Anesthesiology Research Analysis
June 2025 anesthesiology research blended practice-changing randomized trials with circuit-level mechanistic advances. Two thoracic analgesia trials supported replacing epidural or ESPB with intercostal nerve blocks, improving recovery and reducing opioids. In frail elderly hip surgery, remimazolam reduced postoperative delirium and intraoperative burst suppression versus propofol, linking EEG physiology to outcomes. A phase III trial established adamgammadex as a noninferior alternative to suga
Summary
June 2025 anesthesiology research blended practice-changing randomized trials with circuit-level mechanistic advances. Two thoracic analgesia trials supported replacing epidural or ESPB with intercostal nerve blocks, improving recovery and reducing opioids. In frail elderly hip surgery, remimazolam reduced postoperative delirium and intraoperative burst suppression versus propofol, linking EEG physiology to outcomes. A phase III trial established adamgammadex as a noninferior alternative to sugammadex for rapid deep block reversal, and a phase II trial suggested HIF1A stabilization (vadadustat) may protect in severe hypoxic viral lung injury. Together these findings point toward recovery-focused pathways, targeted neuromodulation of emergence, and diversified perioperative pharmacology.
Selected Articles
1. Remimazolam tosylate or propofol and delirium in frail elderly patients after hip surgery: A randomised controlled clinical trial.
In frail elderly hip surgery patients, remimazolam for TIVA reduced postoperative delirium versus propofol (4.4% vs 17.6%), lowered induction hypotension and vasopressor needs, and markedly decreased intraoperative EEG burst suppression.
Impact: Actionable RCT demonstrating anesthetic selection can lower delirium risk while improving hemodynamic stability and EEG physiology in a high-risk population.
Clinical Implications: Consider remimazolam for frail elderly; implement EEG-guided depth monitoring to minimize burst suppression and standardized protocols to prevent hypotension.
Key Findings
- Postoperative delirium: 4.4% (remimazolam) vs 17.6% (propofol); RR 0.25; NNT ≈ 8.
- Lower incidence of induction hypotension and reduced vasopressor requirements with remimazolam.
- Significantly shorter duration and proportion of intraoperative EEG burst suppression.
2. Intercostal or Paravertebral Block vs Thoracic Epidural in Lung Surgery: A Randomized Noninferiority Trial.
In thoracoscopic lung resections, single-shot intercostal nerve block was noninferior to thoracic epidural for pain through POD0–2 and improved recovery metrics by reducing opioids, enhancing mobilization, and shortening length of stay.
Impact: Multicenter noninferiority RCT supporting a simpler, less invasive regional technique that aligns with ERAS and can replace epidurals in many VATS cases.
Clinical Implications: Adopt intercostal nerve blocks as first-line analgesia in suitable VATS patients to reduce opioids and improve recovery; individualize when epidural is specifically indicated.
Key Findings
- Noninferiority to thoracic epidural for pain AUC POD0–2.
- Reduced opioid use and improved QoR-15 at 24 and 48 hours.
- Shorter length of stay and fewer pulmonary/PONV-related events.
3. Identification of HIF1A as a therapeutic target during SARS-CoV-2-associated lung injury.
A phase II RCT of vadadustat (HIF stabilizer) showed on-target gene induction, similar safety to placebo, and a modest overall reduction in severe lung injury with substantial benefit in the most hypoxic subgroup (baseline FiO2 ≥80%).
Impact: Bridges mechanistic biology (HIF1A) to randomized clinical signal, proposing a repurposed, oral therapy for severe hypoxic viral lung injury.
Clinical Implications: Prioritize phase III trials of HIF stabilizers with stratification by hypoxemia severity; not yet ready for routine care but compelling for targeted rescue strategies.
Key Findings
- Vadadustat induced HIF target genes and had safety similar to placebo.
- Day-14 severe lung injury probability: 13.3% (vadadustat) vs 16.9% (placebo); large benefit in baseline FiO2 ≥80%.
- Preclinical models implicated alveolar Hif1a as protective.
4. Efficacy and safety of adamgammadex for reversing rocuronium-induced deep neuromuscular block: a multicentre, randomised, double-blind, positive-controlled phase III trial.
In a multicentre phase III noninferiority trial, adamgammadex 8 mg/kg rapidly and reliably reversed deep rocuronium block with success to TOF 0.9 in 98.7% and a median recovery time of 2.5 minutes, meeting noninferiority to sugammadex with comparable safety.
Impact: Establishes a rigorously tested alternative to sugammadex, with implications for supply resilience, cost, and OR/PACU workflow where rapid reversal is critical.
Clinical Implications: Prepare for potential adoption pending regulatory approval and cost-effectiveness; adamgammadex offers another reliable option for deep block reversal.
Key Findings
- TOF ratio 0.9 recovery success: 98.7% (adamgammadex) vs 100% (sugammadex), meeting noninferiority.
- Median time to TOF 0.9: 2.5 min (adamgammadex) vs 2.2 min (sugammadex).
- Safety profile comparable between groups.
5. Orexin signalling in the nucleus accumbens promotes arousal from isoflurane anaesthesia and restores communication between the nucleus accumbens and frontal cortex.
Preclinical multi-modal experiments show that orexinergic inputs to the nucleus accumbens produce wake-active signals under isoflurane; activation via optogenetics or orexin-A microinjection shortened emergence, reduced burst suppression, and restored NAc–frontal cortex communication via OX1R on D1R-positive neurons.
Impact: Defines a receptor-specific striatal circuit capable of modulating anesthetic emergence and EEG suppression, opening translational routes for pro-emergence therapies.
Clinical Implications: Supports exploration of orexinergic modulators or OX1R-targeted agents to modulate emergence, agitation, or EEG suppression, pending human trials and safety evaluation.
Key Findings
- NAc orexinergic afferents are wake-active during isoflurane anesthesia and arousal.
- Optogenetic activation reduced burst suppression ratio and shortened emergence.
- Orexin-A microinjection promoted arousal via OX1R on D1R-positive neurons and restored NAc–frontal connectivity.