Daily Anesthesiology Research Analysis
Analyzed 30 papers and selected 3 impactful papers.
Summary
Three impactful studies span perioperative physiology, critical care immunometabolism, and opioid-sparing analgesia. A cohort analysis links higher intraoperative oxygen extraction ratios during cardiopulmonary bypass to postoperative morbidity and acute kidney injury, suggesting physiology-guided perfusion. Mechanistic work identifies an lncRNA axis driving hyperglycemia-exacerbated septic intestinal injury and demonstrates lipid nanoparticle delivery as a protective strategy. A double-blind RCT shows postoperative intravenous lidocaine reduces opioid use after pelvic bone tumor surgery.
Research Themes
- Physiology-guided perfusion in cardiac surgery
- RNA-based immunomodulation in septic hyperglycemia
- Opioid-sparing postoperative analgesia
Selected Articles
1. LncRNA Gm16023 ameliorates hyperglycemia-exacerbated septic intestinal injury by modulating macrophage polarization via miR-377-3p/Sirt1 axis.
Using UK Biobank data and mechanistic models, the authors show that hyperglycemia increases sepsis risk and worsens intestinal injury via macrophage-driven inflammation regulated by the Gm16023/miR-377-3p/Sirt1 axis. Lipid nanoparticle delivery of Gm16023 protected against injury in vivo, positioning RNA therapeutics as a candidate approach for diabetic sepsis.
Impact: This study bridges population evidence with in vivo mechanistic validation and demonstrates a deliverable RNA therapeutic strategy, advancing translational immunometabolism in critical care.
Clinical Implications: Suggests risk stratification of septic patients with hyperglycemia and a potential macrophage-targeted, RNA-based therapy; informs ICU strategies to modulate immunometabolism rather than solely glucose levels.
Key Findings
- In UK Biobank (n=404,184), hyperglycemia was significantly associated with increased sepsis risk.
- Hyperglycemia enhanced macrophage infiltration and intestinal inflammation in septic patients and mice; macrophage depletion attenuated injury.
- Underexpressed lncRNA Gm16023 functioned as a ceRNA for miR-377-3p to regulate Sirt1 and inhibit M1 polarization.
- LNP-encapsulated Gm16023 achieved in vivo delivery and protected against septic intestinal injury in vitro and in vivo.
Methodological Strengths
- Multimodal approach combining large-scale human epidemiology with in vivo and in vitro mechanistic validation
- Demonstration of therapeutic delivery using lipid nanoparticles in preclinical models
Limitations
- Translational efficacy and safety of lncRNA delivery in humans remain untested
- Causality in human association data cannot be definitively established
Future Directions: Early-phase clinical studies of RNA-based modulation of macrophage polarization in septic patients with hyperglycemia; dose-finding and safety of LNP-delivered lncRNAs.
Diabetes is closely associated with inflammation and sepsis, but its clinical significance and underlying mechanisms remain obscure. Leveraging epidemiological data from 404,184 individuals in the UK Biobank cohort, we found that hyperglycemia was significantly associated with increased sepsis risk. Phenotypically, hyperglycemia enhanced macrophage infiltration and exacerbated intestinal inflammation in both septic patients and murine models. Using both a genetic CD11b-DTR model and clodronate liposome (Cls)-mediated chemical ablation, we demonstrated that macrophage depletion markedly attenuated hyperglycemia-driven septic intestinal injury, underscoring their essential pathogenic role. Mechanistically, RNA sequencing analysis identified that underexpressed lncRNA Gm16023 acted as a ceRNA, binding miR-377-3p to regulate Sirt1 expression and inhibit M1 macrophage polarization. To facilitate therapeutic delivery, we engineered a lipid nanoparticle (LNP)-encapsulated Gm16023 plasmid system that efficiently delivered lncRNA in vivo and conferred protection against intestinal injury in both in vitro and in vivo models. Collectively, our findings indicate that hyperglycemia promotes macrophage-mediated septic intestinal injury via the lncRNA Gm16023/miR-377-3p/Sirt1 axis, highlighting a potential RNA-based therapeutic strategy for diabetic sepsis.
2. Oxygen Extraction Trajectories During Cardiopulmonary Bypass Impact Postoperative Outcomes in Coronary Artery Bypass Grafting.
In a retrospective cohort of 885 CABG patients, distinct intraoperative oxygen extraction ratio trajectories were identified. Patients with higher extraction trajectories had significantly increased odds of STS major morbidity or mortality and AKI; maintaining higher indexed oxygen delivery appeared to mitigate risk in high-extraction patients.
Impact: Introduces oxygen extraction trajectories as a physiologically integrative metric linked to outcomes, extending goal-directed perfusion beyond delivery thresholds.
Clinical Implications: Incorporating oxygen extraction ratio into perfusion management may help individualize CPB strategies and reduce AKI and complications, particularly in high-extraction-risk patients.
Key Findings
- Three intraoperative oxygen extraction ratio trajectories (low ~21%, moderate ~23%, high ~24.4%) were identified.
- High extraction trajectory was associated with increased STS major morbidity/mortality (OR 2.04 [1.5–2.8], p<.001) and AKI (OR 1.6 [1.2–2.1], p<.001).
- High extraction patients had more anemia, diabetes, heart failure, and lower average oxygen delivery.
- Exploratory analysis suggested maintaining indexed oxygen delivery ≥300 mL/min/m^2 may mitigate risk in high-extraction patients.
Methodological Strengths
- Unsupervised clustering of physiologic trajectories with weighted logistic modeling
- Adjustment for baseline risk and evaluation of multiple perioperative covariates
Limitations
- Single-center retrospective design with potential residual confounding
- Causality cannot be inferred and ventilatory/perfusion management heterogeneity may influence results
Future Directions: Prospective trials to test O2 extraction–guided perfusion targets and assess impact on AKI and morbidity; integration with continuous metabolic monitoring.
OBJECTIVES: Goal-directed perfusion strategies during cardiopulmonary bypass typically target indexed oxygen delivery thresholds to reduce acute kidney injury and other complications. This delivery-only paradigm may not fully reflect patient-specific metabolic demand. The oxygen extraction ratio integrates delivery and consumption and may better reflect perfusion adequacy. We tested the hypothesis that intraoperative oxygen extraction ratio is associated with postoperative outcomes. METHODS: We retrospectively analyzed 885 adults who underwent isolated coronary artery bypass grafting (10/2021-07/2025). Unsupervised clustering identified distinct extraction ratio trajectory phenotypes. Baseline, intraoperative, and postoperative variables were compared across phenotypes, and weighted logistic models assessed associations with STS major morbidity or mortality and AKI. An exploratory subgroup analysis evaluated whether maintaining higher indexed oxygen delivery mitigated risk in patients with elevated extraction ratio. RESULTS: Three oxygen extraction ratio trajectories were identified: low (mean 21%), moderate (mean 23%), and high (mean (24.4%). High extraction ratio patients had more anemia, diabetes, and heart failure and lower average oxygen delivery. After adjustment for baseline risk, high extraction ratio was associated with greater morbidity and mortality (OR: 2.04[1.5-2.8], p <.001) and AKI (OR:1.6[1.2-2.1], p <.001). In the high extraction ratio group, maintaining an indexed oxygen ≥300 mL/min/m CONCLUSIONS: Elevated oxygen extraction ratio was independently associated with postoperative morbidity and AKI. Incorporating extraction ratio into goal directed perfusion frameworks may enable a more individualized, physiology-guided perfusion strategy.
3. Postoperative intravenous lidocaine infusion for pain management in pelvic bone tumor surgery patients: a randomized, double-blind, controlled trial.
In a double-blind RCT of 70 adults after pelvic bone tumor surgery, postoperative IV lidocaine reduced 72-hour morphine equivalents (median 13 vs 25 mg) and lowered breakthrough pain incidence without affecting PONV, pain scores, or bowel recovery.
Impact: Provides randomized, blinded evidence supporting an opioid-sparing strategy in a high-pain orthopedic oncology population.
Clinical Implications: Postoperative lidocaine infusion can be considered to reduce opioid exposure and breakthrough pain after pelvic bone tumor surgery, with no apparent adverse effect on gastrointestinal recovery or PONV.
Key Findings
- 72-hour cumulative morphine equivalents were lower with lidocaine vs control (median 13 [0–52] mg vs 25 [14–85] mg; P=0.043).
- Breakthrough pain incidence was lower with lidocaine (33.33%) vs control (75.76%; P=0.001).
- No significant differences in PONV, pain scores at rest/movement, time to first bowel evacuation, or time to first oral intake.
Methodological Strengths
- Randomized, double-blind, controlled design with trial registration
- Clinically relevant primary endpoint (72-hour opioid consumption)
Limitations
- Single-center study with modest sample size, limiting generalizability
- No differences in secondary outcomes; analgesic effect size may be procedure-specific
Future Directions: Multicenter RCTs to confirm efficacy, optimize dosing/duration, and assess safety and opioid-sparing benefits across surgical populations.
BACKGROUND: Previous studies have demonstrated that perioperative use of lidocaine effectively reduces opioid requirements in various surgical procedures. Our objective was to evaluate the effect of postoperative intravenous lidocaine infusion on opioid consumption following pelvic bone tumor surgery. METHODS: This single center randomized controlled trial in a tertiary teaching hospital containing a total of 70 patients, aged 18 to 65 years, with American Society of Anesthesiologists(ASA) physical status classifications of I to III, who were scheduled to undergo pelvic bone tumor surgery. Participants were randomly assigned in a 1:1 ratio to either the lidocaine group(L Group) or the control group(C Group). The L Group received lidocaine for postoperative analgesia, whereas the C Group was administered a placebo saline infusion.The primary outcome was postoperative opioid consumption. Secondary outcomes included the time to first bowel movement, the incidence of postoperative nausea and vomiting(PONV), and pain scores at rest and during movement on postoperative days. RESULTS: A significant difference was observed in the cumulative 72-h morphine equivalent consumption between the L Group (n = 33) and the C Group (n = 33). Patients in the L Group required significantly less morphine equivalent consumption compared to the C Group (13 (0-52) mg vs. 25 (14-85) mg, P = 0.043). Additionally, the proportion of patients experiencing breakthrough pain was significantly lower in the L Group compared to the C Group (33.33% vs. 75.76%, P = 0.001). No significant differences were noted between the groups in secondary outcomes, including the incidence of PONV, numerical pain scores at rest or during movement, time to first bowel evacuation, or time to first oral intake. CONCLUSION: Postoperative intravenous lidocaine infusion is effective in reducing opioid consumption and the incidence of breakthrough pain following pelvic bone tumor surgery. TRIAL REGISTRATION: This single-center, prospective RCT was registered with the Chinese Clinical Trial Registry (ChiCTR2100051207, 15/09/2021). The first research participant was enrolled in September 20, 2021.