Weekly ReportDec 15–21, 2025
Anesthesiology, week 51 edition
We read 348 papers and selected 3.
Summary
This week’s anesthesiology literature emphasized mechanisms of emergence, prevention of postoperative complications, and precision perioperative care. A preclinical Anesthesiology study identified dorsomedial periaqueductal gray glutamatergic neurons as a shared arousal substrate across multiple anesthetics, while randomized evidence supported perineural esketamine for reducing chronic postsurgical pain after total knee arthroplasty. A large meta-analysis found that exercise prehabilitation, particularly inspiratory muscle training, reduces postoperative complications and length of stay. Additional trends included blood neurofilament light for cardiac-arrest prognostication, non-intubated thoracic anesthesia, driving-pressure-guided ventilation, and AI-based neonatal risk prediction.
Selected Articles
1. The role of the dorsomedial periaqueductal gray glutamatergic neurons in promoting arousal under multiple general anesthetics in mice.
In mice, dorsomedial periaqueductal gray glutamatergic neurons were suppressed during anesthesia and activated during wakefulness across sevoflurane, propofol, ketamine, and dexmedetomidine exposure. Optogenetic or chemogenetic activation delayed induction, accelerated emergence, and reduced burst suppression, whereas inhibition strengthened anesthetic effects. The findings identify a possible shared arousal circuit across anesthetic classes.
Impact: This rigorous multimodal mechanistic study identifies a convergent neural substrate regulating loss and recovery of consciousness across several anesthetic agents.
Clinical Implications: The findings may guide future pharmacologic or neuromodulatory approaches to accelerate emergence, reduce excessive burst suppression, and manage delayed awakening, although translation from mice to humans remains unproven.
Key Findings
- dmPAG glutamatergic activity was suppressed during anesthesia and elevated during wakefulness across four anesthetic agents.
- Optogenetic activation prolonged induction and shortened emergence under sevoflurane.
- Activation reduced the burst-suppression ratio from approximately 50% to 2.15%.
2. Esketamine as an Adjuvant to Ropivacaine in Genicular Nerve and IPACK Blocks for Total Knee Arthroplasty: A Double-Blind Randomized Trial.
In a double-blind randomized trial of 367 total knee arthroplasty patients, adding perineural esketamine 0.2 mg/kg to ropivacaine for genicular and IPACK blocks reduced six-month chronic postsurgical pain to 4.9%, compared with 17.9% with ropivacaine alone and 27.0% with control. Pain burden and early functional recovery also improved without an increase in reported adverse events.
Impact: The study provides a clinically practical regional-anesthesia strategy that substantially reduced chronic postsurgical pain, an outcome often insufficiently addressed by conventional perioperative analgesia.
Clinical Implications: Perineural esketamine could be considered as an adjuvant to ropivacaine in genicular and IPACK blocks for selected knee arthroplasty patients, pending multicenter confirmation and longer-term safety assessment.
Key Findings
- Six-month chronic postsurgical pain was 4.9% with esketamine, versus 17.9% with ropivacaine alone and 27.0% with control.
- Pain burden and early functional outcomes improved with the esketamine regimen.
- No increase in adverse events was reported in the esketamine group.
3. Pooled Efficacy and Exploration of Effect Modifiers of Exercise Prehabilitation: A Systematic Review and Meta-regression Analysis of Randomized Controlled Trials.
This registered systematic review and meta-regression of 99 randomized trials involving 8,222 patients found that exercise prehabilitation likely reduced postoperative complications by approximately 46% and shortened hospital stay by 0.90 days. Inspiratory muscle training was the only consistent effect modifier associated with greater benefit for both outcomes. The findings support integration of structured prehabilitation into enhanced recovery pathways while highlighting the need for better individualized program design.
Impact: This high-level synthesis across surgical populations provides actionable evidence for preoperative exercise programs and identifies inspiratory muscle training as the most credible component for enhanced benefit.
Clinical Implications: Perioperative teams should consider structured exercise prehabilitation, particularly inspiratory muscle training, for appropriate elective-surgery patients, while accounting for patient fitness, procedure type, program duration, and local implementation resources.
Key Findings
- Across 99 trials and 8,222 patients, exercise prehabilitation reduced complications (OR 0.54).
- Hospital stay decreased by a pooled mean of 0.90 days, although certainty was low because of heterogeneity.
- Inspiratory muscle training was the only consistent effect modifier for both complications and length of stay.