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How is the information-processing architecture of the human brain organised, and how does its organisation support consciousness? Here, we combine network science and a rigorous information-theoretic notion of synergy to delineate a synergistic global workspace, comprising gateway regions that gather synergistic information from specialised modules across the human brain. This information is then integrated within the workspace and widely distributed via broadcaster regions. Through functional MRI analysis, we show that gateway regions of the synergistic workspace correspond to the human brains default mode network, whereas broadcasters coincide with the executive control network. We find that loss of consciousness due to general anaesthesia or disorders of consciousness corresponds to diminished ability of the synergistic workspace to integrate information, which is restored upon recovery. Thus, loss of consciousness coincides with a breakdown of information integration within the synergistic workspace of the human brain. This work contributes to conceptual and empirical reconciliation between two prominent scientific theories of consciousness, the Global Neuronal Workspace and Integrated Information Theory, while also advancing our understanding of how the human brain supports consciousness through the synergistic integration of information.

Background: Paediatric acute kidney injury (AKI) is associated with significant adverse outcomes such as increased mortality, progression to chronic kidney disease and longer length of stay in hospital. Postoperative AKI is a common and recognized complication after surgery in adults. In the paediatric population, AKI postoperatively to cardiac surgery has been extensively studied. However, the incidence of postoperative AKI after non‐cardiac surgery is less clear. Therefore, we aim to assess the available literature on this topic. Methods: We will conduct a systematic review of observational and randomized controlled trials assessing the incidence of paediatric postoperative AKI after non‐cardiac surgery. Pairs of reviewers will independently screen the literature and extract data and assess risk of bias from eligible studies. The databases Pubmed, Cochrane and Web of Sciences will be searched. We will conduct the review in accordance with the Preferred Reporting Items for Systematic Review and Meta‐Analysis (PRISMA) guidelines and the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach. If sufficient homogeneity within the included trials we will conduct meta‐analyses. Discussion: This systematic review aims to investigate the incidence of postoperative AKI in the paediatric non‐cardiac surgery population. The results of this review will provide a foundation for future research in the field of paediatric postoperative AKI. [ABSTRACT FROM AUTHOR]

To describe the use of plasma transfusion in anaesthetized dogs, specifically the triggers for use, the population administered plasma, reported adverse events and human errors associated with transfusion. Retrospective observational study. A total of 85 client-owned dogs. A search of electronic transfusion and anaesthetic records at a university teaching hospital was performed to identify dogs administered plasma during the study period (January 2017 to June 2021). Data collected included signalment, surgical procedure, intraoperative triggers for transfusion, the type of plasma, rate of transfusion and the presence of transfusion reactions, human errors or deviation from transfusion guidelines. During this period, 85 dogs were administered plasma. Sepsis was diagnosed in 49/85 (58%) dogs, with 42/85 (49%) animals undergoing surgery for septic peritonitis. Perianaesthetic hypotension contributed to the decision to administer plasma in 67/85 (79%) dogs. In 33/85 (39%) dogs, hypotension was the only reason for transfusion, while 31/85 (36%) had other influencing factors, most commonly hypoproteinaemia. Fresh frozen plasma was administered in 95% of cases. Only 31% of transfusions were started at a slower 'test dose' rate and 79% of dogs administered boluses of plasma. No definite, probable or possible transfusion reactions were identified using current veterinary guidelines. Plasma transfusions were commonly administered to dogs presenting with sepsis for haemodynamic optimization. Clinicians often chose to bolus plasma instead of initiating transfusions at the recommended initial slow starting rate. No transfusion reactions were identified; however, some reactions may have been masked by the effects of general anaesthesia and/or have been difficult to recognize in this critically ill canine population. [ABSTRACT FROM AUTHOR]

Summary: Background: The 7th National Audit Project of the Royal College of Anaesthetists studied peri‐operative cardiac arrest because of existing knowledge gaps in this important topic. This applies in particular to cardiology patients receiving anaesthetic care, because numbers, types and complexity of minimally invasive interventional procedures requiring planned and unplanned anaesthesia in the cardiac intervention suite is increasing. Methods: We analysed collected data to determine the epidemiology, clinical features, management and outcomes of peri‐operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures. Results: There were 54 reports of peri‐operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures, accounting for 54/881 (6.1%) of all reports to NAP7. The estimated incidence (95%CI) of cardiac arrests in this group was 1/450 or 0.22 (0.17–0.29)%. These patients were older than other adult patients in the NAP7 population, with a notably high proportion of patients of Asian ethnicity when compared with the remaining NAP7 cohort (9/54, 17% vs. 35/709, 5%). Rates of extracorporeal membrane oxygenation cardiopulmonary resuscitation were low (3/53, 6%). A common theme was that of logistical issues and teamworking, with reporters commenting on the difficulties of remote and/or unfamiliar locations and communication issues between specialties, on occasion resulting in poor teamworking and a lack of focus. The NAP7 panel review identified several other common themes which included: cardiogenic shock; late involvement of anaesthesia in the case; and transcatheter aortic valve implantation. Conclusion: Cardiology procedures requiring anaesthesia care account for < 1% of anaesthesia activity but generate 6% of all peri‐operative cardiac arrests. The incidence of cardiac arrest was disproportionately high in cardiological procedures requiring anaesthetic care. The nature of the cardiac arrest reports to NAP7 indicate that logistical and human factors in multidisciplinary teams in the cardiac intervention suite merit addressing to improve care. [ABSTRACT FROM AUTHOR]

Intraoperative controlled hypotension improves surgical field visibility by reducing blood loss (efficacy) but poses potential risks linked to organ hypoperfusion (safety). The use of controlled hypotension persists despite increasing evidence of associations between intraoperative inadvertent hypotension and adverse outcomes. Therefore, we tested the hypothesis that the focus and results of intraoperative controlled hypertension research differ across anaesthesia and surgery investigators because of differing priorities. We systematically reviewed randomised trials comparing controlled hypotension with usual care with trials categorised by investigators' affiliation. We identified 48 eligible trials, of which 37 were conducted by anaesthesia investigators and 11 by surgery investigators. For the primary outcome, 54% of the anaesthesia-led trials focused on safety, whereas all (100%) surgery-led trials focused on efficacy (P =0.004). Compared with usual care, mean arterial pressure in controlled hypotension was 23% (95% confidence interval [CI] 17–29%) lower in anaesthesia trials and 30% (95% CI 14–37%) lower in surgery trials; estimated blood loss was 44% (95% CI 30–55%) less in anaesthesia trials and 38% (95% CI 30–49%) less in surgery trials. Overall, blood loss was reduced by 43% (95% CI 32–53%), and trial sequential analysis supported an efficacy conclusion. Mean arterial pressure and estimated blood loss reductions were associated (R2=0.41, P =0.002). All trials were underpowered for safety outcomes, and none adequately evaluated myocardial or renal injury. Anaesthesia researchers prioritised safety outcomes, whereas surgery researchers emphasised efficacy in controlled hypotension trials. Controlled hypotension significantly reduces blood loss. In contrast, safety outcomes were poorly studied. Given increasing observational evidence linking inadvertent hypotension to myocardial and renal injury, the safety of controlled hypotension remains to be addressed. PROSPERO (CRD42023450397). [ABSTRACT FROM AUTHOR]

The editorial discusses the impact of chronic underinvestment in the NHS on resident doctors' working conditions and job satisfaction, leading to high levels of burnout and emotional exhaustion. The scoping review by Winter et al. highlights the factors affecting wellbeing and stress in anaesthetists in UK training posts, emphasizing the need for policy and practice changes to improve working conditions. The text also addresses the challenges faced by international medical graduates, doctors from ethnic minority backgrounds, and women in anaesthetic training, advocating for systemic changes to support diversity and improve working conditions for all. [Extracted from the article]

Objective To investigate the application efficacy and optimal dosage of dexmedetomidine preconditioning in modified electroconvulsive therapy (MECT) and to explore its optimal dose. Methods Two hundred and fifty-two patients who were to undergo MECT were selected and were randomly divided into group D1, group D2, group D3, group D4, group D5 and control group, respectively, with 42 cases in each. Ten min before anaesthesia induction, 0. 2, 0. 4, 0. 6, 0. 8 and 1. 0 µg/kg dexmedetomidine hydrochloride was intravenously pumped into the D1, D2, D3, D4 and D5 groups, respectively, and the control group was intravenously pumped with an equal volume of normal saline 30 mL; the patients were treated by a MECT therapeutic instrument. Heart rate (HR) and mean arterial pressure (MAP) were recorded in each group at the immediate moment of dexmedetomidine pretreatment (T1), 5 min after pretreatment (T2), 10 min after pretreatment (T3), 15 min after pretreatment (T4), 20 min after pretreatment (T5), 25 min after pretreatment (T6), and 30 min after pretreatment (T7), respectively; and the duration of seizure, the dose of propofol used during MECT, the recovery time of spontaneous respiration, the awakening time and the occurrence of adverse reactions were compared between the groups. Results Compared with the control group at the same time point, HR was reduced in the group D1 at T4, and in the groups D2, D3, D4, and D5 at T2 to T7; and MAP was reduced in the group D2 at T4 to T7, and in the groups D3, D4, and D5 at T2 to T7 (all P<0. 05) . Compared with the same group at T1, HR was reduced in the groups D4 and D5 at T7; MAP was reduced in the groups D3, D4 and D5 at T7 (all P<0. 05) . There was no statistically significant difference in seizure duration among groups (all P>0. 05) ; the dosage of propofol was less in the groups D2, D3, D4, and D5 than in the control group; the recovery time of spontaneous respiration was longer in the groups D4 and D5 than in the control group; the time of awakening was longer in the groups D3, D4, and D5 than in the control group; and the incidence rate of adverse reactions was lower in the groups D1, D2, D3, D4, and D5 than in the control group (all P<0. 05) . Comclusion Dexmedetomidine pretreatment can effectively reduce the haemodynamic fluctuation of MECT patients, reduce the dose of anaesthesia drugs, improve the quality of anaesthesia recovery, and has better safety; in MECT, pretreatment with 0. 4 µg/kg dexmedetomidine has the best effect. [ABSTRACT FROM AUTHOR]

Consciousness, defined as being aware of and responsive to one's surroundings, is characteristic of normal waking life and typically is lost during sleep and general anaesthesia. The traditional view of consciousness as a global brain state has evolved toward a more sophisticated interplay between global and local states, with the presence of local sleep in the awake brain and local wakefulness in the sleeping brain. However, this interplay is not clear for general anaesthesia, where loss of consciousness was recently suggested to be associated with a global state of brain‐wide synchrony that selectively involves layer 5 cortical pyramidal neurons across sensory, motor and associative areas. According to this global view, local wakefulness of layer 5 cortex should be incompatible with deep anaesthesia, a hypothesis that deserves to be scrutinised with causal manipulations. Here, we show that unilateral chemogenetic activation of layer 5 pyramidal neurons in the sensorimotor cortex of isoflurane‐anaesthetised mice induces a local state transition from slow‐wave activity to tonic firing in the transfected hemisphere. This wakefulness‐like activity dramatically disrupts layer 5 interhemispheric synchrony with mirror‐image locations in the contralateral hemisphere, but does not reduce the level of unconsciousness under deep anaesthesia, nor in the transitions to/from anaesthesia. Global layer 5 synchrony may thus be a sufficient condition for anaesthesia‐induced unconsciousness, but is not a necessary one, at least under isoflurane anaesthesia. Local wakefulness‐like activity of layer 5 cortex can be induced and maintained under deep anaesthesia, encouraging further investigation into the local vs. global aspects of anaesthesia‐induced unconsciousness. Key points: The neural correlates of consciousness have evolved from global brain states to a nuanced interplay between global and local states, evident in terms of local sleep in awake brains and local wakefulness in sleeping brains.The concept of local wakefulness remains unclear for general anaesthesia, where the loss of consciousness has been recently suggested to involve brain‐wide synchrony of layer 5 cortical neurons.We found that local wakefulness‐like activity of layer 5 cortical can be chemogenetically induced in anaesthetised mice without affecting the depth of anaesthesia or the transitions to and from unconsciousness.Global layer 5 synchrony may thus be a sufficient but not necessary feature for the unconsciousness induced by general anaesthesia.Local wakefulness‐like activity of layer 5 neurons is compatible with general anaesthesia, thus promoting further investigation into the local vs. global aspects of anaesthesia‐induced unconsciousness. [ABSTRACT FROM AUTHOR]

Recent years have witnessed an unprecedented increase in the search for the use of psychedelics in improving physical and mental health. Anaesthesia has evolved since very early times, born from the need to eliminate pain and reduce suffering and there are reports of the use of anaesthetics to achieve mystical states since the nineteenth century. Nowadays, the renaissance of psychedelics in anaesthesia has been inspired by their potential in the treatment of chronic pain syndromes, palliative care and in the emergency department and pre‐hospital care with the administration of psychedelics in cases of ischaemia, given their potential in neuroprotection. Although there are already some published protocols for the administration of psychedelics in patients with mental illness, little has been addressed concerning non‐mental medical applications. In this sense, in patients with multiple comorbidities, functional limitations and polymedicated, the anaesthetist may play a fundamental role, not only in clinical practice, but also in translational research.This article focuses on the description of psychedelics, with a particular focus on dimethyltryptamine (DMT) and ayahuasca pharmacology, effects, safety and toxicity. A detailed description of the role of the anaesthetist in clinical and experimental research is provided, from participant's screening to preparation and dosing session, expected adverse effects and how to manage them, based on the protocol and standard procedures of a current study with neuroimaging during the psychedelic experience. Specific considerations regarding the management of psychedelic toxicity are also provided as well as future directions for safe psychedelic use in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: spinal anaesthesia has emerged as a most popular technique for abdominal and lower abdominal surgeries for its safety, simplicity and effectivity. Adding adjuvants drugs to intrathecal local anaesthetics improves quality and duration of spinal blockade, and prolongs postoperative analgesia. Intrathecal dexmedetomidine with low-dose bupivacaine provides faster onset, prolonged sensory and motor block and reduced rescue analgesic requirement in patient undergoing TURP. Aims and objectives: To assess the Onset of sensory analgesia, onset of motor block, fixation time of sensory block, highest level of sensory block, quality of analgesia. Material and methods: This Prospective - Randomized study was conducted in the Anaesthesia Anaesthesia Department in Government Medical College, Nagpur from December 2018 to November 2020. 60 adult female patients between the age of 18 and 60 years participated in the study. The samples were equally divided into 2 groups, Group D-Case group-30 patients and Group B-Control group-30 patients. Intravenous cannula of 18/20 G was secured and patient was preloaded with 10ml/kg of Ringer lactate solution over 10-30 minutes. Baseline vital signs such blood pressure, pulse rate were recorded. Result: Maximum number of patients in group D and group B i. e 100% and 60% respectively had an excellent quality of analgesia during the procedure. Quality of analgesia was reported as satisfactory in 30% of patients and poor in 10% patients in group B. Quality of analgesia was found to be comparable in the two groups (p= 0.001). Thus, addition of dexmedetomidine only marginally improved quality of surgical analgesia in our study. Conclusion: Intrathecal inj. Dexmedetomidine 5mcg acts synergistically to potentiate intrathecal local anaesthetic bupivacaine with the result that there is relatively faster onset of sensory block and prolongation of both sensory and motor block. [ABSTRACT FROM AUTHOR]

Background: Advanced ovarian cancer surgery presents anaesthetists with the challenge of managing patients with potential multiple co-morbidities undergoing major open or extended laparoscopic surgeries. The disease has overall amongst the poorest overall survival rates of all malignancies, with an estimated 5-year survival rate of <43%, and the patients being of a generally older age group present specific challenges in terms of their accumulated co-morbidities. Aim and objective: To study the management of patients with ovarian tumours at a tertiary health care centre Methodology: This study was carried out over a period of 1 years from 2023 to 2024 and includes 50 patients with ovarian tumour. Data was collected with pretested questionnaire. Data included sociodemographic data, clinical history and clinical examination. Management was done as per type of ovarian tumours. The complications of ovarian tumour were observed. Data analysed with appropriate statistical tests. Results: The incidence of ovarian tumour was 5.14. In the study 68% were benign tumours, whereas 32% were malignant. Most common mode of management of ovarian tumour was cystectomy (46%). [ABSTRACT FROM AUTHOR]

Introduction: Difficult intubation presents a significant challenge for anaesthesiologists, particularly when it is unexpected. Early recognition of a difficult airway through preoperative assessment is crucial to prevent potential complications associated with airway management failure. This study primarily aims to correlate the Mallampati modified score with the laryngoscopic view to enhance the prediction of difficult airways. Materials and Methods: This study included 80 adult patients, aged 18-75 years, of either sex and classified as ASA Class I and II, all requiring endotracheal intubation. Preoperative airway assessment was performed using the Modified Mallampati test, and the results were correlated with laryngoscopic grading based on the Cormack-Lehane classification. Statistical analysis was conducted using the Chi-square test and Kappa statistics. Results: The study found that 10% of the cases predicted to be easy intubations were actually difficult. Conversely, no difficult intubations were predicted as difficult in advance. Additionally, 10% of the cases that were predicted to be difficult intubations turned out to be easy. Conclusion: The Mallampati classification did not exhibit a grade-to-grade correlation with the Cormack-Lehane grading during direct laryngoscopy, indicating limitations in its predictive accuracy for difficult intubation. [ABSTRACT FROM AUTHOR]

Simple Summary: Doppler ultrasound is a commonly utilised non-invasive blood pressure measurement technique in dogs under general anaesthesia. This prospective clinical study compared the agreement of values obtained by audible return of pulsatile flow using Doppler ultrasound and visual sphygmomanometer needle oscillation with invasive arterial blood pressure in a clinical population of anaesthetised dogs. Visual sphygmomanometer needle oscillation (SNO) can occur before audible return of pulsatile flow (ARPF) when measuring blood pressure by Doppler ultrasound. The aim was to assess the agreement of SNO and ARPF with invasive blood pressure (iABP) in a clinical population of anaesthetised dogs. A total of 35 dogs undergoing surgery in dorsal recumbency necessitating arterial cannulation were included. Paired measurements of iABP and SNO, and iABP and ARPF, were collected. The agreement of non-invasive blood pressure (NIBP) and iABP measurements was analysed with concordance correlation coefficients (CCCs) and Bland–Altman plots. The proportions of SNO and ARPF measurements between 10 and 20 mmHg of iABP were compared. Both SNO and ARPF demonstrated greater agreement with invasive systolic (iSAP) than invasive mean (iMAP) pressures, and SNO demonstrated greater agreement with iSAP than ARPF measurements. The mean differences (95% limits of agreement) for SNO and APRF were −9.7 mmHg (−51.3–31.9) and −13.1 mmHg (−62.2–35.9), respectively. The CCC (95% CI) for SNO was 0.5 (0.36–0.64) and ARPF was 0.4 (0.26–0.54). A significantly greater proportion of SNO measurements were within 20 mmHg of iSAP compared to ARPF. Both NIBP techniques performed more poorly than veterinary consensus recommendations for device validation. Caution should be used clinically when interpreting values obtained by Doppler ultrasound in anaesthetised dogs. [ABSTRACT FROM AUTHOR]

Background: Postoperative delirium is a common distressing symptom experienced following laparoscopic cholecystectomy. The study aimed to investigate the influence of a low preoperative Mini-Cog testing score and 2 different anesthesia methods: total intravenous anaesthesia (TIVA) versus sevoflurane, on postoperative delirium in elderly patients undergoing laparoscopic cholecystectomy. Methods: A total of 84 patients over 60 years old who underwent laparoscopic cholecystectomy between March 1and – October 1 2023 were included in the study. Patients with a Mini-Cog score of 0–2 were considered to have low and possibly impaired neurocognitive function. We invastigated the effects of preoperative Mini-Cog score and the two anesthesia methods used on the incidence of postoperative delirium. Results: The proportion of patients with low Mini-Cog score in the preoperative period was 17.9%. Sevoflurane and TIVA was used in 41 and 43 patients respectively. The incidence of postoperative delirium in patients with low preoperative Mini-Cog scores was 66.7% at postoperative 0 h and 33.3% at the 1st hours. Postoperative delirium was found to be statistically higher in patients with low Mini-cog scores than in those with negatively-screened for Mini-cog scores (p: 0.01–0.035). In patients using sevoflurane, the incidence of postoperative delirium was 26.8% and 24.4% at the 0 and 1st hours, respectively. This was found to be statistically higher than in patients receiving TIVA (p: 0.036 − 0.010). Conclusion: Low Mini-Cog score was an indicator of a higher risk of early postoperative delirium. Sevoflurane is more likely to cause postoperative delirium than TIVA. Trial registration: The study was registered on ClinicalTrials.gov (Identifier: NCT06597812). [ABSTRACT FROM AUTHOR]

Centralisation of perioperative care for small children to a limited number of specialised paediatric centres has many theoretical advantages, but neither the optimal balance nor the current distribution of paediatric anaesthesia on a national scale are well elucidated. The aim of this study was to describe the distribution, adverse events, and mortality in children undergoing anaesthesia in Sweden. In this cohort study, data from all paediatric anaesthesia procedures registered in Sweden during the years 2019–22 were extracted from the Swedish Perioperative Register (SPOR). Data were analysed according to hospital level of care and ASA physical status. Data from 81 hospitals were analysed. During the 4-yr period, 214,964 procedures were registered. Most procedures in neonates and infants were managed in paediatric (73%) and other university hospitals (21%). Adverse events occurred in 2.71% of cases and severe adverse events in 0.067%. The all-cause 24-h mortality rate was 6.6:10,000 anaesthetics and the all-cause 30-day mortality was 14.7:10,000 anaesthetics. The 30-day all-cause estimated mortality was highest in paediatric hospitals (95% confidence interval [CI] 30–39) compared with other university hospitals (95% CI 6.1–12), county (95% CI 1.9–4.8), district (95% CI 0.07–2.2), and smaller hospitals (95% CI 0.0–22). Most procedures in neonates and infants were performed in tertiary centres, with county hospitals managing mainly older children, in accordance with national recommendations. Mortality was more common in tertiary centres, reflecting increased comorbidity and centralisation of anaesthesia of neonates and infants. [ABSTRACT FROM AUTHOR]

Summary: Introduction: The objective of this document is to guide best practice to ensure the safety and dignity of transgender and gender‐diverse people in the peri‐operative period. While transgender and gender‐diverse people may have specific health needs in relation to gender dysphoria, their health requirements go beyond their gender identity. Most doctors will provide care to someone who is transgender or gender‐diverse at some stage in their career. It is therefore important that all anaesthetists are educated on specific considerations when caring for these patients. Methods: A working party was assembled consisting of individuals with experience in direct clinical care of the relevant patient group, those who have expertise in endocrinology and gender‐affirming hormones, educators on the topic of transgender and gender‐diverse healthcare, and authors of both cisgender and transgender identities. After discussion among the working party, targeted searches of literature were undertaken. Results: The authors initially came up with a list of over 25 recommendations which was subsequently revised to a list of 15 recommendations after further review by the working party. These included airway assessment and management; management of hormonal therapy; relevant issues in obstetric anaesthesia; and hospital infrastructure and processes. Conclusions: This document provides the first guidance produced to advise on best practice to ensure the safety and dignity of trans and gender‐diverse individuals in the peri‐operative period. [ABSTRACT FROM AUTHOR]

Summary: Background: We analysed the clinical practice of anaesthesia associates in the UK, as reported to the 7th National Audit Project of the Royal College of Anaesthetists, and compared these with medically qualified anaesthetists. Methods: We included data from our baseline survey, activity survey and case registry as with other reports from the project. Results: Among 197 departments of anaesthesia, 52 (26%) employed anaesthesia associates. Of 10,009 responding anaesthesia care providers, 71 (< 1%) were anaesthesia associates, of whom 33 (47%) reporting working nights or weekends (compared with 97% of medically qualified anaesthetists in training and > 90% of consultants). Anaesthesia associates reported less training and confidence in managing peri‐operative cardiac arrest and its aftermath compared with medically qualified anaesthetists. Anaesthesia associates were less directly involved in the management and the aftermath of peri‐operative cardiac arrest than medically qualified anaesthetists, and the psychological impacts on professional and personal life appeared to be less. Among 24,172 cases, anaesthesia associates attended 432 (2%) and were the senior anaesthesia care provider in 63 (< 1%), with indirect supervision in 27 (43%). Anaesthesia associates worked predominantly in a small number of surgical specialties during weekdays and working daytime hours. Complication rates were low in cases managed by anaesthesia associates, likely reflecting case mix. However, activity and registry case mix data show anaesthesia associates do manage high‐risk cases (patients who are older, comorbid, obese and frail) with the potential for serious complications. Registry cases included higher risk cases with respect to the clinical setting and patient factors. Conclusion: Anaesthesia associates work in enhanced roles, relative to the scope of practice at qualification agreed by organisations. Recent changes mean the Royal College of Anaesthetists and Association of Anaesthetists do not currently support an enhanced scope of practice. [ABSTRACT FROM AUTHOR]

Background: Little is known about patients' or carers' reported experiences of dental care provided using dental behaviour support (DBS) techniques. Qualitative literature can provide unique insight into these experiences. Aim: To explore and synthesize qualitative literature related to patient experience of dental behaviour support. Methods: A PROSPERO‐registered systematic review of qualitative articles was undertaken. Studies were identified through MEDLINE, Embase and PsycINFO. Abstracts were screened by two reviewers and data were extracted to summarize the qualitative findings included within them. A thematic summary approach was used to synthesize the qualitative data identified. Results: Twenty‐three studies were included. Studies primarily explored experiences of dental care of children by speaking to their parents (n = 16), particularly regarding paediatric dental general anaesthesia (DGA) (n = 8). Studies of adults' experiences of DBS (n = 7) covered a range of techniques. Nine studies explored broader dental care experiences and did not study specific DBS approaches. A thematic synthesis identified five themes applicable across the studies identified: Trust and the therapeutic alliance supporting effective care delivery; considered information sharing often alleviated anticipatory anxiety; control and autonomy‐reduced anxieties; variations in the perceived treatment successes and failures of DBS techniques; and DBS techniques produced longer positive and negative impacts on patients beyond direct care provision. Conclusion: Qualitative research has been under‐utilized in research on DBS techniques. Care experiences of most DBS techniques outside of paediatric DGA are poorly understood. Building trust with patients and enabling autonomy appear to support positive patient‐reported experiences of care. [ABSTRACT FROM AUTHOR]

Introduction: The ERAS protocol is a set of international guidelines established to expedite patients' discharge after colorectal surgery. It does this by aiming to prevent postoperative complications early, and return the patient to normal function allowing earlier discharge. Complications such as PONV, DVT, ileus and pain are common after surgery to name a few, and delay discharge. Early treatment and prevention of these complications however is suggested to aid a patients' return to home at earlier rates than traditional practice. Methods: A prospective chart review and questionnaire was performed on patients undergoing colorectal surgery in UHL in a 6-month period from February to September 2023. Patients were approached on the 3rd day postoperatively and informed about the project. Exclusion criteria included patients who went to HDU or ICU postoperatively. Results: In total, 33 patients were recruited. A target of greater than 70% compliance was reached for a variety of the elements of the ERAS protocol such as laparoscopic surgery, preoperative assessments, nutritional drinks, LMWH, oral intake within 24 h of surgery, and intraoperative antiemetics. Unsatisfactory compliance was found with documentation of postoperative antibiotics use of preoperative gabapentin. Conclusion: UHL has a satisfactory compliance of over 70% with a large variety of elements of the ERAS protocol. Areas of improvement required include postoperative antibiotic and preoperative gabapentin usage. With the collective effort of the multidisciplinary team, along with education, the ERAS protocol can successfully be applied and implemented in a model 4 hospital in Ireland. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate whether and to what extent perioperative hypnosis and relaxation techniques are used in German anaesthesia departments, what they are, where any difficulties in their application lie and how great the interest in this type of therapy is. Another research question was to find out whether there are specialist areas in which these methods are used more frequently than in other specialist areas. Methods: A descriptive survey was conducted by means of a questionnaire in all hospitals with anaesthesia departments in Germany. 1124 questionnaires were sent out by post. The survey period was five months from 27/02/2023 to 31/07/2023. The clinic directors of all anaesthesiology departments in German hospitals were surveyed. Results: 476 departments (42%) responded by pre-paid envelope. Of these, only 39 (8%) use hypnosis and relaxation techniques perioperatively. These are mostly progressive muscle relaxation, hypnotic trance according to Erickson, calming words and suggestions or the use of virtual reality (e.g. using VR-glasses). Conclusions: Hypnosis techniques have been shown in many studies to be effective in increasing patient comfort (less anxiety and stress) and reducing both the need for medication and perioperative pain. The therapy is rarely used in Germany, although once established it can be easily integrated into perioperative procedures. Many departments have shown great interest in the topic. In the interests of patients, a structural change should be considered to promote the use of hypnotic procedures. [ABSTRACT FROM AUTHOR]

Background: Invasive blood pressure measurement is the in-hospital gold standard to guide hemodynamic management and consecutively cerebral perfusion pressure in patients with traumatic brain injury (TBI). Its prehospital use is controversial since it may delay further care. The primary aim of this study was to test the hypothesis that patients with severe traumatic brain injury who receive prehospital arterial cannulation, compared to those with in-hospital cannulation, do not have a prolonged time between on-scene arrival and first computed tomography (CT) of the head by more than ten minutes. Methods: This retrospective study included patients 18 years and older with isolated severe TBI and prehospital induction of emergency anaesthesia who received treatment in the resuscitation room of the University Hospital of Graz between January 1st, 2015, and December 31st, 2022. A Wilcoxon rank-sum test was used to test for non-inferiority (margin = ten minutes) of the time interval between on-scene arrival and first head CT. Results: We included data of 181 patients in the final analysis. Prehospital arterial line insertion was performed in 87 patients (48%). Median (25–75th percentile) durations between on-scene arrival and first head CT were 73 (61–92) min for prehospital arterial cannulation and 75 (60–93) min for arterial cannulation in the resuscitation room. Prehospital arterial line insertion was significantly non-inferior within a margin of ten minutes with a median difference of 1 min (95% CI − 6 to 7, p = 0.003). Conclusion: Time-interval between on-scene arrival and first head CT in patients with isolated severe traumatic brain injury who received prehospital arterial cannulation was not prolonged compared to those with in-hospital cannulation. This supports early out-of-hospital arterial cannulation performed by experienced providers. [ABSTRACT FROM AUTHOR]

Background: Climate change is one of the leading threats to humanity today, and the practice of anaesthesia has an appreciable impact on it. This study aims to determine the knowledge regarding environmentally sustainable anaesthesia and the current practices of anaesthetists working in the Department of Anaesthesiology at the University of the Witwatersrand. Methods: A prospective, descriptive research design was followed. The study population consisted of all anaesthetists working in the Department of Anaesthesiology at the University of the Witwatersrand. A convenience sampling method was used. Data was collected through an online, self-administered questionnaire. Results: There were 141 responses to the distributed questionnaire. Adequate knowledge of environmentally sustainable anaesthesia was found in 14.90% of participants. There was no significant association between adequate knowledge and age, professional designation, or years of experience (p = 0.949). The detrimental effect of inhalational anaesthetic gases (IAG) on the environment was widely known; however, only 15.60% of participants were aware of the risk of propofol to marine life, and 81.56% thought that reusable equipment poses an infection risk. Fresh gas flows (FGF) were not calculated by 66.67% of participants, and their respective knowledge of them was low. Anaesthetic practices were environmentally unsustainable since they were not in keeping with the World Federation Societies of Anaesthesiologists (WFSA), the American Society of Anesthesiologists (ASA), or the South African Society of Anaesthesiologists (SASA) guidelines. Conclusion: The knowledge of environmentally sustainable anaesthetic practices was low among all anaesthetists at the University of the Witwatersrand; however, there was fair knowledge of the environmental impact of IAGs. Anaesthetic practices were generally environmentally unsustainable, possibly due to the low level of knowledge. Financial constraints and resource limitations need to be considered when analysing practices. Anaesthetists need further training in environmentally sustainable anaesthesia to limit the impact of climate change, given the world's present predicament. [ABSTRACT FROM AUTHOR]

Background: Critical events in anaesthesia are defined as events requiring immediate intervention to prevent major disability or death. South African research on risk factors predisposing our vulnerable paediatric patients to critical events is limited. Methods: A prospective, observational, cross-sectional study was conducted at Rahima Moosa Mother and Child Hospital (RMMCH) in Johannesburg. The study included 206 paediatric patients up to the age of 12 years undergoing anaesthesia for elective and emergency procedures. The study aimed to describe the incidence and management of perioperative critical events, determine risk factors, and describe the immediate postoperative outcomes. Results: The median age of patients with a critical event was four years with a weight of 13 kg. The cumulative incidence of critical events was 34% (95% confidence interval [CI] 27 to 40), with hypoglycaemia having the highest incidence of 21% (95% CI 16 to 27). The incidence of respiratory critical events was 11% (95% CI 7 to 16), emergence delirium 2.4% (95% CI 0.90 to 5.9), cardiovascular events 1.9% (95% CI 0.62 to 5.2), and temperature abnormalities 0.5% (95% CI 0.03 to 3.1). Risk factors associated with respiratory events included younger age and using endotracheal tubes (ETT). The management of the events varied according to physician preference. Of the patients included, 87% were discharged to the ward. Conclusion: The cumulative incidence of critical events was more than double the number previously reported in a large South African multicentre study. Hypoglycaemia continues to be the biggest contributor. To improve patient outcomes, attention should be given to improving in-service training and continuous medical education (CME). [ABSTRACT FROM AUTHOR]

Cognitive impairment and older age are major risk factors for postoperative delirium. Professional societies have advocated preoperative screening to identify at-risk individuals for implementation of interventions, which have moderate effectiveness in preventing delirium. However, it remains unclear from the guidelines whether screening should be completed routinely for all older individuals or targeted, and also which specific screening tool is preferred. In addition, the responsibility for screening remains undesignated in the guidelines provided. We reviewed the benefits and risks of routine screening. We also performed a cost-benefit analysis of routine screening (versus no screening). Furthermore, we summarised the sensitivities and specificities of commonly used screening tools and reviewed evolving screening tools that may have an increasing role in future practice. We concluded that routine screening is useful and appears to be cost-effective for reducing postoperative delirium, with a cost-benefit ratio of 2.89 (adjusted ratio of 2.34), and has additional advantages over other approaches such as targeted screening or routine intervention. [ABSTRACT FROM AUTHOR]

Oesophageal intubations are more common than may be realised and can potentially cause significant patient harm even if promptly identified and corrected. Reports of morbidity due to unrecognised oesophageal intubation continue to present in coroner and media reports. Therefore, it would be helpful to identify mechanisms to prevent these events and implement strategies to avoid and identify incorrect endotracheal tube placement. This analysis of oesophageal intubations reported to webAIRS aims to provide an in-depth analysis of all events in which oesophageal intubation occurred. WebAIRS is a web-based, bi-national incident reporting system collecting voluntarily reported anaesthetic events across Australia and New Zealand, with more than 10,500 incidents registered. A structured search through the webAIRS database identified 109 reports of oesophageal intubation reported between July 2009 and September 2022. A common cause of oesophageal intubation was the misidentification of the larynx due to a poor laryngeal view. Desaturation directly attributed to the misplaced endotracheal tube occurred in 43% of all reports. The authors precisely defined early recognised oesophageal intubation and delayed or unrecognised oesophageal intubation. Most reports (74%) described early recognition of the misplaced intubation, of which 27% led to directly contributed to hypoxia. Cardiovascular collapse as a direct consequence of the late recognition of oesophageal intubation was described in five (18%) of these events. There was inconsistency in end-tidal carbon dioxide monitoring and interpretation of the resulting waveform. Findings show that oesophageal intubation continues to be an issue in anaesthesia. Incidents described confusion in diagnosis, human factors issues and cognitive bias. Clear diagnostic guidance and treatment strategies are required to be developed, tested and implemented. [ABSTRACT FROM AUTHOR]

Remazolam is a new ultra-short-acting benzodiazepine that produces sedation by acting on γ-aminobutyric acid type A (GABAA) receptors. Remazolam has characteristics of rapid onset of action, short half-life, high clearance, and no accumulation in the body. It also has a low incidence of injection pain and mild effects on hepatic and renal function, respiration, and haemodynamics. Additionally, it can be rapidly reversed by flumazenil. The clinical research progress on remazolam in the areas of procedural sedation, induction, and maintenance of general anesthesia were reviewed to provide references for its clinical application. [ABSTRACT FROM AUTHOR]

The present study was undertaken to evaluate the anaesthetic effect of propofol isoflurane and propofol sevoflurane in twelve dogs with history of chronic cough, dyspnoea, laboured breathing, nasal discharge, exercise intolerance which were presented to the Department of Surgery and Radiology, Mumbai Veterinary College and Bai Sakarbai Dinshaw Petit Hospital for Animals, Parel, Mumbai. These dogs were randomly divided into two equal groups. In both the groups dogs were premedicated with acepromazine (0.04 mg/kg b.wt.) intravenously, and atropine sulphate (0.04 mg/kg b.wt.) and dexamethasone sodium (0.025 mg/kg b.wt.) SC 10 min before induction of anaesthesia. In both the groups, anaesthesia was induced with propofol (5 mg/kg b.wt.) intravenously. In group I anaesthesia was maintained using 2.5% isoflurane and in group II, 2.5% sevoflurane along with oxygen at a flow rate ranging from 500 to 1200 mL/min. History, physiological parameters, anaesthetic parameters were recorded at different time intervals during the study period. The present study findings suggest that induction with propofol and maintenance with isoflurane and sevoflurane proved best anaesthetic technique for thoracoscopy in dogs. [ABSTRACT FROM AUTHOR]

Aim Most cases of oesophageal strictures can be treated effectively with elective outpatient endoscopic dilation in a specialized centre. With this case series review, we aim to evaluate our patient cohort from June 2020 to January 2022. Methods: We retrospectively analyzed 185 consecutive patients submitted to oesophageal and pyloric dilation procedures in day surgery settings from June 2020 to January 2022. Results: In our retrospective case series, we analyzed 185 patients submitted to oesophageal dilation (89%) or pyloric dilation (11%). Analysis of the type of anaesthesia correlated to the primary diagnosis showed that 52% of achalasia patients had deep sedation via native airway, and caustic stricture was corrected in almost all cases during general anaesthesia (89%). It is worth noting that in our study, only 1.6% of patients experienced complications that prevented same-day discharge, such as fever or arrhythmia. Severe complications, including significant bleeding or perforation, were entirely absent. Conclusions: We can conclude that oesophageal dilations were performed with safety and efficiency in our centre, with very few unplanned recoveries and a negligible rate of complications. The standardization of outpatient care pathways has further bolstered our efficiency, ensuring the best possible outcomes for our patients. [ABSTRACT FROM AUTHOR]

Background: Palatal dysfunction (PD), which encompasses palatal instability (PI) and intermittent dorsal displacement of the soft palate, is the most common performance‐limiting upper respiratory tract obstruction in young Thoroughbred racehorses. Soft palate thermocautery (SPT) performed under general anaesthesia is a routinely performed procedure for PD in some countries, but the procedure for and outcome of SPT performed under standing sedation has not been published. Objectives: (1) To describe a technique for SPT performed under standing sedation; and (2) to assess post‐operative performance in horses compared to controls using the Racing Post rating (RPR), British Horseracing Authority official rating (OR), Performance Index and Earnings. Study design: Retrospective case series. Methods: Medical records were reviewed for all horses that had SPT performed under standing sedation following topical and local infusion of lidocaine hydrochloride into the rostral soft palate, and that were identified to have PI by overground endoscopy. Two matched controls were identified for each case. The median RPR, OR, Performance Index and Earnings for the three pre‐operative and three post‐operative races were compared. Results: No significant differences were identified between the SPT (n = 23) and Control groups (n = 46) for baseline characteristics or outcomes. Main limitations: Retrospective study design, small sample size. Conclusions: No significant differences in racing performance were identified between horses that had SPT performed under standing sedation and controls. [ABSTRACT FROM AUTHOR]

A study published in the journal Diabetes, Obesity & Metabolism examined the use of semaglutide, a medication for type 2 diabetes, and its association with the risk of postoperative pneumonia in older patients with type 2 diabetes in Ontario, Canada. The study found that there was no increased risk of pneumonia among patients using semaglutide compared to those who did not use the medication. This information is important for healthcare providers and patients considering the use of semaglutide before surgery. However, further research is needed to fully understand the safety of semaglutide and similar medications in the perioperative period. [Extracted from the article]

To evaluate the agreement between measurements of invasive blood pressure (IBP) and oscillometric blood pressure from the tongue (OBPton) using a multiparameter monitor. Unblinded, prospective, experimental study. A total of 12 female Large White crossbreed pigs. Pigs undergoing experimental procedures that required arterial cannula placement were recruited. A blood pressure cuff with the closest width to 40% of the circumference of the tongue was placed rostral to the lingual frenulum. Systolic, mean and diastolic IBP and OBPton were measured simultaneously at 5 minute intervals. Agreement between paired measurements was examined using Bland–Altman analysis. Mean bias, precision (standard deviation of mean bias), 95% limits of agreement, correlation coefficients and percentage of measurements within 10 and 20 mmHg of IBP were calculated. The total numbers of paired measurements recorded were 124, 126 and 124 for systolic, mean and diastolic blood pressures, respectively. The mean bias, precision and 95% limits of agreement for systolic OBPton were 11.5, 11.5 (–11.1 to 34.2), for mean OBPton 5.6, 5.7 (–5.7 to 16.8) and for diastolic OBPton 7.6, 10.1 (–12.1 to 27.4) mmHg. Correlation coefficients were greater than 0.9 for mean OBPton only. More than 50% of measurements were within 10 mmHg of IBP and 80% of measurements were within 20 mmHg of IBP for mean and diastolic OBPton only. The tongue as a cuff site for oscillometric blood pressure measurement is a useful site for measuring mean arterial, but not systolic or diastolic blood pressure in anaesthetized Large White crossbreed pigs. This technique fulfils the American College of Veterinary Internal Medicine criteria for measuring mean arterial pressure but not systolic or diastolic arterial pressure. [ABSTRACT FROM AUTHOR]

Cerebrovascular autoregulation is defined as the capacity of cerebral blood vessels to maintain stable cerebral blood flow despite changing blood pressure. It is assessed using the pressure reactivity index (the correlation coefficient between mean arterial blood pressure and intracranial pressure). The objective of this scoping review is to describe the existing evidence concerning the association of EEG and cerebrovascular autoregulation in order to identify key concepts and detect gaps in the current knowledge. Embase, MEDLINE, SCOPUS, and Web of Science were searched considering articles between their inception up to September 2023. Inclusion criteria were human (paediatric and adult) and animal studies describing correlations between continuous EEG and cerebrovascular autoregulation assessments. Ten studies describing 481 human subjects (67% adult, 59% critically ill) were identified. Seven studies assessed qualitative (e.g. seizures, epileptiform potentials) and five evaluated quantitative (e.g. bispectral index, alpha-delta ratio) EEG metrics. Cerebrovascular autoregulation was evaluated based on intracranial pressure, transcranial Doppler, or near infrared spectroscopy. Specific combinations of cerebrovascular autoregulation and EEG metrics were evaluated by a maximum of two studies. Seizures, highly malignant patterns or burst suppression, alpha peak frequency, and bispectral index were associated with cerebrovascular autoregulation. The other metrics showed either no or inconsistent associations. There is a paucity of studies evaluating the link between EEG and cerebrovascular autoregulation. The studies identified included a variety of EEG and cerebrovascular autoregulation acquisition methods, age groups, and diseases allowing for few overarching conclusions. However, the preliminary evidence for the presence of an association between EEG metrics and cerebrovascular autoregulation prompts further in-depth investigations. [ABSTRACT FROM AUTHOR]

Applied respiratory physiology is crucial for perioperative patient management. This article reviews respiratory mechanics, gas exchange, and ventilation regulation, focusing on their practical applications from preoperative assessment to postoperative recovery. Cardiopulmonary exercise testing (CPET) is emphasized for predicting perioperative risk, with metabolic equivalents (METs) highlighted as indicators of cardiovascular fitness. The significance of oxygen delivery (DO 2) components and types of hypoxia are detailed. Anaesthesia's effects on respiratory physiology, including the suppression of ventilatory response and impact on upper airway muscles, are analysed. Postoperative strategies to prevent atelectasis, such as positive end-expiratory pressure (PEEP) and recruitment manoeuvres, are discussed. [ABSTRACT FROM AUTHOR]

This double-blind, randomised clinical trial aimed to find out whether there is a difference in the prevalence of neurosensory disturbance (NSD) between patients who received 2% lidocaine and those who received 4% articaine during inferior alveolar nerve blocks (IANBs). Patients who underwent third molar extraction were randomised into two groups. IANB was performed using 2% lidocaine in Group 1 and 4% articaine in Group 2. The occurrence of NSD was documented. Patients were visited within 48 hours and one week after the tooth was removed. The type of anaesthetic drug (4% articaine versus 2% lidocaine) was the study's predictive factor. A total of 2400 patients were studied in two groups (1200 in each group). The mean (range) age of the patients was 28.40 (18–44) years. Five patients (0.41%) in the lidocaine group and seven (0.58%) in the articaine group had NSD after injection (p = 0.77). The prevalence of NSD after IANB was no higher in the articaine group than in the lidocaine group. [ABSTRACT FROM AUTHOR]

Background: Complications are a practical consideration for elective magnetic resonance imaging (MRI) studies performed under general anaesthesia but relatively little is known about their distribution and risk factors. Objectives: To describe the incidence of complications associated with MRI performed under general anaesthesia at a large referral facility and evaluate potential risk factors for these complications. Study design: Retrospective case–control study. Methods: Patient information and details of the MRI procedure were collected retrospectively from medical records of all horses that had undergone an MRI under general anaesthesia at the University of Pennsylvania, New Bolton Center, between September 2005 and April 2012. Complications and categorical variables were examined by chi‐squared or Fisher's exact tests as appropriate. A mixed‐effects logistic regression approach was used to evaluate associations between explanatory variables and the outcome variable (complications or pyrexia). A univariable screen was used to select variables (likelihood ratio test p < 0.2) for inclusion in the multivariable analysis. Statistical significance was inferred when p ≤ 0.05. Results: Complications were noted after MRI in 51 (17.4%) of 293 events eligible for inclusion. Complications included pyrexia (n = 35), pneumonia (n = 14), colic (n = 10), facial/nerve paralysis (n = 6), diarrhoea (n = 4), and other (n = 3). The odds of developing a post‐anaesthetic complication were significantly decreased in horses that received peri‐anaesthetic antimicrobials (OR 0.29, 95% CI 0.14–0.63, p = 0.002). Increased age (OR 0.87, 95% CI, 0.76–0.99, p = 0.03) and peri‐anaesthetic antimicrobial administration (OR 0.23, 95% CI 0.08–0.65, p = 0.005) were associated with a decreased odds of developing pyrexia. Main limitations: Single centre retrospective design. Conclusions: Potential complications including pyrexia, pneumonia and colic should be recognised when pursuing MRI under general anaesthesia. The administration of peri‐anaesthetic antimicrobials decreased the odds of a complication and warrants consideration, particularly in horses that might be classified as high risk. [ABSTRACT FROM AUTHOR]

Abstract Purpose A bench study to assess the elimination of sevoflurane from an anesthetic workstation using three different processing methods. Methods Sevoflurane concentrations from samples of the inspiratory breathing hose and air samples from within the investigation room were assessed during predetermined flush out intervals using Gas Chromatography-Ion Mobility Spectrometry. The primary objective was to determine the time to reach concentrations below 5 ppmv. Results Reduction of sevoflurane volume concentrations below a threshold of 5 ppmv was achieved within the first minute after removal of the vaporizer and the complete exchange of the soda and the breathing system and within the 15 min measurement interval after inclusion of two activated charcoal filters without a 90 s of flushing and without changing of the breathing hoses as required by the manufacturer. Conclusions Complete removal of the vaporizer and an exchange of the soda and the ventilation unit most quickly reduced sevoflurane concentrations, but the total processing interval may exceed 30 min. Inserted activated charcoal filters without a previous 90 s of flushing and without changing the breathing hoses followed by flushing only with raised fresh gas flow allow ventilation below trigger threshold to be reached within due time.

Abstract Background Postoperative delirium is a common distressing symptom experienced following laparoscopic cholecystectomy. The study aimed to investigate the influence of a low preoperative Mini-Cog testing score and 2 different anesthesia methods: total intravenous anaesthesia (TIVA) versus sevoflurane, on postoperative delirium in elderly patients undergoing laparoscopic cholecystectomy. Methods A total of 84 patients over 60 years old who underwent laparoscopic cholecystectomy between March 1and – October 1 2023 were included in the study. Patients with a Mini-Cog score of 0–2 were considered to have low and possibly impaired neurocognitive function. We invastigated the effects of preoperative Mini-Cog score and the two anesthesia methods used on the incidence of postoperative delirium. Results The proportion of patients with low Mini-Cog score in the preoperative period was 17.9%. Sevoflurane and TIVA was used in 41 and 43 patients respectively. The incidence of postoperative delirium in patients with low preoperative Mini-Cog scores was 66.7% at postoperative 0 h and 33.3% at the 1st hours. Postoperative delirium was found to be statistically higher in patients with low Mini-cog scores than in those with negatively-screened for Mini-cog scores (p: 0.01–0.035). In patients using sevoflurane, the incidence of postoperative delirium was 26.8% and 24.4% at the 0 and 1st hours, respectively. This was found to be statistically higher than in patients receiving TIVA (p: 0.036 − 0.010). Conclusion Low Mini-Cog score was an indicator of a higher risk of early postoperative delirium. Sevoflurane is more likely to cause postoperative delirium than TIVA. Trial registration The study was registered on ClinicalTrials.gov (Identifier: NCT06597812) .

Aims: This study aimed to assess the carbon footprint associated with total hip arthroplasty (THA) in a UK hospital setting, considering various components within the operating theatre. The primary objective was to identify actionable areas for reducing carbon emissions and promoting sustainable orthopaedic practices. Methods: Using a life-cycle assessment approach, we conducted a prospective study on ten cemented and ten hybrid THA cases, evaluating carbon emissions from anaesthetic room to recovery. Scope 1 and scope 2 emissions were considered, focusing on direct emissions and energy consumption. Data included detailed assessments of consumables, waste generation, and energy use during surgeries. Results: The carbon footprint of an uncemented THA was estimated at 100.02 kg CO2e, with a marginal increase to 104.89 kg CO2e for hybrid THA. Key contributors were consumables in the operating theatre (21%), waste generation (22%), and scope 2 emissions (38%). The study identified opportunities for reducing emissions, including instrument rationalization, transitioning to LED lighting, and improving waste-recycling practices. Conclusion: This study sheds light on the substantial carbon footprint associated with THA. Actionable strategies for reducing emissions were identified, emphasizing the need for sustainable practices in orthopaedic surgery. The findings prompt a critical discussion on the environmental impact of single-use versus reusable items in the operating theatre, challenging traditional norms to make more environmentally responsible choices. Cite this article: Bone Jt Open 2024;5(9):742–748.

Background and Aims: General anaesthesia (GA) is the preferred modality for breast surgeries; however, neuraxial anaesthesia can be performed in cases where GA poses a significant risk. We hypothesise that neuraxial blockade is a safe and effective alternative to GA in short-duration breast surgeries. Methods: This randomised study included 30 patients of the American Society of Anesthesiologists physical status I and II, who were scheduled for elective breast surgeries of a duration of less than 90 min. Group I received thoracic spinal anaesthesia, while in Group II, standardised GA was administered. The primary outcome was the time to the first rescue analgesic, and the secondary outcomes were time to recovery, patient satisfaction and the cost incurred. Results: The demographic characteristics of both groups were comparable (P > 0.05). The time to first rescue analgesic in Group I was more than in Group II (P = 0.001). Patient satisfaction score was superior in Group I compared to Group II (P = 0.002). The average cost was lower in Group I compared to Group II (P = 0.002). Recovery was quicker in Group I than in Group II (P = 0.001). There were no significant haemodynamic disturbances or major complications in either group. Conclusion: Thoracic spinal anaesthesia is an excellent alternative to GA in terms of analgesic efficacy, patient satisfaction, recovery and cost-effectiveness for short-duration breast surgeries.

Background and Aims: A quality improvement project (‘Safe Anaesthesia for ALL-SEAL’) was implemented to reduce preventable medication errors and drug wastage in the operating theatre (OT) of a tertiary hospital. The primary objective of this quality improvement project was to prevent the incidence of medication errors, and the secondary objective was to reduce the wastage of unused drugs. Methods: A pre-intervention questionnaire and an audit survey were performed, and multidirectional interventions were designed post-survey. A post-intervention survey was conducted to evaluate effectiveness. The incidence of medication errors, including near misses, was assessed for root causes. Unused drugs drawn or diluted in syringes were recorded daily in each OT. The weekly drug orders and mid-week reordering frequency were also monitored. The data were reported as simple means and percentages. Results: Ninety-eight anaesthesia care providers participated in the survey (72.4% doctors and 27.6% anaesthetic nurses). Pre-intervention, 76.1% of respondents had experienced medication errors during their practice. Common errors included misidentification of ampoules or vials (65.2%), miscalculation of dosages (65.2%), improper syringe labelling (56.5%), accidental drug omission (54.3%) and wrong prescriptions (39.1%). The main sources of errors were fatigue/overwork (80.4%) and a hectic OT environment (71.7%). Post-intervention, no incidents of medication errors were reported. In addition, there was a significant reduction in drug wastage. Conclusions: The SEAL project positively prevented medication errors and reduced drug wastage, which should be further validated in other clinical settings.

Abstract Background The aim of this study was to investigate whether and to what extent perioperative hypnosis and relaxation techniques are used in German anaesthesia departments, what they are, where any difficulties in their application lie and how great the interest in this type of therapy is. Another research question was to find out whether there are specialist areas in which these methods are used more frequently than in other specialist areas. Methods A descriptive survey was conducted by means of a questionnaire in all hospitals with anaesthesia departments in Germany. 1124 questionnaires were sent out by post. The survey period was five months from 27/02/2023 to 31/07/2023. The clinic directors of all anaesthesiology departments in German hospitals were surveyed. Results 476 departments (42%) responded by pre-paid envelope. Of these, only 39 (8%) use hypnosis and relaxation techniques perioperatively. These are mostly progressive muscle relaxation, hypnotic trance according to Erickson, calming words and suggestions or the use of virtual reality (e.g. using VR-glasses). Conclusions Hypnosis techniques have been shown in many studies to be effective in increasing patient comfort (less anxiety and stress) and reducing both the need for medication and perioperative pain. The therapy is rarely used in Germany, although once established it can be easily integrated into perioperative procedures. Many departments have shown great interest in the topic. In the interests of patients, a structural change should be considered to promote the use of hypnotic procedures.

Background and Aims: Preoperative parental anxiety can have a profound impact on their children undergoing surgery. The present study was done to analyse the correlation between preoperative parental anxiety and their child’s anxiety in paediatric patients undergoing elective surgery. Methods: Paediatric patients aged 2–12 years, scheduled for elective surgeries under general anaesthesia, were included in the study. The child’s behaviour and anxiety were assessed in the preoperative area using the modified Yale Preoperative Anxiety Scale (m-YPAS). The parent filled out the demographic questionnaire and the Spielberger State–Trait Anxiety Inventory (STAI) form in the preoperative area on the day of surgery. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) statistics software version 23.0 (IBM Corp, Armonk, NY, USA). Results: A total of 150 children undergoing elective surgery were analysed. Our results showed a strong positive correlation between a child’s m-YPAS and his/her parents’ anxiety on the day of the surgery (STAI-state) (r = 0.545, P < 0.001). However, the correlation between a child’s m-YPAS and his/her parents’ anxiety levels (STAI-trait) was not found to be significant (r = 0.109, P = 0.188). A positive correlation was observed between a parent’s STAI-state and STAI-trait (r = 0.366, P < 0.001). Factors like area of residence, type of surgery and previous hospitalisation had an influence on the anxiety levels of the child. The birth order of the child, previous hospitalisation and gender of the parent also influenced parental anxiety. Conclusion: Parental anxiety has a significant impact on the child’s anxiety during the preoperative period.

Background and Aims: Surgeons often request a Valsalva manoeuvre (VM) at the end of surgery (head–neck surgery, craniotomy) to check haemostasis and to unmask covert venous bleeders. We aimed to compare an anaesthesia machine-generated objective technique for delivering VM under pressure-control (PC) mode with the traditional subjective technique of delivering VM in manual mode. Methods: This randomised controlled study included 60 adult patients randomised to manual (Group M) and controlled ventilation (Group C) groups. Our primary outcome measure was internal jugular vein (IJV) diameter at pre-determined time points (T0 = baseline, T1 = VM initiation, T2 = 20 s after VM initiation, T3 = immediately after VM release, and T4 = 1 min, T5 = 2 min and T6 = 5 min post-VM release). Secondary outcome measures included mean arterial pressure (MAP), heart rate, time to desired plateau airway pressure, number of patients with bleeders unmasked and surgeon satisfaction. Independent/paired sample t-tests were applied. Results are expressed as mean (standard deviation), mean difference (95% confidence interval), dotted box–whisker plots and trendlines. P

Abstract Background The National Health Service (NHS) has pledged to reach carbon net-zero by 2040. In alignment with this goal, a London hospital’s anaesthesia department is actively reducing desflurane use and transitioning towards total intravenous anaesthesia (TIVA) as a sustainable alternative, contributing to environmentally responsible practices within the healthcare sector. Methods We conducted a rapid qualitative appraisal through online interviews with 17 anaesthetic practitioners to explore their perspectives regarding this climate change mitigation strategy. Data analysis was undertaken through the use of rapid appraisal sheets and a framework analysis method. Results Participants highlighted the disadvantages of TIVA, including the increased effort, heightened monitoring requirements, operational challenges, and a lack of clinical confidence associated with its use. Despite these reservations, participants acknowledged TIVA’s potential to reduce postoperative nausea. There were perceptions that senior staff members might resist this change due to habits and scepticism over its impact on climate change. To facilitate greater TIVA adoption, participants recommended enhanced training, the implementation of a dashboard to raise awareness of greenhouse gas (GHG) emissions, and the presence of strong climate change leadership within the department. Participants believed that a shift to TIVA should be followed by specific measures such as addressing waste management which is crucial for GHG reduction, emphasising the perceived link between waste and emissions. Conclusions The evaluation examines stakeholder attitudes, perceptions, and behaviours, focusing on transitioning from desflurane to TIVA. The study highlights the importance of staff engagement, organisational support, and underscores the crucial role that healthcare practitioners and leadership play in fostering sustainability within the healthcare sector.

Abstract 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