Daily ReportOct 28, 2026
Anesthesiology, October 28 edition
We read 48 papers and selected 3.
Summary
Today’s most impactful anesthesiology research included a multidisciplinary, procedure-specific framework for perioperative anticoagulant management, a randomized trial showing superior recovery after infraorbital nerve block compared with sphenopalatine ganglion block in septorhinoplasty, and an umbrella review clarifying the recovery and safety trade-offs among desflurane, sevoflurane, and propofol. Collectively, these studies emphasize individualized, evidence-informed anesthesia planning while highlighting areas where evidence certainty remains limited.
Research Themes
- Individualized periprocedural bleeding-risk assessment and anticoagulant management
- Regional anesthesia and patient-reported postoperative recovery
- Comparative effectiveness and safety of maintenance anesthetics
Selected Articles
1. Procedure-specific bleeding risk assessment: a multidisciplinary expert consensus companion to the 2026 periprocedural anticoagulant management guidelines.
This multidisciplinary consensus developed a standardized bleeding-risk classification covering 24 procedural domains, including regional anesthesia, digestive endoscopy, cardiac surgery, neurosurgery, and ophthalmology. It identifies procedures requiring delayed anticoagulant resumption or short-acting/reversible anticoagulants, thereby translating heterogeneous evidence into a practical framework for individualized decision-making.
Impact: Periprocedural anticoagulant decisions are common, high-stakes clinical problems, yet existing classifications are fragmented and inconsistent. This framework has broad potential to improve communication, reduce preventable bleeding or thrombotic events, and standardize care across specialties.
Clinical Implications: Clinicians can use the procedure-specific categories to determine whether anticoagulants should be continued, interrupted, resumed after a delay of at least 72 hours, or replaced temporarily with a short-acting or reversible agent. The framework is particularly relevant to neuraxial and regional anesthesia planning, but should be integrated with patient-specific thrombotic risk, renal function, and procedural factors.
Key Findings
- A standardized bleeding-risk framework was developed across 24 procedural domains.
- The classification includes regional anesthesia, endoscopy, cardiac surgery, neurosurgery, ophthalmology, and other major procedural areas.
- Procedures requiring delayed anticoagulant resumption of at least 72 hours or use of short-acting/reversible anticoagulants were specifically identified.
Methodological Strengths
- Formal multidisciplinary consensus involving 24 surgical and interventional specialty societies.
- Systematic literature review performed within each procedural domain and explicit classification of evidence-limited scenarios.
Limitations
- Some classifications necessarily relied on expert opinion because high-quality comparative evidence was unavailable.
- The framework requires prospective validation to determine whether its implementation improves bleeding, thrombotic, and patient-centered outcomes.
Future Directions: Future studies should prospectively validate the classification, quantify inter-rater agreement, assess implementation in electronic clinical decision-support systems, and evaluate effects on perioperative bleeding, thromboembolism, cancellations, and resource use.
BACKGROUND: Periprocedural anticoagulant management requires balancing thrombotic risk against procedure-specific bleeding risk. Existing procedure bleeding risk classifications are fragmented across specialties, inconsistent in methodology, and rarely extend beyond a few procedural domains, limiting their clinical applicability. OBJECTIVE: To develop a comprehensive, standardized, procedure-specific bleeding risk classification to accompany the 2026 GIHP-SFAR periprocedural anticoagulant management guidelines. METHODS: A formal multidisciplinary consensus was conducted under the auspices of GIHP and SFAR, in collaboration with 24 surgical and interventional specialty societies.
2. Infraorbital versus sphenopalatine ganglion block for patient-reported recovery after septorhinoplasty: A randomized controlled trial.
In this patient- and assessor-blinded randomized trial, bilateral ultrasound-guided infraorbital nerve block produced better 24-hour QoR-15 recovery scores than bilateral transnasal sphenopalatine ganglion block after septorhinoplasty. Pain was lower at all assessed time points and rescue analgesia was required less often, while nausea, anesthetic consumption, and recovery-room stay were similar.
Impact: The trial directly compares two clinically used regional techniques using a patient-centered recovery endpoint rather than pain alone. The magnitude of benefit exceeded the prespecified minimal clinically important difference, supporting a potentially practice-changing analgesic strategy for septorhinoplasty.
Clinical Implications: For elective septorhinoplasty, bilateral ultrasound-guided infraorbital nerve block may be considered as an alternative to transnasal sphenopalatine ganglion block to improve early patient-reported recovery and reduce postoperative pain and rescue analgesic use. Operator training and confirmation in broader surgical populations are still needed.
Key Findings
- QoR-15 at 24 hours was higher with infraorbital nerve block than with sphenopalatine ganglion block: 129.1 versus 116.6 points.
- The between-group difference of 12.5 points exceeded the prespecified minimal clinically important difference of 8 points.
- Rescue analgesia was required in 11.4% of the infraorbital group versus 53.3% of the sphenopalatine ganglion group.
Methodological Strengths
- Prospective randomized, patient- and assessor-blinded parallel-group design.
- Use of a validated patient-reported recovery instrument with a prespecified minimal clinically important difference.
Limitations
- The study was single-center and included a relatively small sample of mostly healthy ASA I-II adults.
- Secondary outcomes should be interpreted as supportive or hypothesis-generating rather than definitive.
Future Directions: Multicenter trials should compare infraorbital nerve block with other regional and local infiltration strategies, evaluate procedure-specific complications and long-term recovery, and assess effectiveness in patients with more substantial comorbidity and varied surgical techniques.
STUDY OBJECTIVE: To compare ultrasound-guided infraorbital nerve block with transnasal sphenopalatine ganglion block on recovery quality 24 h after septorhinoplasty. DESIGN: Prospective, randomized, patient- and assessor-blinded, parallel-group trial. SETTING: Tertiary training hospital; operating room and postoperative ward. PATIENTS: Ninety adults aged 18 to 65 years, ASA physical status I or II, undergoing elective septorhinoplasty; 89 were analyzed. INTERVENTIONS: After induction of general anesthesia, patients received bilateral transnasal sphenopalatine ganglion block (SPG group) or bilateral ultrasound-guided infraorbital nerve block (IO group), 2 mL of 0.5% bupivacaine per side.
3. Evidence for formulating recommendations on the use of desflurane vs sevoflurane and propofol in general anaesthesia: an umbrella review.
This umbrella review synthesized 31 systematic reviews using AMSTAR 2 and GRADE. Desflurane generally provided faster recovery than sevoflurane, but the certainty of evidence was low or very low; comparisons with propofol were less consistent, and propofol may offer advantages for postoperative nausea and vomiting and emergence agitation.
Impact: The study consolidates a large body of comparative anesthetic evidence into a clinically usable interpretation and explicitly communicates uncertainty. Its main contribution is to discourage routine preference based solely on recovery speed and to support individualized anesthetic selection.
Clinical Implications: Desflurane may be conditionally selected when rapid emergence is a priority, particularly when compared with sevoflurane, but clinicians should not assume superiority for overall morbidity or recovery compared with propofol. Patient characteristics, postoperative nausea and vomiting risk, emergence agitation risk, environmental considerations, and institutional resources should inform the choice.
Key Findings
- Thirty-one systematic reviews published between 2014 and 2024 were included.
- Desflurane was consistently associated with faster recovery than sevoflurane, but certainty of evidence was low or very low.
- No clinically relevant morbidity differences were identified overall; propofol may be advantageous for postoperative nausea and vomiting and emergence agitation.
Methodological Strengths
- Umbrella review design integrating evidence from 31 systematic reviews.
- Use of AMSTAR 2 for methodological quality and GRADE for certainty of evidence.
Limitations
- Most clinically relevant conclusions were supported by low- or very-low-certainty evidence.
- Heterogeneity across patient subgroups, procedures, anesthetic protocols, and recovery definitions may limit direct comparability.
Future Directions: Future comparative effectiveness studies should use standardized recovery and patient-centered outcomes, report clinically important morbidity consistently, incorporate environmental and cost outcomes, and identify patient subgroups most likely to benefit from each maintenance strategy.
OBJECTIVE: To evaluate the efficacy, effectiveness, and safety of desflurane compared with sevoflurane and propofol for the maintenance of general anaesthesia across different patient subgroups. METHODS: Umbrella review including evidence synthesis studies published between 2014 and 2024. Methodological quality was assessed using AMSTAR 2, and certainty of evidence using the GRADE approach. RESULTS: Thirty-one systematic reviews were included. Desflurane was consistently associated with faster recovery than sevoflurane across the analysed subgroups, although the certainty of evidence was low or very low. Compared with propofol, favourable findings for desflurane in selected early recovery outcomes were less consistent.