Anaesthesiology
Intravenous dexamethasone ranked best for preventing rebound pain after a single-shot nerve block
A network meta-analysis of 24 trials favoured IV dexamethasone, with perineural adjuncts mainly delaying the rebound. Protocolised blood pressure targets in noncardiac surgery showed no consistent benefit over usual care, and lower oxygen delivery on bypass was linked to higher mortality.
Intranasal dexmedetomidine the night before joint replacement matched a pre-induction infusion for delirium
A 316-patient non-inferiority trial moved delirium prophylaxis to the ward the evening before; auricular vagal stimulation halved rebound pain after interscalene block; and chronic pain after caesarean shifted from function to mood across the first year.
Perioperative COX-2 inhibitors cut pain interference by a clinically meaningful margin
A meta-analysis of 38 trials backs selective COX-2 inhibitors in multimodal analgesia; a quarter of day-case patients still have function-limiting pain at a week; narrow pulse pressure flags AKI risk when the MAP looks fine; and intraoperative ketamine shows no long-term opioid-sparing signal after spine surgery.
A pre-induction crystalloid bolus does not prevent post-induction hypotension
A 504-patient blinded trial retires a common habit, pre-2023 data find no extra aspiration with GLP-1 receptor agonists, and the trials behind perioperative guidelines turn out to hinge on about four events.
Regional anaesthesia cuts chronic postsurgical pain by about a quarter; in real-world infant intubation, videolaryngoscopy did worse on first attempt
A network meta-analysis of 158 trials supports blocks to prevent chronic postsurgical pain, a Japanese registry finds videolaryngoscopy linked to lower first-pass success and more desaturation in neonates and infants, UK societies publish a day-surgery consensus, and meta-analyses revisit ventilation on bypass and hydroxyethyl starch in surgical patients.
An adductor canal catheter added nothing to a single shot with dexamethasone after knee replacement
A blinded TKA trial finds no 24–48 hour opioid saving from a 50-hour catheter; PUMA publishes extubation guidance built on 'at risk' assessment; antiemetic-dose steroids did not prevent pulmonary complications in the iPROVE trials; and femoral catheters did not beat adductor canal catheters after ACL repair.
1 in 71 patients on GLP-1 agonists regurgitated or aspirated under anaesthesia, against 1 in 802 not taking them — mostly at emergence
A UK national cohort of 47,039 anaesthetics puts a number on GLP-1 aspiration risk; drug allergy labels were associated with more complications; a caudal-versus-penile block trial and a dexamethasone-versus-ondansetron trial after caesarean; and a Class II dexmedetomidine recall.
Low end-tidal CO2 predicts death independently of blood pressure
In 185,455 non-cardiac anaesthetics, every 5 mmHg below the median carried 1.63 times the in-hospital mortality — after adjusting for hypotension and minute ventilation. Plus phenylephrine and the beach chair, and the esketamine dose that prolongs a paravertebral block without delaying wake-up.
Intravenous dexamethasone comes out first for rebound pain after a single-shot block
A network meta-analysis ranks eight prophylactic strategies and finds pre-emptive opioids probably worse than nothing; plus which postoperative complication carries most of the deaths in an African cohort, a fragile opioid-free signal in cardiac surgery, and where to put the electrodes.
Ear stimulation cut rebound pain after interscalene block from 43% to 20%
A sham-controlled trial finds a number needed to treat of four for a problem regional anaesthesia has never had an answer to. Also today: intravenous lidocaine works for fusion and not for decompression, esketamine moves day-one pulmonary complications and nothing after, and a national audit of paediatric teleconsultation finds the failures are all technical.
A normal MAP with a narrow pulse pressure is not a safe pressure
In 30,039 non-cardiac cases, a narrow pulse pressure raised the odds of postoperative AKI even when the MAP stayed above 65 — and the stroke volume index behind it was 27 against 47. Plus COX-2 inhibitors measured on function rather than a pain score, an autonomic phenotype you can pull from the record, and dexmedetomidine given the night before.
Esketamine cut the odds of postoperative delirium by 43%, on low-certainty evidence
Pooled randomised data in patients over 60, a negative trial of nociception-guided remifentanil in scoliosis surgery, erector spinae block beating intercostal block on pain but not on opioids, and a 29.3% rate of myocardial injury after thoracic surgery in patients with coronary disease.
A third of day-case surgery patients had poorly controlled pain in the first week, and a quarter were still limited by it at day 7
The UK POPPY study of recovery after day-case surgery closes the edition. Before it: a new consensus on day surgery, opioid-free esketamine–dexmedetomidine analgesia, the cost of intraoperative handovers, and remote ischaemic preconditioning.
A simple MAP alarm at 72 mmHg matched the Hypotension Prediction Index in a blinded trial
Two randomised trials suggest the proprietary index adds little over an earlier blood pressure trigger; international extubation guidelines make 'at-risk' assessment explicit; and propofol versus volatile makes no difference to survival after cancer surgery.
A dexmedetomidine recall, and the weight you should be dosing remimazolam against
Baxter's premixed dexmedetomidine bags are under a Class II recall for manufacturing deviations. Plus population pharmacokinetics that settle which body weight to use in class 2 and 3 obesity, and serum bupivacaine levels during chronic intrathecal infusion.
The capnograph is telling you something the arterial line is not
In 185,455 anaesthetics, low end-tidal carbon dioxide predicted in-hospital death independently of both hypotension and minute ventilation; underweight children desaturate and fail first-pass intubation; and a bolus phenylephrine regimen needed half the interventions of an infusion.
One patient in four carries a label that makes their surgery worse
Across 13,646 UK surgical patients, a drug allergy label came with a 25% complication rate against 20% - and roughly nine in ten of those labels are thought to be wrong. Plus dexamethasone against ondansetron after caesarean, caudal blocks and hypospadias fistulas, what actually kills after surgery in Africa, and a resuscitation order that quietly withholds a nerve block.
A pain desk day: intrathecal pumps, phantom limbs, and the ibuprofen question settled less than you would like
A 38,000-patient record study finds more phantom limb coding after nerve blocks and explains why that is probably not causal; intrathecal delivery takes 91% of advanced cancer patients off systemic opioids; and a paediatric meta-analysis declines to crown ibuprofen.
A rude surgeon doubled the odds of proceeding, and 21 mm is the number to remember
Six societies say the sterile gown is not mandatory for single-shot spinal; a crossover study shows incivility pushing residents to proceed with ambiguous cases; and a prospective airway study puts a figure on the mouth opening below which Macintosh videolaryngoscopy starts to fail.
Four in five adolescents on GLP-1 agonists had solid gastric contents after fasting 13 hours
A gastric ultrasound cohort finds standard fasting does not empty the stomach in this group; the obesity paradox for postoperative delirium turns out to depend entirely on comorbidity burden; and real-time ultrasound nearly doubles first-pass success at lower thoracic epidural puncture.
A normal MAP with a narrow pulse pressure is a low-flow state
Thirty thousand non-cardiac cases: pulse pressure under 40 mmHg raised postoperative kidney injury even when mean arterial pressure never dropped below 65, and stroke volume index in that group was 27 against 47. Plus COX-2 inhibitors measured on function rather than a pain score, and a new European guideline on anaesthetising inherited myopathies.
A third of day-case patients still hurt at a week, and the adductor canal catheter added nothing to a single injection
The POPPY study follows 7,331 UK day-case patients through the first postoperative week, an autonomic vulnerability phenotype identifiable before surgery predicts silent myocardial injury, and intravenous lidocaine helps in fusion but not in decompression.
Opioid-free cardiac anaesthesia scrapes a win, and it is a fragile one
A two-centre trial finds fewer complications without sufentanil, on a margin one patient wide. Elsewhere: 114 trials fail to convict hydroxyethyl starch of renal injury, remimazolam dosing in obesity gets its numbers, and the largest network so far puts regional anaesthesia behind chronic pain prevention.
New international extubation guidelines treat taking the tube out as a planned procedure
The Project for Universal Management of Airways has published guidelines framing every planned extubation as elective and deferrable, a network meta-analysis names intravenous dexamethasone the first-line drug for preventing rebound pain after nerve block, and an umbrella review supports propofol and rocuronium for caesarean general anaesthesia.
IV dexamethasone comes out on top for preventing rebound pain after nerve blocks
A network meta-analysis ranks intravenous dexamethasone first for stopping the rebound pain that follows a single-shot block, a Caesarean trial shows a quadratus lumborum block adds to intrathecal morphine, and perioperative duloxetine gives real but modest opioid-sparing after joint replacement.