Daily Anesthesiology Research Analysis
Analyzed 40 papers and selected 3 impactful papers.
Summary
Two high-quality randomized trials address core perioperative outcomes: perioperative butorphanol reduced postoperative pulmonary complications after thoracoscopic lung resection, and oliceridine decreased postoperative nausea and vomiting after gynecologic laparoscopy. A mechanistic cohort study in cardiac surgery links impaired extracellular DNA clearance (high dsDNA/low DNase activity) to postoperative atrial fibrillation and mortality, offering biomarker-driven risk stratification.
Research Themes
- Perioperative prevention of pulmonary complications
- Optimization of antiemetic strategies via opioid selection
- Biomarker-driven risk stratification for postoperative atrial fibrillation
Selected Articles
1. Perioperative Butorphanol for the Prevention of Postoperative Pulmonary Complications After Thoracoscopic Lung Resection: A Randomized, Double-Blind, Placebo-Controlled Trial.
In a double-blind RCT (n=506 mITT), perioperative butorphanol reduced 7-day postoperative pulmonary complications after thoracoscopic lung resection (21.3% vs 32.9%; RR 0.65), largely by lowering atelectasis and pleural effusion. Recovery quality improved and opioid use decreased without new safety signals.
Impact: This is a rigorously designed RCT demonstrating a clinically meaningful reduction in pulmonary complications, a key driver of morbidity after thoracic surgery. It also suggests an opioid-sparing, recovery-enhancing perioperative strategy.
Clinical Implications: Consider incorporating perioperative butorphanol as part of multimodal analgesia and respiratory-protective pathways in thoracoscopic lung resections to reduce PPCs and enhance recovery, while monitoring standard opioid-related adverse events.
Key Findings
- Butorphanol reduced 7-day PPCs: 21.3% vs 32.9% (RR 0.65; 95% CI 0.48–0.87; P=0.004).
- Absolute risk reduction 11.7% with NNT=9; reductions driven by less atelectasis and pleural effusion.
- Higher QoR-40 at 24 h, lower postoperative opioid consumption, and modestly shorter hospital stay without increased early safety events.
Methodological Strengths
- Randomized, double-blind, placebo-controlled design with modified intention-to-treat analysis
- Clinically relevant primary endpoint with effect size estimates and confidence intervals
Limitations
- Single-center study over a short enrollment period, which may limit generalizability
- Composite PPCs outcome; individual components beyond atelectasis/pleural effusion not detailed in abstract
Future Directions: Multicenter trials across diverse thoracic procedures to validate efficacy, explore optimal dosing/timing, and assess longer-term respiratory outcomes and cost-effectiveness.
PURPOSE: Postoperative pulmonary complications (PPCs) remain common after thoracoscopic lung resection. Butorphanol, a κ-opioid receptor agonist with analgesic and potential opioid-sparing properties, may influence postoperative respiratory recovery. This trial evaluated whether perioperative butorphanol reduces PPCs after elective thoracoscopic lung resection. PATIENTS AND METHODS: In this randomized, double-blind, placebo-controlled trial conducted at a tertiary teaching hospital in China from January to July 2025, adults aged 18-65 years with American Society of Anesthesiologists physical status I-III scheduled for elective thoracoscopic lung resection were assigned to receive butorphanol or placebo. The butorphanol group received an intravenous bolus of 10 μg/kg before anesthesia induction followed by 5 μg/kg/h until the end of surgery. The control group received volume-matched saline. The primary outcome was PPCs within 7 postoperative days. RESULTS: Of 520 randomized patients, 506 were included in the modified intention-to-treat analysis. PPCs occurred in 54 of 254 patients (21.3%) in the butorphanol group and 83 of 252 patients (32.9%) in the control group (relative risk, 0.65; 95% CI, 0.48-0.87; P = 0.004), corresponding to an absolute risk reduction of 11.7% and a number needed to treat of 9. The difference was mainly driven by lower rates of atelectasis and pleural effusion. Butorphanol was also associated with higher QoR-40 scores at 24 h, lower opioid consumption, and a modestly shorter hospital stay. Safety outcomes were similar between groups. CONCLUSION: Perioperative butorphanol reduced composite PPCs within 7 days after elective thoracoscopic lung resection, mainly through reductions in atelectasis and pleural effusion, without increasing early safety events.
2. Oliceridine versus Sufentanil on Postoperative Nausea and Vomiting in Women Undergoing Gynecological Laparoscopic Surgery: A Randomized Double‑Blind Controlled Trial.
In 260 women undergoing gynecologic laparoscopy, oliceridine halved the 48-hour PONV incidence versus sufentanil (22.5% vs 43.0%; OR 0.38) under standardized anesthesia and antiemetic prophylaxis. Recovery quality (QoR-15) and satisfaction improved without loss of analgesia or excess adverse events.
Impact: Demonstrates the clinical value of a G protein-biased μ-agonist to reduce PONV—a common, high-priority outcome—while maintaining analgesia, informing opioid selection in enhanced recovery pathways.
Clinical Implications: For high-risk PONV patients in gynecologic laparoscopy, consider oliceridine as an alternative to conventional μ-agonists within multimodal antiemetic strategies, balancing availability, formulary status, and patient-specific risk.
Key Findings
- 48-hour cumulative PONV was significantly lower with oliceridine (22.5%) vs sufentanil (43.0%); OR 0.38 (95% CI 0.22–0.66).
- Improved QoR-15 and patient satisfaction without compromising analgesia; adverse events and OIRD were not increased.
- Standardized anesthetic technique and prophylactic antiemetics across groups support internal validity.
Methodological Strengths
- Prospective, double-blind, randomized controlled design with modified intention-to-treat analysis
- Standardized anesthesia and antiemetic prophylaxis to minimize confounding
Limitations
- Single-center, female-only gynecologic laparoscopic population limits generalizability to other surgeries and sexes
- Abstract truncation precludes full visibility of secondary endpoint statistics and p-values
Future Directions: Multicenter trials across surgical populations, head-to-head comparisons with other μ-agonists and non-opioid regimens, and cost-effectiveness analyses to define optimal positioning of oliceridine.
PURPOSE: To evaluate whether oliceridine, a G protein-biased μ-opioid receptor agonist, reduces postoperative nausea and vomiting (PONV) compared with sufentanil in women undergoing gynecological laparoscopic surgery. PATIENTS AND METHODS: This prospective, double-blind, randomized controlled trial recruited 260 female patients, ASA physical status I-III, undergoing elective gynecological laparoscopic surgery under general anesthesia at Shanghai East Hospital, Shanghai, People's Republic of China. Patients were randomized to receive oliceridine (induction 0.05 mg/kg; postoperative infusion 0.4 mg/kg) or sufentanil (induction 0.5 μg/kg; postoperative infusion 2.0 μg/kg), with standardized general anesthesia and prophylactic antiemetics. The primary outcome was 48-hour cumulative PONV incidence. Secondary outcomes included PONV severity, opioid-induced respiratory depression (OIRD), adverse events, pain scores, 15-item Quality of Recovery (QoR-15) score, and patient satisfaction. All analyses were performed on the modified intention-to-treat population. RESULTS: The 48-hour PONV incidence was significantly lower with oliceridine (22.5% vs 43.0%; odds ratio 0.38; 95% CI 0.22-0.66; CONCLUSION: Oliceridine significantly reduced PONV incidence and improved recovery quality and patient satisfaction compared with sufentanil, without compromising analgesia, in women undergoing gynecological laparoscopic surgery.
3. Impaired extracellular DNA clearance is associated with post-operative atrial fibrillation and mortality after cardiac surgery.
In 503 major cardiovascular surgery patients, higher preoperative extracellular DNA (dsDNA) and lower DNase activity independently associated with POAF; a composite DNase factor (dsDNA/DNase) improved prediction beyond clinical scores. The biomarker profile also related to long-term mortality, indicating a vulnerability phenotype.
Impact: Bridges mechanistic immunothrombosis biology with perioperative arrhythmia risk, offering a measurable biomarker axis (dsDNA/DNase) that augments clinical risk models and may inform targeted interventions.
Clinical Implications: Preoperative dsDNA and DNase activity could refine POAF risk stratification beyond standard scores, guiding monitoring intensity and prophylaxis; they also suggest therapeutic exploration of extracellular DNA clearance pathways.
Key Findings
- POAF occurred in 42.1% of 503 cardiac surgery patients.
- Higher preoperative dsDNA independently associated with increased POAF risk; higher DNase activity associated with lower risk.
- The DNase factor (dsDNA/DNase) improved predictive models beyond clinical risk scores and associated with long-term mortality.
Methodological Strengths
- Biomarker panel with preoperative sampling and multivariable adjustment
- Incremental predictive value assessed over established clinical scores
Limitations
- Observational design limits causal inference; interventional validation is needed
- Single-center design likely; exact follow-up duration for mortality not specified in abstract
Future Directions: External validation cohorts and trials testing DNase modulation or extracellular DNA-targeted strategies to prevent POAF; integration into multifactorial prediction tools.
BACKGROUND: Post-operative atrial fibrillation (POAF) is considered a convergence of pre-existing vulnerability and periprocedural stressors. While clinical risk scores such as the CHA OBJECTIVE: We investigated neutrophil markers and DNase activity as indicators of POAF. METHODS: 503 patients undergoing major cardiovascular surgery were investigated. dsDNA, citrullinated histone H3, neutrophil elastase, myeloperoxidase and DNase activity were measured prior to surgery. Associations with POAF were assessed using logistic regression adjusted for the CHA RESULTS: POAF occurred in 42.1% of patients. While baseline dsDNA levels did not differ between groups, multivariable analysis identified dsDNA as independently associated with POAF. DNase activity was independently associated with lower risk of POAF. The DNase factor, calculated as dsDNA divided by DNase activity, conferred increased risk of POAF. Inclusion of the DNase factor significantly improved model fit beyond the CHA CONCLUSIONS: Pre-operative extracellular DNA burden and DNase activity associate with POAF and long-term mortality after major cardiovascular surgery. Impaired regulation of extracellular DNA reflects a vulnerability phenotype not captured by established clinical risk scores and provides incremental prognostic information.