Daily Anesthesiology Research Analysis
Analyzed 35 papers and selected 3 impactful papers.
Summary
Analyzed 35 papers and selected 3 impactful articles.
Selected Articles
1. Neurophysiological connectomic signatures of consciousness during propofol-induced general anesthesia.
High-density EEG with source localization in 31 patients, validated in 46 mildly sedated patients, shows that decreased parietal–occipital alpha-band connectivity consistently marks the transition to propofol-induced unconsciousness. Delta/theta connectivity increases while alpha/beta/gamma decrease, defining a connectomic signature of anesthesia.
Impact: Identifies a robust neural connectivity marker of consciousness with validation across cohorts, advancing neurobiologically grounded anesthesia monitoring. Provides mechanistic insight that can inform next-generation EEG-based depth-of-anesthesia metrics.
Clinical Implications: Alpha connectivity centered on parietal–occipital networks could augment EEG-based depth monitoring to more reliably detect loss of consciousness and transitions during induction and sedation. This may improve titration of propofol and reduce awareness or oversedation.
Key Findings
- Propofol increased delta/theta and decreased alpha/beta/gamma functional connectivity.
- Loss of parietal–occipital (and subcortical) alpha connectivity marked the transition to unconsciousness.
- Findings replicated in an independent cohort of 46 patients under mild propofol sedation.
Methodological Strengths
- High-density 128-channel EEG with source localization
- Independent validation cohort under mild sedation
Limitations
- Non-randomized observational design with modest sample size
- Generalizability beyond propofol and across diverse surgical populations remains to be tested
Future Directions: Prospective trials integrating alpha-connectivity metrics into closed-loop anesthesia control and outcome studies linking connectome-based monitoring to delirium, awareness, and recovery quality.
General anesthesia induces reversible changes in consciousness through cortical activity and connectivity alterations, yet the functional connectome dynamics underlying propofol-induced unconsciousness remains unclear. We analyze high-density 128-channel electroencephalogram (EEG) from 31 surgical patients using source localization to identify neurobiological connectome signatures of propofol anesthesia. Propofol anesthesia increases delta and theta functional connectivity and decreases alpha, beta, and gamma connectivity. A classification model and dynamic analysis of consciousness loss reveals that alpha-band connectivity between parietal, occipital, and subcortical regions is critical for sustaining consciousness, with its disruption marking a key transition to unconsciousness. EEG from 46 additional patients under mild sedation with low-dose propofol confirms that decreased parietal-related alpha connectivity serves as a stable marker of reduced consciousness, insensitive to subtle fluctuations but sensitive to the transition from consciousness to unconsciousness. These findings suggest that parietal, occipital, and subcortical alpha connectivity serves as a reliable neural correlate of propofol-induced unconsciousness.
2. Prehabilitation in Patients Undergoing Cardiac Procedures: A Systematic Review and Meta-Analysis.
Across 44 RCTs (n=3,925), prehabilitation improved functional capacity (6MWD +68.9 m), shortened hospital (−0.95 days) and ICU stays (−6.03 h), and reduced post-procedural pneumonia (OR 0.33). Benefits appeared greater in studies with more women, though heterogeneity and risk of bias were substantial.
Impact: Synthesizes the latest randomized evidence demonstrating perioperative benefits of prehabilitation in cardiac care and highlights sex-related effect modification.
Clinical Implications: Structured prehabilitation programs can be considered before cardiac procedures to improve capacity and recovery, with attention to program components, feasibility, and tailoring—potentially prioritizing patients likely to benefit (e.g., women, deconditioned patients).
Key Findings
- Prehabilitation improved 6-minute walk distance by a mean of 68.87 m across six trials.
- Hospital length of stay decreased by 0.95 days and ICU stay by 6.03 hours.
- Postprocedural pneumonia odds were reduced (OR 0.33), with greater effects in studies including more women.
Methodological Strengths
- Focus on randomized controlled trials with meta-analytic synthesis
- Predefined outcomes including functional capacity and recovery metrics
Limitations
- Substantial heterogeneity and risk of bias across included trials
- Component analysis did not identify consistently effective elements
Future Directions: Multicenter, standardized RCTs to define optimal prehabilitation components, timing, and patient selection; evaluation of cost-effectiveness and implementation strategies.
BACKGROUND: Evidence supporting prehabilitation before cardiac procedures is growing, but the efficacy of different components remains unclear. OBJECTIVES: The primary aim was to assess the efficacy of prehabilitation on clinical outcomes based on recent randomized controlled trials (RCTs). The secondary aim was to identify effective intervention and which patient subgroups benefit most. METHODS: We searched Medline, Web of Science, PsycINFO, Embase, Scopus, and Cochrane Central Register of Controlled Trials Library for RCTs comparing prehabilitation with standard care in cardiac patients up to August 2024. Trials were screened by 2 reviewers and meta-analyses were performed using random-effects models. RESULTS: Forty-four RCTs including 3,925 patients were identified. Prehabilitation improved preprocedural functional capacity (6-minute walk distance) and recovery (in-hospital length of stay, intensive care unit stay, and occurrence of postprocedural pneumonia). Six trials (n = 600) showed improved 6-minute walk distance (mean difference [MD] 68.87 m; 95% CI: 12.76-124.98 m; P = 0.020). In 18 studies (n = 1,568), length of stay was shorter (MD -0.95 days; 95% CI: -1.77 to -0.13 days; P = 0.026) and meta-regression showed greater effect in studies including more women (P = 0.015). In 16 trials (n = 1,149), intensive care unit stay was reduced (MD -6.03 hours; 95% CI: -12.01 to -0.06 hours; P = 0.048). In 5 studies (n = 729), postprocedural pneumonia occurred less frequently (OR: 0.33; 95% CI: 0.15-0.72; P = 0.017). The analysis revealed substantial heterogeneity and risk of bias. Analysis of specific components showed no consistent effects. CONCLUSIONS: Prehabilitation before cardiac procedures may enhance preprocedural functional capacity and postprocedural recovery, particularly in women. Further multicenter studies are needed.
3. Desflurane versus propofol for ambulatory surgery: A systematic review and meta-analysis.
Across 22 trials (n=1,504), desflurane shortened early recovery times and reduced variability versus propofol, without consistent advantages in intermediate/late recovery. However, desflurane increased in-hospital PONV and antiemetic rescue rates.
Impact: Provides quantitative, methodologically rigorous comparison informing anesthetic maintenance choices in ambulatory surgery, balancing efficiency gains against higher PONV risk.
Clinical Implications: Desflurane may be preferred when early turnover and PACU efficiency are prioritized, provided robust PONV prophylaxis is implemented; propofol remains favorable in patients at high PONV risk or when environmental impact is weighed.
Key Findings
- Desflurane reduced early recovery mean time by at least 9.1% and variability by 4.2% versus propofol (lower bound of 99% CI).
- No consistent differences in intermediate and late recovery metrics.
- Higher rates of in-hospital PONV (RR 2.15) and antiemetic rescue (RR 2.59) with desflurane.
Methodological Strengths
- Use of generalized pivotal method and Knapp-Hartung adjustment for robust meta-analytic estimates
- Multiple sensitivity adjustments including Benjamini-Hochberg correction for multiplicity
Limitations
- Heterogeneity in anesthetic adjuncts and PONV prophylaxis across trials
- Environmental impact not directly evaluated despite clinical relevance
Future Directions: Head-to-head trials incorporating standardized PONV prophylaxis and environmental life-cycle assessment to guide balanced anesthetic selection.
BACKGROUND: This study aimed to evaluate the efficacy, side effects and recovery profile of two commonly used anesthetic agents, desflurane versus propofol, for maintaining general anesthesia in ambulatory surgery. METHODS: Studies compared propofol with desflurane in adult patients undergoing ambulatory surgery were included. The generalized pivotal method was used to estimate the median and variance of the ratios of means and standard deviations of recovery times, and these ratios were then pooled in a DerSimonian-Laird random-effects meta-analysis with Knapp-Hartung adjustment. RESULTS: Twenty-two studies with a total of 1504 adult participants were included in this review. Compared with propofol, desflurane significantly reduced early recovery times, with reductions of at least 9.1% in mean time and 4.2% in standard deviation (variability) (both based on the lower limit of the 99%CI), all significant after Benjamini-Hochberg (BH) correction. In contrast, no significant differences were observed for most intermediate and late recovery metrics. Desflurane increased the risk of in-hospital PONV (RR: 2.15, 95%CI: 1.12 to 4.11), and postoperative antiemetic rescue (RR: 2.59, 95%CI: 1.35 to 4.95), all significant after BH correction. The subgroup analysis indicated that adding N CONCLUSIONS: In ambulatory surgery, desflurane demonstrated faster early recovery, higher incidence of in-hospital PONV and antiemetic rescue, compared with propofol. The reductions in mean time and variability for early recovery with desflurane could potentially contribute to improved operating room efficiency and lower labor costs. Future studies are needed to confirm these findings.