Daily Anesthesiology Research Analysis
Three impactful anesthesiology studies stand out today: a meta-analysis shows perioperative esketamine reduces early postpartum depression after cesarean delivery while improving analgesia; a meta-analysis indicates ciprofol provides comparable endoscopy sedation efficacy to propofol with markedly less injection pain and improved hemodynamic stability; and an EEG-fMRI translational analysis links propofol-induced cortico-subcortical decoupling with bedside EEG signatures (rising frontal alpha, f
Summary
Three impactful anesthesiology studies stand out today: a meta-analysis shows perioperative esketamine reduces early postpartum depression after cesarean delivery while improving analgesia; a meta-analysis indicates ciprofol provides comparable endoscopy sedation efficacy to propofol with markedly less injection pain and improved hemodynamic stability; and an EEG-fMRI translational analysis links propofol-induced cortico-subcortical decoupling with bedside EEG signatures (rising frontal alpha, falling qCON), informing depth-of-anesthesia monitoring.
Research Themes
- Perioperative mental health and obstetric anesthesia
- Optimization of sedative agents and safety profiles
- Neurophysiologic monitoring and depth-of-anesthesia biomarkers
Selected Articles
1. Perioperative use of esketamine for the prevention of postpartum depression after cesarean section: a meta-analysis.
This registered meta-analysis (9 RCTs, 1 retrospective; n=1,975) shows that perioperative esketamine during cesarean delivery halves early postpartum depression risk within 1 week (RR 0.49) and lowers EPDS scores, while also reducing 48-hour postoperative pain. These findings support esketamine as a preventive strategy for early PPD with concurrent analgesic benefits.
Impact: Addresses a major unmet need in obstetric anesthesia by preventing early postpartum depression and improving pain control using an accessible intervention.
Clinical Implications: Consider integrating low-dose esketamine as an adjunct during cesarean delivery (with spinal anesthesia) for patients at risk of PPD, with appropriate monitoring and shared decision-making on benefits and adverse effects.
Key Findings
- Across 10 studies (9 RCTs; n=1,975), esketamine reduced 1-week postpartum depression incidence versus controls (RR 0.49, 95% CI 0.30–0.79, p=0.004).
- Edinburgh Postnatal Depression Scale scores within 1 week postpartum were significantly lower with esketamine (SMD −1.10, 95% CI −1.67 to −0.52, p<0.0005).
- Postoperative pain scores at rest and during activity at 48 hours were significantly reduced in the esketamine group.
Methodological Strengths
- Registered protocol (PROSPERO: CRD42024527906) with duplicate screening and bias assessment.
- Focus on randomized controlled trials as primary evidence with clinically relevant outcomes (PPD incidence, EPDS, pain).
Limitations
- Effect estimates focus on early PPD (within 1 week); longer-term depression outcomes are not established.
- Potential heterogeneity in dosing regimens, adjunct analgesia, and anesthesia practices across trials.
Future Directions: Pragmatic multicenter RCTs with standardized esketamine dosing, extended follow-up (≥6–12 months), and stratification by PPD risk to define durable benefits and safety.
BACKGROUND: Esketamine has a relatively low adverse effect on mothers and infants during cesarean sections, making it an ideal adjunct in spinal anesthesia. However, its efficacy, dosage, analgesic effects, and safety in preventing postpartum depression (PPD) remain controversial. METHODS: We searched PubMed, Embase, and Web of Science up to January 18, 2024, for studies examining the perioperative use of esketamine to prevent PPD. Two researchers independently assessed studies for eligibility and risk of bias and extracted data on the incidence of PPD and adverse reactions, EPDS scores, and postoperative pain scores. The study protocol was registered with PROSPERO (CRD42024527906). FINDINGS: Of the 214 studies identified, ten (one retrospective study and nine randomized controlled trials) were selected through full-text reading, involving a total of 1975 cases. The PPD incidence within 1 week after childbirth in the esketamine group was significantly lower than that in the control group (RR = 0·49, 95% CI: 0·30 to 0·79, P = 0·004). The score of Edinburgh Postnatal Depression Scale (EPDS) within 1 week postpartum was also significantly lower in the esketamine group (SMD = -1·10, 95% CI: -1·67 to -0·52, P < 0·0005). The pain scores during activity and rest, obtained 48 h postoperatively, showed a significant reduction in the esketamine group. INTERPRETATION: Perioperative use of esketamine during cesarean section can prevent the early occurrence of PPD while providing effective analgesia. Our findings may guide the clinical use of esketamine for PPD prevention.
2. Efficacy and safety of ciprofol versus propofol for anesthesia in patients undergoing gastrointestinal endoscope: a systematic review and meta-analysis of randomized controlled trials (RCT).
In 20 RCTs (n=3,779), ciprofol achieved a similar sedation success rate and waking time compared with propofol for gastrointestinal endoscopy but markedly reduced injection pain (RR 0.10) and improved hemodynamic stability (lower hypotension/bradycardia). Respiratory adverse events and hypoxemia also favored ciprofol in pooled analyses.
Impact: Offers robust comparative evidence supporting ciprofol as a practical alternative to propofol with a superior tolerability profile in common endoscopy sedation.
Clinical Implications: Ciprofol may be preferred when minimizing injection pain and hemodynamic instability is prioritized, with similar efficacy to propofol. Institutions may consider formulary inclusion and staff training for appropriate dosing and monitoring.
Key Findings
- No significant difference in sedation success rate between ciprofol and propofol across 20 RCTs (n=3,779).
- Injection pain was substantially lower with ciprofol (RR 0.10, 95% CI 0.07–0.16, p<0.001).
- Lower incidence of hypotension and bradycardia with ciprofol, indicating improved hemodynamic stability.
- Overall respiratory disorders and hypoxemia occurred less frequently with ciprofol in pooled analyses.
Methodological Strengths
- Focused meta-analysis of randomized controlled trials with large aggregate sample size.
- Comprehensive safety outcomes including hemodynamic and respiratory events.
Limitations
- Heterogeneity in dosing regimens, procedural types, and definitions of adverse events may influence pooled estimates.
- Some reporting inconsistencies regarding recovery time warrant cautious interpretation.
Future Directions: Head-to-head multicenter RCTs with standardized dosing and adjudicated adverse events to confirm safety advantages and define optimal patient subgroups for ciprofol.
BACKGROUND: Ciprofol is considered an alternative to propofol and can be used to achieve anesthesia at a lower dose with a lower incidence of adverse events. The primary objective of this study was to compare the efficacy and safety of ciprofol and propofol used in patients undergoing gastrointestinal endoscopes. METHODS: The databases of PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure were retrieved for randomized controlled trials of ciprofol and propofol used in gastrointestinal endoscopes from inception to May 10, 2024. All statistical analyses were conducted using Stata 14.0. Primary outcomes encompassed a successful rate of sedation and other safety outcomes, including injection pain, hypotension, bradycardia, overall respiratory disorders, and hypoxemia. Secondary outcomes concluded time to onset of successful induction, waking time, and discharge time. RESULTS: A total of 20 studies were included, involving 3779 patients. The results of the meta-analysis showed that the successful rate of anesthesia and waking time were not significantly different between ciprofol and propofol, while ciprofol was better than propofol in injection pain (RR: 0.10, 95% CI: 0.07 to 0.16, p < 0.001, I CONCLUSION: Based on the results of pooled analysis, we conclude that ciprofol takes longer for cipofol to recover after surgery, it may greatly improve the pain problem and hemodynamic stability of intravenous propofol. Therefore, we believe that ciprofol can be used as an excellent substitute for propofol.
3. Electroencephalographic changes related to cortico-subcortical decoupling during propofol-induced loss of consciousness: A secondary analysis of a prospective observational study.
In a secondary analysis of 19 volunteers, artifact-corrected EEG revealed that propofol-induced cortico-subcortical decoupling aligns with a decrease in qCON (from >80 to <60) and a significant increase in frontal alpha power (median 0.07 to 0.48, p<0.001). These EEG signatures translate fMRI observations to clinically accessible markers for anesthetic depth.
Impact: Bridges mechanistic fMRI findings with practical EEG markers, potentially enhancing real-time depth-of-anesthesia monitoring and reducing awareness or excessive anesthesia.
Clinical Implications: Increases confidence in using frontal alpha augmentation and declining qCON as bedside indicators of loss of consciousness under propofol, informing titration and avoiding over- or under-anesthesia.
Key Findings
- Propofol-induced LOC occurred at median target plasma 4.5 μg/mL and effect-site 4.0 μg/mL.
- qCON remained >80 before decoupling and decreased to <60 after decoupling.
- Frontal alpha band power increased significantly around decoupling (median 0.07 to 0.48; p<0.001) after artifact correction.
Methodological Strengths
- Synchronous EEG-fMRI acquisition with robust gradient and cardioballistic artifact correction.
- Prospective data collection with registered protocol (EudraCT 2016-004833-25).
Limitations
- Small sample size (16 analyzable EEG datasets) of healthy volunteers limits generalizability to surgical patients.
- Secondary analysis; not designed to test clinical outcomes or alternative anesthetics.
Future Directions: Validate EEG decoupling markers in surgical populations under varying anesthetic regimens and correlate with intraoperative awareness and recovery endpoints.
BACKGROUND: Cortico-subcortical decoupling has been observed in functional magnetic resonance imaging (fMRI) during slow propofol-induced loss of consciousness (LOC). However, corresponding electroencephalography (EEG) free of the cardioballistic and fMRI artifacts is essential for translating decoupling observations to clinical monitoring. OBJECTIVE: To describe artifact-corrected EEG changes corresponding to cortico-subcortical decoupling at LOC. DESIGN: Secondary analysis of a prospective observational study. SETTING: Tertiary-care hospital, data collection from June 2017 to January 2019. PARTICIPANTS: Nineteen healthy volunteers receiving a targeted propofol infusion. INTERVENTIONS: Frontal EEG was recorded synchronously with clinical signs and fMRI. Gradient artifact correction was based on iterative peak detection. Cardioballistic artifact correction was accomplished with a recently described algorithmic method based on peak detection combined with temporal constraints. MAIN OUTCOME MEASURES: The qCON index and frontal EEG before and after decoupling at LOC. RESULTS: Algorithm-filtered EEG tracings were suitable for analysis in 16 subjects. Propofol-induced LOC was achieved at a median (IQR) target plasma concentration of 4.5 (3.91 to 4.61) μg/mL and an effect-site concentration of 4.0 (2.94 to 4.31) μg/mL. The qCON index remained over 80 before decoupling and gradually decreased to values below 60 afterwards. Frontal alpha band power increased significantly from a median of 0.07 (0.03 to 0.15) 30 s before decoupling to 0.48 (0.08 to 0.58) 30 s after decoupling (p < 0.001). CONCLUSIONS: Cortico-subcortical decoupling related to propofol-induced LOC coincides with a gradual decrease in the qCON index and an increase in frontal alpha power. These results help translate fMRI findings to bedside settings. Registered at EudraCT (reference 2016-004833-25). Principal Investigator: Juan L. Fernández-Candil. Date of registration: January 4, 2017. Start Date: June 13, 2017.