Weekly Anesthesiology Research Analysis

This double-blind, placebo-controlled multicenter randomized trial across 23 French hospitals included 1,210 patients undergoing elective curative digestive cancer surgery. Preoperative methylprednisolone 20 mg/kg did not reduce major postoperative complications compared with placebo: 23% versus 20% among 1,188 patients with 30-day follow-up. No improvement was observed in infections, wound healing, hospital stay, or other secondary outcomes.

Impact: This large, rigorously designed randomized trial provides practice-changing negative evidence against routine high-dose corticosteroid use to prevent complications after elective digestive cancer surgery. It supports avoiding an ineffective intervention and reserving corticosteroids for established indications.

Clinical Implications: Routine preoperative methylprednisolone 20 mg/kg should not be recommended solely to reduce postoperative complications or inflammation in elective digestive cancer surgery. Corticosteroids should be used only for established clinical indications, with procedure-specific risks and benefits considered.

In this randomized trial of 100 older adults undergoing lumbar spine fusion, electroencephalographic spectrogram-guided dexmedetomidine-ketamine anesthesia produced a smaller decline in 24-hour QoR-15 scores than conventional balanced anesthesia. It reduced sevoflurane, intraoperative fentanyl, and PACU morphine use, but increased norepinephrine and atropine requirements. Possible reductions in 3-month pain were exploratory.

Impact: The study combines brain-pattern-guided anesthetic titration with multimodal, opioid-sparing pharmacology and demonstrates a patient-centered early recovery benefit in a high-pain surgical population. It represents an emerging precision-anesthesia strategy while clearly identifying hemodynamic trade-offs.

Clinical Implications: This approach may be considered for older adults undergoing lumbar spine fusion when reducing opioid and volatile-anesthetic exposure is desirable. Close hemodynamic monitoring and readiness to use vasopressors or atropine are necessary, and broader adoption should await larger multicenter trials.

This three-round modified Delphi study obtained complete participation from 60 nationally representative anesthesiology stakeholders. Consensus recommendations proposed new minimum requirements for arterial lines, central lines, fiberoptic intubation, one-lung ventilation, neuromonitoring, point-of-care ultrasound, and non-operating-room anesthesia. Increased requirements were also supported for peripheral nerve blocks and cardiac cases, although competency-based implementation and local feasibility remain important.

Impact: The study converts concerns that residency case logs are outdated into specific national consensus recommendations that can directly inform anticipated 2027 ACGME revisions. Its potential impact extends across anesthesiology education, procedural competency, and future workforce preparedness.

Clinical Implications: Residency programs and accrediting organizations can use the proposed categories and thresholds to improve exposure to invasive monitoring, advanced airway management, lung isolation, neuromonitoring, POCUS, regional anesthesia, and non-operating-room anesthesia. Case numbers should supplement, not replace, competency assessment, supervision quality, simulation, and equitable access to cases.