BACKGROUND The incidence of severe adverse events in children with SARS-CoV-2 undergoing anaesthesia has not been well established. We examined the relationship between SARS-CoV-2 infection and severe perioperative adverse events in children. METHODS This multicentre (21 North American institutions), retrospective cohort study included children <18 years old, with American Society of Anesthesiologists

Life cycle assessment is increasingly used in the healthcare sector to facilitate more environmentally informed supply and medication use. A thorough life cycle assessment comparing the carbon impacts of 10 different single-use anaesthetic drug trays yielded surprising findings. Although life cycle assessment can guide decision-making, results must be interpreted clinically and in light of all available

BACKGROUND Recent advances in artificial intelligence (AI) have enabled development of natural language algorithms capable of generating coherent texts. We evaluated the quality, validity, and safety of this generative AI in preoperative anaesthetic planning. METHODS In this exploratory, single-centre, convergent mixed-method study, 10 clinical vignettes were randomly selected, and ChatGPT (OpenAI

BACKGROUND Total hip replacement surgery is performed to improve quality of life (QoL). We explored the association between multimorbidity and change in QoL after total hip replacement. METHODS Analysis of patients included in the NHS England hip replacement Patient Reported Outcome Measures (PROMs) database with complete preoperative from 3 to 6 months postoperative EQ-5D QoL data from April 2013

Deciding the optimal time for surgery in patients with pre-existing comorbid disease is complex. A careful balance of risks is required to weigh up the therapeutic benefits of surgery against an increased risk of perioperative adverse outcomes, whereas the subsequent risk of adverse events and mortality is more dependent on pre-existing conditions. A study in a recent issue of BJA shows that people

BACKGROUND The acute hypoxic ventilatory response is a critical chemoreflex originating at the carotid bodies. This study investigates the impact of low-dose i.v. esketamine on the ventilatory response to 20 min of isocapnic hypoxia to test the hypothesis that esketamine does not affect hypoxic ventilation. METHODS In this open-label study, 18 healthy subjects received a 3-h escalating i.v. infusion

This narrative review evaluates the evidence regarding the protection offered by isolation gowns, approaches to imparting antimicrobial activity to gowns, and the environmental impacts of gown use, particularly during the COVID-19 pandemic. We conducted a search of the Medline, PubMed, and Google Scholar databases for articles published between January 1, 2019 to February 20, 2024. We found that current

BACKGROUND Physical prehabilitation can enhance patient resilience to surgical stress, but its effects are unclear in vulnerable and frail patients. We aimed to determine the effect of a structured exercise prehabilitation programme on the quality of recovery after cardiac surgery in vulnerable and frail participants. METHODS This single-blinded, parallel-arm, superiority, randomised controlled trial

BACKGROUND Optimal composition and infusion rates of intravenous maintenance fluids for children undergoing surgery are not well defined. Avoidance of hypoglycaemia, ketosis, and hyponatraemia is important, and current guidelines recommend isotonic fluids containing 1.0-2.5% glucose. However, evidence for its safe use in infants is insufficient. The aim of this study was to investigate whether normoglycaemia

The score for prediction of postoperative respiratory complications in infants and children (SPORC-C) was recently reported. The score was developed using a large cohort of patients by applying a multivariate model, then internally and externally validated on a different cohort of patients. In order to encourage use of this score, an online calculator (https://sites.google.com/view/sporc-for-children/home)

BACKGROUND Risk prediction scores are used to guide clinical decision-making. Our primary objective was to externally validate two patient-specific risk scores for 30-day in-hospital mortality using the Multicenter Perioperative Outcomes Group (MPOG) registry: the Pediatric Risk Assessment (PRAm) score and the intrinsic surgical risk score. The secondary objective was to recalibrate these scores. METHODS

BACKGROUND Methoxyethyl etomidate hydrochloride (ET-26) is a novel etomidate analogue. This is the first-in-human study of a bolus i.v. formulation of ET-26 to assess its safety, tolerability, hypnotic effects, and pharmacokinetics. METHODS We enrolled 58 subjects in a dose-escalating study (stage 1a, 10 cohorts, ET-26 0.05-2.8 mg kg-1) and 40 subjects in a head-to-head study (stage 1b, four cohorts)

BACKGROUND Propofol accounts for a substantial proportion of medication waste. Evidence-based waste reduction methods are scarce. METHODS In a retrospective analysis of 331 procedures, the total propofol waste per surgery was compared between manual and syringe pump induction of anaesthesia during total intravenous anaesthesia (TIVA), with a syringe pump used to maintain TIVA after induction. The secondary

Patient blood management (PBM) encompasses implementing multimodal evidence-based strategies to screen, diagnose, and properly treat anaemia and coagulopathies using goal-directed therapy while minimising bleeding. The aim of PBM is to improve clinical care and patient outcomes while managing patients with potential or ongoing critical anaemia, clinically significant bleeding, and coagulopathies. The

BACKGROUND The EFFORT Protein trial assessed the effect of high vs usual dosing of protein in adult ICU patients with organ failure. This study provides a probabilistic interpretation and evaluates heterogeneity in treatment effects (HTE). METHODS We analysed 60-day all-cause mortality and time to discharge alive from hospital using Bayesian models with weakly informative priors. HTE on mortality was

BACKGROUND Postoperative anxiety and depression can negatively affect surgical outcomes and patient wellbeing. This study aimed to quantify the incidence of postoperative worsening anxiety and depression symptoms and to identify preoperative predictors of these conditions. METHODS This prospective, observational cohort study included 1168 patients undergoing surgery lasting >1 h with overnight admission

Flexible bronchoscopy for tracheal intubation is indicated in patients with difficult airways, but the upper airway is frequently obstructed in sedated or anaesthetised apnoeic patients. This makes it more difficult to locate the glottis through bronchoscopy, and increases the risk of hypoxaemia. Nasal high-flow oxygenation is useful to prevent hypoxaemia during airway management, but no studies have

Concerns regarding residual neuromuscular block (RNMB) have persisted since the introduction of neuromuscular blocking agents, with reported incidences in the 21st century up to 50%. Advances in neuromuscular transmission (NMT) monitoring and the introduction of sugammadex have addressed this issue, but the impact of these developments remains unclear.

Delayed gastric emptying increases the risk of pulmonary aspiration during anaesthesia for Caesarean delivery. Our aim in conducting this narrative review was to consider the effect of pregnancy on gastric emptying. The indices of gastric emptying after liquids, solids, or both and when fasted in the various trimesters of pregnancy, at the time of Caesarean delivery, in labour, and the postpartum period

BACKGROUND There is well-established evidence linking adverse childhood experiences (ACEs) and chronic pain in adulthood. It is less clear how ACE exposure might influence the response to chronic pain treatment. In this systematic review, we synthesise the literature assessing the impact of ACE exposure on outcomes relating to the use, benefits, and harms of analgesic medications (analgesia-related

Deaths from unrecognised oesophageal intubation continue despite national campaigns emphasising the importance of capnography to confirm tracheal intubation. A two-person verbal intubation check is recommended in consensus guidelines intended to prevent such deaths. This check can be performed by the intubator with their assistant, either as a one-step process (identification of sustained exhaled carbon

BACKGROUND Postoperative neurocognitive decline is a frequent complication triggered by unclear signalling mechanisms. This observational case-control study investigated the effects of hip or knee replacement surgery on the composition of circulating extracellular vesicles (EVs), potential periphery-to-brain messengers, and their association with neurocognitive outcomes. METHODS We mapped the microRNAome

BACKGROUND Cardiac surgery poses a significant risk of perioperative bleeding and allogeneic blood transfusions, particularly in patients with bleeding disorders. Increasingly frequent use of coagulation factor concentrates could impact haemorrhagic risks, thromboembolic events, and costs. We describe the use of coagulation factor concentrates and allogeneic blood products in cardiac surgical patients

BACKGROUND Preoperative anaemia and red blood cell (RBC) transfusions are associated with poorer clinical outcomes. It is unknown whether perioperative RBC transfusions mediate the relationship between preoperative haemoglobin levels and postoperative outcomes. METHODS This was a prospective observational study among patients aged ≥50 yr undergoing elective major noncardiac surgery from four Swedish

BACKGROUND Over the last two decades, significant research interest has led to the development of a wide variety of supraglottic airways (SGAs) for anaesthesia providers to choose from. METHODS In this network meta-analysis, we analysed 111 studies, enrolling 12 045 patients undergoing airway management with 29 SGAs. We targeted outcomes that contribute to clinicians' choice of one SGA over another

BACKGROUND Sugammadex hypersensitivity is an emerging safety concern. We aimed to describe the clinical and diagnostic features of perioperative hypersensitivity to sugammadex, and secondarily to provide an estimate of perioperative sugammadex hypersensitivity incidence in Australia. METHODS We retrospectively analysed cases of hypersensitivity to sugammadex diagnosed by positive intradermal or skin

Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common after noncardiac surgery. Postsurgical pain is frequent and can persist as chronic postsurgical pain (CPSP). The association between postsurgical pain and POD or POCD is biologically plausible. We conducted this systematic review to evaluate the association between acute postsurgical pain or CPSP and POD or POCD

BACKGROUND Plexus injury results in lifelong suffering from flaccid paralysis, sensory loss, and intractable pain. For this clinical problem, regenerative medicine concepts set high expectations. However, it is largely unknown how dorsal root ganglia (DRG) are affected by accidental deafferentation. METHODS Here, we phenotyped DRG of a clinically and MRI-characterised cohort of 13 patients with plexus

Nitrous oxide (N2O) is a potent greenhouse gas that contributes significantly to the healthcare sector's carbon footprint. Pre-utilisation losses of N2O are up to 95%. Decommissioning manifolds can reduce these losses.

INTRODUCTION Intravenous lidocaine is increasingly used as a nonopioid analgesic, but how it acts in the brain is incompletely understood. We conducted a functional MRI study of pain response, resting connectivity, and cognitive task performance in volunteers to elucidate the effects of lidocaine at the brain-systems level. METHODS We enrolled 27 adults (age 22-55 yr) in this single-arm, open-label

BACKGROUND The accurate diagnosis of heart failure (HF) before major noncardiac surgery is frequently challenging. The impact of diagnostic accuracy for HF on intraoperative practice patterns and clinical outcomes remains unknown. METHODS We performed an observational study of adult patients undergoing major noncardiac surgery at an academic hospital from 2015 to 2019. A preoperative clinical diagnosis

BACKGROUND Delaying surgery after a major cardiovascular event might reduce adverse postoperative outcomes. The time interval represents a potentially modifiable risk factor but is not well studied. METHODS This was a longitudinal retrospective population-based cohort study, linking data from Hospital Episode Statistics for NHS England and the Myocardial Ischaemia National Audit Project. Adults undergoing

The first measures to reduce the environmental harm from volatile anaesthetics are implementation of minimal fresh gas flow strategies and avoidance of desflurane. Although anaesthetic waste gas capture systems generally exert high capturing efficiencies, only about half of volatile anaesthetics used in the operating room are accessible for capture. Industry-sponsored reports promise a reduction of

Authorship provides academic recognition for substantial intellectual contributions to scholarly articles. Beyond recognition, authorship has become a form of currency within the academic community, acting as an indicator of academic output and thus influencing standing within an institution and the general medical community. It might further impact salary as well as job and research grant funding

Patient–physician communication is an integral part of daily anaesthetic practice. Although it is an undeniably powerful means of building a solid therapeutic alliance, several of its fundamental aspects are often overlooked, which can hinder successful communication in the preoperative period. We outline these underexploited elements by analysing the various phases of preoperative patient–physician

Older adults (≥65 yr) account for the majority of emergency laparotomies in the UK and are well characterised with reported outcomes. In contrast, there is limited knowledge on those patients that require emergency laparotomy but do not undergo surgery (NoLaps).

BACKGROUND Managing postoperative pain in patients with obesity is challenging. Although multimodal analgesia has proved effective for pain relief, the specific impacts of different nonopioid i.v. analgesics and adjuvants on these patients are not well-defined. This study aims to assess the effectiveness of nonsteroidal antiinflammatory drugs, paracetamol, ketamine, α-2 adrenergic receptor agonists

Clinical guidelines and consensus statements are an essential aid to clinical practice. However, they bring with them risks. Amongst these are the exclusion of key stakeholders, the creation of mutual self-citation networks, and a lack of rigour in implementing and documenting the consensus process. This editorial explores the challenges of producing robust consensus statements and guidelines that

This systematic review and meta-analysis aimed to inventory all outcome measures that are affected by tapering in chronic noncancer pain and to investigate the effectiveness of tapering.

This review summarises the current evidence for the perioperative preparation in children with upper respiratory tract infections (URTI), including COVID-19 infection. URTI, including COVID-19 infection, are common and frequent in children who present for elective surgery. Children with URTI are at increased risk of perioperative respiratory adverse events. Perioperative respiratory adverse events

BACKGROUND Structured training in regional anaesthesia includes pretraining on simulation-based educational platforms to establish a safe and controlled learning environment before learners are provided clinical exposure in an apprenticeship model. This scoping review was designed to appraise the educational outcomes of current simulation-based educational modalities in regional anaesthesia. METHODS

Fluid therapy is an integral component of perioperative management. In light of emerging evidence in this area, the Perioperative Quality Initiative (POQI) convened an international multiprofessional expert meeting to generate evidence-based consensus recommendations for fluid management in patients undergoing surgery. This article provides a summary of the recommendations for perioperative fluid management

BACKGROUND Previous meta-analyses of intravenous iron supplementation for reducing red blood cell (RBC) transfusion risk after cardiac surgery were inconclusive because of limited data. This updated meta-analysis incorporates recent evidence. METHODS Major databases were searched on May 2, 2024 for randomised controlled trials comparing the incidence of RBC transfusion between adult patients receiving

Chronic postsurgical pain (CPSP) significantly impairs quality of life and poses a substantial healthcare burden, affecting up to a quarter of patients undergoing surgery. Although acute pain is recognised as a predictor for CPSP development, the role of patient experience remains underexplored. This study examines the predictive value of patient experience alongside traditional risk factors for CPSP

Procedural sedation is practised by a heterogeneous group of practitioners working in a wide array of settings. However, there are currently no accepted standards for the competencies a sedation practitioner should have, the content of sedation training programmes, and guidelines for credentialing. The multidisciplinary International Committee for the Advancement of Procedural Sedation sought to develop

BACKGROUND With crewed deep space exploration on the horizon, preparation for potential astronaut health crises in space missions has become vital. Administration of anaesthesia and analgesia presents many challenges owing to constraints specific to space (physiologic and ergonomic challenges associated with microgravity) and nonspecific factors (isolation and lack of supplies). Regional anaesthesia