Daily Anesthesiology Research Analysis

Digital health interventions (DHIs), delivered via digital platforms such as internet-based programs, mobile applications or short messages, may improve patient-reported outcomes (PROs), but comparative effectiveness is unclear. We conducted a network meta-analysis of randomized controlled trials in adults undergoing elective surgery under general anesthesia, identified in PubMed, Embase, CENTRAL, and Web of Science to March 1, 2025. Standardized mean differences (SMDs), mean differences (MDs) with minimal important differences (MIDs), and 95% CIs were estimated. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE. Fifty-six trials (6,154 patients) were included. Extended reality (XR) most effectively reduced perioperative anxiety (SMD 0.60; 95% CI 0.37-0.84; MD 8.05; MID 6.71; moderate-certainty). For postoperative pain, mobile applications (SMD 0.64; 95% CI 0.32-0.95; MD 1.36; MID 1.0; moderate-certainty) and XR (SMD 0.51; 95% CI 0.26-0.76; MD 1.09; MID 1.0; moderate-certainty) were probably effective. For quality of life, 2D video yielded the greatest gain (SMD 0.99; 95% CI 0.11-1.88; MD 0.11; MID 0.05; high-certainty). XR also improved satisfaction (SMD 1.27; 95% CI 0.63-1.91; MD 1.91; MID 0.75; moderate-certainty). These findings suggest that DHIs may improve perioperative PROs.

IMPORTANCE: Before elective surgery, direct oral anticoagulants (DOACs) are discontinued following a standardized protocol. However, this could result in insufficient lowering of DOAC levels that could increase bleeding risk. OBJECTIVE: To estimate the proportion of patients with elevated DOAC levels at the time of elective surgery, evaluate factors associated with DOAC levels, and examine associated blood loss. DESIGN, SETTING, AND PARTICIPANTS: This cohort study (DOAC Level Prior to Incision [DALI]) assessed adult patients prescribed a DOAC (apixaban, dabigatran, or rivaroxaban) for any indication and at any dose, undergoing an elective procedure requiring DOAC interruption between May 27, 2018, and February 25, 2024, at 2 Dutch hospitals. EXPOSURE: Standardized interruption protocol (1 day before moderate- and 2 days before high bleeding-risk procedures) with interruption adjustments for the patient's kidney function. MAIN OUTCOMES AND MEASURES: Blood was drawn immediately before surgery to determine DOAC levels (by liquid chromatography-mass spectrometry). Proportions of preoperative DOAC levels of 30 ng/mL or higher and their 95% CIs were estimated, stratified by DOAC type and surgical bleeding risk. Factors associated with DOAC levels were identified through multivariable linear regression. Surgical blood loss and 30-day postoperative complications were described according to DOAC concentrations. RESULTS: The study was terminated after including 257 patients (100 receiving apixaban, 100 receiving rivaroxaban, and 57 receiving dabigatran due to the slow inclusion rate of those receiving dabigatran; median [IQR] age, 72 [66-78] years; 173 male [67%]); 212 patients (82%) underwent a high bleeding-risk operation. Preprocedural DOAC levels were 30 ng/mL or higher in 7.6% (95% CI, 4.9%-11.6%) of patients. Dabigatran and rivaroxaban had similar proportions, whereas 13.1% (95% CI, 7.8%-21.2%) of patients treated with apixaban had levels of 30 ng/mL or higher. Treatment with apixaban, decreased kidney function, and a shorter interruption time were associated with higher levels. Surgical blood loss (median [range], 0 [0-4250] mL) was not associated with DOAC levels. Twelve patients (4.7%; 95% CI, 2.7%-8.0%), who all had DOAC levels less than 30 ng/mL, experienced major bleeding. CONCLUSIONS AND RELEVANCE: In this cohort study, most patients following the current protocol had DOAC levels less than 30 ng/mL, although the proportion of patients with elevated levels was higher for apixaban. Preoperative DOAC levels were not associated with blood loss during surgery.

AIMS: To assess the prevalence and risk factors of increased residual gastric content (RGC) under fasting conditions in patients with type 2 diabetes mellitus (T2DM) treated with glucagon-like peptide-1 receptor agonists (GLP-1 RAs), providing evidence for peri-procedural medication management. MATERIALS AND METHODS: This single-centre prospective cohort study enrolled inpatients with T2DM at the Endocrinology Department of Ningbo No.2 Hospital between April and December 2024. Patients aged 18-80 years with BMI <40 kg/m RESULTS: Of 390 patients included (237 [60.8%] male), 224 (57.4%) were GLP-1 RA users. After propensity score matching, the prevalence of increased RGC remained significantly higher in GLP-1 RA users compared with non-users (53.3% vs. 32.1%; p < 0.001). In multivariate logistic regression adjusted by inverse probability of treatment weighting (IPTW), GLP-1 RA use was robustly associated with increased RGC (OR 2.52; 95% CI 1.84-3.45). Notably, diabetic retinopathy (OR 1.84; 95% CI 1.14-2.99) and diabetic kidney disease (OR 1.67; 95% CI 1.17-2.39) emerged as independent risk factors, identifying a high-risk microvascular phenotype. Furthermore, among GLP-1 RA users, each additional day since the last GLP-1 RA dose reduced the odds of increased RGC by 23% (adjusted OR 0.77; 95% CI 0.65-0.90). CONCLUSIONS: GLP-1 RA therapy is a potent, independent driver of significant gastric retention in patients with T2DM, persisting despite standard fasting. Crucially, the presence of diabetic retinopathy or nephropathy identifies a "double-hit" high-risk phenotype, where pharmacological delay interacts with microvascular burden. These findings suggest that current fasting protocols may be insufficient for these patients, necessitating individualized preoperative assessment based on microvascular status and dosing timing.