Weekly ReportJun 29 – Jul 5, 2026
Anesthesiology, week 27 edition
We read 672 papers and selected 3.
Summary
This week’s anesthesiology literature emphasized individualized perioperative risk management, hemodynamic optimization, and recovery-focused anesthesia. The HISTAP multicenter RCT showed that targeting intraoperative MAP ≥80 mmHg reduced major organ dysfunction, particularly acute kidney injury, in older hypertensive patients undergoing major abdominal surgery. Intraoperative dexmedetomidine markedly reduced first-night postoperative sleep disturbance in older adults, while a large international cohort demonstrated that biological age independently predicts postoperative mortality and complications beyond conventional risk scores. Additional advances included more precise noninvasive respiratory support selection, ultrasound-based difficult-airway prediction, and environmentally sustainable intensive care.
Selected Articles
1. HIgh versus STAndard blood Pressure target in hypertensive high-risk patients undergoing elective major abdominal surgery: the HISTAP multicenter randomized clinical trial.
In 630 older hypertensive high-risk adults undergoing major abdominal surgery, targeting intraoperative MAP ≥80 mmHg rather than ≥65 mmHg reduced the composite of 30-day mortality or major organ dysfunction from 48.9% to 38.1% (RR 0.78). The benefit was primarily driven by lower acute kidney injury rates, achieved with continuous monitoring and protocolized fluid management.
Impact: This multicenter randomized trial directly challenges a one-size-fits-all blood pressure target and provides practice-directing evidence for higher intraoperative MAP in a clearly defined hypertensive population.
Clinical Implications: For older hypertensive patients undergoing major abdominal surgery, clinicians should consider targeting MAP ≥80 mmHg with continuous hemodynamic monitoring and protocolized fluids, while individualizing vasopressor exposure and assessing cardiovascular tolerance.
Key Findings
- The primary composite outcome was 38.1% with MAP ≥80 mmHg versus 48.9% with MAP ≥65 mmHg (RR 0.78; P=0.006).
- Acute kidney injury occurred in 23.5% versus 33.7%, respectively (P=0.005).
- The achieved mean MAP was 88±9 mmHg versus 77±7 mmHg under continuous monitoring and protocolized fluid therapy.
2. Intraoperative dexmedetomidine reduces postoperative sleep disturbance in older adults undergoing major abdominal surgery: a single-center, randomized, double-blind, placebo-controlled trial.
In a randomized double-blind trial of 203 evaluable older adults, intraoperative dexmedetomidine at 0.3 or 0.6 μg/kg/h substantially reduced first-night postoperative sleep disturbance compared with saline, with relative risks of 0.31 and 0.18 and an approximate NNT of 2. Benefits extended to second-night sleep and early recovery without significant increases in hypotension, bradycardia, delirium, or 30-day mortality.
Impact: This trial identifies a common anesthetic adjunct as a potentially powerful, low-complexity intervention for postoperative sleep disruption, an important but often neglected determinant of recovery in older adults.
Clinical Implications: A low-dose intraoperative dexmedetomidine infusion may be considered for older adults undergoing major abdominal surgery to improve early sleep and recovery, with routine monitoring for hemodynamic adverse effects.
Key Findings
- First-night sleep disturbance decreased from 65.7% with saline to 20.6% with low-dose and 11.8% with high-dose dexmedetomidine.
- Relative risks were 0.31 and 0.18, with an approximate number needed to treat of 2.
- No significant increase in hypotension, bradycardia, delirium, or 30-day mortality was observed.
3. Biological aging increases risk of postoperative morbidity and mortality: an international, multi-cohort study.
Across more than 430,000 surgical patients from the UK, USA, and South Korea, PhenoAge independently predicted 1-year mortality, major adverse cardiovascular events, readmission, and early postoperative complications beyond chronological age, frailty, comorbidity, ASA status, and surgical complexity. Patients classified as fast agers had 49% higher mortality risk than normal agers, and findings were replicated across independent cohorts and prospectively validated.
Impact: The study advances perioperative risk prediction from chronological age to measurable biological aging, with exceptional sample size, international replication, and prospective validation using routine laboratory data.
Clinical Implications: PhenoAge could support preoperative counseling, targeted prehabilitation, geriatric anesthesia planning, and selection of patients requiring enhanced postoperative monitoring, although prospective intervention studies are still needed.
Key Findings
- PhenoAge independently predicted 1-year mortality, major adverse cardiovascular events, and 30-day readmission.
- Fast agers had a 49% higher mortality risk than normal agers.
- The findings were replicated in three independent cohorts and prospectively validated for acute 3-day complications.