Daily Anesthesiology Research Analysis
Analyzed 89 papers and selected 3 impactful papers.
Summary
Three clinically meaningful anesthesiology/critical care studies stood out. A double-blind RCT in Anaesthesia showed perioperative lidocaine plus low-dose esketamine modestly reduced movement-evoked pain and opioid use after hepatectomy. A registry-based cohort in Critical Care Medicine revealed persistent sex-based inequities in ventilator settings that indirectly increased mortality, and a randomized trial found remimazolam caused milder respiratory suppression and better hemodynamics than propofol during non-intubated general anesthesia.
Research Themes
- Opioid-sparing multimodal analgesia after major abdominal surgery
- Safer sedation strategies for non-intubated general anesthesia
- Sex-equitable, precision lung-protective ventilation in critical care
Selected Articles
1. Lidocaine combined with low-dose esketamine for movement-evoked pain after hepatectomy: a double-blind randomised controlled trial.
In 304 adults undergoing hepatic resection, continuous perioperative lidocaine plus low-dose esketamine reduced movement-evoked pain at 24, 48, and 72 hours and decreased cumulative opioid consumption versus placebo. Quality-of-recovery scores improved modestly, with no major safety signals reported.
Impact: This double-blind RCT in a leading specialty journal provides rigorous evidence for an opioid-sparing, multimodal analgesia strategy after hepatectomy, showing consistent reductions in movement-evoked pain.
Clinical Implications: Consider adding low-dose esketamine to systemic lidocaine as part of multimodal, opioid-sparing analgesia after hepatic resection, recognizing that benefits are modest and should be balanced against resources and patient selection.
Key Findings
- Movement-evoked pain scores were significantly lower at 24, 48, and 72 hours with lidocaine-esketamine versus placebo (all p < 0.001).
- Moderate-to-severe movement-evoked pain at 24 hours occurred in 34% with lidocaine-esketamine vs 56% with placebo (p < 0.001).
- Cumulative opioid (sufentanil equivalents) consumption was reduced at each time point with lidocaine-esketamine.
- Quality-of-recovery scores improved modestly with lidocaine-esketamine; no serious safety signals were observed.
Methodological Strengths
- Double-blind, randomized controlled design with adequate sample size (n=304).
- Standardized analgesic co-interventions (e.g., transverse abdominis plane blocks) and prespecified movement-evoked pain outcomes.
Limitations
- Effect sizes were modest, potentially limiting routine applicability for all patients.
- Single surgical context (hepatic resection) may limit generalizability; enhanced recovery pathways may have attenuated between-group differences.
Future Directions: Head-to-head trials comparing other multimodal regimens, dose–response optimization of esketamine, and long-term outcomes (function, chronic pain) are warranted.
INTRODUCTION: Pain following hepatectomy may delay recovery and increase opioid use. We tested the primary hypothesis that combining lidocaine and low-dose esketamine would reduce movement-evoked pain 24 h after hepatic resection. We also evaluated whether this approach reduced opioid consumption and improved quality of recovery. METHODS: Patients having elective hepatic resections were allocated randomly to receive lidocaine-esketamine or placebo from induction of anaesthesia until the end of surgery. After surger
2. Sex-Specific Differences in Tidal Volumes and Mortality of Mechanically Ventilated Patients.
In a registry cohort of 20,351 ventilated adults across nine ICUs, women—who were shorter on average—consistently received higher daily tidal volumes per PBW and higher driving pressures than men. Each 1 mL/kg PBW increase in daily tidal volumes was associated with higher mortality (HR 1.10), with no direct effect of sex after accounting for ventilator settings, suggesting a modifiable, management-mediated risk.
Impact: The study identifies a pervasive, modifiable driver of sex disparities in outcomes—ventilator settings relative to predicted body weight—linking daily tidal volume and driving pressure to mortality.
Clinical Implications: Routinely measure height to calculate PBW, target lung-protective tidal volumes (e.g., ~6 mL/kg PBW) and lower driving pressures, and adjust daily—particularly in shorter female patients—to reduce mortality.
Key Findings
- Among 20,351 ventilated adults, women received higher daily tidal volumes (+0.6 mL/kg PBW; 95% CrI +0.6 to +0.7) and higher driving pressures than men.
- Every 1 mL/kg PBW increase in daily tidal volumes was associated with increased mortality (HR 1.10; 95% CrI 1.07–1.13), adjusted for time-varying severity.
- A substantial proportion lacked height documentation (37% women vs 34% men), undermining accurate PBW-based settings.
- No direct effect of sex on mortality was observed after accounting for ventilator management, indicating mediation by modifiable settings.
Methodological Strengths
- Large, multi-ICU registry with 20,351 patients and Bayesian joint modeling of longitudinal ventilator data and mortality.
- Adjustment for time-varying severity and assessment of indirect (mediated) vs direct effects of sex.
Limitations
- Observational design limits causal inference; residual confounding may persist.
- Height missingness in over one-third may bias PBW calculations and generalizability.
Future Directions: Implement and test system-level interventions (mandatory height capture, automated PBW-based ventilator presets) and evaluate mortality impact, with particular focus on shorter female patients.
OBJECTIVES: Previous work reported that critically ill female patients received higher tidal volumes per predicted body weight (PBW) than male patients during the first 24 hours of mechanical ventilation, which might be associated with higher mortality. We investigated if sex inequity in daily tidal volumes during mechanical ventilation persisted beyond the first 24 hours and remained associated with mortality. Also, we examined if the association was mainly explained by baseline factors that d
3. The effect of remimazolam versus propofol on respiratory depression for non-intubated general anesthesia: a randomized controlled trial.
Among 173 analyzed patients undergoing non-intubated general anesthesia for benign breast surgery, remimazolam yielded a lower incidence of respiratory depression (89.7% vs 97.7; p=0.031), fewer airway interventions, and better hemodynamic stability than propofol. Adverse events such as injection pain, hypotension, and bradycardia were significantly less frequent with remimazolam.
Impact: Provides randomized evidence that remimazolam may enhance respiratory and hemodynamic safety during non-intubated general anesthesia, informing agent selection in ambulatory and procedural settings.
Clinical Implications: When planning non-intubated general anesthesia with remifentanil, remimazolam may be favored over propofol to reduce severe respiratory suppression and hemodynamic adverse events, while recognizing the overall high incidence of respiratory depression in both groups.
Key Findings
- Lower respiratory depression incidence with remimazolam vs propofol (89.7% vs 97.7%; p=0.031), with fewer airway interventions.
- Remimazolam predominantly caused mild respiratory depression (73.6%), while propofol more often caused severe suppression (44.2%).
- Adverse events were lower with remimazolam: injection pain 0% vs 39.5% (p<0.001), hypotension 29.9% vs 46.5% (p=0.024), bradycardia 18.4% vs 44.2% (p<0.001).
- Hemodynamic stability was superior with remimazolam throughout anesthesia.
Methodological Strengths
- Randomized controlled design with prespecified primary endpoint (respiratory depression) and continuous sedation monitoring (MOAA/S).
- Detailed adverse event profiling enables safety comparisons beyond sedation efficacy.
Limitations
- Single-center study and female-only surgical population (benign breast surgery) may limit generalizability.
- Open-label risk cannot be excluded if blinding was not feasible; very high absolute respiratory depression rates in both groups.
Future Directions: Multicenter, blinded trials across diverse procedures and mixed-sex populations should assess external validity, optimal dosing, and interaction with opioid co-administration.
BACKGROUND: This randomized controlled trial aimed to compare the respiratory safety profiles of remimazolam versus propofol during non-intubated general anesthesia. METHODS: This single-center, randomized controlled trial investigated 200 female patients undergoing Open Excision of Benign Breast Nodule (OEBN) under non-intubated general anesthesia. Participants were randomly assigned to receive either remimazolam or propofol for anesthesia induction and maintenance, combined with remifentanil.