Remimazolam TIVA was non-inferior to propofol for delirium after neurovascular surgery, with less hypotension

The edition in brief

In a single-centre double-blind trial of 686 adults having elective neurovascular surgery, remimazolam-based TIVA with flumazenil reversal was non-inferior to propofol for postoperative delirium within five days (12.8% vs 10.8%), with much less hypotension and more extubation in theatre (85.2% vs 67.3%); delirium was rarer than expected, which makes the 10-point margin generous. A multicentre paediatric trial stopped early found no clear difference in urethrocutaneous fistula after hypospadias repair between caudal and penile block, while caudal block reduced opioid use and early pain scores. Daily lung and venous ultrasound after major gastrointestinal surgery found signs of reduced fluid tolerance in 37% of 200 patients, mainly pulmonary congestion, associated with longer stay. In 360 older adults having bidirectional endoscopy, adjunctive oliceridine reduced extra sedative doses but increased hypotension by about 16 percentage points. A US survey of 1,725 anaesthesiologists found 94% had been involved in a perioperative catastrophe; 20% never fully recovered emotionally, and formal debriefing and time off were rarely offered.