Weekly Anesthesiology Research Analysis
This week’s anesthesiology literature highlights translational advances with immediate clinical relevance: a deep‑learning metabolic index from newborn dried blood spots offers generalizable prematurity risk stratification; a randomized double‑blind trial shows nebulized salbutamol better prevents reperfusion hyperkalemia during liver transplantation than glucose–insulin; and mechanistic preclinical work identifies truncated procalcitonin neutralization as a promising endothelial‑targeted sepsis
Summary
This week’s anesthesiology literature highlights translational advances with immediate clinical relevance: a deep‑learning metabolic index from newborn dried blood spots offers generalizable prematurity risk stratification; a randomized double‑blind trial shows nebulized salbutamol better prevents reperfusion hyperkalemia during liver transplantation than glucose–insulin; and mechanistic preclinical work identifies truncated procalcitonin neutralization as a promising endothelial‑targeted sepsis therapy. Together these reports emphasize AI-enabled prognostics, perioperative electrolyte prevention strategies, and endothelial‑focused biologics as accelerating research directions.
Selected Articles
1. Quantitative assessment of neonatal health using dried blood spot metabolite profiles and deep learning.
Using 13,536 newborn dried blood spot metabolomic profiles, the authors developed a deep‑learning metabolic health index that stratifies risk for bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity beyond gestational age and birthweight; the model was externally validated in 3,299 infants and reproduced metabolic risk subgroups.
Impact: Introduces a generalizable, biologically grounded prognostic metric derived from routinely collected newborn screening samples with direct potential to change early neonatal surveillance and care pathways.
Clinical Implications: Integrating the metabolic health index into neonatal workflows could refine risk stratification for preterm infants, enabling targeted surveillance and earlier interventions beyond GA/BW‑based triage.
Key Findings
- Deep-learning derived metabolic health index from 13,536 dried blood spots stratified risk for BPD, IVH, NEC, and ROP independent of gestational age and birthweight.
- Model outperformed other machine‑learning and clinical-variable models and was externally validated in 3,299 very preterm infants, reproducing metabolic risk subgroups.
2. Comparison of nebulized salbutamol and glucose-insulin for preventing acute hyperkalemia in liver transplantation: a randomized, double-blind trial.
In a randomized double‑blind trial of 100 liver transplant recipients with baseline K ≥4 mmol/L, prophylactic nebulized salbutamol reduced hyperkalemia incidence 30 seconds after reperfusion compared with glucose–insulin (36% vs 56%; P=0.045), produced greater potassium decreases, milder glycemic swings, and fewer postoperative atelectasis events without increasing postreperfusion syndrome.
Impact: Provides immediate, actionable intraoperative evidence to blunt a potentially lethal reperfusion potassium surge in liver transplantation and may change prophylactic practice where rapid potassium control is critical.
Clinical Implications: Nebulized salbutamol can be considered as first‑line prophylaxis against reperfusion hyperkalemia in liver transplantation, particularly when avoiding hyperglycemia is desired or insulin–glucose is contraindicated; multicenter validation and dosing/timing optimization are next steps.
Key Findings
- Hyperkalemia incidence at 30 s after reperfusion was lower with salbutamol vs glucose–insulin (36% vs 56%; P=0.045).
- Salbutamol produced a greater maximum serum potassium decrease, milder blood glucose fluctuations, and fewer postoperative atelectasis events without increasing postreperfusion syndrome.
3. Endothelial cell responses in sepsis are attenuated by targeting truncated procalcitonin.
Preclinical work demonstrates that neutralizing truncated procalcitonin reduced >50% of endothelial transcriptomic perturbations in sepsis models, preserved lung and intestinal barrier integrity, mitigated vasoplegia, preserved endothelial NO bioavailability, and improved organ‑level outcomes; mechanistically linked to decreased IL‑17 pathway signaling.
Impact: Identifies a druggable, endothelial‑centric mechanism linked to a clinically measured biomarker (procalcitonin), providing mechanistic and translational rationale for novel sepsis therapies aimed at vascular protection.
Clinical Implications: Supports development of anti‑procalcitonin strategies to preserve endothelial barrier function and reduce vasoplegia in septic shock; requires pharmacology, large‑animal safety, and early human trials to define target populations and windows for intervention.
Key Findings
- Anti‑procalcitonin antibodies reduced endothelial transcriptomic changes by >50% and preserved lung and intestinal barrier integrity in sepsis models.
- Neutralization mitigated vasoplegia, preserved endothelial NO bioavailability, improved organ integrity, and was mechanistically tied to reduced IL‑17 signaling.