The edition · Anaesthesiology
For postoperative pneumonia, the blood pressure that matters is relative to baseline
Plus a motor-sparing alternative to the interscalene block, less nausea with remimazolam, and a real-world check on videolaryngoscopy in infants.
The edition in brief
Today's anaesthesiology edition leads on intra-operative blood pressure. In 151,036 non-cardiac surgery patients, postoperative pneumonia was linked to hypotension defined as a relative fall from the patient's own baseline, not to fixed absolute mean-arterial-pressure thresholds, which lost their association after adjustment — supporting individualised blood-pressure targets. A randomised trial found the superior trunk block matches the interscalene block for shoulder-arthroscopy analgesia while sparing upper-limb motor function, fitting enhanced-recovery goals and the wish to avoid dense motor and phrenic blockade. Another randomised trial found remimazolam-based maintenance roughly halved postoperative nausea and vomiting versus sevoflurane in high-risk gynaecological surgery, though the trial was small and single-centre. A pearl reaffirms pre-oxygenation and apnoeic oxygenation before induction. The practice-changer is a 3,250-encounter neonatal and infant airway registry: videolaryngoscopy gave a better glottic view yet was associated with lower first-attempt intubation success and more desaturation than direct laryngoscopy, an efficacy-effectiveness gap that argues for structured training rather than assuming the device alone improves outcomes.
Relative, not absolute, intra-operative hypotension tracked postoperative pneumonia
Judge intra-operative hypotension against the patient's own baseline — a ≥20% fall tracked postoperative pneumonia better than any fixed absolute threshold.
Superior trunk block matched the interscalene block but spared motor function
The superior trunk block gives shoulder-arthroscopy analgesia comparable to the interscalene block while sparing arm motor function — a reasonable motor-sparing alternative.
Remimazolam maintenance roughly halved nausea versus sevoflurane
In high-risk gynaecological surgery, remimazolam maintenance roughly halved postoperative nausea versus sevoflurane — a reasonable option alongside antiemetic prophylaxis.
Pre-oxygenate every patient, and add apnoeic oxygenation when desaturation is likely
Pre-oxygenate everyone and add apnoeic oxygenation in fast-desaturators to widen the safe apnoea window before intubation.
In real-world infant intubation, videolaryngoscopy did not raise first-attempt success
Do not assume videolaryngoscopy improves infant first-attempt intubation on its own — it needs structured training, and direct laryngoscopy skills must stay sharp.
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