Daily Anesthesiology Research Analysis
Analyzed 52 papers and selected 3 impactful papers.
Summary
Analyzed 52 papers and selected 3 impactful articles.
Selected Articles
1. Dysfunctional resting state network connectivity predicts postoperative delirium after major surgery.
In a preoperative cohort of 120 older adults undergoing major surgery, reduced within-network resting-state functional connectivity in default mode, salience-ventral attention, and cognitive control networks was associated with postoperative delirium. A machine-learning classifier using network connectivity achieved 68% accuracy. These findings position rs-fMRI connectivity as a biomarker of delirium vulnerability.
Impact: Provides mechanistic and predictive evidence linking higher-order cortical network dysfunction to postoperative delirium using preoperative rs-fMRI and machine learning. This supports risk stratification and targeted prevention strategies for perioperative brain health.
Clinical Implications: Preoperative rs-fMRI connectivity patterns could inform delirium risk stratification, enabling tailored mitigation strategies (e.g., depth-of-anesthesia management, non-pharmacologic prevention, targeted monitoring).
Key Findings
- Preoperative rs-fMRI in 120 older adults identified decreased within-network connectivity in default mode, salience-ventral attention, and cognitive control networks in those who developed postoperative delirium.
- Machine learning using network features predicted delirium with 68% accuracy.
- Default mode network connectivity was globally weaker with specific sub-network alterations related to higher-order cognition.
- Non-parametric permutation testing confirmed differences at P<0.05.
Methodological Strengths
- Prospective preoperative imaging with standardized rs-fMRI acquisition and denoising across 400 cortical regions
- Use of supervised machine learning (support vector machine) and network-level analyses
Limitations
- Moderate predictive accuracy (68%) limits immediate clinical deployment
- Sample size is modest and external validation/generalizability were not reported
Future Directions: External validation across institutions; integration with clinical and intraoperative variables to improve predictive performance; interventional trials targeting at-risk network phenotypes.
2. Therapeutic effectiveness and safety profile of steroid-based greater occipital nerve blocks in cluster headaches: a systematic review and meta-analysis.
Across 19 studies (n=758), particulate steroid-based greater occipital nerve blocks yielded high responder proportions in cluster headache with mostly transient, minor adverse events. Chronic cluster headache showed a significant reduction in attack frequency versus control (RR 2.67), and mean duration of benefit ranged from approximately one to two months depending on subtype.
Impact: Synthesizes heterogeneous literature into actionable estimates for efficacy, durability, and safety of steroid-based GONB in cluster headache subtypes, addressing a clinical need with limited preventive options.
Clinical Implications: For patients with episodic or chronic cluster headache, steroid-based GONB can be considered as a bridging or adjunctive therapy with expected benefit lasting several weeks and a favorable safety profile, especially in chronic forms where attack reduction is significant.
Key Findings
- Responder proportions: CH 73%, ECH 77%, CCH 69% (sensitivity: CH 79%, ECH 75%, CCH 70%).
- Mean duration of effect: 43 days (CH), 61.6 days (ECH), 32.2 days (CCH).
- Binary meta-analysis showed a significant reduction in attack frequency for chronic cluster headache (RR 2.67, p=0.01), with non-significant trends for CH and ECH.
- Adverse events were mostly minor and transient; no significant difference versus controls (p=0.43).
Methodological Strengths
- Prospectively registered protocol (OSF) with PRISMA-concordant methods and risk-of-bias assessment (RoB 2.0, ROBINS-I)
- Random-effects meta-analyses with subgroup and sensitivity analyses across ECH and CCH
Limitations
- High heterogeneity in pooled estimates (e.g., I² up to ~90%) and mixed study designs
- Non-significant effects in some subgroups; overall certainty of evidence ranged from very low to moderate
Future Directions: Well-powered, placebo/sham-controlled RCTs with standardized steroid formulations and dosing; head-to-head comparisons of particulate versus non-particulate steroids; longer-term safety and recurrence outcomes.
3. Efficacy Comparison of Ultrasound-Guided and Dual-Guided (Ultrasound Plus Nerve Stimulation) Subcostal Quadratus Lumborum Block in Retroperitoneal Laparoscopic Nephrectomy: A Randomized Controlled Trial.
In 84 patients undergoing laparoscopic nephrectomy, adding nerve stimulation to ultrasound guidance for subcostal quadratus lumborum block increased early block success (92.5% vs 62.5%), broadened sensory spread, reduced 24-hour opioid use, and lowered pain scores up to 48 hours. The trade-off was longer puncture time and more attempts, with no increase in adverse events.
Impact: Demonstrates a practical, immediately applicable technique modification that substantially improves block success and analgesic outcomes for a commonly used truncal block in urologic laparoscopy.
Clinical Implications: When performing subcostal quadratus lumborum blocks for laparoscopic nephrectomy, adding peripheral nerve stimulation to ultrasound can increase success and reduce postoperative opioid consumption and pain; plan for slightly longer procedural time.
Key Findings
- Block success within 5 minutes: 92.5% (US+NS) vs 62.5% (US alone), P<0.05.
- Lower 24-hour opioid requirements and fewer rescue analgesic interventions in the US+NS group.
- Broader sensory block coverage at 5, 10, and 15 minutes post-injection and lower NRS pain scores at 6, 12, 24, and 48 hours.
- Longer puncture time and more needle attempts with dual guidance; no differences in ultrasound image quality or adverse events.
Methodological Strengths
- Randomized controlled design with clearly defined primary and secondary endpoints
- Standardized local anesthetic dose and comprehensive assessment of sensory block spread and analgesic outcomes
Limitations
- Longer procedure time and increased needle attempts with dual guidance may limit throughput
- Single procedure and surgical population; blinding not reported; follow-up limited to 48 hours for pain outcomes
Future Directions: Evaluate dual guidance across other truncal blocks and surgeries; assess cost-effectiveness, learning curves, and patient-centered outcomes (e.g., recovery trajectories, quality of recovery).