Daily Anesthesiology Research Analysis

BACKGROUND: No previous study has described in-hospital cardiac arrest (IHCA) aetiologies prospectively through a protocolised investigation. In this study, we investigated IHCA aetiologies in both IHCA patients achieving return of spontaneous circulation (ROSC) as well as IHCA patients not achieving ROSC. METHODS: Adult IHCA patients were included at Aarhus University Hospital in Denmark. In patients with ROSC, the investigation consisted of blood tests including toxicology, echocardiography, and whole-body computed tomography (CT). In patients without ROSC, the investigation consisted of blood tests including toxicology and whole-body CT and magnetic resonance imaging (MRI). The primary outcome was the IHCA aetiology as determined by a four-person expert panel using pre-defined main- and subcategories. Secondary outcomes included the presumed cause as determined by cardiac arrest team leaders as well as the discrepancy between presumed and expert panel causes. RESULTS: 150 patients were included, and 71 (47 %) achieved ROSC. Expert panel aetiologies (with between-expert ranges) were determined as cardiac in 29 % (27-29 %) and pulmonary in 30 % (25-32 %) of cases. Myocardial ischaemia and hypoxia were the most prevalent specific subcategories in 11 % (10-15 %) and 21 % (14-23 %) of cases, respectively. The cause was deemed unknown in 7 % (0-14 %) of cases, and presumed causes were deemed unknown in 26 % of cases. Agreement between presumed and expert panel causes was low (Kappa: 0.16-0.42 across experts). CONCLUSION: The predominant aetiologies of IHCA are pulmonary and cardiac. A protocolised investigation, including post-mortem investigations, aided in disclosing IHCA aetiologies. Presumed causes are often unknown and often differ from expert panel causes.

INTRODUCTION: This study aims to identify potentially causal circulating proteins and novel drug targets for delirium using a Mendelian randomization (MR)-based analytical framework and various bioinformatics and genomics methods. MATERIAL AND METHODS: Large-scale two-sample MR was employed to estimate the effects of thousands of plasma proteins on delirium. Additional analysis included Bayesian Colocalization, Steiger filtering, protein-altering variant assessment, and mapping of expression quantitative trait loci (eQTL) to protein quantitative trait loci (pQTL). Protein-protein interaction (PPI) networks, pathway enrichment analysis, and evaluation of drug targets were conducted to identify potential therapeutic targets for delirium. RESULTS: Several plasma proteins were identified that show significant causal effects on delirium. Bayesian Colocalization confirmed that these proteins share a common genetic architecture with delirium-associated loci. Steiger filtering analysis validated the direction of causality. Assessment of protein-altering variants and eQTL-pQTL mapping provided further evidence supporting the MR findings. PPI networks and pathway enrichment analysis revealed involvement in key biological processes and pathways related to brain function and neuroinflammation. Several proteins were identified as potential therapeutic targets, offering new avenues for prevention and treatment of delirium. CONCLUSIONS: This study identifies several plasma proteins that have a significant causal relationship with delirium, suggesting their potential as biomarkers and therapeutic targets. Our comprehensive analysis using MR, Colocalization, and other bioinformatics approaches strengthens the evidence for these associations. The findings enhance our understanding of the molecular mechanisms underlying delirium and highlight new targets for intervention, which could lead to improved prevention and treatment strategies for this condition.

INTRODUCTION: The incidence of postoperative neurocognitive disorder (PND) in elderly patients with hip fractures poses a significant clinical challenge, with current management strategies offering limited efficacy in prevention or resolution. This prospective study evaluated the effectiveness of pre-and postoperative electroacupuncture (EA) intervention in mitigating PND in this patient cohort. METHODS: A double-masked, randomized controlled trial was conducted involving 60 elderly patients (≥65 years) with fragility hip fractures scheduled for surgical repair. Participants were randomly assigned to either the EA intervention group (Group A) or a non-stimulated control group (Group C). Mini-Mental State Examination (MMSE) scores were recorded at baseline and 1, 3, and 7 days postoperatively, while ELISA was used to assess IL-1β, IL-6, and S-100β levels. Time-varying MAP, SpO2, and HR were measured. Adverse cardiovascular events, extubation duration, recovery room stay, VAS scores, analgesia pump use, postoperative adverse responses, and hospitalization length were recorded. RESULTS: Among 60 randomized patients (mean age 74.02 years; 54.7 % male), 53 were analyzed for primary outcomes. Postoperative day 1 PND incidence was significantly lower in Group A (25.0 %) than Group C (56.0 %; P < 0.05), persisting on day 3 (Group A: 14.3 %, Group C: 48.0 %; P < 0.05). By day 7, PND incidence was similar in both groups. Time-group interactions were significant for IL-1β, IL-6, and blood pressure (P < 0.05). Group A exhibited a lower VAS score at 24 h postoperatively (2.65 ± 0.94 vs. 3.96 ± 0.96; P < 0.05). Adverse events were reported in 26 Group A and 32 Group C cases. Postoperative nausea and vomiting (PONV) significantly differed (Group A: 3.7 %, Group C: 30.8 %). CONCLUSIONS: The findings suggest that pre- and postoperative EA stimulation may significantly reduce the risk of PND, modulate inflammatory responses, and lower blood pressure. Furthermore, EA intervention was associated with reduced postoperative pain and a marked decrease in the incidence of PONV in elderly patients with hip fractures. These results highlight the potential therapeutic benefits of EA in managing PND in this vulnerable patient population and warrant further investigation. SUBJECT WORDS: electroacupuncture, transcutaneous electrical acupoint stimulation, hip surgery, perioperative neurocognitive disorders, pain, postoperative nausea and vomiting.