Daily Anesthesiology Research Analysis

IMPORTANCE: Patients with in-hospital cardiac arrest have poor outcomes. Sodium bicarbonate is commonly administered during cardiac arrest, but the effects on clinical outcomes are unknown. OBJECTIVE: To determine whether administration of sodium bicarbonate during in-hospital cardiac arrest increases the proportion of patients with return of spontaneous circulation. DESIGN, SETTING, AND PARTICIPANTS: Randomized, parallel-group, double-blind, placebo-controlled clinical trial conducted at 21 hospitals in Denmark. Participants were adults with in-hospital cardiac arrest, who received at least 1 dose of epinephrine. Patients were enrolled from February 6, 2023, to February 11, 2026, with the last 90-day follow-up conducted on May 4, 2026. Final statistical analysis was conducted on May 5, 2026. INTERVENTION: Sodium bicarbonate (up to 100 mmol) or placebo intravenously. MAIN OUTCOMES AND MEASURES: The primary outcome was sustained return of spontaneous circulation. Key secondary outcomes were survival at 30 days and survival at 30 days with a favorable neurologic outcome, defined by a score of 0 to 3 on the modified Rankin Scale (scores range from 0 to 6, with higher scores indicating greater disability). RESULTS: A total of 2913 patients with in-hospital cardiac arrest were screened; 913 patients were randomized, of which 779 were eligible for the primary analyses, with 372 randomized to receive sodium bicarbonate and 407 randomized to receive placebo. The median (IQR) age of patients was 73 (64-79) years and 502 were male (64%). Sustained return of spontaneous circulation occurred in 146 patients (39%) in the sodium bicarbonate group and 150 (37%) in the placebo group (risk ratio, 1.05 [95% CI, 0.88-1.24]; P = .62). At 30 days, 45 patients (12%) in the sodium bicarbonate group and 37 (9.1%) in the placebo group were alive (risk ratio, 1.25 [95% CI, 0.84-1.88]); a favorable neurologic outcome at 30 days occurred in 30 patients (8.1%) and 22 patients (5.4%), respectively (risk ratio, 1.39 [95% CI, 0.82-2.34]). Alkalosis and hypernatremia after cardiac arrest were more common in the sodium bicarbonate group. CONCLUSIONS AND RELEVANCE: There was no significant difference in sustained return of spontaneous circulation between sodium bicarbonate and placebo in adults with in-hospital cardiac arrest. These findings do not support routine administration of sodium bicarbonate for patients with in-hospital cardiac arrest. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05564130; ClinicalTrialsRegister.eu Identifier: 2022-501304-10-00.

INTRODUCTION: The Standardised Endpoints in Perioperative Medicine Initiative recommends the 12-item WHO Disability Assessment Schedule (WHODAS) 2.0 to measure postoperative functional impairment. However, evidence describing long-term postoperative disability, particularly at 1 year, remains limited. This study aimed to: describe disability up to 1 year after non-cardiac, non-neurosurgical procedures; examine associations between periprocedural risk, postoperative complications and new-onset disability; and evaluate associations between social support, delirium, and frailty and postoperative disability. METHODS: We conducted a prospective, multicentre cohort study. The primary endpoint was new onset clinically significant disability (an increase in WHODAS 2.0 score ≥ 5% points from baseline to a final score ≥ 35%) or death at 1 year. Independent variables included: periprocedural risk; postoperative complications; frailty; and patient-reported social support. RESULTS: In total, 1081 patients were included: 726 (67%) male, median (IQR) [range] age 67 (60-75 [50-101]) y. New onset clinically significant disability was present in 139/1081 (12.9%) patients at 1 year and in 238/1066 (22.3%) patients at 30 days. Periprocedural risk (adjusted odds ratio (aOR) 1.05, 95%CI 1.03-1.07, per percent in American College of Surgeons National Surgical Quality Improvement Program score) and postoperative complications of all grades were associated with 1-year new onset clinically significant disability. New onset (1 year) clinically significant disability was not associated with social support: OR 0.87, 95%CI 0.54-1.39 for moderate; and OR 0.76, 95%CI 0.47-1.24 for strong social support. Frailty was strongly associated with new onset clinically significant disability after 1 year (aOR 3.97, 95%CI 2.54-6.21). DISCUSSION: One year after non-cardiac surgery, 13% of surviving patients experienced a new onset clinically significant disability. Postoperative complications, even those of low severity, were associated with new onset postoperative disability. WHAT WE DID: We followed a large group of people who had surgery that was not on the brain or heart. We checked how well they were able to do everyday activities before surgery, then again after 30 days and after 1 year. We also looked at things like how risky their surgery was, if they had problems after surgery, how strong or frail they were and whether they had support from others. WHY DID WE DO IT: We wanted to understand how surgery affects people in the long term, especially whether they develop new disabilities that make daily life harder. This helps doctors know who might need extra care and support after surgery. WHAT WE FOUND: We found that about 1 in 8 people had new problems with daily activities one year after surgery. More people had problems soon after surgery, but some improved over time. People who had higher risk for surgery, had complications after surgery, or were already frail were more likely to have long‐term disability. Having social support did not seem to make a big difference in this study. This shows that preventing complications and supporting frail patients is very important for recovery.

OBJECTIVES: This study assessed whether reducing immediate perioperative anticholinergic burden improves functional recovery in older patients undergoing coronary artery bypass grafting (CABG). DESIGN: Prospective randomized controlled study. SETTING: Single-institution tertiary care hospital. PARTICIPANTS: One hundred twenty-two patients aged ≥60 years with preoperative Anticholinergic Cognitive Burden scores ≥3. INTERVENTIONS: Patients were assigned to either standard anesthetic and/or analgesic care including anticholinergic drugs (standard group) or a deprescribing strategy avoiding perioperative anticholinergic anesthetic and analgesic drugs (deprescribing group). MEASUREMENTS AND MAIN RESULTS: Primary outcomes were functional recovery on postoperative day 90 assessed using the Katz Index and the Clinical Frailty Scale. On postoperative day 90, full independence (Katz Index score of 6) was significantly more frequent in the deprescribing group than in the standard group (75.0% v 41.1%, p < 0.001). Frailty scores were significantly lower in the deprescribing group at 90 days (median, 3 [interquartile range (IQR), 3-3] v 4 [IQR, 3-4]; p < 0.001). Multivariate logistic regression identified perioperative use of anticholinergic anesthetic and analgesic drugs as an independent predictor of 90-day total complications (odds ratio, 2.430; 95% confidence interval, 1.031-5.726; p = 0.042). Within-group analyses showed decreased frailty scores and increased Katz Index scores from baseline to day 90 in the deprescribing group (p < 0.001 for both), whereas the standard group showed increased frailty (p < 0.001) with no significant change in Katz Index scores (p = 0.317). CONCLUSIONS: In older CABG patients, immediate perioperative deprescribing of anticholinergic medications improved 90-day functional recovery trajectories and was associated with fewer cardiac and pulmonary complications. Anticholinergic burden may represent a modifiable perioperative risk factor that should be routinely addressed in surgical care pathways to optimize outcomes in older adults.