Weekly Anesthesiology Research Analysis
This week’s anesthesiology literature highlights three impactful randomized and high-quality studies: a phase‑3 trial showing a modest but significant analgesic effect of a full‑spectrum Cannabis sativa extract for chronic low back pain; a pediatric RCT where low‑dose intraoperative esketamine substantially reduced emergence delirium and early maladaptive behaviours after adenotonsillectomy; and a high‑certainty meta‑analysis showing videolaryngoscopy improves glottic view but not first‑pass int
Summary
This week’s anesthesiology literature highlights three impactful randomized and high-quality studies: a phase‑3 trial showing a modest but significant analgesic effect of a full‑spectrum Cannabis sativa extract for chronic low back pain; a pediatric RCT where low‑dose intraoperative esketamine substantially reduced emergence delirium and early maladaptive behaviours after adenotonsillectomy; and a high‑certainty meta‑analysis showing videolaryngoscopy improves glottic view but not first‑pass intubation success in mostly normal pediatric airways. Together, the papers emphasize pragmatic perioperative strategies — opioid‑sparing regional adjuncts and intraoperative agents to improve recovery — and reinforce careful device and medication selection informed by high‑quality evidence.
Selected Articles
1. Full-spectrum extract from Cannabis sativa DKJ127 for chronic low back pain: a phase 3 randomized placebo-controlled trial.
In a multicenter phase‑3 randomized placebo‑controlled trial of 820 adults with chronic low back pain, the full‑spectrum Cannabis sativa extract VER‑01 produced a modest but statistically significant reduction in pain (mean NRS reduction −1.9; mean difference vs placebo −0.6; P<0.001) and improved neuropathic pain symptoms in a predefined subgroup, with mostly mild‑to‑moderate adverse events and no dependence signals.
Impact: First large phase‑3 randomized evidence for a full‑spectrum cannabis product in chronic low back pain, informing an emerging treatment class with measurable benefit and a defined safety profile.
Clinical Implications: VER‑01 could be considered as an adjunct in multimodal chronic low back pain management with counseling on modest effect size and higher rates of primarily mild adverse events; weigh regulatory, cost, and long‑term safety considerations.
Key Findings
- Primary endpoint met: mean NRS pain reduction −1.9 in VER‑01 arm; mean difference vs placebo −0.6 (95% CI −0.9 to −0.3; P<0.001).
- Neuropathic pain subgroup (PainDETECT>18) showed larger NPSI improvement (MD vs placebo −7.3; P=0.017).
- Adverse events higher with VER‑01 (83.3% vs 67.3%) but were predominantly mild‑to‑moderate and transient; no dependence/withdrawal signals observed.
2. Intravenous esketamine for the prevention of emergence delirium and negative behavioural changes after paediatric adenotonsillectomy: a randomised controlled trial.
In a double‑blind RCT of 228 children (aged 3–7) undergoing adenotonsillectomy, a single intraoperative low dose of IV esketamine (0.2 mg/kg) reduced emergence delirium (17% vs 43%; RR 0.40) and decreased negative behavioural changes at day 7 (42% vs 61%; RR 0.70), with benefits persisting to day 30 and no increase in adverse events.
Impact: Provides high‑quality RCT evidence for a simple intraoperative intervention that substantially reduces pediatric emergence delirium and early maladaptive behaviours, a common clinical challenge.
Clinical Implications: Consider adding a single low dose of IV esketamine (0.2 mg/kg) to anesthetic regimens for adenotonsillectomy in young children to reduce emergence delirium and improve early postoperative behaviour, with standard monitoring for adverse effects.
Key Findings
- Emergence delirium: 17% (esketamine) vs 43% (saline); RR 0.40 (97.5% CI 0.23–0.68), p<0.001.
- Negative behavioural changes at day 7: 42% vs 61%; RR 0.70 (97.5% CI 0.51–0.95), p=0.009.
- Benefits extended to day 30 with improved analgesia and parental satisfaction; adverse event rates similar.
3. Videolaryngoscopy versus direct laryngoscopy for paediatric tracheal intubation: a systematic review with meta-analysis and trial sequential analysis.
A systematic review and meta‑analysis of 53 RCTs (n=4,887) rated the evidence for first‑attempt intubation success as high certainty and found no significant difference between videolaryngoscopy and direct laryngoscopy for first‑pass success (RR 1.03; 95% CI 0.99–1.07), although videolaryngoscopy improved glottic visualisation and reduced oesophageal intubation in infants under 1 year.
Impact: Provides high‑certainty, comprehensive synthesis clarifying when videolaryngoscopy confers benefits in pediatric practice, informing device selection, training, and guideline updates.
Clinical Implications: Routine use of videolaryngoscopy solely to increase first‑pass success in children with mostly normal airways is not supported; reserve VL for improving glottic view, managing infants, or anticipated difficult airways, and ensure training covers both VL and DL techniques.
Key Findings
- No significant difference in first‑attempt success between VL and DL (RR 1.03; 95% CI 0.99–1.07; high GRADE certainty).
- VL improved glottic visualisation (POGO +9.8%) and slightly increased intubation time (+3 s).
- In children <1 year, VL reduced oesophageal intubation (RR 0.16); trial sequential analysis cautions that some subgroup effects remain underpowered.