Daily Anesthesiology Research Analysis
Analyzed 39 papers and selected 3 impactful papers.
Summary
The most impactful studies addressed scalable perioperative evidence generation, potential harms of therapeutic coma in non-convulsive status epilepticus, and evidence-based optimization of regional analgesia after laparoscopic cholecystectomy. Collectively, these papers emphasize adaptive trial infrastructure, careful reassessment of entrenched interventions, and clinically meaningful improvements in postoperative recovery.
Research Themes
- Adaptive platform trials for perioperative complication prevention
- Safety and effectiveness of anesthetic-induced therapeutic coma
- Regional anesthesia and postoperative recovery
Selected Articles
1. A perioperative medicine platform trial (PROMPT) evaluating interventions to reduce the risk of infection and other major complications after surgery: rationale and design.
PROMPT is a multicentre Bayesian adaptive platform trial designed to evaluate multiple perioperative interventions against surgical site infection and other major postoperative complications. Its master protocol permits interventions to be added, replaced, or stopped as evidence accumulates, while incorporating patient-centered outcomes such as quality of recovery and days alive and at home.
Impact: This study provides a reusable infrastructure for rapidly testing successive perioperative interventions rather than conducting isolated, slow, single-question trials. Its adaptive design could accelerate translation of reliable evidence into surgical and anesthesiology practice while identifying ineffective or harmful treatments.
Clinical Implications: PROMPT may establish a more efficient framework for evaluating oxygen strategies, infection-prevention measures, and other perioperative interventions across diverse surgical populations. Its results could inform future guidelines, although the present publication describes the protocol rather than clinical outcomes.
Key Findings
- PROMPT is a multicentre Bayesian adaptive platform trial with a master protocol and domain-specific appendices.
- The design can determine superiority, efficacy, equivalence, inferiority, harm, or futility and can incorporate new interventions over time.
- The primary outcome is surgical site infection through 30 days, with additional outcomes including major complications, quality of recovery, and days alive and at home.
Methodological Strengths
- Adaptive platform architecture enables efficient comparison and replacement of multiple interventions within a common infrastructure.
- Bayesian decision rules explicitly accommodate benefit, harm, futility, and equivalence rather than focusing only on superiority.
- The protocol includes clinically meaningful patient-centered outcomes in addition to infection outcomes.
Limitations
- This publication reports rationale and design, so effectiveness and safety results are not yet available.
- The first intervention and subsequent domain-specific interventions may have different eligibility criteria and outcome structures, which can complicate cross-domain interpretation.
- The protocol does not establish whether the platform will recruit rapidly enough to provide timely conclusions across all planned domains.
Future Directions: The priority is completion and transparent reporting of the first and subsequent platform domains, with prespecified adaptation rules, subgroup analyses, and sharing of statistical code and aggregate data where feasible. External validation across health systems and surgical settings will determine the generalizability of the platform.
BACKGROUND: Platform trials are an extremely powerful, cost-effective innovation in clinical trial design and evidence-to-practice translation. As questions are answered progressively, additional new interventions, within the same or new domains, are substituted into the platform. This design is ideal for evaluation of interventions aiming to reduce surgical site infection, which remains the most common serious complication after surgery. OBJECTIVE: To efficiently identify effective, ineffective, or harmful treatments to reduce the incidence of perioperative infections and other major complications after surgery. STUDY DESIGN: Perioperative medicine adaptive platform trial (PROMPT) is a multicentre, Bayesian adaptive platform trial designed to reach conclusions regarding superiority, efficacy, equivalence, inferiority, harm, or futility.
2. Therapeutic coma in non-convulsive status epilepticus is associated with increased complications and mortality: a retrospective cohort study.
In 283 patients with non-convulsive status epilepticus, 111 received therapeutic coma with continuous intravenous and/or inhalational anesthetics. After inverse probability treatment weighting, therapeutic coma was associated with markedly higher odds of pneumonia, sepsis, arrhythmia, acute renal failure, renal replacement therapy, and cardiopulmonary resuscitation, as well as higher mortality and longer intensive care, without improved short-term seizure termination.
Impact: This study provides an important negative safety signal for a widely used escalation strategy whose benefit in non-convulsive status epilepticus is uncertain. The findings challenge routine anesthetic-induced coma and support more selective, individualized treatment decisions and prospective evaluation.
Clinical Implications: Clinicians should not assume that therapeutic coma improves outcomes in NCSE. When used, the decision should account for severity, treatment resistance, goals of care, and the substantial risks of infection, cardiovascular instability, renal injury, prolonged intensive care, and death.
Key Findings
- Among 283 patients with NCSE, 111 patients received therapeutic coma.
- After propensity-based inverse probability weighting, therapeutic coma was associated with pneumonia, sepsis, arrhythmias, acute renal failure, renal replacement therapy, and cardiopulmonary resuscitation.
- Therapeutic coma was associated with higher in-hospital mortality, longer ICU stay, and lower observed NCSE termination than non-coma management.
Methodological Strengths
- The cohort included a clinically relevant tertiary-care population and assessed multiple predefined medical complications.
- Inverse probability treatment weighting was used to address confounding by indication, a major challenge in observational treatment comparisons.
- The study evaluated both effectiveness and patient-important harms rather than focusing only on seizure termination.
Limitations
- The retrospective design cannot eliminate residual confounding, including differences in baseline neurological severity and treatment selection.
- The single-center setting may limit generalizability to other intensive care systems and patient populations.
- Therapeutic coma was not assigned randomly, and the reported association should not be interpreted as definitive proof of causation.
Future Directions: Prospective multicentre comparative-effectiveness studies should define which NCSE phenotypes, if any, benefit from anesthetic coma and should use standardized seizure, neurological, functional, and patient-centered outcomes. Pragmatic randomized or carefully emulated target-trial designs may be appropriate when ethically feasible.
INTRODUCTION: While therapeutic coma is an established escalation strategy in generalized convulsive status epilepticus, evidence for benefit in non-convulsive status epilepticus (NCSE) is limited and treatment-related complications may affect outcome. METHODS: We performed a retrospective cohort study of patients with NCSE treated at a tertiary hospital. Patients were classified according to receipt of therapeutic coma, defined as continuous intravenous and/or inhalational anesthetic administration for seizure control. The primary outcome was the occurrence of predefined clinically relevant in-hospital medical complications, including pneumonia, sepsis, cardiac arrhythmias, acute renal failure, renal replacement therapy, venous thromboembolism and cardiopulmonary resuscitation.
3. Efficacy and safety of laparoscopic-guided transversus abdominis plane block versus port-site local anesthetic infiltration in laparoscopic cholecystectomy: A systematic review, meta-analysis, and trial sequential analysis.
This PRISMA-conducted, prospectively registered review included eight randomized controlled trials with 711 patients undergoing laparoscopic cholecystectomy. Laparoscopic-guided transversus abdominis plane block reduced pain scores at 1, 3, 6, and 24 hours and modestly shortened hospital stay, while no clear differences were found in rescue analgesia, shoulder pain, postoperative nausea and vomiting, or discharge within 24 hours.
Impact: The study synthesizes randomized evidence for a technically attractive regional technique and confirms a consistent early analgesic benefit. Its use of trial sequential analysis and certainty grading helps distinguish robust early pain findings from outcomes that remain underpowered or heterogeneous.
Clinical Implications: LTAP block is a reasonable option for improving early pain control after laparoscopic cholecystectomy, particularly when early opioid-sparing analgesia is desired. Clinicians should recognize that evidence for reduced opioid use, shoulder pain, nausea, and same-day discharge remains less certain.
Key Findings
- Eight randomized controlled trials involving 711 patients were included.
- LTAP block significantly reduced pain scores at 1, 3, 6, and 24 hours compared with port-site infiltration.
- No significant differences were observed for operative time, shoulder pain, rescue analgesia, postoperative nausea and vomiting, or discharge within 24 hours; hospital stay was modestly shorter with LTAP.
Methodological Strengths
- The review was prospectively registered and conducted according to PRISMA 2020 with independent risk-of-bias assessment using RoB 2.
- Randomized controlled trials were synthesized with random-effects models, certainty grading, and trial sequential analysis.
- Sensitivity analyses addressed substantial heterogeneity in selected pain outcomes.
Limitations
- Only eight trials and 711 participants were available, limiting precision for several secondary outcomes.
- Substantial heterogeneity was present for some pain outcomes, and the included studies differed in unilateral versus bilateral LTAP techniques.
- The review does not establish the optimal local anesthetic dose, block approach, operator experience, or comparative cost-effectiveness.
Future Directions: Future multicentre randomized trials should standardize LTAP technique, local anesthetic dosing, co-analgesia, and enhanced-recovery pathways while measuring opioid consumption, functional recovery, adverse events, and patient-reported outcomes. Larger trials should also clarify whether LTAP improves same-day discharge and overall cost-effectiveness.
BACKGROUND: Postoperative pain following laparoscopic cholecystectomy remains a major clinical concern, and the optimal method of local anesthetic delivery is unresolved. This systematic review and meta-analysis evaluated the efficacy and safety of laparoscopic-guided transversus abdominis plane (LTAP) block versus port-site local anesthetic infiltration for reducing pain, opioid use, and improving recovery in patients undergoing LC. METHODS: This review was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and was prospectively registered on the International Prospective Register of Systematic Reviews (CRD420261344930). PubMed, Embase, and the Cochrane Library were searched from inception to March 2026, without language restriction, for randomized controlled trials (RCTs) comparing LTAP block with standard port-site local anesthetic infiltration in adults undergoing LC.