Daily ReportSep 14, 2026
Anesthesiology, September 14 edition
We read 10 papers and selected 3.
Summary
The highest-impact studies addressed perioperative neurocognitive dysfunction, sutureless vascular repair, and failure of epidural anesthesia conversion for intrapartum cesarean delivery. Together, they combine mechanistic experimentation, preclinical translational development, and clinically relevant retrospective risk stratification.
Research Themes
- Mechanisms of sevoflurane-associated perioperative cognitive impairment
- Preclinical development of sutureless vascular hemostasis
- Risk factors for failed conversion of labor epidural analgesia
Selected Articles
1. Anesthesia inhalation agent sevoflurane induces perioperative cognitive impairment: Apelin/early growth response 1 axis induces ferritinophagy and exacerbates ferroptosis.
Integrated analysis of the GEO dataset GSE139220 and in vivo experiments identified the apelin/early growth response 1 axis as a potential mediator of sevoflurane-associated perioperative neurocognitive disorder. Sevoflurane altered ferroptosis-related markers and increased the ferritinophagy marker nuclear receptor coactivator 4, while Apelin-13 reversed these effects.
Impact: The study proposes a specific molecular pathway linking a commonly used anesthetic to perioperative cognitive impairment and identifies Apelin-13 as a candidate countermeasure. This creates a mechanistic and therapeutic hypothesis that can be tested in translational anesthesia research.
Clinical Implications: The findings do not justify changing anesthetic practice immediately, but they support investigation of neuroprotective strategies, biomarker-guided risk assessment, and whether ferroptosis-modulating interventions can reduce postoperative neurocognitive disorder.
Key Findings
- Bioinformatics analysis of GSE139220 implicated the apelin/early growth response 1 axis in sevoflurane-associated perioperative neurocognitive disorder.
- Sevoflurane reduced glutathione peroxidase 4, xCT, and early growth response 1 and increased nuclear receptor coactivator 4, consistent with enhanced ferroptosis and ferritinophagy.
- Apelin-13 reversed the reported molecular changes and cognitive impairment phenotype in the in vivo experiments.
Methodological Strengths
- Combined public-dataset bioinformatics with in vivo experimentation to connect molecular associations with a biological phenotype.
- Examined a mechanistically coherent pathway involving ferroptosis, ferritinophagy, and a candidate pharmacologic rescue strategy.
Limitations
- The provided abstract does not report the in vivo sample size, detailed randomization, blinding, or behavioral testing protocol.
- The findings are preclinical and do not establish that sevoflurane causes clinically meaningful cognitive impairment in human patients or that Apelin-13 is safe and effective in humans.
Future Directions: Replication in independent animal models, causal manipulation of the apelin/early growth response 1 pathway, dose-response studies, and prospective human biomarker and outcome studies are needed before clinical translation.
JOURNAL/mgres/04.03/01612956-202701000-00004/figure1/v/2026-09-13T085902Z/r/image-tiff Sevoflurane is a widely used inhaled anesthetic for inducing and maintaining general anesthesia in surgical patients. After inhalation, sevoflurane crosses the alveolar capillary membrane barrier to enter the circulatory system and act on the central nervous system, producing anesthetic effects. Recent research has found that sevoflurane can induce ferroptosis and trigger neurological disorders. However, the exact process behind this is not yet understood. In this study, we used an integrated approach combining bioinformatics analysis with in vivo experiments to investigate the complex relationships between sevoflurane, ferroptosis, and ferritinophagy, along with their underlying mechanisms.
2. Sutureless repair of inferior vena cava injury using an elastomeric sealant in a mouse model with histopathological analysis of vascular healing.
In a mouse model of infrarenal inferior vena cava injury, Hydrofit-applied sheets achieved immediate hemostasis in all 19 animals, with 94.7% overall survival. Histology showed progression through inflammatory, proliferative, and maturation phases with endothelial coverage by day 10, but later material-associated fibrous encapsulation and intimal hyperplasia.
Impact: The study evaluates both technical feasibility and the biological consequences of a sutureless venous repair strategy. Its demonstration of reliable acute hemostasis together with late adverse tissue responses provides essential information for designing safer translational vascular sealants.
Clinical Implications: The technique may eventually support minimally invasive surgery or damage-control management when venous suturing is difficult or time-consuming. However, the late fibrous encapsulation and intimal hyperplasia require careful safety evaluation before clinical use.
Key Findings
- Immediate hemostasis was achieved in all 19 mice, with an exact 95% confidence interval of 82.4% to 100%.
- Overall survival was 18 of 19 mice, or 94.7%, although one postoperative death was potentially anesthesia-related and could not be definitively classified.
- Endothelial coverage was established by day 10, while later healing included material-driven fibrous encapsulation and intimal hyperplasia.
Methodological Strengths
- Used a defined venous injury model with an explicitly reported primary hemostasis endpoint and exact confidence interval.
- Included serial histopathological assessment and CD31 immunostaining to characterize both early and late vascular healing.
Limitations
- The study used only 19 male mice and lacked a conventional suture or alternative hemostatic control group.
- The animal model does not establish performance in larger vessels, under clinical bleeding conditions, or in human surgery; one animal was excluded from histopathological scoring.
Future Directions: Future studies should compare the sealant with suturing and other hemostatic products, evaluate larger-animal models and clinically relevant bleeding pressures, and determine whether the late intimal response compromises venous patency.
OBJECTIVE: To evaluate the feasibility of sutureless repair for inferior vena cava (IVC) injury using an elastomeric sealant (Hydrofit; Sanyo Chemical Industries) and to characterize the histopathological pathway of vascular healing in a mouse model. METHODS: Nineteen male C57BL/6 mice underwent laparotomy under general anesthesia. A longitudinal incision exceeding 1 mm was made in the infrarenal IVC, and hemostasis was achieved using Hydrofit-applied sheets with 2 minutes of compression. The primary end point was immediate hemostatic success rate with exact 95% confidence intervals (CIs). Surviving mice were distributed across the three time points (n = 6, 6, and 6 at days 5, 10, and 30, respectively) by random allocation; one mouse at day 30 was excluded from histopathological scoring owing to inability to reliably identify the incision site. CD31 immunostaining was performed to assess endothelial coverage at the repair site.
3. Association of patient and clinical characteristics with failed conversion of neuraxial anesthesia for intrapartum cesarean delivery among patients who had top-up of indwelling labor epidural catheters: a retrospective single center study.
Among 455 patients undergoing intrapartum cesarean delivery after top-up of an indwelling labor epidural catheter, neuraxial anesthesia conversion failed in 70 patients, or 15%. Multivariable analysis identified epidural catheter replacement during labor and emergency cesarean delivery as independent factors associated with conversion failure.
Impact: The study identifies practical warning signs for inadequate epidural anesthesia before urgent obstetric surgery. These findings can inform earlier anesthetic planning, patient counseling, and readiness for alternative anesthesia when conversion failure risk is elevated.
Clinical Implications: Patients whose epidural catheter required replacement during labor or who require emergency cesarean delivery may warrant early assessment of block function, prompt senior anesthesiology involvement, and preparation for spinal or general anesthesia if epidural top-up is inadequate.
Key Findings
- The final analysis included 455 patients undergoing intrapartum cesarean delivery after attempted epidural top-up.
- Neuraxial anesthesia conversion failure occurred in 70 patients, corresponding to 15% of the cohort.
- Epidural catheter replacement during labor was independently associated with failure, with an adjusted odds ratio of 3.03 and a 95% confidence interval of 1.13 to 8.12; emergency cesarean delivery was also independently associated.
Methodological Strengths
- Analyzed a clinically focused cohort of 455 patients over a defined four-year period.
- Used multivariable logistic regression rather than relying solely on unadjusted associations.
Limitations
- The retrospective single-center design is vulnerable to selection bias, documentation bias, and residual confounding.
- The abstract does not provide the complete adjusted model, all effect estimates, block assessment criteria, or details of institutional anesthetic protocols.
Future Directions: Prospective multicenter studies should validate these predictors, standardize definitions of conversion failure and epidural function, and test risk-based protocols for early catheter replacement, alternative neuraxial techniques, or general anesthesia preparation.
BACKGROUND: The primary aim of our study was to determine which patient and clinical characteristics were associated with failed conversion from neuraxial labor analgesia to neuraxial anesthesia for intrapartum cesarean delivery (CD) at our hospital. METHODS: The study included patients who had a CD between July 1, 2019, and December 31, 2023, and had attempted conversion from neuraxial labor analgesia to neuraxial anesthesia for intrapartum CD by top-up of an indwelling labor epidural catheter. We performed a bivariate analysis comparing patients who did and did not have neuraxial anesthesia conversion failure along with a multivariate logistic regression to determine which variables were associated with neuraxial anesthesia conversion failure. RESULTS: Among the 455 patients in the final analysis, 70 (15%) had neuraxial anesthesia conversion failure. A multivariate logistic regression found that replacement of the epidural catheter during labor (adjusted odds ratio [aOR] 3.03, 95% confidence interval [CI] 1.13-8.12;