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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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.