Weekly Anesthesiology Research Analysis
This week’s anesthesiology literature highlights pragmatic trials and actionable perioperative strategies: a multicenter RCT shows lateral-position bronchial blocker placement dramatically reduces malposition in thoracic surgery; OPTPRESS demonstrates harm from high MAP targets (80–85 mmHg) in older septic-shock patients; and multimodal prehabilitation lowers postoperative pulmonary complications after lung resection. Across the week, advances emphasized opioid-sparing pathways, individualized v
Summary
This week’s anesthesiology literature highlights pragmatic trials and actionable perioperative strategies: a multicenter RCT shows lateral-position bronchial blocker placement dramatically reduces malposition in thoracic surgery; OPTPRESS demonstrates harm from high MAP targets (80–85 mmHg) in older septic-shock patients; and multimodal prehabilitation lowers postoperative pulmonary complications after lung resection. Across the week, advances emphasized opioid-sparing pathways, individualized ventilation/PEEP titration, and perioperative risk stratification for thrombosis and airway events.
Selected Articles
1. Lung isolation with a bronchial blocker placed in the lateral position for patients undergoing thoracic surgery: A multicenter, randomized clinical trial.
In a multicenter randomized clinical trial of 306 patients, placing a bronchial blocker in the lateral decubitus position reduced malposition from 25.3% to 0.7%, decreased the need for repositioning and postural injuries, and increased patient and surgeon satisfaction without prolonging intubation time.
Impact: Massive absolute reduction in a common intraoperative problem; directly implementable technique likely to change standard practice and reduce repeated fiberoptic adjustments and related complications.
Clinical Implications: Adopt lateral-position bronchial blocker placement for thoracic procedures to minimize malposition, reduce intraoperative interruptions and posture-related injuries, and improve surgical workflow and oxygenation stability.
Key Findings
- Malposition incidence: 0.7% (lateral) vs 25.3% (supine); P < 0.001
- Fewer repositioning maneuvers in lateral group (median 0 vs 1; P < 0.001)
- Lower incidence of postural injury and higher patient/surgeon satisfaction without longer intubation time
2. Efficacy of targeting high mean arterial pressure for older patients with septic shock (OPTPRESS): a multicentre, pragmatic, open-label, randomised controlled trial.
OPTPRESS randomized 518 septic shock patients aged ≥65 to MAP targets of 80–85 mmHg versus 65–70 mmHg and was stopped early for harm: 90-day mortality was higher in the high-target group (39.3% vs 28.6%; absolute difference 10.7%). Renal replacement therapy–free days were shorter with higher MAP and no subgroup (including those with chronic hypertension) benefited.
Impact: Definitive pragmatic evidence that aiming for higher MAP targets in older septic patients causes harm — immediate implications for vasopressor titration protocols and guidelines.
Clinical Implications: Maintain MAP targets around 65–70 mmHg in older septic-shock patients; avoid systematic escalation to 80–85 mmHg even when baseline hypertension exists, and review vasopressor titration protocols to prevent overtitration.
Key Findings
- 90-day mortality: 39.3% (high MAP) vs 28.6% (control); absolute difference 10.7% (95% CI 2.6–18.9)
- Renal replacement therapy–free days at 28 days fewer in high-target group
- No subgroup, including patients with chronic hypertension, benefited from higher MAP targets
3. Multimodal prehabilitation before lung resection surgery: a multicentre randomised controlled trial.
A multicentre RCT (n=122) in high-risk lung resection candidates found multimodal prehabilitation (including high-intensity respiratory muscle training) reduced postoperative pulmonary complications from 55% to 34% (OR 2.29, P=0.029) and shortened median hospital stay from 9 to 7 days.
Impact: High-quality randomized evidence that a scalable prehabilitation program reduces clinically meaningful pulmonary complications and length of stay in a high-risk surgical population.
Clinical Implications: Implement structured multimodal prehabilitation (respiratory muscle training, exercise, education/nutrition) for high-risk lung resection candidates to reduce PPCs and shorten hospitalization; integrate into preoperative pathways where feasible.
Key Findings
- Postoperative pulmonary complications: 34% (prehabilitation) vs 55% (usual care); OR 2.29 (95% CI 1.10–4.77); P=0.029
- Hospital length of stay median reduced from 9 to 7 days (P=0.038)
- Intervention included high-intensity respiratory muscle training as a core component