Daily Anesthesiology Research Analysis

BACKGROUND: Postoperative pain remains a major challenge following major abdominal surgery. Noise in the operating room is a modifiable stressor, and the efficacy of targeted noise isolation requires prospective investigation. This study investigated the effects of intraoperative noise isolation on the incidence of moderate-to-severe postoperative pain. METHODS: This multicentre randomized clinical trial assessed patients who underwent elective major abdominal surgery under general anaesthesia in four medical centres in China between April, 2024 and May, 2025. Following anaesthesia induction, patients were randomized to either wear noise-cancelling headphones or not (control). The primary outcome of this study was the incidence of moderate-to-severe pain (numeric rating scale (NRS) score ≥ 4) within the 24-hour (h) period after surgery. Secondary outcomes included the incidence of moderate-to-severe pain, cumulative postoperative pain NRS scores within 48 h after surgery, and the consumption of analgesic drugs within 24 and 48 h after surgery. RESULTS: In all, 304 patients were enrolled and randomized; 302 patients were included in the final analysis (150 in the noise isolation group, 152 in the control group). The incidence of moderate-to-severe pain was higher in the control than noise isolation group within 24 h after surgery (49 versus 23%, respectively; relative risk (RR) 0.47; 95% confidence interval (c.i.) 0.33 to 0.65; P < 0.001) and within 48 h after surgery (51 versus 25%, respectively; RR 0.48; 95% c.i. 0.35 to 0.66; P < 0.001). During the 24-h and 48-h periods after surgery, the number of patient-controlled intravenous analgesia boluses was significantly higher in the control group, which also had a higher extra analgesia requirement and increased total analgesic consumption compared with the noise isolation group. The cumulative and maximum rest and movement pain scores were higher in the control than noise isolation group during the 48-h period after surgery. CONCLUSIONS: Intraoperative noise isolation was found to be an effective, safe, and non-invasive preventive intervention that significantly lowered the incidence of moderate-to-severe pain after major abdominal surgery, arguing for its integration into standard multimodal analgesic strategies. Registration number: NCT06316440 (http://www.clinicaltrials.gov).

INTRODUCTION: Prognostic assessment in critically ill patients traditionally relies on severity scores or single biomarkers, each with limited ability to capture the biological heterogeneity of critical illness. OBJECTIVE: To compare the prognostic performance of multiple biomarkers, individually and in combination with clinical variables, using machine learning approaches for the prediction of mortality and kidney-related outcomes. MATERIALS AND METHODS: We performed a post-hoc analysis of the FROG-ICU cohort, a prospective observational study of patients admitted to ICUs. The study included critically ill patients who required invasive mechanical ventilation or a vasoactive agent for more than 24 h. The primary outcome was day-90 mortality, secondary outcome was major adverse kidney event (MAKE) in ICU. A total of 15 plasma biomarkers were evaluated using multiparametric approach. ML models involved Random Forest (RF) and LASSO regression. Mean decrease in accuracy was used to determine variable importance in RF model. External validation was performed in the MARS cohort which involved ICU patients admitted for sepsis and septic shock. RESULTS: Among 2,061 patients in the FROG-ICU day-90 mortality was 30.1%. Machine learning models achieved AUCs of 0.74, outperforming severity scores (AUC 0.64, p < 0.001). Variable importance analysis consistently identified sTREM-1 as the strongest predictor. When evaluated alone, sTREM-1 demonstrated high prognostic performance (AUC 0.72), comparable to ML models. These findings were confirmed in the MARS cohort. Similar results were observed for MAKE prediction. CONCLUSION: sTREM-1 is a robust biomarker associated with mortality and kidney-related outcomes in critically ill patients. Its predictive performance were comparable to multiparametric machine learning models and superior to severity scores.

BACKGROUND: Remimazolam is a novel ultra-short-acting benzodiazepine sedative, but its clinical positioning, delirium risk profile, and comparative efficacy against standard-of-care sedatives remain incompletely defined. This study aimed to comprehensively evaluate its efficacy and safety compared with propofol (Analysis A) and dexmedetomidine (Analysis B) across diverse clinical settings. METHODS: Two independent meta-analyses were performed: Analysis A compared remimazolam vs. propofol in intubated surgical adults (primary endpoint: postoperative delirium incidence and recovery quality); Analysis B compared remimazolam vs. dexmedetomidine in perioperative/ICU adults with sedation (primary endpoint: time to achieve target sedation). Standard meta-analytic methods, trial sequential analysis (TSA), meta-regression, GRADE evidence grading, and heterogeneity source analysis were applied. RESULTS: Analysis A (vs. Propofol): Remimazolam showed a delirium risk comparable to propofol (OR 1.06, 95% CI 0.78-1.45; Moderate certainty), a finding confirmed by TSA as robust. Quality of recovery (QoR-15) was similar between two agents (MD -1.85, 95% CI -7.01 to 3.31), though the certainty was very low due to very serious inconsistency and serious imprecision (I CONCLUSIONS: Remimazolam is a safe and effective alternative to propofol for surgical anesthesia, offering superior hemodynamic stability without increasing the risk of postoperative delirium. Compared with dexmedetomidine, remimazolam provides a faster onset of sedation, an advantage that may be especially pronounced in patients with pre-existing agitation. It is well-suited for ambulatory, high-turnover surgery and hemodynamically vulnerable populations. Its long-term neurocognitive safety in ICU sedation requires further investigation.