Daily Anesthesiology Research Analysis
Analyzed 51 papers and selected 3 impactful papers.
Summary
Personalized ventilator strategies during minimally invasive surgery reduced postoperative pulmonary complications and driving pressure in a new meta-analysis. A mechanistic study identified the RNA-binding protein MBNL2 as a regulator of CCR2 mRNA stability, mitigating chemotherapy-induced neuropathic pain. A multinational cohort showed new-onset postoperative atrial fibrillation is common after cardiac surgery and associated with higher 1-year atrial fibrillation and mortality, with wide variation in antithrombotic management.
Research Themes
- Personalized intraoperative ventilation to minimize driving pressure
- RNA-binding protein regulation of neuroinflammation and neuropathic pain
- Perioperative atrial fibrillation incidence, management, and outcomes
Selected Articles
1. Individualised positive end-expiratory pressure to minimise driving pressure and postoperative pulmonary complications in minimally invasive thoracic and abdominal surgery a systematic review and meta-analysis.
Across 30 studies (n=3295), individualized PEEP strategies during minimally invasive thoracic and abdominal surgery were associated with fewer postoperative pulmonary complications (RR 0.67, 95% CI 0.56–0.79) and lower driving pressures compared with standard lung-protective ventilation. Benefits were observed despite heterogeneity in protocols, supporting PEEP titration to minimize driving pressure.
Impact: Provides the most comprehensive synthesis to date suggesting that individualized PEEP lowers postoperative pulmonary complications during minimally invasive surgery, directly informing intraoperative ventilation strategies.
Clinical Implications: Consider individualized PEEP titration (e.g., targeting minimal driving pressure) during minimally invasive surgery to reduce postoperative pulmonary complications, while monitoring hemodynamics and tailoring to patient factors.
Key Findings
- Individualized PEEP reduced postoperative pulmonary complications versus standard lung-protective ventilation (RR 0.67, 95% CI 0.56–0.79).
- Driving pressures were lower with individualized PEEP strategies.
- Findings were consistent across minimally invasive thoracic and abdominal procedures despite heterogeneous protocols.
Methodological Strengths
- Prospective PROSPERO registration (CRD42023495377).
- Comprehensive multi-database search (Medline, Central, LILACS, Embase, Scopus).
- Random-effects meta-analysis with prespecified and post hoc subgroup analyses and heterogeneity assessment.
Limitations
- Heterogeneity in individualized PEEP titration methods and patient populations.
- Observational components and non-uniform outcome definitions limit causal inference; further RCTs are needed.
Future Directions: Large, CONSORT-compliant RCTs comparing specific individualized PEEP algorithms versus standard care, with standardized outcome definitions and long-term respiratory endpoints.
BACKGROUND: Mechanical ventilation during minimally invasive surgery is associated with postoperative pulmonary complications. Limiting driving pressure appears to reduce pulmonary complications with lung-protective ventilation strategies. Whether individualising PEEP minimises driving pressure to reduce pulmonary complications is unknown. In this systematic review, we assessed whether individualised PEEP strategies during minimally invasive surgery reduce postoperative pulmonary outcomes and driving pressures or both. METHODS: We searched Medline, Central, LILACS, Embase, and Scopus for studies comparing individualised PEEP to lung-protective ventilation in minimally invasive thoracic and abdominal surgery (PROSPERO CRD42023495377). The primary outcome was postoperative pulmonary complication. Random-effects models generated risk ratios (RRs) with 95% confidence intervals (95% CIs) for binary outcomes. We conducted prespecified subgroup analyses by surgery type and post hoc subgroup analyses by individualised PEEP strategy and patient factors. We compared driving pressure differences between individualised PEEP and lung-protective strategies. Statistical heterogeneity was assessed using the I RESULTS: Thirty studies were included (n=3295 participants). Individualised PEEP was associated with reduced risk of postoperative pulmonary complications, compared with lung-protective ventilation (RR=0.67, 95% CI=0.56-0.79, I CONCLUSION: Individualised PEEP was associated with fewer postoperative pulmonary complications and lower driving pressures during minimally invasive surgery; showing causality requires further research.
2. RNA-binding protein MBNL2 mitigates neuropathic pain after chemotherapy through destabilizing CCR2 expression in primary sensory neurons.
Paclitaxel downregulates the RNA-binding protein MBNL2 in DRG neurons, increasing CCR2 expression by stabilizing Ccr2 mRNA via reduced 3′UTR binding. Restoring MBNL2 prevents CCR2 upregulation and attenuates multiple pain phenotypes, while MBNL2 knockdown induces CINP-like symptoms in naïve mice.
Impact: Reveals a previously unrecognized post-transcriptional mechanism linking an RNA-binding protein to chemokine receptor control in neuropathic pain, nominating the MBNL2–CCR2 axis as a therapeutic target.
Clinical Implications: Targeting MBNL2 function or CCR2 mRNA stability in primary sensory neurons could prevent or treat chemotherapy-induced neuropathic pain; CCR2 blockade or MBNL2 stabilizers merit translational exploration.
Key Findings
- Paclitaxel reduces MBNL2 in DRG neurons; restoring MBNL2 blocks CCR2 upregulation and alleviates mechanical, heat, cold, and ongoing pain.
- MBNL2 downregulation stabilizes Ccr2 mRNA by reducing MBNL2 binding to its 3′UTR, increasing CCR2 expression.
- MBNL2 and CCR2 are co-expressed in DRG neurons; knockdown of MBNL2 induces CINP-like behaviors in naïve mice.
Methodological Strengths
- In vivo behavioral assays covering multiple pain modalities (mechanical allodynia, heat/cold hyperalgesia, ongoing pain).
- Mechanistic dissection linking RNA–protein interaction at the 3′UTR to mRNA stability and receptor expression.
- Bidirectional manipulation (rescue and knockdown) of MBNL2 in DRG neurons demonstrating causality.
Limitations
- Preclinical mouse and cellular models limit direct clinical generalizability.
- Safety, delivery methods, and off-target effects of modulating MBNL2 in humans remain unknown.
Future Directions: Validate MBNL2–CCR2 regulation in human DRG samples from patients with CINP; develop small molecules or gene therapy approaches to modulate MBNL2–CCR2 signaling with safety profiling.
Chemotherapy drug-induced changes of gene expression in the dorsal root ganglion (DRG) are critical for the genesis of chemotherapy-induced neuropathic pain (CINP). However, the mechanisms driving these changes remain elusive. Here, we report the downregulation of muscleblind-like protein 2 (MBNL2), an RNA-binding protein, in the DRG neurons after intraperitoneal injection of paclitaxel. Rescuing this downregulation blocks an increase of the C-C chemokine receptor type 2 (CCR2) in the DRG and mitigates paclitaxel-induced mechanical allodynia, heat and cold hyperalgesia and ongoing pain. Conversely, DRG downregulation of MBNL2 increases the expression of CCR2 in the DRG neurons and leads to CINP-like symptoms in naïve mice. Mechanistically, paclitaxel-induced downregulation of MBNL2 reduces its binding to the 3'-untranslated region of Ccr2 mRNA, thereby enhancing the stability of Ccr2 mRNA in the DRG. Given that MBNL2 and CCR2 are co-expressed in DRG neurons, these findings suggest that MBNL2 alleviates CINP, likely by destabilizing CCR2 expression in the DRG, and may represent a promising therapeutic strategy for this condition.
3. New-onset postoperative atrial fibrillation management and outcomes: the VISION Cardiac Surgery cohort.
In a 12-country prospective cohort (n=12,234), 31.8% developed POAF within 30 days of cardiac surgery. At 1 year, clinical AF occurred in 6.9% with POAF versus 0.6% without (aHR 11.30), with higher all-cause mortality (aHR 1.54). Discharge antithrombotic and antiarrhythmic strategies varied widely.
Impact: Clarifies global POAF incidence, management patterns, and prognostic implications in a large prospective cohort, informing perioperative surveillance and antithrombotic decision-making.
Clinical Implications: Implement structured post-discharge rhythm surveillance and risk-stratified antithrombotic strategies in patients with POAF; standardize perioperative AF pathways (rate/rhythm control, anticoagulation) to reduce adverse outcomes.
Key Findings
- POAF occurred in 31.8% within 30 days after cardiac surgery in 12,234 patients.
- At 1 year, clinical AF was more frequent with POAF (6.9% vs 0.6%; aHR 11.30, 95% CI 8.17–15.70).
- All-cause mortality was higher with POAF (3.0% vs 1.7%; aHR 1.54, 95% CI 1.18–2.00); antithrombotic management at discharge was heterogeneous.
Methodological Strengths
- Large, international prospective cohort with standardized data collection across 12 countries.
- Multivariable adjustment for patient/operative characteristics and antithrombotic therapies.
Limitations
- Observational design limits causal inference despite adjustment.
- Heterogeneity in AF detection intensity and management strategies across centers.
Future Directions: Randomized strategies for standardized POAF management (rate vs rhythm control, anticoagulation thresholds) and remote rhythm monitoring to reduce recurrent AF and adverse outcomes.
BACKGROUND AND AIMS: New-onset atrial fibrillation (AF) is the most common complication of cardiac surgery. We aimed to describe the incidence of postoperative AF (POAF), its management, and its relationship to long-term outcomes in a prospective multi-centre cohort, as our current understanding comes primarily from registries and single-centre studies. METHODS: VISION Cardiac Surgery was a prospective cohort of adults who underwent cardiac surgery in 12 countries. The association of POAF with outcomes occurring between 30 days and 1 year postoperatively was estimated using a multivariable Cox model adjusted for patient and operative characteristics and for antithrombotic therapies. RESULTS: Among 12 234 patients (55.3% isolated coronary artery bypass grafting), 31.8% had POAF within 30 days of surgery. The proportion of participants with POAF who received anticoagulation alone at hospital discharge was 15.6%, 54.3% received antiplatelets alone, 23.9% received anticoagulation and antiplatelets, and 6.3% received neither; 48.8% were receiving amiodarone. At 1 year, clinical AF was detected in 6.9% of patients with POAF compared to 0.6% in those without [adjusted hazard ratio (aHR), 11.30; 95% confidence interval (CI) 8.17-15.70]. The primary composite outcome of stroke or vascular death occurred in 2.3% of patients with POAF and 1.5% in those without POAF (aHR 1.32; 95% CI 0.99-1.77). Patients with POAF had a higher risk of all-cause death (3.0% vs 1.7%; aHR 1.54; 95% CI 1.18-2.00). CONCLUSIONS: New-onset POAF occurs in a third of patients after cardiac surgery; its antithrombotic and antiarrhythmic management varies. Patients with POAF have increased risks of both clinical AF and of all-cause death in the year following surgery.