Anesthesiology

Consensus supports liberal adult clear-fluid fasting and rapid postoperative oral intake

This international Delphi consensus maintains current fasting recommendations for solids and non-clear liquids before anaesthesia or sedation. It explicitly encourages clear liquids until 2 hours before anaesthesia, with scope for even more liberal institutional protocols. The group recommends implementing local protocols that allow clear liquids within 2 hours preoperatively when deemed safe. Salivation stimulants may be used until transfer, and oral intake should resume as soon as clinically feasible post-procedure. Preprocedural gastric ultrasound by trained providers can guide decisions when aspiration risk is uncertain, supporting individualized fasting plans. 1

Paediatric perioperative oxygen strategies show no clearly superior regimen

This systematic review of 16 RCTs (1337 children) compared high versus low intraoperative FiO2 and postoperative HFNO, NIV, and COT. Evidence was very uncertain that high FiO2 (60–80%) versus low FiO2 (30–35%) affected surgical-site infection or pulmonary complications. Postoperative HFNO reduced reintubation versus conventional oxygen therapy, but certainty of evidence was low. HFNO versus NIV comparisons yielded very uncertain effects on reintubation and pneumothorax. Overall, current trials do not support routine use of any single paediatric oxygen strategy solely to improve clinical outcomes. 2

Intraoperative dexamethasone linked to lower postoperative delirium, attenuated by hyperglycaemia

This retrospective cohort of 92,832 adults undergoing non-cardiac, non-neurosurgical, non-transplant operations evaluated intraoperative dexamethasone and 7-day postoperative delirium. Dexamethasone, given in 45% of patients at a median dose of 8 mg, was associated with lower delirium risk (aOR 0.63; absolute risk difference −1.1%). Benefit appeared greater when postoperative hyperglycaemia (>180 mg/dL) did not occur, with no clear association in hyperglycaemic patients. Analyses adjusted for 43 patient and procedural variables, though unmeasured confounding cannot be excluded. These findings support dexamethasone use while emphasizing tight perioperative glucose control when targeting delirium reduction. 3

Conservative versus liberal oxygen targets yield similar outcomes in ventilated ICU adults

This meta-analysis pooled nine RCTs with 20,447 mechanically ventilated critically ill adults comparing conservative and liberal oxygen targets. Conservative targets (SpO2 88–94% or PaO2 <80 mm Hg) produced similar 90-day mortality to liberal targets (RR 1.01; 95% CI 0.94–1.09). ICU length of stay, ventilator-free days, vasopressor-free days, and major adverse events were comparable overall between strategies. In sepsis, conservative targets increased vasopressor-free days, and post–cardiac arrest patients showed a possible survival advantage. Evidence certainty was moderate for mortality and length of stay but lower for ischemic events due to imprecision and open-label designs. 4