Daily Anesthesiology Research Analysis
Three impactful studies in anesthesiology span mental health prevention, global pharmacoepidemiology, and ventilation physiology. A single-center randomized clinical trial shows intraoperative esketamine reduces postpartum depression after cesarean delivery. A 20-million–pregnancy multinational cohort maps global opioid use in pregnancy, and a post hoc analysis of three trials clarifies how respiratory rate and pressures drive mechanical power in ventilated, non-ARDS patients.
Summary
Three impactful studies in anesthesiology span mental health prevention, global pharmacoepidemiology, and ventilation physiology. A single-center randomized clinical trial shows intraoperative esketamine reduces postpartum depression after cesarean delivery. A 20-million–pregnancy multinational cohort maps global opioid use in pregnancy, and a post hoc analysis of three trials clarifies how respiratory rate and pressures drive mechanical power in ventilated, non-ARDS patients.
Research Themes
- Peripartum mental health prevention with anesthetic adjuncts
- Global opioid utilization patterns in pregnancy
- Mechanical power optimization in protective ventilation
Selected Articles
1. Intraoperative Esketamine and Postpartum Depression Among Women With Cesarean Delivery: A Randomized Clinical Trial.
In a single-center RCT of 308 cesarean deliveries, a single 0.25 mg/kg intraoperative esketamine infusion halved the 6-week postpartum depression incidence versus saline. The effect was assessed by the Edinburgh Postnatal Depression Scale using an intention-to-treat analysis.
Impact: This pragmatic RCT links an intraoperative anesthetic intervention to a meaningful mental health outcome, potentially redefining peripartum care pathways.
Clinical Implications: Intraoperative esketamine may be considered for PPD prevention in cesarean deliveries, with attention to safety, dosing, and patient selection. Larger, multicenter trials should confirm efficacy and assess neonatal and breastfeeding outcomes.
Key Findings
- Esketamine reduced 6-week postpartum depression incidence: 10.4% vs 19.5% (RR 0.53; 95% CI 0.30–0.93; P=.02).
- Intervention: single intraoperative infusion 0.25 mg/kg over 20 minutes versus saline control.
- Randomization 1:1, cesarean population, intention-to-treat analysis at a tertiary center.
Methodological Strengths
- Randomized, controlled, intention-to-treat design with prespecified primary outcome.
- Clinically relevant endpoint (PPD) assessed by a validated scale at a fixed time point.
Limitations
- Single-center study in China may limit generalizability across diverse health systems.
- Short follow-up (6 weeks) and limited safety/neonatal outcomes reporting.
Future Directions: Multicenter, pragmatic RCTs comparing dosing strategies and timing; evaluation of maternal-infant bonding, breastfeeding, neonatal neurobehavior, and cost-effectiveness.
2. Global Trends in Analgesic Opioid Use in Pregnancy: A Retrospective Cohort Study.
Across 20,306,228 pregnancies in 14+ jurisdictions using a harmonized protocol, at least one analgesic opioid prescription/dispensing occurred in 55 per 1,000 pregnancies, with wide geographic variation (UK 4/1,000; US publicly insured 191/1,000). Trends were stable or declining in most settings; codeine and tramadol predominated.
Impact: Provides the most comprehensive, harmonized multinational picture of opioid exposure in pregnancy, informing obstetric anesthesia, prescribing stewardship, and regulatory policy.
Clinical Implications: Clinicians should recognize stark regional differences and prioritize non-opioid analgesia when feasible, especially in high-prevalence contexts. Findings can guide targeted stewardship, counseling, and risk-benefit discussions.
Key Findings
- Among 20,306,228 pregnancies, 55 per 1,000 had at least one opioid dispensing/prescription; UK 4/1,000 vs US publicly insured 191/1,000.
- Largest relative decrease: Hong Kong (PR 0.2; 95% CI 0.1–0.2, 2005–2020); largest increase: Iceland (PR 4.4; 95% CI 3.7–5.2, 2004–2017).
- Codeine and tramadol were among the three most used opioids across most populations; sensitivity analysis (≥2 events) yielded 17 per 1,000.
Methodological Strengths
- Harmonized, common protocol applied across diverse, population-based and payer-linked datasets.
- Very large sample enabling robust estimation of trends and subgroup patterns.
Limitations
- Retrospective dispensing/prescription data lack clinical indication, dosing, and adherence details.
- Heterogeneity across data sources and potential misclassification; no linkage to maternal-fetal outcomes.
Future Directions: Link utilization data to maternal and neonatal outcomes; evaluate stewardship interventions; assess drivers of cross-country variation including policy and payer effects.
3. Association of ventilation volumes, pressures and rates with the mechanical power of ventilation in patients without acute respiratory distress syndrome: exploring the impact of rate reduction.
Using individual patient data from three RCTs in non-ARDS patients (n=1,732), post hoc analyses showed mechanical power had a median of 12.3 J/min and was most strongly driven by pressures and respiratory rate. Rate reduction emerged as a practical lever to reduce mechanical power.
Impact: Clarifies actionable ventilator settings that dominate mechanical power, informing strategies to minimize ventilator-induced lung injury beyond tidal volume alone.
Clinical Implications: When targeting lower mechanical power in non-ARDS patients, prioritize careful respiratory rate and pressure adjustments (with permissive hypercapnia considerations) over tidal volume alone, balancing gas exchange and lung protection.
Key Findings
- Median mechanical power was 12.3 J/min (IQR 9.3–17.1; range 3.7–50.1) across 1,732 non-ARDS patients.
- Respiratory rate and pressure were the strongest determinants of mechanical power in regression and mediation analyses.
- Rate reduction identified as an attractive ventilator adjustment to lower mechanical power.
Methodological Strengths
- Individual patient data across three randomized trials, enabling robust multivariable and mediation analyses.
- Double stratification to test consistency across subgroups.
Limitations
- Post hoc observational analysis; causality cannot be inferred.
- Findings limited to non-ARDS populations and may not generalize to severe lung injury.
Future Directions: Prospective interventional trials testing respiratory rate-targeted strategies to reduce mechanical power and clinical outcomes, including VILI and mortality.