Precision Anesthesia: Opportunities for Personalized Perioperative Care

Archana Bharadwaj, MD, MPH, CHES

When the human genome was first sequenced, it cost over one billion dollars. With advances in technology over the past two decades, the cost has dropped to about $1,000. This has enabled greater insight into disease and provided an opportunity to revolutionize the practice of anesthesia. The panel, “Leveraging Multi-Omic Technologies for Precision Anesthesiology,” co-sponsored by the Early-Stage Anesthesiology Scholars (eSAS), on Friday, May 17, during the 2024 Annual Meeting, presented by IARS and SOCCA, focused on this cross-section of the human genome and the practice of anesthesia and proposed future avenues for this area of research.

This forward-looking session was moderated by Joseph Scarpa, MD, PhD, a CA3 and Van Pozanak Research Scholar at New York Presbyterian Hospital at Weill Cornell Medicine, and Saul Siller, MD, PhD, an anesthesiologist and current T32 fellow at Yale School of Medicine.

Opening the discussion, Miles Berger, MD, PhD, a neuroanesthesiologist and translational neuroscientist and associate professor of anesthesiology at Duke University School of Medicine, presented, “Why So Much Confusion? The ‘Omics’ of Perioperative Neurocognitive Disorders.” The CSF-to-plasma albumin ratio is a marker for the integrity of the blood-brain barrier, and there is a larger increase in this ratio in individuals that develop postoperative delirium. Individuals with lower baseline cognitive function experienced greater risk. Using liquid chromatology-mass spectrometry, complement factors were identified as the prominent proteins leaking into the CSF.

The next speaker, Brice Gaudilliere, MD, PhD, associate professor of anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine, discussed “Single-cell immune monitoring and predictive modeling of surgical outcomes.” Recovering after surgery is variable and unpredictable due to numerous factors including infection. Currently, the clinical metric for predicting the risk for surgical site infection is the ACS NSQIP. However, this test has limited utility with an area under the curve of approximately 0.7. Therefore, there is a need for more predictive biomarkers.

To accomplish this, single cell suspension and imaging mass cytometry were utilized. Through measuring the immune trajectory of patients before and after surgery, the project seeks to elucidate cell types and responses predictive of infection. To accomplish this, blood is collected from patients before surgery, it is exposed to simulations that mimic surgical stressors, preoperative immune states are characterized, and predictive biomarkers are analyzed. This process has led to the development of a diagnostic model, which is being actively tested, and has an AUC of approximately 0.9.

To round out the panel, Jochen D. Muehlschlegel, MD, MMSc, MBA, the professor and chair of the department of anesthesiology and critical care medicine at Johns Hopkins University, presented “Genomics and Transcriptomics in Cardiac Disease and Cardiovascular Surgery.” Atrial fibrillation is the most common outcome after cardiac surgery and increases the risk of stroke, heart failure, and mortality. Research has demonstrated that variants on the 4q25 region is associated with risk for atrial fibrillation. Through examining allele expression, SNPs contributing to atrial fibrillation have been identified.

Taken together, these projects represent opportunities to identify patients at elevated risk for negative perioperative outcomes and tailor anesthetic care accordingly.