Daily Anesthesiology Research Analysis

Postpartum blues (PPB) is considered a prodromal stage of postpartum depression. This randomized controlled trial evaluated the effectiveness of transcutaneous auricular vagus nerve stimulation (taVNS) in alleviating PPB following cesarean delivery. One hundred participants were randomly assigned to receive active (n = 50) or sham (n = 50) taVNS over 5 days, with outcomes monitored through three months postpartum. The primary outcome demonstrated a significantly smaller increase in visual analogue scale scores, reflecting PPB severity, after the mood induction procedure in the active group than in the sham group on postpartum day 5 (median difference, 4.13 cm; 95% CI, 3.39-4.93; mixed-effects model, p < 0.001). The taVNS also significantly improved general postpartum mood on day 5, as assessed by Profile of Mood States (mixed-effects model, p < 0.001) and Stein Maternity Blues Scale (p < 0.001). At 1 month postpartum, the proportion of participants with Edinburgh Postnatal Depression Scale scores ≥13 was lower in the active group than in the sham group (4% vs. 26%; p = 0.003). Active taVNS also lowered postoperative pain scores at 4, 12, 24, 48, and 72 h (all p < 0.001) and improved sleep quality (assessed by the Richards-Campbell Sleep Questionnaire) on postoperative days 1 to 4 (all p < 0.001). These findings indicated that a 5-day taVNS intervention mitigated PPB severity after cesarean delivery and were associated with improved general mood, lower rates of Edinburgh Postnatal Depression Scale scores ≥13 at 1 month postpartum, reduced acute postoperative pain, and improved sleep quality. Chinese Clinical Trial Registry (https://www.chictr.org.cn/indexEN.html), ChiCTR2500108903.

BACKGROUND: Although neuromuscular blockade reduces oculocardiac reflex (OCR) incidence compared with no neuromuscular blockade, the effect of blockade depth on OCR has not been prospectively evaluated. This study aimed to evaluate whether the depth of neuromuscular blockade influences the incidence of the OCR during pediatric strabismus surgery. METHODS: In this prospective, double-blinded randomized controlled trial, 204 pediatric patients aged 3 to 18 years undergoing strabismus surgery under general anesthesia were randomly assigned to moderate-to-deep neuromuscular blockade (MD-NMB; train-of-four count 0-3) or minimal-to-shallow neuromuscular blockade (MS-NMB; train-of-four count 4 with ratio <0.9). The primary outcome was the incidence of OCR grade ≥2, defined as a ≥20% decrease in heart rate from baseline. Secondary outcomes included severe OCR (grade ≥3, defined as a ≥30% decrease in heart rate), as well as the magnitude and duration of heart rate reduction. RESULTS: A total of 201 patients were analyzed (MS-NMB, n=102; MD-NMB, n=99). The incidence of OCR grade ≥2 was lower in the MD-NMB group compared with the MS-NMB group (30.3% vs. 53.9%; odds ratio [OR] 0.37; 95% confidence interval [CI] 0.21-0.66; p = 0.001). OCR grade ≥3 was also reduced in the MD-NMB group (18.2% vs. 35.3%; OR 0.41, 95% CI 0.21-0.78; p = 0.007). Among patients who developed OCR, the magnitude (34.3% [26.9-42.6%] vs. 28.0% [18.2-35.9%]; p=0.003) and duration (46.0s [30.3-65.8s] vs. 37.0s [17.0-49.5s]; p=0.024) of heart rate reduction were smaller in the MD-NMB group. CONCLUSIONS: Moderate to deep neuromuscular blockade significantly reduced both the incidence and severity of OCR during pediatric strabismus surgery compared with minimal to shallow blockade. These findings suggest that deeper neuromuscular blockade may represent an effective strategy to attenuate OCR during extraocular muscle manipulation.

BACKGROUND AND OBJECTIVES: Endovascular thrombectomy (EVT) improves outcome in acute ischemic stroke (AIS) due to large vessel occlusion, yet the optimal anesthetic strategy remains controversial. Previous meta-analyses using frequentist methods reported no significant differences between general anesthesia (GA) and non-GA techniques; however, a recently published trial reported a high posterior probability of functional benefit with GA. We aimed to update the existing systematic review and to re-examine the cumulative randomized evidence using Bayesian statistical methods. METHODS: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed/MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to January 3, 2026, for randomized controlled trials (RCTs) comparing GA with non-GA strategies during EVT in adults with AIS. Primary outcomes were functional independence (modified Rankin Scale [mRS] 0-2) at 90 days, successful reperfusion (thrombolysis in cerebral ischemia 2b-3), and 90-day mortality. Bayesian random-effects meta-analyses with weakly informative priors were performed. Results are reported as odds ratio (OR) or mean difference (MD) with 95% credible intervals (CrIs). A posterior probability of superiority exceeding 80% was considered substantial evidence of benefit. Meta-regression and sensitivity analyses were conducted. RESULTS: Ten RCTs (n = 1,601; mean age 70.0 years; 46.6% female) were included. For functional independence, GA was associated with a 94.2% posterior probability of superiority (OR 1.24, 95% CrI 0.94-1.66). GA was associated with higher successful reperfusion rates (OR 1.73, 95% CrI 1.23-2.43; P (superiority) > 99%). No substantial differences were observed for 90-day mortality (OR 0.92, 95% CrI 0.67-1.27; P [superiority] 69%), excellent functional outcome (mRS 0-1; OR 1.06, 95% CrI 0.80-1.41; P [superiority] 67%), or symptomatic intracranial hemorrhage (OR 0.93, 95% CrI 0.56-1.52; P [superiority] 62%). GA was associated with increased intraoperative hypotension (OR 4.28, 95% CrI 2.35-7.86; P [superiority] 0.01%) and increased pneumonia risk (OR 1.60, 95% CrI 0.95-2.81; P [superiority] 3%). DISCUSSION: This meta-analysis using a Bayesian approach provides evidence that GA during EVT for AIS is associated with improved functional outcomes, challenging previous conclusions of equivalence. These findings should be interpreted considering open-label designs and heterogeneous non-GA comparators. They suggest that GA may be preferred but confirmatory evidence is needed.