Monthly ReportMar 1–31, 2025
Anesthesiology, March 2025 edition
We read 84 papers and selected 5.
Summary
March 2025 anesthesiology research showed a strong shift toward evidence-based perioperative risk reduction, with major advances in cardiac surgery transfusion, perfusion, delirium prevention, and anesthetic technique selection. The month’s most practice-changing evidence included a multicenter randomized trial supporting prothrombin complex concentrate over frozen plasma, and randomized-trial evidence favoring minimally invasive extracorporeal circulation in cardiac surgery. Neuroanesthesia and pain research expanded mechanistic understanding through Piezo2-mediated vascular mechanosensation and demonstrated clinically relevant reductions in postoperative delirium with gastrodin. Additional trends included precision PK/PD-guided sedation, AI-supported ICU prognostication, environmentally sustainable anesthesia, and individualized physiologic monitoring. Scores were normalized to a common 0–100 scale and adjusted for recency using week weights of 1.05, 1.10, 1.15, and 1.20 for weeks 1–4, respectively.
Selected Articles
1. Prothrombin Complex Concentrate vs Frozen Plasma for Coagulopathic Bleeding in Cardiac Surgery: The FARES-II Multicenter Randomized Clinical Trial.
In this pragmatic multicenter randomized trial of approximately 528 analyzed patients, 4-factor PCC was superior to frozen plasma for hemostatic effectiveness during coagulopathic bleeding in cardiac surgery. PCC also reduced allogeneic transfusion exposure and serious adverse events, including postoperative acute kidney injury through day 30.
Impact: This is high-level randomized evidence with immediate implications for cardiac surgical blood-management algorithms and factor-replacement strategies.
Clinical Implications: Cardiac surgery programs should evaluate PCC-first protocols for selected coagulopathic bleeding, while incorporating thrombosis surveillance, laboratory or viscoelastic-guided dosing, and institutional governance.
Key Findings
- Hemostatic effectiveness was higher with PCC than frozen plasma: 77.9% versus 60.4%.
- PCC reduced allogeneic transfusion requirements.
- Serious adverse events, including postoperative acute kidney injury, were lower with PCC through day 30.
2. Vascular motion in the dorsal root ganglion sensed by Piezo2 in sensory neurons triggers episodic pain.
This mechanistic preclinical study showed that dynamic microvascular motion within injured dorsal root ganglia triggers episodic spontaneous neuropathic pain through Piezo2 mechanotransduction in sensory neurons. Angiogenesis and pericyte alterations amplified clustered neuronal firing, while anti-VEGF or Piezo2-targeting approaches reduced pain behaviors in mice.
Impact: The study introduces a paradigm-shifting vascular-neural mechanism and identifies Piezo2 and angiogenic signaling as potentially actionable targets for refractory neuropathic pain.
Clinical Implications: Peripherally restricted Piezo2 modulators or vascular-targeted therapies could become future approaches for spontaneous neuropathic pain, but human tissue validation and early-phase clinical studies are required before clinical translation.
Key Findings
- Microvascular motion in injured dorsal root ganglia triggered spontaneous pain and clustered neuronal firing.
- Piezo2 in sensory neurons was necessary for sensing vascular motion.
- Anti-VEGF or Piezo2-targeted interventions suppressed angiogenesis-linked pain amplification in mouse models.
3. Minimal invasive extracorporeal circulation versus conventional cardiopulmonary bypass in cardiac surgery: a contemporary systematic review and meta-analysis.
A contemporary meta-analysis of 36 randomized trials involving approximately 4,849 patients found that minimally invasive extracorporeal circulation was associated with lower mortality, fewer myocardial infarctions and cerebrovascular events, less transfusion and bleeding, and shorter ventilation, ICU, and hospital stays than conventional cardiopulmonary bypass.
Impact: The analysis synthesizes randomized evidence suggesting that perfusion-system design can influence hard outcomes, not merely surrogate laboratory or transfusion endpoints.
Clinical Implications: Cardiac anesthesia and perfusion teams should assess whether MiECC can be safely implemented locally, with standardized anticoagulation, priming, monitoring, rescue, and staff-training protocols.
Key Findings
- MiECC was associated with lower mortality than conventional cardiopulmonary bypass: odds ratio 0.66.
- Myocardial infarction, cerebrovascular events, transfusion, and re-exploration for bleeding were reduced.
- Ventilation, ICU, and hospital durations were shorter with MiECC.
4. Efficacy and safety of gastrodin in preventing postoperative delirium following cardiac surgery: a randomized placebo controlled clinical trial.
In a double-blind randomized trial of 155 patients undergoing CABG with or without valve surgery, gastrodin reduced postoperative delirium from 35.9% to 19.5% through postoperative day 6. The intervention was associated with a higher likelihood of hospital discharge and no apparent drug-related safety signal.
Impact: This is a clinically actionable randomized trial addressing a frequent and consequential complication for which effective pharmacologic prevention remains limited.
Clinical Implications: Gastrodin may be considered a candidate for multimodal delirium-prevention bundles in cardiac surgery, but replication in larger, diverse populations and evaluation against standard nonpharmacologic bundles are required.
Key Findings
- Postoperative delirium decreased from 35.9% with placebo to 19.5% with gastrodin.
- The relative risk was 0.54, with a statistically significant between-group difference.
- No drug-related adverse events were reported, and hospital discharge was more likely with gastrodin.
5. Safety and recovery profile of patients after inhalational anaesthesia versus target-controlled or manual total intravenous anaesthesia: a systematic review and meta-analysis of randomised controlled trials.
This meta-analysis of 385 randomized trials found no difference in serious intraoperative adverse events between TIVA and inhalational anesthesia. TIVA reduced postoperative nausea and vomiting and emergence agitation, whereas inhalational anesthesia was associated with faster recovery and lower costs. The findings support individualized anesthetic selection rather than universal preference for one technique.
Impact: The large evidence base clarifies clinically important trade-offs between TIVA and inhalational anesthesia and provides a framework for patient-centered anesthetic selection.
Clinical Implications: TIVA may be preferred for patients at high risk of PONV or emergence agitation, while inhalational anesthesia remains reasonable when rapid recovery, cost, or local workflow is prioritized. Technique choice should account for patient risk, surgical context, and institutional capabilities.
Key Findings
- Serious intraoperative adverse events did not differ between TIVA and inhalational anesthesia.
- TIVA reduced postoperative nausea and vomiting and emergence agitation.
- Inhalational anesthesia was associated with faster recovery and lower costs.