Anesthesiology

Extended intraoperative work periods showed no significant composite harm but small mortality signal in sensitivity analyses.

Across 1,648,720 procedures, extended anesthesiologist work periods (≥16 hours) occurred in 0.7% of cases. Primary adjusted analysis found a non‑significant absolute risk difference of 0.1% for the composite of mortality or major complications. Sensitivity and secondary analyses identified a small absolute increase in in‑hospital mortality (1.3% vs 1.0%), with a risk difference of 0.3%. This is an observational, within‑physician cross‑sectional study, so causality cannot be assumed. 1

A 30‑minute nap after a 24‑h shift improved simulated clinical performance and non‑technical skills in residents.

In the R‑NAP randomized trial, a 30‑minute nap increased overall simulated performance by 14.8 points (7.4% improvement; 95% CI 2.8–26.9; p = .018). Non‑technical skills (leadership, resource use) improved significantly, while technical skill differences were not significant. Longer nap duration correlated with greater gains in exploratory analyses. Results apply to anesthesia residents in simulation and do not directly demonstrate patient outcome benefits. 2

Closed‑loop vasopressor systems improve time‑in‑target and reduce hypotension versus manual titration.

Meta‑analysis of eight RCTs (n = 640) found CLV reduced time below target by 15.81 percentage points and increased time in target by 30.18 percentage points. CLV reduced time in hypotension (SMD -0.90) and was associated with a 1.12‑day reduction in hospital length of stay. No clear differences were seen for PACU/ICU stay, and heterogeneity was high for some outcomes. Larger multicenter trials are needed to confirm meaningful patient‑level outcome benefits. 3