Anesthesiology

Regional anesthesia linked to lower persistent postoperative opioid use than general anesthesia

In this nationwide Korean cohort of 558,944 adults undergoing nine common surgeries, anesthesia type influenced long-term opioid utilization. Compared with regional anesthesia, general anesthesia more than doubled the odds of persistent postoperative opioid use (OR 2.13, 95% CI 1.50–3.01). For thoracotomy, combined general/regional anesthesia reduced persistent opioid use and overall opioid consumption versus general anesthesia alone. Across the cohort, regional anesthesia was associated with lower postoperative opioid consumption than general or combined techniques. 1

Remimazolam noninferior to propofol for short-term ICU sedation after surgery

This multicenter phase 3 trial randomized 211 mostly postoperative, mechanically ventilated ICU patients to remimazolam or propofol for up to 24 hours. Sedation success was high and similar: 98.1% with remimazolam versus 96.2% with propofol, meeting noninferiority criteria. Time in target RASS range, need for rescue sedation, and additional dosing requirements were nearly identical between drugs. Adverse event rates were comparable and mostly mild to moderate, with only one severe event, in the propofol group. Remimazolam’s short terminal half-life around 2 hours plus noninferior efficacy supports it as an alternative for brief ICU ventilation. 2

Network meta-analysis favors α-agonist infusions with mild β-activity for cesarean spinal hypotension

This network meta-analysis pooled 55 randomized trials including 5,487 normotensive women undergoing cesarean delivery under spinal or combined spinal–epidural anesthesia. Metaraminol, noradrenaline, phenylephrine, and adrenaline were all definitely superior to no vasopressor infusion for preventing maternal hypotension. Mephentermine and metaraminol best preserved umbilical arterial and venous acid–base balance among agents evaluated. Continuous infusions of α-agonists with mild β-activity, such as noradrenaline and metaraminol, outperformed mixed agonists like ephedrine for maternal hemodynamics. Fetal outcome evidence remained limited, so drug choice should still balance maternal stability against incomplete fetal data. 3

Peripheral IV vasopressors via short catheters show very low major complication rates

This systematic review and meta-analysis included 49 studies with 33,060 peripheral vasopressor catheters in critically ill or hypotensive adults. Across all vasopressors, pooled minor adverse event incidence was 2.3% (95% CI 1.5%–3.7%). Major events clustered in midline catheters, with venous thromboembolism incidence of 1.4%; almost no major events occurred with short peripheral catheters. Only one tissue necrosis event was reported in 29,596 short peripheral catheters, yielding a pooled major adverse event incidence of 0.0%. Peripheral vasopressors frequently obviated central lines, with pooled CVC avoidance near 60%, supporting early short-catheter use when monitoring is available. 4