Daily Anesthesiology Research Analysis
Three impactful anesthesiology studies stood out: a multicenter RCT (SEGA) suggests general anesthesia may improve 90-day outcomes over moderate sedation during endovascular therapy for large-vessel stroke; a single-center RCT shows 40‑Hz light stimulation via VR reduces pediatric emergence delirium after sevoflurane anesthesia; and updated PROSPECT recommendations for laparoscopic sleeve gastrectomy endorse TAP blocks, port-site infiltration, and intraoperative dexamethasone while de-emphasizin
Summary
Three impactful anesthesiology studies stood out: a multicenter RCT (SEGA) suggests general anesthesia may improve 90-day outcomes over moderate sedation during endovascular therapy for large-vessel stroke; a single-center RCT shows 40‑Hz light stimulation via VR reduces pediatric emergence delirium after sevoflurane anesthesia; and updated PROSPECT recommendations for laparoscopic sleeve gastrectomy endorse TAP blocks, port-site infiltration, and intraoperative dexamethasone while de-emphasizing gabapentinoids.
Research Themes
- Anesthetic strategy for neurointerventional stroke care
- Nonpharmacologic neuromodulation to prevent emergence delirium
- Procedure-specific multimodal analgesia optimization in bariatric surgery
Selected Articles
1. Sedation vs General Anesthesia for Endovascular Therapy in Acute Ischemic Stroke: The SEGA Randomized Clinical Trial.
In a 10-center randomized trial (n=260), general anesthesia during EVT for LVO stroke showed a probabilistic advantage in 90-day functional outcomes, with an 81% posterior probability of superiority on ordinal mRS and numerically higher successful reperfusion. Symptomatic intracerebral hemorrhage was less frequent with GA.
Impact: This trial addresses a long-standing debate in neuroanesthesia, providing randomized evidence that GA may confer better outcomes during EVT for LVO stroke.
Clinical Implications: Centers performing EVT should consider standardized GA protocols as a default or strongly considered option, while acknowledging credible intervals straddled unity and local workflow/logistics.
Key Findings
- Ordinal 90-day mRS favored GA with OR 1.22 (95% CrI 0.79–1.87) and 81% posterior probability of superiority.
- Probability of GA superiority for achieving mRS 0–2 at 90 days was 89%.
- Successful reperfusion probability favored GA (69% probability of superiority).
- Symptomatic intracerebral hemorrhage: 0.8% (GA) vs 2.4% (sedation).
Methodological Strengths
- Multicenter randomized, intention-to-treat design with pre-registered protocol (NCT03263117).
- Use of ordinal mRS and Bayesian analysis providing posterior probabilities alongside effect estimates.
Limitations
- Credible intervals included the null; results indicate probabilistic but not definitive superiority.
- Potential variability in anesthetic and EVT techniques across centers; blinding not feasible.
Future Directions: Confirmatory pragmatic multicenter RCTs with standardized GA protocols, cost-effectiveness analyses, and subgroup analyses (e.g., airway risks, hemodynamic lability) are warranted.
2. 40-Hz Light Stimulation and Emergence Delirium Incidence After Sevoflurane Anesthesia in Children: A Randomized Clinical Trial.
In 98 children undergoing elective vascular malformation surgery under sevoflurane anesthesia, 1 hour of 40‑Hz light stimulation via VR reduced emergence delirium by C‑CAPD (22.4% vs 44.9%; RR 0.57) and PAED (14.3% vs 34.7%; RR 0.51). Adjusted analyses remained significant.
Impact: Introduces a nonpharmacologic, scalable neuromodulatory intervention that reduces pediatric emergence delirium, a common and consequential postoperative complication.
Clinical Implications: 40‑Hz visual stimulation can be considered as an adjunct to standard ERAS pathways to prevent emergence delirium in pediatric sevoflurane anesthesia, particularly when pharmacologic strategies are limited.
Key Findings
- C‑CAPD–defined emergence delirium reduced with 40‑Hz stimulation: 22.4% vs 44.9% (RR 0.57; 95% CI 0.33–0.92; P=.02).
- PAED-defined delirium also reduced: 14.3% vs 34.7% (RR 0.51; 95% CI 0.26–0.91; P=.02).
- Adjusted analyses showed significantly lower delirium incidence (adjusted RR 0.86; 95% CI 0.77–0.95; P=.004).
Methodological Strengths
- Randomized, sham-controlled design with validated delirium scales (C-CAPD, PAED).
- Pre-registered trial (NCT06493513) with prespecified adjustments for key confounders.
Limitations
- Single-center study limited to vascular malformation surgery; generalizability to other pediatric surgeries is uncertain.
- Short follow-up (72 hours) and no long-term behavioral outcomes.
Future Directions: Multicenter trials across pediatric procedures, dose–response and timing optimization, and mechanistic EEG/biomarker studies of gamma entrainment are needed.
3. Pain management for laparoscopic sleeve gastrectomy: An update of the systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations.
This PROSPECT update synthesizes 39 RCTs and two meta-analyses to recommend paracetamol plus NSAIDs/COX‑2 inhibitors, bilateral TAP blocks (ultrasound or laparoscopic-guided), port‑site local anesthetic infiltration, and intraoperative IV dexamethasone for sleeve gastrectomy. Opioids are reserved for rescue, and gabapentinoids are no longer advised.
Impact: Provides procedure-specific, evidence-based guidance likely to standardize and improve postoperative analgesia for a high-volume bariatric procedure.
Clinical Implications: Adopt TAP blocks and port-site infiltration within multimodal regimens (paracetamol + NSAIDs/COX‑2) and administer intraoperative dexamethasone; avoid routine gabapentinoids and reserve opioids as rescue in sleeve gastrectomy pathways.
Key Findings
- Update recommends bilateral TAP blocks (US- or laparoscopic-guided) and port-site local anesthetic infiltration as part of multimodal analgesia.
- Intraoperative IV dexamethasone is recommended for analgesia and PONV prevention.
- Opioids are reserved for rescue; gabapentinoids are no longer advised compared with 2019 recommendations.
- Evidence base expanded to 39 RCTs and 2 meta-analyses since the prior review.
Methodological Strengths
- Systematic search across multiple databases with PROSPECT methodology and RoB 2 bias assessment.
- Procedure-specific synthesis enabling actionable recommendations.
Limitations
- Heterogeneity among included RCTs in techniques, dosing, and outcome measures.
- Evidence primarily short-term; limited data on long-term opioid use or chronic pain.
Future Directions: Head-to-head RCTs comparing TAP techniques, dose-finding for local anesthetics, and pragmatic implementation studies on opioid-sparing ERAS pathways in bariatric populations.