A new perioperative cardiac guideline, and a TIVA choice that cut PONV

The edition in brief

Today's anaesthesiology edition opens on a reference update: the 2026 AHA/ACC multisociety guideline for perioperative cardiovascular management in noncardiac surgery, which supersedes the 2014 version and updates risk evaluation, perioperative pharmacology, monitoring and devices, warranting a review of local preoperative pathways. A small randomised trial in total knee replacement found liposomal bupivacaine in adductor canal and iPACK blocks gave slightly lower pain and less rescue analgesia than bupivacaine plus dexamethasone, though the pain difference was below what patients usually notice and the cost is far higher. A randomised trial in hip-fracture surgery found that giving an iliopsoas block the day before rather than an hour before did not reduce postoperative delirium (8.1% vs 12.8%), and a transient pain benefit did not survive correction for multiple comparisons. A clinic pearl restates liberal preoperative clear-fluid fasting. The practice-changer: in laparoscopic cholecystectomy under standard antiemetic prophylaxis, ciprofol-based total intravenous anaesthesia roughly halved 24-hour postoperative nausea and vomiting compared with remimazolam (31.5% vs 58.9%, relative risk 0.53), a reason to prefer it in nausea-prone patients where it is available.