Daily Anesthesiology Research Analysis

IMPORTANCE: Severe burn injury triggers systemic inflammation that can lead to multiple organ dysfunctions and death. High-dose intravenous vitamin C has been proposed to mitigate these effects, but strong evidence in patients with burn injury is lacking. OBJECTIVE: To evaluate the efficacy of high-dose intravenous vitamin C in patients with severe burn injury. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled phase 3 trial conducted across 24 burn centers in North, Central, and South America; Europe; and Asia. Adults (≥18 years) with deep second- and/or third-degree burns covering 20% or more of total body surface area and requiring skin grafting were enrolled between August 18, 2020, and September 12, 2025. Final follow-up was completed in March 2026. The trial was stopped early after the first prespecified interim analysis for futility/harm. INTERVENTIONS: Patients were randomly assigned (1:1) to receive intravenous vitamin C (50 mg/kg every 6 hours for 96 hours) or matched placebo. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of 28-day mortality and persistent organ dysfunction (defined as dependence on mechanical ventilation, kidney replacement therapy, or vasopressor/inotrope support at day 28). The main secondary outcome was time to discharge alive from hospital within 90 days. RESULTS: Among 238 patients enrolled (mean age, 48.9 [SD, 19.1] years; 79% male; mean total body surface area, 37.0% [SD, 14.6%]), 120 were assigned to vitamin C and 118 to placebo. The primary composite outcome occurred in 49 patients (40.8%) in the vitamin C group and 35 patients (29.7%) in the placebo group (adjusted risk ratio [RR], 1.28 [95% CI, 0.99-1.65]; P = .06), crossing the prespecified futility/harm threshold and prompting early trial termination. Time to discharge alive from hospital within 90 days was not improved (adjusted subdistribution hazard ratio, 0.85 [95% CI, 0.62-1.16]; P = .31). Twenty-eight-day mortality was higher in the vitamin C group (15.0% vs 7.6%; adjusted RR, 1.96 [95% CI, 1.32-2.90]; P = .001), as was hospital mortality (23.3% vs 16.1%; adjusted RR, 1.44 [95% CI, 1.03-2.00]; P = .03). CONCLUSIONS AND RELEVANCE: Among patients with severe burn injury, high-dose intravenous vitamin C did not reduce 28-day mortality and persistent organ dysfunction and is possibly harmful. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04138394.

BACKGROUND: Hypoxemia is the most common adverse event during propofol-based procedural sedation for gastroscopy. Conventional nasal cannula oxygenation provides low flow rates, permitting room air entrainment and often proving insufficient. Nasal mask oxygenation delivers higher inspired oxygen concentrations, potentially enhancing respiratory safety during sedation. OBJECTIVE: This study compared the efficacy and safety of nasal mask versus nasal cannula oxygen delivery during propofol-based procedural sedation for gastroscopy. METHODS: Electronic databases/registries were systematically searched from inception to January 24, 2026, for randomized controlled trials (RCTs). Inclusion criteria encompassed adult patients undergoing propofol-based sedation for gastroscopy. The primary outcome was the incidence of hypoxemia. Secondary outcomes included severe hypoxemia, minimum oxygen saturation (SpO₂), need for airway or oxygenation interventions, procedure-related adverse events, and postoperative nausea and vomiting (PONV). Random-effects meta-analyses were performed using risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). Trial sequential analysis (TSA) assessed the sufficiency of the evidence. Risk of bias was evaluated using RoB 2, and certainty of evidence using GRADE. RESULTS: Five RCTs enrolled 1,267 patients, of whom 1,252 (98.8%) were included in the quantitative synthesis. Nasal mask oxygenation significantly reduced hypoxemia (RR 0.40, 95% CI 0.28 to 0.58, p < 0.0001) and severe hypoxemia (RR 0.39, 95% CI 0.22 to 0.67, p = 0.0007) compared with nasal cannula. Nasal masks also decreased the need for jaw thrust (RR 0.40, 95% CI 0.31 to 0.52) and mask-assisted ventilation (RR 0.16, 95% CI 0.05 to 0.46), while elevating minimum SpO₂ (MD 3.78, 95% CI 1.39 to 6.16). No significant differences emerged in coughing, hiccups, or PONV. CONCLUSIONS: Nasal mask oxygenation is associated with greater respiratory safety compared with nasal cannula oxygenation during propofol-sedated gastroscopy. This advantage manifests as reduced incidence of hypoxemia and fewer airway-related interventions, alongside a comparable overall safety profile. PROSPERO: CRD420261291468.

BACKGROUND: Early postoperative atelectasis is common but often underdiagnosed complication that occurs in patients undergoing prolonged nonintubated anesthesia. Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) provides high-flow oxygen with mild positive pressure and may reduce the incidence of perioperative atelectasis. METHODS: In this single-center, single-blind randomized controlled trial, 128 patients who underwent endoscopic mucosal resection for multiple colorectal polyps were randomly assigned to receive THRIVE (Group T) or conventional facemask oxygen therapy (Group C). Lung ultrasound was performed before induction (T1) and immediately after the procedure (T2). The primary outcome was the incidence of early postoperative atelectasis confirmed by lung ultrasound; secondary outcomes included the modified lung ultrasound score (LUSS), intraoperative hypoxemia incidence, the postanesthesia care unit (PACU) length of stay, and endoscopist satisfaction. RESULTS: All 128 randomized patients completed the study. The overall incidence of postoperative atelectasis was 18.75%. Compared with patients receiving conventional facemask oxygen therapy, patients receiving THRIVE had a significantly lower incidence of atelectasis (10.94% vs. 26.56%, P = 0.013) and a lower postoperative LUSS at T2 (P = 0.019). THRIVE was also associated with a reduced incidence of intraoperative hypoxemia (0% vs. 10.94%, P = 0.016), a shorter PACU stay (25.00 min vs. 30.00 min, P < 0.001), and higher endoscopist satisfaction scores (P < 0.001). Multivariate analysis revealed that a longer recovery time was an independent risk factor for atelectasis (OR = 1.19, 95% CI: 1.03-1.39), whereas THRIVE was independently associated with a reduced risk of atelectasis (OR = 0.28, 95% CI: 0.08-0.85). CONCLUSION: THRIVE reduces the incidence of early postoperative atelectasis and the risk of intraoperative hypoxemia and shortens the PACU recovery time in patients undergoing prolonged nonintubated anesthesia. Moreover, it enhances endoscopist satisfaction. THRIVE demonstrated a favorable safety profile and modest benefits in this setting. Further studies are required before broader clinical application or expansion of indications can be established. TRIAL REGISTRATION: ClinicalTrials.gov (NCT06554678) URL: https://clinicaltrials.gov, registered on 12 August 2024. Retrospectively registered.