This Week in Anesthesiology — May 14, 2026

Welcome to This Week in Anesthesiology. This week we're covering 8 notable papers spanning perioperative patient optimization, anesthesia technology and systems, and future directions in research and practice. Let's dive in.

Perioperative Patient Optimization Our first theme focuses on refining care for specific patient populations to improve safety and outcomes. Two papers from the Journal of Clinical Anesthesia tackle common preoperative challenges, while a systematic review in the British Journal of Anaesthesia refines our approach to a rare but important genetic condition.

First, for the growing population of patients with obstructive sleep apnea, or OSA, undergoing outpatient surgery, a study in the Journal of Clinical Anesthesia investigated the value of preoperative CPAP therapy [2]. Using a large United States insurance database, researchers looked at over 120,000 patients undergoing outpatient total hip or knee arthroplasty. They compared three groups: patients without OSA, patients with OSA who were on home CPAP before surgery, and patients with OSA who were not on CPAP. The primary outcome was an emergency department visit within 1 or 7 days postoperatively. The results were clear: patients with untreated OSA had significantly higher odds of visiting the ED within 7 days—about a 25% increase compared to patients without OSA. However, for patients with OSA who were already using CPAP at home, their risk of an ED visit was no different from patients without OSA. This suggests that preoperative CPAP therapy effectively mitigates the increased postoperative risk associated with OSA in this setting, reinforcing the importance of screening and treatment adherence.

Also in the Journal of Clinical Anesthesia, another study addresses the age-old question of fasting times, this time in the context of bowel preparation for endoscopy [4]. The conflict between ensuring an empty stomach to prevent aspiration and achieving a good bowel prep can lead to prolonged and uncomfortable fasting. Investigators used gastric ultrasound to dynamically track gastric emptying in 150 healthy ASA I and II patients after they completed a standard polyethylene glycol, or PEG, solution. The primary goal was to see how long it took for the antral cross-sectional area to fall below 340 square millimeters, a marker for a low-risk, 'empty' stomach. They found that gastric emptying was relatively rapid. By the 2-hour mark, nearly 70% of patients had reached this safety endpoint. This rose to 90% at 3 hours, and 100% by 4 hours. The study did identify diabetes as a significant predictor for delayed emptying. These findings support the feasibility of a two-hour fasting window after PEG prep for many healthy patients, but underscore the value of bedside gastric ultrasound as a tool for individualized risk assessment, especially for those with conditions like diabetes.

Rounding out this theme, a systematic review in the British Journal of Anaesthesia provides an update on butyrylcholinesterase, or BChE, deficiency, the genetic condition that can cause prolonged paralysis after suxamethonium [9]. Traditional diagnosis relies on biochemical phenotyping with dibucaine and fluoride inhibition numbers. However, the authors found that this method can be insensitive, particularly for heterozygous carriers. After reviewing 30 studies that included both genotype and phenotype data, they found that 72% of patients with a so-called 'normal' biochemical phenotype actually carried at least one BCHE variant. The review concludes that genetic testing provides critical information that phenotyping alone cannot, especially in patients who may carry multiple different variants. While the data was too varied to create a single standardized algorithm, the authors propose an assessment framework that integrates both genotyping and phenotyping to improve diagnostic accuracy, risk stratification for patients, and genetic counseling for families.

Anesthesia Technology and Systems Next, we turn to the tools and systems we rely on daily in the operating room. This week, we have a deep dive into pediatric ventilation from Anesthesiology and a look at resource management from Anesthesia and Analgesia.

In a detailed bench study published in Anesthesiology, researchers investigated the precision of six modern anesthesia workstations for pediatric ventilation [7]. The demands on ventilators are highest when caring for the smallest patients. The team created physical models simulating the lungs of a preterm baby, a neonate, an infant, and a toddler. They tested both volume-controlled and pressure-controlled ventilation, with and without an airway leak. The key finding was a clear advantage for pressure-controlled ventilation, or PCV. During volume-controlled ventilation, especially in the preterm baby model, the delivered tidal volume could deviate from the set value by as much as 35%. In contrast, during PCV, the delivered peak and end-expiratory pressures were highly accurate across all devices and lung models. Furthermore, PCV provided better compensation for airway leaks. The authors conclude that for preterm babies and neonates, PCV offers superior precision and reliability, independent of the specific ventilator technology used.

From the micro-level of ventilator breaths to the macro-level of hospital systems, a retrospective study in Anesthesia and Analgesia examines the impact of an IV fluid conservation strategy implemented during a national shortage [5]. Following a hurricane-induced shortage in 2024, one institution implemented a strategy to reduce intravenous fluid use. The results were striking. The median volume of fluid delivered per case was more than halved, dropping from over 1900 mL to about 860 mL. This led to significant weekly cost savings of over $6,700 and a reduction in weekly plastic waste of 77 kilograms. Most importantly, this was achieved with no change in the incidence of provider-reported major adverse intraoperative cardiovascular events or case cancellations. While the authors caution that further research on patient outcomes is needed before such a strategy is widely adopted, the study demonstrates that mindful resource management can dramatically reduce costs and environmental impact without apparent harm to patient safety.

Future Directions in Research and Practice Finally, we look ahead at the evolving landscape of our specialty, from new research methods to foundational science.

A special article in Anesthesiology describes the mission of the American Society of Anesthesiologists' new Center for Perioperative Medicine [3]. Moving beyond the 'why' of perioperative medicine, the Center aims to focus on the 'how'. It serves as an organizational framework to actively implement perioperative medicine through rigorous, inclusive collaboration. By bringing together anesthesiologists, surgeons, hospitalists, and other specialists from national and global perspectives, the Center seeks to advance the field across clinical, educational, research, and leadership domains. This piece summarizes key themes from recent stakeholder summits, highlighting a collective effort to define the practice of perioperative medicine worldwide.

To help us evaluate complex perioperative interventions, a paper in the BMJ introduces a powerful statistical method called component network meta-analysis, or CNMA [1]. Many of our interventions, like ERAS protocols, are complex bundles of different components. A standard meta-analysis can tell you if the bundle works, but not which parts are most effective. CNMA is a set of methods designed to estimate the individual effects of each component, and even to see if they interact with each other. The authors provide practical guidance and acknowledge that implementing CNMA is complex, requiring a multidisciplinary team. However, it represents a major step forward in our ability to generate more clinically meaningful evidence from systematic reviews.

And finally, a basic science paper in Science Translational Medicine provides a fascinating look at the role of the nervous system in tendinopathy [8]. While we often think of nerves as just transmitting pain signals from an injured tendon, this study suggests they play a protective role. Using several mouse models, researchers found that sensory nerves grow into the tendon and interact with local cells. When this innervation was disrupted, tendinopathic changes got worse. Digging deeper with single-cell RNA sequencing, they identified a key signaling molecule: neuron-derived fibroblast growth factor 1, or FGF1. This factor appeared to prevent tendon degeneration. Consistent with this, analysis of human tendinopathy specimens also showed FGF1 associated with nerve fibers in the tendon. This work uncovers a protective function for sensory nerves and suggests that targeting the FGF1 pathway could one day offer a therapeutic strategy to prevent tendinopathy.

Editor's Pick If you only have time for one paper this week, make it the study on anesthesia workstation performance in pediatric ventilation from Anesthesiology [7]. It provides a clear, evidence-based reason to favor pressure-controlled over volume-controlled ventilation in neonates and preterm infants, a simple switch that could improve ventilation precision for our smallest patients.

Clinical Bottom Line Here are the key takeaways from this week in Anesthesiology:

First, for outpatient joint arthroplasty, preoperative CPAP therapy in patients with OSA appears to mitigate the increased risk of early postoperative emergency department visits, bringing their risk profile in line with patients without OSA.

Second, for healthy ASA I and II patients undergoing bowel prep for endoscopy, a two-hour fasting window may be feasible. However, bedside gastric ultrasound is a valuable tool for individual risk assessment, especially in patients with risk factors for delayed emptying like diabetes.

Third, in pediatric anesthesia, pressure-controlled ventilation demonstrates superior precision and better leak compensation compared to volume-controlled ventilation on modern workstations, particularly for preterm babies and neonates.

Fourth, when investigating suspected butyrylcholinesterase deficiency, genetic testing provides more comprehensive information than traditional biochemical phenotyping alone and should be integrated into the diagnostic framework to improve accuracy.

And finally, a system-wide IV fluid conservation strategy, implemented during a shortage, can successfully reduce usage, costs, and waste without an observed increase in major intraoperative adverse events.

That's your roundup for This Week in Anesthesiology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.