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.
OBJECTIVE: To determine the effect of a novel brief general practitioner (GP)-led narrative exposure intervention on post-traumatic stress disorder (PTSD) symptoms after intensive care. DESIGN: Multicentre, observer blind, randomised controlled trial (PICTURE). SETTING: Primary care in 319 general practices across Germany. PARTICIPANTS: 319 adults (18-85 years) who have survived critical illness with symptoms of PTSD, discharged from intensive care and randomised to receive the intervention (n=160) or improved usual care (n=159) from a general practitioner. INTERVENTIONS: Intervention group participants had three narrative exposure consultations with a general practitioner and eight scheduled contacts with a nurse. Control group participants received improved treatment as usual based on the German PTSD guideline. MAIN OUTCOME MEASURES: The primary clinical outcome was self-reported PTSD symptoms using the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5, range 0-80, higher scores indicating more severe symptoms) at six months. The minimal clinically important difference was six points. Secondary outcomes included changes in depression, anxiety, patient activation, health related quality of life and disability at six and 12 months.
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).
Enhanced recovery after cesarean delivery protocols include evidence-based interventions which are designed to improve patient experience and maternal and neonatal outcomes, whilst reducing healthcare related costs. This is the first update to the Enhanced Recovery After Surgery Society guidelines for intraoperative care in cesarean delivery published in 2018. Interventions were selected based on expert consensus. An updated literature search was conducted in September 2024 involving the Embase, PubMed MEDLINE, EBSCO Cumulative Index of Nursing and Allied Health Literature, Scopus, and Web of Science databases. Targeted searches were performed by a medical librarian to identify relevant articles published since the 2018 Enhanced Recovery After Surgery Society guidelines publication, which evaluated each intraoperative enhanced recovery after cesarean delivery intervention, focusing on randomized clinical trials and large observational studies (≥800 patients) to maximize search feasibility and relevance. Following a review of the evidence, consensus was achieved surrounding the quality of evidence and strength of recommendation for each proposed intervention according to the Grading of Recommendations, Assessment, Development, and Evaluation system.
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.
BACKGROUND: This study aimed to evaluate the effect of perioperative intravenous infusion of dexmedetomidine on the quality of early and long-term postoperative recovery in patients undergoing thoracoscopic surgery, and to further analyze its potential mechanism. METHODS: A total of 80 patients were enrolled and randomized to dexmedetomidine group, which received perioperative intravenous infusion of dexmedetomidine and normal saline group, which received equivalent doses of normal saline. The primary outcome was total QoR-15 score on postoperative day 1. Secondary outcomes included total QoR-15 Score on postoperative day 2, day 3, day 7, month 1 and month 3 and the score of dimensions of QoR-15, NRS Score, incidence of moderate to severe pain, physical comfort score, hospital anxiety and depression scale score and adverse reactions on postoperative day 1, day 2, day 3, day 7, month 1 and month 3. RESULTS: The total QoR-15 score of dexmedetomidine group on postoperative day 1 was significantly higher than that of saline group (127.1±7.3 vs. 118.4±9.3, P<0.001), the same as on postoperative day 2, day 3, day 7 and month 1 (all P<0.001). Further analysis of each dimension showed that the enhancement of total QoR-15 score on postoperative day 1, day 2, day 3 in dexmedetomidine group was mainly due to the improvement of pain and physical comfort (all P<0.0.05), which was consistent with NRS score, incidence of moderate to severe pain and physical comfort score (P<0.0.05). The increase of total QoR-15 score on day 7 was mainly due to the combined effect of pain, physical comfort, and emotional dimensions (all P<0.05). The enhancement of total QoR-15 score on postoperative month 1 was mainly due to an improvement in the emotional dimension, which was consistent with hospital anxiety and depression scale score (all P<0.05). In terms of adverse reactions, the incidence of nausea and vomiting on postoperative day 1 and day 2 was significantly reduced in the dexmedetomidine group (48.7% vs. 25.6%, 38.5% vs. 17.9%, both P<0.05), and there was no significance in other aspects (all P<0.05). CONCLUSIONS: Perioperative intravenous infusion of dexmedetomidine significantly improved the quality of recovery after thoracoscopic surgery without increasing the occurrence of adverse reactions, and the early enhancement may be mainly through the improvement of pain and physical comfort, the long-term enhancement may be mainly through the improvement of emotional state.