Daily Anesthesiology Research Analysis
Large-scale pediatric data support reducing preoperative clear fluid fasting to ≤1 hour without increasing pulmonary aspiration. A randomized noninferiority trial shows video-based, self-directed training on a new anesthesia workstation matches instructor-led teaching, easing education constraints. An HPI-guided strategy in prone spine surgery did not lower time-weighted hypotension but shortened total hypotension duration, underscoring nuanced benefits of predictive monitoring.
Summary
Large-scale pediatric data support reducing preoperative clear fluid fasting to ≤1 hour without increasing pulmonary aspiration. A randomized noninferiority trial shows video-based, self-directed training on a new anesthesia workstation matches instructor-led teaching, easing education constraints. An HPI-guided strategy in prone spine surgery did not lower time-weighted hypotension but shortened total hypotension duration, underscoring nuanced benefits of predictive monitoring.
Research Themes
- Liberalized preoperative fasting for pediatric anesthesia
- Scalable education and competency in anesthesia technology
- Predictive hemodynamic monitoring and intraoperative hypotension
Selected Articles
1. Impact of liberal preoperative clear fluid fasting regimens on the risk of pulmonary aspiration in children (EUROFAST): an international prospective cohort study.
Across 306,900 pediatric anesthetics, allowing clear fluids until 1 hour preoperatively or sip-til-send was noninferior to ≥2 hours fasting for confirmed pulmonary aspiration and regurgitation-related outcomes, with zero aspiration-related deaths. These data support liberalizing clear fluid fasting in children <16 years.
Impact: This is the largest prospective multicentre analysis to date directly comparing liberal clear fluid fasting strategies in pediatric anesthesia with robust noninferiority results.
Clinical Implications: Institutions can safely revise pediatric fasting policies to allow clear fluids up to 1 hour before anesthesia (and consider sip-til-send with appropriate safeguards), potentially improving hydration, comfort, and perioperative flow without increasing aspiration risk.
Key Findings
- Confirmed pulmonary aspiration incidence: sip-til-send 1.18/10,000; ≥1 h 0.96/10,000; control (≥2 h) 1.83/10,000.
- No aspiration-related mortality across 306,900 anesthetics.
- Both sip-til-send and ≥1 h regimens were statistically noninferior to ≥2 h for confirmed aspiration, transient regurgitation, and regurgitation requiring escalation of care.
Methodological Strengths
- Prospective multicentre design with very large sample size (306,900 anesthetics).
- Predefined outcome capture of regurgitation and aspiration with noninferiority comparisons.
Limitations
- Observational cohort with potential center-level confounding and policy selection bias.
- Very low event rates limit precision for subgroup analyses.
Future Directions: Cluster-randomized or stepped-wedge trials and high-risk subgroup analyses (e.g., emergency cases, gastroesophageal reflux) to refine patient selection and implementation protocols.
2. Self-directed learning versus traditional instructor-led learning for education on a new anaesthesia workstation: a noninferiority, randomised, controlled trial.
In a single-centre randomized noninferiority trial (n=222), video-supported self-directed training on a new anesthesia workstation achieved competence rates noninferior to instructor-led workshops at ~3 months. This approach can reduce instructor time while maintaining user competency.
Impact: Demonstrates a scalable, evidence-based alternative to traditional instruction for device onboarding, addressing workforce and scheduling constraints without compromising competence.
Clinical Implications: Hospitals can deploy structured video-based self-directed modules for new anesthesia workstations to maintain competency across rotating staff, freeing instructor time for high-risk training and potentially improving device safety culture.
Key Findings
- Randomized noninferiority design with 222 participants; success rate difference -0.9% (90% CI -3.8% to 1.7%), meeting the 10% noninferiority margin.
- Both groups received a 1-hour session; competence on 12 tasks assessed ~3 months later.
- Participants included anesthesia nurses (n=97) and physicians (n=125), enhancing generalizability within perioperative teams.
Methodological Strengths
- Randomized, controlled, noninferiority design with prespecified margin.
- ClinicalTrials.gov registration and delayed competence assessment to test retention.
Limitations
- Single-centre study; external validity may vary across institutions and devices.
- Educational outcomes assessed; no direct measurement of clinical events or patient safety outcomes.
Future Directions: Multicentre trials linking training modality to device-related error rates, patient outcomes, and cost-effectiveness across diverse anesthesia platforms.
3. Effectiveness of hypotension prediction index software in reducing intraoperative hypotension in prolonged prone-position spine surgery: a single-center clinical trial.
In prone spine fusion, HPI-guided management did not lower the time-weighted average of intraoperative hypotension versus standard care but significantly reduced the total duration of hypotension per patient, without affecting postoperative complications. Findings suggest selective benefits of predictive monitoring on hypotension burden.
Impact: Provides randomized evidence on machine learning-guided hemodynamic management in a high-risk surgical context, clarifying which hypotension metrics may be modifiable.
Clinical Implications: HPI-guided strategies may help minimize total hypotension exposure even if TWA is unchanged; institutions should consider protocolized responses and evaluate benefit in broader, multicentre settings before wide adoption.
Key Findings
- Primary outcome not met: no significant difference in TWA of IOH (0.10 vs 0.15 mmHg; p=0.088).
- Total duration of hypotension per patient significantly reduced with HPI guidance (4 vs 11.2 minutes; p=0.019).
- No significant differences in postoperative in-hospital complications; 77 patients analyzed; trial registered (NCT05341167).
Methodological Strengths
- Randomized, single-blind design with pre-registered protocol.
- Clear primary and secondary outcomes; clinically relevant prone spine population.
Limitations
- Single-centre study with modest sample size; 8 exclusions for technical issues.
- Primary endpoint negative; clinicians could not be fully blinded to intervention.
Future Directions: Larger, multicentre RCTs testing protocolized HPI responses, evaluating patient-centered outcomes (AKI, MI, stroke) and cost-effectiveness; exploration of composite hypotension burden metrics.