Daily Anesthesiology Research Analysis

OBJECTIVE: The Intravenous versus Intraosseous Vascular Access for Out-of-Hospital Cardiac Arrest (IVIO) trial was a randomised clinical trial that investigated initial vascular access strategy for out-of-hospital cardiac arrest. The current manuscript presents outcomes at 6 months and 1 year. METHODS: Adults with non-traumatic out-of-hospital cardiac arrest, in whom vascular access was indicated, were randomised to initial intraosseous or intravenous access. The allocated method was attempted up to two times. Prespecified 6-months and 1-year outcomes included survival, survival with a favourable neurological outcome, defined as a modified Rankin Scale score of 0 to 3, and health-related quality-of-life assessed using the EuroQoL 5-Dimension 5-Level questionnaire on domains of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. RESULTS: Of the 1,479 patients included in the main manuscript primary analyses, three were lost to follow-up for 1-year survival. At 1 year, 82 patients (11%) in the intraosseous group and 68 patients (9%) in the intravenous group were alive (risk ratio 1.24; 95% confidence interval 0.91-1.67). Survival with a favourable neurological outcome was observed in 76 patients (10%) and 61 patients (8%), respectively (risk ratio 1.28; 95% confidence interval 0.93-1.77). Among survivors, the mean EQ-5D-5L numeric score was 83 in the intraosseous group and 76 in the intravenous group (mean difference 7; 95% confidence interval 1-13). CONCLUSION: Long-term outcomes were similar between patients who received initial intraosseous versus intravenous vascular access during adult out-of-hospital cardiac arrest. These findings do not support a difference in patient outcomes between the two vascular access strategies. Trial registration EU Clinical Trials number 2022-500744-38-00; ClinicalTrials.gov number NCT05205031.

PURPOSE: Compared with neostigmine, sugammadex promotes faster neuromuscular recovery, but its impact on diaphragmatic function and respiratory recovery in the morbidly obese cohort, and the mechanism underlying its reduction of postoperative pulmonary complications remain unclear. This study aims to compare the effects of sugammadex and neostigmine on diaphragmatic function and respiratory recovery in morbidly obese patients after surgery, and to investigate the role of diaphragmatic function in the reduction of sugammadex-associated postoperative pulmonary complications. PATIENTS AND METHODS: For neuromuscular blockade reversal, 104 morbidly obese patients with moderate neuromuscular block (train-of-four count = 2, ratio <0.9) were randomly assigned to receive either neostigmine (50 μg kg-1+atropine 20 μg kg-1, n=51) or sugammadex (2 mg kg-1, n=53). Measurements of diaphragmatic excursion (DE) and thickening fraction (TF) were taken during deep and quiet breathing at T0 (baseline), T1 (10 min), and T2 (30 min) after extubation. The primary outcome measure was the change in deep breathing diaphragmatic excursion (ΔDE RESULTS: At T2, the ΔDE CONCLUSION: In morbid obesity, sugammadex promotes faster diaphragmatic recovery and improves respiratory outcomes compared with neostigmine and is associated with a lower incidence of postoperative pulmonary complications.

BACKGROUND: The concurrent use of serotonergic antidepressants (SSRIs, SNRIs) and opioid analgesics is frequent in the perioperative setting. While this combination carries a known risk of serotonin syndrome, large-scale epidemiological evidence remains scarce. METHODS: We performed a multinational pharmacovigilance study using data from the US FDA Adverse Event Reporting System (FAERS) and the Japanese Adverse Drug Event Report database (JADER) from Q1 2004 to Q2 2025. Disproportionality analyses, including Reporting Odds Ratio (ROR) with a multi-algorithm framework, were employed to quantify signals for serotonin syndrome and other adverse events. We further characterized clinical profiles and conducted gender-stratified and time-to-onset analyses. RESULTS: Opioids (e.g., tramadol, fentanyl, oxycodone) were consistently among the top drugs associated with serotonin syndrome reports. Concomitant SSRI/SNRI-opioid use showed exceptionally strong signals for serotonin syndrome (SSRI-opioid ROR 95.94, 95% CI 88.9-103.53; SNRI-opioid ROR 57.68, 95% CI 52.32-63.59). SSRI-opioid combinations were uniquely associated with cardiac disorders (ROR 1.87, 95% CI 1.77-1.98), whereas SNRI-opioid use was linked to drug withdrawal syndrome. Gender-stratified analysis indicated a higher reporting proportion for serotonin syndrome in males prescribed SSRI-opioids. Notably, up to 30% of adverse events occurred more than 300 days after therapy initiation, indicating a persistent risk. CONCLUSION: This study provides robust multinational evidence that concomitant serotonergic antidepressant and opioid use is strongly associated with a high risk of serotonin syndrome and distinct adverse event profiles. These findings highlight the urgent need for systematic preoperative medication review, tailored perioperative monitoring, and sustained clinical vigilance.