, whereas the standard group received 2 g every 2 hours up to 8 g. The primary endpoint was the incidence of surgical site infection (SSI) within 30 days postoperatively. Secondary endpoints included intraoperative cumulative cefoxitin dose. Acute kidney injury (AKI) was assessed as an additional safety endpoint. RESULTS: No statistically significant difference in SSI incidence was detected between groups (TCI: 69/1,224 (5.6%) vs standard: 69/1,233 (5.6%); P=0.965; RR: 1.01; 95% CI: 0.73-1.39). The intraoperative cumulative cefoxitin dose was lower in the TCI group (median 1.38 g [IQR, 1.15-1.71]) than in the standard group (2.00 g [2.00-4.00]); Mann-Whitney P<0.001. The median difference was -0.62 g (95% CI, -0.65 to -0.59), representing ∼30% reduction for patients with median operative time (93 min) and body weight (62.5 kg). Pharmacokinetic simulations showed the dosing gap between regimens widened with longer operative duration and lower body weight. AKI incidence did not differ significantly between groups (215/1,224, (17.6%) vs 193/1,233, (15.7%); P=0.223; RR: 1.12; 95% CI: 0.94-1.34). CONCLUSION: In this randomized clinical trial, use of target-controlled infusion of cefoxitin was not associated with a reduction in surgical site infection compared with standard dosing, while resulting in lower intraoperative antibiotic exposure. TRIAL REGISTRATION NUMBER: NCT05253339.

Intraoperative cardiac arrhythmias present distinct characteristics compared to non-surgical environments, yet publicly available electrocardiogram (ECG) databases have primarily focused on ambulatory or intensive care environments. To address this gap, we present the VitalDB Arrhythmia Database, a comprehensive collection of intraoperative ECG recordings with beat and rhythm labels specifically designed for developing and validating arrhythmia detection algorithms in surgical patients. The database comprises 734,528 seconds of continuous ECG data from 482 surgical patients, with a median annotated recording duration of 20 minutes. It contains over 660,000 annotated heartbeats across four beat types and 10 distinct rhythm categories. To efficiently process the extensive source data, we developed a custom deep learning beat classifier that serves as an automated screening tool for arrhythmia candidate segments. All annotations underwent rigorous validation by five anesthesiologists, with each segment independently reviewed by at least two anesthesiologists, and 9.3% required full committee consensus. Inter-rater reliability analysis demonstrated excellent agreement with an overall Cohen's kappa of 0.930 ± 0.130. This publicly accessible resource provides the research community with clinically validated intraoperative arrhythmia data, facilitating the development of robust arrhythmia detection algorithms and enabling multimodal analysis to investigate the hemodynamic impact of intraoperative arrhythmias.

OBJECTIVES: To evaluate the analgesic efficacy of the erector spinae plane (ESP) block in adults undergoing vertebral surgery and to determine whether the available evidence is sufficient to support definitive conclusions. METHODS: We conducted an updated systematic review and meta-analysis of randomized controlled trials (PROSPERO: CRD42025117873). The primary outcome was 24-h postoperative opioid consumption (morphine milligram equivalents [MME]). Secondary outcomes included pain scores at rest and during movement (0-48 h), rescue analgesia requirement, time to first rescue analgesic, time to mobilization, postoperative nausea and vomiting (PONV), hospital length of stay (LOS), quality of recovery, and chronic postsurgical pain. Random-effects models were used; publication bias was assessed with Egger's test when applicable. Risk of bias was assessed using RoB 2 and certainty using GRADE. Prespecified subgroup analyses, sensitivity analysis, meta-regression for the primary outcome, and trial sequential analysis (TSA) were performed. RESULTS: Sixty trials (n = 4167, ESP block 2081, control 2086) were included. The ESP block was associated with a modest reduction in 24-h opioid consumption (MD -8.89 mg MME, 95% CI -11.44 to -6.33; p < 0.001, I CONCLUSIONS: There is low-certainty evidence supporting a modest reduction in 24-h opioid consumption and early postoperative pain with ESP block in patients undergoing vertebral surgery. In contrast, high-certainty evidence supports a significant reduction in the incidence of PONV.