Daily Anesthesiology Research Analysis
Analyzed 102 papers and selected 3 impactful papers.
Summary
Three studies reshape perioperative anesthesiology practice: a prospective multicenter study links semaglutide therapy to markedly higher residual gastric contents on preoperative gastric ultrasound; a causal-inference analysis suggests earlier fluid administration thresholds can reduce intraoperative hypotension in longer surgeries; and a systematic review/meta-analysis supports neuromuscular blocker use to lower difficult pediatric intubation risk.
Research Themes
- Perioperative risk stratification and airway safety in GLP-1 RA users
- Causal inference to optimize intraoperative hemodynamic management
- Evidence synthesis guiding neuromuscular blockade for pediatric intubation
Selected Articles
1. Gastric ultrasound in patients receiving semaglutide: a prospective, multicentre, matched control study.
In a prospective multicenter matched study (44 semaglutide users, 44 controls), semaglutide was associated with a markedly higher prevalence of preoperative 'full stomach' on gastric ultrasound (49% vs 18%; OR 4.29, 95% CI 1.63–11.29). Solid gastric contents were more frequent (42% vs 7%), while calculated gastric volumes were similar. Findings suggest persistently elevated aspiration risk despite withholding one dose and support bedside ultrasound to individualize anesthetic strategy.
Impact: This study directly informs perioperative management of the rapidly growing population on GLP-1 receptor agonists by controlling key confounders and quantifying aspiration risk using point-of-care ultrasound.
Clinical Implications: Consider gastric ultrasound in semaglutide-treated patients to guide airway strategy (rapid-sequence induction, intubation vs supraglottic airway), fasting interval adjustments, and aspiration prophylaxis; discuss delaying elective surgery or extended withholding for high-risk profiles.
Key Findings
- Full-stomach prevalence was 49% with semaglutide vs 18% in matched controls (OR 4.29, 95% CI 1.63–11.29, p=0.003).
- Solid gastric contents were significantly more frequent with semaglutide (42% vs 7%; OR 9.85, 95% CI 2.57–37.76, p<0.001).
- Calculated gastric volume did not differ significantly, underscoring the importance of content type (solid vs liquid).
Methodological Strengths
- Prospective multicenter matched case-control design controlling age, BMI, and diabetes
- Standardized two-position gastric ultrasound protocol with predefined 'full stomach' criteria
Limitations
- Modest sample size and non-randomized design
- Only one withheld dose evaluated; optimal withholding interval remains uncertain
Future Directions: Randomized studies to test anesthetic strategies (e.g., RSI vs standard induction) guided by gastric ultrasound; trials defining optimal withholding intervals across GLP-1 RA dosing schedules and phenotypes.
INTRODUCTION: Delayed gastric emptying is a known effect of glucagon-like peptide-1 receptor agonists, such as semaglutide. While tachyphylaxis has been reported, recent clinical data indicate an increased risk of residual gastric content on pre-operative gastric ultrasound in patients who are fasted. However, the limited available data do not control for several important potential confounders. METHODS: We conducted a prospective, multicentre, matched case-control study, enrolling patients receiv
2. Blood pressure thresholds for the administration of balanced crystalloids and the effect on intra-operative hypotension: A proof-of-concept causal inference analysis featuring idealised dynamic treatment regimens.
Using the INSPIRE cohort (n=23,305), idealized dynamic treatment regimens that trigger 250 mL balanced crystalloids at MAP thresholds (60–75 mmHg) were evaluated with causal inference methods. For surgeries >2 hours, earlier fluid administration (higher MAP thresholds) reduced intraoperative hypotension by >4% toward the end of surgery, suggesting a beneficial effect of fluids on hypotension in longer cases.
Impact: Introduces a rigorous causal-inference framework to test time-dependent hemodynamic strategies at scale, offering actionable hypotheses for fluid thresholds that could guide future RCTs and protocol design.
Clinical Implications: For procedures exceeding two hours, consider earlier fluid triggers (e.g., MAP ≤70–75 mmHg) as part of goal-directed therapy to mitigate hypotension, while awaiting prospective validation; tailor to patient risk and surgical context.
Key Findings
- Across dynamic treatment regimens, earlier fluid administration reduced intraoperative hypotension by >4% late in longer surgeries.
- Short surgeries (<2 hours) showed similar hypotension incidences across thresholds, indicating duration-dependent benefit.
- Higher MAP thresholds naturally increased fluid volume, linking volume to hypotension reduction in this causal framework.
Methodological Strengths
- Large cohort (n=23,305) with time-resolved intraoperative hemodynamic data
- Modern causal inference addressing time-dependent confounding and treatment–confounder feedback
Limitations
- Observational design with idealized regimens; residual confounding cannot be excluded
- Focused on crystalloids and MAP thresholds without integrating vasopressor strategies
Future Directions: Prospective trials testing pragmatic DTRs that integrate fluids and vasopressors; external validation across diverse surgical populations and incorporation into closed-loop hemodynamic management.
BACKGROUND: Haemodynamic management and fluid administration constitute a challenging cornerstone of intra-operative care to counteract hypotension. Observational studies remain a vital source of evidence regarding the associations of fluids and vasopressors with peri-operative outcomes. OBJECTIVE: To evaluate dynamic treatment regimens (DTRs) of balanced crystalloids on the incidence of intra-operative hypotension. DTRs constitute a statistical framework to evaluate the causal impact of different t
3. Effects of avoidance versus use of neuromuscular blocking agents for facilitation of tracheal intubation in children and infants: A systematic review with meta-analysis and trial sequential analysis.
Across 47 randomized trials (n=2,276), avoiding neuromuscular blockers increased difficult intubation risk in children and infants (RR 3.47, 95% CI 2.52–4.77; α-spending adjusted RR 3.68 with TSA). No significant increase in serious adverse events was detected. Evidence supports routine NMBA use to facilitate pediatric tracheal intubation.
Impact: High-level evidence with trial sequential analysis clarifies a long-debated pediatric airway practice question and supports guideline-concordant NMBA use.
Clinical Implications: Use neuromuscular blockade to facilitate pediatric tracheal intubation to reduce difficult intubation; ensure adequate monitoring (quantitative NMT), appropriate dosing, and timely reversal to minimize residual paralysis.
Key Findings
- Avoiding NMBA increased difficult intubation risk (RR 3.47, 95% CI 2.52–4.77; TSA-adjusted RR 3.68).
- No significant difference in serious adverse events between NMBA use and avoidance (very low certainty).
- Findings consistent across 30 trials reporting primary outcome with moderate heterogeneity (I2=18%).
Methodological Strengths
- Comprehensive systematic review and meta-analysis with trial sequential analysis
- Large aggregate sample from randomized trials with predefined primary endpoint
Limitations
- Only three trials were at low risk of bias; outcome definitions and operator experience varied
- Adverse event reporting was limited, reducing certainty for safety outcomes
Future Directions: High-quality, contemporary RCTs stratified by age and airway device with standardized monitoring and safety endpoints to refine NMBA dosing and reversal strategies.
BACKGROUND: Use of neuromuscular blocking agents (NMBAs) is recommended by European Society of Anaesthesiology and Intensive Care in neonates (<1 month) and infants (<1 year) to facilitate tracheal intubation, but the use in other paediatric age groups is still debated. OBJECTIVE: We assessed the effects of avoidance versus use of NMBA for facilitation of tracheal intubation in children and infants. The primary outcome was incidence of difficult tracheal intubation. DESIGN: A systematic review of randomise