Daily Anesthesiology Research Analysis

IMPORTANCE: Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are known to increase the risk of retained gastric contents. High-quality data are lacking to guide periprocedure management of GLP-1 and GIP agonists. OBJECTIVE: To compare the risk of clinically significant residual gastric volume (RGV) in patients who continue vs hold 1 dose of weekly or daily GLP-1 and GIP agonists prior to sedation. DESIGN, SETTING, AND PARTICIPANTS: This randomized, single-masked clinical trial conducted at 2 large tertiary referral centers in the US included patients undergoing elective upper endoscopy (EGD) who were receiving GLP-1 or GLP-1/GIP agonists between July 2024 and May 2025. Eligible participants were adults aged 18 years or older, scheduled for EGD with or without colonoscopy, under moderate sedation or monitored anesthesia care, and taking a stable dose of a GLP-1 or GLP-1/GIP agonist for at least 1 month. Exclusion criteria were prior foregut surgery, achalasia, documented gastroparesis, RGV on previous endoscopy, gastric outlet obstruction, planned general anesthesia, or recent opioid use. Data were analyzed May 2025. INTERVENTION: Participants were randomized to either continue their medication or hold 1 dose prior to the procedure. MAIN OUTCOMES AND MEASURES: Clinically significant RGV, a composite of gastric contents that (1) precludes endoscopic examination, (2) requires premature termination or endotracheal intubation, and/or (3) results in an aspiration event that necessitates extended observation or monitoring, unplanned therapeutics, or hospital admission.

BACKGROUND: Postoperative delirium (POD) is a prevalent and devastating complication in elderly patients undergoing major surgery, marked by substantial increases in morbidity, mortality, and long-term cognitive decline. However, treatment and prevention methods are limited. Accumulating evidence suggests that vagus nerve stimulation effectively enhances cognitive function. OBJECTIVE: To evaluate the efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) on POD in elderly patients undergoing major non-cardiac surgery. METHODS: Patients aged ≥65 years scheduled for major non-cardiac surgery were randomly assigned to either the active taVNS group or the sham taVNS group, with stimulation targeting the cymba conchae or earlobe, respectively. In both groups, stimulation was initiated 5 minutes prior to anesthesia induction and continued until the end of surgery. The only difference between the two groups was the stimulation site. The primary outcome was the incidence of POD during the first 3 postoperative days.

BACKGROUNDSepsis encompasses considerable biological and clinical heterogeneity. Previously, 2 phenotypes ("hyperinflammatory" and "hypoinflammatory") have been consistently identified within sepsis via latent class analysis. These phenotypes differ in their biological features, clinical outcomes, and therapeutic responses to interventions. Prior studies of sepsis heterogeneity have focused primarily on the host response. Here, we investigate the potential influence of the causative pathogen on sepsis heterogeneity and pathobiology.METHODSWe performed a retrospective observational analysis of 8,280 critically ill patients with sepsis to identify associations between pathogen characteristics and the hyperinflammatory and hypoinflammatory patient phenotypes. We also performed controlled murine and swine modeling of sepsis and lung injury and a secondary analysis of 449 patients enrolled in the EUPHRATES randomized controlled trial.RESULTSPathogen characteristics (pathogen identity, burden, virulence, and anatomic site of infection) were strongly and independently associated with the previously reported phenotypes. In a cohort of critically ill patients with sepsis, infection with gram-negative pathogens, primarily Enterobacterales spp. (e.g., Escherichia coli, Klebsiella pneumoniae), was strongly associated with the hyperinflammatory phenotype. The hyperinflammatory phenotype was also independently associated with increased pathogen burden, virulence, and initial anatomic site of infection. In controlled murine and swine modeling, both the identity and burden of the pathogen provoked key biological features of the hyperinflammatory phenotype. Among patients with sepsis, the prognostic value of lactate clearance varied substantially by phenotype. In a secondary analysis of a randomized trial of polymyxin B hemoadsorption (which removes circulating endotoxin), hypoinflammatory patients experienced worse survival.CONCLUSIONSOur results demonstrate the central importance of pathogen features in the clinical and biological heterogeneity of sepsis. Future studies of sepsis pathobiology and heterogeneity should expand their scope beyond the host response, as understanding pathogen-host interactions will be crucial in the development of precision therapeutic strategies to improve patient outcomes.TRIAL REGISTRATIONEUPHRATES trial NCT01046669.FUNDING5P30AG024824, IK2CX002766, R01HL144599, K24HL159247, R01HL158626, R01HL173531, R35GM142992, R35GM145330, R35GM136312, K23HL166880, R35HL140026.