Daily Anesthesiology Research Analysis

BACKGROUND: The vascular endothelial glycocalyx (VEG) plays a critical role in maintaining vascular barrier integrity, regulating inflammation, and ensuring microcirculatory homeostasis. Surgical stress and systemic inflammation can disrupt the glycocalyx, leading to endothelial dysfunction, impaired microcirculation, and adverse postoperative outcomes. dexmedetomidine (DEX), an α2-adrenergic agonist with anti-inflammatory and organ-protective properties, has been suggested in preclinical and clinical studies to mitigate glycocalyx degradation, yet evidence in gastrointestinal cancer surgery remains limited. AIM: To determine whether perioperative DEX attenuates surgical inflammation-induced VEG degradation and preserves endothelial barrier function in patients undergoing gastrointestinal cancer resection. METHODS: This was a prospective, single-center, randomized, double-blind, placebo-controlled trial conducted at the First Affiliated Hospital of University of Science and Technology of China. A total of 110 patients undergoing elective gastric or colorectal tumor resection were randomly assigned (1:1) to receive intraoperative DEX or saline placebo. Anesthesia and analgesia were standardized across groups. The primary outcome was plasma syndecan-1 concentration, a marker of endothelial glycocalyx injury, measured at four perioperative timepoints (T0-T3). Secondary outcomes included inflammatory biomarkers [interleukin-6 (IL-6), tumor necrosis factor-alpha, C-reactive protein, heparan sulfate], microcirculatory parameters [perfused vessel density (PVD), flow index, P(v-a)CO

Since malignant hyperthermia (MH) was first described in 1960, the number of cases of this potentially life-threatening reaction to anaesthesia with fatal or serious outcomes has been markedly reduced thanks to continuous advances in knowledge about triggering, clinical course, and treatment. Another essential and evolving pillar of patient safety remains diagnostics, which serve to confirm or rule out suspected cases of MH and to identify other individuals at risk of MH for prevention. For more than 40 yr, the British Journal of Anaesthesia has published the updated consensus diagnostic protocols of the European Malignant Hyperthermia Group at regular intervals. The presented diagnostic guidelines have been comprehensively revised 10 yr after the last update after substantial advances in DNA-based testing methods. In addition to the previous classification of MH susceptibility by the in vitro halothane/caffeine contracture test, a new diagnostic designation, the MH genotype, has been introduced. The latter is reflected in the revised diagnostic pathways, which also include the adapted European Malignant Hyperthermia Group curation system for the classification of genetic variants with regard to their relevance to MH. In addition to minor changes in the in vitro halothane/caffeine contracture test protocol, the guidelines address updated patient referral criteria and clinical interpretation of diagnostic results. And for the first time, the guidelines provide a consensus definition of a clinical MH event.

BACKGROUND: Myocardial injury after hip fracture surgery is common and associated with increased mortality. Acute pain is an important risk factor, but whether peripheral nerve block (PNB) could reduce postoperative myocardial injury remains unclear. This study aimed to evaluate the association between single-injection PNB, administered as an adjunct to general or neuraxial anesthesia, and postoperative myocardial injury in high-risk cardiac older adults undergoing hip fracture surgery. METHODS: In this retrospective cohort study, patients aged ≥65 years who underwent hip fracture surgery under general or neuraxial anesthesia between 2012 and 2023 were included. Based on medical records, patients who received a single-injection PNB as an adjunct were assigned to the PNB group; those who did not were assigned to the non-PNB group. The primary outcome was postoperative myocardial injury, defined as any postoperative cardiac troponin measurement exceeding the 99th percentile upper reference limit during the index hospitalization. Confounding effects were adjusted using inverse probability of treatment weighting based on 27 baseline and intraoperative variables. A weighted logistic regression model was used to estimate odds ratio for PNB versus non-PNB groups. Missing data (24.3% of cases) were imputed using multiple imputation. RESULTS: Data from 1,467 patients were included in the final analysis. Postoperative myocardial injury occurred in 12.0% (96/798) of patients in the PNB group and 21.5% (144/669) in the non-PNB group. The weighted logistic regression analysis showed that single-injection PNB was associated with a significantly lower odds of postoperative myocardial injury (adjusted odds ratio, 0.60; 95% confidence interval, 0.44-0.82; P=0.002). CONCLUSIONS: Single-injection PNB as an adjunct to general or neuraxial anesthesia was associated with a reduced risk of postoperative myocardial injury in high-risk cardiac older adults undergoing hip fracture surgery, possibly through mitigating the link between pain and myocardial injury. Further prospective trials are needed to validate these findings.