Weekly Anesthesiology Research Analysis
This week highlighted translational and clinical advances that may change perioperative risk stratification and analgesia. A mechanistic translational study identified suPAR as a kidney-specific vasoconstrictor linking innate immunity to perioperative AKI risk. High-quality trials and meta-analyses informed practice: an RCT showing erector spinae plane block improves recovery after PCNL, and basic neuroscience work mapped a sex-specific brainstem circuit that alters emergence from isoflurane. To
Summary
This week highlighted translational and clinical advances that may change perioperative risk stratification and analgesia. A mechanistic translational study identified suPAR as a kidney-specific vasoconstrictor linking innate immunity to perioperative AKI risk. High-quality trials and meta-analyses informed practice: an RCT showing erector spinae plane block improves recovery after PCNL, and basic neuroscience work mapped a sex-specific brainstem circuit that alters emergence from isoflurane. Together these papers point to biomarker-guided risk stratification, targeted mechanistic therapies, and pragmatic changes in regional anesthesia practice.
Selected Articles
1. Soluble urokinase receptor is a kidney-specific vasoconstrictor.
Translational work integrating a propensity-score matched cardiac surgery cohort with ex vivo porcine kidney perfusion and intravital mouse imaging demonstrates that elevated suPAR reduces renal blood flow by causing afferent arteriolar constriction and increased renal vascular resistance. Findings position suPAR as a kidney-specific vasoconstrictor linking innate immune activation to perioperative AKI risk.
Impact: Provides the first cross-species mechanistic evidence that an innate immune mediator directly constricts renal microvasculature, reframing AKI risk beyond tubular injury and opening biomarker-guided prevention and targeted therapeutic strategies.
Clinical Implications: Consider preoperative suPAR measurement in high-risk surgeries (e.g., cardiac) to refine AKI risk stratification; investigate interventions to lower suPAR or block its vasoconstrictive signaling as potential AKI-preventive strategies.
Key Findings
- In propensity-score–matched cardiac surgery patients, higher suPAR correlated with lower baseline eGFR.
- Ex vivo porcine kidney perfusion with suPAR reduced renal blood flow and increased renal vascular resistance.
- Intravital multiphoton imaging in mice showed suPAR-induced afferent arteriolar constriction and reduced glomerular perfusion.
2. Sex-specific Effects of Acute Stress on Emergence from Isoflurane Anesthesia via Brainstem Circuitry in Mice.
Using restraint stress, EEG, fiber photometry, optogenetic/chemogenetic manipulations, and receptor knockdown, this preclinical study shows acute stress accelerates emergence from isoflurane in male but not female mice via locus coeruleus norepinephrine projections to dorsal raphe GABA neurons and α1-adrenergic receptors. Disruption of this LC→DRN GABA circuit or α1 signaling abolished the effect.
Impact: Mechanistic, sex-stratified mapping of a brainstem circuit that links psychological stress to anesthetic emergence, offering a biologic explanation for perioperative variability and potential targets to individualize anesthetic dosing and emergence strategies.
Clinical Implications: Awareness of stress and sex effects on anesthetic emergence may justify preoperative assessment of stress and selective use of α1-modulating drugs or tailored anesthetic titration; translational evaluation in humans is warranted.
Key Findings
- Acute restraint stress shortened emergence time from isoflurane in male mice (~16 to ~6.8 min) but not in females.
- Stress increased LC norepinephrine neuron activity; chemogenetic inhibition of LC NE neurons abolished the accelerating effect.
- The LC→DRN GABA projection and α1-adrenergic receptors in DRN GABA neurons were necessary for the stress-induced emergence acceleration.
3. Erector spinae plane block versus paravertebral block and placebo for recovery quality after percutaneous nephrolithotomy: A randomized controlled trial.
In a randomized, double-blind, placebo-controlled trial of 120 PCNL patients, ESPB improved 24-hour QoR-15 versus placebo (median difference 11 points) and was non-inferior to thoracic paravertebral block. Both ESPB and TPVB reduced pain scores and morphine consumption by ~40% compared with placebo without increased complications.
Impact: High-quality comparative effectiveness RCT supporting ESPB as a practical, effective alternative to paravertebral block for PCNL analgesia, with patient-centered recovery benefit and opioid-sparing effects.
Clinical Implications: ESPB can be adopted where TPVB expertise or feasibility is limited to improve recovery and reduce opioid needs after PCNL; incorporate into multimodal analgesia pathways.
Key Findings
- ESPB improved 24-hour QoR-15 versus placebo (median difference 11 points; P < 0.001).
- ESPB met non-inferiority criteria versus TPVB for QoR-15 (median difference 1 point).
- Both ESPB and TPVB reduced pain scores and morphine consumption by ~40% vs placebo without block-related complications.