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Background and Aims: Intrathecal bupivacaine is used for anaesthesia and analgesia but is associated with hypotension. Ropivacaine is an alternative drug that may have fewer cardiotoxic and neurotoxic events. This meta-analysis investigated whether intrathecal ropivacaine is associated with reduced hypotension as compared to bupivacaine. Methods: The meta-analysis is registered in the International Prospective Register of Systematic Reviews (PROSPERO). The databases PubMed, Cinahl Plus, Google Scholar, and Scopus were searched, and papers from January 1980 to January 2023 were deemed eligible and filtered using predetermined inclusion and exclusion criteria. The primary outcome was the incidence of hypotension. Secondary outcomes were the duration of sensory block, duration of motor block, incidence of bradycardia, ephedrine usage, and duration of analgesia. Jadad scores were used to evaluate the quality of the papers. RevMan statistical software® utilised inverse variance and a random effect model to calculate the standardised mean difference with 95% confidence intervals for continuous variables and the Mantel--Haenszel test and the random effect model to calculate the odds ratio for dichotomous variables. Results: Thirty-three papers, including 2475 patients in total, were included. The Jadad score was between 1 and 5. The incidence of hypotension was significantly higher with intrathecal bupivacaine than with ropivacaine (P = 0.02). The duration of sensory block (P < 0.001) and motor block (P < 0.001) was prolonged with intrathecal bupivacaine. The duration of analgesia favoured intrathecal bupivacaine (P = 0.003). Conclusion: Intrathecal ropivacaine has a reduced incidence of hypotension and a reduced duration of sensory block compared to bupivacaine. [ABSTRACT FROM AUTHOR]

Problem identification: Perioperative emergencies, although infrequent, may lead to significant morbidity and mortality associated with anaesthesia and/or surgery. Human factor errors account for between 43 to 65 per cent of sentinel events in the perioperative environment. Cognitive aids were introduced to reduce a user's cognitive workload and assist in adherence to key interventions during emergencies. Despite the availability of these aids, implementation of their use remains low. This integrative literature review will identify the barriers to and facilitators of the implementation of cognitive aids during perioperative emergencies. Literature search: An electronic database search of EBSCO databases (CINAHL Complete, Health Source: Nursing/Academic Edition, MEDLINE, MEDLINE Complete), Pubmed and Scopus were conducted to obtain contemporary literature. Duplicates were removed and inclusion and exclusion criteria were applied. A total of 14 articles were identified for inclusion. Data evaluation and synthesis: Included articles were critically analysed and appraised using the JBI critical appraisal tools to assess for the methodological quality of the research, and the National Health and Medical Research Council (NHMRC) evidence hierarchy to assess for reliability and validity. A data extraction table (literature matrix) was used to record the article's author, date of publication, research title, population, study design, level of evidence, key findings, implications for practice and limitations. This aided in synthesis of the selected studies, thematic analysis and drawing conclusions. Implications for practice: Strong design and staff education were identified as facilitators of cognitive aid implementation while poor design and lack of organisational support were identified as barriers to cognitive aid implementation. Nursing leaders and educators have a vital role to play in gaining organisational support to provide staff education and training and develop appropriately designed cognitive aids. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) is making giant strides in the medical domain, and the field of anaesthesia is not untouched. Enhancement in technology, especially AI, in many fields, including medicine, has proven to be far superior, safer and less erratic than human decision-making. The intersection of anaesthesia and AI holds the potential for augmenting constructive advances in anaesthesia care. AI can improve anaesthesiologists' efficiency, reduce costs and improve patient outcomes. Anaesthesiologists are well placed to harness the advantages of AI in various areas like perioperative monitoring, anaesthesia care, drug delivery, post-anaesthesia care unit, pain management and intensive care unit. Perioperative monitoring of the depth of anaesthesia, clinical decision support systems and closed-loop anaesthesia delivery aid in efficient and safer anaesthesia delivery. The effect of various AI interventions in clinical practice will need further research and validation, as well as the ethical implications of privacy and data handling. This paper aims to provide an overview of AI in perioperative monitoring in anaesthesia. [ABSTRACT FROM AUTHOR]

This document is a summary of a search conducted on various databases to find relevant articles on the topic of metamizole (also known as dipyrone) and its use in dogs and cats for pain relief. The search yielded three relevant papers, which were reviewed to assess the effectiveness and safety of metamizole for postoperative pain management in cats and dogs. The studies found that metamizole may help reduce postoperative pain levels in healthy cats and dogs undergoing ovariohysterectomy, but it was not effective as the sole analgesic in dogs. The studies did not find any evidence of higher incidence of side effects with metamizole use. However, the studies had limitations such as small sample sizes and lack of detail on randomization and blinding techniques. The document emphasizes that the application of this evidence should consider multiple factors and individual circumstances. The authors encourage library patrons to contribute to the evidence base by sharing their information needs or writing knowledge summaries. The document concludes with a disclaimer stating that the opinions expressed in the summaries are those of the authors and not necessarily reflective of the views of the organization. [Extracted from the article]

BACKGROUND: Succinylcholine is a commonly used muscle relaxant in anaesthesia that is associated with significant side effects, including muscle fasciculations and postoperative myalgia. Succinylcholine is used to facilitate tracheal intubation, especially in emergency situations when the risk of aspiration of gastric contents is present. AIM AND OBJECTIVE: This research paper investigates the effect of administering magnesium sulfate in conjunction with propofol induction on succinylcholine-induced fasciculations and myalgia. MATERIAL & METHODS: A total of 80 adult patients scheduled for elective surgery under general anaesthesia were divided into two groups (group I and II). The group I patients were treated with magnesium sulphate (40 mg/kg weight) in 10 ml volume while Group II patients were pretreated with normal saline (0.9% in 10 ml volume). They were given slowly intravenously over a period of 10 mim. Then Anesthesia was induced with fentanyl 1.5 mcg/kg and propofol 2 mg/kg, followed by administration of succinylcholine 2 mg/kg intravenously. Muscle fasciculation and Myalgia were observed after 24 hours of surgery. They were graded as nil, mild, moderate and severe. RESULTS: The overall incidence of muscle fasciculation in group I was 52.5% while it was 100% in group II. In group I, 22.5%,12 % mild and moderate muscle fasciculation were developed and no severe cases of fasciculation were observed. While in group II, 52.5% moderate, 40 % mild and 7.5% severe muscle fasciculation were observed. Postoperative myalgia was observed after 24 hrs, and it was observed that patients of Group I were not showing any sign and symptoms of myalgia while in group II, 12.5% were mild, 7.5% were moderate and 80% were negative for myalgia. CONCLUSION: The study found that the administration of magnesium sulfate significantly reduced both the incidence and severity of succinylcholine-induced fasciculations and myalgia, suggesting a beneficial role for magnesium sulfate in anesthesia protocols. [ABSTRACT FROM AUTHOR]

Sedation is common during digestive endoscopy to provide comfort and pain relief for patients. However, the use of sedation in endoscopy also poses potential risks, and recent issues have been raised regarding its safety and administration. This literature review paper will discuss the most recent developments in the field of sedation in digestive endoscopy, including the adverse events that might be associated with sedation and how to manage it, the legal issues associated with administration, the impact of COVID-19 on sedation practices, and sedation in special situations. It will also touch upon the current guidelines and recommendations for sedation, including the importance of patient selection and monitoring and the need for training and certification for endoscopists administering sedation. The review will also analyse studies evaluating the safety and efficacy of various sedation techniques, including propofol, midazolam, and others. It will examine the benefits and drawbacks of these agents. [ABSTRACT FROM AUTHOR]

The British Journal of Anaesthesia (BJA) had an eventful 2021, following what was a cataclysmic 2020 for the whole world. Despite the tragic challenges of multiple waves of the COVID-19 pandemic and the unparalleled burdens this created for everyone working in anaesthesia and critical care, the BJA underwent a major transformation during 2021. The BJA strongly supported research and education relevant to the pandemic, and to the broader missions of anaesthesia, critical, and pain medicine. Innovations to the BJA in 2021 included a special section on COVID-19 and the Anaesthetist; a new open access journal in the BJA stable; creation of a new social media editor position; new webinar and author interview series; transition to a new manuscript management system; and a move away from paper to electronic publication. [ABSTRACT FROM AUTHOR]

In this paper, we investigate the effect of sedation using low-dose propofol on patient reported outcome measures (PROMS) in patients undergoing cataract surgery. This is a randomised, single-blinded observational prospective study. Patients undergoing elective cataract surgery using peribulbar anaesthesia over consecutive cataract lists were selected for this trial. Patients were randomised to receive either no sedation or low-dose propofol (20 to 30 mg followed by 10 mg increments until the patient developed slurred speech alone) prior to the administration of local anaesthesia. Pain, satisfaction, anxiety, needle recall, pulse, and blood pressure (BP) were measured. A total of 97 patients were included, 50 of whom received propofol. There were 4 senior surgeons and anaesthetists. There were no ocular or systemic complications and all patients had uncomplicated surgery. Anxiety (p = 0.026), needle recall (p < 0.001), difference in systolic BP (p = 0.043), and pulse (p = 0.046) were dependent on patient age (p < 0.001) and the use of propofol (p = 0.007). Lower pain was associated with propofol (p = 0.008), as well as lower anxiety (p = 0.002), and increased patient age (p = 0.014). The administration of propofol was significantly associated with lower needle recall (p < 0.001), pre- to post-operative difference in systolic BP (p = 0.029), and mean BP (p = 0.044). Low-dose propofol given immediately prior to administration of local anaesthesia was associated with reduced pain and needle recall, as well as lower BP. [ABSTRACT FROM AUTHOR]

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Introduction. The paper describes the process of editing and validating documents on the basis of which a patient gives their informed consent for anaesthesia before surgery. Our objective was to adapt such documents to plain language standards, thanks to which they will be more accessible to an average patient. Material and methods. Two documents were drafted: Information about anaesthesia and Informed consent for anaesthesia. Within the editing process, we applied the principles of Plain Polish worked out for the Polish language. Results. Similar documents available in Polish medical institutions were collected. For the comparison of the texts, the readability formula – Plain Language Index (PLI) – recently available in Poland was used. This algorithm assesses 10 properties of the style and, based on these, it measures the simplicity of the text. Conclusions. Both documents which we designed obtained the standard of plain language (PLI 50% and more). They turned out to be the most accessible out of all the texts examined. [ABSTRACT FROM AUTHOR]

Prolapse of the gland of the third eyelid (cherry eye) is one of the most common canine-related ophthalmic conditions presented to veterinary clinics and hospitals. In most poor resource settings, veterinarians embark on excision of the gland due to possible lack of skill, necessary ophthalmic tools and a misconception of the postoperative complications associated with excision of the gland. Currently, repositioning of the prolapsed gland is the gold standard for management. The Morgan’s Pocket Technique (MPT) is one of the preferred methods for repositioning the gland. This paper presents some modifications of the MPT, which involved making two elliptical incisions above and below the point of rent or laxity on the gland’s conjunctival tissue following proper visualisation of the gland using a magnifying loop and creating a pocket for proper situation of the gland. The anaesthetic protocol adopted for the procedures as well as vital instruments and gadgets have also been highlighted. The medical records of 31 dogs (44 eyes) managed for cherry eye at the Veterinary Teaching Hospital, University of Ibadan, Nigeria from May 2013 to April 2021 were reviewed. Cherry eye was most prevalent in brachycephalic dogs with Boerboel having the highest presentation of 45.2% among others. Seventeen out of the 31 dogs were male, representing 54.8% while the rest were female. Majority of the dogs (93.5%) were below 2 years. The condition was unilateral in 18 dogs (58.1%), while 13 (41.9%) were bilateral. Before modification of the MPT in July 2018, surgery was repeated for 5 out of 23 eyes (21.7%). Following modification, no recurrences were recorded. The authors therefore recommend the modification of the MPT as well as paying attention to suture size, pattern and placement to prevent recurrence and complications. [ABSTRACT FROM AUTHOR]

John Francis Nunn (1925–2022) was an anaesthetist and clinical scientist who used his incomprehension of the science of anaesthesia in his early career to guide an extensive lifetime of innovative research. His interests outside of medicine led to him developing renowned expertise in such diverse areas as Egyptian hieroglyphs and the origins of the Earth's atmosphere. He was an outstanding communicator, writing four books alongside an impressive number of papers covering diverse topics from cell biology to history. His greatest contribution is in the understanding of respiratory physiology during anaesthesia which continues to underpin current routine anaesthetic practice and patient safety. [ABSTRACT FROM AUTHOR]

PICO question In horses undergoing volatile anaesthesia, is recovery quality superior with the use of sevoflurane compared to isoflurane during the maintenance phase? Clinical bottom line The category of research question Treatment Number and type of study designs reviewed Seven papers were available for critical appraisal. Of the seven papers, six were prospective, randomised trials and four of these were of crossover design. Of the same seven papers, three were experimental and four were clinical. Strength of evidence Moderate Outcomes reported Five out of seven critically appraised articles found that there was no clinically significant improvement in recovery quality following volatile anaesthesia with sevoflurane compared to isoflurane. Two of the seven articles did find improvement in recovery quality following the use of sevoflurane over isoflurane, but both studies were of crossover design, one of these studies used non-blinded evaluators and the second study used both unblinded and blinded evaluators and a recovery quality scoring scale that did not show interobserver reliability. Conclusion In healthy horses presented for elective surgical and diagnostic imaging procedures in a clinical setting, there is no significant difference in recovery quality following the use of sevoflurane or isoflurane for the maintenance phase. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Background: Perioperative neurocognitive disorders are often neglected and undiagnosed. There are known risk factors for these disorders (e.g., higher levels of frailty, cognitive decline before surgery). However, these factors are usually not assessed in the daily clinical setting. One of the main reasons for this lack of examination is the absence of a suitable cognitive function test that can be used in acute clinical settings. The primary aim of this study was to determine correlations between preoperative and postoperative scores on three cognitive tests (the Mini Mental State Exam (MMSE), the Clock Drawing Test (CDT) and the Test of Gestures (TEGEST). Methods: This was a prospective, monocentric, observational study that included one cohort of patients aged 65 years and older. Patients underwent acute or elective surgical operations. Preanaesthesia tests were administered. After the operation, the patients completed the same tests between the 2nd postoperative day and discharge. Preoperative and postoperative cognitive test scores were assessed. Results: This study included 164 patients. The arithmetic mean age was 74.5 years. The strongest correlations were observed between MMSE scores and TEGEST scores (r = 0.830 before and 0.786 after surgery, P < 0.001). To compare the MMSE and the TEGEST, the MMSE was divided into 2 categories—normal and impaired—and good agreement was found among 76.2% of the participants (ϰ = 0.515). If the TEGEST scoring system was changed so that scores of 4–6 indicated normal cognition and scores of 0–3 indicated cognitive impairment, the level of agreement would be 90.8%, ϰ = 0.817. Only 5.5% of the patients had impaired MMSE scores and normal TEGEST scores, whereas 3.7% of the respondents normal MMSE scores and impaired TEGEST scores. Conclusion: According to our results, the TEGEST is a suitable option for assessing cognitive functioning before surgery among patients who are at risk of developing perioperative neurocognitive disorders. This study revealed that it is necessary to change the rating scale for the TEGEST so that scores of 4–6 indicate normal cognition and scores of 0–3 indicate cognitive impairment. In clinical practice, the use of the TEGEST may help to identify patients at risk of perioperative neurocognitive disorders. [ABSTRACT FROM AUTHOR]

Background: Inhaled anaesthetic agents like sevoflurane contribute for approximately 5% to healthcare's carbon footprint. Previous studies suggested that the use of these agents should be minimized. Although multiple trauma surgeries can be performed under regional anaesthesia, most are performed under general anaesthesia. This study aims to evaluate the environmental benefits of using regional anaesthesia over general anaesthesia and to compare the associated complication rates. Methods: This retrospective study included all trauma patients (≥ 18 years) who underwent surgical intervention for hand, wrist, hip, or ankle fractures from 2017 to 2021. The hypothetical environmental gain was calculated based on the assumption that all surgeries were performed under regional anaesthesia. Complication rates were compared between regional and general anaesthesia. Results: Of the 2,714 surgeries, 15% were hand, 26% wrist, 36% hip, and 23% ankle fractures. General anaesthesia was used in 95%, regional in 5%. Switching this 95% to regional anaesthesia would reduce the sevoflurane use by 92 k, comparable to driving 406,553 km by car. The complication rate was higher with general anaesthesia compared to regional (7.7% vs 6.9%, p = 0.75). Conclusion: The potential gain of the reduction of sevoflurane in trauma surgeries which can be performed under regional anaesthesia can be significant. [ABSTRACT FROM AUTHOR]

Background: Using anaesthetics is an important application in aquaculture especially where the fish transportation, vaccination, grading, sorting activities and many other handling operations have been conducted during the different stages of production periods in the farms or hatcheries. Objectives: This study aimed to evaluate the efficacy of oregano essential oil (OO) as an anaesthetic for Nile tilapia and to determine the optimal concentration and post‐application stress effects compared to clove oil (CO). Methods: Nile tilapia juveniles were exposed to different concentrations of OO (20–40–60–80–100 mg L−1) and CO (50 mg L−1) for different time periods to determine the optimal concentration and exposure time. After the effective concentration of OO was determined, in the second experiment, stress parameters (glucose, plasma cortisol) were analysed after 0, 2, 6, 12 and 24 h of application. The results compared to the control group and CO results. Results: The study found that OO which has carvacrol compound higher than 78% was an efficient anaesthetic for Nile tilapia, and the effective concentration was found to be 60 mg L−1. No significant differences were found between opercular beats in any concentration of OO and CO. Basal glucose level in blood without anaesthesia application and recorded at 39.33 mg dL−1 and significantly lower than OO and CO at first two sampling points, 0 and 2 h (p < 0.05). According to plasma cortisol level results, although CO experimental group showed secondary stress response at 12 h (17.91 ± 4.21 ng mL−1), OO and CO group cortisol levels decreased at 24 h after anaesthesia application 7.13 ± 0.14and 7.01 ± 0.54 ng mL−1, respectively, below the control group cortisol concentration (12.28 ± 1.81 ng mL−1). Conclusions: These findings have important implications for the aquaculture industry as the use of OO as an anaesthetic could reduce the stress and mortality associated with traditional anaesthetics. Further research is needed to evaluate the efficacy of OO as an anaesthetic agent for other fish species and to determine the optimal concentration and exposure time for different species. [ABSTRACT FROM AUTHOR]

Aims and method COVID-19 has had a heavy impact on healthcare provision worldwide, including delivery of electroconvulsive therapy (ECT). A survey was completed in the UK and Republic of Ireland in April and July 2020 by 95 and 89 ECT clinics respectively. Results In April 2020, 53% of the clinics provided only emergency treatment and 24% had closed. Reasons included unavailability of anaesthetists, infection control measures and staff sickness. Restrictions persisted in July, with disruption to an estimated 437 individuals' treatment and poor outcomes, including clinical deterioration and readmission. Clinical implications Risk stratification, longer clinic sessions, improvements in ventilation, regular virus testing, pragmatic staff rostering and availability of personal protective equipment will protect against service disruption in subsequent waves of the pandemic. [ABSTRACT FROM AUTHOR]

Anaesthesia, crucial to surgical practice, is undergoing renewed scrutiny due to the integration of artificial intelligence in its medical use. The precise control over the temporary loss of consciousness is vital to ensure safe, pain-free procedures. Traditional methods of depth of anaesthesia (DoA) assessment, reliant on physical characteristics, have proven inconsistent due to individual variations. In response, electroencephalography (EEG) techniques have emerged, with indices such as the Bispectral Index offering quantifiable assessments. This literature review explores the current scope and frontier of DoA research, emphasising methods utilising EEG signals for effective clinical monitoring. This review offers a critical synthesis of recent advances, specifically focusing on electroencephalography (EEG) techniques and their role in enhancing clinical monitoring. By examining 117 high-impact papers, the review delves into the nuances of feature extraction, model building, and algorithm design in EEG-based DoA analysis. Comparative assessments of these studies highlight their methodological approaches and performance, including clinical correlations with established indices like the Bispectral Index. The review identifies knowledge gaps, particularly the need for improved collaboration for data access, which is essential for developing superior machine learning models and real-time predictive algorithms for patient management. It also calls for refined model evaluation processes to ensure robustness across diverse patient demographics and anaesthetic agents. The review underscores the potential of technological advancements to enhance precision, safety, and patient outcomes in anaesthesia, paving the way for a new standard in anaesthetic care. The findings of this review contribute to the ongoing discourse on the application of EEG in anaesthesia, providing insights into the potential for technological advancement in this critical area of medical practice. • Review of the current depth of anaesthesia analysis methods • Emphasis on machine learning techniques based on EEG signal analysis • Trends and future direction of EEG-based depth of anaesthesia analysis methods [ABSTRACT FROM AUTHOR]

The quality of training is a major contributor to workforce proficiency in healthcare, and there is a definite need to achieve a uniform level of knowledge and skill in medical education programmes. There is a paucity of literature comparing postgraduate anaesthesia medical education training structure and requirements across the globe. In a zeal to achieve uniform competencies and technical skills, the strengths and scope of training programmes need to be identified. In this article, we describe the core elements of postgraduate training in various countries while proposing an amalgamation of strengths of each programme and providing a roadmap to evolve further the competency-based comprehensive curriculum proposed by the National Medical Commission of India. [ABSTRACT FROM AUTHOR]

Background: Handwritten documentation process has drawbacks. Therefore, anaesthesia electronic record (AER) is becoming commonplace in operating theatres to help clinicians improve perioperative quality. This study aims to evaluate the efficiency of AER are compared to handwritten records in terms of completeness of information, time and cost, and assessing user satisfaction. Methods: A hospital-based cohort study was conducted, which was an Ambi-directional study that included a phase 1 part of the study that was retrospective (using a checklist) and phase 2 that was prospective (using a questionnaire at King Faisal Specialist Hospital and Research Center, Riyadh (KFSHRC), Saudi Arabia. For phase 1, data were collected for 165 handwritten records during 2016 - 2017 and 77 AERs during 2018 - 2019, both from the operating room at KFSHRC. For phase 2 survey was conducted on 47 anaesthetists. Results: The AER shows significantly higher completion of information than the handwritten records (AER: 62.3% versus handwritten: 48%; P = 0.02). In terms of time, the meantime for the handwritten report was 45.9 min compared to 53.9 min for AER, therefore, showing the handwritten method's efficiency compared to AER. The satisfaction survey found that 53% of the respondents recognise the growing role of AER in streamlining workflow and improving the quality of services. Conclusion: The study demonstrates that AER has better completion of information, which supports the enhancement of documentation quality. On the contrary, lesser time is taken for filling handwritten records than AER, therefore, handwritten records are cost-efficient. This also shows how the time spent impacts the cost in operating theatre. We recommend a user-friendly environment for AER with adequate training for its users. [ABSTRACT FROM AUTHOR]

Simple Summary: Medetomidine and dexmedetomidine, commonly used in veterinary practice, induce sedation, muscle relaxation and analgesia. Reduced heart rate is one of the most common side effects of these anaesthetics. Other undesirable effects include increased vascular resistance, deterioration of blood supply to some tissues, and a decrease in cardiac output. These effects can be fatal in a critically ill patient. This study aimed to compare the haemodynamically depressive effects of butorphanol-medetomidine and butorphanol-dexmedetomidine combinations on echocardiographic parameters during propofol anaesthesia in dogs and to determine which anaesthetic produces fewer adverse cardiovascular effect. This study compared the effects of butorphanol-medetomidine and butorphanol-dexmedetomidine combinations on echocardiographic parameters during propofol anaesthesia in dogs. The dogs were randomly divided into two groups. In the butorphanol-medetomidine (BM) group, butorphanol (0.2 mg/kg) and medetomidine (15 μg/kg) were intravenously administered; in the butorphanol-dexmedetomidine (BD) group, butorphanol (0.2 mg/kg) and dexmedetomidine (7.5 μg/kg) was used. Anaesthesia was induced with propofol and maintained with a constant-rate infusion of propofol (0.2 mg/kg/min). The echocardiographic parameters were assessed in conscious dogs (T0). Echocardiography was conducted again at 10 min post premedication (T1), followed by assessments at 30 (T2), 60 (T3), and 90 (T4) mins. The dogs were subjected to diagnostic procedures (radiography, computed tomography) under anaesthesia. A significant reduction in heart rate and cardiac output was noted in both groups at T1. There was no significant difference in the stroke volume between the BM and BD groups. The application of butorphanol-dexmedetomidine caused a significant increase in the left ventricular internal diameter in diastole and the diameter of the left atrium compared to that caused by butorphanol-medetomidine. This study documented that butorphanol-medetomidine and butorphanol-dexmedetomidine combinations caused similar reductions in heart rate and cardiac output in both groups. 'New´ valvular regurgitation occurred following their administration. [ABSTRACT FROM AUTHOR]

Background: Opioids such as sufentanil are used as anaesthetics due to their rapid action and superior analgesic effect. However, sufentanil induces a huge cough in paediatric patients. In contrast, intravenous (IV) lidocaine suppresses opioid-induced cough in children, but its use is limited due to anaesthetists' concern about its toxicity. Therefore, this study aimed to evaluate the effect of dose-dependent IV lidocaine on sufentanil-induced cough (SIC) in paediatric patients. Methods: A total of 188 patients aged 3–12 years scheduled for elective tonsillectomy with or without adenoidectomy were enrolled and divided into four groups depending on different dose of lidocaine: A (0 mg.kg-1), B (1 mg.kg-1), C (1.5 mg.kg-1), and D (2 mg.kg-1). The primary outcome was the SIC grade observed during the induction of general anaesthesia. The secondary outcomes were the incidence of SIC, mean arterial pressure, and heart rate at T0, T1, T2, T3, T4, and T5. Results: The SIC grade was significantly different between groups A and D (P = 0.04) and between groups B and D (P = 0.03). Moreover, the incidence of SIC in groups A, B, C, and D was 81%, 87%, 68%, and 64%, respectively, and the difference between groups B and C (P = 0.03) and between groups B and D (P = 0.0083) was statistically significant. No statistical differences were observed in the hemodynamic parameters between the groups. The incidence of severe cough was statistically different between group D and group A (P < 0.0001), between group D and group B (P < 0.0001), and between group D and group C (P < 0.0001) respectively. Conclusions: Lidocaine suppresses SIC in a dose-dependent manner without severe adverse events. IV lidocaine can be used in paediatric patients safely and efficiently, and the median effective dose was 1.75 mg/kg. Trial registration: This study was approved by the Institutional Review Board of Yichang Central People's Hospital (HEC-KYJJ-2020-038-02), The trial was registered at www.chictr.org.cn (ChiCTR2100053006). [ABSTRACT FROM AUTHOR]

Background and Aims: Short-term hypotension after general anaesthesia can negatively impact surgical outcomes. This study compared the predictive potential of the pleth variability index (PVI), pulse pressure variability (PPV), and perfusion index (PI) for anaesthesia-induced hypotension. This study's primary objective was to evaluate the predictive potential of PI, PVI, and PPV for hypotension. Methods: This observational study included 140 adult patients undergoing major abdominal surgery under general anaesthesia. Mean arterial pressure, heart rate, PVI, PPV, and PI were collected at 1-min intervals up to 20 min post anaesthesia induction. Hypotension was assessed at 5-min and 15-min intervals. Receiver operating characteristic (ROC) curves were plotted to determine the diagnostic performance and best cut-off for continuous variables in predicting a dichotomous outcome. Statistical significance was kept at P < 0.05. Results: Hypotension prevalence within 5 and 15 min of anaesthesia induction was 36.4% and 45%, respectively. A PI cut-off of <3.5 had an area under the ROC curve (AUROC) of 0.647 (P = 0.004) for a 5-min hypotension prediction. The PVI's AUROC was 0.717 (P = 0.001) at cut-off >11.5, while PPV's AUROC was 0.742 (P = 0.001) at cut-off >12.5. At 15 min, PVI's AUROC was 0.615 (95% confidence interval 0.521-0.708, P = 0.020), with 54.9% positive predictive value and 65.2% negative predictive value. Conclusion: PVI, PPV, and PI predicted hypotension within 5 min after general anaesthesia induction. PVI had comparatively higher accuracy, sensitivity, specificity, and positive predictive value than PI and PPV when predicting hypotension at 15 min. [ABSTRACT FROM AUTHOR]

Climate change is an existential threat to humanity. While the healthcare sector must manage the health-related consequences of climate change, it is a significant contributor to greenhouse gas emissions, responsible for up to 4.6% of global emission, aggravating global warming. Within the hospital environment, the three largest contributors to greenhouse gas emissions are the operating theatre, intensive care unit and gastrointestinal endoscopy. Knowledge of the health-related burden of climate change and the potential transformative health benefits of climate action is important to all health professionals, as they play crucial roles in effecting change. This article summarises the available literature on the impact of healthcare on climate change and efforts in mitigation, focusing on the intrinsic differences and similarities across the operating theatre complex, intensive care unit and gastrointestinal endoscopy unit. It also discusses strategies to reduce carbon footprint. [ABSTRACT FROM AUTHOR]

The association of Parkinson's disease and pregnancy is very rare. We present a case of juvenile Parkinson's disease patient who underwent emergency caesarean section. The anaesthetic considerations and management are discussed. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) is making giant strides in the medical domain, and the field of anaesthesia is not untouched. Enhancement in technology, especially AI, in many fields, including medicine, has proven to be far superior, safer and less erratic than human decision-making. The intersection of anaesthesia and AI holds the potential for augmenting constructive advances in anaesthesia care. AI can improve anaesthesiologists' efficiency, reduce costs and improve patient outcomes. Anaesthesiologists are well placed to harness the advantages of AI in various areas like perioperative monitoring, anaesthesia care, drug delivery, post-anaesthesia care unit, pain management and intensive care unit. Perioperative monitoring of the depth of anaesthesia, clinical decision support systems and closed-loop anaesthesia delivery aid in efficient and safer anaesthesia delivery. The effect of various AI interventions in clinical practice will need further research and validation, as well as the ethical implications of privacy and data handling. This paper aims to provide an overview of AI in perioperative monitoring in anaesthesia.

Simple Summary: Craniotomy is a commonly performed surgical procedure in neuroscientific research that causes substantial pain in laboratory animals. The animals' invidious situation has received little previous attention, and therefore, to respect the 3R guidelines, including the minimisation of the animals' pain and suffering, we aimed to improve the conventional anaesthetic and analgesic regimens. The anti-nociceptive effects of four different drug combinations in laboratory mice undergoing general anaesthesia for craniotomies were investigated. Specifically, the efficacy of dexmedetomidine, which is known to have analgesic, sedative, and cardiorespiratory stabilising properties in other species, was evaluated. Our study demonstrated the beneficial effects of dexmedetomidine in mice as the signs of nociception were mitigated in the respective treatment groups. Pain refinement represents an important aspect of animal welfare in laboratory animals. Refining analgesia regimens in mice undergoing craniotomy has been sparsely investigated. Here, we sought to investigate the effect of dexmedetomidine in combination with other analgesic drugs on intraoperative anti-nociceptive effects and cardiorespiratory stability. All mice were anaesthetised with isoflurane and received local lidocaine infiltration at the surgical site. Mice were randomised into treatment groups consisting of either carprofen 5 mg kg−1 or meloxicam 5 mg kg−1 with or without dexmedetomidine 0.1 mg kg−1 administered subcutaneously. Intra-anaesthetic heart rates, breathing rates, isoflurane requirements, and arterial oxygen saturations were continuously monitored. We found that administration of dexmedetomidine significantly improved heart and breathing rate stability during two of four noxious stimuli (skin incision and whisker stimulation) compared to non-dexmedetomidine-treated mice and lowered isoflurane requirements throughout anaesthesia by 5–6%. No significant differences were found between carprofen and meloxicam. These results demonstrate that dexmedetomidine reduces nociception and provides intra-anaesthetic haemodynamic and respiratory stability in mice. In conclusion, the addition of dexmedetomidine to anaesthetic regimes for craniotomy offers a refinement over current practice for laboratory mice. [ABSTRACT FROM AUTHOR]

Background: Hypoxaemia occurs in approximately 30% of children during anaesthesia for flexible bronchoscopy. High-flow nasal oxygen (HFNO) can prolong safe apnoea time and be used in children with abnormal airways. During flexible bronchoscopy, there is limited evidence if HFNO confers advantages over current standard practice in avoiding hypoxaemia. The aim is to investigate feasibility of HFNO use during anaesthesia for flexible bronchoscopy to reduce frequency of rescue oxygenation and hypoxaemia. Methods: BUFFALO is a bi-centre, unmasked, randomised controlled, parallel group, protocol for a pilot trial comparing HFNO techniques to standard practice during anaesthesia. Children (n = 81) aged > 37 weeks to 16 years presenting for elective bronchoscopy who fulfil inclusion but not exclusion criteria will be randomised prior to the procedure to HFNO or standard care oxygenation post induction of anaesthesia. Maintenance of anaesthesia with HFNO requires total venous anaesthesia (TIVA) and with standard, either inhalational or TIVA at discretion of anaesthetist in charge of the patient. Outcomes will include the feasibility of recruitment and adherence to trial procedures, acceptability of the intervention of the protocol and completion rates of data collection methods. Discussion: Findings of this trial will determine feasibility to plan for a larger multicentre randomised clinical trial and support the feasibility of the proposed study procedures. Trial registration: BUFFALO trial was registered with Australia and New Zealand Clinical Trials Registry (TRN12621001635853) on 29 November 2021 and commenced recruitment in May 2022. https://www.anzctr.org.au/. The primary manuscript will be submitted for publication in a peer-reviewed journal. [ABSTRACT FROM AUTHOR]

Background: Local anaesthetic systemic toxicity (LAST) is a rare but life-threatening complication that can occur after local anaesthetic administration. Various clinical guidelines recommend an intravenous lipid emulsion as a treatment for local anaesthetic–induced cardiac arrest. However, its therapeutic application in pregnant patients has not yet been established. This scoping review aims to systematically identify and map the evidence on the efficacy and safety of intravenous lipid emulsion for treating LAST during pregnancy. Method: We searched electronic databases (Medline, Embase and Cochrane Central Register Controlled Trials) and a clinical registry (lipidrescue.org) from inception to Sep 30, 2022. No restriction was placed on the year of publication or the language. We included any study design containing primary data on obstetric patients with signs and symptoms of LAST. Results: After eliminating duplicates, we screened 8,370 titles and abstracts, retrieving 41 full-text articles. We identified 22 women who developed LAST during pregnancy and childbirth, all presented as case reports or series. The most frequent causes of LAST were drug overdose and intravascular migration of the epidural catheter followed by wrong-route drug errors (i.e. intravenous anaesthetic administration). Of the 15 women who received lipid emulsions, all survived and none sustained lasting neurological or cardiovascular damage related to LAST. No adverse events or side effects following intravenous lipid emulsion administration were reported in mothers or neonates. Five of the seven women who did not receive lipid emulsions survived; however, the other two died. Conclusion: Studies on the efficacy and safety of lipids in pregnancy are scarce. Further studies with appropriate comparison groups are needed to provide more robust evidence. It will also be necessary to accumulate data—including adverse events—to enable clinicians to conduct risk–benefit analyses of lipids and to facilitate evidence-based decision-making for clinical practice. [ABSTRACT FROM AUTHOR]

Background: Personalised theatre caps have been shown to improve staff communication in the operating theatre. The impact of these caps on the patient perioperative experience, particularly in Indigenous Australian patients, has not been well established. Methodology: Surgical patients and operating theatre staff at Royal Darwin Hospital in Australia were surveyed before and after the introduction of Indigenous art-themed personalised (name and role) theatre caps in October 2021 and January 2022. Staff name and role visibility in operating theatres was also audited. Results: A total of 223 staff and patients completed surveys. Most patients reported the theatre caps to be helpful (90%, 95% confidence interval [CI] 81–99) and felt more comfortable because staff were wearing them (91%, 95% CI 82–100). These results were consistent across Indigenous and non-Indigenous patients. The majority of staff agreed that personalised name and role theatre caps improved staff communication (89%, 95% CI 81–97), improved the staff-patient interaction (77%, 95% CI 67–87), and made it easier to use staff names (100%). Staff name and role visibility increased from 8 to 51% (p < 0.001) after the introduction of personalised theatre caps. Conclusions: The introduction of Indigenous art-themed personalised theatre caps for operating theatre staff at Royal Darwin Hospital improved perceived staff communication and the patient perioperative experience. [ABSTRACT FROM AUTHOR]

Simulation-based education is now recognised to be a valuable tool to impart both technical and non-technical skills to healthcare professionals of all levels. Simulation is an well accepted educational tool for cultivating teamwork skills among residents globally. Simulation-based education encompasses diverse modalities, ranging from task trainers and simulated patients to sophisticated high-fidelity patient simulators. Notably, anaesthesiologists globally were early advocates of integrating simulation into education, particularly to instruct anaesthesia residents about the intricacies of perioperative crisis resource management and collaborative interdisciplinary teamwork. Given the inherent high-risk nature of anaesthesia, where effective teamwork is pivotal to averting adverse patient outcomes, and also to improve overall outcome of the patient, simulation training becomes imperative. This narrative review delves into the contemporary landscape of simulation training in perioperative anaesthesia management, examining the pedagogical approaches, simulators, techniques and technologies employed to facilitate this training. [ABSTRACT FROM AUTHOR]

Background and Aims: Magnesium sulphate and zinc sulphate have been reported to attenuate postoperative sore throat (POST). The study aims to compare the effect of preoperative magnesium sulphate and zinc sulphate gargle on the incidence and severity of POST following endotracheal intubation within 24 h. Methods: After ethics committee approval, 132 patients were randomly allocated to three groups (M, Z and D). Fifteen minutes before laryngoscopy and tracheal intubation, patients assigned to groups M and Z received a solution for gargle containing magnesium sulphate 20 mg/kg and zinc sulphate containing 40 mg of elemental zinc dissolved in 20 ml of 5% dextrose solution, respectively. Group D received 20 ml of 5% dextrose solution. Incidence and severity of POST (4-point score: Grade 0- no sore throat, Grade 1- mild sore throat, Grade 2- moderate sore throat, Grade 3- severe sore throat) was assessed for 24 h after extubation. Statistica, Version 8.0 (StatSoft, Inc., Tulsa, Oklahoma, USA) was used for analysing the data. Results: The lowest incidence of POST in group M was 13.6% (95% confidence interval [CI] 3.5–23.7) compared to 0% in group Z, whereas the highest incidence recorded in group M was 25% (95% CI 12.2–37.7) in contrast to 13.6% (95% CI 3.5–23.7) in group Z during the first 24 h after operation. It was observed that the incidence of mild POST (POST score 1) was significantly lower (P < 0.05) in group Z compared to group M in the first 4 h postoperatively. Conclusion: Zinc sulphate gargle before laryngoscopy and tracheal intubation is more effective for reducing the incidence of POST than magnesium sulphate gargle. [ABSTRACT FROM AUTHOR]

Caffeine has a multitude of uses in anaesthesia, and numerous studies have evaluated its efficacy and usefulness in various aspects of anaesthesia and medical practice. Its various applications in anaesthesia include its role in awakening from anaesthesia, managing post-dural puncture headache, managing post-sedation paradoxical hyper-activity in children, post-operative bowel paralysis, and apnoea in paediatric populations, that is, apnoea in infancy, paediatric obstructive apnoea, and post-anaesthetic apnoea in pre-mature infants. Though the effects of caffeine on bronchial smooth muscle, neurological, and cardio-vascular systems are well known, the relatively little-known effects on the endocrine and gastro-intestinal (GI) system have been recently taking primacy for eliciting its therapeutic benefits. The literature shows encouraging evidence in favour of caffeine, but unambiguous evidence of caffeine benefits for patients is lacking and needs further investigation. In this narrative review of literature, we summarise the available literature to provide insights into the pharmacokinetics, pharmacodynamics, clinical application of caffeine in modern anaesthetic practice, and evidence available in this field to date. An awareness of the various physiological effects, adverse effects, reported applications, and their evidence will widen the horizon for anaesthesiologists to increase its rational use and advance research in this field. Well-designed randomised controlled trials regarding the various outcomes related to caffeine use in anaesthesia should be planned to generate sound evidence and formulate recommendations to guide clinicians. [ABSTRACT FROM AUTHOR]

Introduction and Objective. General anesthesia is an integral part of many medical procedures. Its main premise is that it is completely reversible and has no effect on the human brain. Unfortunately, a number of scientific findings report potential effects of anaesthetics on the human nervous system. The aim of this review is to present the negative impact of sevoflurane (inhalation anaesthetic) and propofol (intravenous anaesthetic) on the human brain with an analysis of its mechanisms and factors, and possible methods of preventing this phenomenon. Review Methods. A review was undertaken of the most current literature using PubMed and Google Scholar databases, on the mechanism of action and the negative effects of sevoflurane and propofol on the brain and methods of its prevention. Included are both original works, reviews and case reports from Poland and worldwide. Brief description of the state of knowledge. Post-operative cognitive dysfunction affects 10-65% of patients. Sevoflurane and propofol have potentially damaging effects on the human brain. This occurs mainly through induction of neuronal cell apoptosis and disruption of synaprogenesis by affecting receptor proteins, cell organelles (mitochondria, endoplasmic reituclum) and signaling pathways (apoptotic and trophic) of neurons. However, this effect depends on the drug dose and patient-dependent factors (age, diseases, cognitive status before anaesthesia). Summary. Anaesthetics have potentially harmful effects on the human brain, although only in large and repeated doses. One should also not forget the much more notable effect of mechanical damage to tissues during surgery. In order to prevent cognitive dysfunction, both a detailed preoperative assessment of the patient's condition and the use of additional pharmacological and non-pharmacological measures during surgery are important. [ABSTRACT FROM AUTHOR]

Purpose: The need for anaesthesia or analgesia for performing hysteroscopy remains debatable. This study aimed to conduct an overview of the situation of anaesthesia for hysteroscopy in mainland China. Methods: Two questionnaires were separately designed for anaesthesiologists and gynaecologists and distributed to every medical institution that performed hysteroscopic procedures on patients with infertility in mainland China. Electronic questionnaires were distributed via WeChat, and data on anaesthesia regimen, monitoring parameters, procedure number, and other information were collected. Results: Reproductive technology is conducted by 536 institutions in mainland China. The survey received 491 responses from anaesthetists (91.6%) and 436 from gynaecologists (81.3%). In 2021, 552,225 hysteroscopies were conducted in 268 medical centres. The average percentage of hysteroscopy under anaesthesia is 63.8% in 2021, wherein 47.3% of institutions have an anaesthesia percentage of >75%. Propofol and opioid analgesics, such as fentanyl and sufentanil, were the most commonly used intravenous anaesthetics. All sedations were performed by anaesthesiologists. Monitoring parameters included pulse oxygen saturation (98.9%), electrocardiogram (91.6%) and noninvasive blood pressure (91.3%). An anaesthesiologist-to-operating room ratio of <1 was observed in 31.3% of medical institutions. Surprisingly, 52.4% of medical institutions performing hysteroscopy had no postanaesthesia care unit (PACU). Most institutions with PACU were equipped with independent oxygen sources, suction and monitors. Both rigid and flexible hysteroscopes (rigid hysteroscope, 45.1%; flexible hysteroscope, 4.5%; both types, 50.4%) were used, and the hysteroscopic diameter was ≤5 mm in 60.3% of medical centres. Conclusions: China performs a large number of hysteroscopies, and sedation is the most frequently used anesthesia regimen. However, issues such as inadequate emergency support devices, insufficient personnel and weak resuscitation management after anaesthesia, have been observed. [ABSTRACT FROM AUTHOR]

Ultrasound-guided techniques are increasingly prevalent and represent a gold standard of care. Skills such as needle visualisation, optimising the target image and directing the needle require deliberate practice. However, training opportunities remain limited by patient case load and safety considerations. Hence, there is a genuine and urgent need for trainees to attain accelerated skill acquisition in a time- and cost-efficient manner that minimises risk to patients. We propose a two-step solution: First, we have created an agar phantom model that simulates human tissue and structures like vessels and nerve bundles. Moreover, we have adopted deep learning techniques to provide trainees with live visualisation of target structures and automate assessment of their user speed and accuracy. Key structures like the needle tip, needle body, target blood vessels, and nerve bundles, are delineated in colour on the processed image, providing an opportunity for real-time guidance of needle positioning and target structure penetration. Quantitative feedback on user speed (time taken for target penetration), accuracy (penetration of correct target), and efficacy in needle positioning (percentage of frames where the full needle is visualised in a longitudinal plane) are also assessable using our model. Our program was able to demonstrate a sensitivity of 99.31%, specificity of 69.23%, accuracy of 91.33%, precision of 89.94%, recall of 99.31%, and F1 score of 0.94 in automated image labelling. [ABSTRACT FROM AUTHOR]

The Earth's mean surface temperature is already approximately 1.1°C higher than pre-industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three-stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high-, middle- and low-income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists' education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re-evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references.

Awake video-assisted thoracoscopic surgery (A-VATS) enables the surgeon to penetrate the tissue via a small incision and with less contact between the lung and atmospheric pressure; postoperative respiratory functions are also less affected than in open surgery. A-VATS is a safer technique than traditional VATS and non-intubated video-assisted thoracoscopic surgery (NI-VATS) because it does not require muscle relaxants and sedoanalgesics. In particular, diagnostic VATS for pleural effusions can be easily performed over a single port using only local anaesthetic. Anaesthesia-related risks increase even more for elderly patients and those with severe comorbidities. Although there are long and risky operations in thoracic surgery, general anaesthesia is not required for some thoracic surgery procedures. However, A-VATS is limited to minor procedures. Due to regional anaesthesia and sedation, NI-VATS is a safe and effective method for many indications. The results show that this method can be applied with low mortality and morbidity. [ABSTRACT FROM AUTHOR]

Background: Post-operative delirium (POD) is an acute brain failure which may occur following major surgery, with serious implications for participants and caregivers. Evidence regarding optimal anaesthetic management for older participants at higher risk of POD is conflicting. We conducted a feasibility study of our protocol in 5 centres to guide sample size estimation and inform future recruitment strategies for a larger cohort study. Methods: Participants aged over 65 and scheduled for major surgery were recruited. They were assessed pre-operatively for delirium, cognitive impairment, depression, comorbidity, activity levels and alcohol use. Details of management during surgery, all medications and complications were recorded by a trainee-led research team. Participants were assessed for delirium in the immediate recovery period and then on post-operative days 1–4 using the 4 question attention test (4AT) with complications assessed at day 4 using the post-operative morbidity survey (POMS). Primary outcomes were the incident rates of POD. Secondary outcomes were number of eligible patients, recruitment rates and retention rates throughout the study, time required for data collection, preoperative risk factors assessment and daily postoperative delirium assessments. Also to assess the added value of employing the regional trainee research network (INCARNNET) to deliver the study. Specifically, what proportion of patient consent, data collection and post-operative testing is performed by anaesthesia trainees from this group, especially the success of weekend delirium assessment by trainees? A survey was completed at the end of the study by the trainees involved regarding their involvement in the study. Results: Ninety-five participants were recruited, of whom 93 completed the study. Overall, POD occurred in 9 patients. Of these, three were detected in recovery and six on post-op days 1–4. Median length of stay was 6 days. Recruitment rates were high in all but one site. 59 (62%) participants were consented by trainees and 189 (63%) of post op delirium assessments were performed by trainees. A total of six patients declined the study (in a follow up survey of trainees). Pre-existing cognitive impairment, depression and problem drinking were detected in 4(4.3%), 3(3.2%) and 5(5.37%) participants, respectively. Co-morbidity was common with 55(59%) in class three or four of the geriatric index of morbidity. Overall, from a total of 641 data points, levels of missing data were as follows, site A = 9.3%, B = 13.5%, C = 15.4%, D = 10.9%, E = 11.1% (data could not be completed retrospectively). Conclusions: A multi-centre observational cohort study of delirium carried out by UK trainee anaesthetists is feasible. Patients are content to undergo day of surgery consent and multiple short questionnaires pre-operatively. Proposed data, especially pharmacological, should be carefully considered for their relevance to modifiable mechanisms that can lead to POD. Future research to enable prognostic modelling of POD should involve large scale cohort studies of enriched populations to capture a higher POD incidence. POD remains a common complication in older persons undergoing major surgery in the UK and studies of interventions are urgently needed. Trial registration: All methods were carried out in accordance with relevant guidelines and regulations. The study was retrospectively registered with ISRCTN94663125 on 07/02/2018. [ABSTRACT FROM AUTHOR]

Background: Safety has been described as a dynamic non-event and as constantly present in professionals' work processes. Investigating management of complex everyday situations may create an opportunity to elucidate safety management. Anaesthesia has been at the frontline of enhancing patient safety – testing and implementing knowledge from other high-reliability industries, such as aviation, in the complex, adaptive system of an operating room. The aim of this study was to explore factors supporting anaesthesia nurses and anaesthesiologists in managing complex everyday situations during intraoperative anaesthesia care processes. Methods: Individual interviews with anaesthesia nurses (n = 9) and anaesthesiologists (n = 6) using cognitive task analysis (CTA) on case scenarios from previous prospective, structured observations. The interviews were analysed using the framework method. Results: During intraoperative anaesthesia care, management of everyday complex situations is sustained through preparedness, support for mindful practices, and monitoring and noticing complex situations and managing them. The prerequisites are created at the organization level. Managers should ensure adequate resources in the form of trained personnel, equipment and time, team and personnel sustainability and early planning of work. Management of complex situations benefits from high-quality teamwork and non-technical skills (NTS), such as communication, leadership and shared situational awareness. Conclusion: Adequate resources, stability in team compositions and safe boundaries for practice with shared baselines for reoccurring tasks where all viewed as important prerequisites for managing complex everyday work. When and how NTS are used in a specific clinical context depends on having the right organizational prerequisites and a deep expertise of the relevant clinical processes. Methods like CTA can reveal the tacit competence of experienced staff, guide contextualized training in specific contexts and inform the design of safe perioperative work practices, ensuring adequate capacity for adaptation. [ABSTRACT FROM AUTHOR]

Background: With the global disease burden of cancer increasing, and with at least 60% of cancer patients requiring surgery and, hence, anaesthesia over their disease course, the question of whether anaesthetic and analgesia techniques during primary cancer resection surgery might influence long term oncological outcomes assumes high priority. Methods: We searched the available literature linking anaesthetic-analgesic techniques and strategies during tumour resection surgery to oncological outcomes and synthesised this narrative review, predominantly using studies published since 2019. Current evidence is presented around opioids, regional anaesthesia, propofol total intravenous anaesthesia (TIVA) and volatile anaesthesia, dexamethasone, dexmedetomidine, non-steroidal anti-inflammatory medications and beta-blockers. Conclusions: The research base in onco-anaesthesia is expanding. There continue to be few sufficiently powered RCTs, which are necessary to confirm a causal link between any perioperative intervention and long-term oncologic outcome. In the absence of any convincing Level 1 recommending a change in practice, long-term oncologic benefit should not be part of the decision on choice of anaesthetic technique for tumour resection surgery. [ABSTRACT FROM AUTHOR]