Daily Anesthesiology Research Analysis
Analyzed 85 papers and selected 3 impactful papers.
Summary
Analyzed 85 papers and selected 3 impactful articles.
Selected Articles
1. Impact of oliceridine versus sufentanil on postoperative nausea and vomiting in patients undergoing thyroid surgery: a prospective, double-blind, randomized controlled trial.
In a double-blind RCT of 232 thyroid surgery patients, oliceridine reduced 48-hour PONV incidence (12%) versus sufentanil (28%) while maintaining adequate analgesia. Secondary measures suggested fewer rescue antiemetics and comparable pain scores, supporting a favorable tolerability profile.
Impact: Demonstrates a clinically meaningful reduction in PONV with a G protein–biased opioid while preserving analgesia, informing opioid selection in high-PONV-risk surgery.
Clinical Implications: Consider oliceridine as an intraoperative opioid option to reduce PONV in low-risk (ASA I–II), ambulatory-type thyroid surgeries while maintaining analgesia; broader validation across higher-intensity procedures and diverse populations is needed.
Key Findings
- 48-hour PONV was significantly lower with oliceridine (12%) vs sufentanil (28%); OR 0.35, 95% CI 0.17–0.72.
- Analgesic efficacy was adequate and comparable between groups across postoperative time points.
- Fewer rescue antiemetic needs and improved tolerability signals were observed with oliceridine.
Methodological Strengths
- Prospective, double-blind, randomized controlled design with predefined outcomes
- Clinically relevant primary endpoint (48-hour PONV) with effect size and confidence intervals
Limitations
- Single-procedure focus (thyroid surgery) with relatively young ASA I–II patients limits generalizability
- Trial does not assess rare adverse events or long-term outcomes
Future Directions: Replicate in higher-risk and high-intensity surgeries; evaluate multimodal ERAS pathways integrating oliceridine; compare cost-effectiveness and opioid-sparing potential versus other regimens.
PURPOSE: Postoperative nausea and vomiting (PONV) is a common complication following thyroid surgery, often exacerbated by opioid use. Oliceridine, a novel G protein-biased μ-opioid receptor agonist, may reduce opioid-related adverse events. This study aimed to compare the impact of oliceridine versus sufentanil on the incidence and severity of PONV in patients undergoing thyroid surgery. PATIENTS AND METHODS: In this prospective, double-blind, randomised controlled trial conducted between May 2025 and February 2026, 232 patients scheduled for thyroid surgery were randomly assigned to receive either oliceridine or sufentanil for intraoperative analgesia. The primary outcome was the incidence of PONV during the first 48 h postoperatively. Secondary outcomes included PONV severity, need for rescue anti-emetics, postoperative pain scores, recovery quality, and other adverse events. RESULTS: The incidence of PONV within 48 h postoperatively was significantly lower in the oliceridine group [13/107 (12%)] compared with the sufentanil group [31/110 (28%)] (OR = 0.35, 95% CI: 0.17-0.72,
2. Easy DAO2 index: a novel hemodynamic risk factor for predicting mortality in surgical and critically ill patients.
Across 185,535 encounters, a simple composite index (EDI = pulse pressure × heart rate × hemoglobin × SpO2 divided by body surface area) measured frequently was independently associated with 7-day mortality in both surgical anesthesia and ICU cohorts. Longer exposure below a low EDI threshold conferred incrementally higher risk.
Impact: Introduces a noninvasive, computable surrogate of oxygen delivery with continuous-time risk semantics that scales to operating rooms and ICUs and may enable early, automated risk alerts.
Clinical Implications: Integrate EDI into perioperative and ICU monitoring dashboards to flag sustained low values for hemodynamic optimization; prospective interventional trials are needed before protocolized EDI-guided care.
Key Findings
- EDI = (pulse pressure × heart rate × hemoglobin × SpO2) / body surface area, sampled every 5 min intraoperatively and hourly post-ICU admission.
- In non-cardiac surgery, mortality risk rose with each minute below the low-EDI threshold (aOR 1.003; 95% CI 1.000–1.005).
- In ICU patients, risk increased per hour below the low-EDI threshold (aOR 1.014; 95% CI 1.004–1.023), independent of confounders.
Methodological Strengths
- Very large, multi-setting datasets with high-frequency physiologic data capture
- Consistent associations across surgical and ICU populations with adjusted models
Limitations
- Retrospective observational design with potential residual confounding and center-level practice variability
- Thresholds defined by cohort-specific percentiles; external calibration and intervention effects untested
Future Directions: Prospective validation and pragmatic trials to test EDI-guided hemodynamic optimization; evaluate device interoperability, alarm strategies, and integration with oxygen consumption estimates.
BACKGROUND: Measurement of the arterial oxygen delivery index (DAO2I) requires substantial medical resources and invasive procedures. We proposed a novel hemodynamic parameter reflecting DAO2I, the Easy DAO2 index (EDI), and examined its association with mortality in non-cardiac surgical and critically ill patients. METHODS: We retrospectively analyzed the data of 95,115 surgical cases from an Asian hospital and 90,420 intensive care unit (ICU) admissions from multicenter hospitals in the United States. EDI was the product of pulse pressure, heart rate, hemoglobin, and peripheral oxygen saturation, divided by body surface area, measured every 5 minutes during anesthesia and hourly for 24 hours post-ICU admission. We assessed the association between 7-day in-hospital mortality and duration of exposure to EDI values below the fifth percentile levels. RESULTS: In non-cardiac surgical patients, mortality risk increased with duration of exposure below the low EDI threshold (adjusted odds ratio [aOR] 1.003 per minute; 95% CI 1.000-1.005). In critically ill patients, mortality risk increased with duration of exposure below the low EDI threshold (aOR 1.014 per hour; 95% CI 1.004-1.023). CONCLUSIONS: Low EDI values were independently associated with mortality in non-cardiac surgical and critically ill patients, suggesting that EDI may be a useful hemodynamic parameter for risk assessment.
3. Effect of the orexin receptor antagonist, suvorexant, on sleep architecture in the early postoperative period following cardiac surgery: a randomized controlled trial.
In a two-center, double-blind RCT (n=100) after cardiac surgery, suvorexant did not improve EEG-derived sleep parameters (WASO or total sleep time) nor reduce delirium compared with placebo. Rescue sedative use and subjective sleep quality were also similar.
Impact: A rigorous negative trial prevents ineffective pharmacologic adoption for ICU sleep and delirium management after cardiac surgery, redirecting efforts toward alternative strategies.
Clinical Implications: Routine suvorexant use to enhance early postoperative sleep or prevent delirium after cardiac surgery is not supported; prioritize nonpharmacologic sleep hygiene and established delirium-prevention bundles.
Key Findings
- No significant difference in WASO between suvorexant and placebo (median 200.7 vs 184.2 minutes; p=0.33).
- Total sleep time and subjective sleep quality did not differ between groups.
- No reduction in delirium incidence or change in rescue sedative use with suvorexant.
Methodological Strengths
- Double-blind randomized design with objective EEG-based sleep scoring by blinded technologist
- Standardized dosing and systematic daily delirium assessments
Limitations
- Sample size may be underpowered for modest delirium effects or rare adverse events
- EEG monitoring limited to the first post-extubation night; longer objective monitoring not performed
Future Directions: Assess multimodal nonpharmacologic sleep interventions, timing/dosing variations, and personalized approaches targeting specific phenotypes; explore orexin pathways in different ICU populations.
BACKGROUND: Patients recovering from cardiac surgery in the intensive care unit (ICU) do not sleep well. Commonly used sedative-hypnotic medications can disrupt sleep architecture and increase the risk of delirium in critically ill patients after surgery. The orexin receptor antagonist suvorexant, improves sleep onset and duration in patients with chronic insomnia. We hypothesized that suvorexant improves sleep onset and duration while also reducing the incidence of delirium after cardiac surgery. METHODS: This multicentric, double-blind, randomized controlled trial was conducted at two university-based cardiac ICUs. One hundred adult patients were enrolled after admission to the ICU following cardiac surgery. Enrollment occurred between March 2020 and February 2025. Participants were randomized to receive either a once daily oral dose of suvorexant 20 mg or placebo. Treatment began on the first night after extubation and continued until hospital discharge or for a maximum of seven days, whichever occurred first. Sleep was recorded using an electroencephalography (EEG) monitor (SedLine, Masimo Corp., California, USA) on the first night after extubation and was scored blindly by an experienced registered polysomnographic technologist. The primary outcome was wakefulness after persistent sleep onset (WASO). Sleep onset was defined as the first 30-second epoch classified by rapid eye movement (REM) or non-REM stages 1, 2, 3 after lights off. Wakefulness was defined as an awake period of 30s or longer. Sleep questionnaires were administered and delirium screenings were conducted every morning until hospital discharge. RESULTS: One hundred patients were randomized to receive suvorexant (n = 49) or placebo (n = 51). EEG analysis indicated that neither the median [inter-quartile range] nighttime WASO (200.7 [112.1, 328.4] minutes vs. 184.2 [80.4, 304.2] minutes; p = 0.33) nor total sleep time (224.0 [112.0, 379.0] minutes vs. 253.0 [68.0, 420.0] minutes; p = 0.92) differed significantly between the groups. There was no significant difference in rescue medication (melatonin, dexmedetomidine, benzodiazepine) utilization between the groups. Subjective sleep quality, incidence of delirium, and delirium-free days did not differ between the two groups. TRIAL REGISTRATION NUMBER: Clinical Trials Registry no. NCT04092894, Registration Date 09/17/2019. CONCLUSIONS: Among patients recovering in the ICU who underwent cardiac surgery with cardiopulmonary bypass, the suvorexant treatment did not affect wakefulness after sleep onset or post-operative delirium.