Anesthesiology Research Analysis
Q4 2025 anesthesiology research was defined by rigorous trials, translational mechanistic advances, and measurement equity. A large multicenter RCT (IMPROVE-multi) found no benefit of ambulatory-derived personalized intraoperative MAP targets, re-centering attention on physiology- and autoregulation-guided strategies. Translational work linked innate immunity to renal hemodynamics as suPAR emerged as a kidney-specific vasoconstrictor, while cell-type–resolved human genomics localized chronic pai
Summary
Q4 2025 anesthesiology research was defined by rigorous trials, translational mechanistic advances, and measurement equity. A large multicenter RCT (IMPROVE-multi) found no benefit of ambulatory-derived personalized intraoperative MAP targets, re-centering attention on physiology- and autoregulation-guided strategies. Translational work linked innate immunity to renal hemodynamics as suPAR emerged as a kidney-specific vasoconstrictor, while cell-type–resolved human genomics localized chronic pain risk to discrete cortical glutamatergic neurons and hDRG nociceptors. Practice-ready pediatric advances included subcutaneous nitroglycerin dramatically reducing radial artery occlusion and low-dose IV esketamine lowering emergence delirium. Nonpharmacologic neuromodulation (taVNS) improved recovery after cesarean delivery, and a phase-3 cannabis extract expanded multimodal analgesic options. Monitoring equity was highlighted by skin-tone–related bias in pediatric cerebral NIRS, underscoring device validation needs.
Selected Articles
1. Individualized Perioperative Blood Pressure Management in Patients Undergoing Major Abdominal Surgery: The IMPROVE-multi Randomized Clinical Trial.
Across 1,142 high-risk major abdominal surgery patients in 15 centers, individualized intraoperative MAP targets derived from preoperative nighttime ambulatory monitoring did not reduce early organ-injury composites versus standard MAP ≥65 mmHg, with no secondary benefits.
Impact: Provides definitive multicenter evidence against routine adoption of ambulatory-derived personalized MAP targets, redirecting perioperative research toward physiology- and autoregulation-guided care.
Clinical Implications: Maintain standard intraoperative MAP thresholds and prioritize research on perfusion monitoring and autoregulation indices rather than ambulatory-based personalization.
Key Findings
- No reduction in 7-day composite organ injury with individualized MAP vs routine care.
- No benefits across 22 secondary outcomes, including infections and 90-day events.
- Ambulatory nighttime MAP–derived targets did not outperform standard MAP ≥65 mmHg.
2. Full-spectrum extract from Cannabis sativa DKJ127 for chronic low back pain: a phase 3 randomized placebo-controlled trial.
A multicenter phase-3 RCT (n=820) showed a standardized full-spectrum cannabis extract produced modest but significant pain reduction over 12 weeks and improved neuropathic symptoms in a predefined subgroup, with mostly mild-to-moderate adverse events.
Impact: One of the few positive phase-3 analgesic trials, expanding multimodal options beyond opioids/NSAIDs and informing responder-enriched development.
Clinical Implications: Consider as an adjunct for chronic low back pain after shared decision-making about modest effect and tolerability; monitor long-term safety.
Key Findings
- Met the primary endpoint with modest mean pain reduction vs placebo.
- Greater benefit in neuropathic pain subgroup.
- Adverse events more frequent but mostly mild-to-moderate without dependence signals.
3. The cell-type-specific genetic architecture of chronic pain in brain and dorsal root ganglia.
By integrating large GWAS with human single-cell transcriptomics/chromatin, this study localizes chronic pain heritability to specific cortical glutamatergic neurons and a defined hDRG nociceptor subtype, nominating actionable pathways for precision analgesia.
Impact: Delivers a cell-type–resolved roadmap from human genetics to neuronal circuits, accelerating target discovery and biomarker development for analgesics.
Clinical Implications: Prioritizes translational programs toward glutamatergic cortical circuits and hDRG TRPV1/A1.2 nociceptors, informing future patient stratification and drug design.
Key Findings
- Pain GWAS signals enriched in specific cortical glutamatergic neurons.
- Robust enrichment in a defined hDRG nociceptor subtype.
- Candidate pathways include kinase signaling, GABAergic synapses, and axon guidance.
4. Transcutaneous Auricular Vagus Nerve Stimulation for Postpartum Contraction Pain During Elective Cesarean Delivery: A Randomized Clinical Trial.
A randomized, sham-controlled trial (n=156) showed that three days of taVNS after cesarean delivery reduced contraction pain and improved incision pain, sleep, mood, and recovery quality versus sham.
Impact: Demonstrates a scalable nonpharmacologic intervention that improves multiple patient-centered outcomes and may reduce opioid exposure in obstetric ERAS pathways.
Clinical Implications: Consider protocolizing taVNS in multimodal postpartum analgesia with appropriate device access, training, and monitoring.
Key Findings
- Reduced moderate-to-severe uterine contraction pain on POD3.
- Improved incision pain, mood, sleep, and recovery scores.
- Feasible sham-controlled implementation with validated PROs.
5. Soluble urokinase receptor is a kidney-specific vasoconstrictor.
Cross-species translational evidence shows suPAR directly induces renal vasoconstriction, reduces renal blood flow and glomerular perfusion, and associates with lower baseline eGFR, linking innate immunity to perioperative AKI risk.
Impact: Reframes perioperative AKI pathophysiology beyond tubular injury, identifying a mechanistic biomarker and potential therapeutic target.
Clinical Implications: Support evaluation of perioperative suPAR measurement and trials of suPAR-lowering or vasomodulatory strategies within kidney-protective pathways.
Key Findings
- Higher suPAR correlates with lower baseline eGFR in surgical cohorts.
- Intravital imaging and ex vivo perfusion confirm afferent arteriolar constriction and reduced perfusion.
- Positions suPAR as both a risk stratifier and therapeutic target.
6. Subcutaneous Nitroglycerin to Prevent Radial Artery Occlusion in Pediatric Patients: A Randomized Clinical Trial.
In children under 3 years undergoing radial artery catheterization, subcutaneous nitroglycerin (5 μg/kg) before cannulation and prior to removal reduced post-removal occlusion from 73.8% to 25.4% without hypotension or local adverse effects.
Impact: Low-cost, simple, high-yield prevention for a common pediatric vascular complication, with a large absolute risk reduction.
Clinical Implications: Adopt subcutaneous nitroglycerin before ultrasound-guided cannulation and prior to removal in infants/toddlers while monitoring hemodynamics.
Key Findings
- Absolute risk reduction of ~48.5% for post-removal occlusion.
- Improved flow metrics with no hypotension or local complications.
- Per-protocol n=132 due to protocol exclusions among 200 randomized.
7. Intravenous esketamine for the prevention of emergence delirium and negative behavioural changes after paediatric adenotonsillectomy: a randomised controlled trial.
A double-blind RCT (n=228) in children aged 3–7 years found intraoperative low-dose IV esketamine (0.2 mg/kg) reduced emergence delirium and early negative behavioral changes without increasing adverse events, with benefits persisting to day 30.
Impact: Provides pragmatic randomized evidence for a simple intraoperative measure improving neurobehavioral recovery in pediatrics.
Clinical Implications: Consider low-dose IV esketamine protocols in pediatric adenotonsillectomy with routine monitoring and local adaptation.
Key Findings
- Emergence delirium reduced (17% vs 43%).
- Negative behavioral changes reduced at day 7 with persistence to day 30.
- No increase in adverse events; improved analgesia and parental satisfaction.
8. Effect of peri-operative pharmacological interventions on postoperative delirium in patients having cardiac surgery: a systematic review and Bayesian network meta-analysis.
A Bayesian network meta-analysis of 79 RCTs (24,827 patients) compared 29 strategies and ranked dexmedetomidine plus melatonin as leading for delirium reduction, though overall certainty was low.
Impact: The largest synthesis to date that prioritizes candidate regimens for delirium prevention and shapes protocol design despite low certainty.
Clinical Implications: Consider dexmedetomidine plus melatonin within multimodal prevention pathways while acknowledging low certainty and monitoring hemodynamics.
Key Findings
- Combination therapy ranked highest for delirium reduction.
- Signals for shorter ICU and hospital stay.
- Heterogeneity and low certainty across included trials.
9. Near-infrared Spectroscopy and Skin Tone in Children: A Prospective Cohort Study.
Spectrophotometry-measured skin tone independently predicted bias in cerebral NIRS (INVOS 5100C) versus a physiologic reference, with darker skin categories showing larger negative bias.
Impact: Quantifies skin-tone–related device bias in pediatrics, spotlighting the need for cross-tone validation and calibration to ensure equitable monitoring.
Clinical Implications: Interpret cerebral oximetry cautiously in darker skin tones and use supplemental monitoring or validated calibration to avoid inequitable decisions.
Key Findings
- Skin tone independently associated with NIRS bias.
- Darker tones exhibited larger negative bias vs physiologic reference.
- Underscores cross-platform validation and calibration needs.
10. Paravertebral or serratus anterior plane block combined with PECS I (interpectoral) blocks versus paravertebral block for mastectomy: A cluster-randomized trial of 1507 patients.
A pragmatic cluster-RCT of 1,507 mastectomy patients found that adding PECS I to PVB or SAPB did not reduce high postoperative opioid use or improve secondary outcomes versus PVB alone.
Impact: Practice-defining negative evidence that streamlines regional anesthesia strategies and supports resource stewardship.
Clinical Implications: Avoid routine PECS I addition in expander-reconstruction mastectomy; tailor blocks to anatomy, safety, and expertise.
Key Findings
- High postoperative opioid use similar across strategies.
- No improvement in pain, antiemetic use, discharge timing, chronic pain, or QoR.
- Cluster design enhanced external validity across sites and time blocks.