Anesthesiology Manual:
Best Practices and Case Management

A new analysis published in the European Journal of Anaesthesiology has identified a significant association between higher positive perioperative fluid balance and the development of postoperative acute kidney injury (AKI) in patients undergoing elective colorectal surgery. The findings add to growing evidence that excessive fluid accumulation during the perioperative period may contribute to adverse postoperative outcomes and highlight the importance of individualized fluid management strategies. Acute kidney injury remains a major surgical complication Acute kidney injury is one of the most common postoperative complications and is associated with: Increased morbidity Longer hospital stays Higher healthcare costs Increased mortality risk Greater likelihood of long-term renal dysfunction Previous studies have shown that AKI occurs in approximately 13% of patients undergoing major abdominal surgery and is associated with substantially increased mortality. Despite this, optimal perioperative fluid management remains an area of ongoing debate. Study overview Researchers conducted a pre-planned secondary analysis of the multicentre POWER study, which evaluated outcomes in patients undergoing elective colorectal surgery across 80 hospitals in Spain. Study design Prospective observational cohort study 80 participating hospitals Recruitment period of two months 1,139 patients included Follow-up period of 30 days after surgery The primary objective was to examine whether perioperative fluid balance during the first 24 hours after surgery was associated with the risk of developing postoperative AKI. Key findings AKI occurred in 6.4% of patients Among the 1,139 patients included: 73 patients developed postoperative AKI Overall incidence was 6.4% Mild AKI occurred in 2.7% Moderate AKI occurred in 2.7% Severe AKI occurred in 1.0% Higher fluid balance increased risk Patients who developed AKI had a significantly greater positive fluid balance during the first 24 postoperative hours. Average 24-hour fluid balance: AKI patients: 1,780 mL Non-AKI patients: 1,038 mL The relationship persisted even after adjustment for important confounding factors. Fluid balance […]

For decades, transient neurologic symptoms (TNS) have been one of the primary concerns limiting the use of lidocaine for spinal anesthesia. Early studies reported rates as high as 20–40%, leading many anesthesiologists to abandon intrathecal lidocaine in favor of longer-acting alternatives such as bupivacaine. However, modern perioperative care has changed dramatically. Enhanced recovery protocols, multimodal analgesia, and outpatient joint replacement pathways have transformed postoperative patient management. A new study by Amaral and colleagues in RAPM suggests that the historical concerns surrounding lidocaine spinal anesthesia may warrant reconsideration. In a retrospective review of more than 1,000 patients undergoing total hip and knee arthroplasty, investigators found an extremely low incidence of TNS following spinal lidocaine administration. Only two patients developed probable TNS, yielding an incidence of 0.2%. Both cases were mild and resolved completely within days. The findings raise an important question: Has the risk profile of lidocaine spinal anesthesia changed in the era of modern multimodal analgesia? Why transient neurologic symptoms remain important Transient neurologic symptoms are characterized by new-onset pain involving the lower back, buttocks, or lower extremities following spinal anesthesia. The syndrome typically develops within the first 24 hours after surgery and may present as: Lower back pain Buttock discomfort Pain radiating into the thighs Cramping sensations Stretching-type pain Musculoskeletal soreness without neurologic deficits Importantly, TNS does not cause permanent nerve injury. Patients generally do not experience motor weakness, sensory loss, or lasting neurologic impairment. Nevertheless, the condition can be distressing and may negatively affect recovery, mobility, and overall patient satisfaction. Historically, TNS became strongly associated with spinal lidocaine. Numerous studies published during the 1990s reported widely varying incidence rates, ranging from approximately 4% to more than 40%, depending on patient population, surgical procedure, and study methodology. These reports substantially influenced anesthetic practice worldwide. Why lidocaine fell out of […]