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Advances in the Clinical Management of Perioperative Anesthesia: 2nd Edition

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: closed (25 May 2026) | Viewed by 5321

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Editors

Dr. Alessia Mattei

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Guest Editor

Unit of Anaesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
Interests: anesthesia; pain management; perioperative medicine; anesthesiology; intensive care
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Prof. Dr. Rita Cataldo

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Guest Editor

1. Unit of Anaesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
2. Research Unit of Anaesthesia and Intensive Care, Department of Medicine and Surgery, Università Campus Bio Medico di Rome, Via Alvaro del Portillo, 21-00128 Rome, Italy
Interests: anesthesia; pain management; perioperative medicine; anesthesiology; intensive care; anesthesia in robotic surgery; ERAS; ERABS
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Dr. Alessandro Strumia

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Guest Editor

Unit of Anaesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
Interests: anesthesia; pain management; perioperative medicine; cardiac anesthesia; regional anesthesia
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is our pleasure to invite you to contribute to this Special Issue entitled “Advances in the Clinical Management of Perioperative Anesthesia: 2nd Edition”. This is a new volume; more than seven papers were published in the first volume. For more details, please visit the following link: https://www.mdpi.com/journal/jcm/special_issues/DJ43E7QZ31.

Perioperative and anesthetic management undertaken for general surgery improves surgical outcomes. It requires close multidisciplinary collaboration between dedicated anesthetic, surgical, and clinical teams and should be based on a combination of multimodal evidence-based strategies applied to the conventional perioperative techniques, such as the Enhanced Recovery After Surgery (ERAS) protocols.

Preoperative evaluation with risk factor optimization, choice of anesthesia and anesthetic drugs, multimodal analgesia and pain management, fluid management, hemodynamic monitoring, postoperative early feeding, and early mobilization are key elements of a patient-centered strategy to reduce postoperative complications and achieve early recovery.

This Special Issue in the Journal of Clinical Medicine aims to publish topical clinical research related to the perioperative care of surgical patients, involving different areas of interest throughout the surgical pathway to recovery.

We welcome the submission of original research articles, narrative and/or systematic reviews, and meta-analyses focused on the clinical management of perioperative anesthesia.

Dr. Alessia Mattei
Prof. Dr. Rita Cataldo
Dr. Alessandro Strumia
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

perioperative outcomes (surgical, anesthetic, medical)
evidence-based care
perioperative guidelines and consensus statements
preoperative evaluation and risk scores
preoperative testing
surgical optimization and enhanced surgical recovery programs
intensive care unit

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Published Papers (6 papers)

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Research

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13 pages, 1140 KB

Open AccessArticle

Association of Remimazolam-Based Versus Desflurane-Based Maintenance with Early Gastrointestinal Recovery After Laparoscopic Cholecystectomy: A Single-Center Retrospective Cohort Study

by Byeong Gwan Noh, Eun Ji Park, Myunghee Yoon, Hyung Il Seo, Young Mok Park, Myeong Hun Oh, Hyeon-Jeong Lee, Jeong-Min Hong, Boo-young Hwang, Unji Kim and Mingyu Kim

J. Clin. Med. 2026, 15(11), 4202; https://doi.org/10.3390/jcm15114202 - 29 May 2026

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Abstract

Background/Objectives: In standardized low-event surgery such as laparoscopic cholecystectomy (LC), discharge-based outcomes may be insufficiently sensitive to capture differences in recovery trajectory. We investigated whether early gastrointestinal recovery after standardized LC differed according to anesthetic maintenance strategy. Methods: This single-center retrospective cohort study included consecutive adults who underwent scheduled LC between September 2023 and December 2025 within a standardized perioperative pathway. The primary exposure was anesthetic maintenance strategy, comparing remimazolam-based with desflurane-based maintenance. The primary outcome was time to first flatus. Key secondary outcomes included postoperative day 1 (POD 1) high-sensitivity C-reactive protein (hs-CRP), C-reactive protein-to-albumin ratio (CAR), diet delay, prolonged hospital stay, postoperative nausea and vomiting, and 30-day readmission. Associations were evaluated using a log-normal accelerated failure time model, multivariable logistic regression, and log-transformed linear models for inflammatory markers. Results: A total of 316 patients were included (remimazolam, n = 171; desflurane, n = 145). Time to first flatus was shorter in the remimazolam group, with an unadjusted median difference of 8 h (28.0 [24.0–37.0] vs. 36.0 [28.0–52.0] h). After adjustment, remimazolam-based maintenance remained associated with a 21% shorter time to first flatus (time ratio, 0.79; 95% confidence interval [CI], 0.72–0.86; p < 0.001), corresponding to an adjusted median reduction of 8.0 h. The remimazolam group also showed earlier flatus recovery across predefined time windows and lower POD 1 hs-CRP and CAR, whereas later outcomes were largely similar. Conclusions: In standardized LC, early gastrointestinal recovery appeared more sensitive to anesthetic maintenance strategy than discharge-based outcomes. These findings support the use of early functional recovery measures, in addition to discharge timing, when evaluating perioperative recovery in low-event short-stay surgery. Full article

(This article belongs to the Special Issue Advances in the Clinical Management of Perioperative Anesthesia: 2nd Edition)

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12 pages, 783 KB

Open AccessArticle

Single-Shot Subcutaneous Lidocaine Infiltration at Closure Is Associated with Reduced Early Pain and Opioid Requirement After Single-Incision Laparoscopic Totally Extraperitoneal Hernia Repair

by Jong Min Lee

J. Clin. Med. 2025, 14(23), 8324; https://doi.org/10.3390/jcm14238324 - 23 Nov 2025

Cited by 2 | Viewed by 901

Abstract

Background: Subcutaneous wound infiltration with local anesthetics has been proposed as a simple adjunct for postoperative pain control; however, its value in single-incision laparoscopic total extraperitoneal (SILTEP) inguinal hernia repair remains unclear. Methods: We retrospectively analyzed 199 consecutive SILTEP inguinal hernia repairs performed between November 2022 and July 2025 (117 no-lidocaine, 82 lidocaine). A double adjustment, combining 1:1 propensity score matching with multivariable regression across 20 multiply imputed datasets was performed. The primary outcome was maximal numeric pain intensity scale (NPIS) on postoperative day (POD) 0. Results: Eighty-two matched pairs were generated. In the final pooled, adjusted models, lidocaine infiltration was associated with a significant reduction in the primary outcome, maximal NPIS on POD 0 (β = −1.25; 95% CI: −2.01 to −0.50; p = 0.001). Lidocaine was also associated with significantly lower odds of requiring rescue analgesia on POD 0 (OR = 0.12; 95% CI: 0.03–0.46; p = 0.002), fewer rescue doses during hospitalization (β = −1.11; 95% CI: −1.62 to −0.49; p < 0.001), and a lower morphine-equivalent dose (β = −5.14; 95% CI: −7.79 to −2.49; p < 0.001). No increase in postoperative complications was observed. Conclusions: Single-shot subcutaneous lidocaine infiltration in SILTEP hernia repair is a simple, low-risk intervention that was associated with reduced immediate postoperative pain and opioid use without increasing complications. However, the effect was short-lived with no sustained benefit beyond the first postoperative day. Full article

(This article belongs to the Special Issue Advances in the Clinical Management of Perioperative Anesthesia: 2nd Edition)

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Review

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17 pages, 569 KB

Open AccessReview

Anesthetic Management for Encephaloduroarteriosynangiosis in Moyamoya Disease: A Hemodynamic and Neuromonitoring-Integrated Framework

by Vikas Chauhan

J. Clin. Med. 2026, 15(13), 4954; https://doi.org/10.3390/jcm15134954 - 25 Jun 2026

Viewed by 185

Abstract

Moyamoya disease is a progressive steno-occlusive cerebrovascular disorder in which cerebral perfusion may become highly dependent on systemic arterial pressure, arterial carbon dioxide tension, and collateral flow. Encephaloduroarteriosynangiosis (EDAS) is an indirect revascularization procedure that promotes neovascularization over weeks to months but does not immediately augment cerebral blood flow intraoperatively. Anesthetic management therefore requires preservation of cerebral oxygen delivery during a period of persistent physiologic vulnerability. This narrative review presents a practical perioperative framework for EDAS anesthesia, emphasizing maintenance of mean arterial pressure near baseline or modestly above baseline, avoidance of hypotension and hypovolemia, normoxia, normothermia, and careful regulation of carbon dioxide. Hyperventilation should be avoided because hypocapnia can reduce cerebral blood flow through vasoconstriction, while excessive hypercapnia may contribute to regional maldistribution or steal physiology. Raw electroencephalography may provide cortical ischemia surveillance where available, whereas somatosensory evoked potentials, motor evoked potentials, near-infrared spectroscopy, and transcranial Doppler should be considered adjunctive and institution-dependent. A structured algorithm that integrates hemodynamics, ventilation, oxygen delivery, anesthetic depth, neuromonitoring, and surgical communication may support the timely recognition and correction of intraoperative hypoperfusion. Full article

(This article belongs to the Special Issue Advances in the Clinical Management of Perioperative Anesthesia: 2nd Edition)

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14 pages, 628 KB

Open AccessReview

Perioperative Anesthesia Strategies for the Prevention of Postoperative Nausea and Vomiting Within Enhanced Recovery After Surgery Pathways: A Clinical Narrative Review

by Rachel Dombrower, Alyssa McKenzie, Andrew J. Tucker and Johnathan Atwell

J. Clin. Med. 2026, 15(10), 3829; https://doi.org/10.3390/jcm15103829 - 15 May 2026

Viewed by 652

Abstract

Postoperative nausea and vomiting (PONV) remain a leading preventable perioperative complication despite advances in anesthetic and surgical care, significantly affecting recovery within Enhanced Recovery After Surgery (ERAS) pathways. ERAS protocols provide a structured, multidisciplinary framework for perioperative optimization; however, variability in the implementation of PONV prevention strategies persists. This narrative review synthesizes current evidence on perioperative strategies for PONV prevention within ERAS pathways, focusing on patient risk stratification, multimodal pharmacologic prophylaxis, anesthetic techniques, and adjunctive non-pharmacologic interventions. We evaluate validated risk prediction tools, including the Apfel score, and highlight the importance of individualized prophylactic strategies based on patient, surgical, and anesthetic risk factors. Multimodal antiemetic regimens, opioid-sparing anesthesia, total intravenous anesthesia (TIVA), and regional techniques are discussed as key components of perioperative management. In addition, non-pharmacologic interventions such as optimized fluid therapy, early mobilization, and supportive perioperative care are reviewed as integral elements of ERAS-based recovery pathways. Complementing existing consensus guidelines, this review provides a practical, workflow-based framework spanning preoperative risk assessment, intraoperative decision-making, and postoperative monitoring for direct application within ERAS protocols. Full article

(This article belongs to the Special Issue Advances in the Clinical Management of Perioperative Anesthesia: 2nd Edition)

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Other

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12 pages, 646 KB

Open AccessCase Report

Perioperative Anesthetic Considerations in HMG-CoA Lyase Deficiency: Case Report and Literature Review

by Vasileia Nyktari, Georgios Papastratigakis, Alexandra Koulousi, Chrysi Mandola, Foteini Chaniotaki, Ioannis Goniotakis, Stavroula Ilia and Alexandra Papaioannou

J. Clin. Med. 2025, 14(20), 7332; https://doi.org/10.3390/jcm14207332 - 17 Oct 2025

Viewed by 1203

Abstract

Background/Objectives: 3-Hydroxy-3-methylglutaryl-CoA lyase deficiency (HMGCLD) is an extremely rare autosomal recessive metabolic disorder caused by mutations in the HMGCL gene. HMGCLD disrupts ketogenesis and β-oxidation, leading to energy failure during fasting or stress, with clinical episodes characterized by hypoglycemia, hyperammonemia, lactic acidosis, and encephalopathy. Only 211 cases have been reported worldwide, with no prior reports on anesthetic management in these patients. Methods: We report a 14.5-year-old girl with known HMGCLD who was admitted with abdominal pain and nausea following a fatty meal. Imaging confirmed acute cholecystitis. Initial conservative management failed due to persistent vomiting and inability to tolerate feeding. Deviation from the metabolic protocol led to lactic acidosis and hypoglycemia, requiring intensive care with bicarbonate, carnitine, and glucose infusion. Once optimized, she underwent emergency laparoscopic cholecystectomy under sevoflurane-based anesthesia. Propofol was avoided, given the patient’s compromised lipid metabolism. Intraoperative glucose and acid-base status were closely monitored, with balanced dextrose-based fluids. Results: The patient remained hemodynamically stable throughout and was discharged three days postoperatively. Conclusions: This case highlights the anesthetic challenges of HMGCLD, where system-level miscommunication can trigger severe metabolic decompensation. A review of the literature emphasizes fasting avoidance, continuous glucose supplementation, careful drug and fluid selection, and multidisciplinary coordination. This report provides the first anesthetic roadmap for HMGCLD, underscoring the need for individualized care and meticulous perioperative metabolic control. Full article

(This article belongs to the Special Issue Advances in the Clinical Management of Perioperative Anesthesia: 2nd Edition)

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7 pages, 317 KB

Open AccessCase Report

Successful Cancer Surgery Without Transfusion Following Early Discontinuation of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention for Acute Myocardial Infarction

by Sungmin Suh, Nayoung Kim and Sangho Kim

J. Clin. Med. 2025, 14(18), 6456; https://doi.org/10.3390/jcm14186456 - 13 Sep 2025

Viewed by 971

Abstract

A 75-year-old Jehovah’s Witness with recent ST-elevation myocardial infarction (STEMI) underwent percutaneous coronary intervention (PCI) with stenting of the proximal LAD. She was later diagnosed with gallbladder cancer and required urgent surgery but firmly refused allogeneic blood transfusion. This posed a major challenge, as the surgery was expected to cause significant bleeding, and the patient had undergone coronary stenting within the previous three months, which is when the risk of stent thrombosis is highest if dual antiplatelet therapy (DAPT) is interrupted. After conducting a careful multidisciplinary discussion and obtaining informed consent, both aspirin and clopidogrel were discontinued five days preoperatively. Through comprehensive blood conservation strategies—including acute normovolemic hemodilution (ANH), intraoperative cell salvage, and robotic-assisted minimally invasive surgery—the patient successfully underwent extended cholecystectomy without transfusion. This case highlights the possibility of safe, completely transfusion-free major surgery in patients with recent PCI and high thrombotic risk when individualized perioperative planning is applied. Full article

(This article belongs to the Special Issue Advances in the Clinical Management of Perioperative Anesthesia: 2nd Edition)

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