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.
Chronic musculoskeletal (MSK) pain affects a substantial proportion of youth, with 5 % reporting high-impact symptoms. Chronic pain in youth leads to multifaceted negative consequences that profoundly affect adolescents' quality of life (QoL) and future outcomes. Recent studies suggest that neuro-immune interactions significantly contribute to chronic pain. However, how systemic immune dysregulation influences brain function, and how these brain changes affect well-being and functioning in chronic pain remains unclear. This study aims to examine the convergence between immune function and brain processing during a multisensory task to identify novel mechanistic pathways that may explain reduced QoL in adolescents with chronic MSK pain (N = 129). We used a multisensory fMRI task designed to mimic the unpleasant sensory experiences that adolescents and adults with chronic pain often encounter in daily life. Higher task-evoked activation in the rostral an
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.
OBJECTIVE: This study aimed to investigate the effects of perioperative esketamine on postoperative depression and pain in patients undergoing laparoscopic total hysterectomy. METHODS: 135 patients undegoing laparoscopic total hysterectomy were recruited and randomly allocated to three groups. Finally, a total of 127 patients were selected into the statistical analysis, with the final grouping information as follows: sufentanil group (S1, n = 44), sufentanil combined with 0.25 mg/kg esketamine group (SK1, n = 42) and sufentanil combined with 0.5 mg/kg esketamine group (SK2,n = 41) intraoperatively, then postoperative analgesia was maintained with sufentanil (2 µg/kg) via patient-controlled intravenous analgesia (PCIA) in all groups, while a 1 mg/kg dose of esketamine was added to the PCIA regimen for patients in groups SK1 and SK2. The peripheral blood serum brain-derived neurotrophic factor (BDNF) level, 5-hydroxytryptamine (5-HT) level, Hamilton Depression Scale (HAM-D) scores, visual a
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.
BACKGROUND: Unexpected difficult intubation during general anesthesia can significantly increase patient morbidity and mortality. The McGRATH videolaryngoscope is recognized for its ability to enhance laryngeal visibility in patients with both difficult and normal airways. This study aims to compare the efficacy of McGrath videolaryngoscopes and Macintosh laryngoscope in adult patients under general anesthesia, utilizing data from prospective randomized trials. METHODS: A comprehensive literature search was performed across databases including PubMed, Web of Science, and Embase. Data on the success rate of the first intubation attempt, intubation time, and glottic visualization during tracheal intubation were extracted from the identified studies. The data were analyzed using Stata 15 software. The risk of bias was assessed using the five domains of the Cochrane Collaborations tool. RESULTS: Nineteen articles met our inclusion criteria. The McGrath laryngoscope demonstrated superior glottic visualization compared to the Macintosh laryngoscope (RR, 1.47; 95% CI, 1.14 to 1.89). However, there were no significant differences between the McGrath and Macintosh laryngoscopes in terms of intubation time (SMD, 0.35; 95% CI, -0.14 to 0.85) and the success rate of the first intubation attempt (RR, 1.01; 95% CI, 0.96 to 1.07). Additionally, there were no statistically significant differences in the incidence of sore throat between the two laryngoscopes (RR, 1.00; 95% CI, 0.71 to 1.42). CONCLUSIONS: Our study indicates that the McGrath videolaryngoscope provides superior glottic visualization compared to the Macintosh laryngoscope. Nevertheless, there are no statistically significant differences between the two laryngoscopes regarding first-attempt tracheal intubation success rates and intubation times.