Weekly Anesthesiology Research Analysis

In a double‑blind, placebo‑controlled RCT of 204 women with baseline sleep disturbance undergoing surgical abortion, a single intravenous esketamine 0.2 mg/kg given at procedure start reduced first‑night postoperative sleep disturbance (47.1% vs 71.6%; OR 0.35) without serious treatment‑related adverse events.

Impact: High‑quality randomized evidence in a high‑impact journal showing a simple, low‑dose intraoperative pharmacologic intervention can improve an important patient‑centered outcome (postoperative sleep) with good safety, suggesting immediate translational potential.

Clinical Implications: Consider perioperative low‑dose esketamine (0.2 mg/kg) as an adjunct for patients with pre‑existing sleep disturbance undergoing short gynecologic procedures to improve early postoperative sleep quality, after evaluating individual risk‑benefit.

This comprehensive meta‑analysis of 162 studies (675,361 patients) found postoperative AKI after abdominal surgery occurs in ~16% and is associated with stage‑dependent increases in short‑ and long‑term mortality and hospital stay. Importantly, pooled RCT data showed individualized intraoperative blood pressure targets reduced AKI risk (RR 0.67).

Impact: By quantifying AKI burden across procedures and identifying a modifiable strategy (individualized BP targets) with RCT evidence of efficacy, this synthesis directly informs anesthetic hemodynamic management and guideline development.

Clinical Implications: Prioritize individualized intraoperative MAP targets tailored to patient baseline and comorbidities to reduce AKI risk; incorporate AKI risk stratification and bundles rather than relying on single perioperative interventions like fluid type alone.

In a randomized trial of 168 adults undergoing CRS with cisplatin‑based HIPEC, targeting higher intraoperative urine output (≥3 mL/kg/h or ≥200 mL/h) versus routine hydration (≥0.5 mL/kg/h) reduced 7‑day AKI (21.4% vs 39.3%; RR 0.55) and 30‑day major complications without increasing adverse events.

Impact: A pragmatic, randomized intraoperative fluid strategy that produced a clinically meaningful (>40%) reduction in AKI in a high‑risk surgical population — immediately relevant for perioperative protocols and renal‑protective bundles.

Clinical Implications: Implement urine‑guided intraoperative hydration targets (e.g., ≥3 mL/kg/h or ≥200 mL/h) in CRS‑HIPEC and consider testing in other high‑risk, high‑blood‑loss procedures to reduce AKI and complications, while balancing hemodynamic goals and nephrotoxicity risks.