Daily Anesthesiology Research Analysis

BACKGROUND: Perioperative beta blockade lowers heart rate and decreases the risk of myocardial infarction but increases the risk of hypotension, death, and stroke. Ivabradine, a selective heart rate-lowering agent, may prevent prognostically important myocardial injury after noncardiac surgery (MINS) without causing hemodynamic instability. METHODS: In this multicenter, double-blind, placebo-controlled trial, we assigned patients ≥45 years of age with, or at risk of, atherosclerotic disease undergoing noncardiac surgery to receive ivabradine (5 mg orally twice daily for up to 7 days, starting 1 hour before surgery) or placebo. The primary outcome was MINS within 30 days from randomization. RESULTS: All of the 2101 participants who underwent randomization were included in the intention-to-treat population. MINS occurred in 178 of 1050 patients (17.0%) in the ivabradine group and in 159 of 1051 patients (15.1%) in the placebo group (relative risk, 1.12 [95% CI, 0.92 to 1.37]; CONCLUSIONS: Among patients undergoing noncardiac surgery, ivabradine did not reduce the occurrence of MINS. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05279651.

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a common complication in elderly surgical patients and has been associated with excessive anesthetic depth. Electroencephalogram (EEG)-guided anesthesia provides real-time cerebral monitoring (e.g., bispectral index [BIS]), but its effect on POCD remains inconclusive across randomized controlled trials (RCTs). METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines, searching PubMed, Embase, Cochrane Library, and Web of Science for RCTs evaluating EEG-guided anesthesia versus standard care in elderly surgical patients. Primary outcome was POCD incidence; secondary outcomes included cognitive scores across acute (1–7 days), subacute (1–3 months), and chronic (≥ 6 weeks) phases. Risk of bias was assessed using the Cochrane Tool. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were calculated with fixed/random-effects models. Trial sequential analysis (TSA) and sensitivity analyses validated evidence robustness; funnel plots and Egger’s test evaluated publication bias. RESULTS: Ten RCTs (4,367 patients) were included. EEG-guided anesthesia significantly reduced POCD incidence by 22% (pooled OR = 0.78, 95% CI: 0.69–0.90, CONCLUSIONS: Intraoperative EEG-guided anesthesia—particularly using BIS monitoring—reduces POCD incidence and improves subacute cognitive outcomes in elderly patients, likely by avoiding excessive anesthetic depth and optimizing hemodynamics. While long-term effects on global cognition remain unproven, these findings support EEG monitoring as a valuable adjunct in high-risk populations, particularly for major non-cardiac surgery. Standardized POCD assessment, personalized strategies, and long-term follow-ups are needed to refine clinical guidelines and understand persistent cognitive trajectories. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-025-03297-3.

BACKGROUND: Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle triggered by certain anesthetic agents. While Ryanodine Receptor 1 ( METHODS: We conducted gene panel testing targeting 24 calcium-related genes in 338 individuals from 247 Japanese families with suspected or confirmed MH. Variants were analyzed on a gene-by-gene basis, and their pathogenicity was assessed using in silico prediction tools. Additionally, patients were classified into subgroups based on the results of the calcium-induced calcium release (CICR) assay and the Clinical Grading Scale (CGS) score. RESULTS: Candidate pathogenic variants were identified in 118 families (48.2%), including 73 (29.8%) in CONCLUSIONS: Our findings confirm the predominant role of RYR1 and CACNA1S in MH susceptibility in the Japanese population and highlight additional candidate genes that may contribute to the condition. Broader genetic screening and functional validation studies are warranted to further elucidate the polygenic nature of MH.