Daily Anesthesiology Research Analysis
A multicentre RCT in BMJ shows a brief GP-led narrative exposure intervention reduces PTSD symptoms in ICU survivors at 6 and 12 months. Updated ERAS Society intraoperative guidelines for cesarean delivery provide 10 strong, evidence-based recommendations central to obstetric anesthesia. A randomized trial reports perioperative dexmedetomidine improves early and 1‑month recovery quality and reduces postoperative nausea/vomiting after thoracoscopic surgery.
Summary
A multicentre RCT in BMJ shows a brief GP-led narrative exposure intervention reduces PTSD symptoms in ICU survivors at 6 and 12 months. Updated ERAS Society intraoperative guidelines for cesarean delivery provide 10 strong, evidence-based recommendations central to obstetric anesthesia. A randomized trial reports perioperative dexmedetomidine improves early and 1‑month recovery quality and reduces postoperative nausea/vomiting after thoracoscopic surgery.
Research Themes
- Post-ICU mental health interventions and primary care integration
- Obstetric anesthesia and ERAS implementation for cesarean delivery
- Perioperative dexmedetomidine to enhance recovery and reduce PONV
Selected Articles
1. Effects of a general practitioner-led brief narrative exposure intervention on symptoms of post-traumatic stress disorder after intensive care (PICTURE): multicentre, observer blind, randomised controlled trial.
In 319 ICU survivors with PTSD symptoms, a brief GP-led narrative exposure intervention reduced PDS-5 scores by 4.7 points at 6 months and 5.4 points at 12 months versus enhanced usual care, though below the pre-specified MCID of 6 points. Benefits extended to depression, health-related quality of life, and disability, with high follow-up retention.
Impact: This pragmatic, multicentre, observer-blind RCT in a top-tier journal demonstrates a scalable primary-care intervention that addresses post-ICU mental health, a major survivorship gap.
Clinical Implications: Post-ICU follow-up programs can integrate brief GP-led narrative exposure with nurse contacts to reduce PTSD symptoms and improve patient-centered outcomes; however, expectations should be tempered given effects just below MCID.
Key Findings
- At 6 months, PDS-5 decreased by a mean 4.7 points versus control (95% CI 1.6 to 7.8; P=0.003; d=0.37).
- At 12 months, PDS-5 decreased by 5.4 points (95% CI 1.8 to 9.0; P=0.003; d=0.41), indicating sustained benefit.
- Secondary outcomes showed improvements in depression, health-related quality of life, and disability.
- Follow-up completion was high (85% at 6 months; 77% at 12 months); trial was registered (NCT03315390).
Methodological Strengths
- Multicentre, observer-blind randomized controlled design with high retention
- Pre-registered protocol with sustained 12-month follow-up and patient-centered outcomes
Limitations
- Effect size did not exceed the predefined minimal clinically important difference
- Self-reported PTSD scale and healthcare system context (Germany) may limit generalizability
Future Directions: Evaluate implementation at scale in diverse health systems, refine the intervention dose/timing, and test combinations with digital tools or trauma-focused therapies to achieve or exceed MCID.
2. Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery After Surgery Society recommendations (part 2)-2025 update.
This 2025 ERAS Society update presents 10 intraoperative recommendations for cesarean delivery, including antibiotic prophylaxis, vaginal/abdominal prep, antiemetic prophylaxis, prevention of spinal hypotension, normothermia, euvolemia, optimal uterotonics, multimodal analgesia, personal support persons, and early skin-to-skin care. Recommendations are mostly strong with low-to-moderate evidence, reflecting pragmatic consensus prioritizing maternal and neonatal outcomes.
Impact: Authoritative, consensus-based guidance synthesizes current evidence for intraoperative obstetric anesthesia and is likely to standardize care pathways globally.
Clinical Implications: Anesthesia teams should update cesarean intraoperative pathways to include strong recommendations: timely prophylactic antibiotics, antiseptic prep, antiemetics, vasopressor-based prevention of spinal hypotension, active temperature management, judicious fluids, standardized uterotonic use, multimodal analgesia, and early skin-to-skin.
Key Findings
- Ten intraoperative ERAS categories were recommended with strong consensus (e.g., antibiotics, antiemetics, prevention of spinal hypotension, normothermia, euvolemia, uterotonics, multimodal analgesia, early skin-to-skin).
- Evidence quality ranged from low to high, but most recommendations were strong per GRADE.
- Updated literature review prioritized RCTs and large observational studies (≥800 patients) across multiple databases.
Methodological Strengths
- Comprehensive multi-database search with targeted strategy and GRADE framework
- Expert consensus using structured methodology to translate evidence into practice
Limitations
- Many recommendations rely on low to moderate quality evidence and heterogenous studies
- Guideline does not provide quantitative meta-analysis or cost-effectiveness modeling
Future Directions: Prospective ERAC implementation studies measuring maternal/neonatal outcomes, equity, and cost; high-quality RCTs to strengthen weak evidence domains (e.g., antiemetic bundles, fluid targets).
3. Effect of perioperative intravenous infusion of dexmedetomidine on the quality of early and long-term postoperative recovery in patients undergoing thoracoscopic surgery: a randomized controlled trial.
In 80 thoracoscopic surgery patients, perioperative dexmedetomidine increased QoR‑15 scores on postoperative days 1–7 and at 1 month, with early gains driven by pain/comfort and later gains by emotional recovery. Postoperative nausea and vomiting were significantly reduced on days 1–2 without other adverse event increases.
Impact: Randomized evidence links dexmedetomidine to both early and longer-term recovery quality and reduced PONV in thoracoscopic surgery, informing anesthetic adjunct choices.
Clinical Implications: Consider dexmedetomidine infusion as part of multimodal anesthesia/analgesia for thoracoscopy to enhance QoR‑15 and reduce early PONV, with attention to hemodynamic monitoring and individualized dosing.
Key Findings
- Primary outcome: Day‑1 QoR‑15 was higher with dexmedetomidine (127.1±7.3) vs saline (118.4±9.3), P<0.001.
- QoR‑15 improvements persisted on days 2, 3, 7 and month 1 (all P<0.001).
- Early gains were driven by pain and physical comfort domains; month‑1 gains by emotional domain.
- PONV incidence reduced on postoperative days 1–2 (48.7%→25.6% and 38.5%→17.9%; both P<0.05) without other adverse event increases.
Methodological Strengths
- Randomized controlled design with predefined primary and multiple longitudinal secondary outcomes
- Granular domain analysis of QoR‑15 with concurrent pain, comfort, mood, and adverse event assessments
Limitations
- Single-centre, small sample size (n=80) limits precision and generalizability
- Blinding and trial registration not detailed; limited power for safety endpoints
Future Directions: Larger multicentre RCTs with standardized dosing, blinding, and cost-effectiveness analyses to validate recovery benefits and define patient subgroups most likely to benefit.