Daily Anesthesiology Research Analysis

BACKGROUND: Postoperative delirium is associated with increased morbidity, mortality, future cognitive decline, or dementia. Understanding the neural mechanisms that differentiate individual brain vulnerabilities is critical for future therapeutic development and prevention of postoperative delirium. We investigated the hypothesis that impaired resting state functional connectivity indicates predisposition to delirium. METHODS: Preoperative blood oxygen level-dependent functional MRI data were collected from 120 participants (>65 yr, 52 female) undergoing major elective non-intracranial surgery. Denoised blood oxygen level-dependent signal time-series for 400 cortical regions were used to calculate resting state functional connectivity within and between canonical resting state networks. We used a support vector machine to determine whether resting state functional connectivity across higher-order cortical networks was predictive of postoperative delirium. RESULTS: Group comparisons revealed significantly decreased within-network connectivity in salience-ventral attention, cognitive control, and default mode network in participants with postoperative delirium (n=31) compared with non-delirious participants (n=89; non-parametric permutation test, 1000 iterations, P<0.05). We found overall weaker connectivity within the default mode network and specific differences across the sub-networks of the default mode which overlap with higher-order cognitive processing. Supervised machine learning identified that the visual and salience-ventral attentional networks predicted postoperative delirium incidence with an accuracy of 68%. CONCLUSIONS: Resting state functional connectivity is a neural correlate of vulnerability to postoperative delirium. Disrupted resting state connectivity within higher-order cognitive association areas, including the default mode network, salience attention, and cognitive control networks, was specifically correlated with delirium. CLINICAL TRIAL REGISTRATION: NCT01980511 and NCT03124303.

BACKGROUND: Interscalene brachial plexus block (ISB) remains the gold standard for analgesia in arthroscopic shoulder surgery (ASS). However, ISB is associated with a higher incidence of hemidiaphragmatic paralysis (DP). OBJECTIVES: This study compares ultrasound-guided interscalene brachial plexus block (USG-ISB) with a combination of ultrasound-guided pericapsular nerve block (USG-PENB) and superficial cervical plexus block (SCPB) to evaluate analgesic efficacy and the incidence of DP. METHODS: In this prospective, triple-blinded randomized trial, 42 American Society of Anesthesiologists (ASA) I - II patients undergoing elective ASS were randomized into two groups after induction of general anesthesia (GA): Group A (ISB, 10 mL 0.25% bupivacaine) or group B [pericapsular nerve block (PENB) 10 mL + SCPB 5 mL 0.25% bupivacaine]. Blocks were performed under ultrasound guidance. The primary outcome was the incidence of DP; secondary outcomes included pain scores, opioid consumption, pulmonary function, and patient satisfaction. RESULTS: Compared with group A, group B demonstrated a delayed time to first request for rescue analgesia (13.24 vs. 8.38 hours; P < 0.001) and reduced 24-hour fentanyl consumption (135.71 vs. 192.86 mcg; P = 0.012). Pulmonary function was significantly better preserved in group B (P < 0.05). The incidence of DP was lower in group B (4.76% vs. 38.1%; P = 0.02). Pain scores at 6, 12, and 18 hours were also lower in group B (P < 0.05). Both groups showed no differences in hypotension, bradycardia, or patient satisfaction. CONCLUSIONS: The combination of PENB and SCPB provides analgesia non-inferior to ISB, while significantly reducing the incidence of DP and opioid requirements. For individuals at risk of respiratory impairment, this approach presents a lower-risk alternative without compromising pain control efficacy.

BACKGROUND: Chronic kidney disease (CKD) is a well-established risk factor for adverse outcomes after cardiac surgery. However, the long-term trajectory of kidney function in this high-risk group remains poorly characterised. This study's primary aim was to describe CKD progression and kidney failure in patients with kidney impairment before cardiac surgery. The secondary aim was to evaluate the impact of preexisting CKD in association with known risk factors (age, sex, and postoperative acute kidney injury) on CKD disease progression after cardiac surgery. METHODS: This retrospective observational multicentre study included adult patients who underwent cardiac surgery at the Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, between 2000 and 2022, and the Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, between 2008 and 2024. Three outcomes were assessed, according to Kidney Disease: Improving Global Outcomes (KDIGO): rapid progression (confirmed estimated glomerular filtration rate [eGFR] decline ≥5 ml min RESULTS: Among 27 483 adult cardiac surgery patients, 3512 patients (12.8%) had preexisting CKD (KDIGO stages G3a-G5), based on preoperative eGFR levels. Five-year survival decreased with worsening baseline kidney function: 86.1% in stages G1-2, 70.6% in stage G3a, 61.4% in stage G3b, 45.7% in stage G4, and 51.9% in stage G5. Cumulative 5-yr incidence was 38.7% for rapid progression, 23.8% for CKD stage progression, and 5.5% for kidney failure. Events clustered early post discharge, with 43% of rapid progression, 26% of kidney failure, and 18% of CKD progression events occurring within the first year. Males aged ≤70 yr with stage G4 CKD who developed postoperative acute kidney injury faced highest risks across all outcomes. CONCLUSIONS: Cardiac surgery patients with preexisting CKD face substantial kidney disease progression, especially early after discharge. These findings highlight the need for research into structured follow-up programmes and kidney-preventive interventions.