Daily Anesthesiology Research Analysis

BACKGROUND: Older adults often have impaired physiologic reserve and are at higher risk for postoperative complications after spinal fusion surgery. OBJECTIVE: To evaluate the efficacy of multimodal prehabilitation plus Enhanced Recovery After Surgery (PREERAS) versus ERAS alone on 90-day postoperative complications in older adults undergoing elective spinal fusion. DESIGN: Multicenter, open-label, assessor-blinded, 1:1 parallel-group randomized controlled trial. (ClinicalTrials.gov: NCT06140797). SETTING: 3 tertiary hospitals in China. PARTICIPANTS: Adults aged 75 years or older undergoing elective spinal fusion surgery between May 2024 and May 2025. INTERVENTION: Participants were randomly assigned to receive either preoperative Vivifrail-based, multimodal PREERAS (PREERAS group) or ERAS alone (ERAS group). The 4-week prehabilitation program integrated supervised group sessions, Vivifrail multicomponent exercise, nutritional optimization, and psychological interventions. MEASUREMENTS: The primary outcome was the occurrence of any postoperative complication within 90 days of surgery, recorded and graded per the Clavien-Dindo classification system. RESULTS: A total of 312 patients were assessed for eligibility, with 164 randomly assigned. Of the 159 patients included in the final analysis (mean age, 78.7 years; 59% women), 59 patients (74.7%) in the PREERAS group and 73 patients (91.2%) in the ERAS group experienced at least 1 complication (risk ratio, 0.80 [95% CI, 0.67 to 0.95]; risk difference, -18.0% [CI, -27.0% to -9.0%]). LIMITATIONS: Unblinded participants and clinicians. Generalizability may be limited with longer hospital stays in the Chinese health care system. CONCLUSION: The implementation of multimodal prehabilitation in 3 tertiary hospitals in China reduced 90-day postoperative complications in older adults undergoing enhanced recovery after spinal fusion surgery. However, individual sites will need to consider applicability of findings and resource requirements of prehabilitation before implementation. PRIMARY FUNDING SOURCE: Capital's Funds for Health Improvement and Research.

BACKGROUND: Postoperative delirium (POD) is an acute neuropsychiatric syndrome that occurs following surgery, characterized by inattention and broader cognitive deficits. This study aimed to synthesize randomized evidence on perioperative strategies that prevent POD in elderly patients undergoing orthopaedic surgery. METHODS: We conducted a Bayesian network meta-analysis of randomised controlled trials (RCTs) retrieved from PubMed, Embase, Web of Science, and Cochrane Library from inception to March 2026. Eligible trials enrolled adults aged 60 years or older undergoing orthopaedic surgery and reported POD incidence with validated assay assessments. Risk ratios (RR) and mean differences with 95% Credible Interval (CrI) were estimated. The risk of bias was assessed using the Cochrane tool, and the certainty of the evidence was evaluated with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation). RESULTS: 79 RCTs comprising 16,012 patients were included. Compared with placebo, dexmedetomidine (RR 0.49, 95% CrI 0.39-0.61) has the most consistent evidence for reducing the risk of POD incidence, while ketamine (RR 0.39, 95% CrI 0.23-0.64), rivastigmine (RR 0.33, 95% CrI 0.16-0.65), olanzapine (RR 0.35, 95% CrI 0.17-0.71), and lidocaine (RR 0.41, 95% CrI 0.21-0.77) showed promising but heterogeneous benefits across current literature. Evidence for analgesic and anaesthetic interventions was limited. CONCLUSION: Dexmedetomidine offers the most substantial evidence for lowering POD incidence after orthopaedic surgery in elderly; ketamine, rivastigmine, olanzapine, and lidocaine warrant further evaluation. High-quality, low-bias RCTs are needed to verify the effects of specific analgesic or anaesthetic regimens on POD occurrence. TRANSLATIONAL POTENTIAL STATEMENT: This network meta-analysis highlights the promising translational potential of dexmedetomidine in preventing POD for elderly orthopaedic patients. Dexmedetomidine emerges as the most reliable option for immediate clinical adoption, while ketamine, rivastigmine, olanzapine, and lidocaine show promise but require confirmatory trials before routine use. The findings set the stage for personalized anaesthetic protocols that minimize POD and its associated morbidity and healthcare costs.

INTRODUCTION: Reliable continuous non-invasive blood pressure monitoring technology should support clinicians to maintain blood pressure within appropriate limits peri-operatively. Previous studies have shown conflicting results regarding measurement accuracy. METHODS: This systematic review and six meta-analyses evaluated the accuracy and precision of non-invasive continuous arterial blood pressure measurement technologies (volume clamp technology, applanation tonometry and photoplethysmography) compared with invasive arterial measurement in adults. We analysed pooled bias (mean difference between non-invasive and invasive measurement), standard deviation and limits of agreement. In each meta-analysis, mean arterial pressure (MAP), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were analysed separately. Acceptability was defined according to Association for the Advancement of Medical Instrumentation® (AAMI) criteria. RESULTS: Sixty-five studies were included: two meta-analyses for volume clamp technology (ClearSight™, CNAP™); three meta-analyses for applanation tonometry (T-Line™, Vasotrac™ and N-CAT™); and one meta-analysis for photoplethysmography technology. For volume clamp technologies, none met AAMI criteria for bias and SD in relation to MAP, SBP and DBP. T-Line, Vasotrac and N-CAT met the AAMI criteria for bias for MAP (2.53 mmHg, 0.36 mmHg, -0.37 mmHg), SBP (-0.07 mmHg, 1.20 mmHg, -3.68 mmHg) and DBP (3.09 mmHg, 1.09 mmHg, 0.84 mmHg), respectively. In terms of standard deviation, only N-CAT (MAP 6.97 mmHg, SBP 7.14, mmHg, DBP 6.55 mmHg) met AAMI criteria for all blood pressure parameters. Photoplethysmography technology met AAMI criteria for bias (MAP -0.09 mmHg, SBP 0.49 mmHg, DBP -0.26 mmHg) and standard deviation (MAP 6.86 mmHg, DBP 6.38 mmHg). DISCUSSION: Overall, the AAMI criteria for bias and SD were not fulfilled for most of the devices tested and wide limits of agreement are of concern. One applanation tonometry device (N-CAT) shows promise. Clinicians should be aware of the lack of interchangeability with invasive blood pressure management. WHAT WE DID: Researchers looked at 65 studies that tested different non‐invasive machines used to measure blood pressure continuously. They compared these machines with the standard invasive method (putting a tube into an artery), which is usually more accurate. The technologies studied included volume clamp devices, applanation tonometry devices and photoplethysmography devices. The researchers checked how close the non‐invasive readings were to the invasive readings. WHY DID WE DO IT: Doctors need accurate blood pressure readings during and after surgery so they can keep patients safe. New non‐invasive machines are easier and safer to use, but it is important to know whether they are accurate enough to replace invasive monitoring. The researchers wanted to find out which devices worked best. WHAT WE FOUND: Most of the non‐invasive devices were not accurate enough to fully match the standard invasive method. Some devices gave readings that were too different from the invasive readings, which could make treatment decisions harder. One device called N‐CAT performed better than most others and showed promising results. Overall, the study found that doctors should be careful when using these non‐invasive devices because they may not always give the same results as invasive blood pressure monitoring.