Anesthesiology Research Analysis
September’s anesthesiology research emphasized scalable nonpharmacologic analgesia, pharmacologic prevention of postoperative delirium in cardiac surgery, and equity in physiologic monitoring. A randomized trial showed taVNS significantly reduced postpartum contraction pain and improved recovery after cesarean delivery. A large Bayesian network meta-analysis ranked dexmedetomidine plus melatonin as the leading regimen to prevent delirium after cardiac surgery, albeit with low certainty. Monitori
Summary
September’s anesthesiology research emphasized scalable nonpharmacologic analgesia, pharmacologic prevention of postoperative delirium in cardiac surgery, and equity in physiologic monitoring. A randomized trial showed taVNS significantly reduced postpartum contraction pain and improved recovery after cesarean delivery. A large Bayesian network meta-analysis ranked dexmedetomidine plus melatonin as the leading regimen to prevent delirium after cardiac surgery, albeit with low certainty. Monitoring equity advanced with prospective evidence of skin-tone–related bias in pediatric cerebral NIRS, while EEG-guided anesthesia and AEP biomarkers highlighted objective brain monitoring to protect cognition and titrate neonatal sedation.
Selected Articles
1. Transcutaneous Auricular Vagus Nerve Stimulation for Postpartum Contraction Pain During Elective Cesarean Delivery: A Randomized Clinical Trial.
A single-center randomized, sham-controlled trial (n=156) found that daily taVNS for three days after cesarean delivery significantly reduced moderate-to-severe uterine contraction pain on postoperative day 3 and improved incision pain, mood, sleep, and recovery quality versus sham.
Impact: Demonstrates a nonpharmacologic, scalable neuromodulation that improves multiple patient-centered outcomes after cesarean delivery, with potential to reduce opioid exposure in obstetric ERAS.
Clinical Implications: Consider integrating taVNS into multimodal postpartum analgesia to reduce contraction pain and enhance recovery; short-term safety appears acceptable, but logistics (device access and training) are required.
Key Findings
- taVNS reduced moderate-to-severe uterine contraction pain on POD3 versus sham.
- Improved incision pain, mood, sleep, and recovery-quality scores.
- Randomized, sham-controlled, intention-to-treat design with validated PROs.
2. Effect of peri-operative pharmacological interventions on postoperative delirium in patients having cardiac surgery: a systematic review and Bayesian network meta-analysis.
A Bayesian network meta-analysis of 79 RCTs (24,827 patients) compared 29 pharmacologic strategies and ranked dexmedetomidine plus melatonin as most effective for reducing postoperative delirium and associated length of stay, though the overall certainty of evidence was low.
Impact: Provides the largest synthesis to date and an actionable regimen candidate for delirium prevention in high-risk cardiac surgical patients, informing protocols and trial design.
Clinical Implications: A dexmedetomidine-plus-melatonin approach may be considered within multimodal delirium prevention pathways for cardiac surgery while monitoring for bradycardia and hypotension and acknowledging low evidence certainty.
Key Findings
- Dexmedetomidine plus melatonin ranked most effective versus placebo for delirium reduction.
- Signals for shorter ICU and hospital stays with combination therapy.
- Overall certainty rated low; other agents showed inconsistent effects.
3. Near-infrared Spectroscopy and Skin Tone in Children: A Prospective Cohort Study.
A prospective cohort of children undergoing cardiac catheterization found that spectrophotometry-measured skin tone was independently associated with bias in cerebral NIRS measurements using the INVOS 5100C, with darker skin categories showing substantial negative bias versus mixed venous saturation.
Impact: Quantifies skin-tone–related device bias against a physiologic reference in pediatrics, underscoring urgent needs for cross-tone validation and calibration.
Clinical Implications: Interpret pediatric cerebral NIRS cautiously in darker skin tones, consider device-specific biases, and use supplemental monitoring or validated calibration to avoid inequitable decisions.
Key Findings
- Skin tone independently predicted NIRS bias on multivariable analysis.
- Darker skin categories exhibited larger negative bias versus physiologic reference.
- Findings emphasize need for cross-platform validation and calibration.
4. EEG-guided anesthesia to reduce postoperative cognitive dysfunction in older adults: implications for cognition-sparing pathways.
Weekly evidence highlighted that EEG-guided anesthesia can reduce postoperative cognitive dysfunction in older adults, supporting adoption of brain-monitoring–guided titration to minimize anesthetic over/under-dosing and protect cognition.
Impact: Promotes objective brain monitoring to improve neurocognitive outcomes, aligning with broader efforts to personalize anesthetic depth.
Clinical Implications: Consider integrating EEG-guided protocols for older surgical patients at risk of POCD, with staff training on interpretation and thresholds.
Key Findings
- EEG-guided titration associated with lower POCD incidence in older adults.
- Feasibility of incorporating EEG metrics into intraoperative decision-making.
- Supports cognition-sparing anesthesia pathways.
5. Auditory evoked potential (AEP) wave VI as an objective biomarker of neonatal sedation depth.
Weekly data indicated that AEP wave VI may serve as an objective marker of sedation depth in neonates, enabling standardized titration and reducing reliance on subjective assessments.
Impact: Addresses a critical gap in neonatal anesthesia by providing an objective physiologic marker for sedation depth.
Clinical Implications: Consider pilot integration of AEP-based monitoring in neonatal sedation protocols where available, alongside conventional clinical scales.
Key Findings
- AEP wave VI correlates with sedation depth in neonates.
- Potential to standardize sedation titration and reduce variability.
- Feasible adjunct to existing neonatal monitoring frameworks.