Weekly Anesthesiology Research Analysis
This week’s anesthesiology literature emphasized data-driven physiologic phenotyping, randomized trials addressing long-standing clinical questions, and high-quality syntheses guiding practice. An unsupervised deep‑learning model reproducibly identified four hypotension endotypes with potential to enable physiology‑directed therapy. A large RCT found no overall difference in 1‑year recurrence after HCC hepatectomy between propofol TIVA and sevoflurane (with a signal favoring TIVA in open surgery
Summary
This week’s anesthesiology literature emphasized data-driven physiologic phenotyping, randomized trials addressing long-standing clinical questions, and high-quality syntheses guiding practice. An unsupervised deep‑learning model reproducibly identified four hypotension endotypes with potential to enable physiology‑directed therapy. A large RCT found no overall difference in 1‑year recurrence after HCC hepatectomy between propofol TIVA and sevoflurane (with a signal favoring TIVA in open surgery). A network meta‑analysis ranked parental presence plus video games highest for reducing pediatric preoperative anxiety, supporting scalable non‑pharmacologic interventions.
Selected Articles
1. Deep learning model to identify and validate hypotension endotypes in surgical and critically ill patients.
An unsupervised deep learning autoencoder + Gaussian mixture approach identified four reproducible hypotension endotypes (vasodilation, hypovolaemia, myocardial depression, bradycardia) using stroke volume index, heart rate, systemic vascular resistance index, and stroke volume variation during MAP<65 mmHg events. The model was developed on 871 surgical patients/events and externally validated in two large datasets (surgical and ICU), providing per‑event endotype probabilities to support physiology‑directed therapy.
Impact: Provides a validated, interpretable framework reframing hypotension as heterogeneous, mechanistically distinct states — enabling targeted selection of fluids, vasopressors, inotropes, or chronotropic strategies rather than treating blood pressure alone.
Clinical Implications: If implemented in real time, endotype probabilities could guide causal interventions (e.g., vasopressors for vasodilation, fluids for hypovolaemia, inotropes for myocardial depression, pacing/chronotropes for bradycardia). Integration into monitors could standardize physiology‑directed hemodynamic care.
Key Findings
- Four reproducible hypotension endotypes were identified: vasodilation, hypovolaemia, myocardial depression, and bradycardia.
- Independent validation in two external cohorts (surgical and ICU datasets) reproduced the same endotypes and supported generalizability.
2. Recurrence-free survival after hepatectomy using propofol-based total intravenous anaesthesia and sevoflurane-based inhalational anaesthesia: a randomised controlled study.
A randomized controlled trial in patients undergoing hepatectomy for hepatocellular carcinoma (n≈454 analyzed) found no difference in 1‑year recurrence-free survival between propofol TIVA and sevoflurane anesthesia overall (79.1% vs 77.7%). A prespecified subgroup showed a lower hazard of recurrence or death with TIVA in open hepatectomy, suggesting surgical approach may modify any anesthetic effect.
Impact: A well-powered RCT addressing the clinically important question of anesthetic modality and cancer recurrence, providing high‑quality evidence to inform anesthetic planning in oncologic surgery.
Clinical Implications: Routine use of TIVA solely to reduce HCC recurrence is not supported by this trial overall. Consideration of TIVA for open hepatectomy may be reasonable but requires cautious interpretation and further validation.
Key Findings
- One‑year recurrence‑free survival was similar between TIVA and sevoflurane (79.1% vs 77.7%; adjusted HR ≈1.04).
- Predefined subgroup: open hepatectomy patients had lower hazard with TIVA (HR 0.49), suggesting effect modification by surgical approach.
3. Non-pharmacological Interventions for Preoperative Anxiety in Children: A Systematic Review and Network Meta-Analysis.
Network meta‑analysis of 36 randomized trials (n=3,182) found that psychological plus digital health interventions—specifically parental presence during induction combined with video games—ranked highest in reducing pediatric preoperative anxiety vs controls and most comparators. The work prioritizes scalable, low‑risk strategies for preoperative pathways.
Impact: Highest‑quality synthesis prioritizing simple, implementable non‑drug strategies that can be rapidly adopted into pediatric preoperative workflows and policy.
Clinical Implications: Implement structured parental presence during induction combined with interactive digital distractions (video games) as first‑line non‑pharmacologic measures to reduce anxiety in children; standardize protocols and staff training.
Key Findings
- Psychological plus digital health interventions had the highest SUCRA ranks for reducing preoperative anxiety.
- Parental presence during induction combined with video games outperformed most other interventions consistently.