Daily Anesthesiology Research Analysis

This three-round modified Delphi study surveyed 60 nationally representative anesthesiology stakeholders, all of whom completed the study. Consensus recommendations included new minimum requirements for arterial lines, central lines, fiberoptic intubation, one-lung ventilation, neuromonitoring, point-of-care ultrasound (POCUS), and non-operating-room anesthesia, as well as increased requirements for peripheral nerve blocks and cardiac cases.

Impact: The study translates broad concerns about outdated training requirements into specific, stakeholder-validated thresholds that can directly inform the planned 2027 ACGME revisions. Its value lies in improving alignment between residency assessment and contemporary perioperative practice rather than merely reporting educational outcomes.

Clinical Implications: Residency programs and accrediting bodies can use the proposed thresholds to ensure adequate exposure to invasive monitoring, advanced airway management, lung isolation, neuromonitoring, POCUS, and non-operating-room anesthesia. Implementation should remain competency-based and account for case availability, supervision quality, and patient safety rather than relying on case numbers alone.

Future Directions: Future studies should evaluate whether the proposed case categories and thresholds predict objective competence, procedural retention, and patient safety. Multicenter implementation studies should also examine feasibility, equity of case access, simulation as a supplement, and outcomes after adoption of revised requirements.

This PRISMA-guided systematic review and meta-analysis included 27 studies involving 21,908 children undergoing noncardiac surgery. The estimated incidence of postoperative acute kidney injury remained uncertain because of substantial heterogeneity and overrepresentation of high-risk populations, although incidence was particularly high among neonates and liver-transplant recipients.

Impact: The study addresses a major perioperative safety gap in children by quantifying the available evidence while explicitly demonstrating why current estimates cannot be considered definitive. Its negative finding—substantial uncertainty—supports better prospective surveillance and prevents inappropriate use of imprecise incidence estimates in clinical policy.

Clinical Implications: Clinicians should maintain heightened renal surveillance in neonates, younger children, higher-ASA patients, and other high-risk surgical populations. The findings support standardized use of KDIGO criteria and careful perioperative documentation, but they do not justify a single universal pediatric incidence estimate or a uniform prevention protocol.

Future Directions: Prospective, multicenter studies should enroll representative pediatric surgical populations, apply uniform KDIGO definitions and timing, and measure long-term renal outcomes. Future research should also develop validated perioperative risk models and evaluate prevention bundles in high-risk children.

In this single-center, prospective, double-blind randomized trial of 391 older adults, ciprofol, propofol, and etomidate produced no significant differences in hypoxemia or apnea. Etomidate caused a smaller blood-pressure decrease and reduced hypotension and vasoactive-drug use, but increased myoclonus, coughing, and hiccups; ciprofol was associated with less injection pain and less postoperative dizziness.

Impact: This head-to-head randomized comparison provides clinically actionable information for selecting induction agents in an older population at increased risk of hypotension and respiratory complications. The study is particularly useful because it demonstrates trade-offs rather than claiming universal superiority of one drug.

Clinical Implications: Etomidate may be considered when preservation of hemodynamic stability is the primary objective, while clinicians should anticipate myoclonus and airway-related reactions. Ciprofol may be useful when minimizing injection pain and postoperative dizziness is important, but drug selection should remain individualized because the primary respiratory safety outcome did not differ.

Future Directions: Larger multicenter trials should compare these agents in frail and high-risk older adults, assess patient-centered recovery and cost outcomes, and evaluate dose-adjustment strategies. Studies should also determine whether specific procedural or comorbidity subgroups derive greater benefit from ciprofol or etomidate.