Joshi GP, Abdelmalak BB, Weigel WA, et al. · Anesthesiology (2023)
Updated fasting guidelines permitting clear liquids up to 2 hours before elective procedures for healthy patients. Endorses carbohydrate-rich clear drinks for enhanced recovery. Provides new guidance on fasting intervals for patients with obesity and diabetes.
Clinical ImpactLiberalized fasting guidelines reduce patient discomfort and support ERAS protocols without increasing aspiration risk.
generalpediatric
Barberan-Garcia A, Ubre M, Roca J, et al. · Annals of Surgery (2023)
RCT of structured prehabilitation (exercise, nutrition, psychological support) versus standard care before major cancer surgery. Prehabilitation improved functional capacity by 20% and reduced postoperative complications (Clavien-Dindo grade II+) by 30%.
Clinical ImpactStructured prehabilitation programs should be considered standard of care before major elective surgery in deconditioned patients.
general
Douketis JD, Spyropoulos AC, Murad MH, et al. · JAMA Internal Medicine (2023)
Comprehensive review covering perioperative bridging decisions, DOAC hold times, and resumption protocols. Recommends against routine bridging for most patients on warfarin with atrial fibrillation. Provides procedure-specific risk stratification for bleeding versus thrombosis.
Clinical ImpactRoutine bridging anticoagulation is unnecessary for most AF patients on warfarin undergoing elective procedures.
cardiacgeneral
Forget P, Cata JP, et al. · Anesthesiology (2023)
Systematic review of opioid-free anesthesia (OFA) techniques including dexmedetomidine, ketamine, lidocaine, and magnesium combinations. Found OFA reduces PONV and may improve immediate recovery but has limited evidence for long-term outcomes. OFA is not appropriate for all surgical contexts.
Clinical ImpactOFA is a promising approach for PONV-prone patients and selected procedures, but should not be universally adopted without more robust long-term outcome data.
paingeneral
Apfelbaum JL, Hagberg CA, Connis RT, et al. · Anesthesiology (2022)
Major revision of the ASA Difficult Airway Algorithm incorporating video laryngoscopy as a first-line approach. Emphasizes cognitive aids, team-based communication, and updated emergency invasive airway access techniques. Introduces a simplified decision pathway for the "cannot intubate, cannot oxygenate" scenario.
Clinical ImpactVideo laryngoscopy should be considered as the initial intubation approach rather than reserved as a rescue device.
airwaygeneral
Gustafsson UO, Scott MJ, Hubner M, et al. · World Journal of Surgery (2022)
Comprehensive perioperative care pathway for colorectal surgery covering preoperative optimization, intraoperative fluid and analgesia management, and early mobilization. Recommends multimodal opioid-sparing analgesia including regional techniques and goal-directed fluid therapy.
Clinical ImpactAdoption of the full ERAS bundle reduces hospital stay by 2-3 days and decreases postoperative complications by up to 40%.
generalpain
Postoperative Cognitive Dysfunction in Elderly Patients: Mechanisms and Prevention
Evered L, Silbert B, Knopman DS, et al. · British Journal of Anaesthesia (2022)
State-of-the-art review on perioperative neurocognitive disorders using standardized NCD nomenclature. Reviews neuroinflammation as a key mechanism and discusses modifiable risk factors including depth of anesthesia, BIS-guided protocols, and dexmedetomidine use for delirium prevention.
Clinical ImpactAvoiding deep anesthesia (BIS <40) and using multimodal delirium prevention protocols can reduce postoperative cognitive decline in elderly patients.
neurogeneral
Horlocker TT, Vandermeuelen E, Kopp SL, et al. · Regional Anesthesia & Pain Medicine (2021)
Fourth edition of the definitive guidelines for neuraxial and peripheral nerve blocks in anticoagulated patients. Includes updated hold times for DOACs, guidance on anti-platelet agents, and risk stratification for catheter removal. Introduces new recommendations for subcutaneous heparin dosing.
Clinical ImpactProvides clear hold-time intervals for all modern anticoagulants before neuraxial procedures, reducing spinal hematoma risk.
regionalpain
ASA Standards for Basic Anesthetic Monitoring (2020 Update)
American Society of Anesthesiologists Committee on Standards · Anesthesiology (2020)
Reaffirms requirements for continuous oxygenation, ventilation, circulation, and temperature monitoring during all anesthetics. Clarifies the role of capnography during moderate and deep sedation. Emphasizes qualified anesthesia personnel presence throughout every case.
Clinical ImpactCapnography is now mandated during moderate and deep sedation, not just general anesthesia.
general
Guay J, Parker MJ, Griffiths R, et al. · Cochrane Database of Systematic Reviews (2020)
Systematic review of 45 trials (8,872 patients) comparing regional vs general anesthesia for hip fracture repair. Found no significant difference in 30-day mortality. Regional anesthesia was associated with lower rates of DVT and reduced acute postoperative confusion.
Clinical ImpactNeither technique has a clear mortality benefit for hip fracture; choice should consider patient factors, with regional potentially reducing delirium.
regionalgeneral
Dexmedetomidine for Procedural Sedation: A Systematic Review and Meta-Analysis
Bao N, Tang B, et al. · PLOS ONE (2020)
Meta-analysis of 25 RCTs comparing dexmedetomidine to propofol or midazolam for procedural sedation. Dexmedetomidine provided comparable sedation with less respiratory depression and more hemodynamic stability. Main disadvantage was slower onset and more frequent bradycardia.
Clinical ImpactDexmedetomidine is a viable sedation option when respiratory depression must be minimized, such as in awake fiber-optic intubation or ICU sedation.
generalneuro
Neal JM, Barrington MJ, Fettiplace MR, et al. · Regional Anesthesia & Pain Medicine (2020)
Updated ASRA advisory on LAST prevention, recognition, and treatment. Emphasizes weight-based dosing limits, ultrasound-guided techniques to reduce vascular injection, and immediate lipid emulsion therapy (Intralipid 20%) for cardiovascular collapse. Recommends at least 15 minutes of monitoring after blocks.
Clinical ImpactIntralipid 20% (1.5 mL/kg bolus) should be immediately available wherever regional anesthesia is performed.
regionalpain
Wildes TS, Mickle AM, Ben Abdallah A, et al. · New England Journal of Medicine (2019)
Large multicenter RCT of 6,331 adults randomized to BIS-guided or ETAG-guided anesthesia. Found no significant difference in awareness rates between groups (0.16% vs 0.19%). BIS monitoring did not reduce postoperative delirium or 30-day mortality.
Clinical ImpactRoutine BIS monitoring does not reduce awareness compared to ETAG-guided protocols; clinical judgment remains paramount.
generalneuro
Futier E, Lefrant JY, Guinot PG, et al. · Anesthesiology (2019)
Multicenter RCT (n=2,222) comparing individualized MAP targets (within 10% of baseline) versus standard care (MAP >60 mmHg). Individualized blood pressure management reduced the risk of postoperative organ dysfunction composite outcome.
Clinical ImpactMaintaining MAP within 10% of preoperative baseline may reduce organ dysfunction compared to a fixed MAP >60 mmHg threshold.
cardiacgeneral
Kirmeier E, Eriksson LI, Lewald H, et al. · Lancet Respiratory Medicine (2019)
Prospective cohort of 22,803 patients across 211 hospitals found that use of neuromuscular blocking agents was associated with increased postoperative pulmonary complications. Quantitative neuromuscular monitoring at extubation and neostigmine reversal reduced complication rates.
Clinical ImpactQuantitative NMB monitoring should be standard practice; clinical assessment alone is insufficient to exclude residual paralysis.
general
Wijeysundera DN, Pearse RM, Shulman MA, et al. · Journal of the American Medical Association (2018)
Multicenter prospective study of 1,401 patients found that CPET-derived peak VO2 and AT were only moderate predictors of 30-day death or complications. Subjective functional assessment had comparable predictive value for many patients.
Clinical ImpactCPET adds modest prognostic value beyond standard clinical assessment and should not be used as a sole gatekeeper for surgery.
cardiacgeneral
DREAMS Trial Collaborators · British Medical Journal (2017)
Multicenter RCT of 1,350 patients undergoing major GI surgery. A single 8 mg dose of IV dexamethasone at induction reduced PONV by 33% and was associated with earlier return to oral intake. No increase in surgical site infection or impaired glucose control was observed.
Clinical ImpactSingle-dose dexamethasone 8 mg at induction is safe and effective PONV prophylaxis even in major abdominal surgery.
general
Hristovska AM, Duch P, Allingstrup M, et al. · Anesthesiology (2017)
Meta-analysis of 41 RCTs (n=4,206) found sugammadex provides faster, more reliable reversal of neuromuscular blockade compared to neostigmine. Sugammadex reduced residual paralysis (TOF <0.9) from 40% to 3% and shortened time to TOF 0.9 by approximately 12 minutes.
Clinical ImpactSugammadex virtually eliminates residual neuromuscular blockade when dosed appropriately, improving patient safety at extubation.
general
Devereaux PJ, Sessler DI, Leslie K, et al. · New England Journal of Medicine (2014)
Large factorial trial (n=10,010) found perioperative aspirin did not reduce MI or death but increased major bleeding. Perioperative clonidine did not reduce MI or death but increased clinically significant hypotension and non-fatal cardiac arrest.
Clinical ImpactPerioperative aspirin initiation should be avoided in non-cardiac surgery, and clonidine should not be started for cardiovascular risk reduction.
cardiacgeneral
Myles PS, Leslie K, Chan MT, et al. · Anesthesiology (2014)
Multicenter RCT of 7,112 patients with cardiac risk factors undergoing non-cardiac surgery. 70% N2O vs N2O-free anesthesia showed no significant difference in death or cardiovascular complications at 30 days. N2O slightly increased PONV.
Clinical ImpactNitrous oxide does not increase cardiovascular risk in at-risk surgical patients but offers no protective benefit and increases PONV.
cardiacgeneral
Abdallah FW, Chan VW, Brull R. · Anesthesia & Analgesia (2012)
Meta-analysis of 18 RCTs evaluating transversus abdominis plane blocks for post-abdominal surgery analgesia. TAP blocks reduced 24-hour morphine consumption by approximately 15 mg and provided superior pain scores compared to placebo for the first 24 hours post-surgery.
Clinical ImpactTAP blocks are an effective component of multimodal analgesia for abdominal surgery, particularly when neuraxial techniques are contraindicated.
regionalpain