Perioperative oliguria is a renal signal during anesthesia, but its automatic interpretation as acute kidney injury may misclassify renal endpoints in anesthetic research. The available evidence is strongest for sevoflurane rather than for volatile anesthetics as a homogeneous class. Small mechanistic and randomized clinical studies suggest that sevoflurane can reduce urine output and natriuresis and increase renin activity compared with propofol-based total intravenous anesthesia, consistent with renal sympathetic and renin–angiotensin–aldosterone system-mediated sodium and water retention. However, these excretory differences have not been consistently accompanied by parallel increases in tubular injury biomarkers or by uniform differences in creatinine-defined or patient-centered kidney outcomes. Therefore, sevoflurane-associated oliguria should be interpreted as a context-dependent renal signal rather than as either benign physiology or definite kidney injury. This narrative review proposes a layered approach that separates excretory physiology, creatinine-defined functional acute kidney injury, tubular stress or injury biomarkers, and patient-centered kidney outcomes. The framework is intended as an analytical aid, not as a validated diagnostic or treatment algorithm. Its practical implication is that oliguria during sevoflurane anesthesia should prompt reassessment of perfusion, venous congestion, anesthetic exposure, baseline kidney risk, and postoperative trajectory before reflexive fluid administration or automatic labeling as acute kidney injury.
The optimal central venous catheter (CVC) tip position remains controversial. Shallow placement above the pericardial reflection was recommended to avoid cardiac tamponade, whereas recent practice has favored positioning near the cavo-atrial junction (CAJ) to reduce risks of thrombosis and catheter dysfunction. We compared complications across tip positions: Zone A (CAJ/lower superior vena cava [SVC]/upper right atrium), Zone B (upper SVC), and Zone C (left brachiocephalic vein). We searched MEDLINE, Embase, CENTRAL, Ichushi-Web, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform from inception to January 2026. We included randomized and non-randomized studies comparing CVC tip positions in adults. Two reviewers screened studies and assessed risk of bias. Random-effects meta-analyses synthesized adjusted odds ratios (ORs) and crude risk ratios (RRs). Certainty was assessed using GRADE. Fifteen studies (9,589 participants; 9,815 catheters) were included. Compared with Zone B, Zone A probably reduces catheter-related thrombosis in adjusted analyses (OR 0.17; 95
This study aimed to investigate whether CO₂ pneumoperitoneum and liver retraction affect predictive performance of the Marsh pharmacokinetic model for propofol target-controlled infusion (TCI) during laparoscopic or robot-assisted gastrectomy. Adult patients undergoing elective laparoscopic or robot-assisted gastrectomy were enrolled. Arterial blood samples were collected at predefined intraoperative time points, and plasma propofol concentration (Cp) was measured by high-performance liquid chromatography. Performance error (PE), median PE (MDPE), median absolute PE (MDAPE), wobble, and divergence were calculated. Associations between PE and procedural factors, time after anesthetic induction, and cardiac index (CI) were evaluated using linear mixed-effects models. Finally, an exploratory PE-correction equation was internally evaluated by leave-one-patient-out cross-validation. A total of 155 measurements from 16 patients were analyzed. The overall MDPE and MDAPE were 10.2 and 20.4
To determine the associations of participant-level mean airway-derived total and dynamic mechanical power with postoperative pulmonary complications (PPCs) after laparoscopic bariatric surgery in adults with obesity, and to characterise the intraoperative trajectories of power components. This was a secondary analysis of a single-centre, parallel-group randomised trial in 160 adults with obesity undergoing laparoscopic bariatric surgery. Mechanical power was calculated at four predefined intraoperative timepoints (T1–T4). Mean dynamic mechanical power (MP_dynamic) was the primary exposure and mean total mechanical power (MP_total) was the key secondary exposure. For both exposures, the primary analysis used multivariable logistic regression across quartiles, with Q1 as the reference. Quartile-based modelling was selected after exploratory assessment indicated departure from linearity and because quartile categories provide clinically interpretable event rates and adjusted odds ratios. This analytic hierarchy was not prespecified in the parent-trial protocol and was defined post hoc after assessment of the observed exposure–outcome form. Restricted cubic spline analysis of mean MP_dynamic was supportive, and continuous per-standard-deviation models for both exposures were sensitivity analyses of a linear association. Models were adjusted for randomised group, age, sex, BMI, surgery duration, smoking status, diagnosed obstructive sleep apnoea (OSA), and asthma. The individualised strategy reduced mean MP_dynamic (6.42 ± 1.21 vs 6.99 ± 1.11 J/min; mean difference −0.57, 95
Postoperative delirium (POD) is a severe neuropsychiatric complication characterized by acute cognitive dysfunction and neuroinflammation, particularly prevalent in frail elderly patients. While the gut–brain axis is recognized as a regulator of neuroinflammation, specific preventive strategies remain limited. We investigated whether preoperative administration of raffinose, a prebiotic trisaccharide, prevents POD-like behaviors through gut microbiota-mediated neuroimmune modulation in frail senescence-accelerated mice. Twenty-six-week-old senescence-accelerated mice (SAMP10) were randomly assigned to control (N), surgery (O), or raffinose-treated surgery (R) groups (n = 5–6 per group, depending on the endpoint). Raffinose (5
This study characterized nationwide trends, demographic distributions, and regional disparities in cardiac anesthesia and intraoperative transesophageal echocardiography (ITEE) in Japan. We conducted a retrospective observational study using the National Database of Health Insurance Claims (NDB) Open Data Japan (2019–2023). Cardiac anesthesia was defined using reimbursement codes for cardiac or thoracic great-vessel surgery requiring cardiopulmonary bypass. ITEE was evaluated using add-on claims classified into two categories: ITEE for cardiac/non-cardiac surgeries, and ITEE for percutaneous interventions. Trends were assessed using linear and Poisson regression models. Age- and sex-specific distributions and regional disparities (Gini coefficients) were assessed. A total of 179,920 cardiac anesthesia events were identified (28.7 per 100,000 person-years), with a male predominance (male-to-female ratio, 1.6:1). Age distribution was bimodal, peaking at 0–4 and 75–79 years. Both cardiac anesthesia and ITEE use declined transiently during Japan’s first coronavirus disease 2019 state of emergency in May 2020, followed by recovery in the latter half of fiscal year 2020. Age-adjusted rates of cardiac anesthesia demonstrated no significant annual change. In contrast, ITEE use increased significantly in both cardiac/non-cardiac surgeries (relative risk [RR], 1.011/year; P < 0.0001) and percutaneous interventions (RR, 1.117/year; P < 0.0001). Regional disparities in cardiac anesthesia decreased over time, with Gini coefficients declining from 0.20 to 0.15. Cardiac anesthesia remained generally stable in Japan from 2019 to 2023. Increasing ITEE, especially for percutaneous interventions, suggests evolving cardiovascular perioperative practice, although claims-based categories require cautious interpretation.
Postoperative nausea and vomiting (PONV) remains a major clinical challenge undergoing thyroidectomy. The study aimed to investigate the effect of rapid sequence induction and intubation (RSI) on the incidence of PONV in patients undergoing thyroidectomy. Adult patients were randomized 1:1 to the RSI group (no assisted ventilation before endotracheal intubation) or the control group (face-mask pressure-controlled ventilation during induction). A standardized general anesthesia protocol and PONV prophylaxis strategy with dexamethasone and ondansetron was implemented for all patients. The primary outcome was the overall incidence of PONV in ward within 24h after surgery. Secondary outcomes were the incidence of PONV in post-anesthesia care unit (PACU), the use of rescue antiemetic, gastric antral cross-sectional area (CSA), and the incidence of adverse events. Sensitivity analysis includes intention-to-treat assessment to test robustness. A total of 214 patients were included in the per-protocol analysis (RSI n=106, control n=108). The overall PONV incidence (13.2
We studied the impact of a prospective, probabilistic scheduling method to replace surgeon-led booking, balancing contradictory goals of maximizing theatre utilised time while minimizing risk of over-utilised time. Implemented in an NHS Scotland hospital, the study analyzed 2420 surgical lists across multiple specialties. The Infix Schedule tool used median and median absolute deviation (MAD) of historical case times to calculate probability of finishing within allocated times, targeting a range 80–90
Postoperative delirium (POD) is highly prevalent among patients undergoing cardiac surgery, particularly in older adults. The lactate-to-albumin ratio (LAR), a composite biomarker reflecting both hypoxia and inflammatory pathways, could help elucidate the pathophysiological mechanisms underlying POD. This study aimed to determine the relationship between preoperative LAR and POD and to evaluate the potential predictive value of LAR. This retrospective cohort analysis utilized data extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Patients eligible for inclusion were those ≥65 years of age and having received cardiac surgery. Hierarchical multivariable logistic regression assessed associations, controlling for multicollinearity (VIF) and modeling non-linearity (RCS). Predictive performance was evaluated using Youden index, AUC (DeLong), NRI, IDI, likelihood ratio tests and trend analysis. This retrospective study analyzed data from 1770 elderly patients undergoing cardiac surgery. Of the 1770 patients, 412 (23.28
This study aimed to describe the distribution of clinically selected endotracheal tube size and insertion depth in relation to pediatric growth charts in Japan. This single-center retrospective analysis included patients aged 0–15 years who underwent general anesthesia at a university hospital in Japan between December 2006 and July 2023. The correlations between the average endotracheal tube size and depth curves and the growth charts, developed by the Japanese Society for Pediatric Endocrinology and the Japanese Association for Human Auxology, were determined using Pearson’s correlation coefficient for the children with heights and weights within ± 2 standard deviations (SD) of the growth chart. For children under 6 years of age in the − 2 to − 3 SD, below − 3 SD, and ± 2 SD groups, a linear mixed model (LMM) was used to model age-related changes in tube size and depth while accounting for clustering by anesthesiologist. A total of 6460 patients were included. In females, uncuffed tube size showed correlations of 0.97 and 0.94 with the height and weight growth charts, respectively; the corresponding correlations for depths were 0.95 and 0.92. In males, the corresponding correlations for size were 0.97 and 0.93, and the corresponding correlations for depth were 0.94 and 0.90. The LMM that accounted for the growth rate of the children showed R-squared values of 0.80 for tube size and 0.76 for insertion depth. The curves for the average endotracheal tube size and depth stratified by age showed concordance with the growth chart.
Spinal anesthesia induces hemodynamic disturbances such as hypotension and bradycardia. Granisetron, a 5-HT₃ receptor antagonist primarily used for antiemesis, has been proposed to mitigate these effects. This meta-analysis of randomized controlled trials evaluated intravenous granisetron versus placebo/no treatment in adults undergoing elective surgery under spinal anesthesia, reporting hypotension (primary outcome), bradycardia, shivering, hemodynamic changes, and vasopressor use. A random-effects model was used to calculate relative risks (RR) or mean differences (MD) with 95 https://www.crd.york.ac.uk/prospero/
One-lung ventilation (OLV) frequently induces hypoxemia. This study investigated whether intraoperative esketamine is non-inferior to dexmedetomidine in maintaining oxygenation during OLV and evaluated its impact on postoperative recovery. In this prospective, double-blind, non-inferiority trial, 126 adults undergoing thoracoscopic surgery were randomized to saline (Control), dexmedetomidine, or esketamine. The primary outcome was PaO₂/FiO₂ (P/F) ratio at 60 min after OLV initiation. The key secondary outcome was Quality of Recovery-15 (QoR-15) at 24 h. Linear mixed effects models were used. A total of 120 patients were included in the modified intention-to-treat analysis. At T3, esketamine was noninferior to dexmedetomidine for P/F ratio (adjusted mean difference [MD] − 1.92 mmHg; 95
While multiple factors contribute to acute post-spinal low back pain (LBP), the role of preoperative anxiety in obstetric patients remains unclear. This prospective study investigated the association between preoperative anxiety and acute post-spinal LBP following cesarean delivery (CD). Patients undergoing elective (category 4) or non-elective (categories 2 and 3) CD under spinal anesthesia were enrolled. Preoperative anxiety was defined as an Amsterdam Preoperative Anxiety and Information Scale score ≥ 11. The primary outcome was the incidence of acute post-spinal LBP during movement at 24 h after surgery. Based on LBP scores, patients were categorized into no-to-mild pain (Numeric Rating Scale [NRS] 0–3) and moderate-to-severe pain (NRS ≥ 4). Logistic regression was used to identify risk factors for the incidence and presence of moderate-to-severe acute post-spinal LBP. Among 295 patients analyzed, 78 (26
