Daily ReportOct 3, 2026
Anesthesiology, October 3 edition
We read 4 papers and selected 3.
Summary
Among the four papers, the randomized controlled study of relaxation exercises and virtual reality after impacted third molar surgery provides the strongest clinical evidence, showing improvements in postoperative pain and anxiety. A retrospective cataract-surgery study supports topical cyclopentolate as a practical alternative to intracameral mydriasis, while a cardiac surgery case report highlights an important echocardiographic diagnostic pitfall involving the inferior vena cava.
Research Themes
- Nonpharmacological perioperative pain and anxiety management
- Optimization of ophthalmic anesthesia and mydriasis
- Diagnostic integration in perioperative echocardiography
Selected Articles
1. How Virtual Reality and Relaxation Exercises Shape Pain, Sleep, Kinesiophobia and Anxiety Over Time After Impacted Third Molar Surgery?: A Randomized Controlled Study.
This randomized controlled study enrolled 36 adults undergoing mandibular impacted third molar extraction and compared relaxation exercises, relaxation exercises combined with virtual reality, and patient education alone. On postoperative days 2 and 7, the groups differed significantly in Visual Analog Scale pain and State-Trait Anxiety Inventory-State scores, supporting nonpharmacological approaches for postoperative symptom management.
Impact: The study addresses a common postoperative problem with a low-risk, potentially scalable intervention and prospectively evaluates several patient-centered outcomes over time. Its randomized design provides stronger evidence than the observational and case-report studies in this set.
Clinical Implications: Relaxation exercises and virtual reality may be incorporated into perioperative education and supportive care to reduce pain and anxiety after impacted third molar extraction. The findings are promising but should not yet replace standard analgesic or anxiolytic strategies.
Key Findings
- The study included 36 adults aged 18–35 years undergoing mandibular impacted third molar extraction.
- Participants were assigned to relaxation exercise, relaxation exercise plus virtual reality, or patient education-only groups.
- Significant between-group differences in pain and state anxiety were observed on postoperative days 2 and 7.
Methodological Strengths
- Randomized controlled design with a prespecified clinical trial registration.
- Repeated assessment at immediate postoperative time, day 2, and day 7 using established patient-reported instruments.
Limitations
- The sample size was small, with only 36 participants, limiting statistical power and generalizability.
- The abstract does not describe allocation concealment, blinding, adherence to the interventions, or the magnitude of between-group effects.
Future Directions: Larger, multicenter randomized trials should clarify the independent and combined effects of relaxation exercises and virtual reality, assess clinically meaningful effect sizes, and evaluate longer-term recovery, analgesic consumption, and cost-effectiveness.
BACKGROUND: Surgical extraction of Impacted Third Molar (ITM) is one of the most frequently performed oral surgical procedures. The effects of relaxation exercises and VR after ITM surgery remain underinvestigated. OBJECTIVE: This study aimed to evaluate the effects of relaxation exercises and VR on pain, sleep quality, kinesiophobia, and anxiety levels following ITM surgery. METHODS: This study included 36 individuals between the ages of 18 and 35 with mandibular third molars in Class 2 position B, according to the Pell and Gregory classification. All third molar extractions were performed under local anaesthesia. Participants in the Relaxation Exercise Group (G1) received relaxation exercises and patient education; participants in the Relaxation Exercise + VR Group (G2) received relaxation exercises, VR and patient education; and participants in the Control Group (G3) received patient education only.
2. Optimizing Mydriasis in Cataract Surgery: Efficacy and Safety of Intracameral Regimen vs Topical Cyclopentolate in RayOne EMV Implantation.
In a retrospective comparison of 100 eyes undergoing uncomplicated phacoemulsification with enhanced monofocal intraocular lens implantation, topical cyclopentolate plus intracameral lidocaine produced a larger initial pupil than intracameral Mydrane. Surgical duration, postoperative visual acuity, and major complications were comparable between groups.
Impact: The study provides clinically relevant comparative data for a widely performed operation and suggests that an accessible topical regimen can maintain surgical efficiency while achieving greater initial dilation. Its findings may be particularly useful where intracameral products are costly or unavailable.
Clinical Implications: Topical cyclopentolate with intracameral lidocaine may be considered as an alternative mydriatic and anesthetic strategy for uncomplicated cataract surgery, especially in resource-limited settings. Prospective evidence is needed before extending the approach to complex cases or high-risk eyes.
Key Findings
- The retrospective analysis included 100 patients and 100 eyes, with 50 eyes in each treatment group.
- Initial pupil diameter was larger with topical cyclopentolate plus intracameral lidocaine than with intracameral Mydrane: 7.39 ± 0.47 mm versus 6.08 ± 1.05 mm, with Cohen's d = 1.61.
- Surgical duration, postoperative visual acuity, and major intraoperative complications did not differ significantly between groups.
Methodological Strengths
- Direct comparison of two clinically used mydriatic and anesthetic strategies in the same surgical context.
- Assessment included pupil size, operative duration, visual outcomes, intraoperative complications, and postoperative adverse events.
Limitations
- The retrospective design permits selection bias and residual confounding.
- The cohort involved uncomplicated cataract cases and does not establish safety or efficacy in complex surgery, small pupils, or high-risk eyes.
Future Directions: Prospective randomized studies should compare patient comfort, intraoperative pupil stability, medication costs, recovery, and safety in complex cataract cases and patients with poor pharmacologic dilation.
BACKGROUND This study aimed to compare the safety and efficacy of phacoemulsification performed using topical cyclopentolate (Cykloftyal) vs standard intracameral mydriatic and anesthetic combination (Mydrane) in patients undergoing implantation of enhanced monofocal intraocular lenses. MATERIAL AND METHODS The medical records of 100 patients (100 eyes, 50 per group) were retrospectively analyzed. Patients received either intracameral Mydrane alone or topical cyclopentolate with intracameral lidocaine. Pupil diameter at the start and end of surgery, surgical duration, visual acuity, intraoperative complications, and postoperative adverse events were compared. RESULTS There was no statistically significant difference in surgical duration between the intracameral Mydrane group (8.80 min) and the topical cyclopentolate plus intracameral lidocaine group (9.24 min; P=0.54), nor in postoperative visual acuity at any distance.
3. Inferior vena cava hyperechoic structure in a patient with cardiac myxoma: a surgical case report and literature review.
This surgical case report describes a 62-year-old woman with cardiac myxoma and a 33-mm linear hyperechoic structure in the suprarenal inferior vena cava that mimicked organized thrombus on transthoracic echocardiography. The structure was absent on cardiac magnetic resonance imaging, intraoperative inspection, transesophageal echocardiography under general anesthesia, and postoperative echocardiography, suggesting an artifact or spontaneous echo contrast rather than true thrombus.
Impact: The case identifies a potentially dangerous imaging pitfall during planning for cardiopulmonary bypass, where mistaken identification of an IVC thrombus could alter cannulation strategy or cause unnecessary concern for embolization. It emphasizes multimodality confirmation and intraoperative correlation rather than reliance on a single echocardiographic image.
Clinical Implications: When a suspected inferior vena cava thrombus is seen on echocardiography but is not supported by computed tomography, magnetic resonance imaging, laboratory data, or repeat echocardiography, clinicians should consider artifact and spontaneous echo contrast. Multimodality confirmation is particularly important before cardiopulmonary bypass cannulation.
Key Findings
- A 33-mm immobile linear hyperechoic structure was observed in the suprarenal inferior vena cava by transthoracic echocardiography.
- The suspected thrombus was not confirmed by cardiac magnetic resonance imaging, preoperative transesophageal echocardiography, or intraoperative direct inspection.
- The structure disappeared on postoperative echocardiography, supporting an echocardiographic artifact or spontaneous echo contrast rather than a fixed lesion.
Methodological Strengths
- The report integrates transthoracic and transesophageal echocardiography, computed tomography, magnetic resonance imaging, laboratory data, and surgical inspection.
- Direct intraoperative visualization provided an unusually strong clinical reference standard for excluding an actual inferior vena cava thrombus.
Limitations
- This is a single case report, so the frequency, mechanisms, and generalizability of the phenomenon cannot be established.
- The proposed roles of spontaneous echo contrast and imaging artifact were not confirmed experimentally or quantitatively.
Future Directions: Prospective studies should characterize the prevalence and imaging features of transient inferior vena cava hyperechoic structures, determine technical and hemodynamic contributors, and develop an echocardiographic verification algorithm for patients undergoing cardiac surgery.
BACKGROUND: IVC hyperechoic structure detected by echocardiography is relatively uncommon and is usually associated with deep vein thrombosis and cancers. In most cases, the etiology can be clarified using computed tomography (CT) and magnetic resonance imaging (MRI). However, we encountered an IVC hyperechoic structure that was not confirmed by multimodality imaging in a patient with cardiac myxoma. CASE PRESENTATION: A 62-year-old woman presented with sudden-onset left hemiplegia and right homonymous hemianopsia. On arrival, her left arm was cold to the touch. Contrast-enhanced CT demonstrated a left atrial mass, left subclavian artery occlusion, and splenic infarction. Brain MRI revealed an acute infarction in the right occipital lobe. Transthoracic echocardiography (TTE) showed a mobile mass in the left atrium and a 33 mm immobile linear hyperechoic structure with surrounding blood flow in the suprarenal IVC, suggestive of organized thrombus.