Daily Anesthesiology Research Analysis
Analyzed 115 papers and selected 3 impactful papers.
Summary
Analyzed 115 papers and selected 3 impactful articles.
Selected Articles
1. Choice of anesthesia in microelectrode recording-guided deep brain stimulation surgery for Parkinson's disease (CHAMPION): A noninferiority randomized controlled trial.
In 188 patients undergoing MER-guided subthalamic DBS, general anesthesia with titrated desflurane was noninferior to dexmedetomidine conscious sedation for achieving high-quality MER (nRMS>2.0). Operative time was shorter under general anesthesia, and 6-month motor outcomes, medication reductions, and complication rates were similar across groups.
Impact: This trial resolves a key practical question by demonstrating that asleep DBS can preserve electrophysiologic mapping quality while improving efficiency, potentially broadening access and standardizing workflows.
Clinical Implications: Centers can confidently offer general anesthesia for MER-guided STN DBS without compromising signal quality or medium-term outcomes, with potential gains in OR efficiency and patient comfort. Anesthetic titration to signal quality may aid standardization.
Key Findings
- General anesthesia was noninferior to conscious sedation for high-quality MER (89.4% vs 90.3%; difference -0.96%; 95% CI -9.62 to 7.70).
- Operative time was shorter with general anesthesia (mean difference -9.07 minutes; 95% CI -13.99 to -4.14; P<0.001).
- Six-month changes in UPDRS, levodopa equivalent dose, and complication rates were similar between groups.
- Protocolized desflurane titration against MER quality enabled asleep DBS without loss of electrophysiologic signal intensity.
Methodological Strengths
- Prospective randomized noninferiority design with objective primary electrophysiologic endpoint (nRMS).
- Predefined secondary clinical outcomes including 6-month efficacy and complications.
Limitations
- Anesthetic regimens were limited to desflurane (GA) and dexmedetomidine (sedation), potentially affecting generalizability.
- Longer-term outcomes beyond 6 months and patient-reported measures were not reported in the abstract.
Future Directions: Multicenter replication across anesthetic regimens, integration of patient-reported outcomes and cost-effectiveness, and evaluation of intraoperative workflow and staffing implications.
BACKGROUND: Deep brain stimulation for Parkinson's disease is often performed under conscious sedation or general anesthesia. However, anesthetic agents may influence intraoperative microelectrode recording, and the optimal anesthesia method for microelectrode recording remains unclear. This study compared general anesthesia and conscious sedation in preserving microelectrode recording signal intensity during deep brain stimulation. METHODS: In this prospective, noninferiority randomized controlled trial, patients with Parkinson's disease (UK Brain Bank criteria) undergoing elective bilateral surgery were randomized 1:1 to the conscious sedation or the general anesthesia group. During surgery, a desflurane anesthetic titrated against the quality of the electrophysiologic signal was applied in the general anesthesia group, whereas patients in the conscious sedation group received dexmedetomidine anesthesia. The primary outcome was the proportion of patients with high-quality microelectrode recording (normalized root mean square, nRMS >2.0), assessed postoperatively off-line. Secondary outcomes included operation and recording duration, 6-month clinical efficacy, and complication rates. RESULTS: Of 188 randomized patients (94 general anesthesia, 93 conscious sedation), desflurane anesthesia was noninferior for high nRMS proportion (89.4% vs. 90.3%; difference, -0.96%; 95% CI, -9.62 to 7.70). The general anesthesia group had shorter operative time (difference, -9.07 minutes; 95% CI, -13.99 to -4.14; P<0.001). At 6 months, changes in Unified Parkinson's Disease Rating Scale score (difference, -2.50; 95% CI, -7.20 to 2.20; P=0.297), levodopa equivalent daily dose (difference, -58.4 mg; 95% CI, -133.56 to 16.75; P=0.128) and the complication rates (general anesthesia: 10.9% vs. conscious sedation: 8.9%; p=0.655) were comparable between the groups. CONCLUSION: General anesthesia is noninferior to conscious sedation for microelectrode-guided subthalamic nucleus deep brain stimulation, providing equivalent signal intensity and clinical outcomes while improving procedural efficiency, supporting its use as a valid clinical option.
2. Low cardiac index during periods of arterial hypotension and risk of acute kidney injury in cardiac surgery.
In 1,272 CAB patients with minute-by-minute hemodynamics, acute kidney injury and longer length-of-stay were associated with joint exposure to hypotension and low cardiac index (≤2 L/min/m²), but not with hypotension when cardiac index was >2. These findings explain why MAP-only interventions may fail and support targeting flow plus pressure.
Impact: By integrating flow and pressure, this study reframes intraoperative renal risk assessment and provides a mechanistic rationale for combined MAP and cardiac output targets.
Clinical Implications: Consider continuous or frequent cardiac output monitoring and avoid sustained periods of hypotension with CI ≤2 L/min/m² during CPB-era cardiac surgery. CI-guided inotropy/volume optimization alongside MAP targets may better protect the kidney.
Key Findings
- Among 1,272 CAB patients, 30% experienced ≥5 minutes of joint hypotension with low CI (≤2 L/min/m²).
- Joint exposure to hypotension and CI ≤2 was associated with acute kidney injury and longer length-of-stay.
- Hypotension with CI >2 was not associated with increased AKI risk, suggesting the importance of flow in addition to pressure.
Methodological Strengths
- High-resolution minute-by-minute intraoperative MAP and CI data enabling joint exposure modeling.
- Multivariable logistic regression with adjustment for covariates and exposure durations.
Limitations
- Observational design limits causal inference and residual confounding cannot be excluded.
- Findings are specific to CAB with cardiopulmonary bypass and may not generalize to other surgeries.
Future Directions: Prospective interventional trials testing CI-augmented hemodynamic protocols versus MAP-only targets for kidney protection, and validation across diverse cardiac procedures.
BACKGROUND: Cardiac index (CI) and mean arterial pressure (MAP) are concurrent determinants of renal perfusion. Hypotension is associated with acute kidney injury (AKI), but clinical trials focused solely on raising intraoperative MAP showed no benefit. Whether CI provides useful clinical information is controversial. We evaluated the association between AKI and low CI during periods of hypotension in cardiac surgery. Length of stay (LOS) was a secondary outcome. METHODS: In adults undergoing coronary artery bypass (CAB) surgery with cardiopulmonary bypass, MAP and CI were recorded every minute. Duration of exposure to eight joint ranges of MAP (< or ≥65 mm Hg) and quartiles of CI were calculated. Logistic regression estimated odds ratios (ORs) with 95% confidence intervals for AKI adjusted for all covariates, time in each joint MAP/CI range, and duration of hypotension. RESULTS: Among 1272 participants (67 [50-90] yr, 21% female), 379 (30%) were exposed to ≥5 min of joint hypotension/low CI (CI≤2 L min CONCLUSIONS: Joint exposure to hypotension/CI≤2 during cardiac surgery was associated with AKI and increased LOS, whereas exposure to hypotension/CI>2 was not. Prospective interventional trials are needed to evaluate whether the relationship between CI and AKI is indeed causal and whether CI-guided therapy can help reduce AKI.
3. Respiratory Depression after Perioperative Methadone Administration: A Systematic Review and Meta-analysis.
Across 25 studies (116,815 patients), perioperative IV methadone did not increase postoperative respiratory depression versus other opioids (RR 1.22, 95% CI 0.76–1.95), with consistent findings across Bayesian and subgroup analyses. However, overall certainty was very low due to bias and limited continuous respiratory monitoring.
Impact: These results address a key safety concern that limits methadone’s perioperative use and may inform multimodal, opioid-sparing strategies when paired with robust monitoring.
Clinical Implications: Clinicians may consider methadone as part of perioperative analgesia without expecting higher respiratory depression than with other opioids, while ensuring vigilant and preferably continuous respiratory monitoring and standardized dosing protocols.
Key Findings
- Primary meta-analysis of 12 RCTs (n=845) showed no significant increase in respiratory depression with methadone vs controls (RR 1.22, 95% CI 0.76–1.95).
- Bayesian meta-analysis and subgroup analyses (dose, timing, surgical population) did not identify excess risk.
- Retrospective data were consistent with RCT findings, but overall certainty was very low due to bias and limited continuous monitoring.
Methodological Strengths
- Comprehensive multi-database search spanning five decades with inclusion of RCTs.
- Robust synthesis using frequentist, Bayesian, and prespecified subgroup analyses.
Limitations
- Very low certainty of evidence due to risk of bias and lack of continuous respiratory monitoring in most studies.
- Heterogeneity in dosing regimens and definitions of respiratory depression limits precision.
Future Directions: Prospective, adequately powered RCTs with continuous capnography/oximetry and standardized dosing to define dose–response and real-world safety across surgical populations.
BACKGROUND: Despite evidence supporting methadone analgesic efficacy, perioperative methadone use remains limited due to concerns regarding respiratory depression. The aim of this systematic review and meta-analysis is to objectively evaluate the current evidence on the association between perioperative intravenous methadone administration and postoperative respiratory depression, compared with other opioids.1. METHODS: Ovid MEDLINE, Ovid Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus were searched from January 1, 1970 to April 5, 2025. Eligible studies were randomized clinical trials (RCT) and retrospective studies comparing perioperative intravenous methadone administration with other opioids in adult or pediatric surgical patients and reporting postoperative respiratory depression events. Summary estimates were calculated as relative risks with a 95% confidence interval for the main analysis. The primary outcome was postoperative respiratory depression, defined as naloxone use, respiratory rate <8 breaths per minute, or SpO2 <90%. RESULTS: Twenty-five studies comprising 116,815 surgical patients were included. Twelve RCTs (n = 845) contributed data to the primary analysis. Respiratory depression occurred in 7.7% of methadone-treated patients and 6.6% of controls. Methadone was not associated with a significant greater risk of respiratory depression (relative risk [RR] 1.22, 95% confidence interval [CI], 0.76-1.95). Bayesian meta-analysis, subgroup analyses stratified by methadone dose, timing of events, and surgical population, and analyses of retrospective studies did not reveal greater risk of respiratory depression. Certainty of evidence was rated very low due to risk of bias and lack of continuous monitoring strategies in most of the included studies. CONCLUSION: Perioperative intravenous methadone was not associated with a higher risk of respiratory depression, compared to other opioids. The available evidence is predominantly derived from retrospective datasets, emphasizing the need for prospective studies with rigorous respiratory monitoring to further validate the safety of perioperative intravenous (i.v.) methadone administration.