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.
Vetrix Anesthesiology
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Podcast Overview
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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🇺🇲
Publishing Since
11/30/2025
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Recent Episodes
June 28, 2026
Low-dose intrathecal morphine versus intrathecal fentanyl for post-caesarean analgesia in a resource-constrained setting: a pragmatic randomised trial
<p>Citation:</p><p>Chetty S, Paruk F, Kamerman P. Low-dose intrathecal morphine versus intrathecal fentanyl for post-caesarean analgesia in a resource-constrained setting: a pragmatic randomised trial. BMC Anesthesiol. 2026. doi:10.1186/s12871-026-04034-0</p><p></p><p>This trial asked whether low-dose intrathecal morphine reduces rescue morphine use compared with intrathecal fentanyl after caesarean delivery. Intrathecal morphine probably reduced 24-hour rescue morphine use compared with fentanyl. The trial was single-centre, retrospectively registered, and mainly analysed per protocol.</p><p></p><p>Study at a glance</p><p>- Design and setting: Single-centre, participant- and outcome-assessor-blinded, parallel-group pragmatic randomised trial at Rahima Moosa Mother and Child Hospital, a tertiary public-sector maternity hospital in Johannesburg, South Africa, between July and September 2015. Randomisation was blocked in a 1:1:1 ratio with adequate allocation concealment; the attending anaesthetist preparing and administering the intrathecal solution was aware of allocation.</p><p>- Population: 105 women were screened, 100 were randomised, and 93 were analysed: M100 32, M50 29, and F25 32. Eligible participants were women aged 18 years or older undergoing elective or emergency caesarean delivery under single-shot spinal anaesthesia; sex female was 100%. Age, mean (range), was 31 (21–40) years in M100, 30 (23–39) years in M50, and 30 (21–41) years in F25.</p><p>- Interventions: M100 received hyperbaric bupivacaine 0.5% 1.8 ml plus preservative-free intrathecal morphine 100 μg; M50 received hyperbaric bupivacaine 0.5% 1.8 ml plus preservative-free intrathecal morphine 50 μg; F25 received hyperbaric bupivacaine 0.5% 1.8 ml plus intrathecal fentanyl 25 μg. Total intrathecal volume was standardised to 2.3 ml during single-shot spinal anaesthesia. Postoperative analgesia included intravenous morphine patient-controlled analgesia solution 1 mg.ml-1, 1 mg bolus, 5-minute lockout, maximum 10 mg.h-1, no background infusion, plus rectal indomethacin.</p><p>- Primary outcome: Cumulative 24-hour intravenous patient-controlled analgesia morphine consumption probably was lower with intrathecal morphine versus fentanyl (moderate certainty): medians were M100 12.5 mg (interquartile range 6 to 20.25), M50 15 mg (interquartile range 9 to 25), and F25 26 mg (interquartile range 16.5 to 38.5); overall p=0.00078. Hodges-Lehmann estimates were M100 vs F25 -13 mg (95% CI -20 to -7; p=0.00081), M50 vs F25 -10.5 mg (95% CI -18 to -3; p=0.019), and M100 vs M50 -3 mg (95% CI -8 to 3; p=0.326).</p><p>- Key secondary outcome: Intravenous patient-controlled analgesia morphine consumption during 0–12 h may have been lower with morphine: M100 8 mg (interquartile range 2.75 to 12), M50 8 mg (interquartile range 4 to 17), and F25 16 mg (interquartile range 11 to 25.5); overall p=0.0021. Pairwise point estimates and 95% confidence intervals were not reported (low certainty).</p><p>- Safety: Respiratory depression, defined as respiratory rate < 8 breaths/min, occurred in 0/32 M100, 0/29 M50, and 0/32 F25. Any nausea or vomiting occurred in 9/32, 9/29, and 9/32; severe nausea or vomiting in 5/32, 0/29, and 5/32; any pruritus in 12/32, 14/29, and 9/32; severe pruritus in 1/32, 1/29, and 1/32; and any sedation in 7/32, 7/29, and 10/32, respectively. Serious adverse events and withdrawals due to adverse events: Not reported; harms were descriptive and the study was powered for analgesic efficacy rather than uncommon adverse events.</p><p>- Risk of bias and certainty: RoB 2 overall judgement was Some concerns. Low risk was judged for randomization process and measurement of outcome; Some concerns were judged for deviations from intended interventions, missing outcome data, and selection of reported result, including unblinded attending anaesthetist, per-protocol primary contrasts after post-randomisation exclusions, outcome data available for 93/100 randomised participants, and retrospective registration. Overall GRADE certainty was Moderate for the primary outcome and Low for secondary outcomes.</p>
June 21, 2026
Residual gastric content after holding of glucagon-like peptide-1 receptor agonists before elective surgery: a cross-sectional study - The RESIDUAL study
<p>Citation:</p><p>Boudreau C, Couture M, Rousseau-Saine N, Laferrière-Langlois P, Roy-Renaud É, Burey J, et al. Residual gastric content after holding of glucagon-like peptide-1 receptor agonists before elective surgery: a cross-sectional study - The RESIDUAL study. BMC Anesthesiol. 2026. doi:10.1186/s12871-026-03999-2</p><p></p><p>This episode asks whether fasted elective-surgery patients who held weekly injectable glucagon-like peptide-1 receptor agonists for at least 7 days still had more residual gastric content. Evidence is very uncertain whether use was associated with increased residual gastric content; aspiration outcomes were not collected.</p><p></p><p>Study at a glance</p><p>- Design and setting: Prospective cross-sectional study of fasted adults scheduled for elective surgery under anesthetic care at two university-affiliated hospitals in Montreal, Quebec, Canada, from October 2024 through February 2025; registered at ClinicalTrials.gov, NCT06500143.</p><p>- Population: 94 patients undergoing elective procedures were included; 1 patient in the GLP-1 RA group was excluded after gastric ultrasound because the last dose was less than 7 days before surgery. 93 patients were analyzed: 52 in the GLP-1 RA group and 41 controls. Female sex was 40.9%. Inclusion required age at least 18 years, American Society of Anesthesiologists physical status I to IV, and fasting according to Canadian guidelines. In the exposure group, 50/52 (96%) received semaglutide, one patient received tirzepatide, one patient received dulaglutide, 45/52 (87%) had diabetes as the treatment indication, and median time since last dose was 11 days (IQR 9 to 13).</p><p>- Exposure and comparator: Exposure was weekly injectable semaglutide, tirzepatide or dulaglutide use for more than 4 weeks, regardless of indication, with the last dose at least 7 days before surgery. The comparator group was not receiving any GLP-1 RA. Specific drug, dose in milligrams, and day of last injection were collected.</p><p>- Primary outcome: Increased residual gastric content on preoperative gastric ultrasound after guideline-concordant fasting was defined as thick liquid, solid content, or more than 1.5 mL/kg clear liquid. It is very uncertain whether GLP-1 RA use was associated with increased residual gastric content: 22/52 (42.3) in the GLP-1 RA group versus 10/41 (24.4) in controls; unadjusted prevalence ratio 1.73, 95% CI 0.96 to 3.75; adjusted prevalence ratio 1.65, 95% CI 0.7 to 3.7; adjusted average treatment effect 15.4%, 95% CI -10 to 35.6; p-value not reported (very low certainty).</p><p>- Key secondary outcome: Exploratory analyses were also very uncertain. For increased residual gastric content, the adjusted odds ratio per additional day since last GLP-1 RA injection was 1.08, 95% CI 0.86 to 1.39; per hour since last oral intake was 1.12, 95% CI 0.9 to 1.46; and per mg semaglutide dose was 2.19, 95% CI 0.47 to 12.7. p-values were not reported (very low certainty).</p><p>- Confounding: The primary adjusted analysis used propensity-score overlap weighting for age, sex, American Society of Anesthesiologists physical status classification, BMI, diabetes, opioid use, moderate to severe preoperative pain (> 3 on the verbal rating scale), and time since last oral intake; balance threshold was 0.1 with no variables imbalanced. The planned augmented inverse probability weighting estimator was changed because of inadequate covariate balancing. Sensitivity analysis with augmented inverse probability weighting showed prevalence ratio 1.84, 95% CI 0.74 to 4.24, and average treatment effect 18.1%, 95% CI -10.2 to 38.7. Residual confounding by unmeasured diabetes-related factors remained a serious concern.</p><p>- Risk of bias and certainty: ROBINS-I overall risk of bias was Serious, driven mainly by serious bias due to confounding. Selection of participants, exposure classification, deviations from intended exposure, and selection of reported result were Moderate; missing data and outcome measurement were Low. Overall GRADE certainty for increased residual gastric content was very low because of residual confounding, indirectness for clinical aspiration risk, and imprecision.</p>
June 14, 2026
Prospective Evaluation of Routine Extubation Criteria in Children with Upper Respiratory Symptoms Undergoing Elective Surgery
<p>Citation:</p><p>Templeton TW, Smith LD, Mosher T, Saha AK, Hodges AS, Vishneski SR, et al. A Prospective Evaluation of Routine Extubation Criteria in Children with Upper Respiratory Symptoms Undergoing Elective Surgery. Anesthesiology. 2026. doi:10.1097/ALN.0000000000006197</p><p></p><p>This episode asks whether routine awake-extubation readiness criteria remain reassuring in children with upper respiratory infection symptoms undergoing elective surgery. The primary comparison is very uncertain: observed success was 94.7% without symptoms versus 93.9% with symptoms. Symptomatic children may have more desaturation, and unadjusted confounding limits causal conclusions.</p><p></p><p>Study at a glance</p><p>- Design and setting: Prospective observational cohort at a single center in the United States, conducted between November 20, 2019 and June 24, 2025, in elective outpatient or day-hospital pediatric surgery with planned general endotracheal anesthesia and awake extubation. Registered at ClinicalTrials.gov as NCT04155892 and prepared using Strengthening the Reporting of Observational Studies in Epidemiology guidelines.</p><p>- Population: 927 subjects were screened; 799 were enrolled and extubated with one or more of the five extubation criteria; 756 patients were analyzed in the primary cohorts, including 379 in the non-upper respiratory infection symptom group and 377 in the upper respiratory infection symptom group. Inclusion criteria were children aged ≤9 years presenting for elective outpatient or day-hospital surgery with anticipated discharge on the day of surgery or postoperative day 1 and planned general endotracheal anesthesia; primary analysis required at least 3 of the Big Five extubation criteria. Female sex was 31.1%; age was 31.0 ± 26.4 months in the non-upper respiratory infection group and 37.9 ± 25.0 months in the upper respiratory infection group.</p><p>- Exposure and comparator: Primary exposure was preoperative upper respiratory infection symptom status based on a parent or caregiver questionnaire: scores ≥3 defined the upper respiratory infection symptom group; scores 0 or 1 defined the non-upper respiratory infection reference group; score 2 was excluded as indeterminate. The questionnaire gave one point for each positive response plus a parent or caregiver sickness assessment scored 0 to 3; in the upper respiratory infection group, the median survey score was 4 (IQR 3 to 6). At emergence and extubation, an independent observer recorded the Big Five criteria: tidal volume >5 mL/kg, conjugate gaze, facial grimace, purposeful movement, and eye opening.</p><p>- Primary outcome: Successful awake extubation at extubation occurred in 359/379 patients in the non-upper respiratory infection group, 94.7% (95% CI 92.5% to 97.0%), versus 354/377 patients in the upper respiratory infection group, 93.9% (95% CI 91.5% to 96.3%). Adjusted effect estimate not reported; unadjusted risk difference for non-upper respiratory infection versus upper respiratory infection was 0.8% (95% CI -2.6% to 4.2%); p-value not reported. The observed estimate fell within the study’s 5% clinical equivalence margin, but causal equivalence is very uncertain (very low certainty).</p><p>- Key secondary outcome: At least one peri-extubation desaturation event occurred in 103/377 patients in the upper respiratory infection group, 27.3% (95% CI 22.8% to 31.8%), versus 62/379 in the non-upper respiratory infection group, 16.4% (95% CI 12.6% to 20.1%). Adjusted effect estimate not reported; unadjusted risk difference was 10.9% (95% CI 5.1% to 16.0%); p-value not reported, so upper respiratory infection symptoms may be associated with more desaturation (low certainty). Other secondary contrasts included visible endotracheal tube secretions, risk difference 43.3% (95% CI 37.1% to 49.5%, low certainty); major intervention, risk difference 1.0% (95% CI -1.1% to 3.2%, very low certainty); laryngospasm, risk difference 0.0% (95% CI -1.5% to 1.5%, very low certainty); postdischarge respiratory healthcare, risk difference 1.6% (95% CI -0.2% to 3.4%, very low certainty); and postanesthesia care unit oxygen saturation nadir, 96% (IQR 94 to 98) versus 95% (IQR 92 to 97), p-value <0.001 (very low certainty).</p><p>- Confounding: No multivariable regression, propensity score, g-method, instrumental-variable, or other formal confounding adjustment was reported; group contrasts were unadjusted. Baseline prognostic factors differed between groups, including age, American Society of Anesthesiologists physical status, sleep-disordered breathing, and surgery type, and clinician experience was not accounted for. Clinicians were not blinded to questionnaire score, and albuterol administration differed as printed: 5/377 (1.3%) in the non-upper respiratory infection group versus 31/379 (8.2%) in the upper respiratory infection group, with printed denominators differing from final cohort sizes.</p><p>- Risk of bias and certainty: ROBINS-E overall risk of bias was Serious. The main concern was serious confounding; moderate concerns included selection of participants, exposure classification, deviations from intended exposure, missing data, and selection of reported results, while outcome measurement was Low primarily for standardized observer-graded peri-extubation outcomes. Overall certainty was very low for successful awake extubation, low for peri-extubation desaturation and visible secretions, and very low for most other outcomes.</p>
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