Daily Anesthesiology Research Analysis
Analyzed 66 papers and selected 3 impactful papers.
Summary
A multicenter randomized non-inferiority trial found magnetic seizure therapy achieves depression remission non-inferior to right unilateral ultra-brief ECT with markedly fewer cognitive adverse effects. In perioperative care, a programmed intermittent adductor hiatus block improved early function and posterior knee analgesia after total knee arthroplasty without quadriceps weakness, while preoperative intranasal long-acting insulin reduced postoperative delirium after esophagectomy, linked to downregulation of the NLRP3/caspase-1/IL-1β pathway.
Research Themes
- Convulsive therapies with improved cognitive safety
- Motor-sparing regional anesthesia optimization
- Perioperative neuroprotection and delirium prevention
Selected Articles
1. Confirmatory efficacy and safety trial of magnetic seizure therapy versus right unilateral ultra-brief electroconvulsive therapy in depression (CREST-MST): a randomised, double-blind, non-inferiority trial in Canada and the USA.
In a multicenter, randomized, double-blind non-inferiority trial, MST achieved depression remission rates non-inferior to RUL-UB ECT (difference 5.3% favoring ECT; non-inferiority met) while causing substantially fewer autobiographical memory deficits (2.7% vs 17.3%). More ECT recipients discontinued due to non-serious adverse events, supporting MST’s favorable risk–benefit profile.
Impact: This high-quality RCT provides definitive evidence that MST can be considered a first-line convulsive therapy with superior cognitive safety, potentially reshaping clinical practice and anesthesia workflows for convulsive treatments.
Clinical Implications: MST can be offered as an alternative to RUL-UB ECT, especially for patients prioritizing cognitive preservation or those refusing ECT, with anesthesia teams anticipating similar convulsive therapy workflows but reduced cognitive risks.
Key Findings
- MST remission rates were non-inferior to RUL-UB ECT (difference 5.3% favoring ECT; non-inferiority achieved, p=0.048).
- Autobiographical memory worsening was markedly lower with MST (2.7%) than with ECT (17.3%).
- Treatment discontinuations due to non-serious adverse events were more common with ECT (12 vs 3 in MST).
Methodological Strengths
- Multicenter, randomized, double-blind, non-inferiority design with prespecified margins and clinical trial registration
- Coprimary outcomes capturing both efficacy and cognitive safety with validated instruments
Limitations
- Enrollment ended before planned sample size; generalizability limited by predominantly White population
- Short-term outcomes during acute treatment phase; longer-term relapse and cognitive trajectories not reported
Future Directions: Head-to-head cost-effectiveness studies, longer-term cognitive and functional outcomes, and implementation studies to integrate MST into clinical pathways.
BACKGROUND: Magnetic seizure therapy (MST) is an innovative convulsive therapy that is clinically beneficial for patients with depression and has fewer cognitive adverse effects. This trial aimed to confirm the efficacy, tolerability, and cognitive safety of MST compared with right unilateral ultra-brief pulse-width (RUL-UB) electroconvulsive therapy (ECT). METHODS: This multisite randomised, double-blind, parallel-group, non-inferiority trial was conducted at three academic centres across Canada and the USA. Participants aged 18 years and older with major depressive diso
2. Programmed intermittent adductor hiatus block enhances early recovery after total knee arthroplasty: a randomized controlled trial.
Compared with continuous adductor canal or hiatus blocks, programmed intermittent adductor hiatus block (PIAHB) improved active knee flexion on postoperative days 1–3 and shortened TUG times on days 1–2 after TKA, with better posterior knee analgesia, fewer rescue analgesic needs, and lower ropivacaine consumption, without quadriceps weakness or increased complications.
Impact: This RCT refines motor-sparing analgesia for TKA by targeting posterior knee pain while preserving quadriceps strength, enabling earlier mobilization and potentially enhancing ERAS pathways.
Clinical Implications: Consider PIAHB to enhance early rehabilitation and posterior knee analgesia after TKA while reducing local anesthetic consumption; integrate into multimodal, motor-sparing ERAS protocols.
Key Findings
- PIAHB increased active knee flexion versus CAHB and CACB on POD1–3 (all p<0.001).
- TUG times were shorter with PIAHB on POD1–2 (p<0.001), with no difference by POD3.
- Posterior knee VAS (rest and 30° flexion) was lower with PIAHB (p=0.004 and p<0.001).
- Rescue analgesia within 72 h was reduced and ropivacaine consumption was lower with PIAHB (p=0.030; p<0.001).
- No differences in quadriceps strength, complications, or 6-month HSS scores.
Methodological Strengths
- Prospective, randomized, three-arm design with trial registration and ethics approval
- Objective functional endpoints (active ROM, TUG) and pain localization (anterior vs posterior)
Limitations
- Single-center study with moderate sample size; potential lack of blinding to infusion pattern
- Short-term primary outcomes; no difference detected in long-term functional scores (6-month HSS)
Future Directions: Multicenter trials to validate generalizability, dose-optimization studies for intermittent regimens, and cost-effectiveness analyses within ERAS pathways.
BACKGROUND: Multimodal analgesia based on ultrasound-guided regional block is widely used after total knee arthroplasty (TKA). The goal of this study was to investigate the analgesic efficiency and knee motor function of programmed intermittent infusion combined with adductor hiatus block in total knee arthroplasty. METHODS: This prospective randomized controlled trial was approved by the Medical Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (ethical approval number: 2024-302-01) and was reg
3. Effects of intranasal long-acting insulin pretreatment on postoperative delirium and the NLRP3/caspase-1/IL-1β pathway in older patients with esophageal cancer.
Preoperative intranasal long-acting insulin reduced POD after esophagectomy (16.7% vs 46.7%; P=0.012) and blunted postoperative increases in IL-1β, with lower NLRP3 and caspase-1 mRNA expression versus control. The intervention weakened correlations between early inflammatory surges and POD, suggesting sustained neuroprotection during the critical postoperative window.
Impact: This randomized clinical study introduces a feasible, low-burden preconditioning strategy with mechanistic links to inflammasome suppression, addressing a major geriatric perioperative complication.
Clinical Implications: Intranasal long-acting insulin may be considered as a perioperative neuroprotective adjunct in high-risk older patients, with glucose monitoring and larger multicenter trials needed before routine adoption.
Key Findings
- POD incidence was reduced with long-acting intranasal insulin vs control (16.7% vs 46.7%; P=0.012).
- Postoperative IL-1β increases were suppressed in the insulin group (P<0.05).
- NLRP3 and caspase-1 mRNA expression were lower postoperatively with insulin (P<0.05).
- Inflammatory marker surges on POD1 correlated with POD in controls but not in the insulin group.
Methodological Strengths
- Randomized controlled design with standardized delirium assessments (CAM-ICU) on POD1–3
- Integration of mechanistic biomarkers (NLRP3/caspase-1/IL-1β) linked to clinical outcomes
Limitations
- Single-center, small sample size limits generalizability; short follow-up restricted to first 3 postoperative days
- Peripheral biomarkers may not fully reflect central neuroinflammatory dynamics; blinding details not fully specified
Future Directions: Multicenter RCTs evaluating dosing, timing, safety (glycemic effects), and efficacy across diverse surgeries; CSF biomarker and neuroimaging studies to confirm central mechanisms.
BACKGROUND: Insulin exhibits neuroprotective and anti-inflammatory properties. Preoperative intranasal insulin preconditioning is a potential strategy to prevent postoperative delirium (POD), but prior studies mainly used rapid-acting formulations. This investigation focused on intranasal long-acting insulin, which ensures sustained central nervous system exposure, in elderly patients undergoing radical esophagectomy. We assessed its impact on POD incidence and the NLRP3/caspase-1/IL-1β pathway. METHODS: Sixty older patients schedu