Citation (Vancouver):

Raymond BL, Allen BFS, Freundlich RE, McEvoy MD, Parrish CG, Ruble SR, et al. IMpact of PerioperAtive KeTamine on Enhanced Recovery After abdominal Surgery (IMPAKT ERAS): a pragmatic randomised single-cluster trial. Br J Anaesth. 2025;135(6):1770–1778. doi:10.1016/j.bja.2025.08.001.

Study at a glance

- Design and setting: Pragmatic, double-blind, placebo-controlled single-centre cluster RCT by week (Vanderbilt, USA) in adults ≥18 yr undergoing elective major abdominal ERAS surgery (colorectal, surgical oncology, complex ventral hernia; N=1,522 analysed ITT).

- Interventions: Ketamine arm received 0.5 mg kg−1 i.v. bolus at induction, then 5 μg kg−1 min−1 intraoperatively and 2.5 μg kg−1 min−1 for 48 h postoperatively; placebo arm received volume- and rate-matched saline. Both arms followed an intensive multimodal ERAS analgesic pathway (regional block, lidocaine, NSAIDs, gabapentin, opioids as needed).

- Primary outcome (hospital length of stay): Median LOS 5 days in both arms (ketamine IQR 4–8; placebo 3–7). Cluster- and covariate-adjusted OR for longer stay with ketamine 1.21 (95% CI 1.00–1.47) – no reduction in LOS, possible small increase; moderate-certainty evidence.

- Key secondary (opioids and recovery): Total in-hospital opioid use was similar (median 82.5 vs 90 MME; adjusted OR 0.85, 95% CI 0.71–1.01). Fewer patients on ketamine met early discharge milestones by 48 h (12.5% vs 17.3%; adjusted OR 0.68, 95% CI 0.50–0.93), suggesting no functional recovery benefit.

- Safety: Ketamine increased adverse effects and early infusion discontinuation (any early stop for side-effects 32.3% vs 13.3%; OR ≈2). Debilitating hallucinations (2.7% vs 0.9%; OR 2.69) and debilitating dizziness (8.3% vs 1.5%; adjusted OR 6.05) were more frequent; ICU transfer was also higher with ketamine (5.7% vs 2.9%; adjusted OR 2.03, 95% CI 1.14–3.63). Thirty-day readmissions were similar.

- Certainty and take-home: Well-conducted, double-blind cluster RCT with objective EHR outcomes and low attrition; overall RoB 2 judgement “some concerns” (selective reporting of some exploratory outcomes) but generally robust. Moderate-certainty evidence that adding a 48 h ketamine infusion to high-intensity ERAS multimodal analgesia does not improve LOS or opioid use and increases neuropsychiatric and other adverse effects.

Comparative effects of remimazolam and propofol on hemodynamic stability during sedation for painless gastroscopy: a randomized clinical trial

Citation (Vancouver):

Gong F, Gui Q, Lan L, Zhou G, Wen Q, Wei Y, Li X, Cao X. Comparative effects of remimazolam and propofol on hemodynamic stability during sedation for painless gastroscopy: a randomized clinical trial. BMC Anesthesiol. 2025;25:587. doi:10.1186/s12871-025-03484-2.

Study at a glance

- Design and setting: Single-centre, prospective, randomized, single-blind parallel-group trial (n=300) in adults undergoing painless gastroscopy in China.

- Population: Low-risk outpatients, 18–65 years, BMI 18–30 kg/m², ASA I–II; all received topical lidocaine, butorphanol, and nasal oxygen.

- Interventions: Remimazolam tosilate 0.2 mg/kg IV (0.1 mg/kg top-ups; propofol rescue allowed) versus propofol 2 mg/kg IV (0.5 mg/kg top-ups) for gastroscopy sedation.

- Primary hemodynamics: Remimazolam maintained higher MAP at the start and end of endoscopy (T1 MD ≈ +7.5 mmHg, T2 MD ≈ +5.0 mmHg; both statistically significant) with similar or slightly higher cardiac output (no clear difference at T1; small increase at T2).

- Safety: Compared with propofol, remimazolam markedly reduced hypotension (37/150 vs 8/150), bradycardia (22/150 vs 0/150), hypoxia (8/150 vs 0/150), and injection pain (38/150 vs 10/150).

- Recovery profile: Endoscopy duration was similar (~5 min), but remimazolam had slower onset and longer recovery (time to MOAA/S 5 median 10 vs 6 minutes).

- Risk of bias and certainty: Overall RoB 2 judgment “some concerns” (mainly unclear allocation concealment and reporting of prespecified analyses); GRADE certainty for key hemodynamic and safety outcomes rated moderate.