Daily ReportOct 4, 2026
Anesthesiology, October 4 edition
We read 30 papers and selected 3.
Summary
Today's strongest anesthesiology evidence includes a randomized pediatric trial showing that methylprednisolone, unlike dexamethasone, prolongs sugammadex-mediated neuromuscular reversal and extubation. A randomized adult trial found substantially less 24-hour postoperative nausea and vomiting with ciprofol than with remimazolam, while a meta-analysis of 38 randomized trials found that liposomal bupivacaine provides little clinically meaningful advantage over conventional analgesic strategies in open orthopedic surgery.
Research Themes
- Drug interactions affecting neuromuscular blockade reversal
- Comparative intravenous anesthesia and postoperative recovery
- Evidence-based evaluation of extended-release local anesthetics
Selected Articles
1. Comparison of Methylprednisolone and Dexamethasone in Their Interaction With Sugammadex in Pediatric Patients: A Randomized Controlled Trial.
In this randomized trial of 60 children undergoing adenotonsillar surgery, methylprednisolone was associated with significantly longer sugammadex-mediated reversal than dexamethasone or control. Extubation time showed the same pattern, whereas postoperative nausea, pain, and overall adverse events were similar across groups.
Impact: The study identifies a potentially clinically important interaction between the choice of perioperative corticosteroid and sugammadex reversal. This finding could influence steroid selection and neuromuscular monitoring in pediatric anesthesia.
Clinical Implications: When methylprednisolone is administered during pediatric anesthesia, clinicians should anticipate potentially delayed rocuronium reversal and extubation, use quantitative neuromuscular monitoring, and avoid relying solely on expected reversal times. The finding requires confirmation before changing routine corticosteroid protocols.
Key Findings
- Reversal time was 82.8 ± 16.1 seconds with methylprednisolone, compared with 63.4 ± 13.4 seconds with dexamethasone and 56.1 ± 13.7 seconds in the control group.
- Extubation time showed a similar prolongation pattern with methylprednisolone.
- Postoperative nausea, pain scores, and overall adverse-event rates did not differ significantly between groups.
Methodological Strengths
- Prospective randomized controlled design with a clinically relevant three-group comparison.
- ClinicalTrials.gov registration and assessment of both neuromuscular reversal and extubation outcomes.
Limitations
- The sample size was small, with only 60 children from a specific adenotonsillar surgery population.
- The provided abstract does not establish whether the findings generalize to other surgeries, age groups, steroid doses, or neuromuscular blocking agents.
Future Directions: Larger multicenter trials should evaluate the interaction across different pediatric age groups, corticosteroid doses, neuromuscular blocking agents, and quantitative monitoring strategies, with particular attention to residual neuromuscular blockade and respiratory outcomes.
BACKGROUND: Sugammadex may interact with steroidal compounds; however, comparative clinical data on different peri-operative corticosteroids in children are limited. This randomized controlled trial primarily aimed to compare the effect of methylprednisolone and dexamethasone, administered at clinically equivalent glucocorticoid doses, on sugammadex-mediated reversal time of rocuronium-induced neuromuscular block in children. Secondary aims were to compare extubation time, postoperative nausea, pain, and adverse events related to upper airway oedema between groups.
2. Effects of Ciprofol- versus Remimazolam-Based Total Intravenous Anesthesia on Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy: A Randomized Controlled Trial.
Among 146 randomized adults undergoing laparoscopic cholecystectomy, 24-hour PONV was substantially less frequent with ciprofol than with remimazolam despite standardized dexamethasone and ondansetron prophylaxis. Pain, QoR-15 recovery scores, overall adverse events, and vasopressor use were similar, but the trial was not powered to establish safety equivalence.
Impact: The trial directly compares two contemporary intravenous anesthetics using a patient-important postoperative outcome. The magnitude of PONV reduction suggests that ciprofol may be useful in patients at high risk of nausea and vomiting, although external validation is needed.
Clinical Implications: Ciprofol may be considered as an alternative to remimazolam when minimizing PONV is a priority, particularly within multimodal prophylaxis protocols. The result should not yet be generalized to other operations, antiemetic regimens, or broader safety outcomes.
Key Findings
- PONV within 24 hours occurred in 31.5% of patients receiving ciprofol and 58.9% receiving remimazolam (RR 0.53, 95% CI 0.36-0.79; P = 0.001).
- After adjustment for clinically relevant risk factors, the odds of PONV remained lower with ciprofol (adjusted OR 0.289, 95% CI 0.135-0.623; P = 0.002).
- Postoperative pain, QoR-15 score, overall adverse events, and vasopressor use were not significantly different.
Methodological Strengths
- Randomized, parallel-group design with assessor blinding and standardized antiemetic and analgesic protocols.
- The primary outcome was clinically meaningful and supported by adjusted analysis for relevant PONV risk factors.
Limitations
- This was a single-center trial with 146 participants, limiting generalizability.
- The study was not powered to establish equivalence for secondary recovery or safety outcomes, and follow-up was centered on the early postoperative period.
Future Directions: Multicenter randomized trials should compare ciprofol and remimazolam across different surgeries, PONV risk strata, and multimodal antiemetic strategies, while prospectively assessing recovery quality, hemodynamic effects, cost, and broader safety outcomes.
BACKGROUND: Postoperative nausea and vomiting (PONV) remains common after laparoscopic cholecystectomy. Whether ciprofol-based anesthesia reduces PONV compared with remimazolam-based anesthesia remains unclear. METHODS: In this single-center, randomized, assessor-blinded, parallel-group trial, adults undergoing laparoscopic cholecystectomy were assigned to receive ciprofol- or remimazolam-based total intravenous anesthesia. All participants received standardized antiemetic prophylaxis with dexamethasone and ondansetron, together with a standardized analgesic protocol. The primary outcome was the cumulative incidence of PONV within 24 h after surgery.
3. Nerve block or wound infiltration with liposomal bupivacaine for postoperative pain management in open orthopedic surgery: a meta-analysis of 38 randomized controlled trials involving 3,389 patients.
This systematic review and meta-analysis of 38 randomized trials involving 3,389 patients found only a small pain-score benefit for liposomal bupivacaine, primarily on postoperative day 2, with no significant reduction in opioid consumption, adverse events, patient satisfaction, or hospital stay. The findings challenge broad assumptions that the formulation provides substantial perioperative advantages over conventional analgesia.
Impact: The study synthesizes a relatively large randomized evidence base and reports a clinically important negative result. It can inform formulary decisions and discourage routine adoption of a costly long-acting local anesthetic without demonstrated patient-centered benefits.
Clinical Implications: Routine use of liposomal bupivacaine in open orthopedic surgery is not supported by the pooled evidence for reducing opioids, complications, or hospital stay. Clinicians should select nerve block, wound infiltration, or conventional analgesia based on procedure-specific evidence, patient factors, availability, and cost.
Key Findings
- Liposomal bupivacaine produced a statistically significant but small reduction in pain on postoperative day 2 (SMD -0.25, 95% CI -0.49 to -0.02).
- There was no significant difference in total or daily opioid consumption, adverse events, patient satisfaction, or hospital length of stay.
- The authors concluded that liposomal bupivacaine did not demonstrate a significant overall perioperative advantage over conventional medications.
Methodological Strengths
- Large synthesis of 38 randomized controlled trials involving 3,389 patients.
- Use of PRISMA and Cochrane Handbook methods, independent literature retrieval, and formal risk-of-bias assessment.
Limitations
- The pooled studies likely included heterogeneous orthopedic procedures, administration techniques, comparators, and follow-up periods.
- Functional benefits were not consistently demonstrated, and the available evidence did not establish durable benefit or long-term safety.
Future Directions: Future trials should use standardized procedure-specific protocols, patient-centered outcomes, cost-effectiveness analyses, and longer follow-up. Individual patient or procedure subgroups that may benefit from liposomal bupivacaine should be prespecified rather than inferred from pooled averages.
BACKGROUND: Patients undergoing open orthopedic surgeries often report substantial postoperative pain. The present work aimed to provide effective evidence for perioperative pain management in open orthopedic surgeries through comprehensive electronic database searches and the inclusion of more high-quality randomized controlled trials (RCTs) that report on the safety and effectiveness of liposomal bupivacaine (LB) in these surgeries. METHODS: We performed the present work strictly under the guidelines of the Cochrane handbook and PRISMA recommendations. Under the guidance of the established retrieval strategy, two researchers independently performed the literature retrieval. Each included study was assessed in according with Cochrane risk of bias tool.