Daily Anesthesiology Research Analysis

BACKGROUND: Patients undergoing minimally invasive esophagectomy (MIE) frequently experience moderate-to-severe postoperative pain and anxiety-depressive symptoms, compromising postoperative quality of recovery (QoR). Esketamine is a promising adjunct for analgesia and anxiolysis; however, the effect of low-dose esketamine on patient-centered recovery outcomes in MIE remains unclear. METHODS: In this double-blinded, multicenter randomized controlled trial, patients scheduled for elective McKeown esophagectomy were allocated to esketamine (0.25 mg/kg loading dose and 0.125 mg/kg/h continuous infusion during surgery) or placebo (equivalent volume and rate of saline). The primary outcome was the QoR-15 score on postoperative day (POD) 2. Secondary outcomes included QoR-15 scores on POD 1, 3, 7 and 30. Hospital Anxiety and Depression Scale - Anxiety Subscale (HADS-A) and Depression Subscale (HADS-D) scores, numeric rating scale (NRS) pain scores, and the Brief Pain Inventory (BPI) scores on POD 1 to 3, and safety evaluations. RESULTS: A total of 198 patients were analyzed (esketamine, CONCLUSIONS: Intraoperative low-dose esketamine improved early, patient-reported recovery after MIE by enhancing analgesia and reducing postoperative anxiety and depression without increasing adverse events. TRIAL REGISTRATION: Chinese Clinical Trial Register (identifier: ChiCTR2400088916). Patients undergoing minimally invasive esophagectomy often experience poor quality of recovery due to postoperative pain, anxiety, and depression. Effective analgesia and psychological support are essential to improving postoperative recovery in these patients.No prior studies have specifically examined the effect of low-dose esketamine on patient-centered recovery outcomes in patients undergoing minimally invasive esophagectomy.Low-dose esketamine (0.25 mg/kg loading dose and 0.125 mg/kg/h continuous infusion during surgery) improved early, patient-reported recovery after minimally invasive esophagectomy by enhancing analgesia and reducing postoperative anxiety and depression, without increasing adverse events.

IMPORTANCE: The number of older adults living with frailty who undergo surgery is rapidly increasing worldwide. Life-space mobility (LSM) can capture physical and social dimensions of recovery and has been linked to functional decline and reduced quality of life. OBJECTIVE: To examine postoperative recovery using LSM among older adults living with frailty and to identify factors associated with restricted mobility and readmission. DESIGN, SETTING, AND PARTICIPANTS: This cohort study within the larger Functional Improvement Trajectories After Surgery study used a convergent mixed-methods exploratory design. Seventeen hospitals across Canada included older adults aged 65 years or older with a clinical frailty score (CFS) of 3 or more who underwent major elective noncardiac surgery from March 2021 to June 2023. Data were analyzed from September to October 2025. EXPOSURE: Elective noncardiac surgery among older adults. MAIN OUTCOMES AND MEASURES: LSM (range 0-120, with higher scores indicating more mobility) was measured at 1 to 2 months and 6 months postoperatively, with retrospective presurgery LSM captured at 1 to 2 months. Multivariable linear mixed-effects models and multivariable mixed-effects logistic regression were used to identify factors associated with LSM trajectories, restricted mobility (ie, LSM < 60), and hospital readmission. RESULTS: This study included 204 participants (mean [SD] age, 72.8 [5.6] years; 108 males [53%]). The mean (SD) LSM was 65.1 (26.7) presurgery, 56.6 (26.7) at 2 months postsurgery, and 64.9 (25.9) at 6 months postsurgery. Eighty participants (39.2%) had restricted mobility presurgery, 114 (56.4%) at 2 months postsurgery, and 84 (41.2%) at 6 months postsurgery. Restricted mobility was associated with being a woman (odds ratio [OR], 4.72; 95% CI, 2.27-9.84), greater frailty (OR, 10.42; 95% CI, 3.56-30.49), and concurrent need for support from formal or informal caregivers (OR, 5.43; 95% CI, 2.72-10.86). Elevated-risk surgery was associated with hospital readmission at 6 months (OR, 3.18; 95% CI, 1.48-7.25). CONCLUSIONS AND RELEVANCE: In this nested cohort study, mean LSM recovered by 6 months postsurgery, but 41% of older adults still had restricted mobility. Being a woman, having greater frailty, and needing support from caregivers were associated with poor recovery. Integrating life-space assessments into individualized perioperative care planning may enhance evaluation of functional recovery, inform shared decision-making, and guide support strategies.

OBJECTIVES: Families of patients admitted to ICUs experience numerous care transitions, poor communication across these transitions, and emotional distress associated, in part, with the challenges of obtaining care consistent with patients' values. Specialized support from ICU to postacute setting may improve outcomes. DESIGN: Multicenter randomized, controlled trial of a "communication facilitator" intervention. SETTING: One healthcare system, three hospitals in Seattle, WA. PARTICIPANTS: ICU patients (n = 449) with chronic life-limiting illness (2-yr median survival, and/or acute, severe illness with greater than 15% hospital mortality risk) and their family members (n = 505). Patients were the unit of randomization (control, n = 224; intervention, n = 225). INTERVENTIONS: Nurse communication facilitators trained to support, model, and teach communication strategies to promote goal-concordant care. Facilitators engaged with participants in the ICU and for 3 months postrandomization. MEASUREMENT AND MAIN RESULTS: The primary outcome was family member depression, measured using the Hospital Anxiety and Depression Scale (HADS) at four time points (randomization, 1-, 3-, and 6-mo postrandomization). Among respondents, HADS-depression tended to decrease over time (mean ± sd = 7.2 ± 4.6 for control and 7.2 ± 4.2 for intervention at baseline; 5.9 ± 4.1 for control and 5.9 ± 4.5 for intervention at 6 mo). The difference in mean HADS-depression between intervention and control over 6 mo was not significantly different: -0.07 (95% CI, -0.70 to 0.55). Differences in family-reported secondary outcomes were in the expected direction, including relationship with the healthcare team (p = 0.0162) and goal concordance (p = 0.0504), but their effect sizes were small. CONCLUSIONS: For family members of critically ill patients facing a high likelihood of death or serious disability, involving a communication facilitator during and after an ICU stay did not lead to a reduction in depressive symptoms.