Daily Anesthesiology Research Analysis
Analyzed 51 papers and selected 3 impactful papers.
Summary
Three studies with direct relevance to anesthesiology and perioperative medicine stood out today: a randomized trial showing a scalable, medical assistant–coached digital CBT program improves long-term pain interference and global symptom burden; a double-blind RCT identifying brain network correlates and predictors of esketamine’s perioperative antidepressant effect; and a systematic review/meta-analysis indicating fospropofol achieves comparable induction success to propofol with less injection pain and bradycardia but slower onset and more paresthesia/pruritus.
Research Themes
- Scalable behavioral interventions for perioperative and chronic pain management
- Neurobiological predictors of perioperative antidepressant response (esketamine)
- Anesthetic induction pharmacology and safety trade-offs (fospropofol vs propofol)
Selected Articles
1. Randomized controlled trial of medical assistant-coached behavioral intervention for chronic pain.
In adults with chronic spinal pain and fibromyalgia symptoms, a medical assistant–coached, resilience-enhanced digital CBT program (PRISM-CBT) did not outperform usual care at 8 weeks on the primary FIQR endpoint but produced superior long-term improvements, including sustained reductions in BPI pain interference and meaningful gains in global symptom burden up to 12 months. Benefits also exceeded those of standard CBT across multiple time points.
Impact: Demonstrates a scalable, low-resource behavioral intervention that yields durable pain-related benefits and could be integrated into perioperative and chronic pain pathways supported by anesthesiology-led services.
Clinical Implications: Anesthesiology and pain services can consider implementing medical assistant–coached digital CBT to reduce pain interference and improve long-term outcomes, while setting expectations that early (8-week) global symptom changes may be modest.
Key Findings
- No difference vs usual care on 8-week FIQR primary endpoint; by 12 months, PRISM-CBT improved FIQR by 7.4 points vs usual care.
- PRISM-CBT consistently reduced BPI pain interference vs usual care at 8 weeks, 6 months, and 12 months, and vs standard CBT at all time points.
- Pain severity improvements favored PRISM-CBT at 6 months vs usual care and at 12 months vs CBT.
Methodological Strengths
- Randomized, three-arm design with active comparator and usual care control
- Longitudinal follow-up to 12 months with consistent secondary outcome benefits
Limitations
- Primary endpoint at 8 weeks was negative, raising multiplicity concerns for secondary endpoints
- Potential expectation/performance bias due to challenges in blinding behavioral interventions
Future Directions: Confirm effectiveness in pragmatic, multi-center settings; evaluate perioperative integration and cost-effectiveness; identify patient subgroups most likely to benefit.
BACKGROUND: Chronic spinal pain with widespread symptoms often responds poorly to peripherally focused treatments. Cognitive-behavioral therapy (CBT) can help but typically yields modest effects. This trial evaluated whether adding resilience-enhancing activities to medical assistant-coached CBT (PRISM-CBT) improves outcomes. METHODS: Adults with spinal pain and fibromyalgia symptoms were randomized to PRISM-CBT (n=119), standard CBT (n=120), or usual care (UC; n=60). The primary outcome was the Fibromyalgia Impact Questionnaire-Revised (FIQR) global impact score at 8 weeks (0-100; higher=worse). Secondary outcomes were pain interference and pain severity measured with the Brief Pain Inventory (BPI) (0-10; higher=worse). RESULTS: The primary outcome showed no difference between PRISM-CBT and usual care at 8 weeks, with an adjusted between-group difference of 0.20 points (95% CI -4.81 to 5.20, p=0.939). Yet, by 12 months, PRISM-CBT demonstrated a 7.4-point greater improvement compared with usual care (95% CI 0.15 to 14.64, p=0.045) and a 4.8-point greater improvement versus CBT at 8 weeks (95% CI 0.00 to 9.57, p=0.050). PRISM-CBT produced the most consistent benefit in BPI pain interference. Compared with usual care, interference was lower by 0.88 points at both 8 weeks (95% CI 0.25 to 1.50, p=0.006) and 6 months (95% CI 0.23 to 1.54, p=0.009) and by 1.42 points at 12 months (95% CI 0.53 to 2.32, p=0.002). Compared with standard CBT, interference was lower at 8 weeks (0.98 points, 95% CI 0.38 to 1.57, p=0.001), 6 months (0.63 points, 95% CI 0.01 to 1.25, p=0.045), and 12 months (1.92 points, 95% CI 1.09 to 2.76, p<0.001). BPI pain severity also favored PRISM-CBT, with greater improvements of 0.56 points vs usual care at 6 months (95% CI 0.03 to 1.08, p=0.039) and 0.86 points vs CBT at 12 months (95% CI 0.19 to 1.53, p=0.011). CONCLUSIONS: This scalable, medical assistant-coached digital program shows promising benefits, including greater reductions in pain interference and a long-term improvement in global symptom burden, despite no difference at the primary endpoint.
2. Brain functional network correlates and predictors of the perioperative antidepressant effect of esketamine in breast cancer patients: a double-blind randomized controlled trial using resting-state fMRI and graph theory.
In a double-blind RCT of 35 breast cancer patients with preoperative depressive symptoms, intraoperative esketamine increased degree centrality of the left inferior frontal gyrus (opercular part) from baseline to postoperative day 1, correlating with improved depressive symptoms. Baseline global, nodal, and edge-level functional network measures predicted short- and long-term antidepressant responses to esketamine.
Impact: Links an intraoperative anesthetic intervention with measurable brain network changes and predictive biomarkers for antidepressant response, advancing perioperative psychiatry within anesthesiology.
Clinical Implications: Esketamine may be considered for perioperative mood management in selected patients; resting-state network metrics could inform precision selection once validated in larger cohorts.
Key Findings
- Esketamine increased degree centrality in the left inferior frontal gyrus (opercular part) from baseline to postoperative day 1, correlating with depressive symptom improvement.
- Baseline global, nodal, and edge-level network metrics predicted short- and long-term antidepressant response to esketamine.
- Placebo showed no significant network change over the same interval.
Methodological Strengths
- Double-blind randomized controlled design with placebo comparator
- Multimodal analysis integrating resting-state fMRI and graph theory metrics pre/post intervention
Limitations
- Small single-center sample (n=35) limits generalizability
- Short primary imaging follow-up (postoperative day 1) and clinical outcomes not powered for hard endpoints
Future Directions: Validate predictive network biomarkers in larger, multi-center perioperative cohorts; assess durability of clinical benefits and impacts on functional recovery and quality of life.
Postoperative depression adversely influences breast cancer patients' clinical outcomes. Our prior study demonstrated that intraoperative esketamine ameliorated postoperative depression in breast cancer patients, yet the underlying neural mechanism remains incompletely understood. We performed a double-blind randomized controlled trial in 35 breast cancer patients with preoperative depressive symptoms, who were randomly given intraoperative esketamine 0.25 mg·kg⁻¹ (n = 18) or saline placebo (n = 17) over the initial 40 min of anesthesia. Resting-state functional magnetic resonance imaging data were collected at preoperative baseline and postoperative day 1 follow-up to calculate brain functional network measures. In contrast to no significant change in the placebo group, the esketamine group showed increased degree centrality of the left inferior frontal gyrus, opercular part from baseline to follow-up, which was related to improvement in depressive symptoms. Additionally, we found significant associations of baseline network measures at the global, nodal, and edge levels with short-term and long-term improvements in depressive symptoms following esketamine administration. These findings may not only provide novel insights into the neural mechanism by which esketamine exerts its antidepressant efficacy during the perioperative period, but also highlight the prospect of functional network measures as useful predictors of antidepressant response to esketamine in patients with breast cancer.
3. Efficacy and safety of fospropofol disodium versus propofol for general anesthesia induction: a systematic review and meta-analysis.
Across nine RCTs, high-dose fospropofol disodium achieved similar induction success to propofol while markedly reducing injection pain and bradycardia. These advantages are offset by longer induction times and substantially higher rates of pruritus and paresthesia, suggesting a role in selected patients intolerant of propofol’s injection pain or at risk of bradycardia.
Impact: Provides quantitatively robust, trial-level evidence on a propofol prodrug’s benefit–risk profile for induction, informing drug selection and pre-induction counseling.
Clinical Implications: Consider fospropofol for patients at high risk of injection pain or bradycardia, while planning for slower onset and counseling about frequent paresthesia/pruritus; institutional protocols should reflect these trade-offs.
Key Findings
- Induction success comparable to propofol (RR 0.99; 95% CI 0.97–1.01).
- Significantly longer induction time (SMD 2.76; 95% CI 2.11–3.41).
- Reduced injection pain (RR 0.23) and bradycardia (RR 0.69).
- Higher pruritus (RR 20.57) and paresthesia (RR 21.36) rates.
- No significant differences in heart rate or mean arterial pressure changes; recovery time similar.
Methodological Strengths
- Comprehensive multi-database search including Western and Chinese sources with PROSPERO registration
- Cochrane Risk of Bias assessment and random-effects meta-analytic methods
Limitations
- Only nine RCTs with heterogeneous dosing regimens and outcome definitions
- Delayed onset and high rates of sensory adverse events may limit broad applicability; long-term safety remains unclear
Future Directions: Head-to-head, CONSORT-compliant RCTs to define optimal dosing, patient selection, and mitigation strategies for sensory AEs; evaluate peri-induction hemodynamic stability in high-risk subgroups.
BACKGROUND: Propofol is a widely used agent for general anesthesia induction, with well-established anesthetic efficacy. However, its use is frequently associated with adverse reactions such as injection pain and circulatory depression. Fospropofol disodium, a water-soluble prodrug of propofol, has the potential to alleviate these issues. This study aimed to systematically review and meta-analyze the differences in efficacy and safety between fospropofol disodium and propofol for general anesthesia induction. METHODS: A comprehensive search was conducted in PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang Data, VIP, and SinoMed, covering studies up to July 2025. Additional searches were performed in Google Scholar, ClinicalTrials.gov, and the Chinese Clinical Trial Registry (ChiCTR). Randomized controlled trials (RCTs) comparing fospropofol disodium and propofol for anesthesia induction were included. Data were analyzed using Review Manager 5.4 and Stata 15.1. Study quality was assessed using the Cochrane Risk of Bias tool. RESULTS: A total of nine RCTs were included. Compared to propofol, fospropofol disodium (≥ 20 mg/kg) showed no significant difference in induction success rate (RR = 0.99; 95% CI 0.97 to 1.01; P = 0.15; high-certainty), but was associated with a significantly longer anesthesia induction time (SMD = 2.76; 95% CI 2.11 to 3.41; P < 0.00001; moderate-certainty). No significant difference was observed in recovery time (SMD = 0.19; 95% CI - 0.27 to 0.64; P = 0.42; low-certainty). For hemodynamic change during induction, there were no significant differences in heart rate (MD = - 1.54; 95% CI -3.15 to 0.07; P = 0.06; moderate-certainty) or mean arterial pressure (MD = - 2.91; 95% CI - 6.55 to 0.74; P = 0.12; moderate-certainty). Regarding adverse event indicators, fospropofol disodium significantly reduced the incidence of injection pain and bradycardia (RR = 0.23; 95% CI 0.18 to 0.29; P < 0.00001; moderate- to high-certainty; RR = 0.69; 95% CI 0.56 to 0.86; P = 0.0008). However, it was associated with significantly higher rates of pruritus and paresthesia compared to propofol (RR = 20.57; 95% CI 9.78 to 43.27; RR = 21.36; 95% CI 12.01 to 38.01; P < 0.00001; high-certainty). CONCLUSIONS: This meta-analysis suggests that high-dose fospropofol disodium achieves a comparable induction success rate to propofol and provides clear advantages in reducing injection pain and bradycardia. However, these benefits should be weighed against its delayed onset and the markedly higher rates of paresthesia and pruritus. Overall, fospropofol disodium may serve as a feasible alternative for selected patients. Given the limited current evidence, further high-quality RCTs are needed to clarify its indications and long-term safety profile. Research registration This study was registered in PROSPERO (CRD420251110352).