Daily Anesthesiology Research Analysis
Today's top anesthesiology-related studies span perioperative pharmacology, critical care nutrition, and systems immunology. A Japanese GRADE-based guideline endorses early enteral nutrition and microbiome-directed strategies in ICU care, while a retrospective cohort suggests intra-arterial lidocaine during TACE may prolong survival in HCC. Proteomic profiling shows perioperative dexamethasone blunts surgical inflammation and modulates bone and immune pathways after total knee arthroplasty.
Summary
Today's top anesthesiology-related studies span perioperative pharmacology, critical care nutrition, and systems immunology. A Japanese GRADE-based guideline endorses early enteral nutrition and microbiome-directed strategies in ICU care, while a retrospective cohort suggests intra-arterial lidocaine during TACE may prolong survival in HCC. Proteomic profiling shows perioperative dexamethasone blunts surgical inflammation and modulates bone and immune pathways after total knee arthroplasty.
Research Themes
- Perioperative drugs and long-term outcomes
- Critical care nutrition and microbiome strategies
- Systems immunology of surgical stress
Selected Articles
1. The Japanese Critical Care Nutrition Guideline 2024.
A multidisciplinary, GRADE-based guideline for critical care nutrition in Japan issues 24 recommendations across 37 clinical questions. Strong adult recommendations include early enteral nutrition within 48 hours and provision of pre/synbiotics; multiple weak recommendations address protocols, protein targets, post-pyloric and continuous EN, omega-3-enriched formulas, probiotics, and indirect calorimetry. Pediatric guidance endorses early EN, bolus feeding, and energy/protein-dense formulas.
Impact: Guidelines shape bedside practice for ICU nutrition and introduce microbiome-directed strategies (pre/synbiotics) with strong recommendations, likely to influence protocols and research priorities.
Clinical Implications: Adopt early enteral nutrition within 48 hours for most critically ill adults and children; consider pre/synbiotics and probiotics where feasible; use structured nutrition protocols, target higher protein, prefer EN over PN, and use indirect calorimetry to guide energy delivery.
Key Findings
- Strong adult recommendations: initiate enteral nutrition within 48 hours and provide pre/synbiotics.
- Weak adult recommendations: use nutrition protocols; prefer enteral over parenteral nutrition; target higher protein doses; favor post-pyloric and continuous EN; consider omega-3-enriched EN, probiotics, and indirect calorimetry.
- Pediatric recommendations: early EN within 48 hours, bolus EN, and energy/protein-dense formulas; nutritional assessment is a good practice statement for both adults and children.
Methodological Strengths
- GRADE methodology with explicit rating of evidence quality and recommendation strength
- Modified Delphi consensus across a multidisciplinary expert panel
Limitations
- Guideline applicability tailored to Japan; external generalizability may vary
- Evidence base heterogeneity; some recommendations are weak due to limited high-quality trials (e.g., microbiome-directed therapies)
Future Directions: Prospective, multicenter RCTs to test pre/synbiotics, omega-3–enriched EN, and higher protein targets in diverse ICU populations; implementation studies of protocolized nutrition and indirect calorimetry.
2. Intra-arterial lidocaine improves long-term survival in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolisation: a retrospective propensity score-matched study.
In 374 HCC patients undergoing initial TACE, intra-arterial lidocaine was associated with longer progression-free and overall survival. Benefits persisted after propensity score matching and on multivariable analysis, and were observed in a platinum-based TACE subgroup.
Impact: Suggests a readily implementable, low-cost adjunct (lidocaine) may confer survival benefit during TACE, potentially changing interventional oncology anesthesia protocols.
Clinical Implications: Consider evaluating intra-arterial lidocaine as an adjunct during TACE, especially with platinum regimens, while awaiting confirmatory randomized trials and safety/pharmacokinetic data.
Key Findings
- Intra-arterial lidocaine was associated with longer progression-free survival (P=0.004) and overall survival (P<0.001).
- Survival benefits remained after propensity score matching (PFS P<0.001; OS P=0.001).
- Lidocaine was an independent prognostic factor on multivariable analysis (PFS P=0.011; OS P=0.044), including in platinum-based TACE subgroup analyses.
Methodological Strengths
- Propensity score matching to reduce confounding
- Multivariable analyses and consistent subgroup results (platinum-based regimens)
Limitations
- Retrospective, single-center design with potential residual confounding
- Dosing, timing, and mechanistic/pharmacokinetic data were not detailed
Future Directions: Randomized controlled trials to confirm survival effects, define optimal dosing/timing, and explore mechanistic synergy with chemotherapeutics.
3. Dexamethasone vs. placebo modulation of the perioperative blood immune proteome in patients undergoing total knee arthroplasty.
Using samples from a randomized TKA trial, perioperative dexamethasone produced a less pro-inflammatory proteomic profile than placebo: IL-6 response was attenuated (2.5 vs 4.7 log2-fold-change), with reduced signaling for osteoclast activity and innate/adaptive immune responses and increased CSF3. Findings underscore strong modulation of surgical stress pathways.
Impact: Provides systems-level molecular evidence for dexamethasone’s perioperative immunomodulation, informing mechanistic understanding and safety/benefit considerations for routine steroid use.
Clinical Implications: Supports the anti-inflammatory rationale for perioperative dexamethasone in TKA and raises hypotheses regarding effects on bone remodeling (osteoclast pathways) and infection immunity that warrant clinical correlation.
Key Findings
- Placebo (surgery alone) elicited a strong IL-6 increase (4.7 log2-fold-change; adj. p<0.01) with upregulation of immune signaling and bone marrow mobilization.
- Dexamethasone plus surgery showed attenuated IL-6 response (2.5 log2-fold-change; adj. p<0.01) and reduced signaling for osteoclast activity and innate/adaptive immune reactions.
- Direct dexamethasone effect included CSF3 upregulation (1.55 log2-fold-change; adj. p<0.01) and inhibition of extracellular matrix formation pathways.
Methodological Strengths
- Use of randomized, placebo-controlled trial biobank with pre- and postoperative sampling
- High-throughput proteomics (Olink) with multiple-testing correction and pathway-level interpretation
Limitations
- Proteomic endpoints are exploratory; clinical outcomes were not directly tested in this analysis
- Unequal group sizes (n=60 dexamethasone vs n=20 placebo) and single surgical context (TKA) may limit generalizability
Future Directions: Correlate proteomic signatures with clinical endpoints (pain, infection, prosthesis loosening) and test dosing/timing strategies in RCTs across surgeries.