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Mapping High-Level Evidence in Neuroanesthesia: A Scoping Review of Multicenter Randomized Controlled Trials in
Mouad Elganga1, Abramo Aziz Rizk2, Tumul Chowdhury3,4
1Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 3K3, Canada.
Journal of Clinical Medicine
|March 14, 2026
Summary
Multicenter trials in neuroanesthesia are limited and focus on short-term outcomes. More robust studies are needed to assess patient-centered results for improved intracranial neurosurgery care.
Area of Science:
- Neurosurgery
- Anesthesiology
- Clinical Trials
Background:
- Intracranial neurosurgery demands precise anesthesia due to brain sensitivity to physiological changes.
- Current neuroanesthetic practices show variability and lack strong evidence.
- Multicenter randomized controlled trials (RCTs) are crucial for advancing neuroanesthesia.
Purpose of the Study:
- To map and characterize multicenter RCTs on perioperative management in intracranial neurosurgery.
- To identify research gaps and inform future clinical trial design.
- To assess the scope and focus of existing high-level evidence in neuroanesthesia.
Main Methods:
- Scoping review adhering to PRISMA extension guidelines.
- Comprehensive search of major databases (MEDLINE, PubMed, EMBASE, Cochrane, Web of Science).
- Inclusion of multicenter RCTs evaluating anesthetic, hemodynamic, ventilatory, or perioperative interventions in adult intracranial neurosurgery patients.
Main Results:
- 13 multicenter RCTs (2765 participants, 9 countries, 1997-2025) were identified.
- Most trials focused on anesthetic maintenance, opioid regimens, and pain control.
- Outcomes were primarily short-term and process-based; patient-centered and long-term outcomes were rarely assessed.
Conclusions:
- Multicenter RCT activity in neuroanesthesia is sparse and narrowly focused.
- Existing trials often have a high risk of bias.
- There is a critical need for larger, methodologically sound trials addressing patient-centered and long-term outcomes in neuroanesthesia.
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