This Week in Anesthesiology — Oct 26, 2026
Generated Oct 27, 2026 · 11:16
The week's practice-changing Anesthesiology research, summarized for clinicians.
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Effect of electrical impedance tomography-guided positive end-expiratory pressure optimisation on postoperative pulmonary complications in laparoscopic colorectal surgery: a randomised controlled trial.
In 117 high-risk laparoscopic colorectal patients, impedance tomography-guided PEEP cut thirty-day pulmonary complications from about 72 to 49 percent versus fixed PEEP of 5, in a single-centre trial.
British Journal of Anaesthesia · 2026 · PubMed
This week’s papers
- 01
Effect of electrical impedance tomography-guided positive end-expiratory pressure optimisation on postoperative pulmonary complications in laparoscopic colorectal surgery: a randomised controlled trial.
In 117 high-risk laparoscopic colorectal patients, impedance tomography-guided PEEP cut thirty-day pulmonary complications from about 72 to 49 percent versus fixed PEEP of 5, in a single-centre trial.
Wang TH et al. · British Journal of Anaesthesia · 2026
From the briefingIf you only have time for one paper this week, make it the electrical impedance tomography trial from Wang and colleagues in the British Journal of Anaesthesia [1]. It is one of the few individualised ventilation studies to show a meaningful reduction in clinically adjudicated pulmonary complications, reopening the question of whether personalised PEEP genuinely changes outcomes rather than just physiology.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 02
Intraoperative hypotension and postoperative acute kidney injury: Evidence and controversies.
Observational data consistently link intraoperative hypotension to kidney injury, but randomised trials of higher or individualised blood pressure targets have not shown kidney protection, so benefit remains unproven.
Zha YF et al. · Journal of Clinical Anesthesia · 2026
From the briefingA useful counterpoint comes from the Journal of Clinical Anesthesia, where Zha and colleagues review intraoperative hypotension and acute kidney injury [2]. Observational data show a consistent, roughly dose-dependent link between mean pressures below about 60 to 65 and postoperative kidney injury, especially in patients with limited renal reserve. Yet randomised trials of higher or individualised blood pressure targets have generally not shown kidney protection, and pooled analyses with trial sequential methods have not changed that. The authors conclude that avoiding severe, sustained hypotension remains reasonable, while a general kidney benefit from higher targets is not supported, and they label that conclusion provisional. Read together, these two papers illustrate how a strong physiological rationale sometimes translates into hard outcomes and sometimes does not.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 03
Frailty patterns in European surgical patients: The FRAGILE multicentre prospective cohort.
Across 1,472 European surgical patients, frailty affected roughly one in ten preoperatively, rose to one in five by 30 days, and more than doubled the odds of complications.
Aldecoa C et al. · European Journal of Anaesthesiology · 2026
From the briefingAldecoa and colleagues followed 1,472 patients across 64 centres in 10 countries in the FRAGILE cohort [3]. Depending on the tool, roughly one in ten to one in seven patients were frail before surgery, and about twelve percent of previously non-frail patients became frail within 30 days, pushing overall prevalence to about one in five. Preoperative frailty more than doubled the odds of complications and was associated with substantially higher thirty-day mortality and postoperative cognitive impairment, although the mortality estimate rests on few deaths and is imprecise.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 04
Postoperative delirium and 1-year functional decline, institutionalization and mortality.
In a 43-hospital Spanish cohort, early postoperative delirium was independently associated with worse one-year disability, higher institutionalisation, and one-year mortality near 17 percent versus 3 percent.
de la Varga-Martínez O et al. · European Journal of Anaesthesiology · 2026
From the briefingThe companion paper, from de la Varga-Martínez and colleagues, followed 2,442 surgical patients across 43 Spanish hospitals [4]. Delirium in the first 48 hours was independently associated with worse disability scores at one year, about two and a half times the odds of institutionalisation, and one-year mortality of roughly seventeen percent versus three percent in patients without delirium. Both are observational, so they establish association and prognosis rather than causation, and the delirium study lost a fair share of patients to follow-up, but together they reinforce frailty and delirium as markers with consequences well beyond discharge.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 05
Preoperative cognitive training for preventing perioperative neurocognitive disorders: A systematic review and meta-analysis with trial sequential analysis and meta-regression of randomised controlled trials.
Pooling 13 trials, preoperative cognitive training was associated with roughly halving postoperative delirium, but certainty was low and benefit for delayed neurocognitive recovery was not robust.
Gao Y et al. · Journal of Clinical Anesthesia · 2026
From the briefingIn the Journal of Clinical Anesthesia, Gao and colleagues pooled 13 randomised trials of preoperative cognitive training involving 1,446 patients [5]. Training was associated with roughly halving the risk of postoperative delirium, with traditional formats possibly outperforming digital ones, but the certainty was low, several trials carried high risk of bias, and trial sequential analysis warned of possible false positives. For delayed neurocognitive recovery, the apparent benefit did not survive sensitivity analyses. This is a promising signal, not an established intervention.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 06
Relative efficacy of exercise prehabilitation interventions and their components: a systematic review and network meta-analysis of randomised controlled trials.
Across 96 trials, combined aerobic, pulmonary and functional prehabilitation ranked best for fewer complications and about three days shorter stay, though no programme improved physical recovery.
McIsaac DI et al. · British Journal of Anaesthesia · 2026
From the briefingOn the physical side, McIsaac and colleagues in the British Journal of Anaesthesia performed a network meta-analysis of 96 randomised trials of exercise prehabilitation involving about 7,400 patients [6]. Combined aerobic, pulmonary and functional exercise ranked highest for reducing complications and shortened hospital stay by about three days, the latter with moderate certainty, while combined aerobic and strength training ranked best for quality of life. No exercise programme significantly improved physical recovery, and most of the evidence was low certainty. The authors suggest the benefit may be outcome-specific and that aerobic and pulmonary components look most promising, while calling for low risk of bias trials.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 07
Preoperative Intranasal Oxytocin and Probable Acute Stress Disorder After Traumatic Fracture Surgery: A Randomized Clinical Trial.
A single 40 unit preoperative intranasal oxytocin dose roughly halved probable acute stress disorder after traumatic fracture surgery, 16 versus 30 percent, without serious adverse events in one centre.
Huang Q et al. · JAMA Internal Medicine · 2026
From the briefingRounding out this theme, and from outside the anesthesia journals, JAMA Internal Medicine published a double-blind trial from Huang and colleagues testing a single 40 unit dose of intranasal oxytocin given ten minutes before induction in 328 adults having traumatic fracture surgery [7]. Screening-positive probable acute stress disorder within three days fell from about thirty percent with saline to about sixteen percent with oxytocin, roughly halving the risk, with no serious adverse events. This is a single-centre trial with a short follow-up and a screening questionnaire as its outcome, so whether this translates into less chronic post-traumatic stress is unknown, but it opens an intriguing perioperative window for psychological prevention.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 08
Liberal vs. conventional pre-operative clear fluid fasting policies in children: a systematic review and meta-analysis of randomised and non-randomised studies.
Among over 580,000 children, aspiration occurred in about 0.03 percent under both liberal and conventional clear fluid fasting, with no detectable difference, though evidence certainty was very low.
Nagase T et al. · Anaesthesia · 2026
From the briefingIn Anaesthesia, Nagase and colleagues pooled 33 studies involving more than 580,000 children to compare liberal clear fluid fasting of under two hours with conventional fasting of two hours or more [8]. Pulmonary aspiration was rare under both policies, at about three in ten thousand, with no detectable difference between them, and vomiting rates were similar. The authors rate the certainty as very low, reflecting largely non-randomised data, but the sheer scale offers reassurance to departments that have already adopted liberal policies.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 09
Comparative Analysis of Tracheal Intubation-Associated Cardiac Arrest in 2015-2023: A Report From the National Emergency Airway Registry for Children Multicenter Registry.
Intubation-associated cardiac arrest occurred in 1.2 percent of pediatric ICU intubations, rising with shock and each extra attempt, while video laryngoscopy and ketamine were associated with lower odds.
Padiyath A et al. · Critical Care Medicine · 2026
From the briefingIn Critical Care Medicine, Padiyath and colleagues analysed nearly 28,000 intubations in pediatric and cardiac intensive care units from the National Emergency Airway Registry for Children [9]. Cardiac arrest associated with intubation occurred in about one in eighty-five procedures. Shock roughly quadrupled to quintupled the odds, oxygenation failure before intubation more than doubled them, and each additional attempt raised the odds by about seventy percent. Ketamine, propofol, neuromuscular blockade and video laryngoscopy were each associated with lower odds, and only about an eighth of video laryngoscopy's apparent benefit was explained by fewer attempts. As registry data, these associations are vulnerable to confounding by clinician choice, yet they align with the broader push toward first-pass success and physiologically informed induction in critically ill children.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 10
Pain management after total shoulder arthroplasty: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations.
PROSPECT recommendations for shoulder arthroplasty support paracetamol, NSAIDs, dexamethasone and single-shot interscalene block with plain local anaesthetic, while evidence for catheters and liposomal bupivacaine was conflicting.
Mrazek I et al. · Anaesthesia · 2026
From the briefingFinally, also in Anaesthesia, Mrazek and colleagues deliver PROSPECT recommendations for total shoulder arthroplasty, built on 30 randomised trials and seven systematic reviews [10]. The evidence supports paracetamol, a non-steroidal anti-inflammatory drug continued postoperatively, intravenous dexamethasone at 8 to 10 milligrams, opioids for rescue, and a single-injection interscalene block with plain bupivacaine or ropivacaine, with local infiltration analgesia as a reasonable alternative. Evidence was conflicting for interscalene catheters and for liposomal bupivacaine, which the panel does not recommend, and no surgical technique stood out.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
The full briefing
This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.
Welcome to This Week in Anesthesiology. This week we're covering 10 notable papers spanning intraoperative lung and blood pressure management, the vulnerable older surgical patient and the brain, and pediatric airway safety alongside procedure-specific analgesia. Let's dive in.
We start in the operating room itself, with two papers that ask whether individualising physiological targets actually changes outcomes. In the British Journal of Anaesthesia, Wang and colleagues ran a single-centre randomised trial of 117 adults at intermediate to high risk of pulmonary complications undergoing laparoscopic colorectal surgery, a setting where pneumoperitoneum and steep Trendelenburg positioning drive atelectasis. Patients received either PEEP titrated with electrical impedance tomography, which visualises regional lung collapse, or a fixed PEEP of 5 centimetres of water. The tomography-guided group ran at a lower driving pressure, and the headline result was striking: thirty-day pulmonary complications occurred in about half of the guided patients versus nearly three quarters of the fixed-PEEP patients, roughly halving the hazard, with atelectasis and pneumonia both less frequent [1]. The caveats matter, though. This is one centre, a modest sample, and a comparator of 5 centimetres that many would regard as low for this surgery, so it remains unclear whether the benefit comes from the imaging or simply from higher, better-matched PEEP. The trial strengthens the case for individualised PEEP in this population, but it needs multicentre replication before it can be called settled. A useful counterpoint comes from the Journal of Clinical Anesthesia, where Zha and colleagues review intraoperative hypotension and acute kidney injury [2]. Observational data show a consistent, roughly dose-dependent link between mean pressures below about 60 to 65 and postoperative kidney injury, especially in patients with limited renal reserve. Yet randomised trials of higher or individualised blood pressure targets have generally not shown kidney protection, and pooled analyses with trial sequential methods have not changed that. The authors conclude that avoiding severe, sustained hypotension remains reasonable, while a general kidney benefit from higher targets is not supported, and they label that conclusion provisional. Read together, these two papers illustrate how a strong physiological rationale sometimes translates into hard outcomes and sometimes does not.
Our largest theme this week is the vulnerable surgical patient, with five papers on frailty, delirium, and what might be done before and during surgery to protect them. Two large European cohorts, both in the European Journal of Anaesthesiology, set the scene. Aldecoa and colleagues followed 1,472 patients across 64 centres in 10 countries in the FRAGILE cohort [3]. Depending on the tool, roughly one in ten to one in seven patients were frail before surgery, and about twelve percent of previously non-frail patients became frail within 30 days, pushing overall prevalence to about one in five. Preoperative frailty more than doubled the odds of complications and was associated with substantially higher thirty-day mortality and postoperative cognitive impairment, although the mortality estimate rests on few deaths and is imprecise. The companion paper, from de la Varga-Martínez and colleagues, followed 2,442 surgical patients across 43 Spanish hospitals [4]. Delirium in the first 48 hours was independently associated with worse disability scores at one year, about two and a half times the odds of institutionalisation, and one-year mortality of roughly seventeen percent versus three percent in patients without delirium. Both are observational, so they establish association and prognosis rather than causation, and the delirium study lost a fair share of patients to follow-up, but together they reinforce frailty and delirium as markers with consequences well beyond discharge.
The natural question is whether anything done before surgery helps. In the Journal of Clinical Anesthesia, Gao and colleagues pooled 13 randomised trials of preoperative cognitive training involving 1,446 patients [5]. Training was associated with roughly halving the risk of postoperative delirium, with traditional formats possibly outperforming digital ones, but the certainty was low, several trials carried high risk of bias, and trial sequential analysis warned of possible false positives. For delayed neurocognitive recovery, the apparent benefit did not survive sensitivity analyses. This is a promising signal, not an established intervention. On the physical side, McIsaac and colleagues in the British Journal of Anaesthesia performed a network meta-analysis of 96 randomised trials of exercise prehabilitation involving about 7,400 patients [6]. Combined aerobic, pulmonary and functional exercise ranked highest for reducing complications and shortened hospital stay by about three days, the latter with moderate certainty, while combined aerobic and strength training ranked best for quality of life. No exercise programme significantly improved physical recovery, and most of the evidence was low certainty. The authors suggest the benefit may be outcome-specific and that aerobic and pulmonary components look most promising, while calling for low risk of bias trials.
Rounding out this theme, and from outside the anesthesia journals, JAMA Internal Medicine published a double-blind trial from Huang and colleagues testing a single 40 unit dose of intranasal oxytocin given ten minutes before induction in 328 adults having traumatic fracture surgery [7]. Screening-positive probable acute stress disorder within three days fell from about thirty percent with saline to about sixteen percent with oxytocin, roughly halving the risk, with no serious adverse events. This is a single-centre trial with a short follow-up and a screening questionnaire as its outcome, so whether this translates into less chronic post-traumatic stress is unknown, but it opens an intriguing perioperative window for psychological prevention.
Our final theme turns to children and to analgesia. In Anaesthesia, Nagase and colleagues pooled 33 studies involving more than 580,000 children to compare liberal clear fluid fasting of under two hours with conventional fasting of two hours or more [8]. Pulmonary aspiration was rare under both policies, at about three in ten thousand, with no detectable difference between them, and vomiting rates were similar. The authors rate the certainty as very low, reflecting largely non-randomised data, but the sheer scale offers reassurance to departments that have already adopted liberal policies. In Critical Care Medicine, Padiyath and colleagues analysed nearly 28,000 intubations in pediatric and cardiac intensive care units from the National Emergency Airway Registry for Children [9]. Cardiac arrest associated with intubation occurred in about one in eighty-five procedures. Shock roughly quadrupled to quintupled the odds, oxygenation failure before intubation more than doubled them, and each additional attempt raised the odds by about seventy percent. Ketamine, propofol, neuromuscular blockade and video laryngoscopy were each associated with lower odds, and only about an eighth of video laryngoscopy's apparent benefit was explained by fewer attempts. As registry data, these associations are vulnerable to confounding by clinician choice, yet they align with the broader push toward first-pass success and physiologically informed induction in critically ill children.
Finally, also in Anaesthesia, Mrazek and colleagues deliver PROSPECT recommendations for total shoulder arthroplasty, built on 30 randomised trials and seven systematic reviews [10]. The evidence supports paracetamol, a non-steroidal anti-inflammatory drug continued postoperatively, intravenous dexamethasone at 8 to 10 milligrams, opioids for rescue, and a single-injection interscalene block with plain bupivacaine or ropivacaine, with local infiltration analgesia as a reasonable alternative. Evidence was conflicting for interscalene catheters and for liposomal bupivacaine, which the panel does not recommend, and no surgical technique stood out.
If you only have time for one paper this week, make it the electrical impedance tomography trial from Wang and colleagues in the British Journal of Anaesthesia [1]. It is one of the few individualised ventilation studies to show a meaningful reduction in clinically adjudicated pulmonary complications, reopening the question of whether personalised PEEP genuinely changes outcomes rather than just physiology.
Here is what this week's evidence adds up to in Anesthesiology. First, individualised PEEP guided by impedance tomography lowered pulmonary complications in high-risk laparoscopic colorectal patients, but a single small trial against a low fixed PEEP cannot yet settle whether the imaging itself is the active ingredient. Second, the case for higher or individualised blood pressure targets to protect the kidney remains unproven in randomised trials, even as avoiding severe hypotension stays reasonable. Third, frailty and early postoperative delirium are now firmly linked to complications, institutionalisation and death up to a year out, while preventive strategies such as cognitive training and exercise prehabilitation show encouraging but mostly low-certainty signals. Fourth, pooled data from over half a million children suggest liberal clear fluid fasting carries no detectable excess aspiration risk, though the certainty is very low. And fifth, registry data tie multiple intubation attempts and shock to cardiac arrest in critically ill children, with video laryngoscopy and certain induction agents associated with lower risk, findings that are observational and await prospective confirmation.
That's your roundup for This Week in Anesthesiology. The full transcript and references are available on the episode page. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.
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