Daily Anesthesiology Research Analysis

In this pragmatic multicenter randomized trial of 2508 adults aged 50 years or older undergoing major noncardiac surgery, TIVA did not increase days alive and at home at 30 days compared with volatile anesthesia. Mortality, delirium, quality of recovery, and major postoperative complications were also similar, although TIVA was associated with less thirst, hoarseness, and nausea and vomiting.

Impact: This large, pragmatic randomized trial directly addresses a longstanding anesthetic technique debate using a patient-centered recovery outcome. Its null result supports individualized selection of TIVA or volatile anesthesia rather than routine preference for one technique.

Clinical Implications: Clinicians should not expect TIVA to improve short-term recovery or major safety outcomes solely because of the anesthetic technique. Choice of TIVA versus volatile anesthesia can be guided by patient characteristics, procedural requirements, clinician expertise, resource availability, and preferences regarding symptoms such as nausea or hoarseness.

Future Directions: Future research should examine whether specific surgical subgroups, frail patients, or patients at high risk for postoperative nausea, delirium, or cognitive dysfunction derive differential benefit from either technique, and should evaluate longer-term functional outcomes and environmental effects.

This multicenter retrospective cohort analyzed 289,047 cesarean deliveries and quantified adherence to several guideline-supported obstetric anesthesia practices. Adherence was high for avoidance of general anesthesia and maintenance of post-spinal systolic blood pressure, but substantially lower for perioperative hypothermia prevention and post-spinal vasopressor infusion, with poorer performance associated with higher patient acuity, off-hours cases, and less specialized institutions.

Impact: By converting guideline recommendations into measurable multicenter performance indicators, this study identifies specific, actionable quality gaps in cesarean anesthesia care. The results can support targeted audit-and-feedback programs, protocol redesign, and resource allocation without assuming that overall guideline adherence is uniform.

Clinical Implications: Obstetric anesthesia services should prioritize systems-based interventions for perioperative temperature management and post-spinal vasopressor infusion, particularly during nighttime or emergency cesarean deliveries and in hospitals without obstetric fellowship or Center of Excellence status. Local dashboards and feedback may help reduce practice variation.

Future Directions: Future studies should test targeted implementation strategies, such as electronic order sets, real-time temperature and blood pressure dashboards, standardized vasopressor protocols, and audit-and-feedback interventions, while measuring maternal, neonatal, and operational outcomes.

Using propensity-score-matched electronic health record data from adults with type 2 diabetes undergoing anesthesia, preoperative GLP-1 receptor agonist use was associated with lower short-term mortality than metformin or DPP-4 inhibitor use. Importantly, GLP-1 receptor agonists were not associated with increased aspiration pneumonitis, emergency intubation, or other major postoperative safety outcomes, although residual confounding remains possible.

Impact: This study directly informs the rapidly evolving perioperative debate over whether GLP-1 receptor agonists should be withheld before anesthesia. The absence of an observed increase in aspiration-related outcomes challenges blanket medication-holding policies, while the observational design appropriately limits causal interpretation.

Clinical Implications: Preoperative GLP-1 receptor agonist use should not automatically be interpreted as increasing aspiration risk based on these data. Medication decisions should remain individualized, incorporating gastrointestinal symptoms, delayed gastric emptying risk, glycemic status, procedure urgency, and current institutional guidance until prospective trials are available.

Future Directions: Prospective multicenter studies should stratify patients by GLP-1 receptor agonist type, dose, timing of the last dose, gastrointestinal symptoms, gastric ultrasound findings, and procedure risk to define which patients require medication interruption or additional aspiration precautions.