Daily Anesthesiology Research Analysis
Analyzed 82 papers and selected 3 impactful papers.
Summary
Today’s strongest anesthesiology-related evidence includes a multicenter randomized trial showing that perioperative dapagliflozin substantially reduced acute kidney injury after elective cardiac surgery, a randomized trial demonstrating that a validated local-anesthetic dose calculator markedly reduced simulated overdose errors, and a randomized trial supporting intercostal nerve cryoablation as an opioid-sparing alternative to thoracic epidural analgesia after the Nuss procedure. Together, these studies address perioperative organ protection, medication safety, and postoperative recovery using clinically actionable interventions.
Research Themes
- Perioperative organ protection and acute kidney injury prevention
- Medication safety and digital decision support
- Opioid-sparing regional analgesia and enhanced recovery
Selected Articles
1. Dapagliflozin and Acute Kidney Injury Following Cardiac Surgery: A Randomized Clinical Trial.
In this multicenter, double-blind randomized clinical trial of 784 adults undergoing elective cardiac surgery, four perioperative doses of dapagliflozin reduced postoperative AKI from 52% to 28% compared with placebo (relative risk 0.54, 95% CI 0.45-0.65; P<.001). Follow-up testing was completed in 99% of participants, and atrial fibrillation and reoperation rates were similar between groups.
Impact: This is a large, registered, multicenter randomized trial addressing a common and clinically consequential complication for which preventive pharmacotherapy has been lacking. The magnitude of benefit could change perioperative cardiac-surgery kidney-protection strategies, although external validation and broader safety assessment remain necessary.
Clinical Implications: Dapagliflozin initiated one day before elective cardiac surgery may become a candidate strategy for preventing postoperative AKI. Before routine adoption, clinicians should consider patient selection, perioperative volume status, renal function, risks associated with sodium-glucose cotransporter 2 inhibition, and confirmation in other populations and healthcare systems.
Key Findings
- Among 778 participants with follow-up data, AKI occurred in 28% with dapagliflozin versus 52% with placebo.
- The relative risk of AKI was 0.54 with dapagliflozin, with a 95% CI of 0.45-0.65 and P<.001.
- Atrial fibrillation occurred in 45% of each group, while reoperation occurred in 11% with dapagliflozin and 10% with placebo.
Methodological Strengths
- Multicenter, double-blind, placebo-controlled randomized design with 784 enrolled participants.
- ClinicalTrials.gov registration and 99% completion of follow-up testing.
- AKI was defined using standardized Kidney Disease: Improving Global Outcomes criteria.
Limitations
- The study was conducted in the Netherlands and included a population that was 97% White, which may limit generalizability.
- The intervention began only one day before surgery and was evaluated during a short seven-day postoperative period.
- The abstract does not establish effects on longer-term kidney function, mortality, or patient-centered recovery outcomes.
Future Directions: Future studies should replicate the findings in diverse international populations, evaluate longer-term renal and survival outcomes, define safety in patients with reduced kidney function or diabetes, and compare dapagliflozin with other perioperative kidney-protection strategies.
IMPORTANCE: Two percent to 50% of patients undergoing elective cardiac surgery experience acute kidney injury (AKI) postoperatively. Medications to prevent AKI after elective cardiac surgery have not been identified. OBJECTIVE: In patients undergoing elective cardiac surgery, to evaluate whether initiating dapagliflozin 1 day prior to surgery reduces the incidence of AKI at 7 days after cardiac surgery, compared with placebo. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, double-blind, placebo-controlled randomized clinical trial conducted at 2 academic medical centers and 5 nonacademic hospitals in the Netherlands.
2. Intercostal nerve cryoablation versus thoracic epidural analgesia for minimal invasive repair of pectus excavatum: a randomized clinical trial (ICE-trial).
In this randomized clinical trial of adolescents and young adults undergoing the Nuss procedure, intercostal nerve cryoablation reduced median hospital stay from 4 to 1 day compared with thoracic epidural analgesia (P<.001). It also reduced opioid consumption by 83% during hospitalization and 97% after discharge, but persistent chest-wall hypoesthesia occurred in 56% at six months.
Impact: The trial evaluates a procedure-specific analgesic strategy with large effects on hospital length of stay, opioid exposure, pain, and mobilization. Its importance is balanced by the substantial rate of persistent sensory loss, which highlights the need to weigh enhanced recovery against long-term neurologic adverse effects.
Clinical Implications: Intercostal nerve cryoablation may be considered as an alternative to thoracic epidural analgesia for selected patients undergoing minimally invasive pectus excavatum repair, particularly when rapid mobilization, reduced opioid exposure, and shorter hospitalization are priorities. Informed consent should explicitly address the possibility of prolonged chest-wall numbness.
Key Findings
- Median hospital stay was 1 day with intercostal nerve cryoablation versus 4 days with thoracic epidural analgesia (P<.001).
- Opioid consumption was reduced by 83% during hospitalization and 97% after discharge with cryoablation.
- Persistent chest-wall hypoesthesia at six months occurred in 56% of patients after cryoablation.
Methodological Strengths
- Randomized clinical trial with a prospectively registered superiority design and intention-to-treat analysis.
- Compared the new intervention directly with the established thoracic epidural analgesia strategy.
- Assessed clinically meaningful outcomes including hospital stay, opioid consumption, pain, mobilization, and sensory effects.
Limitations
- The study was single-center, unblinded, and included only 48 patients in the intention-to-treat analysis.
- Persistent hypoesthesia was common, and the long-term functional and quality-of-life consequences were not fully established.
- The findings may not generalize to older patients, open procedures, or institutions with different perioperative protocols.
Future Directions: Larger multicenter trials should compare cryoablation with contemporary multimodal analgesia, evaluate sensory recovery beyond six months, measure patient-reported quality of life and functional outcomes, and identify patients most likely to benefit without clinically important numbness.
OBJECTIVES: Postoperative pain after the Nuss procedure remains a significant burden for patients. While thoracic epidural analgesia (TEA) has been the standard for postoperative pain management, intercostal nerve cryoablation (INC) has emerged as a promising alternative. Hence, we aimed to determine the impact of INC on recovery after the Nuss procedure for pectus excavatum in comparison to TEA. METHODS: This single center, unblinded, randomized clinical trial (NCT05731973) was conducted at Zuyderland Medical Center, The Netherlands. Participants aged 12 to 24 years and scheduled for the Nuss procedure were randomly allocated to receive either INC or TEA.
3. Evaluation of the Impact of a Mobile App (LoAD Calc) on the Calculation of Maximum Safe Doses of Local Anesthetics: Randomized Controlled Trial.
In a single-center randomized trial involving 50 anesthesiologists and 500 simulated dose calculations, LoAD Calc reduced overdose errors from 79.2% with usual calculation methods to 12.0% using comprehensive safety rules (relative risk 0.15; P<.001). Calculation time and underdose rates were similar, while user confidence increased and usability was rated very highly.
Impact: The study addresses a preventable medication-safety hazard and demonstrates a very large reduction in dosing errors without a time penalty. It is particularly impactful because the intervention is scalable, low-cost relative to training or system redesign, and directly targets patient-specific calculation complexity.
Clinical Implications: A validated dose-calculation application could be integrated into regional anesthesia and acute pain workflows to standardize maximum-dose assessment and reduce local-anesthetic systemic toxicity risk. Clinical deployment should include independent verification of dosing rules, integration with institutional protocols, cybersecurity review, and post-implementation monitoring for automation-related errors.
Key Findings
- Using comprehensive calculation rules, overdose rates were 12.0% with LoAD Calc versus 79.2% with usual methods (relative risk 0.15; P<.001).
- Underdose rates were similar between groups: 10.0% with LoAD Calc versus 10.8% with usual methods.
- Mean calculation time was similar, while confidence was higher with the app and the median System Usability Scale score was 98.
Methodological Strengths
- Randomized controlled design with all 50 participants completing ten clinically varied vignettes.
- The primary outcome used a comprehensive patient-specific safety rule set rather than a simple weight-based calculation alone.
- Reported error rates separately for lidocaine, levobupivacaine, and ropivacaine, along with time, confidence, and usability outcomes.
Limitations
- The trial was single-center, unblinded, and conducted using simulated clinical vignettes rather than actual patient care.
- Only 50 anesthesiologists participated, and the results may depend on baseline familiarity with dose calculations and digital tools.
- The reference maximum-dose rules were defined by the study team and may not be identical across institutions or jurisdictions.
Future Directions: Future research should evaluate the application prospectively in real-world regional anesthesia practice, assess rates of local-anesthetic systemic toxicity and near misses, compare it with electronic health record-integrated decision support, and test performance across countries and professional groups.
BACKGROUND: Local anesthetics (LAs) are widely used in clinical practice, but their administration carries the risk of LA systemic toxicity, a potentially fatal complication. Calculating maximum safe doses is complex and error-prone when considering multiple patient-specific factors. Most existing tools and mobile apps have not been scientifically validated and may propose unsafe doses. The Local Anesthetics Dose Calculator (LoAD Calc) mobile app was developed at the Geneva University Hospitals to calculate maximum safe doses by integrating comprehensive patient parameters.