Anesthesiology Research Analysis
March 2025 anesthesiology research emphasized practice-changing randomized evidence and translational precision. A multicenter RCT (FARES-II) supported a PCC-first strategy for coagulopathic bleeding in cardiac surgery, while the SESAR RCT cautioned against inhaled sevoflurane sedation in moderate–severe ARDS. A large BJA PK study overturned assumptions about intranasal oxytocin, demonstrating ~0.7% bioavailability and releasing an open dosing simulator. Additional syntheses clarified trade-offs
Summary
March 2025 anesthesiology research emphasized practice-changing randomized evidence and translational precision. A multicenter RCT (FARES-II) supported a PCC-first strategy for coagulopathic bleeding in cardiac surgery, while the SESAR RCT cautioned against inhaled sevoflurane sedation in moderate–severe ARDS. A large BJA PK study overturned assumptions about intranasal oxytocin, demonstrating ~0.7% bioavailability and releasing an open dosing simulator. Additional syntheses clarified trade-offs between TIVA and inhalational anesthesia and reinforced airway preparation with NIPPV where feasible.
Selected Articles
1. Prothrombin Complex Concentrate vs Frozen Plasma for Coagulopathic Bleeding in Cardiac Surgery: The FARES-II Multicenter Randomized Clinical Trial.
A multicenter randomized trial demonstrated that 4-factor PCC achieved higher hemostatic effectiveness than frozen plasma in coagulopathic bleeding during cardiac surgery, reduced allogeneic transfusion exposure, and lowered serious adverse events including AKI through day 30.
Impact: Practice-changing randomized evidence that supports updating perioperative bleeding algorithms toward PCC-first strategies with meaningful safety and resource benefits.
Clinical Implications: Adopt PCC as first-line factor replacement for coagulopathic bleeding in cardiac surgery, update transfusion protocols, and monitor thromboembolic safety while leveraging reduced transfusion exposure and AKI risk.
Key Findings
- Hemostatic effectiveness: PCC 77.9% vs FFP 60.4% (difference 17.6%; 95% CI 8.7%–26.4%).
- Allogeneic transfusion requirements were reduced with PCC.
- Serious adverse events, including AKI, were lower through day 30 in the PCC group.
2. Plasma pharmacokinetics of intravenous and intranasal oxytocin in nonpregnant adults.
Using LC/MS and population PK modeling, the study showed intravenous oxytocin follows a robust two-compartment model, whereas intranasal oxytocin has very low bioavailability (~0.7%) with high variability; LC/MS concentrations exceeded ELISA, and a public dosing simulator was released.
Impact: Resolves long-standing uncertainty about intranasal oxytocin exposure, explaining prior efficacy inconsistencies and providing open tools to redesign dosing and routes.
Clinical Implications: Reconsider intranasal oxytocin in clinical research and practice; prefer IV administration or redesign intranasal regimens using the simulator while accounting for very low bioavailability.
Key Findings
- Intranasal oxytocin bioavailability ≈0.7% with high intersubject variability.
- Intravenous oxytocin PK fits a two-compartment model with low bias.
- LC/MS concentrations were systematically higher than ELISA; a public dosing simulator was released.
3. Efficacy and safety of gastrodin in preventing postoperative delirium following cardiac surgery: a randomized placebo controlled clinical trial.
In a double-blind RCT of 155 cardiac surgery patients, perioperative gastrodin infusion reduced postoperative delirium (19.5% vs 35.9%), increased likelihood of discharge, and showed no drug-related adverse events.
Impact: First high-quality blinded RCT showing a pharmacologic agent can reduce postoperative delirium after cardiac surgery, addressing a major unmet need in perioperative neuroprotection.
Clinical Implications: Consider integrating gastrodin into multimodal delirium prevention bundles for cardiac surgery patients pending replication, with appropriate monitoring and multicenter validation before routine adoption.
Key Findings
- Postoperative delirium incidence reduced: 19.5% vs 35.9% (RR 0.54, p=0.022).
- No drug-related adverse events were reported.
- Higher odds of hospital discharge in the gastrodin group (subhazard ratio 1.20).
4. Inhaled Sedation in Acute Respiratory Distress Syndrome: The SESAR Randomized Clinical Trial.
In a multicenter phase 3 RCT of adults with moderate–severe ARDS, inhaled sevoflurane sedation led to fewer ventilator-free days at 28 days and lower 90-day survival compared with propofol, with higher early mortality and fewer ICU-free days.
Impact: High-quality randomized evidence that directly redirects ICU sedation practice away from volatile-based sedation in severe ARDS.
Clinical Implications: Favor intravenous propofol over inhaled sevoflurane for deep sedation in moderate–severe ARDS; re-evaluate protocols endorsing volatile sedation and prioritize patient safety.
Key Findings
- Ventilator-free days at day 28 were fewer with sevoflurane vs propofol (median difference −2.1 days).
- 90-day survival was lower with sevoflurane (47.1% vs 55.7%; HR 1.31).
- Sevoflurane was associated with higher 7-day mortality and fewer ICU-free days.
5. Safety and recovery profile of patients after inhalational anaesthesia versus target-controlled or manual total intravenous anaesthesia: a systematic review and meta-analysis of randomised controlled trials.
A meta-analysis of 385 RCTs found no difference in major intraoperative adverse events between TIVA and inhalational anesthesia; TIVA reduced PONV and emergence agitation, whereas inhalational anesthesia shortened recovery time and reduced cost, with similar safety for TCI vs manual TIVA.
Impact: Provides comprehensive, immediately actionable guidance on anesthetic technique trade-offs to tailor care to patient priorities (PONV avoidance vs speed/cost).
Clinical Implications: Prefer inhalational anesthesia when rapid recovery and lower cost are priorities; select TIVA for high PONV or emergence agitation risk; consider potential cognitive effects of TCI-TIVA pending head-to-head trials.
Key Findings
- No difference in ClassIntra grade 3–4 adverse events between TIVA and inhalational anesthesia across 385 RCTs.
- TIVA reduced PONV and emergence agitation.
- Inhalational anesthesia shortened recovery time and reduced cost; TCI vs manual TIVA showed similar safety.