This Week in Anesthesiology — Jul 28, 2026

Welcome to This Week in Anesthesiology. This week we're covering 7 notable papers spanning perioperative airway and physiological management, regional anesthesia anatomy and chronic neuromodulation, and healthcare delivery economics and drug safety. Let's dive in.

Beginning with airway management and perioperative physiology, a single-center randomized controlled trial published in the Journal of Clinical Anesthesia investigated transnasal humidified rapid insufflation ventilatory exchange, known as THRIVE, in obese patients undergoing elective surgery with a body mass index of 35 kilograms per meter squared or greater [1]. Researchers used electrical impedance tomography to assess changes in end-expiratory lung impedance as a surrogate for lung volume during an early apneic window of 2 to 6 minutes [1]. The mean global impedance change during early apnea was significantly better preserved with THRIVE compared to facemask oxygen, with a mean difference of 0.67 [1]. THRIVE attenuated the rate of lung volume decline and was associated with greater preservation, particularly in mid-ventral and mid-dorsal regions [1]. Safe apnea time was prolonged, with a median of 600 seconds in the THRIVE group versus 319 seconds with facemask oxygen, offering physiological insight into improved oxygenation during apneic oxygenation [1]. Shifting to regional anesthesia and pain medicine, an anatomical study published in Regional Anesthesia and Pain Medicine investigated the pericapsular nerve group, or PENG block, in 10 cryopreserved cadavers under ultrasound guidance [3]. Gross anatomical dissection demonstrated methylene blue staining in close proximity to the femoral nerve and its branches, without staining of the obturator nerve [3]. Cryo-cross-sectional and histological analyses revealed that injectate localization was predominantly subepimysial and intramuscular within the iliopsoas muscle compartment, without consistent involvement of the hip capsule [3]. The authors identified small nerve branches within adipose-containing connective tissue planes, suggesting that intramuscular neural blockade contributes to analgesic effects, while potential femoral nerve involvement warrants further investigation [3]. Complementing this in the chronic pain space, a retrospective cohort study published in Regional Anesthesia and Pain Medicine evaluated 125 patients undergoing temporary 60-day percutaneous peripheral nerve stimulation at Massachusetts General Hospital and Brigham and Women's Hospital [7]. Among patients with complete data, 24 percent met the primary responder threshold of a 30 percent or greater reduction from day-of-procedure to median postprocedural numerical rating scale pain score [7]. Sensitivity analyses yielded responder rates spanning 8 to 14 percent depending on thresholds and pain anchors applied, falling short of rates reported in indication-specific trials [7]. Early device removal occurred in 19 percent of patients, with lead migration, dislodgement, or fracture concentrated among non-responders, and over half of the cohort carried at least one comorbid mental health diagnosis [7].

Turning to healthcare delivery, economics, and safety, a retrospective cohort study published in the British Journal of Anaesthesia evaluated virtual versus in-person anesthesiology consultations using a target trial emulation framework in Ontario, Canada [2]. Among 17,027 patients undergoing elective, noncardiac, non-orthopaedic moderate- to high-risk surgery, nearly half received a virtual consultation [2]. The primary outcome of 90-day major morbidity or mortality occurred in 26.3 percent of virtual consult patients and 24.9 percent of in-person consult patients, leaving primary outcome noninferiority inconclusive based on instrumental variable and propensity-score adjusted analyses [2]. However, virtual care was noninferior for length of hospital stay, costs of care, and days alive and at home within 90 days, and was associated with reduced carbon emissions [2]. In a systematic review published in Anaesthesia, investigators assessed the effect of surgical procedures on disability using the World Health Organization Disability Assessment Schedule 2.0 questionnaire across 39 studies [4]. Preoperative disability ranged widely from 2 to 61 percent, and in 21 studies, disability increased by 1 to 17 percent within 3 months of surgery [4]. Orthopaedic surgery generally reported high preoperative disability above 35 percent with subsequent reductions of 10 to 37 percent within 3 months, whereas cancer surgery reported lower preoperative disability below 20 percent but small persistent increases of 1 to 8 percent at 3 months, highlighting that postoperative disability is heavily influenced by surgical type [4]. Examining pharmacogenetics, a study published in the British Journal of Anaesthesia assessed the function of six novel ryanodine receptor type 1 variants detected in Japanese patients with malignant hyperthermia [5]. Using human embryonic kidney cells expressing these variants, calcium release in response to caffeine and 4-chloro-m-cresol showed that all six variants exhibited hypersensitivity, with best-fit concentration-response values significantly lower than wild-type [5]. One variant, proline 2366 arginine, was classified as pathogenic or likely pathogenic, while others were designated as variants of uncertain significance or likely pathogenic [5]. Finally, a model-based evaluation published in the British Journal of Anaesthesia examined the economic impact of switching to licensed ready-to-administer prefilled syringes within National Health Service practice in England [6]. Under modelling assumptions, switching to prefilled presentations for epinephrine, ephedrine, atropine, and lidocaine 2 percent was associated with reduced overall system costs of more than 5.3 million pounds annually, driven by reduced wastage, preparation workload, and preventable adverse drug events [6]. Conversely, rocuronium and midazolam were associated with increased costs due to higher acquisition prices despite operational advantages, indicating that while ready-to-administer medicines offer safety and workflow benefits, acquisition cost remains a barrier for certain agents [6].

If you only have time for one paper this week, make it the trial from the Journal of Clinical Anesthesia by Tanaka and colleagues on THRIVE in obese patients [1]. It provides immediate, actionable physiological confirmation that apneic oxygenation significantly prolongs safe apnea times and preserves lung volume during the vulnerable induction window [1].

Here are the key takeaways from this week in Anesthesiology. Transnasal humidified rapid insufflation ventilatory exchange substantially slows lung volume decline and prolongs safe apnea time in obese patients during general anesthesia induction [1]. Anatomical dissection of the PENG block demonstrates that injectate is largely confined to the iliopsoas muscle compartment, pointing to intramuscular neural blockade rather than a pure pericapsular spread [3]. Virtual preoperative anesthesiology consultations showed inconclusive noninferiority for 90-day major morbidity and mortality compared to in-person visits, but achieved noninferiority for secondary recovery metrics and reduced carbon emissions [2]. Postoperative disability trajectories measured by the WHODAS 2.0 questionnaire vary markedly by surgical specialty, with orthopaedic procedures improving disability and cancer surgery showing persistent early increases [4]. Switching select emergency injectables to licensed prefilled syringes reduces overall system costs and waste in the National Health Service, though acquisition costs remain prohibitive for neuromuscular blockers and benzodiazepines [6].

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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