Weekly Anesthesiology Research Analysis
This week’s anesthesiology literature emphasized system-level perioperative optimization, mechanistic EEG markers of anesthetic emergence, and the comparative effectiveness of acute pain service models. A PROSPERO-registered meta-analysis quantified the added benefit of comprehensive enhanced recovery programmes in cardiac surgery. Randomized EEG work revealed distinct remimazolam emergence signatures linked to delayed recovery, and a network meta-analysis ranked nurse-based anesthesiologist-sup
Summary
This week’s anesthesiology literature emphasized system-level perioperative optimization, mechanistic EEG markers of anesthetic emergence, and the comparative effectiveness of acute pain service models. A PROSPERO-registered meta-analysis quantified the added benefit of comprehensive enhanced recovery programmes in cardiac surgery. Randomized EEG work revealed distinct remimazolam emergence signatures linked to delayed recovery, and a network meta-analysis ranked nurse-based anesthesiologist-supervised APS models as top-performers for postoperative analgesia.
Selected Articles
1. Efficacy of enhanced recovery programmes for cardiac surgery: a systematic review and meta-analysis.
This PRISMA-compliant, PROSPERO-registered meta-analysis of 18 studies (n=2,625) found that ERPs or fast-track pathways reduced hospital stay (−1.40 days), ICU stay (−13.22 h) and ventilation time (−4.68 h) compared to usual care. Importantly, ERPs provided additive benefit over fast-track-only strategies for hospital length of stay (ERP −2.11 days vs FT −0.30 days).
Impact: Quantifies the incremental, system-level gains of comprehensive ERPs over intraoperative fast-track approaches in cardiac surgery, providing high-level evidence to change program design and resource allocation.
Clinical Implications: Cardiac programs should implement standardized, multimodal ERPs (pre-, intra-, and postoperative elements) rather than relying solely on fast-track intraoperative measures to reduce LOS, ICU utilization and ventilation time.
Key Findings
- ERP/FT reduced hospital length of stay by −1.40 days (95% CI −2.19 to −0.61).
- ICU stay decreased by −13.22 hours and ventilation time by −4.68 hours.
- ERPs had additive benefit over FT for hospital LOS (ERP −2.11 days vs FT −0.30 days; P=0.003).
2. Electroencephalogram Correlates of Delayed Emergence After Remimazolam-Induced Anesthesia Compared to Propofol.
In a randomized trial of 48 patients undergoing laparoscopic cholecystectomy, remimazolam produced higher theta/alpha EEG power, reduced functional connectivity (PLE/PLI), lower PACU PSI values, and a significantly slower time to reach Aldrete 9 versus propofol. Recovery time correlated strongly with alpha-band connectivity metrics (PLE r = −0.78; PLI r = 0.69).
Impact: Provides mechanistic, agent-specific EEG signatures linked to delayed emergence, enabling clinicians to anticipate and monitor drug-specific recovery profiles and refine perioperative monitoring strategies.
Clinical Implications: When using remimazolam, anticipate slower emergence and consider EEG-informed titration and recovery planning (monitoring PLE/PLI/PSI trends) to detect and manage delayed recovery in PACU.
Key Findings
- Remimazolam increased theta (eyes-open) and alpha (eyes-closed/open) EEG power during emergence versus propofol.
- Functional connectivity (PLE/PLI) in alpha/beta bands was reduced with remimazolam.
- PACU PSI values were lower and time to Aldrete 9 was significantly longer with remimazolam; recovery time correlated with alpha-band PLE/PLI.
3. Acute pain service for postoperative pain in adults: a network meta-analysis.
This network meta-analysis of 38 RCTs found all APS subtypes outperformed the traditional ward doctor–nurse model for postoperative pain. Nurse-based anesthesiologist specialist–supervised APS (NBASS-APS) ranked highest (SMD −1.99; SUCRA 98%), followed by nurse-based anesthesiologist-supervised APS and multidisciplinary teams.
Impact: Provides comparative, randomized-trial–based evidence to guide hospital-level APS design and prioritization, identifying the most effective staffing/model to improve postoperative analgesia.
Clinical Implications: Hospitals should consider implementing nurse-based anesthesiologist specialist–supervised APS where feasible, with structured protocols and training to achieve superior postoperative pain control vs usual care.
Key Findings
- All APS subtypes provided superior analgesia compared with traditional ward doctor–nurse model.
- NBASS-APS had the largest effect size (SMD −1.99, 99% CI −2.55 to −1.43) and highest SUCRA (98%).
- Other APS models (NBAS-APS, PMDT, C-APS) also outperformed usual care.