Daily Anesthesiology Research Analysis
Analyzed 85 papers and selected 3 impactful papers.
Summary
Analyzed 85 papers and selected 3 impactful articles.
Selected Articles
1. Perioperative Resuscitation and Life Support (PeRLS): An Update.
This evidence-based PeRLS update synthesizes the latest data using GRADE to provide cause-directed, time-sensitive resuscitation algorithms tailored to the perioperative and ICU settings. Emphasis is placed on early recognition, rapid differential diagnosis, and targeted therapy where precipitating etiologies are often identifiable.
Impact: PeRLS offers practical, consensus-backed algorithms likely to standardize and accelerate perioperative arrest management, with spillover benefits for ICU and emergency care.
Clinical Implications: Adopting PeRLS algorithms can guide team training, simulation, and protocolized, cause-directed resuscitation for witnessed perioperative arrests, potentially improving time-to-diagnosis and outcomes.
Key Findings
- PeRLS organizes perioperative arrest response around rapid cause identification and targeted therapy.
- Evidence synthesis uses GRADE to underpin recommendations and algorithms.
- Recommendations extend beyond the operating room to ICU and emergency settings.
Methodological Strengths
- GRADE-based evidence appraisal and transparent recommendation strength
- Focus on witnessed events enabling cause-directed algorithms
Limitations
- Guideline synthesis without new randomized trials; dependent on underlying evidence quality
- Implementation fidelity and outcome impact were not tested within this article
Future Directions: Prospective studies to evaluate adherence and outcome impact of PeRLS algorithms, and adaptation for diverse resource settings.
Cardiovascular collapse and arrest in the periprocedural setting and intensive care unit differ from arrests in other contexts (such as out-of-hospital or hospital ward) because clinicians almost always witness the event, and the most likely precipitating cause may be known. In comparison to other settings, the response can be timelier and more focused on treating the underlying cause(s). Since many patients deteriorate over minutes to hours, clinicians can evaluate the patient expeditiously, generate a diagnosis, and initiate appropriate treatment more rapidly than in other arrest circumstances. This iteration of Perioperative Resuscitation and Life Support (PeRLS) employs Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology to review the most recent evidence on preventing and managing cardiac arrest during the perioperative period. Furthermore, many of the recommendations and algorithms may also be applicable to areas outside the operating room, such as the intensive care unit and emergency room.
2. Neurofilament light chain as a potential biomarker of perioperative neurocognitive disorders: a systematic review and meta-analysis.
Across observational studies, perioperative blood NfL rises postoperatively, and patients who develop postoperative delirium have higher pre- and postoperative blood NfL and higher preoperative CSF NfL versus those without delirium. The findings support NfL as a candidate biomarker for delirium risk stratification pending prospective validation.
Impact: Identifying an accessible biomarker for postoperative delirium could enable early risk detection and targeted prevention strategies in high-risk surgical patients.
Clinical Implications: Baseline and perioperative NfL measurements could augment delirium risk models and inform preventive bundles; however, standardized thresholds, assay timing, and interventional trials are required before routine use.
Key Findings
- Postoperative blood NfL increases within groups for both POD and no-POD patients (SMD 0.49 and 0.67, respectively).
- Between-group analyses show higher preoperative CSF NfL in POD versus no-POD patients (SMD 0.27).
- Both pre- and postoperative blood NfL levels are higher in POD than in no-POD patients (SMD 0.53 and 0.58).
Methodological Strengths
- PRISMA-guided systematic review and quantitative meta-analysis
- Risk of bias assessed via Newcastle-Ottawa Scale with multi-reviewer extraction
Limitations
- Heterogeneous observational designs and potential residual confounding
- Limited CSF data and incomplete reporting of heterogeneity statistics in abstract
Future Directions: Prospective, standardized studies to define NfL thresholds, optimal sampling windows, and to test NfL-guided prevention of delirium.
OBJECTIVES: Although neurofilament light chain (NfL) is used as a biomarker of neurodegenerative decline, its application in surgery- and anaesthesia-induced acute cognitive dysfunction remains uncertain. We aimed to synthesise existing evidence to evaluate the potential of NfL as a biomarker for perioperative neurocognitive disorder (PND). DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, EMBASE, MEDLINE, the Cochrane Library and the Cochrane Central Register of Clinical Trials were systematically searched up to March 2024. ELIGIBILITY CRITERIA: Observational studies-including cohort, case-control and cross-sectional designs-were included if they reported cerebrospinal fluid (CSF) or blood NfL levels in individuals with and without PND. DATA EXTRACTION AND SYNTHESIS: Three independent reviewers assessed each article. Quality scoring was conducted, and the extracted data were analysed using STATA. Risk of bias was evaluated using the Newcastle-Ottawa Scale. Meta-analytical model selection was guided by the I RESULTS: Within-group analyses showed significant postoperative increases in blood NfL levels in both the postoperative delirium (POD) group (standardised mean difference (SMD) = 0.49; 95% CI 0.34 to 0.64) and the no-POD group (SMD=0.67, 95% CI 0.53 to 0.81). Between-group comparisons revealed significantly higher preoperative CSF NfL levels in the POD group (SMD=0.27, 95% CI 0.07 to 0.47). Both preoperative and postoperative blood NfL levels were also significantly elevated in the POD group (SMD=0.53, 95% CI 0.40 to 0.66, and SMD=0.58, 95% CI 0.43 to 0.73, respectively). CONCLUSIONS: This meta-analysis suggests that NfL may be a potential biomarker for POD. Further research is needed to clarify the association between CSF and blood NfL levels and other forms of PND. PROSPERO REGISTRATION NUMBER: CRD42024516907.
3. Selective nonreporting of 5-min Apgar scores and its safety assessment of out-of-hospital births: a population-based study of United States' birth data, 2016-2023 a population based study.
In US term, midwife-attended singleton births, 5-min Apgar missingness was substantially higher in birth centers and planned home births than hospitals. Deterministic sensitivity analyses show that imputing even half of missing scores as <4 dramatically inflates severe compromise risk estimates, indicating major bias from selective nonreporting.
Impact: By exposing informative missingness in a core neonatal metric, this study challenges current safety narratives around out-of-hospital births and underscores the ethical need for complete outcome reporting.
Clinical Implications: Counseling for planned out-of-hospital birth should acknowledge documentation biases; regulators and registries should mandate complete Apgar reporting to ensure valid safety comparisons and informed consent.
Key Findings
- Among 3,066,021 births, 5-min Apgar missingness was 0.13% (hospital), 1.9% (birth center), 3.1% (home).
- Severe compromise (Apgar <4) was 0.17% in hospitals, 0.20% in birth centers, and 0.26% in home births.
- Imputing half of missing scores as <4 increased adjusted odds of severe compromise to 7.7 (home) and 4.9 (birth center) versus hospital births.
Methodological Strengths
- Nationwide, population-based cohort with over 3 million births
- Deterministic sensitivity analyses quantifying bias from missingness
Limitations
- Retrospective registry analysis subject to misclassification and unmeasured confounding
- Assumptions in sensitivity analyses may not reflect true distribution of missing scores
Future Directions: Mandated complete outcome reporting, linkage to neonatal morbidity/mortality, and prospective audits to validate safety comparisons by birth setting.
BACKGROUND: The safety of out-of-hospital birth in the United States remains contested. A neglected methodological issue is the selective nonreporting of 5-min Apgar scores, which may conceal adverse outcomes and bias safety comparisons. This study examined whether Apgar score missingness differs systematically by birth setting and whether such "informative missingness" alters risk estimates. METHODS: We conducted a population-based analysis of 3,066,021 term, normal-birthweight, midwife-attended singleton births in the United States (2016-2023). Birth settings included hospitals, freestanding birth centers, and planned home births. Missing 5-min Apgar scores were quantified, and deterministic sensitivity analyses modeled the impact of varying assumptions about unrecorded low scores (<4 and <7). Hospital births served as the reference group. FINDINGS: Five-minute Apgar scores were missing in 0.13% of hospital, 1.9% of birth-center, and 3.1% of home births. Severe compromise (Apgar <4) occurred in 0.17%, 0.20%, and 0.26%, respectively. When half of missing scores were imputed as <4, adjusted odds of severe compromise increased to 7.7 for home and 4.9 for birth-center births vs. hospitals. INTERPRETATION: This study evaluates documentation integrity of US births. Selective nonreporting of 5-min Apgar scores at out-of-hospital births introduces major bias, distorting apparent safety of out-of-hospital births. Complete and enforceable outcome reporting is essential for scientific validity and ethically sound informed consent. FUNDING: None declared.