Daily Anesthesiology Research Analysis
Analyzed 48 papers and selected 3 impactful papers.
Summary
The strongest studies addressed perioperative safety and recovery through rigorous prospective designs. A randomized trial supported one-hour carbohydrate-rich clear-fluid fasting in healthy children, while a prospective monitoring study showed that kinemyography and electromyography are not interchangeable during neuromuscular blockade. A randomized trial also provided an important negative result: liposomal bupivacaine did not improve clinically meaningful analgesic outcomes over bupivacaine plus dexamethasone.
Research Themes
- Pediatric perioperative fasting and aspiration-risk assessment
- Quantitative neuromuscular monitoring and measurement validity
- Comparative regional anesthesia and opioid-sparing analgesia
Selected Articles
1. Ultrasound-Based Assessment of Gastric Fluid Volume in the Pediatric Population Undergoing Elective Surgery: A Prospective, Randomized, Double-Blind Comparison of Carbohydrate-Rich Clear Fluid Versus Water at One- and Two-Hour Fasting Intervals.
In this prospective, randomized, double-blind trial of 140 ASA I-II children, drinking 3 mL/kg of carbohydrate-rich clear fluid one hour before anesthesia produced a higher gastric fluid volume than two-hour fasting, but no child exceeded the 1.5 mL/kg risk threshold. The one-hour carbohydrate-fluid regimen also produced better comfort, supporting its use in appropriately selected healthy children undergoing elective surgery.
Impact: This study provides prospective quantitative evidence directly relevant to evolving pediatric fasting guidelines. It links a liberalized fasting interval to objective gastric ultrasound measurements and patient comfort rather than relying solely on historical convention.
Clinical Implications: For healthy children undergoing elective non-gastrointestinal surgery, 3 mL/kg of a carbohydrate-rich clear fluid one hour before induction may be a feasible alternative to a two-hour clear-fluid fast, potentially improving comfort without exceeding the assessed gastric-volume safety threshold. The findings should not automatically be extrapolated to emergency surgery, gastrointestinal disease, aspiration-risk conditions, or other populations.
Key Findings
- All 140 children completed the study, and no participant exceeded a gastric fluid volume of 1.5 mL/kg.
- Mean gastric fluid volume was 0.947 mL/kg after one-hour carbohydrate-fluid fasting versus 0.340 mL/kg after two-hour carbohydrate-fluid fasting.
- Comfort was significantly higher after one-hour carbohydrate-fluid fasting, with no pulmonary aspiration episodes observed.
Methodological Strengths
- Prospective randomized double-blind parallel-group design with prospective trial registration.
- Objective point-of-care gastric ultrasound assessment using predefined quantitative and qualitative thresholds.
Limitations
- The sample consisted of healthy ASA I-II children undergoing elective non-gastrointestinal surgery, limiting generalizability.
- The study was not powered to detect rare pulmonary aspiration events, and gastric ultrasound was used as a surrogate rather than direct aspiration outcome.
Future Directions: Larger multicenter studies should evaluate one-hour carbohydrate-fluid fasting in infants, children with comorbidities or aspiration risk, emergency settings, and diverse fluid formulations, while monitoring actual aspiration and perioperative outcomes.
BACKGROUND: Preoperative fasting guidelines have evolved from the traditional "nil per os after midnight" rule toward more liberal regimens. The European Society of Anaesthesiology and Intensive Care (ESAIC) and the Association of Pediatric Anesthetists of Great Britain and Ireland (APAGBI) now recommend a one-hour clear fluid fast for children, yet objective evidence quantifying the gastric fluid volume (GFV) resulting from carbohydrate-rich clear fluids at this abbreviated interval remains limited. AIMS: To evaluate the effect of one- versus two-hour fasting following the ingestion of 3 mL/kg of a carbohydrate-rich clear fluid or plain water on GFV, as assessed by point-of-care gastric ultrasound (POCUS), in healthy children undergoing elective surgery.
2. Comparison of kinemyography and electromyography during onset of and recovery from non-depolarising neuromuscular blockade: prospective observational study.
Among 137 analyzed patients, electromyography and kinemyography produced significantly different onset times for non-depolarising neuromuscular blockade, whereas recovery-time differences were not statistically significant. The findings indicate that the two modalities should not be treated as interchangeable and suggest that kinemyography may overestimate the degree of blockade; an EMG-derived T1% parameter remains investigational.
Impact: This study addresses a clinically important measurement-validity problem in neuromuscular monitoring. Its negative finding regarding interchangeability may prevent clinicians from assuming that values from different technologies represent equivalent physiologic states.
Clinical Implications: Clinicians should interpret KMG and EMG measurements according to the technology used and avoid direct interchangeability, particularly during onset assessment. EMG-based monitoring may offer a safer reference in selected settings, but management thresholds and the clinical role of T1% require further validation.
Key Findings
- In 137 patients, onset time was 158 ± 74 seconds with EMG and 118 ± 68 seconds with KMG, with significant disagreement (P < 0.001).
- Recovery time was 27 ± 22 minutes with EMG versus 24 ± 21 minutes with KMG, without statistically significant disagreement (P = 0.242).
- The results indicate that KMG and EMG are not interchangeable, and EMG-derived T1% requires further validation.
Methodological Strengths
- Prospective simultaneous comparison of both monitoring modalities in the same patients.
- Evaluation included both blockade onset and recovery, plus exploration of a novel EMG-derived parameter.
Limitations
- The observational design cannot establish whether EMG-guided management improves clinical outcomes.
- The study did not provide definitive validation of T1% or determine whether modality differences alter extubation safety or postoperative residual blockade.
Future Directions: Future multicenter studies should standardize electrode placement and calibration, compare modality-specific train-of-four ratios with clinical outcomes, and test whether EMG-guided protocols reduce residual neuromuscular blockade and respiratory complications.
BACKGROUND: Quantitative neuromuscular monitoring is essential for the safe management of neuromuscular blockade. Although electromyography (EMG) is increasingly regarded as a reference technique, kinemyography (KMG) remains widely used in clinical practice; however, clinically relevant differences between these modalities during onset and recovery of neuromuscular blockade are not fully understood. METHODS: In this prospective observational study, adult patients undergoing general anaesthesia with non-depolarising neuromuscular blocking agents were simultaneously monitored using EMG and KMG applied to opposite hands, and onset and recovery times of neuromuscular block were compared between modalities; additionally, a novel EMG-derived parameter (T1%) was explored as a marker of recovery.
3. Liposomal Bupivacaine versus Bupivacaine with Dexamethasone for Rhomboid Intercostal and Sub-Serratus Block in Thoracoscopic Lobectomy: A Randomized Controlled Trial.
In this randomized double-blind trial of 78 patients undergoing thoracoscopic lobectomy, liposomal bupivacaine and bupivacaine plus dexamethasone produced comparable 72-hour resting pain burden and opioid consumption. Although liposomal bupivacaine prolonged the measured duration of analgesia, it did not yield a clinically meaningful improvement in postoperative analgesia.
Impact: The study supplies a useful negative result against routine assumption that liposomal formulations are superior in fascial plane blocks. It may inform cost-conscious analgesic selection while preserving the value of dexamethasone as an adjuvant strategy.
Clinical Implications: For RISS block after thoracoscopic lobectomy, bupivacaine plus dexamethasone may be preferred over liposomal bupivacaine when analgesic efficacy, opioid use, and resource utilization are considered together. Liposomal bupivacaine should not be selected solely on the expectation of longer duration without evidence of patient-centered benefit.
Key Findings
- The 72-hour area under the curve for resting pain was comparable between liposomal bupivacaine and bupivacaine plus dexamethasone.
- Liposomal bupivacaine did not reduce postoperative oxycodone consumption or improve clinically relevant pain outcomes.
- Liposomal bupivacaine prolonged the duration of analgesia, but the incremental clinical benefit was limited.
Methodological Strengths
- Randomized double-blind parallel-group design with a prespecified 72-hour pain-burden primary outcome.
- Direct comparison with an active adjuvant regimen and assessment of opioid consumption and adverse effects.
Limitations
- The sample size was modest, with 39 patients per group, which may limit detection of smaller clinically relevant differences.
- The study evaluated a single thoracic procedure and a specific fascial plane block, limiting generalizability to other operations and regional techniques.
Future Directions: Larger pragmatic trials should evaluate cost-effectiveness, patient-reported recovery, functional respiratory outcomes, and procedure-specific analgesic protocols across thoracic and other surgical populations.
BACKGROUND: Liposomal bupivacaine may prolong analgesia in regional anesthesia; however, its effectiveness in fascial plane blocks remains uncertain. This study compared liposomal bupivacaine plus bupivacaine with bupivacaine plus dexamethasone for rhomboid intercostal and sub-serratus (RISS) plane block for postoperative analgesia following thoracoscopic lobectomy. METHODS: In this randomized, double-blind, parallel-group trial, 78 patients undergoing thoracoscopic lobectomy were randomly assigned (1:1) to receive either liposomal bupivacaine plus bupivacaine (LB group, n = 39) or bupivacaine plus dexamethasone (BD group, n = 39) for RISS block. The primary outcome was the area under the curve (AUC) of resting Numeric Rating Scale (NRS) pain scores over 72 h postoperatively.