Anesthesiology

Meta-analysis: TIVA vs volatile maintenance shows no clear neurocognitive benefit

Across 29 trials (N = 11,896), postoperative delirium incidence was similar between volatile and propofol-based intravenous anesthesia (RR 0.94, 95% CI 0.71–1.25). Volatile anesthesia was associated with increased delayed neurocognitive recovery (RR 1.35; 95% CI 1.07–1.70), but effects were heterogeneous across timepoints. Mean MMSE scores were slightly lower with volatile anesthesia (mean difference −1.4 points), a difference authors judged not clinically meaningful. Trial-sequential analysis indicated current evidence is imprecise and more trials are needed before changing practice. 1

Multicenter cohort: rocuronium replaces succinylcholine for RSI without worse outcomes

In 82,772 abdominal surgery cases across 13 centers, documented RSI occurred in 9,352 cases and succinylcholine use fell from 85.4% (2015) to 37.3% (2022). Rocuronium increasingly supplanted succinylcholine as the common RSI paralytic during the study period. Adjusted analyses found no difference in 30-day mortality (RR 0.85; 95% CI 0.67–1.09) or in hypoxia, pulmonary complications, or AKI between rocuronium and succinylcholine. Findings describe contemporary practice and associations but remain observational and subject to unmeasured confounding. 2

Scoping review: dreaming during anaesthesia is common and often pleasant

The review included 157 studies with 87,866 participants and found wide variability in dream recall across settings. Experimental studies reported 40%–80% recall, while large clinical trials typically reported 3%–8% recall. Ketamine and propofol showed the strongest associations with dream recall; most recalled dreams were pleasant and mundane. Evidence linking dreams to clinical outcomes is sparse; unpleasant dreams may reduce willingness for repeat anesthesia. 3