Anesthesiology

Postoperative delirium in older adults predicts longer stay, complications, and late mortality

In this UK prospective cohort of 7128 surgical patients aged ≥60 years, postoperative delirium incidence was 6.7%. Delirium was independently associated with a 5.2-day increase in median hospital length of stay versus patients without delirium. Delirious patients had markedly increased odds of postoperative morbidity (adjusted OR 10.2; 95% CI 7.4–13.9). Delirium was also linked with higher 120-day (aOR 1.8) and 1-year mortality (aOR 2.0) after surgery. These data support explicit delirium risk communication and proactive prevention and surveillance strategies in older surgical candidates. 1

Higher systolic targets with noradrenaline during spinal cesarean improve maternal stability and neonatal acidaemia

This multicenter RCT randomized 1183 term women undergoing spinal cesarean to maintain systolic blood pressure at ≥90% or ≥80% of baseline using noradrenaline boluses. Mean umbilical artery pH was similar between groups, but neonatal acidaemia (pH <7.2) was less frequent with the 90% target (0.5% vs 2.2%). The higher blood pressure target reduced maternal hypotension, severe hypotension, and intraoperative nausea and vomiting compared with the 80% target. Women in the 90% group received more noradrenaline boluses but without apparent adverse effects in reported outcomes. These findings support targeting systolic blood pressure close to baseline rather than accepting lower pressures during spinal anesthesia for cesarean delivery. 2

Ultrasound-guided recruitment maneuvers reduce early atelectasis after abdominal surgery

In this multicenter 2×2 factorial RCT of 353 intermediate- to high-risk abdominal surgery patients, all received lung-protective ventilation and end-of-case recruitment maneuvers. Ultrasound-guided maneuvers reduced early postoperative atelectasis versus conventional technique (41.9% vs 61.5%; RR 0.67; 95% CI 0.53–0.83). Ultrasound guidance also improved lung ultrasound scores, lowered hypoxemia incidence, improved oxygenation index, reduced 7-day pulmonary complications, and decreased hospitalization costs. Stepwise versus sustained lung inflation patterns produced no meaningful differences in primary or secondary outcomes. These findings support ultrasound-guided recruitment as a practical strategy to optimize postoperative respiratory outcomes in higher-risk abdominal surgery. 3

Sleep apnea–specific hypoxic burden stratifies postoperative cardiovascular risk in OSA

This multicenter cohort included 2286 adults with obstructive sleep apnea undergoing major noncardiothoracic surgery, linked to baseline diagnostic sleep data. The 30-day composite cardiovascular events and mortality rate rose from 1.6% in low to 5.8% in high sleep apnea–specific hypoxic burden strata. Compared with low SASHB, adjusted odds for the primary outcome were 2.79 (95% CI 1.42–5.49) in those with high hypoxic burden (≥80% min/h). A risk score incorporating age, emergency admission, and SASHB achieved an AUC of 0.73 for predicting 30-day events. Similar associations using oximetry-only SASHB suggest feasible incorporation into preoperative OSA risk stratification workflows. 4