Clinical commentary
Blog
Notes from practice on perioperative care, written by Jeffery Christensen, DO (also known as Jeffrey Christensen), an anesthesiologist in Casper, Wyoming.
Posts
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Can IV Acetaminophen Prevent Shivering After a Spinal?
My take on a November 2026 trial in 92 patients having surgery under a spinal. IV acetaminophen given before the block cut shivering from 50.0% to 26.2%, though the result was fragile and needs a larger trial.
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Video or Direct Laryngoscopy for Doctors Still Learning to Intubate?
My take on the November 2026 VILARE trial in 1001 surgical patients. When residents intubated, videolaryngoscopy raised first attempt success from 70.2% to 79.2% and cut procedural complications by more than half compared with direct laryngoscopy.
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Esketamine or Sevoflurane for Calmer Wake Ups in Young Children?
My take on a November 2026 trial in 116 young children having a short eye procedure. Esketamine with dexmedetomidine cut emergence agitation from 27.6% to 6.9% compared with sevoflurane, but raised blood pressure and eye pressure.
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Does IV Lidocaine Help After Liver Surgery?
My take on a November 2026 Anesthesiology trial in 124 patients having minor liver surgery. A lidocaine infusion did not significantly reduce 24 hour opioid use, though it eased early pain and plasma levels stayed safe.
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Can Earmuffs in the OR Cut Postoperative Nausea?
My take on a November 2026 Anesthesiology trial in women having gynecologic laparoscopy. Noise blocking earmuffs during surgery lowered 48 hour nausea and vomiting from 52.1% to 35.4% on top of two antiemetics, though it was a single, modest sized trial.
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For Kids Having Tonsils Out, Is a Laryngeal Mask Safer Than a Tube?
My take on the November 2026 BMJ trial in 400 children having adenotonsillectomy. A laryngeal mask cut perioperative respiratory events from 57.5% to 22.5% compared with a breathing tube, though experience and patient selection still matter.
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Should We Match Blood Pressure to Each Patient's Baseline in Cardiac Surgery?
My take on the November 2026 Anesthesiology OPTIPAM trial. Individualized MAP targets near each patient's baseline did not reduce death, kidney injury, or neurologic events, and the trial stopped early for more bleeding.
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After a Fascia Iliaca Block for Hip Fracture, Does Pain Pattern Predict Quiet Delirium?
My take on a November 2026 BMC Anesthesiology cohort of 328 older hip fracture patients after suprainguinal fascia iliaca block. Persistent pain trajectories tracked with higher hypoactive delirium risk, though the signal softened with heavier adjustment.
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Can Low Dose Esketamine Help Patients Sleep After Surgery?
My take on a November 2026 BMC Anesthesiology review of 15 trials and 1,863 patients. Perioperative esketamine cut early postoperative sleep disturbance, with supportive sequential analysis on days 1 and 3, and modest dosing was enough.
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Does Brain Monitoring During Anesthesia Lower Delirium Risk? A New Look at 87 Trials
My take on an October 2026 Journal of Clinical Anesthesia review of 87 trials. Processed EEG guided anesthesia was linked to less anesthetic use, about 27% less postoperative delirium, and slightly faster wake ups.
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Can Low Dose Esketamine Prevent Lingering Pain After Lung Surgery?
My take on an October 2026 BJA trial in 873 patients having thoracoscopic lung surgery. A low dose esketamine infusion during and for 48 hours after surgery cut 3 month chronic pain from 21% to 15%.
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Can Twenty Minutes of Virtual Reality Calm Nerves Before Surgery?
My take on the October 2026 Anesthesia & Analgesia AMBLUMEEN trial. One 20 minute virtual reality session cut anxiety sharply before outpatient surgery, though it did not reduce the need for sedative medication.
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Remimazolam or Propofol for Brain Vascular Surgery: What Happens to Delirium?
My take on an October 2026 BJA trial in 686 neurovascular surgery patients. Remimazolam TIVA was noninferior to propofol for delirium, with less hypotension and more extubations in the OR, though the margin was wide.
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Do OR Air Purifiers Prevent Surgical Infections? The ORACLE Trial
My take on the October 2026 Anesthesiology ORACLE trial. Supplemental air purification in 68 operating rooms and more than 110,000 surgeries did not reduce wound infections, complications, or death, and here is where I would focus instead.
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Cardiac Index Targets in High-Risk Abdominal Surgery: The PELICAN Trial
My take on the October 2026 JAMA PELICAN trial. Holding each patient at their own resting cardiac index with fluids and dobutamine did not reduce early complications after major abdominal surgery, and a 90-day mortality signal deserves attention.
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Inhaled Isoflurane Sedation in the ICU: What SAVE-ICU Showed
Thoughts on the October 2026 JAMA SAVE-ICU trial of isoflurane versus IV sedation in ventilated adults with hypoxemic respiratory failure. No mortality difference, no clear harm signal, and a lesson about sedation depth.
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Remimazolam Versus Propofol in Adult Cardiac Surgery
My take on an October 2026 JCVA meta-analysis of remimazolam versus propofol for induction and maintenance in adult cardiac surgery. Fewer hypotension and bradycardia events looked real, certainty was very low, and hard outcomes were too thin to pool.
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High-Flow Nasal Oxygen During Vitrectomy Sedation
An October 2026 randomized trial of high-flow versus low-flow nasal oxygen during moderate sedation for pars plana vitrectomy. No frank hypoxemia in either arm, and the HFNO signal showed up more in below-target SpO2 and ASA III respiratory stability.
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Protocolized Intraoperative BP Targeting: A Bayesian Look at the Evidence
My take on a September 2026 Anesthesiology Bayesian meta-analysis of protocolized intraoperative blood pressure targeting. Mortality and MINS looked null, the AKI signal was soft, and here is how I weigh that against day-to-day hypotension management.
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ANH Plus Cell Salvage: Extra Blood Sparing in Major Orthopedics?
A September 2026 randomized trial found less allogeneic transfusion when acute normovolemic hemodilution was added to intraoperative cell salvage in major orthopedic surgery. Small study, practical question.
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Does a Preop Fluid Bolus Prevent Post-Induction Hypotension?
My take on a September 2026 Anesthesiology trial of 504 higher risk patients. A crystalloid bolus in the hour before induction did not reduce hypotension after induction, and here is what I focus on instead.
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Ciprofol Versus Remimazolam TIVA and PONV After Lap Chole
A September 2026 randomized trial found much less nausea and vomiting with ciprofol than with remimazolam TIVA after laparoscopic cholecystectomy. The bigger lesson is that the drug matters, not just the IV route.
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Omitting Face-Mask Ventilation Before Intubation in Low-Risk Adults
A clinician’s read of a September 2026 non-inferiority RCT that skipped face-mask ventilation before intubation in low-risk thyroid patients. No patient desaturated, formal NI was not established, and a gastric insufflation signal is worth remembering.
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Periplexus Versus Intraplexus Interscalene Block for Shoulder Arthroscopy
Thoughts on a September 2026 RCT comparing peri- versus intraplexus interscalene injection for regional-only rotator cuff repair, in which conditions were excellent with both approaches but non-inferiority was not demonstrated.
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Preanesthetic Opioids and Subjective Effects Before Induction
A clinician’s read of a September 2026 randomized trial of pre-induction morphine, oxycodone, and fentanyl: what patients actually feel, and why routine “comfort” opioids before anesthesia deserve a second look.
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Perioperative Esketamine and Postoperative Delirium in Older Adults
Thoughts on a September 2026 systematic review and meta-analysis of esketamine-containing perioperative strategies and delirium risk after surgery in adults 60 and older, including the signal, the caveats, and how I weigh it against non-drug prevention.
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Sugammadex, SNaPP, and Postoperative Pulmonary Complications
A clinician’s read of the SNaPP trial comparing sugammadex and neostigmine after major abdominal or thoracic surgery: what changed, what did not, and how I think about reversal in day-to-day practice.
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Intensive MAP Targets, Delirium, and Surgical-Site Infection
Thoughts on a September 2026 meta-analysis of intensive versus standard intraoperative blood-pressure management in noncardiac surgery, with a signal for delirium and SSI and quieter findings elsewhere.
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These posts are professional commentary for educational discussion. They are not medical advice for any individual’s personal care. Decisions about anesthesia and perioperative management belong with the treating clinician and patient.