Anesthesiology Manual:
Best Practices and Case Management

A large preplanned analysis of the PADDI trial provides reassuring evidence for anesthesiologists and surgeons managing patients with diabetes. Although a single 8 mg intraoperative dose of dexamethasone increased perioperative blood glucose levels, the study found no increase in surgical-site infections, additional insulin requirements, hypoglycemia, or hospital length of stay.  Dexamethasone remains a cornerstone of perioperative care Dexamethasone is widely administered during surgery to prevent postoperative nausea and vomiting (PONV). Its effectiveness as an antiemetic has made it a routine component of anesthetic practice worldwide. However, because dexamethasone is a glucocorticoid, clinicians have long questioned whether its hyperglycemic effects could increase postoperative complications, particularly among patients with diabetes mellitus. The newly published preplanned analysis of the international Perioperative Administration of Dexamethasone and Infection (PADDI) trial addresses this important clinical concern using data from more than 1,100 surgical patients with diabetes. The findings suggest that while dexamethasone causes a measurable but temporary increase in blood glucose concentrations, this does not translate into worse clinical outcomes during the first postoperative month in appropriately selected patients. Study overview Researchers performed a preplanned analysis of diabetic participants enrolled in the PADDI randomized controlled trial. Study characteristics 1,130 patients with diabetes mellitus were included. Patients underwent elective or expedited non-cardiac, non-obstetric surgery. Participants received either: A single intravenous 8 mg dose of dexamethasone, or Placebo. Patients with poorly controlled diabetes (HbA1c > 9%) were excluded. Most participants (97%) had type 2 diabetes. Mean age was 65 years. Median diabetes duration was approximately eight years. The primary outcome was the maximum blood glucose concentration recorded during the first 24 hours after anesthesia induction. Researchers also evaluated: Surgical-site infections Insulin requirements Hypoglycemic events Hospital length of stay Blood glucose trends throughout the perioperative period Blood glucose increased after dexamethasone The principal finding confirmed that dexamethasone significantly increased […]

Long-acting local anesthetics have become a cornerstone of modern perioperative pain management, enabling clinicians to provide prolonged analgesia while reducing opioid requirements and improving postoperative recovery. Over the past decade, advances in drug delivery technologies have generated considerable excitement, particularly with the introduction of liposomal formulations and the development of innovative carrier-based and carrier-free anesthetic systems. However, despite growing commercial adoption and ongoing technological innovation, a new review published in Current Opinion in Anaesthesiology suggests that enthusiasm should be balanced by evidence. While several novel formulations show promise in extending analgesia and improving drug pharmacokinetics, the clinical advantages of currently available products—particularly liposomal bupivacaine—appear more modest than initially anticipated. At the same time, concerns regarding local anesthetic systemic toxicity (LAST), dosing variability, and cost-effectiveness continue to influence clinical decision-making. Long-acting local anesthetics remain central to multimodal analgesia Regional anesthesia has transformed perioperative pain management by allowing targeted pain control while minimizing systemic opioid exposure. Traditional long-acting local anesthetics—including bupivacaine, levobupivacaine, ropivacaine, and tetracaine—have been widely used for decades in peripheral nerve blocks, neuraxial anesthesia, wound infiltration, and fascial plane blocks. More recently, these agents have become integral components of enhanced recovery after surgery (ERAS) protocols, where prolonged analgesia facilitates earlier mobilization, shorter hospital stays, and improved patient satisfaction. The review notes that current research is focused less on discovering entirely new anesthetic molecules and more on developing innovative delivery systems capable of prolonging drug action while minimizing systemic toxicity and adverse effects. Drug delivery technology is driving the next generation of local anesthetics Instead of relying solely on the pharmacological properties of existing drugs, researchers are engineering sophisticated delivery platforms that release local anesthetics gradually. Two major approaches are currently under investigation: Carrier-based formulations Carrier-free formulations Both strategies aim to maintain effective tissue concentrations for longer periods without increasing peak […]