Daily Anesthesiology Research Analysis
Three perioperative studies stand out today. A large randomized controlled trial shows repeated maternal voice orientation significantly reduces pediatric emergence agitation after tonsillectomy/adenoidectomy. A Bayesian network meta-analysis ranks nonpharmacological strategies for reducing anxiety at anesthesia induction in children, while an RCT in the British journal of anaesthesia finds continuous norepinephrine infusion does not reduce postinduction hypotension versus bolus dosing in low-to
Summary
Three perioperative studies stand out today. A large randomized controlled trial shows repeated maternal voice orientation significantly reduces pediatric emergence agitation after tonsillectomy/adenoidectomy. A Bayesian network meta-analysis ranks nonpharmacological strategies for reducing anxiety at anesthesia induction in children, while an RCT in the British journal of anaesthesia finds continuous norepinephrine infusion does not reduce postinduction hypotension versus bolus dosing in low-to-moderate risk patients.
Research Themes
- Pediatric perioperative anxiety and emergence agitation
- Nonpharmacological interventions in anesthesia
- Hemodynamic management during induction
Selected Articles
1. The effect of repeated maternal voice orientation on postoperative emergence agitation in children following tonsillectomy and adenoidectomy: A randomized controlled trial.
In 360 children undergoing tonsillectomy/adenoidectomy, repeated maternal voice orientation significantly lowered the incidence and severity of emergence agitation compared with both a silent recording control and a maternal-voice-at-awakening group. Benefits were most pronounced in 5–8-year-olds and were reflected in lower PAED scores immediately post-extubation and at 10 minutes.
Impact: A large, pragmatic RCT demonstrates a simple, scalable nonpharmacological intervention that reduces pediatric emergence agitation. This is immediately implementable without drug-related adverse effects.
Clinical Implications: Incorporate structured maternal voice orientation protocols during emergence and early PACU to reduce emergence agitation, particularly in younger children. This can be integrated into standard recovery workflows and caregiver education.
Key Findings
- Repeated maternal voice orientation reduced emergence agitation incidence versus control and versus maternal voice only at awakening.
- Greatest benefit observed in the 5–8-year subgroup.
- PAED scores were lowest in the orientation group immediately post-extubation and at 10 minutes.
Methodological Strengths
- Randomized controlled design with large sample size (n=360).
- Standardized outcome measures (PAED, FLACC/NRS) and prespecified primary endpoint.
Limitations
- Likely single-center setting may limit generalizability.
- Blinding of participants and staff to intervention is inherently challenging.
- No long-term behavioral follow-up was reported.
Future Directions: Multicenter trials across diverse cultural/linguistic contexts, mechanistic studies on sensory modulation, and evaluation of integration with multimodal strategies (e.g., distraction, PPIA).
2. Nonpharmacological interventions for decreasing anxiety during anesthesia induction in children: a systematic review and Bayesian network meta-analysis.
Across 34 RCTs (n=3,040), combinations of distraction with parental presence (PDI-PPIA, IDI-PPIA) and distraction alone (IDI, PDI) reduced child anxiety at induction versus usual care, while PPIA and IDI also improved compliance. No intervention significantly reduced parental anxiety; all were safe.
Impact: Provides comparative effectiveness rankings to guide selection and implementation of nonpharmacologic strategies to mitigate pediatric induction anxiety, supported by a registered, Bayesian network meta-analysis.
Clinical Implications: Implement distraction-based strategies (interactive or passive) with parental presence where feasible to reduce child anxiety and improve cooperation at induction. Standardize protocols and staff training to match local resources.
Key Findings
- PDI-PPIA and IDI-PPIA ranked highest for reducing child anxiety versus usual care.
- PPIA, IDI, and IDI-PPIA improved child compliance at induction.
- No significant differences were observed in parental anxiety reduction across interventions.
- All six nonpharmacologic strategies were reported as safe with no significant adverse events.
Methodological Strengths
- Registered protocol (PROSPERO) and PRISMA-compliant network meta-analysis.
- Inclusion of 34 RCTs (n=3,040) with Bayesian ranking of interventions.
Limitations
- Indirect comparisons predominate due to limited head-to-head RCTs.
- Potential heterogeneity in interventions, settings, and outcome measurements.
- Quality and risk of bias may vary across included trials.
Future Directions: Conduct head-to-head RCTs of top-ranked strategies, evaluate cost-effectiveness and implementation fidelity, and assess effects on long-term behavioral outcomes.
3. Continuous versus bolus norepinephrine administration to treat hypotension after induction of general anaesthesia in low-to-moderate risk noncardiac surgery patients: a randomised trial.
In a randomized trial of 261 analyzed low-to-moderate risk surgical patients, continuous norepinephrine infusion did not significantly reduce postinduction hypotension versus repeated manual boluses, as measured by the area under a MAP of 65 mmHg and duration <65 mmHg within 15 minutes of induction.
Impact: This negative RCT challenges a common assumption that continuous infusion is superior for preventing postinduction hypotension. It informs resource allocation and vasopressor strategies during routine induction.
Clinical Implications: For low-to-moderate risk cases with intermittent noninvasive monitoring, bolus norepinephrine dosing is reasonable; prioritizing vigilant hemodynamic monitoring and individualized thresholds may be more impactful than defaulting to continuous infusion.
Key Findings
- Primary endpoint (AUC below MAP 65 mmHg within 15 minutes) was not significantly different between continuous infusion and bolus dosing (3.6 vs 5.5 mmHg×min; P=0.070).
- Duration of MAP <65 mmHg trended lower with infusion but was not significant (1.0 vs 1.4 minutes; P=0.052).
- Both strategies were feasible via peripheral IV with intermittent oscillometric monitoring; continuous blinded noninvasive monitoring quantified hypotension.
Methodological Strengths
- Randomized design with objective, blinded continuous blood pressure capture for outcome quantification.
- Clinically relevant endpoint (MAP <65 mmHg AUC) during the critical peri-induction window.
Limitations
- Blood pressure management was guided by intermittent oscillometry, which may attenuate detectable differences.
- Restricted to low-to-moderate risk patients; results may not generalize to high-risk or invasive-monitoring populations.
- Borderline p-values suggest the study may have been underpowered to detect small differences.
Future Directions: Evaluate high-risk cohorts with invasive continuous monitoring, standardized hemodynamic protocols, and cost/resource analyses comparing infusion versus bolus strategies.