Daily Anesthesiology Research Analysis
A network meta-analysis of 36 RCTs (n=3,182) identified non-pharmacological strategies—especially parental presence plus video games—as the most effective approach to reduce preoperative anxiety in children. A double-blind randomized trial showed ultrasound-guided stellate ganglion block improves oxygenation, respiratory mechanics, and inflammatory profiles during single-lung ventilation. Another randomized trial found remimazolam increased intraoperative frontal alpha EEG power and improved pos
Summary
A network meta-analysis of 36 RCTs (n=3,182) identified non-pharmacological strategies—especially parental presence plus video games—as the most effective approach to reduce preoperative anxiety in children. A double-blind randomized trial showed ultrasound-guided stellate ganglion block improves oxygenation, respiratory mechanics, and inflammatory profiles during single-lung ventilation. Another randomized trial found remimazolam increased intraoperative frontal alpha EEG power and improved postoperative cognitive function in older adults undergoing fracture surgery.
Research Themes
- Pediatric preoperative anxiety management
- Thoracic anesthesia optimization during single-lung ventilation
- Perioperative neurocognitive protection in older adults
Selected Articles
1. Non-pharmacological Interventions for Preoperative Anxiety in Children: A Systematic Review and Network Meta-Analysis.
Across 36 RCTs (n=3,182), non-pharmacological strategies reduced pediatric preoperative anxiety, with psychological plus digital health interventions ranking highest. The combination of parental presence during induction and video games consistently outperformed most other approaches.
Impact: Provides comparative effectiveness evidence to guide pediatric perioperative practice, prioritizing scalable, low-risk interventions. Findings can be rapidly integrated into preoperative workflows.
Clinical Implications: Adopt structured parental presence with interactive video games as first-line non-pharmacological anxiety reduction in pediatric preoperative pathways; integrate digital tools and staff training.
Key Findings
- Psychological plus digital health interventions ranked highest for reducing preoperative anxiety.
- Parental presence during induction combined with video games outperformed most comparators.
- Benefits were consistent across subgroup and sensitivity analyses.
Methodological Strengths
- PRISMA 2020–compliant systematic review and registered protocol (PROSPERO).
- Frequentist random-effects network meta-analysis with SUCRA ranking and sensitivity analyses.
Limitations
- Heterogeneity in intervention formats and anxiety measurement tools.
- Potential risk of bias across included trials and limited long-term outcomes.
Future Directions: Standardize outcome measures, evaluate implementation fidelity, and test hybrid models combining digital tools with parental presence in pragmatic multicenter RCTs.
AIMS: This study aimed to compare the efficacy of non-pharmacological interventions in children with preoperative anxiety. BACKGROUND: It is estimated that preoperative anxiety affects up to 60% of children which is associated with both immediate and long-term adverse outcomes. Several non-pharmacological interventions have been demonstrated to be effective, but further research is necessary to determine which is the most effective. DESIGN: This study was conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 checklist. METHODS: We searched randomised controlled trials in twelve databases from which inception to March 31, 2024. The primary outcome was the severity of preoperative anxiety change from the baseline to the endpoint which is usually before the anaesthesia induction. Within the frequentist framework, a random-effects network meta-analysis (NMA) was used to compare the primary outcomes. The surface under the cumulative ranking curve (SUCRA) was used to rank each intervention separately. Subgroup and sensitivity analyses were carried out for the primary outcomes. RESULTS: A total of 36 randomised controlled trials (RCTs) with 3182 paediatric patients were included. Based on the results, psychological + digital health intervention was significantly more effective than control groups and ranked highest. Combined parental presence during induction anaesthesia and video games (PPIA + VG) had significant benefits compared to almost all other interventions with the highest rank. CONCLUSION: Psychological + digital health interventions, especially PPIA + VG, may be the most effective non-pharmacological interventions for reducing preoperative anxiety in children. It is necessary to conduct more RCTs to evaluate the efficacy of different non-pharmacological interventions. RELEVANCE TO CLINICAL PRACTICE: Non-pharmacological interventions can effectively improve preoperative anxiety in children. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution applies to this work. TRIAL REGISTRATION: PROSPERO CRD42024509512 (https://www.crd.york.ac.uk/PROSPERO/).
2. Effects of ultrasound-guided stellate ganglion block on intrapulmonary shunt and oxygenation in patients with single-lung ventilation.
In a double-blind randomized trial (registered ChiCTR2200063210), ultrasound-guided stellate ganglion block during thoracoscopic lobectomy improved oxygenation-related physiology by reducing intrapulmonary shunt and enhancing respiratory mechanics and hemodynamics. Anti-inflammatory effects were also observed, supporting a protective role during single-lung ventilation.
Impact: Addresses a persistent challenge in thoracic anesthesia—hypoxemia during single-lung ventilation—with a feasible regional technique that can be integrated into perioperative pathways.
Clinical Implications: Consider ultrasound-guided stellate ganglion block as an adjunct for patients at risk of hypoxemia during single-lung ventilation in thoracic surgery, with appropriate team training and monitoring.
Key Findings
- SGB improved respiratory mechanics and hemodynamics during SLV compared with control.
- SGB reduced intrapulmonary shunt and enhanced oxygenation parameters.
- Inflammatory responses were attenuated with SGB, suggesting organ-protective effects.
Methodological Strengths
- Prospective, randomized, double-blind design with trial registration.
- Standardized thoracoscopic lobectomy and perioperative protocols.
Limitations
- Single-center study with modest sample size (n=88 analyzed).
- Limited reporting on long-term clinical outcomes beyond perioperative physiology.
Future Directions: Multicenter trials should validate efficacy, define optimal timing/dosing, and assess impacts on hypoxemia episodes, ICU admission, and recovery metrics.
BACKGROUND: Single-lung ventilation (SLV) is a widely used procedure in thoracic surgery; however, it can lead to hypoxemia, which is attributed to intrapulmonary shunt and hypoxic pulmonary vasoconstriction. Stellate ganglion blockade (SGB) has shown protective effects during SLV in various pulmonary conditions. The objective of the study was to assess the clinical utility of ultrasound-guided SGB in patients undergoing thoracoscopic pulmonary lobectomy through a prospective clinical trial. METHODS: This prospective randomized controlled double-blind trial included 116 patients who underwent SLV. After exclusion, 88 patients were randomly assigned to either the SGB group ( RESULTS: SLV induced upregulation of P CONCLUSIONS: Ultrasound-guided SGB improves respiratory mechanics, hemodynamics, and inflammatory responses during SLV. Our findings suggest a protective role of SGB in reducing complications associated with SLV. CLINICAL TRIAL REGISTRATION: The study was registered in the Chinese Clinical Trial Registry (#ChiCTR2200063210).
3. Effects of Remimazolam on Intraoperative Frontal Alpha Band Power Spectrum Density and Postoperative Cognitive Function in Older Adults Undergoing Lower Extremity Fractures Surgeries: A Randomized Controlled Trial.
Compared with midazolam, remimazolam increased intraoperative frontal alpha EEG power and was associated with better postoperative cognitive performance in older adults undergoing lower extremity fracture surgery.
Impact: Links a modifiable anesthetic choice to neurophysiologic markers and cognitive outcomes, informing perioperative brain-protective strategies in older adults.
Clinical Implications: Consider remimazolam as an induction/maintenance option when prioritizing postoperative cognitive preservation in older adults, while validating findings in larger multicenter trials.
Key Findings
- Remimazolam increased intraoperative frontal alpha band power compared with midazolam.
- Improved postoperative cognitive function was observed in the remimazolam group.
- Protocol specified bolus and maintenance dosing to achieve targeted sedation/anesthesia.
Methodological Strengths
- Randomized controlled design with objective EEG metrics and cognitive outcomes.
- Focused older adult surgical population at risk for cognitive dysfunction.
Limitations
- Sample size and single-center details not specified in abstract; generalizability uncertain.
- Comparator limited to midazolam; lack of longer-term cognitive follow-up.
Future Directions: Conduct multicenter trials comparing remimazolam with propofol and dexmedetomidine, include long-term cognitive trajectories, and integrate EEG-guided titration protocols.
PURPOSE: Low density of electroencephalogram alpha band power was reported to be associated with perioperative cognitive dysfunction. Few studies have conducted to explore the effects of remimazolam on intraoperative frontal alpha band power spectrum density in older adults. Here, we aimed to explore the impact of remimazolam on intraoperative frontal brain wave alpha band activity and postoperative cognitive function in older adults undergoing lower extremity fractures surgeries. METHODS: Patients undergoing elective general anesthesia for lower extremity fracture surgery were randomly allocated to remimazolam group (Group R) and midazolam group (Group M). Group R was induced with remimazolam bolus 0.1 mg/kg followed by a maintenance dose of 0.1 mg·kg RESULTS: Compared with Group M, Group R had significantly higher intraoperative power spectral density of the frontal alpha band ( CONCLUSION: Remimazolam can increase frontal brain wave alpha band power spectrum density and improve postoperative cognitive function in older adults undergoing lower extremity fractures surgeries.