Daily Anesthesiology Research Analysis

INTRODUCTION: Postoperative cognitive dysfunction (POCD) is common in the perioperative period among older adults and has been linked to inflammatory responses, neural injury-related biomarkers, and mood changes. Evidence for safe, feasible, and effective non-pharmacological interventions remains limited. This prospective, double-blind, randomized controlled trial evaluated the association between transcutaneous auricular vagus nerve stimulation (taVNS) and postoperative cognitive test performance, and examined concomitant changes in inflammatory and neural injury-related biomarkers and mood. MATERIALS AND METHODS: A total of 103 older adults scheduled for elective laparoscopic gastrointestinal tumor resection were consecutively enrolled and randomly assigned to taVNS or sham stimulation; 99 participants completed follow-up and were included in the primary analysis. Cognitive function was assessed preoperatively and at postoperative day 1, day 7, month 1, and month 3 using the Montreal Cognitive Assessment (MoCA). Serum interleukin-1β (IL-1β) and S100β were measured preoperatively and on postoperative day 7. Mood was assessed preoperatively and on postoperative day 7 using the 24-item Hamilton Depression Scale (HAMD-24). RESULTS: From postoperative day 7 onward, MoCA scores were higher in the taVNS group than in the sham group (p = 0.01), with differences maintained at postoperative months 1 and 3 (absolute between-group differences of 2.06 and 2.97 points, respectively; both p < 0.01). RM ANOVA and ANCOVA indicated significant main effects of time and a significant group × time interaction. On postoperative day 7, the taVNS group showed lower postoperative IL-1β and S100β levels than the control group (both p < 0.001) and a smaller worsening in HAMD-24 scores. ΔMoCA was negatively correlated with ΔIL-1β (r = -0.425), ΔS100β (r = -0.248), and ΔHAMD-24 (r = -0.234). Exploratory stratified analyses showed broadly consistent effect directions across subgroups. Adverse event rates were similar between groups (approximately 4.1% in each), and events were mild local reactions. DISCUSSION: In this exploratory randomized controlled trial, perioperative taVNS was associated with a more favorable MoCA trajectory after laparoscopic gastrointestinal tumor surgery in older adults, with between-group differences in IL-1β, S100β, and HAMD-24 on postoperative day 7. Clinical significance and generalizability require confirmation in larger studies.

BACKGROUND: Postoperative nausea and vomiting (PONV) is common after video-assisted thoracoscopic surgery (VATS). Opioid-free anesthesia (OFA) may reduce PONV; however, procedure-specific evidence remains limited. This review evaluated the effects of OFA versus opioid-inclusive anesthesia (OIA) on PONV, pain, and recovery after VATS lung resection. METHODS: Randomized controlled trials (RCTs) involving adults who underwent VATS lung resection and compared OFA, defined as no intraoperative opioid use, with OIA, were included. MEDLINE, Embase, and Cochrane Central were searched until January 18, 2026, and ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched on January 19, 2026. The risk of bias was assessed using the RoB 2 tool. Random-effects meta-analyses were performed, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation framework. The primary outcomes were PONV and pain at 24 h. RESULTS: Eleven RCTs involving 1183 participants were included, all of which used regional anesthesia. Most studies were conducted in China (n = 8), with one study each conducted in Poland, Turkey, and South Korea. Across the included studies, the mean age of participants ranged from 44.6 to 67.8 years. OFA was associated with reduced PONV within 24 h compared with OIA (eight studies; risk ratio, 0.58; 95% confidence interval [CI], 0.41-0.81; moderate certainty). Pain scores at 24 h were lower with OFA (eleven studies; mean difference, - 0.30; 95% CI, - 0.54 to - 0.07), although the difference did not reach the minimally important difference. OFA improved the quality of recovery (QoR) at 24 h (three studies; standardized mean difference, 0.40; 95% CI, 0.07 to 0.72; moderate certainty). No meaningful difference was observed in postoperative opioid consumption, and adverse event findings were inconsistent. CONCLUSIONS: In selected patients undergoing VATS lung resection within multimodal pathways including regional analgesia, OFA protocols probably reduce PONV and improve early QoR compared with heterogeneous OIA regimens, while having little or no clinically important effect on acute postoperative pain. However, the independent contribution of intraoperative opioid avoidance remains uncertain owing to heterogeneity in regional analgesia, comparator opioid exposure, antiemetic strategies, and anesthetic management.

OBJECTIVES: To explore the superiority of fibrinogen concentrate (FC) versus cryoprecipitate for bleeding after cardiac surgery. DESIGN: Secondary analysis of the FIBRES randomized trial. SETTING: Eleven Canadian hospitals, February 2017-November 2018. PARTICIPANTS: Adult cardiac surgery patients experiencing significant postbypass bleeding and acquired hypofibrinogenemia (fibrinogen <2.0 g/L or FIBTEM A10 <10 mm). INTERVENTIONS: FC (4 g) or cryoprecipitate (10 units) dosed within 24 hours after cardiopulmonary bypass as needed. MEASUREMENTS AND MAIN RESULTS: In total, 735 patients (372 FC, 363 cryoprecipitate) were included in the primary analysis (median age 64 years, 30% women). The primary endpoint was cumulative blood components (red cells, platelets, plasma) administered within 24 hours postbypass. Superiority was assessed using deviance-scaled Poisson regression. FC was superior to cryoprecipitate in the a priori‒defined, well-balanced subgroups of non-critically ill patients (n = 634, 86% of population; mean 13.6 versus 16.2 units, mean ratio 0.84 [95% CI 0.73, 0.96]; p = 0.01) and elective surgery patients (n = 466, 63% of population; 11.7 versus 14.4 units, 0.81 [0.69, 0.96]; p = 0.02). In elective surgery patients, adverse events (relative risk 0.85 [0.75, 0.97]; p = 0.02) and serious adverse events (0.71 [0.52, 0.99]; p = 0.04) were less frequent with FC. CONCLUSION: FC showed superior hemostatic efficacy to cryoprecipitate in the prespecified subgroups of elective cardiac surgery patients and patients who were not in a critical state before surgery, representing the large majority of patients with bleeding postbypass. FC may also offer safety advantages over cryoprecipitate.