Daily Anesthesiology Research Analysis
Three impactful anesthesiology studies stood out today: a SPAQI multidisciplinary consensus standardizes perioperative management of GLP-1 receptor agonists, a Critical Care cohort links the R/I ratio with EIT-guided PEEP optimization in severe ARDS on ECMO, and an RCT shows sugammadex improves early recovery versus neostigmine after VATS lobectomy in older adults. Together they advance medication safety, individualized ventilation, and recovery quality.
Summary
Three impactful anesthesiology studies stood out today: a SPAQI multidisciplinary consensus standardizes perioperative management of GLP-1 receptor agonists, a Critical Care cohort links the R/I ratio with EIT-guided PEEP optimization in severe ARDS on ECMO, and an RCT shows sugammadex improves early recovery versus neostigmine after VATS lobectomy in older adults. Together they advance medication safety, individualized ventilation, and recovery quality.
Research Themes
- Perioperative management of GLP-1 receptor agonists
- Individualized ventilator settings in severe ARDS on ECMO
- Neuromuscular block reversal and recovery quality in thoracic surgery
Selected Articles
1. Perioperative management of patients taking glucagon-like peptide 1 receptor agonists: Society for Perioperative Assessment and Quality Improvement (SPAQI) multidisciplinary consensus statement.
Using a modified Delphi process informed by a systematic review, SPAQI provides harmonized recommendations for perioperative management of GLP-1 receptor agonists, including guidance on fasting times. The statement aims to reduce aspiration risk and practice variability while supporting pragmatic tools such as gastric ultrasound and tailored induction strategies.
Impact: Rapid adoption of GLP-1RAs has created uncertainty around aspiration risk and fasting. This consensus delivers immediately actionable recommendations likely to standardize care and improve safety.
Clinical Implications: Adopt structured preoperative assessment for GLP-1RA use, consider point-of-care gastric ultrasound in high-risk cases, and apply adjusted fasting and rapid sequence induction as indicated to mitigate aspiration risk.
Key Findings
- Multidisciplinary consensus using a modified Delphi process aligned perioperative GLP-1RA management.
- Recommendations specify preoperative fasting times for solids and liquids in patients on GLP-1RAs.
- Guidance is supported by a systematic review registered on PROSPERO (CRD42023438624).
Methodological Strengths
- Modified Delphi consensus combined with systematic literature review
- Multidisciplinary panel and transparent protocol registration
Limitations
- Recommendations are consensus-based with heterogeneous underlying evidence and few RCTs
- Implementation feasibility and outcomes require external validation
Future Directions: Prospective studies and pragmatic trials should test aspiration risk, gastric emptying, and outcomes under standardized GLP-1RA perioperative pathways.
2. Optimum electrical impedance tomography-based PEEP and recruitment-to-inflation ratio in patients with severe ARDS on venovenous ECMO.
In 54 severe ARDS patients on venovenous ECMO receiving ultra-protective ventilation, the R/I ratio was feasible and informative for PEEP titration. An R/I ratio >0.34 identified likely 'recruiters' who may benefit from EIT-guided higher PEEP, whereas R/I ≤0.34 suggested that moderate PEEP (8–10 cmH2O) may suffice.
Impact: Provides a practical, bedside physiological marker (R/I ratio) to stratify PEEP responsiveness during ECMO while aligning with EIT imaging, supporting individualized ventilation in high-risk patients.
Clinical Implications: Use the R/I ratio to screen for potential recruiters; consider EIT-guided titration when R/I >0.34, and opt for moderate PEEP when R/I ≤0.34 during ultra-protective ventilation on ECMO.
Key Findings
- R/I ratio measurement was feasible during ultra-protective ventilation on venovenous ECMO.
- An R/I ratio threshold >0.34 identified patients likely to benefit from further EIT-guided PEEP optimization.
- Approximately 24% had a measurable airway opening pressure; moderate PEEP (8–10 cmH2O) may suffice when R/I ≤0.34.
Methodological Strengths
- Bedside physiological assessment combined with functional imaging (EIT)
- Standardized ultra-protective ventilation in a well-defined ECMO cohort
Limitations
- Observational cohort without randomized allocation to PEEP strategies
- Single-parameter thresholds may not generalize across centers and ventilator modes
Future Directions: Prospective interventional trials should test R/I-guided versus EIT-guided PEEP strategies on clinical outcomes in ECMO-supported ARDS.
3. Sugammadex or neostigmine for reversal of neuromuscular block on the quality of postoperative recovery in elderly adults undergoing video-assisted thoracoscopic lobectomy: a randomised controlled trial.
In elderly patients undergoing VATS lobectomy, sugammadex improved QoR-15 on POD1, shortened extubation and PACU times, and reduced hypoxemia and PRNB compared with neostigmine. The trial was small and not powered for longer-term outcomes, but supports preferential use of sugammadex for early recovery.
Impact: Addresses a common perioperative decision in a vulnerable population with a randomized, double-blind comparison and patient-centered outcomes.
Clinical Implications: Consider sugammadex to enhance early recovery and reduce residual paralysis and hypoxemia in elderly thoracic surgical patients, while monitoring cost and local formulary constraints.
Key Findings
- Sugammadex increased QoR-15 on POD1 (125 vs 122; P < 0.001).
- Extubation time and PACU stay were shorter with sugammadex (18 vs 27.5 min; 52 vs 62 min).
- Lower rates of hypoxemia (28% vs 53%) and PRNB (5% vs 24%) with sugammadex; PPCs trended lower but were not statistically significant.
Methodological Strengths
- Prospective randomized double-blind design
- Patient-centered primary outcome (QoR-15) with clinically relevant secondary endpoints
Limitations
- Single-center, small sample size limits generalizability and power for long-term outcomes
- Retrospective trial registration
Future Directions: Larger multicenter RCTs should evaluate longer-term pulmonary outcomes, cost-effectiveness, and subgroup effects (e.g., frailty).