Daily Anesthesiology Research Analysis
Analyzed 23 papers and selected 3 impactful papers.
Summary
Three impactful studies span perioperative therapeutics, airway management evidence synthesis, and pain neuro-immunology. A randomized trial shows perioperative esketamine improves early postoperative depression and analgesia after hysterectomy; a meta-analysis finds McGrath videolaryngoscopes improve glottic view without improving first-pass success; and a mechanistic study links neutrophil-driven inflammation to brain network activation and reduced quality of life in adolescents with chronic musculoskeletal pain.
Research Themes
- Perioperative esketamine for pain and mood modulation
- Evidence synthesis in airway device performance
- Neuro-immune mechanisms underlying chronic pain and quality of life
Selected Articles
1. Brain-immune correlates of quality of life in adolescents with chronic musculoskeletal pain.
In adolescents with chronic musculoskeletal pain, higher task-evoked activation of rACC-dmPFC and stronger connectivity to somatosensory and visual cortices were associated with lower physical quality of life. Elevated pro-inflammatory activity in immature neutrophils also tracked lower physical QoL, and rACC-dmPFC activation partially mediated the link between neutrophil-driven inflammation and QoL.
Impact: This work identifies a plausible neuro-immune pathway connecting systemic inflammation to altered brain processing and diminished quality of life, informing mechanistic targets for pain interventions.
Clinical Implications: While not immediately practice-changing, the findings support integrating inflammatory profiling and brain network metrics into risk stratification and guide development of anti-inflammatory or neuromodulatory treatments for adolescent chronic pain.
Key Findings
- Higher rACC-dmPFC activation during a multisensory fMRI task correlated with lower physical QoL (pFWE = 0.005).
- Increased functional connectivity between rACC-dmPFC and somatosensory (pFWE = 0.002) and visual (pFWE = 0.049) cortices was associated with lower physical QoL.
- Greater pro-inflammatory activity in immature neutrophils was associated with lower physical QoL (p = 0.01).
- rACC-dmPFC activation partially mediated the relationship between neutrophil-driven inflammation and reduced physical QoL.
Methodological Strengths
- Multimodal integration of systemic immune profiling with task-based fMRI using family-wise error correction.
- Ecologically informed multisensory task and a relatively large adolescent sample (N=129).
Limitations
- Cross-sectional observational design limits causal inference.
- Generalizability is restricted to adolescents with chronic MSK pain; no interventional validation.
Future Directions: Longitudinal and interventional studies to test whether modulating neutrophil-driven inflammation or rACC-dmPFC circuitry improves QoL; development of neuro-immune biomarkers for stratified care.
2. Esketamine relieves postoperative depression and pain indicators in patients undergoing laparoscopic total hysterectomy.
In a three-arm randomized study (n=127), adding esketamine (0.25 or 0.5 mg/kg intraoperatively plus 1 mg/kg in PCIA) to sufentanil improved early postoperative depression indices (lower HAMD at days 1–5) and analgesia (lower VAS at 1–48 h), increased serum BDNF and 5-HT levels, reduced PCIA presses and intraoperative remifentanil, without increasing adverse events. The 0.5 mg/kg intraoperative dose showed greater early antidepressant effects.
Impact: Addresses the understudied problem of postoperative depression alongside pain, demonstrating a feasible esketamine regimen with multimodal benefits and no excess adverse events.
Clinical Implications: Consider esketamine as an adjunct to opioid-based analgesia in gynecologic laparoscopic surgery to improve early mood and pain outcomes; monitor psychotomimetic effects and tailor dosing (0.5 mg/kg intraop showed stronger early effects).
Key Findings
- Esketamine groups had higher serum BDNF and 5-HT at postoperative days 1, 2, and 5 versus sufentanil alone; the 0.5 mg/kg dose produced greater increases at days 1–2.
- HAM-D scores were reduced at postoperative days 1, 2, and 5 with esketamine, with larger reductions at days 1–2 in the 0.5 mg/kg group; no between-group differences pre-op or at day 7.
- VAS pain scores were lower at 1 h, 6 h, 12 h, 24 h, and 48 h post-op; PCIA press counts and intraoperative remifentanil were reduced in esketamine groups.
- Adverse events (nausea, vomiting, dizziness, respiratory depression, hallucinations) did not differ among groups.
Methodological Strengths
- Randomized three-arm design with prospective registration (ChiCTR2200065198).
- Combined biological (BDNF, 5-HT) and clinical outcomes with repeated measures across early postoperative days.
Limitations
- Single-center study with unclear blinding, increasing risk of performance/assessment bias.
- Short follow-up (up to 7 days) and limited to laparoscopic hysterectomy, reducing generalizability.
Future Directions: Multicenter, blinded trials with longer follow-up to assess durability of antidepressant effects, optimal dosing, and applicability across procedures and risk profiles.
3. A comparison of McGrath video laryngoscope versus macintosh laryngoscope for intubation undergoing general anesthesia: a meta-analysis.
Across 19 randomized trials, McGrath videolaryngoscopes improved glottic visualization relative to Macintosh, but did not improve first-attempt success, intubation time, or sore throat incidence. The findings suggest better views do not necessarily translate into improved intubation efficiency or success in routine adult general anesthesia.
Impact: Provides an evidence-based synthesis to guide device selection and training priorities, clarifying that visualization gains alone may not improve first-pass success.
Clinical Implications: Reserve videolaryngoscope use for anticipated difficult airways or training contexts where visualization is critical; continue emphasizing technique, positioning, and adjuncts to improve first-pass success.
Key Findings
- McGrath improved glottic visualization versus Macintosh (RR 1.47; 95% CI 1.14–1.89).
- No significant difference in first-attempt intubation success (RR 1.01; 95% CI 0.96–1.07).
- No significant difference in intubation time (SMD 0.35; 95% CI −0.14 to 0.85).
- Postoperative sore throat incidence did not differ (RR 1.00; 95% CI 0.71–1.42).
Methodological Strengths
- Synthesizes only prospective randomized trials with Cochrane risk-of-bias assessment.
- Comprehensive database search and quantitative meta-analytic approach with effect sizes and CIs.
Limitations
- Potential heterogeneity in operator experience, airway difficulty, and protocols not fully explored.
- PRISMA adherence and publication bias assessments are not detailed in the abstract.
Future Directions: Stratified analyses by predicted difficult airway, operator experience, and patient-centered outcomes; evaluate cost-effectiveness and training impact.