Daily Anesthesiology Research Analysis
Analyzed 24 papers and selected 3 impactful papers.
Summary
Three high-impact anesthesiology papers span perioperative policy, neurocritical ventilation targets, and rapid infection risk stratification. A SPAQI consensus refines management of SGLT2 inhibitors around surgery, a meta-analysis links hypocapnia to worse outcomes after acute brain injury, and a prospective study introduces a 2-peak serum Raman signature predicting early postoperative pulmonary infection after OPCABG.
Research Themes
- Perioperative medication management and metabolic safety
- Ventilation targets and neurocritical outcomes
- Rapid, label-free diagnostics for postoperative complications
Selected Articles
1. Perioperative management of patients taking sodium-glucose cotransporter 2 inhibitors: Society for Perioperative Assessment and Quality Improvement (SPAQI) multidisciplinary consensus statement.
Using a modified Delphi process supported by a systematic review, SPAQI provides tailored perioperative recommendations for SGLT2 inhibitor management. The consensus emphasizes individualized timing of discontinuation, risk stratification by diabetes status and comorbidities, perioperative dietary considerations, and protocols to prevent and monitor euglycemic diabetic ketoacidosis.
Impact: This consensus addresses a common perioperative dilemma with practical, risk-based guidance that can immediately standardize care and reduce metabolic complications. It reconciles divergent recommendations and operationalizes prevention of euglycemic DKA.
Clinical Implications: Adopt tailored SGLT2i discontinuation windows and monitoring protocols based on diabetes status, comorbidities, surgical stress, and perioperative diet to mitigate euglycemic DKA. Incorporate standardized screening for ketosis and algorithms for perioperative glycemic management.
Key Findings
- FDA recommends stopping SGLT2is 3–4 days preoperatively, but multisociety guidance remains heterogeneous.
- SPAQI used a modified Delphi process plus a systematic review to issue updated, tailored recommendations.
- Recommendations specify management by diabetes status/comorbidities, perioperative diet, and monitoring/prevention of euglycemic DKA.
Methodological Strengths
- Modified Delphi consensus grounded in a systematic literature review
- Multidisciplinary expert panel ensuring broad perioperative perspectives
Limitations
- Consensus-based guidance without randomized comparative trials
- Evidence base includes heterogeneous studies and evolving pharmacovigilance data
Future Directions: Prospective multicenter implementation studies to test safety, adherence, and outcomes of tailored SGLT2i pathways; development of decision-support tools integrating ketosis monitoring and perioperative nutrition.
The perioperative management of patients using sodium-glucose cotransporter 2 inhibitors (SGLT2is) remains controversial. The US Food and Drug Administration currently recommends stopping SGLT2is for 3-4 days before surgery, irrespective of a diagnosis of diabetes mellitus. Other multisociety recommendations vary significantly in terms of SGLT2i management, perioperative monitoring, and mitigating strategies for euglycaemic diabetic ketoacidosis. This multidisciplinary consensus statement led by the Society for Perioperative Assessment and Quality Improvement (SPAQI) provides updated recommendations based on a modified Delphi process and supported by a systematic review of the literature. The recommendations include a tailored approach to management of SGLT2is perioperatively based on the presence of diabetes mellitus and other comorbidities, surgical and periprocedural dietary considerations, as well as monitoring and prevention strategies for euglycaemic diabetic ketoacidosis.
2. Association of mortality and neurological outcomes with hypocapnia in adult patients with acute brain injury: an updated meta-analysis.
This updated meta-analysis (37 studies; up to 51,373 for mortality) finds arterial hypocapnia associated with higher mortality (OR 1.29) and poor neurological outcomes (OR 2.09) after acute brain injury. Associations were stronger in subarachnoid hemorrhage/ischemic stroke for mortality and in traumatic brain injury for neurological outcomes, especially with severe hypocapnia definitions.
Impact: The study consolidates heterogeneous evidence to caution against routine hypocapnia in ABI, informing ventilatory targets in neuroanesthesia and neurocritical care. It highlights diagnosis-specific risk profiles.
Clinical Implications: Avoid prophylactic hyperventilation targeting hypocapnia in ABI; individualize PaCO2 targets with continuous neuromonitoring and consider diagnosis-specific risks (e.g., SAH, ischemic stroke, TBI).
Key Findings
- Across 37 studies, hypocapnia was associated with higher mortality (OR 1.29, 95% CI 1.05–1.59).
- Hypocapnia was linked to poor neurological outcomes (OR 2.09, 95% CI 1.24–3.54), particularly in traumatic brain injury.
- Stronger associations appeared in subarachnoid hemorrhage and ischemic stroke for mortality, and with severe hypocapnia exposure definitions.
Methodological Strengths
- Comprehensive multi-database search with large pooled sample
- Subgroup analyses across ABI subtypes and hypocapnia severity
Limitations
- Predominantly observational evidence with limited randomized data
- Heterogeneity in hypocapnia definitions and neuromonitoring protocols
Future Directions: Prospective, diagnosis-stratified trials testing PaCO2 targets with integrated neuromonitoring to define safe, individualized ventilation strategies.
BACKGROUND: Carbon dioxide is a key determinant of cerebral blood flow and is needed to prevent secondary damage in neurocritical care; however, optimal targets across the heterogeneous spectrum of acute brain injury (ABI) remain to be elucidated. The aim of this study was to evaluate the association between arterial hypocapnia and mortality and neurological outcomes in adult patients with ABI. METHODS: Six electronic databases were systematically searched from inception to January 2025. Observational and randomized controlled trials comparing exposure to hypocapnia, defined as an arterial partial pressure of carbon dioxide (PaCO RESULTS: A total of 8,637 records were identified after duplicate removal, of which 37 studies met inclusion criteria for the systematic review. Twenty-seven studies (51,373 patients) were included for mortality outcomes, and thirteen studies (3,814 patients) were included for neurological outcomes. Hypocapnia was associated with higher odds of mortality in adult patients with ABI (OR 1.29, 95% CI 1.05-1.59). Subgroup analyses demonstrated variability across ABI types, with stronger associations observed in subarachnoid hemorrhage and ischemic stroke populations. Hypocapnia was also associated with increased odds of poor neurological outcomes (OR 2.09, 95% CI 1.24-3.54), particularly in the traumatic brain injury population. Subgroup analyses suggested that the association with neurological outcomes was more consistent in studies defining exposure as severe hypocapnia (PaCO CONCLUSIONS: Arterial hypocapnia was associated with increased mortality and poor neurological outcomes in adults with acute brain injury, although the evidence is predominantly observational and limited randomized data are available. These findings underscore the need for cautious, individualized PaCO
3. Preoperative Serum Raman Spectroscopy: A Rapid, Label-Free Predictor of Postoperative Pulmonary Infection After Off-Pump Coronary Artery Bypass Grafting.
In 276 OPCABG patients, 20.7% developed PPI within 72 hours. A rapid, reagent-free 2-peak serum Raman signature (including a 664 cm−1 peak) derived via t-test, LASSO, and multivariable logistic regression predicted early PPI, suggesting potential for preoperative risk stratification.
Impact: Introduces a fast, label-free, and potentially scalable biomarker strategy tailored to cardiothoracic anesthesia to identify PPI risk preoperatively. It leverages modern chemometrics to distill a minimal signature.
Clinical Implications: Integrate rapid serum Raman assessment before OPCABG to flag high-risk patients for intensified pulmonary prevention bundles and monitoring. Potentially reduces empirical antibiotics by enabling targeted prophylaxis.
Key Findings
- Prospective single-center diagnostic cohort enrolled 276 OPCABG patients with 20.7% early PPI within 72 hours (CDC/NHSN criteria).
- Feature selection (2-sample t-test, LASSO) and multivariable logistic regression yielded a concise 2-peak serum Raman signature including a 664 cm−1 peak.
- Demonstrates feasibility of rapid, reagent-free, preoperative biochemical risk stratification for PPI.
Methodological Strengths
- Prospective cohort design with standardized CDC/NHSN outcome adjudication
- Modern feature selection pipeline (t-test, LASSO) with multivariable modeling
Limitations
- Single-center study without reported external validation metrics
- Spectral generalizability across instruments and populations remains to be tested
Future Directions: External, multicenter validation with predefined thresholds, assessment of net clinical benefit, and integration into perioperative decision support. Evaluate impact on antibiotic stewardship and pulmonary outcomes.
OBJECTIVE: This study aimed to develop and validate a preoperative risk-stratification tool based on serum Raman spectroscopy to identify patients at high risk for postoperative pulmonary infection (PPI) following off-pump coronary artery bypass grafting (OPCABG). DESIGN: A prospective diagnostic cohort study. SETTING: The study was conducted at a single academic medical center. PARTICIPANTS: A total of 276 adult patients undergoing OPCABG were enrolled. Preoperative serum samples were collected from all participants. INTERVENTIONS: Preoperative serum was analyzed using 532 nm confocal Raman spectroscopy (400 MEASUREMENTS AND MAIN RESULTS: PPI within 72 hours was adjudicated by Centers for Disease Control and Prevention/National Healthcare Safety Network criteria. Fifty-seven patients (20.7%) developed early PPI. After feature selection via 2-sample t-test, LASSO regularization, and multivariable logistic regression, a 2-peak Raman signature (664 cm CONCLUSIONS: A rapid reagent-free serum Raman signature comprising 2 peaks (664 cm