Anesthesiology, October 17 edition

In this prospective randomized double-blind trial of 120 adults undergoing elective video-assisted thoracoscopic surgery, ciprofol produced faster induction, less injection pain, and a shorter post-anesthesia care unit stay than propofol. Hemodynamic differences were transient, but higher early intraoperative bispectral index values and more frequent BIS values of at least 60 with ciprofol warrant attention to depth-of-anesthesia monitoring.

Impact: This is a registered randomized double-blind comparison of a newer intravenous anesthetic in a clinically relevant thoracic-surgery population. It identifies potential recovery and tolerability advantages while also revealing a practical monitoring issue that may affect adoption.

Clinical Implications: Ciprofol may be considered as an alternative to propofol when rapid induction, reduced injection pain, or shorter recovery-room stay is desirable. Clinicians should independently verify adequate hypnotic depth because early BIS values may be higher with ciprofol.

Future Directions: Larger multicenter trials should compare dose-adjusted ciprofol and propofol across diverse surgeries, evaluate clinically meaningful recovery outcomes, and clarify how BIS and other electroencephalographic monitors should be interpreted during ciprofol anesthesia.

In 395 randomized total knee arthroplasty patients, spinal and general anesthesia resulted in similar operating-room times, but spinal anesthesia was associated with a longer post-anesthesia care unit stay. General anesthesia used substantially more disposable material and cost more, whereas spinal anesthesia appeared more material-sparing and less frequently required medication for hypotension.

Impact: This randomized study extends anesthesia comparison beyond patient outcomes to workflow, cost, and environmental burden. Its quantitative resource data can inform hospital-level anesthesia policy and sustainability initiatives without assuming that a shorter recovery-room stay necessarily offsets material and financial costs.

Clinical Implications: For total knee arthroplasty, spinal anesthesia may be preferred when reducing disposable materials, medication use, and direct costs is a priority. Operational planning should account for its potentially longer post-anesthesia care unit occupancy rather than relying only on operating-room time.

Future Directions: Multicenter implementation studies should evaluate standardized resource and carbon metrics, include patient-reported outcomes and staffing constraints, and test whether workflow redesign can offset the longer recovery-room time associated with spinal anesthesia.

In a prospective randomized double-blind trial of 100 children aged 2–12 years, sugammadex reversed vecuronium-induced neuromuscular blockade substantially faster than neostigmine. Median time to train-of-four ratios of at least 0.9 and 1.0 was 70 and 85.5 seconds with sugammadex versus 252 and 272 seconds with neostigmine, respectively; sugammadex also caused less post-reversal tachycardia.

Impact: The study directly addresses a high-consequence pediatric safety problem—residual neuromuscular blockade—using objective train-of-four monitoring. The magnitude and consistency of the recovery difference support sugammadex as a clinically important option when rapid and predictable pediatric recovery is needed.

Clinical Implications: Sugammadex should be considered for rapid, reliable reversal of vecuronium in children, particularly when residual paralysis or delayed respiratory recovery would be hazardous. Quantitative neuromuscular monitoring remains important because faster pharmacologic reversal does not eliminate the need to confirm adequate recovery.

Future Directions: Multicenter pediatric trials should assess recovery in infants and medically complex children, quantify clinically important respiratory outcomes, evaluate rare adverse events, and incorporate cost-effectiveness analyses and patient-safety endpoints.