Daily Anesthesiology Research Analysis

Across 34 studies (11,351 patients), pooled patient-reported intraoperative pain during cesarean under neuraxial anesthesia was 17% (95% CI, 13–22). Spinal (14%) and combined spinal-epidural had lower pain incidence than epidural top-up (33%). About half of included studies had high risk of bias, underscoring the need for more rigorous prospective research.

Impact: Quantifies a clinically important and underrecognized complication that affects patient experience, safety, and medicolegal risk in obstetric anesthesia, with actionable differences by neuraxial technique.

Clinical Implications: Counsel patients about a nontrivial risk of intraoperative pain under neuraxial anesthesia; preferentially consider spinal or combined spinal-epidural over epidural top-up for cesarean when feasible; implement vigilant intraoperative testing and rescue analgesia protocols.

Future Directions: Prospective, standardized, patient-centered studies to evaluate predictors, preventions, and intraoperative rescue strategies; incorporate patient-reported experience measures and medicolegal outcomes.

In 128 analyzed children, intranasal dexmedetomidine+ketamine achieved similar 15-min sedation success as chloral hydrate but with significantly fewer complications (3.2% vs 16.7%). In children aged 1–7 years, it increased 15-min success (79.2% vs 51.6%) and reduced 30-min sedation failure (0% vs 29%). In infants <1 year, complications were also reduced.

Impact: Offers a practical, needle-free sedation alternative that reduces complications and improves timeliness of effective sedation in older infants/children, informing shifts away from chloral hydrate.

Clinical Implications: Consider intranasal dexmedetomidine (2 μg/kg) plus ketamine (3 mg/kg) for outpatient pediatric procedural sedation, especially in children 1–7 years, to lower adverse events and improve early sedation success; maintain monitoring for bradycardia/sedation depth.

Future Directions: Head-to-head comparisons with other intranasal regimens and IV standards, dose-finding for different age strata, and evaluation of workflow, parental satisfaction, and cost-effectiveness.

Among 1,528 hereditary bleeding disorder patients and 20,509 controls undergoing elective TKA/THA, bleeding complications were infrequent but higher in BDs (1.1% vs 0.2%; P<.0001). Transfusions were more likely in BD patients (THA OR 2.7; TKA OR 2.6). CFCs were used in 16.4% of BD patients, with pharmacy costs >30× controls. Venous thromboembolism risk was also higher (OR 3.9).

Impact: Defines perioperative risks and resource implications in a vulnerable population, informing individualized anemia management, CFC use, thromboprophylaxis, and budgeting.

Clinical Implications: Plan preoperative optimization and blood management for BD patients; tailor CFC and antifibrinolytics; anticipate higher transfusion and VTE risk with appropriate thromboprophylaxis; counsel on markedly higher pharmacy costs and coordinate with hematology.

Future Directions: Prospective perioperative pathways with PBM bundles, risk-adjusted thromboprophylaxis trials, and cost-effectiveness analyses of targeted CFC/antifibrinolytic strategies.