Daily Anesthesiology Research Analysis
Analyzed 40 papers and selected 3 impactful papers.
Summary
Analyzed 40 papers and selected 3 impactful articles.
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 of 506 patients undergoing thoracoscopic lung resection, perioperative butorphanol reduced 7-day postoperative pulmonary complications from 32.9% to 21.3% (RR 0.65), driven by less atelectasis and pleural effusion. Recovery quality improved and opioid use decreased without safety trade-offs.
Impact: This is a well-designed RCT demonstrating clinically meaningful reduction in pulmonary complications with an accessible pharmacologic intervention, yielding an NNT of 9.
Clinical Implications: Consider incorporating perioperative butorphanol into ERAS pathways for thoracoscopic lung resection to reduce atelectasis and pleural effusion, improve early recovery metrics, and decrease opioid needs while monitoring for hemodynamic effects.
Key Findings
- PPCs within 7 days: 21.3% with butorphanol vs 32.9% with placebo (RR 0.65; 95% CI 0.48-0.87; P=0.004), ARR 11.7%, NNT 9.
- Reductions were primarily in atelectasis and pleural effusion.
- Higher QoR-40 at 24 h, lower postoperative opioid consumption, and modestly shorter hospital stay; safety outcomes were similar.
Methodological Strengths
- Randomized, double-blind, placebo-controlled design with modified intention-to-treat analysis.
- Clinically meaningful primary endpoint and adequate sample size with precise effect estimates.
Limitations
- Single-center study limits generalizability.
- Follow-up limited to early (7-day) complications; mechanisms not directly assessed.
Future Directions: Multicenter trials across broader age and risk profiles; dose–response evaluation; comparative effectiveness versus other opioid-sparing or respiratory-focused strategies; mechanistic studies on respiratory physiology.
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 reduced 48-hour PONV from 43.0% to 22.5% (OR 0.38) versus sufentanil, while maintaining comparable analgesia and safety. QoR-15 and patient satisfaction improved.
Impact: Demonstrates clinically relevant reduction in PONV using a biased μ-opioid agonist with preserved analgesia, aligning with enhanced recovery priorities.
Clinical Implications: Oliceridine may be considered as an alternative to sufentanil for high-risk PONV populations in minimally invasive gynecologic procedures, within multimodal antiemetic protocols and institutional formularies.
Key Findings
- 48-hour PONV incidence: 22.5% with oliceridine vs 43.0% with sufentanil (OR 0.38; 95% CI 0.22–0.66).
- Improved QoR-15 and higher patient satisfaction with oliceridine.
- Analgesia maintained with no increase in opioid-induced respiratory depression or adverse events.
Methodological Strengths
- Prospective, randomized, double-blind design with modified intention-to-treat analysis.
- Standardized anesthesia and antiemetic protocols reduce confounding.
Limitations
- Single-center study in a homogeneous surgical population (female gynecologic laparoscopy).
- Short follow-up limited to 48 hours and lacks cost-effectiveness analysis.
Future Directions: Replicate across diverse surgeries and mixed-sex populations; head-to-head comparisons with other opioids and multimodal opioid-sparing strategies; pharmacoeconomic evaluations.
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. Comparison of Modified Mallampati Score and Ultrasonographic Airway Assessment in Predicting Ease of Glottic Visualization: A Prospective Diagnostic Accuracy Study at a Tertiary Care Hospital in Pakistan.
In 400 adults, ultrasonographic skin-to-epiglottis distance predicted difficult laryngoscopy with an AUC of 0.98 and 100% sensitivity at a >19.5 mm cutoff, far outperforming the modified Mallampati score (AUC 0.50). SED was the sole independent predictor on multivariable analysis.
Impact: Provides a simple, objective, and highly accurate ultrasound metric that could replace or augment traditional visual airway assessment tools.
Clinical Implications: Routine preoperative airway ultrasound to measure SED could improve risk stratification and planning for difficult laryngoscopy, inform equipment selection and personnel allocation, and potentially reduce airway complications.
Key Findings
- SED strongly associated with Cormack-Lehane grade (p < 0.001); AUC 0.98 vs 0.50 for modified Mallampati.
- At >19.5 mm cutoff, SED achieved 100% sensitivity and 89.95% specificity for difficult laryngoscopy.
- SED was the only independent predictor of difficult laryngoscopy (OR 11.29; 95% CI 4.24–30.07; p < 0.001).
Methodological Strengths
- Prospective diagnostic accuracy design with a relatively large sample size (n=400).
- Objective ultrasonographic measurement and multivariable adjustment against a clinically relevant reference (Cormack-Lehane).
Limitations
- Single-center design and potential operator dependence of ultrasound measurements.
- Validation limited to direct laryngoscopy; generalizability to videolaryngoscopy or different settings is unknown.
Future Directions: External multicenter validation, inter-operator reliability studies, integration with composite airway risk scores, and trials assessing impact on intubation success and complications.
INTRODUCTION: The accuracy of preoperative airway assessment remains a challenging issue. The modified Mallampati (MP) scoring system has been commonly employed, though with poor predictive accuracy. The ultrasonographic measurement of skin-to-epiglottic distance (SED) has been proposed as an objective tool. We evaluated the accuracy of MP scoring and ultrasonographic measurement of SED in predicting easy glottic visualization based on Cormack-Lehane grading during direct laryngoscopy. METHODS: This prospective observational diagnostic accuracy study involved 400 adult patients who underwent elective surgery under general anesthesia with an American Society of Anesthesiologists (ASA) grade of I and II. Preoperative MP score and SED by ultrasound examination were performed. The degree of glottic visualization was graded according to the Cormack-Lehane scale. Easy direct laryngoscopy was categorized as a Cormack-Lehane scale of I and II, while difficult direct laryngoscopy was categorized as a Cormack-Lehane scale of III and IV. RESULTS: A significant association was observed between SED and Cormack-Lehane (CL) grade (p < 0.001). The mean SED increased progressively with worsening CL grade (p < 0.001). The area under the ROC curve (AUC) for SED was 0.98 compared with 0.50 for the MP score. At a cutoff >19.5 mm, SED demonstrated 100% sensitivity and 89.95% specificity. The MP score (>3.5) showed sensitivity of 6.25% and specificity of 99.46%. On multivariable analysis, SED was the only independent predictor of difficult laryngoscopy (OR 11.29, 95% CI 4.24-30.07; p < 0.001). CONCLUSION: Ultrasonographic SED is a highly accurate and independent predictor of difficult glottic visualization and outperforms the modified Mallampati score. Incorporating airway ultrasound into routine preoperative assessments may improve the prediction of difficult glottic visualization.