Anesthesiology

Postmenstrual age predicts postanesthesia apnea; neuraxial anesthesia associated with lower odds.

In a systematic review/meta-analysis of 115 articles, median postanesthesia apnea incidence was 7.6% across studies. Meta-regression found postmenstrual age and later publication year most strongly predicted lower apnea odds. Neuraxial anesthesia was associated with lower odds of apnea (OR 0.236; 95% CI 0.094–0.592). Recommendations for monitoring ranged from 6 to 24 hours based on postmenstrual age, pending individual participant data analysis. 1

Sevoflurane linked to higher long-term risk of new-onset depression than propofol.

In a multinational propensity score–matched cohort of 37,936 adults, sevoflurane was associated with higher new-onset depression risk than propofol (aHR 1.51; 95% CI 1.41–1.61). The association persisted across depression severity strata and surgical subgroups. A dose–response appeared: aHR 1.75 for two or more sevoflurane exposures. Findings are observational and susceptible to residual confounding; mechanistic and prospective studies are needed. 2

Neuromuscular blockade did not reduce opioid consumption after high-risk pediatric adenotonsillectomy.

A blinded RCT of 172 high-risk children found no difference in cumulative 24‑hour opioid consumption (0.209 vs 0.188 IV MME kg−1; difference 0.021; 95% CI −0.005 to 0.047). Postoperative respiratory events were numerically lower with blockade (49% vs 59%) but confidence intervals crossed unity (aOR 0.55; 95% CI 0.26–1.12). Low minute ventilation events were more common with blockade (38% vs 25%), without consistent clinical benefit. The trial does not support using neuromuscular blockade to decrease opioid use in this population. 3