Daily Anesthesiology Research Analysis

BACKGROUND: Prehabilitation is hypothesised to play an important role in optimising postoperative outcomes. However, achieving high adherence can be challenging. Our objectives were to synthesise current approaches to adherence measurement and reporting, estimate prehabilitation adherence across trials, identify procedural-, programme-, or patient-level factors associated with adherence, and report barriers and facilitators to adherence. METHODS: Ovid MEDLINE, Embase, the CINAHL, PsycINFO, Web of Science, and the Cochrane CENTRAL Register of Controlled Trials were searched from inception until April 10, 2024. We included randomised trials of adults undergoing major elective surgery allocated to a prehabilitation programme, with at least one binary or continuous measure of adherence to prehabilitation, to an individual component, or both. Random-effects meta-analysis pooled overall adherence rates; meta-regression evaluated predictors of adherence. Qualitative synthesis of reported barriers and facilitators was informed by the Theoretical Domains Framework. RESULTS: We screened 11 652 titles and abstracts, followed by 1232 full texts, and included 105 trials (n=4941). Pooled adherence was 79% (95% confidence interval [CI] 70-88; I CONCLUSIONS: Prehabilitation adherence metrics are variable across trials and standardisation is required to improve reporting and interpretation of prehabilitation evidence. Little credible evidence identifies factors associated with adherence; however, qualitative barriers and facilitators could inform programme design and implementation. SYSTEMATIC REVIEW PROTOCOL: PROSPERO (CRD42024518851).

The autonomic nervous system (ANS) is essential for maintaining physiological homeostasis. Autonomic nervous system imbalance, characterised by sympathetic hyperactivation and low parasympathetic tone, can occur during the perioperative period. These changes drive systemic stress responses, cardiovascular instability, impaired tissue repair, and immunosuppression, which in turn increase infection risk, neurocognitive decline, and multiorgan dysfunction. Surgical trauma, anaesthesia, pain, hypothermia, and psychological stressors all contribute to this dysregulation, and consequently low parasympathetic tone results in the cholinergic anti-inflammatory pathway being less effective. High sympathetic nervous system activity promotes catecholamine surges and pro-inflammatory cytokine release. Pharmacological interventions, including dexmedetomidine and β-blockers, together with nonpharmacological strategies, such as electroacupuncture and temperature management, are measures that have potential to restore ANS balance. This systematic review covers ANS-mediated organ regulation, pathophysiological consequences of perioperative dysautonomia, and evidence-based therapeutic strategies. By integrating findings from multiple basic and clinical studies, the pivotal roles of ANS modulation in mitigating postoperative complications, including neurocognitive disorders, immunosuppression, and cancer recurrence, are discussed. Maintaining balance of the sympathetic and parasympathetic nervous systems is an important prospect in perioperative medicine that could benefit surgical patients' short- or long-term recovery.

BACKGROUND: This study compared postoperative pain and analgesic requirements in women who underwent cesarean section (CS) in the morning and afternoon. SUMMARY BACKGROUND DATA: It is unclear whether there was difference in postoperative pain intensity and analgesic requirements between morning and afternoon CS. METHODS: A single-center retrospective cohort study was conducted to compare postoperative analgesic requirements between women who underwent CS during 06:00-12:00 (morning group, RESULTS: The frequency of analgesic requirements 24 h after CS in the afternoon group was significantly higher than morning group in the retrospective cohort. The AUC of pain NRS and analgesic consumption during 24 h after afternoon CS were significantly higher than those after morning procedures. Significantly lower pressure pain tolerance, higher postoperative serum endorphin levels and higher levels of interleukin-6 were found in the afternoon group compared to those preoperatively, but not in the morning group. CONCLUSION: CS performed in the afternoon predicted severer postoperative pain compared to those performed in the morning, which might be associated with lower postoperative pain tolerance and more drastic responses to surgery. This finding needs to be considered in pain treatment after CS in the future. CLINICAL TRIAL NUMBER AND REGISTRY URL: ChiCTR2000039720, www.chictr.org.cn.