Daily Anesthesiology Research Analysis
Three impactful anesthesiology studies stood out: a multi-omics case-control study identifies immune PI3K–Akt pathway gene signatures as potential blood biomarkers for postoperative delirium; a randomized clinical trial shows light-transmitting eye shields reduce emergence agitation after pediatric strabismus surgery; and a randomized trial demonstrates that high-thoracic bilevel erector spinae plane block improves analgesia versus unilevel block or opioids alone in mastectomy.
Summary
Three impactful anesthesiology studies stood out: a multi-omics case-control study identifies immune PI3K–Akt pathway gene signatures as potential blood biomarkers for postoperative delirium; a randomized clinical trial shows light-transmitting eye shields reduce emergence agitation after pediatric strabismus surgery; and a randomized trial demonstrates that high-thoracic bilevel erector spinae plane block improves analgesia versus unilevel block or opioids alone in mastectomy.
Research Themes
- Perioperative neurocognitive disorders and immune biomarkers
- Pediatric emergence agitation prevention strategies
- Optimization of regional anesthesia for breast surgery
Selected Articles
1. Unveiling the Immune Landscape of Delirium through Single-Cell RNA Sequencing and Machine Learning: Towards Precision Diagnosis and Therapy.
This multi-omics case-control study identifies PI3K–Akt pathway-related gene signatures (e.g., IL6, IL6R, CHRM2, NOS3, NGF up; IGF1 down) in peripheral blood as predictive/diagnostic biomarkers for postoperative delirium, validated by RT-qPCR and scRNA-seq across immune cell subsets. Machine learning models achieved discriminatory performance, supporting translational potential.
Impact: Provides a plausible immune-based blood biomarker panel for POD with orthogonal validation and ML assessment, addressing a critical unmet diagnostic need in perioperative care.
Clinical Implications: If prospectively validated, preoperative or early postoperative blood testing for these immune gene signatures could stratify delirium risk, guide prophylaxis, and tailor monitoring or anti-inflammatory strategies.
Key Findings
- Bulk RNA-seq identified upregulation of CHRM2, IL6, NOS3, NGF, IL6R and downregulation of IGF1 in POD versus controls.
- RT-qPCR in an independent cohort (n=60) and scRNA-seq across T cells, B cells, NK cells, dendritic cells, and monocytes validated these signatures.
- Machine learning and ROC analyses showed these genes have predictive/diagnostic value for POD.
Methodological Strengths
- Orthogonal validation with RT-qPCR and single-cell RNA sequencing across immune subsets
- Use of multiple machine learning models and ROC analysis to quantify diagnostic performance
Limitations
- Case-control design with modest sample size and potential confounding
- Lack of external prospective validation and calibration in diverse perioperative populations
Future Directions: Prospective, multicenter validation with preoperative sampling, integration with clinical risk scores, and interventional trials testing biomarker-guided delirium prevention.
BACKGROUND: Postoperative delirium (POD) poses significant clinical challenges regarding its diagnosis and treatment. Identifying biomarkers that can predict and diagnose POD is crucial for improving patient outcomes. METHODS: To explore potential biomarkers for POD, we conducted bulk RNA sequencing (bulk-seq) on peripheral blood samples from POD patients and healthy controls. The expression levels of genes downstream of the phosphatidylinositol 3-kinase/protein kinase B (PI3K-Akt) signalling pathway were analysed. We then validated the expression of these genes using quantitative real-time polymerase chain reaction (RT-qPCR) in an independent cohort of 30 healthy controls and 30 POD patients. Receiver operating characteristic (ROC) analysis and six machine learning models were used to evaluate the predictive and diagnostic value of these genes. Additionally, single-cell RNA sequencing (scRNA-seq) was performed to validate gene expression in specific subsets of peripheral blood mononuclear cells (PBMCs), including T-cells, B-cells, natural killer (NK) cells, dendritic cells (DCs), and monocytes. RESULTS: Bulk-seq revealed increased expression of genes downstream of the PI3K-Akt signalling pathway, specifically CHRM2, IL6, NOS3, NGF, and IL6R, in the peripheral blood of POD patients compared to healthy controls. Conversely, the expression of IGF1 was significantly decreased. RT-qPCR validation confirmed these findings. ROC analysis and machine learning models indicated that these genes are useful for predicting and diagnosing POD. scRNA-seq further validated the expression of these genes in specific PBMC subsets, including T-cells, B-cells, NK cells, DCs, and monocytes, with results consistent with the bulk-seq and RT-qPCR data. CONCLUSIONS: The abnormal activation of the PI3K-Akt signalling pathway in T-cells, B-cells, NK cells, DCs, and monocytes may serve as potential biomarkers for predicting and diagnosing POD. These findings could inform the development of novel therapeutic strategies for managing POD.
2. Efficacy of light-transmitting eye shields for wound dressing in preventing pediatric emergence agitation following bilateral strabismus surgeries: a randomized clinical trial.
In a randomized trial of 70 preschool children undergoing bilateral strabismus surgery, light-transmitting eye shields reduced emergence agitation versus standard gauze shields (adjusted OR 0.28) and lowered agitation severity and rescue propofol use.
Impact: Demonstrates a simple, low-cost, immediately implementable intervention to reduce emergence agitation in pediatric ophthalmic anesthesia.
Clinical Implications: Consider adopting light-transmitting eye shields for postoperative dressing in pediatric strabismus surgery to mitigate emergence agitation and reduce sedative rescue.
Key Findings
- Emergence agitation incidence was significantly lower with light-transmitting vs gauze eye shields (14.3% vs 42.9%; adjusted OR 0.28, 95% CI 0.08–0.94).
- Peak Aono’s four-point scale scores and PAED ≥16 agitation events were reduced in the light-transmitting group.
- Rescue propofol administration was less frequent with light-transmitting eye shields.
Methodological Strengths
- Randomized parallel-group design with prespecified primary outcome
- Adjusted analyses with multiple agitation scales and false discovery control (BH)
Limitations
- Single-center study with modest sample size
- Blinding of patients and providers to eye shield type was likely not feasible
Future Directions: Multicenter trials to confirm generalizability, cost-effectiveness analyses, and assessment across other pediatric ophthalmologic procedures and anesthetic techniques.
BACKGROUND: Emergence agitation (EA) occurs in preschool children after ophthalmic surgery as eye shields induce visual disturbance. We aimed to investigate the efficacy of light-transmitting eye shields as an alternative to traditional medical gauze eye shields for wound dressing in terms of EA incidence following strabismus surgery. METHODS: We randomly assigned 70 preschool children undergoing bilateral strabismus surgery to receive either light-transmitting (LT group, n = 35) or medical gauze (MG group, n = 35) eye shields upon the completion of surgery. The primary outcome was the difference in EA incidence between the groups. RESULTS: After adjusting the data for age and sex, children in the LT group were less likely to develop EA than those in the MG group (5 of 35 children [14.3%] vs. 15 of 35 children [42.9%]; adjusted odds ratio: 0.28, 95% CI [0.08-0.94], P = 0.040). Compared with the MG group, a significant reduction in the median score of the peak Aono's four-point scale was observed in the LT group (P = 0.024; Benjamini-Hochberg [BH] critical value = 0.050). Additionally, the incidences of agitation (peak Pediatric Anesthesia Emergence Delirium score ≥ 16) and propofol administration in the LT group were significantly lower than those in the MG group (P = 0.022; BH critical value = 0.038 and P = 0.017; BH critical value = 0.025, respectively). CONCLUSIONS: The application of light-transmitting eye shields for wound dressing could help prevent EA after pediatric bilateral strabismus surgery under sevoflurane anesthesia.
3. Role of bilevel erector spinae with high thoracic block vs conventional unilevel block in analgesia and reduction of pain in axilla in breast cancer surgeries: a randomized controlled trial.
In 126 women undergoing modified radical mastectomy, both unilevel and high-thoracic bilevel ESPB reduced postoperative morphine use versus opioid-only control, with bilevel ESPB offering additional analgesic benefits, including improved axillary pain control.
Impact: Supports a practical optimization of ESPB technique to extend analgesic coverage to the axilla, a common pain locus after mastectomy, potentially improving recovery and reducing opioid needs.
Clinical Implications: Consider high-thoracic bilevel ESPB to enhance anterior chest wall and axillary analgesia in modified radical mastectomy, reducing opioid consumption and potentially lowering chronic pain risk.
Key Findings
- Postoperative morphine consumption was lowest with bilevel ESPB, intermediate with unilevel ESPB, and highest in opioid-only control.
- Bilevel ESPB conferred added analgesic benefits over unilevel ESPB, including improved axillary pain outcomes.
- Both ESPB techniques outperformed opioid-only management for overall analgesic profile after mastectomy.
Methodological Strengths
- Three-arm randomized controlled design with clear primary outcome
- Clinically relevant opioid-sparing endpoint in a homogeneous surgical population
Limitations
- Abstract truncation suggests incomplete reporting of secondary outcomes and statistics
- Potential lack of blinding and single-center design may limit generalizability
Future Directions: Detailed reporting of sensory coverage, dermatomal mapping, and long-term outcomes; multicenter confirmation and comparison with pectoral/serratus plane blocks.
INTRODUCTION: Management of pain associated with breast cancer surgeries is crucial in reducing incidence of postmastectomy pain syndrome. The pain distribution involves the anterior chest wall, axillary area and ipsilateral upper limb. OBJECTIVE: This study was designed to investigate the effect of bilevel erector spinae plane block (ESPB) with high thoracic block vs the conventional unilevel ESPB vs opioids in patients with cancer undergoing modified radical mastectomy regarding pain control and reducing pain in axilla. METHODS: One hundred twenty-six female patients with cancer and American Society of Anesthesiology II, III were randomized into 3 groups: bilevel ESPB, unilevel ESPB, and control group. The primary outcome was total postoperative morphine consumption. RESULTS: Total postoperative morphine consumption was higher for the control group compared with the bilevel and unilevel groups (5.5 ± 1.8 vs 3.0 ± 0.0 and 4.3 ± 1.6 mg, CONCLUSION: Both conventional unilevel and high thoracic bilevel ESPB had better analgesic profile when compared with opioids. Although the bilevel ESPB had additional merits to the unilevel ESPB in analgesic effects, both can be used effectively.