Daily ReportAug 15, 2026
Anesthesiology, August 15 edition
We read 17 papers and selected 3.
Summary
The strongest studies were a randomized trial showing that intraoperative esketamine improved postoperative sleep, pain, and depressive symptoms after cesarean delivery, a randomized non-inferiority trial comparing ciprofol with propofol, and a systematic review of non-pharmacological strategies for dental anxiety. Collectively, these papers support broader perioperative outcome assessment beyond intraoperative hemodynamics, while also highlighting the need for larger multicenter trials and stronger implementation evidence.
Research Themes
- Patient-centered postoperative recovery
- New intravenous anesthetic agents
- Non-pharmacological anxiety management
Selected Articles
1. The effect of esketamine on sleep disorders in parturients undergoing cesarean section under general anesthesia: a single-center, randomized, double-blind, placebo-controlled prospective study.
In this single-center randomized, double-blind, placebo-controlled trial of 140 parturients, continuous intraoperative esketamine infusion after delivery reduced postoperative sleep-disorder measures at 3 and 7 days. The intervention also improved pain scores and postpartum depressive symptom outcomes without a reported increase in maternal-neonatal complications.
Impact: The study addresses clinically important but often neglected postoperative outcomes—sleep and postpartum mental health—in addition to analgesia. Its randomized, blinded design provides an important signal that esketamine may have multidimensional perioperative benefits in obstetric anesthesia.
Clinical Implications: Esketamine may be considered as an adjunct to multimodal perioperative care for selected parturients at risk of postoperative pain, sleep disturbance, or depressive symptoms. Routine adoption should await confirmation of dosing, breastfeeding and neonatal safety, and longer-term psychiatric outcomes in multicenter studies.
Key Findings
- A total of 140 parturients were randomized 1:1 to esketamine or placebo.
- Esketamine reduced postoperative sleep-disorder incidence and improved PSQI and sleep-related NRS outcomes at postoperative days 3 and 7.
- Pain scores and postpartum depression incidence were lower in the esketamine group, with no reported increase in maternal-neonatal complications.
Methodological Strengths
- Prospective randomized, double-blind, placebo-controlled design
- Registration of the clinical trial and assessment of sleep, pain, depressive symptoms, and safety outcomes
Limitations
- Single-center study with a relatively modest sample size
- Short follow-up limited to the early postoperative period, leaving long-term maternal mental-health and neonatal outcomes uncertain
Future Directions: Multicenter trials should evaluate dose-response relationships, breastfeeding exposure, neonatal neurobehavioral safety, longer-term postpartum depression, and whether benefits persist when esketamine is integrated with neuraxial or opioid-sparing anesthesia protocols.
BACKGROUND: This study evaluated the primary effect of esketamine on postoperative sleep disorder (PSD) at 3 days after surgery, as well as its secondary effects on pain and depressive symptoms.\nMETHODS: A total of 140 parturients who underwent elective cesarean delivery under general anesthesia were enrolled and randomized 1:1 to the esketamine or placebo group. After delivery, blinded anaesthesiologists administered a continuous infusion of esketamine (0.3 mg/kg/h) or an equal volume of normal saline. We compared baseline data, anesthesia/surgery indicators, postoperative PSQI scores, sleep NRS scores, incidences of PSD, pain NRS scores and postpartum depression (EPDS) between the groups.
2. Comparison of Ciprofol and Propofol on Postoperative Quality of Recovery and Intraoperative Cerebral Oxygen Saturation in Patients Undergoing Thoracoscopic Thoracic Surgery: A Randomized, Double-Blind, Non-Inferiority Trial.
Among 94 patients undergoing thoracoscopic thoracic surgery, ciprofol was non-inferior to propofol for the 24-hour QoR-15 score in this randomized, double-blind non-inferiority trial. Ciprofol was additionally associated with less injection pain, lower vasopressor requirements, and better maintenance of regional cerebral oxygen saturation.
Impact: The trial evaluates a newer intravenous anesthetic against the current reference agent using patient-centered recovery and cerebral oxygenation outcomes rather than induction characteristics alone. The findings support further investigation of ciprofol in patients vulnerable to hemodynamic or cerebral oxygenation disturbances.
Clinical Implications: Ciprofol may be an alternative induction and maintenance agent when preservation of cerebral oxygenation, reduced injection pain, or lower vasopressor use is clinically desirable. The results should not yet be generalized to other surgeries or high-risk populations without external validation.
Key Findings
- Ninety-four patients were randomized equally to ciprofol or propofol, with 88 completing the study.
- Ciprofol was non-inferior to propofol for the global QoR-15 score at 24 hours after surgery.
- Ciprofol reduced injection pain and vasopressor requirements and better maintained intraoperative regional cerebral oxygen saturation.
Methodological Strengths
- Randomized, double-blind, active-controlled non-inferiority design
- Predefined patient-centered primary outcome with additional cerebral oxygenation and hemodynamic measures
Limitations
- Single-center study with a small analyzed sample of 88 completers
- Findings may be specific to thoracoscopic thoracic surgery and the selected patient population
Future Directions: Larger multicenter trials should compare ciprofol with propofol across diverse procedures and high-risk groups, assess cost-effectiveness and recovery beyond 48 hours, and determine whether improved cerebral oxygenation translates into fewer postoperative neurocognitive complications.
PURPOSE: Ciprofol provides more stable induction, though its impact on patients' quality of recovery (QoR) and brain oxygenation requires clarification. This trial assessed whether propofol anesthesia is non-inferior to ciprofol regarding postoperative recovery quality, while additionally comparing their effects on intraoperative cerebral oxygenation.\nPATIENTS AND METHODS: This single-center, randomized, double-blind, non-inferiority study involved 94 patients scheduled for elective surgery, randomized equally to receive ciprofol (Group C) or propofol (Group P). The primary outcome was the global QoR-15 score measured 24 hours after surgery, with a non-inferiority threshold set at -6.0. Secondary outcomes included 48-hour QoR-15 scores, injection pain frequency, vasopressor requirements, and regional cerebral oxygen saturation (rScO
3. Non-pharmacological and physical strategies for managing dental anxiety: a systematic review with implications for dental education.
This systematic review synthesized 126 studies evaluating technological, physical, sensory-relaxation, and digital interventions for dental anxiety in children and adults. The strongest evidence supported computer-controlled anesthesia systems, while aromatherapy, laser-based approaches, and audiovisual distraction had moderate-certainty support; many other interventions remained limited by methodological weaknesses.
Impact: Dental anxiety is a major determinant of avoidance of oral healthcare, yet management often relies on pharmacological sedation. By organizing evidence across multiple non-pharmacological and technology-assisted strategies, this review provides an implementation-oriented framework for patient-centered dental anesthesia and education.
Clinical Implications: Dental services can consider computer-controlled local anesthesia, audiovisual distraction, relaxation techniques, and selected sensory interventions as components of individualized anxiety-management pathways. Interventions should be matched to patient age, anxiety severity, feasibility, and local expertise, while avoiding assumptions of uniform benefit because certainty varies across modalities.
Key Findings
- The review included 126 studies identified through searches of four major databases and Google Scholar.
- Computer-controlled anesthesia systems had the strongest supporting evidence for reducing dental anxiety.
- Moderate-certainty evidence supported aromatherapy, laser-based interventions, and audiovisual distraction, whereas many other interventions had limited-certainty evidence.
Methodological Strengths
- Broad systematic search covering studies from 1971 through 2024 and multiple intervention categories
- Independent study selection and data extraction by two reviewers with certainty assessment using the GRADE framework
Limitations
- The included evidence combined randomized, quasi-experimental, and observational studies with heterogeneous interventions and outcomes
- Many primary studies had methodological weaknesses, limiting certainty regarding long-term effectiveness and implementation
Future Directions: Future research should use standardized anxiety and cooperation outcomes, adequately powered pragmatic randomized trials, longer follow-up, and implementation and cost-effectiveness analyses. Studies should also identify which interventions work best for specific age groups and anxiety phenotypes.
OBJECTIVES: Dental anxiety remains a significant barrier to effective oral healthcare, contributing to treatment avoidance and poorer clinical outcomes. This systematic review aimed to evaluate the effectiveness of non-pharmacological and physical interventions in reducing dental anxiety and improving patient cooperation.\nMETHODS: A systematic search was conducted in PubMed/MEDLINE, Scopus, Dentistry & Oral Sciences Source, and Google Scholar for studies published between 1971 and 2024. Randomized controlled trials, quasi-experimental, and observational studies assessing non-pharmacological or technology-assisted interventions in children and adults were included. Study selection and data extraction were performed independently by two reviewers. The certainty of evidence was assessed using the GRADE framework.