BACKGROUND Antibiotics play a crucial role in preventing surgical site infections, yet adherence to Infectious Disease Society of America (IDSA) guidelines varies widely. This qualitative study aimed to explore factors influencing perioperative antibiotic administration and assess the potential impact of a clinical decision support (CDS) tool on guideline adherence. METHODS In this qualitative study

Lumbar cerebrospinal fluid (CSF) drainage is one of the few preventative and therapeutic practices that may reduce spinal cord ischemia in high-risk thoracic endovascular aortic aneurysm repair (TEVAR). Although this is part of clinical guidelines in open thoracoabdominal aortic repair, there are no randomized controlled trials that provide convincing evidence on the protection conferred by CSF drainage

BACKGROUND The Gompertz-Makeham law describes a characteristic pattern of mortality in human populations where the death rate is near constant between ages 18 and 30 yr (Makeham law) and rises exponentially thereafter (Gompertz law). This pattern has not been described in surgical populations, but if true, it would have important implications for understanding surgical risk and design and interpretation

BACKGROUND The Trial Remifentanil DEXmedetomidine (TREX) trial aimed to determine whether, in children less than 2 yr old, low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia is superior to standard-dose sevoflurane anesthesia in terms of global cognitive function at 3 yr of age. The aim of the current secondary analyses was to compare incidence of intraoperative hypotension and bradycardia

BACKGROUND The efficacy of serratus anterior plane block for treatment of pain after minimally invasive thoracic surgery remains unclear. This trial assesses the impact of serratus anterior plane block on postoperative opioid consumption and on measures of early recovery after thoracoscopic lung resection. METHODS Patients undergoing minimally invasive anatomic lung resection at a single center were

BACKGROUND Prescription rates for buprenorphine in opioid use disorder are increasing, and recent guidelines recommend its continuation during and after surgery; however, evidence from clinical outcome studies is limited. We tested the hypotheses that 1) perioperative continuation of buprenorphine does not result in higher pain scores and 2) that this approach does not result in higher supplemental

BACKGROUND The GAS trial demonstrated evidence that most neurodevelopmental outcomes at 2 years and 5 years of age in infants who received a single general anaesthetic (GA) for elective inguinal herniorrhaphy were clinically equivalent when compared to infants who did not receive GA. More than 20% of the children in the trial had at least one subsequent anaesthetic exposure after their initial surgery

BACKGROUND Emerging evidence indicates that cyclic nucleotide phosphodiesterases exert distinct functions in pain processing and that targeting phosphodiesterases might be a novel strategy for pain relief. This study hypothesized that the phosphodiesterase isoform PDE10A might be a target for analgesic therapy. METHODS In situ hybridization, immunostaining, cyclic nucleotide enzyme immunoassays, real-time

BACKGROUND Postoperative nausea and vomiting (PONV) is common after general anesthesia, with consequences for patient outcomes, satisfaction with care and healthcare costs. Our aim was to compare a new treatment, chewing gum, with a widely-used intravenous agent, ondansetron, to treat PONV in female patients in the post anesthesia care unit (PACU). METHODS We conducted a multicenter, randomized, controlled

BACKGROUND Midazolam is a short-acting benzodiazepine frequently used in the perioperative setting. This study aimed to investigate the potential impact of intraoperative midazolam on postoperative delirium (POD) in older patients undergoing non-cardiac surgery. METHODS This study included patients aged ≥ 65 years who received general anaesthesia between April 2020 and April 2022 in multiple hospitals

BACKGROUND Recent evidence indicates that general anesthesia and sleep-wake behavior share some overlapping neural substrates. GABAergic neurons in the central amygdala (CeA) have a high firing rate during wakefulness and play a role in regulating arousal-related behaviors. The objective of this study is to investigate whether CeA GABAergic neurons participate in the regulation of isoflurane general

BACKGROUND Diaphragm dysfunction is common in intensive care unit and associated with weaning failure and mortality. Diagnosis gold standard is the transdiaphragmatic or tracheal pressure induced by magnetic phrenic nerve stimulation. However, the equipment is not commonly available and requires specific technical skills. We aimed to evaluate ultrasound guided transcutaneous phrenic nerve stimulation

Conscientious objection is a legally protected right of medical professionals to recuse themselves from patient care activities that conflict with their personal values. Anesthesiology is different from most specialties with respect to conscientious objection in that the focus is to facilitate safe, efficient, and successful performance of procedures by others, rather than to perform the treatment

During the past 70 years, patient safety science has evolved through four organizational frameworks known as Safety-0, Safety -1, Safety-2, and Safety-3. Their evolution reflects the realization over time that blaming people, chasing errors, fixing one-offs, and regulation would not create the desired patient safety. In Safety-0, the oldest framework, harm events arise from clinician failure; event

BACKGROUND Drug shortages are a frequent challenge in current clinical practice. Certain drugs, (e.g., protamine) lack alternatives and inadequate supplies can limit access to services. Conventional protamine dosing uses heparin ratio-based calculations for heparin reversal following CPB and may result in excess protamine utilization, and potential harm due to its intrinsic anticoagulation. We hypothesized

BACKGROUND Electroencephalogram burst suppression can be associated with postoperative delirium; however, the results of relevant studies are discrepant. This systematic review and meta-analysis aimed to assess the association between intraoperative burst suppression and postoperative delirium in adult surgical patients. METHODS PubMed, MEDLINE, Embase, Google Scholar, and the Cochrane Central Register

BACKGROUND The incidence of central venous catheter-related thrombosis and the long-term effects of thrombosis on catheterized veins in neonates is unknown. We therefore determined the incidence of central venous thrombosis, identified associated risk factors, and evaluated outcomes at 6 months. METHODS We enrolled neonates aged less than 28 days scheduled for major intestinal or cardiac surgery whom

BACKGROUND Few studies have assessed the dose ratio of calcium gluconate to calcium chloride or defined the time course of change in serum ionized calcium concentration after intravenous injection. METHODS In a bioequivalence (dose ratio) trial, parturients undergoing cesarean delivery were randomly assigned to receive calcium chloride 0.5 grams or calcium gluconate 1.5 or 2 grams by 10-minute intravenous

BACKGROUND Numerous, sometimes conflicting, changes in brain functional connectivity have been associated with the transition from wakefulness to unresponsiveness at induction of general anesthesia. However, relatively few studies have looked at: the detailed time evolution of the transition; for different EEG frequency bands; and in the clinical scenario of surgical patients undergoing general anesthesia

BACKGROUND The efficacy of superficial cervical plexus blocks for reducing persistent pain after craniotomies remains unclear. We therefore tested the primary hypothesis that preoperative ultrasound-guided superficial cervical plexus blocks reduce persistent pain 3 months after suboccipital craniotomies. METHODS We conducted a single-center randomized and blinded parallel-group trial. Eligible patients