Daily Anesthesiology Research Analysis
Three impactful studies span mechanistic pain science, perioperative thrombosis risk, and sedation safety. Neural and facial dynamics decoded acute pain in naturalistic settings, a large validation confirmed a simple patient-factor VTE risk tool after abdominal/pelvic surgery, and a randomized trial showed remimazolam–ciprofol sedation reduced hypoxemia during gastrointestinal endoscopy.
Summary
Three impactful studies span mechanistic pain science, perioperative thrombosis risk, and sedation safety. Neural and facial dynamics decoded acute pain in naturalistic settings, a large validation confirmed a simple patient-factor VTE risk tool after abdominal/pelvic surgery, and a randomized trial showed remimazolam–ciprofol sedation reduced hypoxemia during gastrointestinal endoscopy.
Research Themes
- Objective pain monitoring from neural and behavioral signals
- Perioperative venous thromboembolism risk stratification
- Optimizing deep sedation to reduce hypoxemia in endoscopy
Selected Articles
1. Naturalistic acute pain states decoded from neural and facial dynamics.
In 12 epilepsy patients monitored continuously, machine learning using intracranial EEG and facial expressions classified high versus low pain states at the individual level. Neural representations were stable over hours, modulated by pain onset and relief, and transient “momentary pain” periods were reliably identified.
Impact: Provides objective, multimodal neurobehavioral markers of acute pain in naturalistic contexts, opening avenues for real-time monitoring and personalized analgesia.
Clinical Implications: Although not yet ready for clinical deployment, these markers could inform intraoperative/postoperative pain monitoring, titration of analgesics, and development of closed-loop systems.
Key Findings
- Multimodal machine learning on intracranial EEG and facial expressions decoded individual high vs low pain states.
- Neural representations were stable for hours and modulated by pain onset and relief.
- Facial expressions independently classified pain states, concordant with neural decoding.
- Transient, momentary pain periods were discriminated from affect-neutral epochs using neural and facial features.
Methodological Strengths
- Multimodal continuous monitoring (intracranial EEG, facial analytics, self-reports) in naturalistic conditions
- Within-subject machine learning decoding across distributed brain regions with temporal stability
Limitations
- Small sample size (n=12) restricted to epilepsy patients undergoing intracranial monitoring limits generalizability
- Clinical utility not yet validated in perioperative or ambulatory settings; external validation pending
Future Directions: Validate decoding across larger, diverse cohorts (including perioperative/ICU settings), integrate non-invasive signals, and develop closed-loop analgesia trials.
2. The CLUE postsurgery VTE risk instrument for abdominal and pelvic surgery: validation of patient risk factor component.
In 11,636 patients undergoing major abdominal, urologic, or gynecologic surgery, the CLUE patient-factor component (age ≥75, BMI ≥35, prior VTE) stratified 30-day VTE risk. Compared to low risk, medium and high categories had relative risks of 1.56 and 3.60, rising to 1.91 and 5.41 without antithrombotics.
Impact: Validates a simple, widely-available patient-factor tool that complements procedure-based absolute risks, supporting individualized thromboprophylaxis decisions.
Clinical Implications: Use the validated patient-factor component with procedure-specific risk to stratify VTE risk and tailor prophylaxis intensity and duration; tool available at www.cluevte.org.
Key Findings
- Validated patient-factor component (age ≥75, BMI ≥35 kg/m2, prior VTE) in 11,636-patient VISION cohort.
- 30-day postoperative VTE incidence 0.8%; medium- and high-risk groups had RR 1.56 and 3.60 vs low risk.
- Without antithrombotic medication, relative risks increased to 1.91 (medium) and 5.41 (high).
- Patient-factor risk complements procedure-specific absolute risk estimates from prior systematic reviews.
Methodological Strengths
- Large, international, prospective cohort with standardized 30-day outcome
- Appropriate modified Poisson regression and prespecified risk categorization
Limitations
- Observational validation subject to residual confounding; absolute VTE risk was low (0.8%)
- Focused on major abdominal/pelvic surgeries; generalizability to other surgical populations requires study
Future Directions: Assess integration into clinical pathways, evaluate calibration in diverse health systems, and test impact on prophylaxis use and VTE outcomes.
3. Combined Use of Remimazolam and Ciprofol Reduces Hypoxemia and Shortens Recovery Time During Sedated Gastrointestinal Endoscopy.
In 246 randomized patients undergoing deep-sedation endoscopy, remimazolam–ciprofol reduced the incidence and frequency of hypoxemia versus ciprofol alone, and shortened time to loss of consciousness and awakening. Lower minimum SpO2 correlated with higher BMI and age, and higher preoperative SpO2 predicted higher minimum intraoperative SpO2.
Impact: Addresses a common and clinically important adverse event during endoscopic sedation with a pragmatic regimen that improves safety and efficiency.
Clinical Implications: Consider remimazolam–ciprofol co-administration for deep sedation in PGIE, particularly in higher-risk patients (older, higher BMI), with vigilant monitoring and institutional protocols.
Key Findings
- Randomized comparison (n=246) showed lower hypoxemia incidence and frequency with remimazolam–ciprofol vs ciprofol alone.
- Combination regimen shortened time to loss of consciousness and awakening compared with ciprofol alone.
- Minimum intraoperative SpO2 correlated inversely with age and BMI, and positively with preoperative SpO2.
Methodological Strengths
- Randomized allocation with prespecified primary outcome focused on safety (hypoxemia)
- Concurrent assessment of physiological correlates (age, BMI, baseline SpO2)
Limitations
- Single-center design; blinding details not specified, potentially introducing performance bias
- Sedation depth monitoring and dosing algorithms not fully detailed, limiting reproducibility
Future Directions: Multi-center, blinded trials comparing adjunctive regimens and dosing strategies, with standardized sedation depth monitoring and patient-centered outcomes.