Medical Literature Brief

Anesthesiology · Intensive care · Cardiothoracic · Cardiology · ID

Literature brief

STS POAF guideline, ASA regional analgesia guideline, and RSI ketamine vs etomidate

Nothing new broke in the true last-7-day window, so the brief fell back to popular items still generating strong clinician discussion.

Imported from the original Cowork run log. Days before 2026-08-20 were recorded as titles and links only, so those entries are shorter than the ones written since.

No major new primary-literature items broke in the true last-7-day window (Aug 15–22) beyond what was logged on 2026-08-21. Confirmed via criticalcarereviews.com journal-watch (full Aug 17–20 listing pulled — Aug 20 entries were narrative reviews and commentaries), hot-trials, NEJM “recently published,” JAMA current issue, AJRCCM advance articles (through Aug 14), EJCTS advance articles (through Aug 6), BJA in-press (blocked, 403), and targeted WebSearch per journal and society. This brief is therefore the fallback case — popular items still generating strong discussion, not a “new this week” claim.

1. STS 2026 guidelines — postoperative atrial fibrillation after cardiac surgery

Journal · Published: The Annals of Thoracic Surgery. Publication date is unclear and conflicting across sources (~April or July 2026) — either way older than 7 days, but a new-ish, actively discussed guideline never previously logged. STS news release plus cardiovascularbusiness.com coverage.

The first unified STS phase-based (pre-, intra-, post-operative) framework, harmonised with AATS/EACTS/ESTS methodology, reframing POAF as “a marker of perioperative vulnerability.” Key recommendations per secondary sources:

  • Amiodarone Class I — bradycardia only ~2–4%, heart block 1–2%; cumulative 3–6 g preventive
  • Beta-blockers downgraded to Class IIa
  • Posterior pericardiotomy Class IIa — NNT ~7, <5 min technique
  • Anticoagulation Class IIb / individualised — discourages routine use

Read the guideline · PMID 42009116

2. RSI trial — Ketamine or etomidate for tracheal intubation of critically ill adults

Journal · Published: NEJM, 9 December 2025 — older, but still heavily discussed in anaesthesia, EM and ICU circles into 2026; sent as “still generating discussion,” not new Driver et al.

Pragmatic multicentre RCT, 14 US sites, N=2,365.

  • Primary outcome — 28-day in-hospital mortality, no difference: ketamine 28.1% vs etomidate 29.1% (RD −0.8 pp, 95% CI −4.5 to 2.9, P=0.65), consistent across subgroups including sepsis.
  • But cardiovascular collapse during intubation was higher with ketamine: 22.1% vs 17.0% (RD 5.1 pp, 95% CI 1.9–8.3, NNH 20), widening to NNH 10 in high-risk subgroups (sepsis, APACHE II ≥20).

Interpretation. This contrasts with prior meta-analyses (Koroki 2024, Greer 2025) and trials (KETASED, EvK) that had raised concern about etomidate and adrenal suppression, particularly in sepsis. The trial pushes back the other way on ketamine’s presumed haemodynamic safety edge.

Read the paper

3. 2026 ASA practice guideline — local and regional analgesia

Journal · Published: Anesthesiology 2026;144:19–43, January 2026 — older; flagged in the 2026-08-17 run notes as worth surfacing once, now sent.

The first ASA guideline to formally endorse fascial plane blocks as first-line regional technique across these surgery types, not just neuraxial or paravertebral.

  • Strong recommendation for fascial plane blocks in open cardiothoracic surgery — pain reduction 1.33/10, opioid savings ~60 mg OME
  • Strong for open abdominal/retroperitoneal/pelvic surgery — pain reduction 0.68–0.78/10, ~35 mg OME savings
  • Strong for fascial plane or paravertebral blocks in mastectomy — dynamic pain reduction 1.3/10, ~25 mg OME savings
  • Conditional for minimally-invasive cardiothoracic; strong for minimally-invasive abdominal

Read the guideline · PMID 41363869