Daily Anesthesiology Research Analysis

BACKGROUND: Opioid-related adverse events are common with sufentanil-based patient-controlled intravenous analgesia after laparoscopic gastrointestinal cancer surgery in older adults. Oliceridine, a G protein-biased μ-opioid receptor agonist, may provide effective analgesia with fewer adverse events. METHODS: In this single-center, randomized, double-blind, non-inferiority trial (Tangdu Hospital, Xi'an, China), patients aged ≥60 years undergoing elective laparoscopic radical resection for gastrointestinal malignant tumors were allocated 1:1 to postoperative patient-controlled intravenous analgesia containing oliceridine (0.4 mg/kg) or sufentanil (2 μg/kg), combined with ketorolac and tropisetron, for 48 hours. The primary endpoint was the cumulative area under the curve for resting 0-10 visual analogue scale pain scores over 0-48 hours. The non-inferiority margin was prespecified as 20% of the mean AUC in the sufentanil group (18.3 points), a threshold based on prior studies and deemed clinically acceptable. RESULTS: Of 90 randomized patients, 88 received the study drug and were included in the analyses (44 per group); two patients were excluded as they never received the intervention. In the per‑protocol analysis, the cumulative resting pain area under the curve was 73.02±22.59 with sufentanil and 72.55±23.54 with oliceridine (between-group difference 0.48; 95% CI -9.30 to 10.26), meeting non-inferiority. A modified intention‑to‑treat analysis including all 88 treated patients yielded identical results, confirming robustness. Movement-evoked pain area under the curve was similar (difference 1.77; 95% CI -8.72 to 12.27). Respiratory depression occurred in 1/44 (2.27%) with oliceridine versus 8/44 (18.18%) with sufentanil, and hypotension in 5/44 (11.36%) versus 13/44 (29.55%). CONCLUSION: In elderly patients undergoing laparoscopic gastrointestinal cancer surgery, oliceridine provided non-inferior analgesia to sufentanil while significantly lowering the incidence of respiratory depression and hypotension. These findings suggest that oliceridine may be a preferred opioid option for PCIA when respiratory and hemodynamic safety are critical concerns. TRIAL REGISTRATION: ChiCTR2400090780.

BACKGROUND: Intraoperative hypotension (IOH) is a frequent and clinically important complication associated with adverse postoperative outcomes. Early prediction may facilitate timely intervention, although existing models have limitations in integrating multimodal physiological data and patient-specific characteristics. METHODS: We developed Hypotension Hybrid Forecast (HypoBridCast), a hybrid architecture integrating 1D Convolutional Layer (Conv1D) and Transformer (TF) modules. The model integrates intraoperative waveform data (arterial pressure, electrocardiogram, photoplethysmogram, and capnography) with preoperative clinical variables (including demographic characteristics, medical history, laboratory results, and surgical and anesthetic variables). Data from the VitalDB database (n=3,369) were used for model development and internal evaluation, and an independent cohort from Zhongda Hospital (n=437) was used for external evaluation. Model performance for predicting IOH (MAP≤65 mmHg for≥1 min) 5, 10, and 15 min in advance was assessed using AUROC, AUPRC, and calibration metrics. RESULTS: HypoBridCast achieved strong discriminative performance across prediction horizons in both internal and external evaluations (e.g., internal 5-min AUROC 0.9442 [95% CI 0.9427-0.9456] and AUPRC 0.9387 [0.9376-0.9398]). Compared with Mono-ART models, performance was improved, whereas differences versus multi-channel waveform models were modest. The addition of preoperative variables provided limited and inconsistent gains across datasets. In contrast, performance gains over simple MAP-based baseline models were more pronounced. Calibration was acceptable overall, with some reduction observed in the external cohort, particularly at longer prediction horizons. CONCLUSIONS: The proposed hybrid deep learning framework achieved strong performance for short-term prediction of intraoperative hypotension using routinely collected clinical data. Multimodal integration and preoperative variables provide incremental improvements. Further work is needed to improve generalizability and calibration before clinical deployment. TRIAL REGISTRATION: ChiCTR2500099041.

BACKGROUND: Interscalene block (ISB) is widely used for upper limb surgery but frequently causes hemidiaphragmatic paralysis (HDP). Superior trunk block (STB) has emerged as a promising alternative that preserves phrenic nerve. This study aimed to evaluate whether STB is a safer option than ISB. METHODS: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420250654685). Randomized controlled trials (RCTs) comparing STB and ISB in adults undergoing upper limb surgery and reporting HDP as the primary outcome were included. Secondary outcomes were postoperative pain, opioid consumption, motor block duration, patient satisfaction, and Horner's syndrome. Comprehensive searches were conducted through June 2025 in PubMed, Scopus, Embase, Cochrane, and Web of Science. Data were analyzed using a random-effects model in R, and trial sequential analysis was applied to assess statistical robustness. RESULTS: Eight RCTs involving 597 patients were included. Compared with ISB, STB significantly reduced the incidence of complete HDP (risk ratio [RR], 0.10; 95% confidence interval [CI], 0.07-0.17; I2 = 0%, P < 0.001) and Horner's syndrome (RR, 0.06; 95% CI, 0.01-0.24; I2 = 0%, P < 0.001). No significant differences were observed in opioid consumption (P = 0.262), pain scores (P = 0.661), patient satisfaction on a 0-10 scale (P = 0.117), or motor block duration (P = 0.624). CONCLUSIONS: STB provides postoperative analgesia comparable to ISB while significantly reducing the incidence of HDP and Horner's syndrome, supporting its role as a safer and effective alternative for shoulder surgery.