Daily Anesthesiology Research Analysis

BACKGROUND: Phenylephrine is recommended for the management of hypotension after spinal anaesthesia for women undergoing caesarean delivery. Norepinephrine, an adrenergic agonist with weak β-adrenergic activity, has been reported to have a more favourable haemodynamic profile than phenylephrine. However, there are concerns that norepinephrine may be associated with higher risk of fetal acidosis which can be serious in an already compromised foetus. OBJECTIVE: This study aimed to test the hypothesis that in terms of the umbilical artery base excess norepinephrine is not inferior to phenylephrine when it is used to prevent spinal hypotension during caesarean delivery. DESIGN: A prospective, randomised, double-blind trial. SETTING: Operating room of Tertiary Care Hospital in Northern India from January 2022 to November 2022. PATIENTS: Parturients with non-reassuring fetal heart rate undergoing nonelective caesarean delivery under spinal anaesthesia. INTERVENTION: Equipotent prophylactic infusions of either phenylephrine 80 μg min-1 or norepinephrine 6 μg min-1 were administered to maintain maternal systolic BP between 90 and 110% of baseline using a predefined algorithm. MAIN OUTCOME MEASURES: The primary outcome was umbilical arterial base excess comparing the limits of the 95% confidence interval with a predefined noninferiority margin of -0.05 mmol l-1. The incidence of fetal acidosis was also evaluated for norepinephrine and phenylephrine group. RESULTS: Data were analysed from 104 patients. The mean ± SD umbilical arterial base excess was higher in norepinephrine group than the phenylephrine group: -6.85 ± 2.20 mmol l-1vs. -7.95 ± 2.99 mmol l-1, respectively (P  = 0.034). Norepinephrine was found to be noninferior as the lower limit of 95% CI of mean difference between base excess of two groups was 1.10 (95% CI, 0.084 to 2.123) mmol l-1, P  = 0.034) which did not cross our predefined noninferiority margin of -0.05 mmol l-1. No significant difference in the incidence of fetal acidosis was observed between norepinephrine and phenylephrine groups: 62% vs. 75% (P  = 0.140). CONCLUSION: Prophylactic norepinephrine infusion (6 μg min-1) was found to be noninferior to phenylephrine infusion (80 μg min-1) in terms of umbilical arterial base excess values. A similar incidence of fetal acidosis was observed in both groups. TRIAL REGISTRATION: CTRI/2022/01/039343; dated - 12 January 2022.

PURPOSE: Lumbar spinal fusion (LSF) represents a primary surgical approach for treating degenerative lumbar diseases and spinal instability in elderly patients. However, the impact of ERAS protocols in elderly patients undergoing LSF remains unknown. This article aims to summarize the effectiveness and safety of ERAS protocols in elderly patients undergoing LSF, thereby providing evidence-based guidance for perioperative management of this population. METHODS: A search was performed across multiple databases, including PubMed, Embase, Cochrane Library, Web of Science, Preprint Platforms (MedRxiv), and Clinical Trial database, to identify eligible studies. Retrospective studies and randomized controlled trials that compared the clinical utility of ERAS with conventional pathways in elderly patients (≥ 65years) undergoing LSF were included. The retrieved literature underwent Meta-analysis R software. Trial sequential analyses were conducted for outcomes reported in at least five studies, using the Trial Sequential Analysis Software. RESULTS: The meta-analysis incorporated seventeen eligible studies. Compared with conventional perioperative care, ERAS protocols showed significant benefits across multiple outcomes: reduced length of stay(LOS) (mean difference: -2.29 days; 95%CI: -2.84 to -1.74; I² = 72.7%), decreased intraoperative blood loss (mean difference: -46.2 mL; 95%CI: -73.44 to -19.00; I² = 72.1%), and earlier ambulation (mean difference: -1.53 days; 95% CI: -2.300 to -0.753; I² = 91.7%). The protocol also significantly lowered risks of postoperative complications (OR = 0.44; 95%CI: 0.364 to 0.528; I² = 0%), postoperative nausea and vomiting(PONV) (OR = 0.50; 95%CI: 0.340 to 0.747; I² = 0%), and hospital readmission (OR = 0.66; 95%CI: 0.471 to 0.936; I² = 2.8%). CONCLUSION: The application of the ERAS protocol in elderly patients undergoing LSF was associated with favorable clinical outcomes, including shorter LOS, lower incidence of postoperative complications, reduced risk of PONV, and decreased readmission rates.

Genetically engineered pig lungs have not previously been transplanted into humans, leaving key questions unanswered regarding the human immune response in the context of a xenotransplanted lung and the possibility of hyperacute rejection. Here, we report a case of pig-to-human lung xenotransplantation, in which a lung from a six-gene-edited pig was transplanted into a 39-year-old brain-dead male human recipient following a brain hemorrhage. The lung xenograft maintained viability and functionality over the course of the 216 hours of the monitoring period, without signs of hyperacute rejection or infection. Severe edema resembling primary graft dysfunction was observed at 24 hours after transplantation, potentially due to ischemia-reperfusion injury. Antibody-mediated rejection appeared to contribute to xenograft damage on postoperative days 3 and 6, with partial recovery by day 9. Immunosuppression included rabbit anti-thymocyte globulin, basiliximab, rituximab, eculizumab, tofacitinib, tacrolimus, mycophenolate mofetil and tapering steroids, with adjustments made during the postoperative period based on assessments of immune status. Although this study demonstrates the feasibility of pig-to-human lung xenotransplantation, substantial challenges relating to organ rejection and infection remain, and further preclinical studies are necessary before clinical translation of this procedure.