Daily Anesthesiology Research Analysis
Analyzed 53 papers and selected 3 impactful papers.
Summary
Today's most impactful anesthesiology research included evidence that oliceridine may reduce respiratory depression and postoperative nausea and vomiting compared with sufentanil, while preserving analgesic efficacy. A pediatric meta-analysis found that esketamine substantially lowers emergence delirium, whereas a randomized trial of opioid-free anesthesia showed that reducing opioid-related adverse effects does not necessarily improve overall recovery and may delay emergence.
Research Themes
- Opioid-sparing and opioid safety in perioperative anesthesia
- Prevention of pediatric emergence delirium
- Patient-centered assessment of postoperative recovery
Selected Articles
1. Efficacy and safety of oliceridine versus sufentanil in perioperative anesthesia and analgesia: a systematic review and meta-analysis with trial sequential analysis.
This systematic review and meta-analysis included seven randomized controlled trials involving 1,327 patients. Compared with sufentanil, oliceridine reduced respiratory depression and postoperative nausea and vomiting, improved 24-hour QoR-15 scores, and provided comparable analgesia and hemodynamic stability; trial sequential analysis supported the respiratory and nausea-related findings.
Impact: The study addresses a central perioperative problem: achieving effective opioid analgesia while reducing respiratory and gastrointestinal toxicity. Its use of trial sequential analysis strengthens confidence in the main safety outcomes, although broader validation remains necessary.
Clinical Implications: Oliceridine may be considered as an alternative to conventional potent opioids in selected adults at increased risk of respiratory depression or postoperative nausea and vomiting. Dose selection, monitoring, cost, and confirmation in non-Chinese and multicenter populations remain important before routine substitution.
Key Findings
- Seven randomized controlled trials involving 1,327 patients were included, with 1,242 patients contributing to quantitative synthesis.
- Oliceridine reduced respiratory depression compared with sufentanil (RR 0.48, 95% CI 0.31-0.76; I² = 0%).
- Oliceridine reduced postoperative nausea and vomiting (RR 0.48, 95% CI 0.36-0.65) and improved 24-hour QoR-15 scores, while hypotension and analgesic efficacy were comparable.
Methodological Strengths
- Systematic searches across five major bibliographic databases with random-effects quantitative synthesis.
- Risk-of-bias assessment and trial sequential analysis evaluated both internal validity and robustness of cumulative evidence.
Limitations
- The evidence was based on only seven randomized trials and was largely derived from Chinese adults.
- The authors characterized the findings as preliminary, and several secondary outcomes showed no significant differences.
Future Directions: Large, multicenter randomized trials in diverse ethnic groups, surgical procedures, and perioperative risk strata should compare oliceridine with multiple standard opioids and evaluate clinically important respiratory endpoints, cost-effectiveness, and longer-term recovery.
BACKGROUND: Perioperative pain management is a significant challenge when using conventional µ opioid agonists, which often require careful balancing of efficacy and safety. Oliceridine, a G-protein-biased µ-opioid receptor agonist, may provide comparable analgesia while offering a potentially improved safety profile. METHODS: Randomized controlled trials (RCTs) comparing perioperative oliceridine and sufentanil in adult patients were systematically identified from PubMed, Scopus, Embase, Web of Science, and the Cochrane Library from inception to March 21, 2026.
2. Effects of Esketamine on Emergence Delirium in Children Undergoing Sevoflurane Anesthesia: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis.
This systematic review included eight randomized controlled trials involving 916 children. Esketamine reduced emergence delirium by approximately 65%, lowered postoperative pain and postoperative nausea and vomiting, and caused only a modest prolongation of extubation time; the certainty of evidence was moderate for most outcomes.
Impact: Emergence delirium is common, distressing, and clinically relevant in pediatric anesthesia. The large relative risk reduction, improvement in pain and nausea, and examination of evidence sufficiency through trial sequential analysis make this a potentially practice-informing synthesis.
Clinical Implications: Perioperative esketamine may be considered for children receiving sevoflurane who are at substantial risk of emergence delirium, particularly when analgesic benefit is also desirable. Clinicians should balance this potential benefit against modestly delayed extubation and the remaining uncertainty regarding optimal dose, route, and timing.
Key Findings
- Eight randomized controlled trials involving 916 children were included, and no study was judged to be at high risk of bias.
- Esketamine significantly reduced emergence delirium compared with placebo (RR 0.35, 95% CI 0.26-0.48; p < 0.0001).
- Esketamine reduced postoperative pain and postoperative nausea and vomiting, while prolonging extubation by a mean of 1.72 minutes.
Methodological Strengths
- The review searched seven databases and registries and prespecified clinically relevant primary and secondary outcomes.
- Risk of bias, certainty of evidence using GRADE, meta-regression, and trial sequential analysis were all incorporated.
Limitations
- Only eight trials with 916 children were available, and four studies raised some concerns regarding risk of bias.
- Evidence was insufficient to establish the optimal esketamine dose, route, or timing across different surgeries and age groups.
Future Directions: Future trials should use standardized definitions of emergence delirium, compare dose and timing strategies, include diverse pediatric age groups and surgical populations, and assess neurodevelopmental and longer-term recovery outcomes.
BACKGROUND: Emergence delirium is a frequent and distressing postoperative complication in children, particularly following sevoflurane-based anesthesia. Despite its clinical importance, the optimal preventive strategy remains under investigation. This study aims to systematically evaluate the efficacy and safety of esketamine in preventing emergence delirium in pediatric patients undergoing sevoflurane-based general anesthesia. METHODS: We systematically searched seven databases and registries through 27 March 2026. Randomized controlled trials that compared esketamine with placebo in children undergoing surgical procedures were included.
3. Effect of opioid-free anesthesia on postoperative recovery in elderly patients undergoing laparoscopic abdominal surgery: a randomized controlled trial.
In this single-center randomized trial, 195 elderly patients completed comparisons between opioid-free anesthesia and conventional opioid-based anesthesia. Opioid-free anesthesia modestly reduced postoperative nausea and vomiting and accelerated gastrointestinal recovery, but did not produce a clinically meaningful improvement in QoR-15; it also delayed emergence, prolonged post-anesthesia care unit stay, and increased intraoperative hypertension.
Impact: This study provides an important negative or qualification result for the expanding opioid-free anesthesia movement. It shows that reducing opioid exposure and selected adverse effects does not automatically translate into better global recovery, emphasizing balanced patient-centered evaluation.
Clinical Implications: Opioid-free anesthesia should not be adopted solely to improve overall recovery in elderly patients undergoing laparoscopic abdominal surgery. It may be useful when the principal goal is to reduce opioid-related nausea or gastrointestinal effects, but clinicians should anticipate delayed emergence, longer PACU care, and possible intraoperative hypertension.
Key Findings
- Two hundred patients aged 60 years or older were randomized, and 195 completed the study.
- The opioid-free anesthesia group had a higher 24-hour QoR-15 score, but the mean difference was only 4 points and was not considered clinically meaningful.
- Opioid-free anesthesia reduced postoperative nausea and vomiting and modestly accelerated gastrointestinal recovery, but delayed emergence, prolonged PACU stay, and increased intraoperative hypertension.
Methodological Strengths
- Randomized controlled design with a prespecified patient-centered primary outcome using QoR-15.
- The study assessed both benefits and harms, including pain, nausea, gastrointestinal recovery, emergence, hemodynamics, and PACU utilization.
Limitations
- The study was conducted at a single center and included one specific elderly laparoscopic surgical population.
- The trial may not have been powered to detect differences in uncommon serious adverse events or longer-term outcomes.
Future Directions: Future multicenter trials should identify patient subgroups most likely to benefit from opioid-free anesthesia, compare standardized opioid-sparing protocols, and evaluate longer-term functional recovery, chronic postsurgical pain, and cost-effectiveness.
BACKGROUND: Opioid-free anesthesia (OFA) has been proposed to reduce opioid-related adverse effects, although its impact on overall postoperative recovery remains uncertain. We evaluated whether OFA improves postoperative quality of recovery compared with opioid-based anesthesia (OA) in elderly patients undergoing laparoscopic abdominal surgery. METHODS: In this single-center randomized controlled trial, 200 patients aged ≥60 years undergoing elective laparoscopic abdominal surgery were randomized to receive either OFA (dexmedetomidine, esketamine, and lidocaine) or conventional OA. The primary outcome was quality of recovery measured using the QoR-15 questionnaire at 24 h after surgery.