Daily Anesthesiology Research Analysis

BACKGROUND: Endovascular thrombectomy (EVT) is the standard of care for eligible patients with anterior circulation large vessel occlusion (LVO). The optimal anesthetic strategy during EVT for young adults with LVO remains unclear. METHODS: Using target trial emulation, we performed a pooled analysis of individual patient data from the DEVT, RESCUE BT, and MARVEL trials. We compared anesthetic strategies (general anesthesia [GA] vs. non-GA [conscious sedation/local anesthesia]) during EVT in patients aged 18-50 years. The primary outcome was 90-day functional independence (modified Rankin Scale [mRS] 0-2). Secondary outcomes included ordinal mRS shift, excellent outcome (mRS 0-1), favorable outcome (mRS 0-3), successful reperfusion (expanded Thrombolysis in Cerebral Infarction [eTICI] grade ≥2b), early neurological improvement (ENI), pneumonia, mortality, and symptomatic intracranial hemorrhage (sICH). Average treatment effects were estimated via inverse probability of treatment weighting (IPTW) and G-computation, with risk differences (RDs) and (common) odds ratios (ORs) reported. RESULTS: Among 284 included patients in the target trial, 94 received GA and 190 received non-GA. Non-GA was associated with higher rates of 90-day functional independence (mRS 0-2) compared to GA (RD 0.12, 95%CI: 0.02 to 0.25). GA was associated with increased pneumonia incidence (RD -0.21, 95%CI: -0.35 to -0.11). Additionally, reperfusion success, mortality, and sICH rates did not differ significantly between groups. CONCLUSION: In this emulated trial involving young stroke patients undergoing EVT, non-GA was associated with a higher likelihood of functional independence compared to GA with similar reperfusion success and sICH. These findings may inform anesthetic selection for young adults with anterior circulation LVO pending a dedicated randomized trial. TRIAL REGISTRATION: ChiCTR.org.cn Identifier: ChiCTR-IOR-17013568; ChiCTR-IOR-17014167; ChiCTR2100051729.

BACKGROUND: Modified radical mastectomy (MRM) is frequently associated with moderate to severe postoperative pain, which may negatively affect recovery and quality of life. Regional anesthesia techniques such as the erector spinae plane block (ESPB), thoracic paravertebral block (TPVB), and pectoral nerve block (PECS) have been increasingly used as part of multimodal analgesia strategies for breast surgery. However, their comparative effects on analgesic efficacy and quality of recovery remain unclear. METHODS: The study included 90 female patients undergoing unilateral elective MRM. Patients were randomly allocated into three groups (n = 30 each) to receive ESPB, TPVB, or PECS block preoperatively with 0.25% bupivacaine. All patients subsequently underwent standardized general anesthesia. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 0, 1, 3, 6, 12, and 24 h. The primary outcome was total morphine consumption at 24 h. Secondary outcomes included time to first morphine request, incidence of rescue fentanyl use, postoperative nausea and vomiting, patient satisfaction, and scores. RESULTS: Demographic characteristics and operative durations were comparable among the groups (p > 0.05). Total 24-hour morphine consumption was significantly higher in the ESPB group (median 10 mg) compared with TPVB (9 mg, p = 0.009) and PECS (9 mg, p = 0.018) groups. Kaplan-Meier analysis revealed that the time to first morphine request was significantly shorter in the ESPB group (p < 0.001), while TPVB provided the longest analgesic duration. No significant differences were found in postoperative pain scores, rescue opioid requirements, or nausea-vomiting incidence (p > 0.05). QoR-15 scores were significantly lower in the ESPB group compared with TPVB and PECS groups (p < 0.001). CONCLUSION: Both PECS and TPVB provided superior postoperative analgesia and better quality of recovery scores compared to ESPB in patients undergoing modified radical mastectomy. These findings support the use of PECS or TPVB as effective components of multimodal analgesia strategies for breast cancer surgery. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN17247698.

Early identification of acute kidney injury (AKI), including subclinical AKI, remains a critical challenge in septic patients undergoing major non-cardiac surgery. Exosomal microRNAs (miRNAs) represent emerging biomarkers capable of reflecting early renal cellular stress before detectable changes in serum creatinine occur. This prospective observational cohort study enrolled 120 adult septic patients undergoing major non-cardiac surgery (> 2 h) at Imam Sajjad Hospital, Tabriz, between early 2025 and August 2025 (Ethics Approval ID: IR.IAU.TABRIZ.REC.1404.179). Peripheral blood was obtained at three perioperative time points (preoperative, intraoperative, and 24 h postoperative) for exosome isolation and miRNA quantification. Clinical AKI was defined according to KDIGO criteria. Subclinical AKI was defined as urinary TIMP-2 × IGFBP7 > 0.3 in the absence of any rise in serum creatinine. Diagnostic performance of candidate miRNAs was assessed using receiver operating characteristic (ROC) analysis based on observed patient data. Among the 120 enrolled patients, a proportion developed AKI during the 24-hour postoperative observation period (final numbers provided in the Results section). Patients who developed AKI demonstrated distinct perioperative alterations in specific exosomal miRNAs compared with those who did not develop AKI. Several miRNAs showed measurable discriminatory ability for early AKI detection across different sampling time points, with areas under the ROC curve (AUCs) ranging within clinically relevant thresholds (AUC values reported in the Results and Tables following recalculation using observed data with 95% confidence intervals). These findings suggest that perioperative plasma exosomal miRNAs may serve as promising early indicators of acute kidney injury in septic patients undergoing major surgery. Their potential role in identifying subclinical AKI warrants further investigation in studies specifically powered for this endpoint.