Daily Anesthesiology Research Analysis
Analyzed 90 papers and selected 3 impactful papers.
Summary
Three impactful anesthesiology papers stood out today: a cross-species mechanistic study identifies conserved controllers of information integration and its anesthetic breakdown; a multicenter RCT shows perioperative esketamine reduces short-term postpartum depression after cesarean delivery; and an evidence-based SCA/STS consensus provides practical guidance for managing direct oral anticoagulants in adult cardiac surgery.
Research Themes
- Mechanisms of anesthetic-induced loss of consciousness
- Perioperative mental health and analgesic adjuncts
- Perioperative anticoagulation management in cardiac surgery
Selected Articles
1. Convergent transcriptomic and connectomic controllers of information integration and its anaesthetic breakdown across mammalian brains.
Using fMRI across humans and three non-human species, the authors demonstrate that reduced integrated information under anesthesia is a convergent phenomenon linked to regional PVALB/Pvalb gene expression gradients. Brain dynamics become harder to control during disintegration, and thalamic deep brain stimulation reverses both the loss of integration and controllability in macaques.
Impact: This work uncovers evolutionarily conserved, transcriptomically anchored controllers of anesthetic-induced breakdown of information integration and demonstrates reversibility with targeted neuromodulation, advancing mechanistic understanding of consciousness under anesthesia.
Clinical Implications: While not directly practice-changing, the identification of PVALB-linked regional susceptibility and the reversibility via thalamic stimulation inform future neuromodulation strategies, monitoring targets, and anesthetic agent development aimed at preserving network integration.
Key Findings
- Anesthetic-induced breakdown of information integration is conserved across humans, macaques, marmosets, and mice.
- Loss of integration coincides with reduced controllability of brain dynamics and is reversed by thalamic deep brain stimulation in macaques.
- Regional susceptibility aligns with species-specific PVALB/Pvalb gene expression topography; models integrating connectivity and transcriptomics recapitulate these effects.
Methodological Strengths
- Cross-species design with convergent evidence (humans and three non-human species)
- Integration of functional imaging, causal neuromodulation (DBS), and computational modeling anchored in transcriptomics and connectivity
Limitations
- Single-center prospective cohorts and laboratory settings may limit generalizability to diverse clinical anesthetic contexts
- Indirect translation to clinical outcomes; no randomized clinical trials of monitoring or agent selection are provided
Future Directions: Define patient-level biomarkers (e.g., PVALB-informed EEG signatures) to guide anesthetic dosing, and test neuromodulatory strategies to preserve integration in vulnerable populations.
The mammalian brain orchestrates the processing and integration of information to guide behaviour. Here, to characterize mammalian information-processing architecture, we combine functional neuroimaging and anaesthesia in humans, macaques, marmosets and mice. We show that breakdown of information integration is a convergent effect of diverse anaesthetics across mammalian species. As the system disintegrates, brain dynamics become more difficult to control. Both effects are reversed upon re-awakening induced by thalamic deep-brain stimulation in the macaque. Reg
2. Prophylactic esketamine to reduce postpartum depression in primiparae: A multicentre, double-blind, randomised clinical trial.
In 322 primiparae undergoing elective cesarean delivery, perioperative esketamine (bolus 0.25 mg/kg plus 80 mg adjunct in 24-h PCIA) reduced the overall 3-month PPD incidence (11.6% vs 20.9%; adjusted RR 0.57) driven by a significant benefit at 7 days (4.9% vs 15.2%; RR 0.32). Mild CNS adverse effects (dizziness, hallucination, dissociation) occurred but were manageable.
Impact: This multicenter double-blind RCT provides high-level evidence that perioperative esketamine can reduce early postpartum depression risk in primiparae, informing peri-cesarean analgesic adjunct choices with mental health benefits.
Clinical Implications: Perioperative esketamine may be considered as an adjunct in primiparae at low baseline depression risk to reduce early PPD, with shared decision-making about transient CNS effects and unclear persistence beyond 1 month.
Key Findings
- Esketamine reduced overall postpartum depression incidence within 3 months (11.59% vs 20.89%; adjusted RR 0.57; P=0.028).
- Significant reduction at 7 days postpartum (4.89% vs 15.19%; adjusted RR 0.32; P=0.005), but no significant differences at 1–3 months individually.
- Mild CNS adverse events were more frequent (dizziness 10.98%, hallucination 10.37%, dissociation 5.49%) yet manageable.
Methodological Strengths
- Multicenter, double-blind randomized controlled design with modified intention-to-treat analysis
- Clear primary outcome (PPD incidence) with clinically meaningful effect sizes and confidence intervals
Limitations
- Benefit appears driven by early (7-day) effect; no significant differences at 1–3 months individually
- Generalizability limited to primiparae with low baseline EPDS; CNS side effects require counseling
Future Directions: Evaluate dose-response and duration strategies to extend benefits beyond 1 month, stratify by psychiatric risk, and compare against alternative antidepressant-sparing interventions.
BACKGROUND: Postpartum depression (PPD) is a common complication after childbirth, especially in primiparae. OBJECTIVES: This trial sought to evaluate whether prophylactic administration of esketamine during the perinatal period could prevent PPD in primiparae without predisposition to prenatal depression. DESIGN: A prospective, double-blind, multicentre, randomised controlled trial. SETTING: Three academic hospitals. PATIENTS: Primiparae scheduled for elective caesarean section with an Edinburgh Postnatal Depression Scale (EPDS) score less than 10. INTERVENTIONS: Postnatal women were randomly assigned to receive either i.v. esketamine in a single dose of 0.25 mg kg-1 followed by 80 mg of esketamine as an adjunct to 24-h patient-controlled intravenous analgesia (PCIA). Women in the control group received an equal volume of saline. MAIN OUTCOME MEASURES: The primary outcome was the total incidence of PPD within 3 months postpartum. Secondary outcomes included postoperative EPDS scores, numeric rating scale scores, sufentanil consumption, the number of effective presses for postoperative intravenous analgesia and adverse events. RESULTS: A total of 322 patients were included in the modified intention-to-treat analysis. The total incidence of PPD in the esketamine group (11.59%) was significantly less than the control group (20.89%) [adjusted relative ratio (RR), 0.57; 95% CI, 0.35 to 0.94; P = 0.028] as was the incidence at 7 days postpartum (4.89 vs. 15.19%; adjusted RR, 0.32; 95% CI, 0.15 to 0.72; P = 0.005). However, there were no significant differences in PPD incidence and EPDS scores at 1, 2 and 3 months postpartum, respectively. Several mild central nervous events, such as dizziness (10.98%), hallucination (10.37%) and dissociation (5.49%), were observed during esketamine treatment. CONCLUSION: Peri-operative adjunctive administration of esketamine is relatively safe and can prevent PPD in primi-parae without predisposition to prenatal depression in the short term. TRIAL REGISTRATION: Trial registration: Clinicaltrials.gov. Identifier: NCT04860661.
3. Management of Direct Oral Anticoagulants in Adult Patients Undergoing Cardiac Surgery: A Joint Consensus Statement by the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons.
This SCA/STS joint statement synthesizes evidence and expert consensus on perioperative DOAC management in adult cardiac surgery, covering preoperative cessation timing, laboratory monitoring options, bridging indications, reversal agents, and postoperative resumption. The guidance aims to standardize practice and enhance safety.
Impact: Provides actionable, consensus-based recommendations where high-quality randomized evidence is limited, directly addressing a common and high-risk perioperative scenario in cardiac anesthesia.
Clinical Implications: Adopting standardized DOAC cessation, selective monitoring, judicious bridging, appropriate use of reversal agents, and timing of resumption can reduce bleeding and thrombotic complications in cardiac surgery patients.
Key Findings
- Systematic review summarizes evidence on DOAC cessation timing before cardiac surgery and options for perioperative monitoring.
- Consensus addresses indications for bridging therapy and delineates use of reversal agents (e.g., andexanet alfa, idarucizumab).
- Guidance provides principles for postoperative DOAC resumption balancing bleeding and thrombosis risks.
Methodological Strengths
- Systematic review underpinning consensus recommendations
- Multidisciplinary expert panel from SCA and STS with broad clinical applicability
Limitations
- Evidence base includes heterogeneous observational data; limited randomized trials
- Specific institutional resources (e.g., monitoring assays, reversal agents) may affect implementation
Future Directions: Prospective, pragmatic trials to test standardized protocols for DOAC interruption, monitoring, reversal, and resumption on clinically meaningful bleeding and thrombotic outcomes.
The Society of Cardiovascular Anesthesiologists (SCA) along with the Society of Thoracic Surgeons (STS) sought to improve the care of adult patients undergoing cardiac surgery who are taking direct oral anticoagulants (DOACs), such as factor Xa and direct thrombin inhibitors. To fulfill this, a systematic review of the literature on cessation of DOACs before cardiac surgery, options for monitoring DOACs, the need for bridging, reversal agents, and resuming the medications after surgery was performed. Additionally, an expert consensus around the management of these patients was completed. Summary statements were created using evidence and expert consensus to guide care of patients in each of these domains, with the ultimate goal to enhance patient safety and outcomes.