Daily Anesthesiology Research Analysis

BACKGROUND: Although videolaryngoscopy has shown benefits over direct laryngoscopy for tracheal intubation with single-lumen tubes, its role in double-lumen tube placement remains unclear. METHODS: In this multicentre, randomised trial conducted in four Spanish hospitals, we assigned adults undergoing surgery requiring lung isolation to receive double-lumen tube intubation with either videolaryngoscopy or direct laryngoscopy. The primary outcome was successful intubation on the first attempt. Secondary outcomes included glottic visualisation, ease of intubation, external airway manipulation, oesophageal intubation, double-lumen tube malposition, and other peri-intubation complications. RESULTS: Among the 916 patients enrolled, successful first-attempt intubation occurred in 388 of 458 (84.7%) participants in the videolaryngoscopy group and 352 of 458 (76.9%) in the direct laryngoscopy group (absolute risk difference 7.9 percentage points; 95% confidence interval [CI] 2.8-12.8; P=0.003). A total of 429 participants (93.7%) in the videolaryngoscopy group and 370 (80.8%) in the direct laryngoscopy group had good glottic visualisation (absolute risk difference 12.9%; 95% CI 8.6%-17.1%; P<0.001). Videolaryngoscopy was associated with a higher rate of easy intubation (81.9% vs 68.6%; absolute risk difference, 13.3%; 95% CI 7.8%-18.8%; P<0.001) and reduced external airway manipulation (28.6% vs 40.6%; P<0.001), loss of glottic view (4.4% vs 21.8%; P<0.001), oesophageal intubation (1.7% vs 4.6%; P=0.014), and double-lumen tube malposition (7.6% vs 12.4%; P=0.016). Intubation time and other complications were similar between groups. CONCLUSIONS: Among patients undergoing surgery requiring lung isolation, videolaryngoscopy increased first-attempt success and improved glottic visualisation while reducing procedural difficulty in double-lumen tube placement compared with direct laryngoscopy. TRIAL REGISTRATION: ClinicalTrials.gov: NCT06401486.

OBJECTIVES: Postoperative delirium (POD) is a common complication after cardiac surgery in older patients, associated with higher mortality and prolonged stays. Continuous theta-burst stimulation (cTBS), a noninvasive neuromodulation technique, has been shown to modulate cortical excitability, offering potential as a treatment for cognitive dysfunction after surgery. The posterior cingulate cortex (PCC) is strongly involved in resource allocation, episodic memory, and executive function. This study aims to investigate the efficacy of cTBS on PCC in reducing POD in older patients having cardiac surgery. MATERIALS AND METHODS: A single-center, randomized, double-blind, placebo-controlled trial was conducted. Older patients receiving cardiac surgery were randomly assigned to either active or sham cTBS groups. cTBS was applied to PCC for five days before and after surgery. The primary outcome was POD incidence during the first five postoperative days. Intention-to-treat analysis was performed in February 2026. RESULTS: A total of 78 patients were recruited and randomly assigned to the active cTBS group (39 patients) or the sham cTBS group (39 patients). The active cTBS group showed a significantly lower incidence of POD than did the sham cTBS group (23.1% vs 48.7%). Moreover, the active cTBS group exhibited considerably lower levels of anxiety and pain, and reduced analgesic consumption. However, although the levels of tumor necrosis factor-α and interleukin-6 in the active cTBS group showed a downward trend, the changes did not reach statistical significance. CONCLUSION: PCC-targeted cTBS effectively reduces POD in older patients who undergo cardiac surgery, alleviating anxiety, pain, and sleep disturbances. These findings suggest cTBS as a promising nonpharmacologic treatment for POD. CLINICAL TRIAL REGISTRATION: The Clinicaltrials.gov registration number for the study is NCT0557 5583.

OBJECTIVES: Managing pain after median sternotomy is a clinical challenge of balancing adequate pain relief with avoidance of excessive opioid consumption. While regional anesthesia techniques are increasingly recommended and applied in cardiac surgery, evidence of sustained postoperative benefit remains limited and heterogeneous. The authors aimed to evaluate the efficacy and safety of long-acting regional infiltration anesthesia in patients undergoing coronary artery bypass grafting. DESIGN: The trial was conducted as a double-blinded, placebo-controlled trial in which participants were randomized 1:1 to intervention or placebo. SETTING: Cardiothoracic departments at 2 Danish university hospitals. PARTICIPANTS: Patients undergoing non-emergent coronary artery bypass grafting. INTERVENTIONS: Participants were allocated to receive surgeon-administered intraoperative infiltration of the sternum and chest wall with either 62.5 mL of bupivacaine with epinephrine, clonidine, and dexamethasone or an equivalent volume of isotonic saline solution as placebo. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was total opioid consumption within the first 24 postoperative hours. Secondary endpoints included patient-reported postoperative pain, as well as measures of recovery, respiratory impact, and chronic opioid use. A total of 113 patients were randomized, with 100 patients completing the trial and being included in the final analysis. No difference in opioid consumption was observed between the two groups. The median oral morphine equivalents were 62.3 mg (interquartile range, 70.8 mg) in the active intervention group and 64.0 mg (interquartile range, 46.8 mg) in the placebo group (p = 0.649). None of the secondary or safety endpoints showed significant differences. CONCLUSIONS: In this double-blind, randomized trial, surgeon-administered regional anesthesia did not reduce opioid consumption or provide additional clinical benefits following median sternotomy.