Daily Anesthesiology Research Analysis
Analyzed 102 papers and selected 3 impactful papers.
Summary
Three high-impact studies in anesthesiology and perioperative care stand out today: a large meta-analysis finds that awake prone positioning reduces mortality and intubation in acute hypoxemic respiratory failure; a randomized trial shows preemptive dexmedetomidine improves intraoperative nociception control and postoperative pain; and a randomized trial in obese patients undergoing gastroscopy demonstrates ciprofol yields fewer hypoxemia and apnea events than propofol.
Research Themes
- Perioperative analgesia and sedation optimization
- Noninvasive respiratory strategies in acute hypoxemic respiratory failure
- Safety and hemodynamics in endoscopy sedation for obesity
Selected Articles
1. Comparison of ciprofol and propofol in combination with sufentanil for gastroscopic sedation in people living with obesity: a prospective, randomized, controlled trial.
In obese patients undergoing gastroscopy with sufentanil-based sedation, ciprofol significantly reduced hypoxemia (19.1% vs 34.3%), apnea (5.9% vs 17.9%), and injection pain (1.5% vs 26.9%) versus propofol, with higher endoscopist satisfaction. These findings suggest ciprofol may offer a safer, more comfortable sedation strategy for high-risk obese patients.
Impact: This randomized trial addresses a critical safety issue—respiratory compromise during endoscopy in obesity—and evaluates a next-generation hypnotic (ciprofol) against the standard of care. The large risk reductions in hypoxemia and apnea are clinically meaningful.
Clinical Implications: For obese patients undergoing gastroscopy, ciprofol may be preferred over propofol to reduce hypoxemia and apnea, improve procedural conditions, and minimize injection pain, potentially enhancing safety and efficiency in endoscopy suites.
Key Findings
- Hypoxemia occurred less frequently with ciprofol vs propofol (19.1% vs 34.3%; absolute difference 15.2%).
- Apnea episodes were reduced with ciprofol (5.9% vs 17.9%).
- Lower injection pain with ciprofol (1.5% vs 26.9%).
- Higher endoscopist satisfaction and slightly higher minimum SpO2 with ciprofol.
Methodological Strengths
- Prospective randomized controlled design with active comparator.
- Clinically relevant respiratory and patient-centered outcomes with confidence intervals reported.
Limitations
- Final randomized sample size not explicitly reported in abstract.
- Single-center design may limit generalizability; dosing and monitoring protocols may vary across centers.
Future Directions: Multicenter RCTs with standardized sedation protocols across diverse obese populations and procedures should confirm safety signals, define optimal dosing, and evaluate recovery profiles and cost-effectiveness.
BACKGROUND: Hypoxemia occurs in people living with obesity undergoing gastroscopy under intravenous anesthesia. Preventing hypoxia in people living with obesity with appropriate anesthetics is therefore important. This study aims to compare the safety and efficacy of ciprofol versus propofol, both combined with sufentanil, for sedation during gastroscopy in people living with obesity. METHODS: This prospective, randomized, controlled trial was conducted at the Endoscopic Center of Hangzhou Red Cross Hospital. Between August 2023 and August 2024, 652 patients were assessed for eligibility. Subsequently, Patients aged 18-65 years, classified as American Society of Anesthesiologists II, with a body mass index (BMI) between 30 and 40 kg/m², were enrolled. Participants were randomly assigned to receive either ciprofol or propofol, both combined with sufentanil, during their gastroscopy. The trial was registered with the Chinese Clinical Trial Registry (ChiCTR2300074217). RESULTS: The primary outcome, hypoxemia, occurred in 34.3% of propofol patients vs 19.1% with ciprofol (absolute difference 15.2%; 95% CI 4.9--29.9%). For secondary outcomes, the propofol group experienced significantly more apnea episodes (17.9% vs 5.9%; absolute difference 12%; 95% CI 1.3% to 22.8%) and lower minimum SpO₂ values (90 [80 to 95] vs 93 [90 to 97]; absolute difference --3; 95% CI --8 to 1). Endoscopist satisfaction was higher with ciprofol (4 [3 to 5] vs 5 [4 to 5]; absolute difference --1; 95% CI --1 to 0), and injection pain was significantly more frequent in the propofol group (26.9% vs 1.5%; absolute difference 25.4%; 95% CI 14.4% to 36.4%). CONCLUSIONS: Ciprofol combined with sufentanil for gastroscopy sedation in people living with obesity, results in lower incidences of hypoxemia and injection pain, shorter apnea duration, and higher endoscopist satisfaction compared to propofol. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2300074217; 2023/08/01. People living with obesity can have difficulties breathing during stomach examinations when they are sedated, such as during gastroscopy. This puts them at risk of having low oxygen levels. We compared two drugs used to sedate people, ciprofol and the commonly used propofol, to see which one is safer for people with obesity undergoing gastroscopy. All patients received a pain-reliever (sufentanil), plus either ciprofol or propofol for sedation. We then monitored their breathing, oxygen levels, and any side effects. Patients receiving ciprofol had significantly fewer episodes of low oxygen levels and stopped breathing less often. They also experienced much less pain when the drug was injected and had more stable blood pressure. Doctors were more satisfied with the sedation quality in the ciprofol group. Ciprofol appears to be a safer and more comfortable option than propofol for sedating patients with obesity during gastroscopy. This could lead to fewer breathing problems and a better overall experience for at-risk patients.
2. Dexmedetomidine Preemptive Analgesia on Intra- and Postoperative Pain in Noncardiac Surgery: A Randomized, Double-Blind, Controlled Study.
Preemptive dexmedetomidine infusion significantly increased intraoperative nociception index compliance (90.7% vs 12.5%) and reduced moderate-to-severe postoperative pain at 0, 24, 48 hours, and 7 days. It also lowered rescue opioid use and PONV with improved hemodynamic stability and favorable safety.
Impact: A double-blind RCT integrating objective nociception monitoring demonstrates clinically relevant analgesic and antiemetic benefits of dexmedetomidine preemptive use, informing multimodal analgesia pathways.
Clinical Implications: Incorporating preemptive dexmedetomidine into multimodal analgesia may reduce early postoperative pain, opioid requirement, and PONV while stabilizing hemodynamics, especially where objective nociception-guided anesthesia is practiced.
Key Findings
- NOX compliance (mean NOX ≤60 during stimulation) was higher with dexmedetomidine (90.7% vs 12.5%).
- Moderate-to-severe pain (pNRS >3) was reduced at 0 h, 24 h, 48 h, and day 7 postoperatively.
- Rescue opioid use and postoperative nausea/vomiting were decreased; hemodynamic stability improved without safety concerns.
Methodological Strengths
- Randomized, double-blind, placebo-controlled design with prespecified co-primary outcomes.
- Use of objective nociception index (NOX) alongside patient-reported pain and adverse events.
Limitations
- Single-center study; external validity may be limited.
- Specific dosing/timing may not generalize to all surgeries or populations.
Future Directions: Multicenter trials should evaluate dexmedetomidine preemptive analgesia across surgical types, refine dose-response, and assess recovery quality and opioid-sparing economics.
BACKGROUND: Inadequate pain management affects over half of the 230 million major surgeries performed annually. Preemptive analgesia aims to prevent peripheral and central sensitization. Dexmedetomidine (DEX) offers non-opioid analgesia and opioid-sparing effects. This study evaluated the efficacy of preemptive DEX using the nociception index (NOX) for objective intraoperative monitoring and assessed its impact on perioperative outcomes. METHODS: In this single-center, double-blind, randomized controlled trial, 220 eligible patients were assigned to receive either intravenous DEX (1.5 µg·kg-1·h-1) (DEX group) or placebo (normal saline) (PO group) from 15 minutes before anesthesia induction until 15 minutes post-induction. The co-primary outcomes were the intraoperative NOX compliance rate (mean NOX ≤60 during nociceptive stimulation) and the incidence of moderate-to-severe postoperative pain (pNRS > 3) at 0, 24, 48 hours, and 7 days. Secondary outcomes included hemodynamic parameters, postoperative nausea and vomiting (mPONV), dizziness, analgesic consumption, and safety events. RESULTS: The DEX group demonstrated a significantly higher NOX compliance rate compared to the placebo group (98/108, 90.7% vs 14/112, 12.5%; P <.001). The incidence of NRS>3 was significantly lower in the DEX group at all postoperative time points (3/108, 2.8% vs 29/112, 25.9% at 0 hour; 6/108, 5.6% vs 33/112, 29.5% at 24 hours; 1/108, 0.9% vs 19/112, 17% at 48 hours; 0/108, 0% vs 6/112, 5.4% at 7 d; P = .000). DEX also reduced rescue opioid consumption (z = -2.428, P = .004), decreased mPONV (z = -4.901, P = .001), and improved hemodynamic stability. Safety profiles were favorable in DEX group. CONCLUSION: Preemptive analgesia with DEX significantly improves both intraoperative nociceptive control as objectively measured by the NOX and postoperative pain control. It validates the role in optimizing perioperative analgesia and enhancing recovery.
3. Awake prone positioning reduces mortality, intubation, and hospital stay in acute hypoxemic respiratory failure: a systematic review and meta-analysis of 6,164 patients.
Across 24 studies (6,164 patients), awake prone positioning reduced mortality (OR 0.60), intubation (OR 0.69), and hospital length of stay without increasing adverse events. ICU stay and need for invasive ventilation were also reduced, supporting APP as an effective, low-cost strategy in non-intubated AHRF.
Impact: By synthesizing RCTs and observational data, this meta-analysis provides actionable evidence that APP improves hard outcomes in AHRF, potentially informing respiratory care protocols beyond COVID-19 contexts.
Clinical Implications: Protocols for non-intubated AHRF should incorporate APP with attention to patient selection, session duration, and tolerance, while systems should monitor for heterogeneity in practice and ensure safety surveillance.
Key Findings
- Mortality was reduced with APP (OR 0.60, 95% CI 0.42–0.86).
- Intubation risk decreased with APP (OR 0.69, 95% CI 0.60–0.79).
- Hospital and ICU length of stay were reduced (−0.70 and −2.84 days, respectively) without increased adverse events.
Methodological Strengths
- Systematic inclusion of RCTs and observational studies with ROB 2 and Newcastle-Ottawa Scale risk-of-bias assessment.
- Random-effects meta-analysis with multiple clinically important outcomes.
Limitations
- Study heterogeneity and potential publication bias noted; APP protocols (duration, timing) varied.
- Mix of RCTs and observational designs may introduce residual confounding.
Future Directions: High-quality, protocolized multicenter RCTs should define optimal APP duration, patient selection, and integration with HFNO/NIV to maximize benefit and adherence.
BACKGROUND: Acute hypoxemic respiratory failure (AHRF) is a major cause of morbidity and mortality and often requires advanced respiratory support. Awake prone positioning (APP) has emerged as a simple, low-cost intervention to improve oxygenation in non-intubated patients; however, its clinical effectiveness and safety remain uncertain. AIM: This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of awake prone positioning in non-intubated adult patients with acute hypoxemic respiratory failure. METHODS: A systematic search of PubMed, Scopus, and Web of Science was conducted from database inception to February 2026. Randomized controlled trials and observational comparative studies evaluating APP versus usual care were included. Primary outcomes were mortality, intubation, and length of hospital stay. Secondary outcomes included ICU stay, invasive mechanical ventilation, ICU admission, escalation of respiratory support, time to invasive ventilation, and adverse events. Risk of bias was assessed using ROB 2 for randomized trials and the Newcastle-Ottawa Scale for observational studies. Meta-analysis was performed using a random-effects model. RESULTS: Twenty-four studies involving 6,164 patients were included. APP significantly reduced mortality (OR = 0.60, 95% CI 0.42-0.86, p = 0.005), intubation (OR = 0.69, 95% CI 0.60-0.79, p < 0.00001), length of hospital stay (MD = - 0.70 days, 95% CI - 1.07 to - 0.32, p = 0.0003), ICU stay (MD = - 2.84 days, 95% CI - 5.44 to - 0.24, p = 0.03), and invasive mechanical ventilation (OR = 0.42, 95% CI 0.31-0.58, p < 0.00001). No significant differences were observed in ICU admission, escalation of respiratory support, or adverse events. CONCLUSION: Awake prone positioning was associated with improved clinical outcomes, including reduced mortality, intubation, and hospital stay, without an apparent increase in adverse events. However, these findings should be interpreted cautiously given the observed heterogeneity and potential publication bias. Further high-quality randomized trials are needed to confirm these results.