This study aimed to investigate the incidence, characteristics, risk factors, and prognostic implications of myocardial injury after non-cardiac surgery (MINS) in patients with lung cancer undergoing pulmonary resection. We conducted a retrospective analysis of 1314 consecutive patients with lung cancer undergoing elective pulmonary resection between June and November 2023 at a tertiary cancer referral center. Univariate and multivariate logistic regression analyses were used to identify independent risk factors. Kaplan-Meier survival analysis with log-rank tests were adopted to evaluate the 30day mortality and major adverse cardiovascular events (MACE). Subgroup analyses according to the extent of lung resection were also conducted. The overall incidence of MINS following lung cancer surgery was 10.4%. The majority of cases (92.7%) occurred within the first postoperative day and demonstrated predominantly asymptomatic presentation (78.1%). Independent preoperative risk factors for MINS included male sex, coronary artery disease, creatinine, high-sensitivity cardiac troponin T, thoracotomy, lobectomy, and duration of tachycardia. Although MINS showed no association with 30day postoperative mortality, it significantly increased the risk of MACE at 30 days in the overall (7.3% vs. 0.2%, p < 0.001), lobectomy (7.0% vs. 0.3%, p < 0.001), and sublobar resection (9.1% vs. 0, p = 0.002) cohorts. MINS is a common postoperative complication following lung cancer surgery, and typically occurs in the early postoperative period. Although it is predominantly asymptomatic, it was significantly associated with increased 30day MACE.

McGrath videolaryngoscopy versus direct laryngoscopy for rapid sequence intubation: A multicenter randomized clinical trial.

Impact of continuing renin-angiotensin-aldosterone system inhibitors before surgery on intraoperative hypotensive events: a secondary analysis of the STOP-or-NOT Trial.

The aim of the work is to describe a clinical case of successful anesthetic management of right-sided hemicolectomy in a patient with ischemic cardiomyopathy, critically low ejection fraction (19 %) and transplantation status. Left ventricular ejection fraction is one of the key indicators characterizing the pumping function of the heart. Normal values range within 50–75 %, while a decrease in ejection fraction below 35 % is associated with an increased risk of life-threatening arrhythmias. The presence of structural and functional cardiac abnormalities is recognized as the most important risk factor in predicting perioperative morbidity and mortality. Therefore, in the perioperative period, it is necessary to identify and correct all factors that can provoke cardiac decompensation, even before anesthesia and surgical intervention. A decrease in ejection fraction in our patient was a consequence of an acute myocardial infarction, which caused a persistent violation of myocardial contractility. In such cases, the hemodynamic changes that accompany anesthesia and surgery are of crucial importance, and the task of an anesthesiologist is to understand the pathophysiological mechanisms of the disease in order to prevent complications, including postoperative infarction, severe arrhythmias, critical bradycardia, and pulmonary edema. This clinical case presents a patient with ischemic cardiomyopathy and critically low ejection fraction (19 %) who was a candidate for heart transplantation and had a comorbi­dity in the form of a tumor of the ascending colon. The patient was scheduled for a right-sided hemicolectomy, which had an extremely high anesthetic risk and required an individualized approach.

Concerns about diabetic ketoacidosis (DKA) and euglycemic ketoacidosis (eKA) are balanced against possible organ-protective benefits in the debated perioperative management of sodium-glucose cotransporter-2 (SGLT2) inhibitors. This meta-analysis compared the perioperative clinical and laboratory outcomes associated with perioperative exposure to SGLT2i. Through July 31, 2025, we searched PubMed, Web of Science, Scopus, and CENTRAL for observational studies and randomised controlled trials comparing the outcomes of preoperative use of SGLT2 inhibitors with non-use in patients undergoing cardiac or non-cardiac surgery. We pooled data using a random-effects model and investigated heterogeneity using leave-one-out sensitivity analyses. CRD420251155809. There were 10 studies comprising 246,242 patients. Due to considerable heterogeneity, the primary pooled analysis revealed no significant association between SGLT2 inhibitor use and either eKA (OR 4.86; p = 0.11) or DKA (OR 2.21; p = 0.11). However, a significant increase in the risk of eKA (OR 1.11; p < 0.001) and DKA (OR 5.33; p < 0.001) was observed using leave-one-out sensitivity analysis to identify outliers. On the other hand, the usage of SGLT2 inhibitors was associated with a statistically significant decrease in both mortality (OR 0.73; p = 0.006) and acute renal injury (OR 0.68; p < 0.0001). The SGLT2 inhibitor group had significantly lower perioperative pH, base excess, and blood glucose levels. The use of perioperative SGLT2 inhibitors poses a clinical paradox between significant renoprotection and survival advantages and a latent risk of ketoacidosis concealed by considerable heterogeneity. While metabolic monitoring is essential, current surgeries requiring more prolonged withholding may need to weigh metabolic risk against the drug's significant benefit in reducing acute kidney injury and mortality.

Incidence and risk factors of hypoxemia after general anesthesia in children undergoing non-cardiac surgery: a systematic review and meta-analysis.

Dexmedetomidine can attenuate delirium in patients who are critically ill, but evidence with regards to its preventive effect on postoperative delirium remains equivocal. We hypothesised that the risk of delirium after intra-operative dexmedetomidine administration varies depending on the dose administered and aimed to identify the optimum dose to mitigate delirium. We included 114,786 adults undergoing general anaesthesia for non-cardiac, non-transplant surgery. Primary exposure was intra-operative dexmedetomidine dose in cumulative μg.kg-1 body weight, dichotomised into high vs. low dose based on the cohort median (0.49 μg.kg-1). Primary outcome was delirium within 7 days, identified from discharge notes, Confusion Assessment Method assessments and diagnostic codes. A total of 4804 (4.2%) patients received dexmedetomidine, with a median (IQR [range]) cumulative dose of 0.49 (0.28-0.84 [0.01-2.50]) μg.kg-1. Postoperative delirium occurred in 3227 (2.8%) patients. Compared with no dexmedetomidine, the risk of delirium was lower in patients receiving low doses (≤ 0.49 μg.kg-1) of dexmedetomidine (adjusted odds ratio 0.61, 95%CI 0.44-0.85, p = 0.004), but not among those receiving high doses (> 0.49 μg.kg-1) (adjusted odds ratio 1.06, 95%CI 0.84-1.34, p = 0.62). Fractional polynomial regression analyses suggested that doses between 0.25 μg.kg-1 and 0.35 μg.kg-1 were associated with the lowest delirium risk. Threshold regression and restricted cubic splines confirmed these findings. Low, but not high, dose dexmedetomidine administration was associated with lower risks of delirium, with optimal doses ranging between 0.25 μg.kg-1 and 0.35 μg.kg-1.

Preoperative comorbidities are associated with postoperative acute kidney injury (AKI). However, whether this association is direct or mediated by intraoperative hypotension (IOH) is unclear. We hypothesized that IOH mediates the relationship between preoperative comorbidities and postoperative AKI. Data from adult patients undergoing non-cardiac surgery under general anesthesia were analyzed. Inverse probability of treatment weighting (IPTW) was applied to achieve a balance between the exposure groups by reducing the baseline differences in the measured covariates. Structural equation modeling (SEM)-based mediation analysis was conducted using the American Society of Anesthesiologists physical status (ASA-PS) classification ≥ 3 as an input and postoperative AKI as an outcome. IOH (duration of mean arterial pressure [MAP] < 60 mmHg), along with albumin and hemoglobin levels, was considered a mediator. We also performed interaction analysis between patient sex and age. After IPTW, 8643.9 (10.8%) patients had an ASA-PS of ≥ 3. AKI occurred more frequently (4.5% vs. 6.9%, P < 0.001) in patients with ASA-PS ≥ 3. ASA-PS ≥ 3 was associated with a total effect estimate of 0.02 on the log-odds of postoperative AKI (P < 0.001). Of the total effect of ASA-PS ≥ 3 on postoperative AKI, 48% was significantly mediated by IOH (26%) and hypoalbuminemia (26%), though anemia showed no significance. The effect of high ASA-PS scores on postoperative AKI was significantly modified by sex, but not by age. High ASA-PS scores increase AKI risk after non-cardiac surgery, a relationship partially mediated by statistically significant pathways involving IOH and hypoalbuminemia.

Acute kidney injury is a common perioperative complication that leads to significant downstream effects on the patient and the health system. Patients regularly present for surgery with several risk factors for AKI, but we have not yet determined the optimal method of risk stratification or strategy for prevention of AKI. This paper provides a review of the latest literature on perioperative considerations for anesthesiologists when evaluating and treating patients at higher risk for postoperative kidney injury. The ADQI/PQI recommends a kidney health assessment before surgery, focusing on optimizing preoperative risk factors in patients before surgery. Using goal-directed hemodynamic therapy, incorporating volume status, blood pressure, and cardiac output monitoring to optimize volume status in high-risk patients and using renoprotective medications could further reduce the risk of AKI. We've highlighted some interesting research regarding novel biomarkers and artificial intelligence/machine learning. Promising research is ongoing in this sector, but much work still needs to be done.

Blood pressure is closely monitored during anaesthesia, yet the optimal intraoperative target remains uncertain. This narrative review synthesizes contemporary observational and randomized evidence and explores emerging strategies for individualized haemodynamic management. We reviewed major observational cohort studies, randomized controlled trials (RCTs), consensus statements, and recent technological developments addressing intraoperative hypotension, MAP thresholds, and strategies to prevent perioperative organ injury in adult noncardiac surgery. Large observational datasets consistently demonstrate graded, duration-dependent associations between intraoperative MAP 60-70 mmHg and postoperative myocardial injury, acute kidney injury, and mortality . These findings have informed international recommendations to avoid MAP below 60-65 mmHg. However, contemporary multicentre RCTs enrolling more than 13,000 patients show that targeting higher or individualized MAP thresholds does not improve patient-centred outcomes compared with routine care (typically MAP ≥ 65 mmHg) . Only one small trial reported benefit with individualized systolic targets. Emerging evidence suggests that hypotension reflects heterogeneous haemodynamic endotypes (vasodilation, hypovolaemia, myocardial depression, bradycardia), potentially explaining why uniform pressure targets fail to improve outcomes. Continuous blood pressure monitoring, proactive norepinephrine infusion, predictive analytics, and closed-loop vasopressor systems reliably reduce hypotension exposure, although definitive outcome benefits remain unproven. Observational and randomized data are concordant: MAP ≥ 60-65 mmHg appears sufficient for most noncardiac surgical patients. Future progress will likely depend on mechanistic endotyping, integration of advanced monitoring, and precision-guided haemodynamic strategies rather than escalation of universal MAP targets alone.

Optimizing Perioperative Management of Sarcoidosis in Noncardiac Surgery: A Focused Review and Practical Framework.

Background Several biomarkers are known to predict long-term complications after non-cardiac surgery, including major adverse cardiovascular events (MACE), myocardial infarction, and death. Carotid endarterectomy (CEA), a low to medium-risk procedure for carotid stenosis, aims to prevent stroke. Glycated hemoglobin (HbA1c) may hold prognostic value for MACE. This study evaluates the role of HbA1c in predicting all-cause mortality and MACE in patients undergoing CEA. Methods A post hoc analysis was conducted using data from a prospective database of patients who underwent CEA under regional anesthesia at a tertiary referral center between January 2014 and December 2023. Patients with HbA1c measured within three months prior to surgery were included and divided into two groups (HbA1c <6.5% vs. ≥6.5%). Kaplan-Meier survival and multivariable Cox regression analyses assessed the impact of HbA1c on outcomes. The primary outcome was the incidence of long-term MACE and all-cause mortality. Secondary outcomes included stroke, acute myocardial infarction (AMI), acute heart failure (AHF), and major adverse limb events (MALE). Results A total of 65 patients (mean age 71.4 ± 8.5 years; 81.5% male) were included, with a median follow-up of 30 months. Patients with HbA1c ≥6.5% were significantly younger. Elevated HbA1c was associate with trend toward more stroke risk (log-rank p = 0.045, HR: 3.2 (CI: 0.96-10.7, p = 0.059) HbA1c was an independent predictor of MALE (aHR: 3.387, p = 0.037), while its association with stroke did not reach significance (p = 0.059). Conclusion HbA1c appears to be a useful, accessible biomarker for vascular risk stratification in patients undergoing CEA.

Cognitive impairment is a highly prevalent but frequently overlooked issue among surgical patients preoperatively. This systematic review and meta-analysis aimed to (1) determine the perioperative prevalence of impaired cognitive domains in surgical patients, (2) explore perioperative changes in the different domains, and (3) examine postoperative outcomes associated with preoperatively impaired cognitive domains. Five electronic databases were searched from inception to March 19, 2024. Inclusion criteria were (1) surgical patients ≥18 years of age; (2) preoperative cognitive assessments using a neuropsychological battery; (3) reported the prevalence of impairment in specific cognitive domains or changes perioperatively; and (4) sample size of ≥100 surgical patients. The exclusion criteria included studies involving neurological surgery; cross-sectional, case-control, and case series studies; non-English articles; and studies with overlapping data. In total, of the 12,082 articles identified from 5 databases, 21 studies (5725 patients, 11 non-cardiac surgery studies, and 10 cardiac surgery studies) were included. Among the 6 cognitive domains assessed preoperatively, the pooled prevalence of impairment was highest in executive function (18%; 95% CI, 13%-24%), visuospatial function (16%; 95% CI, 6%-26%), and attention/working memory/processing speed (14%; 95% CI, 9%-18%). Perceptual-motor control (13%; 95% CI, 9%-36%), language (13%; 95% CI, 8%-17%), and learning/memory (12%; 95% CI, 8%-16%) had lower pooled prevalence. The cognitive domains that were assessed postoperatively showed a high prevalence of impairment at 1 week, with 35% (95% CI, 4%-66%) in attention/working memory/processing speed, 34% (95% CI, 16%-51%) in executive function, and 28% (95% CI, 16%-40%) in learning/memory. The pooled prevalence subsequently decreased within 3 months to 16% (95% CI, 3%-35%) in attention/working memory/processing speed, 15% (95% CI, 6%-24%) in executive function, and 12% (95% CI, -2% to 25%) in learning/memory. The prevalence of preoperatively impaired cognitive domains was the highest in executive function, followed by visuospatial function and attention/working memory/processing speed. Identifying commonly impaired cognitive domains may help optimize cognitive assessments in the perioperative setting. Further research is needed to clarify the clinical utility of assessing specific cognitive domains in surgical populations to improve postoperative outcomes and reduce cognitive deterioration.

Erratum: Perioperative Regional Anesthesia on Persistent Opioid Use and Chronic Pain after Noncardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

AimsThe role of electrocardiography (ECG) has been limited in the preoperative risk evaluation in noncardiac surgery due to its low prognostic value. We aimed to evaluate the utility of an AI-enabled ECG (QCG-Critical score) in predicting 30-day postoperative mortality in non-cardiac surgery and compare its performance with traditional perioperative risk-assessment tools.Methods and resultsA retrospective cohort of 46 135 adults who underwent non-cardiac surgery at a tertiary centre between 2020 and 2021 was analysed. Preoperative ECG images acquired within 30 days before surgery were used as input to previously developed CNN-based deep-learning algorithm to generate QCG-Critical score that reflects the risk for critical illness. The primary outcome was 30-day mortality, which occurred in 0.34% of patients. Individuals with QCG-Critical scores >40 had a markedly higher mortality rate of 11.7%. The QCG-Critical score demonstrated strong predictive performance for 30-day mortality (AUROC: 0.909), outperforming the ESC surgical category (0.728) and RCRI (0.725), and was comparable to the ASA classification (0.886). The performance of QCG-Critical score remained consistent across subgroups stratified by age, sex, emergency operation, anaesthesia type, and conventional risk groups. The QCG-Critical score also demonstrated good performance for predicting 7-day mortality (AUROC: 0.933), unplanned PCI (0.857), prolonged mechanical ventilation (0.829), and presumed heart failure (0.774).ConclusionThe preoperative QCG-Critical score accurately predicted postoperative mortality and other adverse outcomes, outperforming conventional risk-stratification tools. The QCG-Critical score may serve as a fast, accessible, and integrable tool for perioperative risk assessments in routine surgical care.

Background: Non-cardiac surgery in patients with cardiovascular risk can lead to Spine surgery often leads to significant postoperative pain, inflammation, and hemodynamic instability, necessitating opioid use, which increases the risk of side effects. Dexmedetomidine (DEX) and magnesium sulfate (MgSO₄) are anesthetic adjuvants that may enhance recovery and reduce opioid consumption. This study aimed to compare the effects of DEX and MgSO₄ as an anesthetic adjuvant on interleukin-6 (IL-6) levels, hemodynamic stability, postoperative recovery, and opioid consumption in spine surgery. Methods: A randomized controlled trial was performed on 24 patients undergoing spine surgery under general anesthesia. Participants were randomly divided into two groups: Group 1 received DEX (a 1 µg/kg bolus followed by a continuous infusion of 0.3–0.5 µg/kg/h), while Group 2 was given MgSO₄ (a 30–50 mg/kg bolus followed by an infusion of 10–20 mg/kg/h). Hemodynamic parameters, IL-6 levels (pre- and postoperatively), opioid use, and recovery outcomes were analyzed. Results: IL-6 levels decreased significantly in both groups (p=0.001), with a greater reduction in the DEX group (-60.5 pg/dL vs. -24.9 pg/dL), though not statistically significant. Hemodynamic stability was comparable, but DEX provided better pulse rate control. Opioid consumption was lower in the DEX group at 24 and 48 hours postoperatively (p &lt; 0.05). The DEX group also showed higher Aldrete scores (p&lt;0.05) and shorter hospital stays (3.75 vs. 4.83 days, p&lt;0.05). Conclusion: DEX provides superior anti-inflammatory effects, hemodynamic stability, reduced opioid use, and improved recovery compared to MgSO₄ as an anesthetic adjuvant in spine surgery patients.

Background: PET/CT is commonly performed during oncologic workup and provides an opportunity for coronary artery calcification (CAC) evaluation. However, technical constraints typically preclude standard Agatston scoring using the attenuation-correction CT images obtained during PET/CT examinations. Objective: To assess the prognostic utility of a simple visual ordinal CAC scoring system applied to PET/CT for perioperative risk stratification after noncardiac surgery. Methods: This retrospective study included 972 patients (559 male, 413 female; median age, 58 years) who underwent [18F]FDG PET/CT with a nongated low-dose CT acquisition followed by intermediate- or high-risk noncardiac surgery within 12 months (median interval, 4 days [IQR 2-7 days]) from April 2013 to June 2024. Three radiologists independently reviewed CT images to assign a visual ordinal CAC score (scale, 0-3) to each of four major coronary arteries; these scores were used to derive a visual CAC grade (none, mild, moderate, severe) for each patient. Multivariable logistic regression analyses were performed to identify the role of visual CAC grades (based on consensus assessments) in predicting 30-day perioperative major clinical events (MCEs, defined as all-cause mortality or in-hospital troponin I elevation), adjusting for age, sex, and revised cardiac risk index (RCRI; a traditional perioperative risk stratification tool). Results: Interobserver agreement for the visual CAC grade was high (kappa=0.875). At least mild CAC and moderate or severe (hereafter, moderate/severe) CAC were present in 46.3% and 16.0% of patients, respectively. Perioperative MCEs occurred in 3.2% of patients. Perioperative MCEs occurred in 1.9%, 3.1%, 5.8%, and 11.3% of patients with no, mild, moderate, and severe CAC, respectively. Moderate/severe CAC was an independent predictor of perioperative MCEs (adjusted OR=2.44; 95% CI, 1.11-5.38). Among 718 patients with RCRI of 1, frequency of perioperative MCEs was higher among those with moderate/severe versus no or mild CAC (8.3% vs 2.3%, respectively; p=.005). The AUC for predicting perioperative MCEs was 0.608 for RCRI and 0.652 for the visual CAC grade (p=.36). Conclusions: Simple visual CAC scoring on routine PET/CT was associated with perioperative events after noncardiac surgeries, independent of the RCRI. Clinical Impact: Standardized CAC reporting on preoperative PET/CT may help refine risk stratification and support clinical decision-making regarding the intensity of perioperative care.

Dexmedetomidine and lidocaine are commonly used adjuvants in postoperative pain management; however, their comparative efficacy is unclear. This meta-analysis compared the effects of intravenous dexmedetomidine and lidocaine on postoperative analgesia and recovery. Cochrane Library, Medline, Embase, and Google Scholar were searched from their inception to July 1, 2024, to identify relevant randomized controlled trials (RCTs) comparing intravenous dexmedetomidine and lidocaine in adult patients undergoing non-cardiac surgery under general anesthesia. The primary outcomes were the postoperative pain score at 24h and postoperative opioid consumption. The secondary outcomes included early postoperative pain scores, intraoperative opioid/anesthetic requirements, hemodynamic parameters, recovery characteristics, and inflammatory markers. Twenty-four studies (1,697 patients) were included. There was no significant difference between dexmedetomidine and lidocaine in terms of pain scores at 24h (mean difference [MD]: 0.01, p = 0.88) or overall postoperative opioid consumption (standardized MD[SMD]: -0.51, p = 0.06). However, dexmedetomidine was associated with lower pain scores at 2-4h postoperatively (MD:-0.41, p = 0.02), reduced intraoperative anesthetic agent requirements (SMD:-1.1, p = 0.004), a longer time to rescue analgesic (MD: -29.93min, p < 0.00001), and improved quality of recovery scores (SMD: 1.72, p = 0.01). Dexmedetomidine resulted in lower heart rate and blood pressure compared to lidocaine, without differences in other recovery characteristics and inflammation. Both dexmedetomidine and lidocaine are effective adjuvants for improving postoperative outcomes. Nevertheless, dexmedetomidine has shown advantages in terms of early pain control, reduced anesthetic requirements, and improved quality of recovery. The choice of these agents should be based on individual patient factors and specific surgical procedures.

Situs inversus totalis (SIT) with congenitally corrected transposition of the great arteries (ccTGA) represents a rare and complex congenital combination that significantly complicates anaesthetic management. We report the anaesthetic management of an early childhood (2-5 years), 13 kg child diagnosed with SIT and ccTGA undergoing elective adenotonsillectomy. Individualised perioperative strategies were implemented, including modified ECG monitoring, arrhythmia preparedness and explicit mg/kg drug dosing. Intraoperative management was uneventful, and the patient had a stable recovery. This case highlights anaesthetic considerations and monitoring adaptations in non-cardiac paediatric surgery involving mirror-image congenital cardiac anatomy.

Postoperative hypotension in patients recovering from noncardiac surgery.