Daily Anesthesiology Research Analysis
Analyzed 47 papers and selected 3 impactful papers.
Summary
Two randomized trials highlight perioperative strategies that improve outcomes: individualized intraoperative blood pressure control reduced postoperative creatinine and renal injury biomarkers, and low-dose sugammadex accelerated reliable reversal of rocuronium-induced neuromuscular block versus neostigmine. A large prospective transcriptomic study identified postoperative immune-related gene expression shifts specifically associated with postoperative delirium, refining mechanistic understanding.
Research Themes
- Personalized intraoperative physiology for organ protection
- Optimizing neuromuscular blockade reversal to enhance recovery
- Immunogenomic mechanisms of postoperative delirium
Selected Articles
1. Individualized vs. standard control of intraoperative blood pressure on serum creatinine profile and release of microRNA-21-5p after major gastrointestinal surgery in older patients with hypertension: a randomized controlled trial.
In older hypertensive patients undergoing major gastrointestinal surgery, maintaining intraoperative blood pressure within ±10% SBP or ±20% MAP led to lower postoperative day-7 creatinine and a greater week-long reduction versus conventional care. Circulating microRNA-21-5p, a renal injury-associated biomarker, was also reduced with individualized management.
Impact: Provides randomized evidence that personalized hemodynamic targets can mitigate renal stress and biochemical injury after major surgery, bridging physiology and clinical outcomes.
Clinical Implications: Consider targeting patient-specific BP (±10% SBP or ±20% MAP from baseline) during major surgery in older hypertensive patients to reduce postoperative creatinine rise and renal injury signaling, alongside vigilant fluid management.
Key Findings
- Randomized 220 older hypertensive patients to individualized vs conventional intraoperative BP control.
- Individualized BP control yielded lower serum creatinine at postoperative day 7 (P<0.05).
- Greater week-long postoperative reduction in creatinine with individualized control (P<0.05).
- Postoperative rise in serum microRNA-21-5p was attenuated with individualized BP management.
Methodological Strengths
- Randomized controlled design with prespecified BP targets.
- Use of both clinical (creatinine) and mechanistic (microRNA-21-5p) endpoints.
Limitations
- Single surgical domain and possibly unblinded; lacked hard AKI outcome definitions.
- Short follow-up limited to one week; generalizability beyond older hypertensive patients uncertain.
Future Directions: Multicenter blinded RCTs assessing AKI (KDIGO criteria), longer-term renal outcomes, and cost-effectiveness of individualized BP targets across surgical types and risk strata.
BACKGROUND: Intraoperative hypotension is associated with a postoperative decline in renal function, and the effect of personalized blood pressure control on renal function remains unknown. The aim of this study was to investigate the effects of individualized intraoperative blood pressure management on renal function and serum microRNA-21-5p levels in older patients with hypertension after major gastrointestinal surgery. METHODS: A total of 220 patients scheduled for elective major gastrointestinal surgery were randomly divided into two groups: conventional blood pressure management (Group C) and individualized blood pressure management (Group S), with 110 patients in each group. In Group S, blood pressure was controlled within ± 10% of baseline systolic blood pressure or ± 20% of baseline mean arterial pressure. Moderately open fluid management strategies were adopted in both groups. Blood samples were collected from all patients before and after surgery to measure creatinine and microRNA-21-5p levels. RESULTS: The creatinine level was significantly lower in Group S than in Group C 7 days after surgery (P < 0.05), and the reduction in creatinine levels in the week following surgery was also significantly greater in Group S than in Group C (P < 0.05). CONCLUSION: Intraoperative individualized blood pressure management could reduce the release of microRNA-21-5p related to renal injury and attenuate the increase in postoperative creatinine levels in older patients with hypertension.
2. Low dose of sugammadex versus neostigmine for reversal of rocuronium induced moderate neuromuscular block: a randomized controlled trial.
Compared with standard neostigmine reversal, low-dose sugammadex (0.5 mg/kg) reduced time to TOF ≥0.9 from 20.6 to 4.3 minutes and halved extubation time, with far fewer patients needing rescue reversal and no increase in respiratory complications.
Impact: Demonstrates that a lower-than-conventional sugammadex dose can achieve rapid, reliable reversal, informing cost-conscious, efficient anesthesia practice without compromising safety.
Clinical Implications: Adopt low-dose sugammadex with quantitative neuromuscular monitoring to accelerate recovery from rocuronium-induced block and reduce need for rescue, while maintaining vigilance for residual blockade.
Key Findings
- Low-dose sugammadex achieved TOF ratio ≥0.9 in median 4.3 minutes vs 20.6 minutes with neostigmine (p<0.001).
- Extubation time was shorter with sugammadex: 11.6 vs 25.9 minutes (p<0.001).
- Rescue reversal was needed in 4.8% vs 60.6% (p<0.001) favoring sugammadex.
- No significant differences in postoperative respiratory complications or PACU stay.
Methodological Strengths
- Randomized, double-blind, controlled design.
- Objective neuromuscular endpoints with TOF monitoring.
Limitations
- Sample size not specified in abstract; may be underpowered for rare adverse events.
- Retrospective trial registration and short-term follow-up only.
Future Directions: Dose-finding trials across block depths and patient risk groups, cost-effectiveness analyses, and pragmatic studies integrating quantitative monitoring to minimize residual paralysis.
BACKGROUND: Residual neuromuscular blockade (rNMB) after surgery can lead to complications such as respiratory distress, increased length of hospital stay, and higher healthcare costs. Sugammadex, a selective relaxant-binding agent, has shown efficacy in reversing rocuronium-induced neuromuscular blockade more rapidly than neostigmine. This study aimed to evaluate the effectiveness of a low dose of sugammadex (0.5 mg.kg METHODS: This randomized, double-blind, controlled trial included adult patients undergoing surgery with rocuronium-induced moderate neuromuscular blockade. Participants were randomized to receive either low-dose sugammadex or standard-dose neostigmine with glycopyrrolate at the end of surgery. The primary outcome was the time to achieve a Train-of-Four (TOF) ratio of ≥ 0.9 after administration of the reversal agent. Secondary outcomes included extubation time, incidence of sugammadex rescue therapy for incomplete reversal, and postoperative complications. Statistical analysis used t-tests and Mann-Whitney-Wilcoxon tests for continuous variables and chi-square tests for categorical variables, with significance set at p < 0.05. RESULTS: The median time to reach TOF ratio of ≥ 0.9 was significantly shorter in the sugammadex group (4.3 min, IQR: 3.2-6) compared to the neostigmine group (20.6 min, IQR: 10.1-21.3, p < 0.001). Extubation times were also reduced with sugammadex, with a median of 11.6 (IQR: 8.6-15.1) minutes versus 25.9 (IQR: 17.7-29.7) minutes in the neostigmine group (p < 0.001). Only 4.8% of patients in the sugammadex group required rescue therapy to reverse the neuromuscular block with TOF ratio of ≥ 0.9, compared to 60.6% in the neostigmine group (p < 0.001). No significant differences were observed in postoperative respiratory complications or PACU length of stay. CONCLUSIONS: Low-dose sugammadex provides a faster and more reliable reversal of moderate neuromuscular blockade than standard-dose neostigmine, with implications for improved operating room efficiency and patient safety. Continuous neuromuscular monitoring remains essential, as a small proportion of patients may still require additional intervention. TRIAL REGISTRATION: Registered retrospectively at ClinicalTrials.gov with registration number NCT05718934 on 2023-02-08.
3. Altered gene expression associated with postoperative delirium in patients undergoing surgery and anesthesia.
In a prospective cohort of 599 older adults, preoperative gene expression did not predict delirium, but postoperative baseline-corrected expression revealed 1,063 differentially expressed genes in delirium patients. Enriched pathways implicated cellular/humoral immunity, RNA metabolism, and platelet function, underscoring systemic immune activation in POD.
Impact: Largest prospective transcriptomic analysis to date linking postoperative immune gene programs with delirium, refining timing and biology of POD and informing biomarker discovery.
Clinical Implications: While not yet diagnostic, perioperative immune gene signatures may guide risk stratification and targeted anti-inflammatory strategies; absence of preoperative signals suggests monitoring and intervention windows are postoperative.
Key Findings
- Prospective cohort of 599 patients ≥65 years with pre- and postoperative (POD1) blood transcriptomics.
- No significant preoperative expression differences in patients who later developed delirium.
- Postoperative baseline-corrected expression identified 1,063 differentially expressed genes (394 up, 681 down) in delirium.
- Enrichment in immune response, RNA metabolism, and platelet function pathways.
Methodological Strengths
- Large prospective cohort with paired pre/postoperative sampling.
- Multivariable adjustment for key clinical covariates and pathway enrichment analyses.
Limitations
- Causality cannot be inferred; peripheral blood may not fully reflect CNS processes.
- Lack of external validation and limited follow-up to 7 days postoperatively.
Future Directions: Validate signatures in independent cohorts, integrate proteomics and single-cell resolution, and test targeted anti-inflammatory interventions guided by postoperative gene programs.
Postoperative delirium is a severe complication associated with poor overall and especially neurocognitive prognosis after anesthesia and surgery. As a systemic phenomenon, peripheral immune response to surgical trauma may play a central role. Although analysis of differential gene expression in peripheral immune cells could provide insights into immune dysregulation in postoperative delirium (POD), no sufficiently powered prospective cohort study has yet been conducted. We performed gene expression analysis in N = 599 cognitively healthy male and female patients ≥65 years who provided blood samples for microarray-based gene-expression data before major elective surgery and on the first postoperative day. Patients were followed up for delirium until the seventh postoperative day. We identified differentially expressed genes in POD using a multivariable linear regression framework adjusted for sex, age, body mass index, preoperative physical status, duration of anesthesia and operative procedure. Preoperative gene expression did not differ significantly in patients who were later diagnosed with POD. However, we identified a total of 1,063 unique significantly associated genes which differed in baseline-corrected mRNA abundance among POD patients after surgery (n = 394 upregulated, n = 681 downregulated). This set was significantly enriched for genes related to cellular and humoral immune response, RNA metabolism and platelet function. Post-, but not preoperative gene expression in peripheral immune cells has been found to be altered in patients with POD. Whereas most enriched pathways were related to immune response and acute phase reaction, few molecular alterations were found, which may reflect nervous system alterations and warrant further investigation.