Vetrix Anesthesiology

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Vetrix Anesthesiology is an AI-driven podcast that dissects contemporary anesthesiology papers, translating dense methods and statistics into clear, clinically focused insights for everyday practice.

  1. 3D AGO

    Proactive haemodynamic management using the hypotension prediction index during caesarean section: a randomised controlled study

    Citation: Shih P-Y, Wei T-J, Lee C-T, Kang J, Shih M-C, Chen Y-H, Lee Y-S, Chen H-T, Wu C-Y. Proactive haemodynamic management using the hypotension prediction index during caesarean section: a randomised controlled study. Anaesthesia. 2026. doi:10.1111/anae.70161. Study at a glance - Design and setting: Single-centre, 3-arm randomised controlled trial (1:1:1) during elective caesarean section under spinal anaesthesia at National Taiwan University Hospital (Taipei, Taiwan). Screened 255; randomised 180; analysed 171. - Population: Adults aged 20–50 years undergoing elective caesarean section under spinal anaesthesia. Key exclusions: pre-eclampsia; significant cardiovascular disease; inadequate spinal level (≤T6). - Groups / monitoring strategies: - Oscillometric group: Oscillometric BP every 2.5 min; CNAP/HPI recorded but blinded to anaesthetist. - CNAP group: Continuous non-invasive arterial pressure (CNAP) displayed; HPI blinded. - HPI group: CNAP + HPI displayed; treatment triggered by MAP 60 bpm. Primary outcome - Time-weighted average hypotension (MAP 65 mmHg), derived from CNAP MAP sampled every 20 s: - Oscillometric: 0.89 mmHg (IQR 0.08–2.06), n=59 - CNAP: 0.30 mmHg (IQR 0.07–0.74), n=55 - HPI: 0.08 mmHg (IQR 0–0.43), n=57 → Descriptively lowest hypotension burden with HPI-guided management. Selected secondary / safety and process outcomes (Table 2) - Area under the threshold for hypotension (mmHg·min): - Oscillometric 68.7 (IQR 5.5–145.3) vs CNAP 22.7 (4.8–57.2) vs HPI 5.7 (0–32.7) - Zero episodes of hypotension (no MAP 65 at all): - 13/59 (22%) oscillometric vs 13/55 (24%) CNAP vs 26/57 (46%) HPI; p=0.009 - Noradrenaline dose (µg): - 50 (30–90) oscillometric vs 70 (30–145) CNAP vs 90 (48–133) HPI; p=0.016 (higher in HPI arm) - Maternal adverse effects: - Nausea: 43/59 vs 29/55 vs 30/57; p=0.038 - Vomiting: 13/59 vs 6/55 vs 3/57; p=0.023 - Bradycardia: 10/59 vs 5/55 vs 4/57; p=0.199 - Neonatal outcomes: Apgar scores similar across groups (median 9 at 1 min and 5 min). - Device agreement (exploratory): Bland–Altman CNAP vs oscillometric MAP showed small mean bias (+1.37 mmHg; 95% CI 0.71–2.03). Important limitations / interpretation notes - Post-randomisation exclusions: 9/180 (5%) were not analysed (protocol violation with ephedrine n=3; inadequate spinal level not reaching T6 n=6), so results reflect a modified analysed cohort rather than strict ITT for all randomised patients. - Many outcomes are presented as medians/IQRs and p-values without effect sizes/CI for between-group differences; multiplicity adjustment is not described (many secondary comparisons in a 3-arm trial).

    11 min

  2. FEB 8

    Benefits in adults allowed to drink clear liquids before anaesthesia until called to the operating room

    Citation: Haas TE, Kranke P, Stegemann MN, Helmer P, Schmid B, Diehl FM, et al. Benefits in adults allowed to drink clear liquids before anaesthesia until called to the operating room: A randomised pilot study. Eur J Anaesthesiol. 2025;43:207–216. doi:10.1097/EJA.0000000000002309. Study at a glance: - Design and setting: Prospective, three-arm, randomised controlled pilot trial at a single German academic centre (University Hospital Würzburg) in 174 adult ASA I–III patients (mainly gynaecology, trauma and urology) undergoing elective or less-urgent surgery with low aspiration risk; web-based 1:1:1 randomisation, single-blind (blinded outcome assessors), intention-to-treat analysis with 0% dropout; overall RoB 2: “some concerns” mainly due to unblinded patient-reported outcomes. - Interventions: • Control (usual care) – standard national guideline advice to stop clear fluids 2 h before anticipated induction, no extra support. • Conservative – same 2 h rule plus “instructed adherence”: yellow fasting card, information on schedule and extra ward visits when delayed to maintain the 2 h interval. • Liberal – same support as conservative but actively encouraged clear fluids up to 200 ml between 2 h before induction and call to the OR (≈100 ml h⁻¹ of delay), i.e. small volumes allowed right up to transfer. - Primary outcome (preoperative thirst before induction): Thirst (none / moderate / severe) via a modified Bauer item. Compared with usual care, both strategies reduced thirst severity: conservative vs control OR 0.41 (95% CI 0.20–0.82; p=0.013), liberal vs control OR 0.21 (95% CI 0.10–0.43; p0.001). Symptom benefit was greatest with the liberal “drink-until-call” protocol (moderate-certainty evidence, limited by unblinded PROs). - Key secondary symptoms: • Postoperative thirst (~2 h post-op): conservative vs control OR 0.80 (95% CI 0.31–2.03; NS); liberal vs control OR 0.32 (95% CI 0.13–0.75; p=0.009), indicating less thirst post-op with liberal intake. • Preoperative headache: conservative vs control OR 0.52 (95% CI 0.21–1.25; NS); liberal vs control OR 0.24 (95% CI 0.07–0.66; p=0.009), suggesting reduced headache with liberal fluids. • Overall preoperative satisfaction and other PROs favoured the liberal strategy but were less completely reported and remain lower certainty. - Fasting behaviour, safety and feasibility: • Liquid fasting time (median [IQR], hours): control 5.38 [3.67–9.53], conservative 3.0 [2.23–4.25], liberal 1.97 [1.20–3.02] – both interventions shortened actual fasting, with liberal clustered near the 2 h boundary. • Pre-op oral liquid volume (median [IQR], ml): control 200 [20–300], conservative 400 [200–600], liberal 400 [212–500]. • No signal of haemodynamic or metabolic harm: similar blood glucose (≈95–98 mg/dl; out-of-range values 6 vs 4 vs 4), similar HR and BP changes around induction (RRsys fall ~54–58 mmHg; RRdia ~29–34 mmHg), and low vasopressor use (Akrinor median 0 ml in all arms). • Safety endpoints: no bronchopulmonary aspiration, no unplanned ICU/intermediate-care admission for respiratory insufficiency, no deaths, and no postoperative delirium (CAM-ICU) in any group; PONV rates were numerically lower with interventions (19% control, 12.1% conservative, 10.3% liberal) but underpowered for firm conclusions. Overall, in low-risk ASA I–III adults, structured support and especially liberal clear-fluid intake until call to the OR substantially improve thirst and headache without evident short-term harm, though rare aspiration-related events remain too infrequent in this pilot to definitively exclude risk.

    10 min

  3. JAN 25

    Preoxygenation with high-flow nasal oxygen at various flow rates in elective surgical patients: a prospective, randomised, single-blind clinical trial

    Citation: Sjoblom A, Hoffman F, Hedberg M, Forsberg I-M, Jonsson Fagerlund M. Preoxygenation with high-flow nasal oxygen at various flow rates in elective surgical patients: a prospective, randomised, single-blind clinical trial. Br J Anaesth. 2025;[Epub ahead of print]. doi:10.1016/j.bja.2025.11.017. Study at a glance: - Design and setting: Prospective, randomised, single-blind 3-arm physiologic RCT in adults (18–84 yr, BMI 35 kg m−2, ASA ≤3) undergoing elective colorectal, urological or gynaecological surgery at a single Swedish university hospital (Karolinska); 75 randomised, 72 analysed after 3 exclusions in the 45 L min−1 arm (1 new Mobitz II AV block before induction, 2 protocol violations). Standardised IV induction (fast-acting opioid, propofol, rocuronium 1 mg kg−1), videolaryngoscopic intubation, and apnoeic oxygenation without mask ventilation until SpO2 93%. - Interventions: 3 min HFNO preoxygenation at FiO2 1.0 in 10° reverse Trendelenburg via Optiflow+ nasal cannula and Hamilton ventilator circuit: • 45 L min−1 HFNO (n=22 analysed) • 70 L min−1 HFNO (n=25) • 95 L min−1 HFNO (n=25; one patient down-titrated to 70 L min−1 for discomfort but kept in 95 L min−1 group). All groups had invasive arterial monitoring and serial ABGs before/during preoxygenation, at apnoea start, during apnoea and at termination; PaCO2 and PaO2 trajectories and PaCO2–ETCO2 gradient were recorded. - Primary outcome (safe apnoea time to SpO2 93%): Median apnoea times were similar across flows—45 L min−1: 472 s (IQR 402–670); 70 L min−1: 523 s (420–664); 95 L min−1: 483 s (375–605); global P=0.59. Most patients in all arms tolerated ≥360 s of apnoea without SpO2 93% (86%, 96%, 80%; P=0.22). Thus, in relatively healthy, non-obese elective surgical patients, higher HFNO flows (70 or 95 L min−1) did not meaningfully prolong safe apnoea time compared with 45 L min−1 (low-certainty evidence, RoB 2 overall “some concerns” due to per-protocol analysis and unbalanced post-randomisation exclusions). - Key secondary and exploratory findings: PaO2 increased similarly during preoxygenation across groups, but at apnoea start PaO2 was higher with 95 vs 45 L min−1 (median 73.5 vs 65.1 kPa; P=0.001) without translating into longer safe apnoea time; PaCO2 at apnoea termination was similar (~8 kPa) regardless of flow. Preoxygenation-related discomfort (VAS 0–10) differed markedly: 45 L min−1 was best tolerated (median 1 [0–2]) versus 70 L min−1 5 (2–5) and 95 L min−1 3 (1–5); global P=0.002, with 45 L min−1 significantly less uncomfortable than both higher flows. Mouth closure during preoxygenation was high in all arms (closed throughout: 100%, 84%, 84%; P=0.37), and an exploratory analysis showed that failure to keep the mouth closed did not significantly shorten safe apnoea time. Serial ABGs demonstrated a nonlinear PaCO2 rise during apnoea (largest increase in the first minute) and a mean PaCO2–ETCO2 gradient of ~1.4 kPa at apnoea termination. - Applicability and implications: Small, single-centre, physiologic OR study in non-obese, ASA 1–3 elective patients; does not address obese, high-risk, emergency, ICU or rapid-sequence settings, nor compare HFNO with conventional facemask preoxygenation. Within this population, 45 L min−1 HFNO for 3 min appears to provide apnoeic oxygenation (safe apnoea time) comparable to 70–95 L min−1, with substantially less patient discomfort; use of higher flows may be reserved for specific scenarios where a modest PaO2 gain is desired, recognising the comfort trade-off and the current low–moderate certainty of evidence.

    11 min

  4. JAN 18

    Deep versus Moderate Neuromuscular Blockade During Total Hip Replacement Surgery on Postoperative Recovery and Immune Function: A Randomized Controlled Trial

    Citation: Bijkerk V, Jacobs LMC, Rijnen WHC, Keijzer C, Warlé MC, Visser J. Deep versus Moderate Neuromuscular Blockade During Total Hip Replacement Surgery on Postoperative Recovery and Immune Function: A Randomized Controlled Trial. Anesthesia & Analgesia. 2026;142(2):355-364. Study at a glance: - Design and setting: Single-centre double-blind RCT (Netherlands) in adults undergoing elective primary or revision total hip arthroplasty under general anaesthesia (n=100; 50 deep vs 50 moderate block). - Interventions: Rocuronium-based moderate neuromuscular blockade (TOF 1–2, bolus dosing, sugammadex 2 mg/kg) vs deep blockade (PTC 1–2 with absent TOF, infusion, sugammadex 4 mg/kg), both with opioid-based anaesthesia and standard perioperative care. - Primary outcome (QoR-40 POD1): Mean QoR-40 scores were similar (163 with moderate vs 167 with deep block; mean difference −4.1 points, 95% CI −10.9 to 2.8; p=0.241), not reaching the minimally important difference and indicating no clear benefit of deep block; moderate-certainty evidence. - Key secondary outcomes: Deep block showed slightly lower pain at rest on POD1 (about 1 NRS point) and lower PACU opioid use (~2 mg morphine equivalent), but estimates were imprecise; pain on movement, QoR-40 at day 30, opioid use over 24 h, surgical field rating, time to mobilisation, and length of hospital stay were all similar. - Immune function and complications: Ex vivo TNF and IL-1β production on POD1 did not differ meaningfully between groups, and 30-day infectious (4/50 vs 1/50) and non-infectious complications (20/50 vs 18/50) were comparable, though the trial was too small for precise safety estimates. - Certainty and applicability: Overall risk of bias was judged as “some concerns”, with GRADE rating mostly moderate but limited by imprecision; findings apply to elective hip arthroplasty in centres using quantitative neuromuscular monitoring and sugammadex and do not clearly support routine deep blockade solely to improve recovery or immune outcomes.

    11 min

  5. JAN 11

    Opioid-free vs. opioid-inclusive anaesthesia with or without regional anaesthesia for postoperative pain: a systematic review with network meta-analysis of randomised controlled trials

    Citation: de Carvalho, El-Boghdadly, Guedes, Dantas, Tome, Ramos, Gomes, Alves, Bezerra, Santos Neto, Pandit, Braz. Opioid-free vs. opioid-inclusive anaesthesia with or without regional anaesthesia for postoperative pain: a systematic review with network meta-analysis of randomised controlled trials. Anaesthesia. 2026; doi:10.1111/anae.70121. Study at a glance: - Design and setting: Prospectively registered systematic review and Bayesian network meta-analysis (PRISMA-NMA; PROSPERO CRD42022318894) of 885 RCTs including 74,880 adults (mainly elective surgery). Six intra-operative strategies were compared, grouped by opioid use (opioid-free, remifentanil-only, other opioids) and presence/absence of regional anaesthesia. Last search: 15 January 2025. - Interventions: (1) Opioid-inclusive anaesthesia with regional techniques (reference); (2) opioid-free with regional; (3) remifentanil as sole opioid with regional; (4) opioid-inclusive without regional; (5) opioid-free without regional; (6) remifentanil as sole opioid without regional. - Primary outcome – pain (0–10) at 2–48 h: Versus opioid-inclusive with regional anaesthesia, opioid-free with regional produced very similar pain scores at all time-points (e.g. 2 h MD −0.14, 95%CrI −0.69 to 0.38; 48 h MD −0.01, −0.43 to 0.41; low-certainty evidence). All three non-regional strategies had clearly higher pain (e.g. at 2 h MD +1.45 to +2.18 points vs reference), suggesting that adding regional anaesthesia is far more important for analgesia than removing intra-operative opioids. - Opioid consumption and recovery: Across 2–48 h, opioid-free with regional anaesthesia consistently ranked best for minimising postoperative opioid use, whereas remifentanil-only without regional ranked worst. At 24 h, differences between techniques often had wide credible intervals and should not be interpreted as proof of equivalence. Techniques without regional anaesthesia were associated with longer PACU stays, and opioid-inclusive anaesthesia without regional prolonged hospital stay compared with opioid-inclusive with regional (MD ~15.7 h longer). - Adverse effects: Opioid-free with regional anaesthesia substantially reduced postoperative nausea and vomiting relative to opioid-inclusive with regional (OR ~0.54, 95%CrI 0.41–0.71) and had the best overall ranking (SUCRA 99%), whereas opioid-inclusive and remifentanil-only techniques without regional roughly doubled PONV odds. Both opioid-free strategies (with and without regional) ranked highest for minimising pruritus, and remifentanil-heavy regimens (especially without regional) markedly increased dizziness. At 24 h, urinary retention was less frequent with opioid-free and remifentanil-based techniques than with opioid-inclusive plus regional (moderate-certainty evidence). - Risk of bias and certainty: Outcome-level RoB 2 showed mostly “some concerns” (60%) and relatively few high-risk judgements (4.6%), but the review itself was rated critically low by AMSTAR 2 and high risk of bias by ROBIS due to lack of a full excluded-studies list and no formal assessment of small-study effects, publication bias, or network inconsistency. The authors’ GRADE ratings indicate Low certainty for all pain outcomes and Moderate certainty for urinary retention, so while regional anaesthesia combined with more opioid-sparing strategies likely improves pain and side-effect profiles compared with opioid-heavy, non-regional techniques, the exact effect sizes and rankings should be interpreted with caution.

    11 min

  6. JAN 4

    Hydroxyethyl starch versus crystalloid in elective major abdominal surgery: PHOENICS trial

    Citation: Buhre W, Díaz-Cambronero O, Schaefer S, Novacek M, Soro Domingo M, Stessel B, et al. Safety and efficacy of 6% hydroxyethyl starch in patients undergoing major surgery: The randomised controlled PHOENICS trial. Eur J Anaesthesiol. 2025;43:1–10. doi:10.1097/EJA.0000000000002307. Study at a glance: - Design and setting: Double-blind, multicentre, parallel-group phase IV noninferiority RCT in adults (40–85 years, ASA II–III) undergoing elective major abdominal surgery with expected blood loss ≥500 ml in 53 European centres (N=1,946 with primary outcome data). - Interventions: Haemodynamic-guided intra-operative and early postoperative volume replacement with balanced 6% HES 130/0.4 (Volulyte; up to 30 ml kg−1 in 24 h) vs balanced crystalloid-only (Ionolyte) within the same goal-directed algorithm. - Primary outcome (change in cystatin C–eGFR to lowest value within 3 postop days): LS mean difference HES vs crystalloid −2.6 ml min−1 1.73 m−2 (95% CI −4.1 to −1.1), well within the prespecified noninferiority margin (−8.1 ml min−1 1.73 m−2) — no clinically important short-term renal impairment; moderate-certainty evidence. - Key secondary: 90-day composite of all-cause mortality and major postoperative complications in 35% of patients in both groups (adjusted risk difference 0.6%, 95% CI −3.8 to 5.1) — no clear difference; 90-day and 1-year mortality and need for renal replacement therapy were also similar but imprecisely estimated (low-certainty for hard outcomes). - Perioperative haemodynamics and safety: HES yielded slightly lower net positive fluid balance (0.6 vs 1.2 l), smaller MAP decrease (−14 vs −16 mmHg), and fewer patients needing vasoactive/inotropic drugs (26% vs 35%); overall adverse events, serious events, AKI (RIFLE/AKIN), and adverse drug reactions were comparable, with findings applicable to stable elective abdominal surgery patients without sepsis or pre-existing renal dysfunction (not to ICU/sepsis resuscitation).

    10 min

  7. 12/28/2025

    Intraoperative driving pressure–guided high PEEP vs standard low PEEP for postoperative pulmonary complications

    Citation: Dorland G, Gama de Abreu M, Hemmes SNT, Hol L, Hollmann MW, van Meenen DMP, Nijbroek SGLH, et al. Intraoperative driving pressure–guided high PEEP vs standard low PEEP for postoperative pulmonary complications. JAMA. 2025;[published online December 3]. doi:10.1001/jama.2025.23373. Study at a glance - Design and setting: International, multicentre, assessor-blinded parallel-group RCT in adults at intermediate/high risk of postoperative pulmonary complications undergoing open abdominal surgery (29 hospitals in 5 European countries; N=1435 analysed). - Interventions: Individualized driving pressure–guided high PEEP with repeated recruitment maneuvers vs standard low PEEP (5 cm H2O) without recruitment; both groups received low tidal volume volume-controlled ventilation and contemporary perioperative care. - Primary outcome (composite postoperative pulmonary complications ≤5 days): 19.8% with high PEEP vs 17.4% with low PEEP; absolute risk difference 2.5 percentage points (95% CI −1.5 to 6.4; p=0.23) — no clear reduction in pulmonary complications; low-certainty evidence. - Key secondary: Intraoperative complications were more frequent with high PEEP, mainly hypotension (54.0% vs 45.0%) and vasoactive drug use (32.0% vs 18.8%), while desaturation was less common (0.8% vs 2.8%); postoperative extrapulmonary complications, ICU/hospital length of stay, and in-hospital mortality (3.6% vs 3.3%) were similar between groups. - Safety: High PEEP increased intraoperative hemodynamic instability without demonstrable benefit on postoperative pulmonary outcomes or mortality; overall evidence suggests avoiding routine driving pressure–guided high PEEP for this population (moderate certainty for intraoperative harms, low to very low for most other clinical endpoints).

    11 min

  8. 12/21/2025

    Interventions to prevent postoperative neurocognitive complications: an umbrella review of meta-analyses of randomised controlled trials

    Citation: D'Amico F, Turi S, Manazza M, Lo Bianco G, Monti G, Zangrillo A, et al. Interventions to prevent postoperative neurocognitive complications: an umbrella review of meta-analyses of randomised controlled trials. Anaesthesia. 2025;doi:10.1111/anae.70061. Study at a glance - Design and scope: PROSPERO-registered umbrella review of meta-analyses of RCTs in adults undergoing cardiac and non-cardiac surgery; 114 meta-analyses (257,077 patients) searched to 23 August 2025. - Interventions: 12 intervention categories (pharmacological and non-pharmacological), including dexmedetomidine, cerebral monitoring, acupuncture, sleep interventions, steroids, antipsychotics, peripheral nerve blocks, esketamine, remimazolam, neuraxial and inhalational techniques, and remote ischaemic preconditioning. - Primary outcome: Any postoperative neurocognitive complication (delirium and/or postoperative cognitive dysfunction). Overall pooled effect for “any intervention vs control” OR 0.57 (95% CI 0.53–0.61; I2=94%), suggesting reduced odds but with extreme heterogeneity and very-low-certainty evidence. - Selected interventions with apparent benefit: Dexmedetomidine (OR 0.48), cerebral monitoring (0.52), acupuncture (0.39), sleep interventions (0.54), antipsychotics (0.48), peripheral nerve blocks (0.55), esketamine (0.42) and remimazolam (0.71) were each associated with lower odds of neurocognitive complications; certainty mostly low or very low. - Interventions without clear benefit or possible harm: Neuraxial anaesthesia, low-dose anaesthesia, remote ischaemic preconditioning and acetylcholinesterase inhibitors showed no convincing reduction in complications. In non-cardiac surgery, inhalational anaesthesia was associated with higher odds of complications vs comparator techniques (OR about 1.6); low-certainty evidence. - Risk of bias and certainty: Many contributing meta-analyses were low or critically low quality. ROBIS rated the umbrella review overall at high risk of bias (likely favouring interventions). GRADE for the overall pooled effect was downgraded to very low (risk of bias, marked inconsistency, indirectness, and suspected publication bias). - Clinical takeaway: A broad range of perioperative strategies look potentially protective against postoperative delirium and cognitive dysfunction, but the body of evidence is very uncertain; results are mainly hypothesis-generating and insufficient for strong practice-changing recommendations.

    11 min
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Vetrix Anesthesiology is an AI-driven podcast that dissects contemporary anesthesiology papers, translating dense methods and statistics into clear, clinically focused insights for everyday practice.

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  • Years Active
    2024 - 2026
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    13
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