Anesthesiology Research Analysis
August anesthesiology research converged on precision perioperative care with immediately actionable strategies. An AI clinical classifier enabled phenotype-guided corticosteroid use in ARDS, while a large multicenter RCT showed lateral positioning during procedural sedation substantially reduces hypoxaemia. Renal protection emerged as a sustained theme, with a comprehensive meta-analysis supporting individualized intraoperative blood pressure targets to reduce AKI risk. Additional highlights in
Summary
August anesthesiology research converged on precision perioperative care with immediately actionable strategies. An AI clinical classifier enabled phenotype-guided corticosteroid use in ARDS, while a large multicenter RCT showed lateral positioning during procedural sedation substantially reduces hypoxaemia. Renal protection emerged as a sustained theme, with a comprehensive meta-analysis supporting individualized intraoperative blood pressure targets to reduce AKI risk. Additional highlights included a randomized trial showing single low-dose intraoperative esketamine improves first‑night postoperative sleep and translational data identifying barrier‑sealing biology (netrin‑1/cortactin) as a neuroprotective axis in chemotherapy neuropathy.
Selected Articles
1. Temporal stability of phenotypes of acute respiratory distress syndrome: clinical implications for early corticosteroid therapy and mortality.
An open-source AI classifier using routine clinical variables identified dynamic ARDS phenotypes and linked them to heterogeneous corticosteroid effects; steroids lowered mortality in hyperinflammatory ARDS but increased mortality in hypoinflammatory ARDS, with benefit persisting only if hyperinflammation remained at day 3.
Impact: Provides a scalable pathway for phenotype-guided immunomodulation using bedside data, advancing precision critical care.
Clinical Implications: Use phenotype classifiers to favor early steroids in hyperinflammatory ARDS, avoid in hypoinflammatory ARDS, and reassess phenotype within 72 hours to confirm ongoing benefit.
Key Findings
- Routine-data AI identified 39% hyperinflammatory and 61% hypoinflammatory ARDS.
- Phenotypes were dynamic; nearly half of hyperinflammatory cases transitioned by day 30.
- Corticosteroids reduced mortality in hyperinflammatory ARDS but increased it in hypoinflammatory ARDS; benefit persisted if hyperinflammation remained at day 3.
2. Effect of a single low-dose esketamine administration during surgical abortion on postoperative sleep disturbance: a randomized controlled trial.
A double‑blind RCT of 204 women with baseline sleep disturbance found that a single intraoperative esketamine 0.2 mg/kg reduced first‑night postoperative sleep disturbance without serious adverse events.
Impact: High-level randomized evidence for a simple pharmacologic adjunct that improves a patient-centered recovery outcome with favorable safety.
Clinical Implications: Consider 0.2 mg/kg intraoperative esketamine for patients with pre-existing sleep disturbance undergoing short procedures, after individualized risk–benefit assessment.
Key Findings
- Esketamine reduced first‑night postoperative sleep disturbance (OR 0.35).
- Randomized, double‑blind, placebo‑controlled design with 204 participants.
- No treatment‑related serious adverse events observed.
3. Effect of lateral versus supine positioning on hypoxaemia in sedated adults: multicentre randomised controlled trial.
A pragmatic multicenter RCT (~2,143 adults) showed that lateral positioning during procedural sedation significantly reduced the incidence and severity of hypoxaemia and decreased airway rescue interventions compared with supine, without safety penalties.
Impact: A low-cost, scalable positioning change that meaningfully reduces a common and dangerous sedation complication.
Clinical Implications: Adopt lateral positioning as default when feasible for procedural sedation to reduce hypoxaemia and airway rescue needs; integrate with oxygenation and monitoring protocols.
Key Findings
- Lateral positioning reduced hypoxaemia incidence and severity vs supine.
- Airway rescue interventions were decreased with lateral positioning.
- No safety compromises across multiple centers.
4. Neuronal toxicity and recovery from early bortezomib-induced neuropathy: blood-nerve barrier dysfunction without dorsal root ganglion damage.
Translational rat and patient data indicate early bortezomib neuropathy is driven by perineurial/blood–nerve barrier leakiness rather than DRG loss; recovery correlates with barrier resealing and upregulation of cortactin and netrin‑1.
Impact: Reframes mechanism from neuronal loss to barrier dysfunction, opening targeted neuroprotective strategies around barrier sealing.
Clinical Implications: Monitor small-fiber integrity in patients on bortezomib and explore barrier-repair strategies (e.g., netrin‑1 agonism) in preclinical and early-phase trials.
Key Findings
- Perineurial leakiness resealed during recovery, paralleling pain resolution.
- Transcriptomics implicated circadian, ECM, and immune regulation; DRG changes were modest.
- Cortactin and netrin‑1 increased with recovery; persistent pain linked to reduced skin innervation and absent netrin‑1 rise.
5. Incidence and risk factors of acute kidney injury after abdominal surgery: a systematic review and meta-analysis.
Meta-analysis of 162 studies (675,361 patients) estimated postoperative AKI incidence at ~16% after abdominal surgery and found randomized evidence that individualized intraoperative blood pressure targets reduce AKI risk.
Impact: Quantifies AKI burden and highlights a modifiable hemodynamic strategy supported by RCT data, guiding perioperative protocols and quality metrics.
Clinical Implications: Implement individualized MAP targets tailored to baseline and comorbidities within renal-protective bundles rather than relying on single interventions.
Key Findings
- Postoperative AKI after abdominal surgery occurs in ~16% of patients.
- AKI severity correlates with stepwise increases in mortality and length of stay.
- Individualized intraoperative BP targets reduced AKI risk in pooled RCTs (RR ~0.67).