Daily ReportNov 1, 2026
Anesthesiology, November 1 edition
We read 12 papers and selected 3.
Summary
The highest-impact studies evaluated practical strategies to improve perioperative respiratory safety, quantify cumulative intraoperative hypotension, and reduce cardiac injury after coronary artery bypass grafting. A randomized trial of an adjustable monitoring nasopharyngeal airway markedly reduced hypoxemia in obese patients undergoing ambulatory gastrointestinal endoscopy, while a multidimensional hypotension score showed outcome associations beyond conventional mean arterial pressure thresholds.
Research Themes
- Respiratory safety and airway monitoring during procedural anesthesia
- Quantification of cumulative intraoperative hypotension and postoperative risk
- Perioperative myocardial protection and recovery after coronary artery bypass grafting
Selected Articles
1. [Safety and efficacy of the adjustable monitoring filtered type-B transnasal specialized airway catheter in anesthesia for ambulatory gastrointestinal endoscopic surgery in obese patients].
In this randomized trial of 92 obese patients undergoing ambulatory gastrointestinal polypectomy, the adjustable monitoring nasopharyngeal airway reduced intraoperative hypoxemia from 32.6% with a standard nasal cannula to 2.2% (P<0.001). It also improved oxygenation and carbon dioxide monitoring, reduced airway interventions and remimazolam use, shortened emergence time, and increased physician satisfaction.
Impact: The magnitude of hypoxemia reduction is clinically striking, and the device simultaneously provides oxygen delivery and continuous end-tidal carbon dioxide monitoring. This offers a potentially scalable airway-safety strategy for high-risk patients undergoing deep sedation outside the operating room.
Clinical Implications: The device could be considered for obese patients undergoing ambulatory gastrointestinal endoscopy with deep sedation, particularly when hypoventilation or difficult airway rescue is a concern. Adoption should be accompanied by training, assessment of nasal trauma, and confirmation in larger multicenter trials.
Key Findings
- Intraoperative hypoxemia occurred in 2.2% of the adjustable airway group versus 32.6% of the standard nasal cannula group (P<0.001).
- The adjustable airway group had higher SpO2 and PaO2, lower PaCO2, and stable continuous PetCO2 waveforms.
- Airway interventions, remimazolam use, emergence time, and endoscopic procedure duration were lower, while physician satisfaction was higher with the adjustable airway.
Methodological Strengths
- Randomized controlled design with balanced baseline characteristics and a clinically relevant primary outcome.
- Assessment included both oxygenation and ventilation, as well as airway interventions, drug use, recovery time, and clinician satisfaction.
Limitations
- The sample size was small and the trial was conducted at a single center, limiting generalizability.
- The study did not establish effects on serious clinical outcomes such as unplanned intubation, post-discharge respiratory events, or mortality.
Future Directions: Multicenter trials should compare the device with other advanced oxygenation systems, evaluate different sedation depths and patient risk strata, and assess cost-effectiveness, nasal adverse events, unplanned airway rescue, and post-discharge safety.
Objective: To evaluate the clinical safety and efficacy of the adjustable monitoring and filtering type B transnasal specialized airway catheter (hereafter referred to as the adjustable monitoring nasopharyngeal airway) during anesthesia for elective ambulatory gastrointestinal polypectomy under digestive endoscopy in obese patients. Methods: This randomized controlled trial enrolled 92 obese patients (body mass index≥28 kg/m²) scheduled for elective ambulatory gastrointestinal polypectomy under digestive endoscopy at the General Hospital of Northern Theater Command between June and December 2025. Using a random number table, we split the participants evenly into an adjustable airway group (Group R, n=46) and a standard nasal cannula group (Group C, n=46).
2. A Multidimensional Weight-Time-Frequency Score for Quantifying Intraoperative Hypotensive Burden During Off-Pump Coronary Artery Bypass Grafting.
This retrospective cohort study of 2,070 patients undergoing off-pump coronary artery bypass grafting developed a weight-time-frequency score that integrates the depth, duration, and frequency of intraoperative hypotension. Each 10-point increase was associated with higher adjusted odds of new-onset atrial fibrillation, acute kidney injury, and 30-day mortality, while test-set analyses generally showed noninferior discrimination compared with conventional mean arterial pressure metrics.
Impact: The score addresses a major limitation of single-threshold blood pressure assessment by representing cumulative hypotensive exposure. It could support more clinically meaningful intraoperative hemodynamic risk stratification and future hemodynamic management trials.
Clinical Implications: Continuous arterial pressure data could be summarized using multidimensional burden metrics rather than isolated hypotension episodes. The score is not yet ready to guide treatment thresholds, but it may help identify patients requiring closer renal, cardiac, and postoperative surveillance.
Key Findings
- Among 2,070 OPCABG patients, each 10-point increase in the WTF score was associated with higher adjusted odds of atrial fibrillation, acute kidney injury, and 30-day mortality.
- The score integrates hypotension depth, duration, and frequency using a mean arterial pressure threshold below 65 mmHg sustained for at least 1 minute.
- The WTF score met the prespecified noninferiority criterion in 14 of 15 comparisons with conventional mean arterial pressure-based metrics, although mortality analyses were limited by only 31 deaths.
Methodological Strengths
- Large cohort with continuous intraoperative arterial pressure monitoring and adjustment for clinically relevant confounders.
- The score was evaluated using test-set discrimination, integrated discrimination improvement, net reclassification improvement, and restricted cubic spline analyses.
Limitations
- The retrospective single-center design cannot establish causality and may limit external validity.
- The mortality association is imprecise because only 31 deaths occurred, and the score has not been prospectively tested to guide blood pressure treatment.
Future Directions: External multicenter validation should assess calibration, transportability to other cardiac and noncardiac surgeries, and whether score-guided hemodynamic interventions reduce acute kidney injury, atrial fibrillation, or mortality.
OBJECTIVES: To develop a multidimensional weight-time-frequency (WTF) score for quantifying cumulative intraoperative hypotensive burden during off-pump coronary artery bypass grafting (OPCABG) and to evaluate its association with postoperative outcomes. DESIGN: Retrospective observational cohort study. SETTING: A tertiary cardiac surgery center. PARTICIPANTS: Adults undergoing OPCABG with continuous intraoperative arterial pressure monitoring. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A qualifying hypotensive episode was defined as mean arterial pressure <65 mmHg sustained for at least 1 minute. The WTF score integrated hypotension depth, duration, and frequency, and outcome-specific cohorts were used for 30-day all-cause mortality, acute kidney injury (AKI), and new-onset atrial fibrillation (AF). Among 2,070 patients undergoing OPCABG, each 10-point increase in WTF was associated with higher adjusted odds of AF (adjusted odds ratio [OR], 1.155; 95% confidence interval [CI], 1.001-1.333), AKI (adjusted OR, 1.216; 95% CI, 1.001-1.478), and 30-day all-cause mortality (adjusted OR, 2.346; 95% CI, 1.332-4.130).
3. Effect of Preoperative Intranasal Dexmedetomidine on Postoperative Myocardial Injury in Patients Undergoing Coronary Artery Bypass Grafting.
In this randomized, double-blind, placebo-controlled trial of 70 patients undergoing on-pump coronary artery bypass grafting, two preoperative doses of intranasal dexmedetomidine reduced 24-hour high-sensitivity cardiac troponin T concentrations from an estimated 357.29 to 170.29 ng/L (P<0.001). It also reduced creatine kinase-MB levels, improved subjective preoperative sleep, and lowered observed postoperative delirium, without significant differences in ventilation duration or intensive care unit stay.
Impact: The intervention is noninvasive and easy to administer, while the large reduction in a prespecified cardiac injury biomarker suggests a potentially important cardioprotective effect. The study also links improved sleep and reduced postoperative delirium with preoperative anesthetic management.
Clinical Implications: Preoperative intranasal dexmedetomidine may be a candidate strategy for myocardial protection and delirium prevention in coronary artery bypass grafting. It should not yet be adopted as standard care solely on the basis of biomarker changes; larger multicenter trials with clinical cardiovascular outcomes are required.
Key Findings
- At 24 hours after surgery, estimated mean hs-cTnT was 170.29 ng/L with dexmedetomidine versus 357.29 ng/L with placebo (P<0.001).
- Postoperative CK-MB concentrations were lower, and the dexmedetomidine group had better subjective preoperative sleep quality.
- Postoperative delirium occurred in 14.3% of the dexmedetomidine group versus 37.1% of controls (P=0.029), while ventilation duration and intensive care unit stay were not significantly different.
Methodological Strengths
- Randomized, double-blind, placebo-controlled design with a prespecified primary biomarker outcome.
- The trial was registered in the Chinese Clinical Trial Registry and assessed cardiac biomarkers, sleep, delirium, and perioperative safety.
Limitations
- The single-center sample was small, limiting power for clinical outcomes and safety events.
- The primary outcome was a surrogate biomarker, and the study did not demonstrate reductions in myocardial infarction, major adverse cardiovascular events, intensive care unit stay, or mortality.
Future Directions: Larger multicenter randomized trials should evaluate dose timing, compare intranasal dexmedetomidine with other cardioprotective strategies, and use myocardial infarction, major adverse cardiovascular events, delirium duration, and long-term outcomes as clinically relevant endpoints.
PURPOSE: To evaluate the effects of preoperative intranasal dexmedetomidine on postoperative myocardial injury biomarkers in patients undergoing on-pump coronary artery bypass grafting (CABG). PATIENTS AND METHODS: In this randomized, double-blind, placebo-controlled trial, 70 patients undergoing on-pump CABG were assigned to receive intranasal dexmedetomidine (1 μg/kg) or saline 30 min before bedtime on the night before surgery and again 30 min before anesthesia induction. The primary outcome was serum high-sensitivity cardiac troponin T (hs-cTnT) at 24 h after surgery. Secondary outcomes included perioperative cardiac biomarkers, preoperative sleep quality, postoperative delirium, and adverse events. RESULTS: For the prespecified primary outcome, hs-cTnT concentrations at 24 h after surgery were significantly lower in the dexmedetomidine group than in the control group (estimated marginal means, 170.29 vs 357.29 ng/L; P < 0.001).