Anesthesiology

Higher intraoperative mechanical power predicts impaired oxygenation and PPCs after orthopedic surgery

In 2,860 orthopedic surgeries, higher time-weighted mechanical power per predicted bodyweight correlated with worse postoperative oxygenation and more pulmonary complications. Each 0.1 J/min/kg PBW increase reduced PACU SpO₂/FiO₂ by 11 points and ward SpO₂/FiO₂ by 8 points. The same increment increased postoperative pulmonary complication odds by 55%, without affecting hospital length of stay. Models using peak or driving pressure explained nearly the same postoperative oxygenation variance as mechanical power. These data support targeting lower driving pressures and mechanical power in routine orthopedic cases to mitigate pulmonary risk. 1

Simple room-air Air-Test helps exclude severe PPCs after major surgery

In 3,268 general anaesthesia patients, the Air-Test used pre- and postoperative room-air SpO₂ to predict severe PPCs within seven days. A positive Air-Test nearly doubled severe PPC odds in both training and validation cohorts. Overall discrimination was modest, but negative predictive value remained high at 95–96% in both cohorts. Sensitivity was about 53–54% and specificity 59–60%, with low positive predictive values of 6–8%. Clinically, a negative Air-Test can reassure that severe PPCs are unlikely, guiding early triage and step-down decisions. 2

Consensus backs regional, opioid-sparing analgesia for major lower extremity amputation

A UK Delphi study of 72 anaesthetists and vascular surgeons generated 32 consensus statements for pain management in major lower extremity amputation. Experts endorsed shared cross-specialty responsibility for analgesia rather than siloed ownership. Locoregional techniques, including perineural catheters, were viewed as the mainstay, within opioid-sparing multimodal protocols and decision aids. Barriers included resource constraints and limited direct evidence, especially around ultrasound-guided catheters and surgeon-delivered regional techniques. Non-consensus on pre-amputation regional initiation identifies priority topics for future research and pathway development. 3

Aortic stenosis substantially increases perioperative mortality and cardiac complications in non-cardiac surgery

This meta-analysis of 19 studies and 100,486 patients quantified perioperative risk in non-cardiac surgery with aortic stenosis. Estimated all-cause in-hospital or 30-day mortality was 3.8% for any aortic stenosis and 9.6% for severe aortic stenosis. Across 14 comparative studies including over 2.8 million patients, aortic stenosis increased mortality risk by 58% versus no aortic stenosis. Risks of postoperative myocardial infarction and heart failure were also higher, with relative risks 1.79 and 2.06, respectively. These findings highlight the need for meticulous haemodynamic management, enhanced monitoring, and careful case selection in aortic stenosis patients. 4