Daily Anesthesiology Research Analysis
Analyzed 41 papers and selected 3 impactful papers.
Summary
Analyzed 41 papers and selected 3 impactful articles.
Selected Articles
1. Videolaryngoscopy versus direct laryngoscopy for double-lumen tube intubation: the DOuble-Lumen intubation with VIdeolaryngoscopy (DOLVI) multicentre randomised trial.
In a four-center randomized trial of 916 adults requiring lung isolation, videolaryngoscopy increased first-pass success (84.7% vs 76.9%), improved glottic view, and reduced esophageal intubation and tube malposition compared with direct laryngoscopy, with similar intubation times and complications.
Impact: Provides robust, generalizable evidence to adopt videolaryngoscopy as the preferred initial approach for double-lumen tube placement, a high-stakes airway task in thoracic anesthesia.
Clinical Implications: Institutions should consider defaulting to videolaryngoscopy for double-lumen intubation, update airway algorithms, and prioritize training and equipment availability accordingly.
Key Findings
- First-attempt success was higher with videolaryngoscopy (84.7%) vs direct laryngoscopy (76.9%); absolute difference 7.9% (95% CI 2.8–12.8; P=0.003).
- Good glottic visualization was more frequent with videolaryngoscopy (93.7% vs 80.8%; P<0.001).
- Videolaryngoscopy reduced esophageal intubation (1.7% vs 4.6%; P=0.014) and tube malposition (7.6% vs 12.4%; P=0.016).
- External airway manipulation and loss of glottic view were less common with videolaryngoscopy.
- Intubation time and other peri-intubation complications were similar between groups.
Methodological Strengths
- Multicenter randomized design with a large sample size (n=916).
- Prospectively registered trial with prespecified primary and secondary outcomes.
Limitations
- Operator blinding to device was not feasible, introducing potential performance bias.
- Generalizability to different videolaryngoscope models and provider experience levels may vary.
Future Directions: Evaluate cost-effectiveness, training curves, and long-term outcomes (e.g., hypoxemia events) across different videolaryngoscope platforms and provider experience levels.
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.
2. Effect of Continuous Theta-Burst Stimulation on Postoperative Delirium in Older Patients Who Undergo Cardiac Surgery.
In a randomized, double-blind, sham-controlled trial (n=78), PCC-targeted cTBS halved postoperative delirium incidence after cardiac surgery (23.1% vs 48.7%) and reduced anxiety, pain, and analgesic consumption, without significant changes in inflammatory cytokines.
Impact: Introduces a nonpharmacologic, targeted neuromodulation strategy to prevent delirium in a high-risk surgical population where effective prophylaxis is limited.
Clinical Implications: cTBS to the PCC may complement multimodal delirium prevention bundles in older cardiac surgery patients; implementation will require protocolized targeting, team training, and validation in multicenter settings.
Key Findings
- POD incidence was lower with active cTBS vs sham (23.1% vs 48.7%).
- Active cTBS reduced anxiety and pain levels and decreased analgesic consumption.
- No statistically significant changes in TNF-α or IL-6 despite downward trends.
- Randomized, double-blind, placebo-controlled design supports causality.
Methodological Strengths
- Randomized, double-blind, sham-controlled design.
- Standardized stimulation protocol targeting a defined cortical hub (PCC).
Limitations
- Single-center trial with modest sample size limits generalizability.
- Inflammatory biomarker changes were not significant, leaving mechanisms uncertain.
Future Directions: Multicenter trials to confirm efficacy, dose-response, and durability; integration with delirium bundles and assessment of cost-effectiveness and implementation feasibility.
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.
3. Effect of Transcranial Magnetic Stimulation in Patients with Postherpetic Neuralgia and Comorbid Depression: A Randomized Controlled Trial.
In a single-center, sham-controlled RCT (n=174), five days of 10 Hz rTMS targeting the primary motor cortex reduced the 3‑month incidence of poor prognosis in PHN patients with comorbid depression versus sham (27.4% vs 42.7%; OR 0.51), with consistent adjusted effects.
Impact: Addresses a difficult pain population with psychiatric comorbidity, showing that perioperative rTMS can improve medium-term outcomes as an adjunct to neuromodulation.
Clinical Implications: Perioperative rTMS may be considered as an adjunct in PHN patients with depression undergoing neuromodulation, pending broader validation and assessment of optimal dosing and patient selection.
Key Findings
- rTMS reduced the 3‑month incidence of poor prognosis vs sham (27.4% vs 42.7%; OR 0.51; 95% CI 0.27–0.97; P=0.039).
- Adjusted analysis confirmed benefit (adjusted OR 0.47; 95% CI 0.23–0.95; P=0.036).
- Intervention: 10 Hz rTMS to the primary motor cortex for five consecutive days.
- Safety was not compromised relative to sham.
Methodological Strengths
- Randomized, sham-controlled design with stratification by neuromodulation therapy.
- Prespecified primary endpoint at 3 months with effect size and confidence intervals reported.
Limitations
- Single-center study limits generalizability; details of the composite 'poor prognosis' endpoint are not elaborated in the abstract.
- Short, five-day stimulation course; optimal dosing and durability remain to be defined.
Future Directions: Replicate in multicenter trials; define patient selection, stimulation parameters, and interactions with concurrent neuromodulation modalities; include patient-centered outcomes and cost analyses.
INTRODUCTION: Postherpetic neuralgia (PHN) frequently coexists with depression and remains associated with poor clinical outcomes despite interventional neuromodulation. Repetitive transcranial magnetic stimulation (rTMS) may lower the incidence of poor prognosis in this population. The aim of this trial was to evaluate the effect of perioperative rTMS in patients with PHN and comorbid depression undergoing neuromodulation. METHODS: This randomized, single-center, sham-controlled trial was conducted at the First Affiliated Hospital of Soochow University in Jiangsu Province from February 2025 to November 2025. A total of 174 participants were randomly assigned, stratified by neuromodulation therapy, to receive either 10 Hz rTMS (n = 87) or sham stimulation (n = 87) targeting the primary motor cortex for five consecutive days. The primary outcome was the incidence of poor prognosis at 3 months. RESULTS: The incidence of poor prognosis was significantly lower in the rTMS group compared with the sham group (27.4% versus 42.7%; odds ratio [OR] 0.51; 95% confidence interval [CI] 0.27-0.97; P = 0.039), corresponding to an absolute risk reduction of 15.3%. After adjusting for potential confounders, patients in the rTMS group were less likely to experience poor prognosis at 3 months than those in the sham group (adjusted OR, 0.47; 95% CI 0.23-0.95; P = 0.036). CONCLUSIONS: In this randomized controlled trial, perioperative rTMS reduced the risk of unfavorable clinical outcomes in patients with PHN and comorbid depression undergoing neuromodulation, without compromising safety. These findings support rTMS as a promising adjunctive therapeutic strategy in this population. TRIAL REGISTRATION: Chinese Clinical Trial Register Identifier: ChiCTR2500096978.