This Week in Anesthesiology — Jun 14, 2026

Welcome to This Week in Anesthesiology. This week we're covering 10 notable papers spanning critical care controversies, long-term postoperative outcomes, and new approaches to anesthetic management. Let's dive in.

We begin in the intensive care unit, where several major trials challenge proposed or long-standing interventions. First, in a study published in JAMA, the VICTORY randomized clinical trial investigated the use of high-dose intravenous vitamin C for patients with severe burn injuries [8]. This large, multicenter trial across 24 burn centers was stopped early for futility and potential harm. The primary composite outcome of 28-day mortality and persistent organ dysfunction occurred in about 41% of patients receiving vitamin C versus 30% in the placebo group. While this difference did not reach statistical significance, it crossed the prespecified boundary for harm. More concerning, 28-day mortality was significantly higher in the vitamin C group, at 15% versus 7.6% in the placebo group, representing a nearly two-fold increase in the adjusted risk of death. The authors conclude that among patients with severe burn injury, high-dose intravenous vitamin C does not reduce mortality or organ dysfunction and may be harmful. Also in JAMA, a Danish randomized trial addressed the common practice of administering sodium bicarbonate during in-hospital cardiac arrest [4]. In this double-blind, placebo-controlled study of nearly 800 patients, there was no significant difference in the primary outcome of sustained return of spontaneous circulation, which occurred in 39% of the bicarbonate group and 37% of the placebo group. Furthermore, there were no significant differences in 30-day survival or favorable neurologic outcomes. These findings do not support the routine administration of sodium bicarbonate for adults with in-hospital cardiac arrest. Rounding out our critical care section is an updated systematic review and meta-analysis from Critical Care Medicine, which informed the 2024 Society of Critical Care Medicine guidelines on glycemic control [10]. Analyzing 45 randomized controlled trials involving over 32,000 patients, the review found no difference in hospital or ICU mortality between intensive and conventional glucose targets. While intensive control was associated with some benefits, including shorter ICU stays and lower rates of infection, it came at a significant cost: a 3.6-fold higher risk of severe hypoglycemia. The authors conclude that intensive targets should not be routinely used, though they may be considered in select centers with optimized protocols and documented low rates of hypoglycemia.

Moving from the ICU to the broader perioperative journey, three papers this week examine key drivers of patient outcomes, from preoperative risk factors to long-term disability. A prospective multicenter cohort study in Anaesthesia provides sobering data on long-term functional impairment after non-cardiac surgery [3]. Using the WHO Disability Assessment Schedule, researchers found that one year after surgery, nearly 13% of patients experienced new, clinically significant disability. Frailty was a powerful predictor, associated with a nearly four-fold increase in the odds of this outcome. Critically, the study found that postoperative complications of all grades, even those considered low severity, were associated with new-onset disability at one year, highlighting the far-reaching impact of any deviation from an uncomplicated recovery. A large observational study in the British Journal of Anaesthesia explores how preoperative anemia differentially affects outcomes in women and men [9]. Analyzing over 228,000 procedures at a major United States academic medical center, the study confirmed that preoperative anemia is associated with adverse outcomes in both sexes. However, the associations with acute kidney injury, ischemic events, and surgical site infection were significantly stronger in women. For instance, compared to non-anemic patients, severe preoperative anemia was associated with an almost three-fold increase in the odds of acute kidney injury in women, versus a more modest 1.4-fold increase in men. This suggests that the risk conferred by anemia is not uniform and may warrant different considerations based on patient sex. Finally, a meta-analysis in the Journal of Clinical Anesthesia revisits the long-standing debate over whether total intravenous anesthesia, or TIVA, reduces postoperative neurocognitive complications compared to volatile agents [2]. Across 29 trials with nearly 12,000 patients, the incidence of postoperative delirium within seven days was similar between the two anesthetic techniques. While volatile anesthesia was associated with a statistically significant increase in delayed neurocognitive recovery, the effects were inconsistent across time points, and the difference in Mini-Mental State Examination scores was small and not considered clinically meaningful. The authors conclude that current evidence does not suggest that TIVA meaningfully improves postoperative neurocognitive outcomes, indicating that the choice of anesthetic agent may be less important than other preventative strategies.

Finally, we turn to several studies evaluating specific techniques for pain control, hemodynamic monitoring, and clinical decision-making. In the Journal of Clinical Anesthesia, a meta-analysis assessed the efficacy of the deep parasternal intercostal plane, or D-PIP block, for pain after cardiac surgery [5]. The analysis of 17 trials found that the D-PIP block was associated with a modest reduction in 24-hour opioid consumption, equivalent to about 9 milligrams of morphine, though there was substantial heterogeneity across studies. More compellingly, the block was associated with a significant reduction in postoperative nausea and vomiting, cutting the odds by approximately 70%, a finding supported by high-certainty evidence. For clinicians managing one-lung ventilation, a study in Anesthesia and Analgesia offers a practical tool for assessing fluid responsiveness [6]. Recognizing that conventional dynamic indices like stroke volume variation are often unreliable during thoracic surgery, researchers tested a simple PEEP-reduction maneuver. In 38 patients, they found that reducing PEEP from 10 to 0 centimeters of water and observing the change in stroke volume was highly predictive of fluid responsiveness, with an area under the ROC curve of 0.95. A stroke volume increase of just over 8.6% served as an effective cutoff. In contrast, baseline stroke volume variation was not predictive. This simple, fluid-free test may be a valuable aid for intraoperative fluid management. A commentary in the British Journal of Anaesthesia discusses the evolving recommendations for perioperative management of SGLT2 inhibitors [1]. It highlights the new consensus statement from the Society for Perioperative Assessment and Quality Improvement, which advocates for a shift away from routine discontinuation. The new strategy is risk-stratified, balancing the low but real risk of euglycemic ketoacidosis against the well-established cardiovascular and renal benefits of continuing these medications. The guidance emphasizes that the risk of ketoacidosis is driven more by the patient's metabolic context, such as diabetes and fasting, rather than by drug continuation alone. And looking to the future, another paper in Anesthesia and Analgesia provides a large-scale evaluation of five different large language models in anesthesia decision-making [7]. Using over 200 standardized hip fracture surgery vignettes, the study found that the AI models provided generally reasonable recommendations, consistently favoring neuraxial anesthesia over general and recommending peripheral nerve blocks. However, a critical flaw emerged in their reasoning: the free-text justifications frequently cited benefits of neuraxial anesthesia that are unsupported by recent, large randomized trials. This suggests the models may be trained on outdated information and highlights the risk that uncritical use could shift practice patterns without actually improving patient outcomes.

If you only have time for one paper this week, make it the VICTORY trial by Stoppe and colleagues in JAMA [8]. This large, randomized controlled trial provides a definitive and practice-changing conclusion, demonstrating that high-dose intravenous vitamin C in severe burn patients is not only ineffective but is also associated with an increased risk of mortality, leading to the trial's early termination for harm.

Here are the key takeaways from this week in Anesthesiology. First: For patients with severe burns, high-dose intravenous vitamin C does not improve outcomes and may increase mortality; its use should be avoided [8]. Second: Routine administration of sodium bicarbonate during in-hospital cardiac arrest does not improve the rate of return of spontaneous circulation and is not supported by current evidence [4]. Third: Preoperative anemia is a significant risk factor for postoperative complications, and its association with acute kidney injury, ischemic events, and surgical site infections is markedly stronger in women than in men, warranting heightened vigilance in this population [9]. Fourth: During one-lung ventilation for thoracic surgery, a PEEP-reduction test is a reliable predictor of fluid responsiveness, outperforming standard stroke volume variation [6]. And finally: The choice between volatile and total intravenous anesthesia does not appear to meaningfully impact the incidence of postoperative delirium, suggesting other factors are more critical in preventing this common complication [2].

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.

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