Daily ReportSep 25, 2026
Anesthesiology, September 25 edition
We read 25 papers and selected 3.
Summary
Today’s most impactful studies evaluated clinically actionable anesthesia strategies using randomized or evidence-synthesis designs. Fospropofol reduced early postoperative nausea and vomiting compared with propofol, virtual reality lowered perioperative anxiety and medication requirements, and emergency-department sedation appeared feasible for selected pediatric forearm fracture reductions, although the latter evidence was limited by observational bias.
Research Themes
- Pharmacologic prevention of postoperative nausea and vomiting
- Non-pharmacologic perioperative anxiety and pain management
- Emergency-department procedural sedation and healthcare efficiency
Selected Articles
1. Fospropofol vs Propofol for Early Postoperative Nausea and Vomiting Prophylaxis in High-Risk Patients Undergoing Gynecological Laparoscopic Surgery: A Randomized Controlled Trial.
In this prospective randomized trial of 102 high-risk patients undergoing gynecological laparoscopy, fospropofol was compared with propofol for induction and maintenance alongside sevoflurane anesthesia. Early postoperative nausea and vomiting within 6 hours occurred less frequently with fospropofol, with an absolute risk reduction of 13.7%.
Impact: This is a randomized clinical comparison addressing a common and patient-important anesthesia outcome. The observed reduction in early postoperative nausea and vomiting supports further evaluation of fospropofol as an alternative anesthetic with potential antiemetic advantages.
Clinical Implications: Fospropofol may be considered as an induction and maintenance option for selected patients at high risk of postoperative nausea and vomiting, particularly in gynecological laparoscopic surgery. Confirmation in larger, multicenter trials with longer follow-up and cost-effectiveness analyses is needed before routine substitution for propofol.
Key Findings
- The trial enrolled 102 high-risk female patients with an Apfel score of at least 3.
- Postoperative nausea and vomiting at 6 hours occurred in 5.9% of the fospropofol group versus 19.6% of the propofol group.
- The absolute risk reduction was 13.7%, suggesting a clinically relevant early antiemetic effect.
Methodological Strengths
- Prospective randomized controlled design with a clearly defined high-risk population.
- Direct comparison of fospropofol and propofol using a clinically relevant postoperative endpoint.
Limitations
- The sample size was modest and the study was limited to female patients undergoing gynecological laparoscopy.
- The primary assessment focused on early postoperative outcomes within 6 hours, limiting conclusions about prolonged benefit and adverse effects.
Future Directions: Larger multicenter randomized trials should evaluate diverse surgical populations, dose-response relationships, adverse effects, recovery quality, and cost-effectiveness, while comparing fospropofol with multimodal prophylaxis strategies.
BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication of gynecological laparoscopic surgeries. Although propofol has established antiemetic properties, the efficacy of its water-soluble prodrug, fospropofol, for PONV prophylaxis remains uncertain. The aim of this study was to compare the impact of fospropofol versus propofol on the incidence of PONV in high-risk patients undergoing gynecological laparoscopic surgery. METHODS: In this prospective randomized controlled trial, 102 high-risk (Apfel score ≥3) female patients scheduled for elective gynecological laparoscopy were allocated to receive either fospropofol (FD group, n=51) or propofol (P group, n=51).
2. Virtual Reality for Anxiety and Pain Management in Lower Limb Orthopedic Surgery Under Spinal Anesthesia: A Randomized Controlled Trial.
This prospective randomized single-blind trial evaluated perioperative virtual reality in patients undergoing lower-limb orthopedic surgery under spinal anesthesia. Among 120 patients included in the final analysis, virtual reality reduced postoperative anxiety, intense anxiety, sedative requirements, postoperative nausea and headaches, and improved satisfaction.
Impact: The study supports a low-risk, non-pharmacological intervention that may improve the patient experience during regional anesthesia. Its potential to reduce sedative exposure is particularly relevant to ambulatory surgery and enhanced recovery pathways.
Clinical Implications: Perioperative virtual reality can be considered as an adjunct for anxiety management in selected patients receiving spinal anesthesia, especially when minimizing sedative medication is desirable. Standardized content, screening for motion sickness or cybersickness, and integration with routine monitoring should be addressed before widespread implementation.
Key Findings
- The study randomized 160 patients, with 60 patients per group included in the final analysis.
- Intense postoperative anxiety occurred less often in the virtual reality group than in controls, at 25% versus 50%.
- Virtual reality was associated with lower sedative requirements, fewer postoperative nausea and headache symptoms, and higher satisfaction.
Methodological Strengths
- Prospective randomized and single-blind design with trial registration in two clinical trial registries.
- Assessment included patient-centered anxiety outcomes as well as medication use, complications, and satisfaction.
Limitations
- The single-center design, incomplete final analysis, and relatively small analyzed sample may limit generalizability.
- Blinding participants and anesthesia teams to virtual reality exposure is difficult, which may introduce performance and expectation bias.
Future Directions: Future multicenter trials should use standardized virtual reality protocols, assess longer-term anxiety and pain outcomes, evaluate cost-effectiveness, and identify patients most likely to benefit.
BACKGROUND AND AIMS: Patients undergoing lower limb orthopedic surgery under spinal anesthesia often experience significant perioperative anxiety and discomfort. Virtual reality (VR) has emerged as a promising non-pharmacological intervention for anxiety and pain management. This study aimed to investigate the efficacy of VR as a complementary method for improving perioperative anxiety and pain management in patients undergoing lower limb orthopedic surgery under spinal anesthesia. METHODS: This prospective, single-center, randomized, single-blind trial included two groups: a VR group, receiving perioperative VR exposure, and a control group with standard care. The primary outcome was perioperative anxiety reduction measured using the State-Trait Anxiety Inventory-6 (STAI-6).
3. Emergency Department Procedural Sedation Versus Operating-Theater General Anesthesia for Closed Reduction of Pediatric Forearm Fractures: A Systematic Review.
This PRISMA 2020 systematic review included six observational studies, including four direct comparative studies involving 958 children. Emergency-department procedural sedation generally shortened treatment and hospital utilization, but evidence for redisplacement and repeat intervention was inconsistent and most studies had high risk of bias.
Impact: The review addresses a common emergency and anesthesia workflow question with implications for operating-room capacity, admission avoidance, and timely pediatric care. It also appropriately tempers implementation enthusiasm by documenting substantial confounding and heterogeneous protocols.
Clinical Implications: Selected children with displaced or angulated forearm fractures may undergo closed reduction with emergency-department procedural sedation when appropriate expertise, monitoring, rescue capability, and patient-selection pathways are available. Theater-based general anesthesia remains appropriate for complex fractures, delayed presentations, older children, or cases with a high likelihood of failed reduction.
Key Findings
- Six observational studies met the inclusion criteria; four direct comparative studies included 958 children.
- Emergency-department management was consistently associated with shorter treatment times, fewer admissions, shorter length of stay, and lower resource utilization.
- Evidence for redisplacement and repeat intervention was inconsistent, and most studies had high risk of bias from confounding and treatment-selection differences.
Methodological Strengths
- The review followed PRISMA 2020 and searched multiple major biomedical and multidisciplinary databases.
- Risk of bias was assessed using ROBINS-I and QUIPS, and the authors avoided inappropriate quantitative pooling because of substantial heterogeneity.
Limitations
- No randomized controlled trials were identified, and most included studies had substantial risk of bias.
- Treatment protocols, sedation regimens, fracture characteristics, resources, and outcome definitions varied considerably across studies.
Future Directions: Prospective multicenter comparative studies should establish validated selection criteria, standardized sedation and monitoring pathways, failure and remanipulation thresholds, and patient-centered outcomes such as pain, anxiety, and family satisfaction.
Displaced pediatric forearm fractures requiring closed reduction are traditionally managed in the operating theater under general anesthesia (GA). However, emergency department (ED)-based procedural sedation may reduce treatment delays, admissions, and resource utilization. This systematic review evaluated clinical outcomes, safety, repeat intervention, and resource implications of ED procedural sedation compared with theater-based GA. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. MEDLINE, the Cochrane Library, Web of Science, and Scopus were searched from 2000 to June 2026.