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.
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.
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.