Daily Anesthesiology Research Analysis
Analyzed 103 papers and selected 3 impactful papers.
Summary
Three studies advance perioperative care: a meta-analysis shows oliceridine reduces postoperative nausea/vomiting and respiratory depression versus sufentanil without sacrificing analgesia; a randomized trial demonstrates THRIVE lowers gastric insufflation during induction in patients at high risk for obstructive sleep apnea; and an ICU cohort challenges the causal link between contrast media and AKI using high-resolution temporal analysis. Together, they inform safer analgesia, airway management, and imaging decisions.
Research Themes
- Opioid-sparing perioperative analgesia and adverse event reduction
- Airway management innovations to mitigate aspiration risk
- Reassessing contrast-associated AKI with temporal methods in critical care
Selected Articles
1. Oliceridine versus sufentanil: a systematic review and meta-analysis of postoperative nausea and vomiting.
Across 10 RCTs (n=1,408), oliceridine significantly reduced postoperative nausea/vomiting and respiratory depression versus sufentanil, with comparable analgesic efficacy and hemodynamic safety. These consistent benefits support oliceridine as an alternative opioid in multimodal, opioid-sparing pathways.
Impact: Synthesizing randomized evidence, this meta-analysis demonstrates clinically meaningful safety advantages without sacrificing analgesia, directly informing perioperative opioid selection.
Clinical Implications: When opioid PCA or intraoperative opioids are needed, oliceridine may reduce PONV and respiratory depression compared with sufentanil, potentially improving PACU flow, patient satisfaction, and ERAS compliance. Institutions should consider formulary evaluation and protocol integration where available.
Key Findings
- Included 10 randomized controlled trials with 1,408 patients comparing oliceridine vs. sufentanil.
- Oliceridine reduced postoperative nausea/vomiting (RR 0.46, 95% CI 0.36–0.58) and rescue antiemetic use (RR 0.46, 95% CI 0.26–0.80).
- Respiratory depression was lower with oliceridine (RR 0.51, 95% CI 0.38–0.70) with no difference in analgesic pump activations or need for rescue analgesia.
- No significant differences in hypotension, bradycardia, or dizziness between groups.
Methodological Strengths
- Systematic identification and pooling of randomized controlled trials with standardized effect measures (RR, 95% CI).
- Risk of bias assessed using the Cochrane tool; consistent direction of effects across studies.
Limitations
- Heterogeneity in surgical procedures, dosing regimens, and perioperative co-interventions may limit generalizability.
- Outcomes focused on early postoperative period; limited data on longer-term analgesic consumption and chronic pain.
Future Directions: Head-to-head effectiveness and cost-effectiveness trials within ERAS pathways, with standardized PONV prophylaxis and longer follow-up, are warranted to define optimal patient selection and dosing.
BACKGROUND: Oliceridine is a novel µ-opioid receptor agonist designed to reduce opioid-related adverse events while maintaining effective analgesia. However, randomized controlled trials comparing oliceridine with conventional opioids, such as sufentanil, have yielded inconsistent results. This systematic review and meta-analysis aims to compare the effects of oliceridine and sufentanil on postoperative nausea and vomiting. METHODS: We searched PubMed, Embase, and the Cochrane Library databases to identify all randomized controlled trials published from the inception through March 14, 2026, that examined the effects of oliceridine and sufentanil on postoperative nausea and vomiting. Data analysis was performed using RevMan 5.4 software. Binary outcomes were analyzed using risk ratios and 95% confidence intervals, while continuous variables were expressed as mean differences. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias Tool. RESULTS: Ten randomized controlled trials involving 1408 patients met the inclusion criteria. Compared with sufentanil, oliceridine was associated with a lower incidence of postoperative nausea and vomiting (RR = 0.46, 95% CI 0.36-0.58, P < 0.00001), reduced requirement for rescue antiemetics (RR = 0.46, 95% CI 0.26-0.80, P = 0.006), and a lower incidence of respiratory depression (RR = 0.51, 95% CI 0.38-0.70, P < 0.0001). No statistically significant differences were observed between groups in the number of effective activations of the analgesic pump, rescue analgesia, hypotension, bradycardia, and dizziness. CONCLUSIONS: Oliceridine may reduce the risk of postoperative nausea and vomiting and respiratory depression compared with sufentanil while maintaining comparable analgesic efficacy. These findings support the potential role of oliceridine as an alternative opioid for perioperative analgesia.
2. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange versus Oropharyngeal Airway-Assisted Face-Mask Ventilation for Gastric Insufflation During Induction of General Anesthesia in Patients at High Risk for Obstructive Sleep Apnea.
In a randomized trial of 94 high-risk OSA patients undergoing major abdominal surgery, THRIVE during induction halved the incidence of post-intubation gastric insufflation compared with oropharyngeal airway-assisted face-mask ventilation. THRIVE also improved preoxygenation and comfort, maintaining oxygenation during apnea with only transient hypercapnia.
Impact: Provides actionable, randomized evidence favoring THRIVE to mitigate gastric insufflation—a key aspiration risk factor—in a vulnerable population.
Clinical Implications: For high-risk OSA patients, consider THRIVE during induction to reduce gastric insufflation, potentially lowering aspiration risk and improving first-pass success by extending safe apnea time.
Key Findings
- Randomized 94 high-risk OSA patients (47 per arm) to THRIVE vs face-mask ventilation with oropharyngeal airway.
- THRIVE reduced post-intubation gastric insufflation incidence (23.4% vs 44.7%).
- THRIVE improved preoxygenation and patient comfort and maintained oxygenation during apnea with a transient increase in PaCO2.
Methodological Strengths
- Randomized allocation with objective gastric antrum ultrasonography assessment.
- Standardized induction workflow enabling fair comparison of airway strategies.
Limitations
- Open-label design and single-procedure context may introduce performance bias and limit generalizability.
- Short-term outcomes; study not powered for aspiration pneumonia or hard clinical endpoints.
Future Directions: Multicenter trials powered for aspiration events and peri-induction hypoxemia, with end-tidal CO2 tracking and standardized PEEP/pressure targets, are needed.
PURPOSE: Obstructive sleep apnea (OSA) is an independent risk factor for gastric insufflation during the induction of general anesthesia. We aimed to compare the impact of oropharyngeal airway-assisted face-mask ventilation and transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on gastric insufflation in patients with high-risk OSA. PATIENTS AND METHODS: Patients at high risk for OSA scheduled for elective major abdominal surgery under general anesthesia were randomized 1:1 to either Group T (THRIVE throughout induction) or Group M (face-mask preoxygenation followed by oropharyngeal airway-assisted pressure-controlled ventilation). Gastric antrum ultrasonography was performed at baseline (T RESULTS: Of 100 randomized patients, 94 completed the study (47 per group). Group T demonstrated a significantly lower incidence of gastric insufflation post-intubation compared to Group M (23.4% vs 44.7%; CONCLUSION: In patients at high risk for OSA, THRIVE reduces the incidence of gastric insufflation during induction compared with oropharyngeal airway-assisted face-mask ventilation. THRIVE improves preoxygenation and patient comfort. Oxygenation was maintained during apnea, with a transient increase in PaCO
3. Contrast Media and Acute Kidney Injury in the ICU.
In 1,057 ICU patients with hourly AKI staging, 16% of contrast-exposed patients met CA-AKI criteria, yet AKI preceded contrast exposure in 76% and no dose–response was observed. Although contrast exposure correlated with longer ICU stay and mortality, temporal patterns and frequent AKI reversal challenge a causal interpretation.
Impact: High-resolution temporal phenotyping and matched comparisons refine the understanding of CA-AKI in critically ill patients, informing risk–benefit decisions around necessary contrast-enhanced diagnostics.
Clinical Implications: Avoid reflexively withholding indicated contrast-enhanced imaging in ICU patients solely due to AKI fears; prioritize hemodynamic optimization and disease control, recognizing that AKI often precedes contrast and lacks a dose–response. Maintain vigilance and nephroprotective strategies post-exposure.
Key Findings
- Among 1,057 ICU patients, 277 received contrast; 16% developed CA-AKI (KDIGO 1/2/3: 63%/23%/14%).
- AKI preceded contrast exposure in 76.2% of cases (95% CI 66%–85%).
- No dose–response relationship between contrast dose quartiles and CA-AKI proportion (p=0.746).
- Contrast exposure associated with longer ICU LOS and higher ICU mortality in matched analysis, but RRT use was similar.
Methodological Strengths
- Hourly KDIGO staging enabling precise temporal attribution relative to contrast exposure.
- Matched analysis controlling for stay duration and renal function to reduce confounding.
Limitations
- Single-center retrospective design limits causal inference and external validity.
- Potential residual confounding from illness severity and indication for imaging.
Future Directions: Prospective multicenter studies with protocolized timing/dosing, hemodynamic covariates, and biomarker panels could clarify causality and identify susceptible phenotypes.
BACKGROUND: Acute kidney injury (AKI) is frequent and influences the prognosis of intensive care unit (ICU) patients. AKI may be categorised as contrast-associated AKI (CA-AKI). We investigated the development of CA-AKI, including temporal and dose-response relationships. METHODS: Adult patients admitted between 2010 and 2015 with a minimum ICU stay of 54 h were eligible for inclusion. AKI was scored on an hourly basis to enable temporal analyses. CA-AKI was defined as an increase in Kidney Disease: Improving Global Outcomes (KDIGO) AKI stage occurring within 48 h of contrast media administration. For the matched analysis, contrast-exposed patients were matched to unexposed patients on duration of stay and renal function. RESULTS: Of 1057 patients, 277 patients were exposed to contrast media. Sixteen percent (n = 43) developed CA-AKI (KDIGO AKI stage 1/2/3: 63%/23%/14%). AKI preceded contrast in 76.2% of cases (95% confidence interval [CI]: 66%-85%, p < 0.001). After contrast exposure, AKI reversal occurred in 65 cases. The proportion of CA-AKI was similar between dose quartiles (p = 0.746). The length of ICU stay (length of stay [LOS]) was longer in the exposed group (10.9 vs. 5.5 days, p < 0.001) regardless of CA-AKI status. In the matched analysis, exposed patients had longer remaining LOS (mean difference 1.47 days, 95% CI: 1.35-1.60) and higher ICU mortality (OR: 1.67, 95% CI: 1.1-2.6), but use of renal replacement therapy (RRT) was similar. CONCLUSIONS: CA-AKI was observed in one of six ICU patients exposed to contrast media and associated with higher mortality and ICU LOS. However, AKI most often precedes contrast. AKI reversal was more common than AKI following exposure. No clear evidence of a dose-response relationship was found. The findings question whether AKI in an ICU population is related to contrast media exposure, but the observational design precludes ruling out contrast media as a cause of AKI. EDITORIAL COMMENT: This ICU cohort analysis presents kidney injury findings where there is intravenous contrast exposure. Where some kidney injury was sometimes present before contrast exposure, this makes exploring the relation of contrast to injury and recovery more complex.