Weekly Anesthesiology Research Analysis
This week’s anesthesiology literature emphasizes implementation-ready perioperative strategies: (1) standardizing prehabilitation adherence metrics to strengthen evidence translation, (2) reframing perioperative risk through autonomic nervous system modulation with actionable pharmacologic and nonpharmacologic levers, and (3) large-scale comparative evidence guiding sedation choices for endoscopy that balance hypoxia, hemodynamics, and PONV. Together these studies push toward measurable implemen
Summary
This week’s anesthesiology literature emphasizes implementation-ready perioperative strategies: (1) standardizing prehabilitation adherence metrics to strengthen evidence translation, (2) reframing perioperative risk through autonomic nervous system modulation with actionable pharmacologic and nonpharmacologic levers, and (3) large-scale comparative evidence guiding sedation choices for endoscopy that balance hypoxia, hemodynamics, and PONV. Together these studies push toward measurable implementation (protocols, monitoring, and decision support) rather than isolated mechanistic findings.
Selected Articles
1. Adherence to prehabilitation in adult surgical patients: a systematic review, meta-analysis, meta-regression, and qualitative synthesis.
Comprehensive review of 105 randomized trials (n=4,941) found pooled prehabilitation adherence ≈79% but wide heterogeneity in adherence metrics. Meta-regression yielded little credible predictors of adherence, while qualitative synthesis identified practical barriers and facilitators that can inform program design and implementation.
Impact: Largest synthesis to date quantifying prehabilitation adherence and exposing measurement heterogeneity that limits translation; lays groundwork for standard metrics and implementation science in perioperative optimization.
Clinical Implications: Adopt standardized adherence definitions and reporting for prehabilitation programs; target identified barriers (access, complexity, motivation) and test digital/telehealth strategies to improve uptake and measure true effectiveness.
Key Findings
- Pooled adherence across 105 trials was 79% (95% CI 70–88) but metrics varied widely.
- No robust trial-level predictors of adherence identified by meta-regression.
- Qualitative synthesis mapped barriers/facilitators using the Theoretical Domains Framework to inform implementation.
2. Pharmacological agents for procedural sedation and analgesia in patients undergoing gastrointestinal endoscopy: a systematic review and network meta-analysis.
Network meta-analysis of 152 RCTs (n=26,527) comparing 37 IV sedation regimens for GI endoscopy. No agent surpassed propofol–opioids for sedation success, but etomidate–opioids reduced hypoxia (RR 0.35) at the cost of increased PONV, while esketamine–remimazolam offered superior hemodynamic stability and faster recovery.
Impact: Provides decision-ready comparative safety profiles for widely used sedation regimens and supports tailoring agent choice to patient cardiopulmonary and PONV risk profiles.
Clinical Implications: For patients at risk of hypoxia consider etomidate–opioid regimens (with enhanced PONV prophylaxis); for hemodynamically fragile patients consider esketamine–remimazolam to minimize hypotension/bradycardia and accelerate recovery.
Key Findings
- Etomidate–opioids reduced hypoxia vs propofol–opioids (RR 0.35) but increased PONV (RR 2.61).
- Esketamine–remimazolam markedly reduced hypotension (RR 0.12) and bradycardia (RR 0.19) and shortened time to full alertness.
- No regimen clearly exceeded propofol–opioids for sedation success; midazolam-based regimens underperformed.
3. Effect of perioperative autonomic nervous system imbalance on surgical outcomes: a systematic review.
Systematic synthesis linking perioperative sympathetic–parasympathetic imbalance to inflammation, cardiovascular instability, immunosuppression, neurocognitive decline, and potential cancer recurrence. It catalogs pharmacologic (dexmedetomidine, β-blockers) and non-pharmacologic (temperature control, electroacupuncture) interventions that may restore autonomic balance.
Impact: Reframes perioperative risk through autonomic dysregulation and maps actionable targets for modulation that can be integrated into ERAS and intraoperative management bundles.
Clinical Implications: Consider ANS-aware perioperative bundles (e.g., dexmedetomidine when appropriate, targeted β-blockade, normothermia, analgesic strategies to blunt sympathetic surges) and develop metrics to monitor dysautonomia in high-risk patients.
Key Findings
- Perioperative ANS imbalance contributes to systemic inflammation, cardiovascular instability, impaired repair, and immunosuppression.
- Low parasympathetic tone weakens cholinergic anti-inflammatory pathways; sympathetic overactivity increases catecholamines and pro-inflammatory cytokines.
- Multiple pharmacologic and nonpharmacologic strategies exist to modulate ANS balance, but RCT evidence is limited and heterogeneous.