Search

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]

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]

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]

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]

The article focuses on the nuances of anesthesia administration during thyroid and parathyroid surgeries, ensuring safe and appropriate anesthesia for patients and identifying potential emergencies during these procedures. Topics include optimizing airway management, maintaining hemodynamic stability, and implementing effective pain management strategies postoperatively.

The article focuses on the implications of primary bone sarcoma (PBS) for anesthetists, emphasizing the importance of preparation for surgery and perioperative management. Topics include preoperative planning coordinated by multidisciplinary teams, histological diagnosis and its impact on treatment strategies, and the specific effects of neoadjuvant treatments such as chemotherapy, radiotherapy, and immunotherapy on patients undergoing surgery.

Arterial pressure monitoring and management are mainstays of haemodynamic therapy in patients having surgery. This article presents updated consensus statements and recommendations on perioperative arterial pressure management developed during the 11th POQI PeriOperative Quality Initiative (POQI) consensus conference held in London, UK, on June 4–6, 2023, which included a diverse group of international experts. Based on a modified Delphi approach, we recommend keeping intraoperative mean arterial pressure ≥60 mm Hg in at-risk patients. We further recommend increasing mean arterial pressure targets when venous or compartment pressures are elevated and treating hypotension based on presumed underlying causes. When intraoperative hypertension is treated, we recommend doing so carefully to avoid hypotension. Clinicians should consider continuous intraoperative arterial pressure monitoring as it can help reduce the severity and duration of hypotension compared to intermittent arterial pressure monitoring. Postoperative hypotension is often unrecognised and might be more important than intraoperative hypotension because it is often prolonged and untreated. Future research should focus on identifying patient-specific and organ-specific hypotension harm thresholds and optimal treatment strategies for intraoperative hypotension including choice of vasopressors. Research is also needed to guide monitoring and management strategies for recognising, preventing, and treating postoperative hypotension. [ABSTRACT FROM AUTHOR]

It is unclear whether optimising intraoperative cardiac index can reduce postoperative complications. We tested the hypothesis that maintaining optimised postinduction cardiac index during and for the first 8 h after surgery reduces the incidence of a composite outcome of complications within 28 days after surgery compared with routine care in high-risk patients having elective major open abdominal surgery. In three German and two Spanish centres, high-risk patients having elective major open abdominal surgery were randomised to cardiac index-guided therapy to maintain optimised postinduction cardiac index (cardiac index at which pulse pressure variation was <12%) during and for the first 8 h after surgery using intravenous fluids and dobutamine or to routine care. The primary outcome was the incidence of a composite outcome of moderate or severe complications within 28 days after surgery. We analysed 318 of 380 enrolled subjects. The composite primary outcome occurred in 84 of 152 subjects (55%) assigned to cardiac index-guided therapy and in 77 of 166 subjects (46%) assigned to routine care (odds ratio: 1.87, 95% confidence interval: 1.03–3.39, P =0.038). Per-protocol analyses confirmed the results of the primary outcome analysis. Maintaining optimised postinduction cardiac index during and for the first 8 h after surgery did not reduce, and possibly increased, the incidence of a composite outcome of complications within 28 days after surgery compared with routine care in high-risk patients having elective major open abdominal surgery. Clinicians should not strive to maintain optimised postinduction cardiac index during and after surgery in expectation of reducing complications. NCT03021525. [ABSTRACT FROM AUTHOR]

Perturbations of consciousness arise from the interplay of brain network architecture, dynamics, and neuromodulation , providing the opportunity to interrogate the effects of these elements on behaviour and cognition. Fundamental building blocks of brain function can be identified through the lenses of space, time, and information. Each lens reveals similarities and differences across pathological and pharmacological perturbations of consciousness, in humans and across different species. Anaesthesia and brain injury can induce unconsciousness via different mechanisms, but exhibit shared neural signatures across space, time, and information. During loss of consciousness, the brain's ability to explore functional patterns beyond the dictates of anatomy may become constrained. The effects of psychedelics may involve decoupling of brain structure and function across spatial and temporal scales. Disentangling how cognitive functions emerge from the interplay of brain dynamics and network architecture is among the major challenges that neuroscientists face. Pharmacological and pathological perturbations of consciousness provide a lens to investigate these complex challenges. Here, we review how recent advances about consciousness and the brain's functional organisation have been driven by a common denominator: decomposing brain function into fundamental constituents of time, space, and information. Whereas unconsciousness increases structure–function coupling across scales, psychedelics may decouple brain function from structure. Convergent effects also emerge: anaesthetics, psychedelics, and disorders of consciousness can exhibit similar reconfigurations of the brain's unimodal–transmodal functional axis. Decomposition approaches reveal the potential to translate discoveries across species, with computational modelling providing a path towards mechanistic integration. [ABSTRACT FROM AUTHOR]

To compare respiratory system compliance (C RS), expressed per kilogram of bodyweight (C RS BW), calculated without end-inspiratory pause (EIP) and after three EIP times (0.2, 0.5 and 1 seconds) with that after 3 second EIP (considered the reference EIP for static C RS) and to determine the EIP times that provided C RS BW values in acceptable agreement with static C RS BW during controlled mechanical ventilation (CMV) in anaesthetized dogs. Prospective, randomized, nonblinded, crossover clinical study. A group of 24 client-owned dogs with healthy lungs undergoing surgery in lateral recumbency. During CMV in dogs undergoing general anaesthesia, five EIPs [0 (no EIP), 0.2, 0.5, 1 and 3 seconds] were consecutively applied in random order. Tidal volume (V t) was set at 10 mL kg–1 and positive end-expiratory pressure (PEEP) was not applied. Respiratory rate and inspiratory time were established according to each EIP time, setting EIP between 0 and 50% of the inspiratory time. The C RS BW was calculated as [expired V t /(plateau pressure – PEEP)]/bodyweight and recorded every 15 seconds for 2 minutes after a 5 minute equilibration period with each EIP. One-way anova for repeated measures and the Bland–Altman analysis were used to compare C RS BW and evaluate agreement between EIP times, respectively. The C RS BW was significantly greater as the EIP time increased up to 1 second (p < 0.05). In the Bland–Altman analysis, none of the tested EIPs (0, 0.2, 0.5 and 1 seconds) provided 95% confidence intervals for limits of agreement within the maximum allowed difference considered for acceptable agreement with 3 second EIP. and clinical relevance An EIP ≤ to 1 second does not provide a C RS BW value in acceptable agreement with static C RS BW in healthy dogs. Besides, the application of an EIP ≤ to 0.5 seconds underestimates the static C RS BW to an increasing extent as the EIP time decreases. [ABSTRACT FROM AUTHOR]

In an industry known for its workplace hazards, such as the management and manipulation of animals that could bite, kick or cause considerable damage simply because of their size, combined with long working hours, lifting of heavy loads and the general mental stress, it is perhaps surprising that the veterinary industry is not also known for its safety culture and structures. One would expect that where such hazards and risks have been identified, there would be many and varied levels of education on risk and hazard management, a comprehensive set of tools with which to mitigate these risks as well as discussion and debriefing of significant adverse events to ensure they do not occur again. One would also assume that there would be a strong sense of safety culture in the workplace and that personnel would expect each other to ensure that the health and safety of themselves and their colleagues was a number one priority. Yet, is this the case in the veterinary industry? A request was made by the Association of Veterinary Anaesthetists (AVA) to provide 'safety guidelines' for use in general practice, particularly pertaining to pregnancy. The AVA set up a task force to address these concerns and to determine if guidelines could be created. This article is offered as a starting point for considering safety in the veterinary industry in a broad sense, with the hope that in the future there may be development of such guidelines. It is hoped that this article also provides the stimulus for further research in this area. [ABSTRACT FROM AUTHOR]

The elements that render anaesthesia a captivating profession can also foster stress and fatigue. Professionals considering anaesthesia as a career choice should have a comprehensive understanding of the negative consequences of fatigue and its implications for clinical performance and of the available preventive measures. Available evidence suggests that factors unrelated to patient characteristics or condition can affect clinical outcomes where anaesthetists are involved. Workload, nighttime work, and fatigue are persistent issues in anaesthesia and are perceived as presenting greater perioperative risks to patients. Fatigue seems to negatively affect both physical and mental health of anaesthetists. Existing evidence justifies specific interventions by institutions, stakeholders, and scientific societies to address the effects of anaesthetist fatigue. This narrative review summarises current knowledge regarding the effects of fatigue on anaesthetist well-being and patient safety, and discusses potential preventive solutions. [ABSTRACT FROM AUTHOR]

A diagnosis of congenital heart disease increases perioperative risk for children having surgical procedures. Some will require anaesthesia at a specialist cardiac centre, while for others it is safe and appropriate to have their procedure in a local district general hospital. Children with complex congenital heart disease and poor physiological status carry the highest risk of cardiac arrest and mortality. Clinical features of cardiomyopathy, cyanosis, pulmonary hypertension, arrhythmia and cardiac failure are most likely to require specialist input and tertiary referral, whereas those with a preoperative stay of less than 10 days undergoing elective, minor surgery, who are older than 2 years of age and physiologically well may be safely anaesthetized in a district general hospital. In order to maximize safety, the anaesthetist must carry out a thorough preoperative assessment, have an understanding of the patient's individual physiology and be prepared for the potential effects of general anaesthesia. Systemic vascular resistance is reduced by most induction agents and volatile anaesthetics; pulmonary vascular resistance is affected by changes in ventilation and gas exchange. The anaesthetist should also be alert to particular potential complications, such as arrhythmias, hypoxia, bleeding and cardiac arrest. [ABSTRACT FROM AUTHOR]

The article thoroughly examines the dynamics of coronary circulation, shedding light on its functionality in healthy individuals and those with various health conditions. It delves into the effects of anaesthesia, the intricacies of cardiac surgical procedures, and the complexities surrounding coronary vessels, offering valuable insights into these critical aspects of cardiovascular health.

The article delves into perioperative management strategies for spina bifida patients, focusing on anesthesia, perioperative care, and spinal dysraphism. Topics include anesthesia, perioperative care, and spinal dysraphism management strategies such as surgical considerations, anesthetic concerns, and postoperative care.

This meta-analysis aimed to evaluate the impact of ketamine/esketamine on postoperative subjective quality of recovery (QoR). MEDLINE, Embase, Cochrane library, and Google Scholar were searched for randomised controlled trials (RCTs) that examined the impacts of perioperative ketamine/esketamine use and postoperative QoR. The primary outcome was subjective QoR (QoR-9, QoR-15, QoR-40) on postoperative day (POD) 1–3, whereas the secondary outcomes included pain severity, anxiety scores, depression scores, risk of adverse events (i.e. nausea, vomiting, dizziness, drowsiness), and length of stay. The analysis included 18 RCTs (1554 participants; ketamine: seven trials, esketamine: 11 trials), of which 15 were conducted in China. Ketamine/esketamine improved the QoR scores on PODs 1 and 2 compared with the control (standardised mean difference [SMD]: 0.63, P <0.0001 for POD 1; SMD: 0.56, P =0.04 for POD 2), without beneficial effect on POD 3. Subgroup analyses revealed significant differences in QoR scores on POD 1 by regimen (SMD: esketamine 1.14, ketamine 0.01) and country (SMD: China 0.82, other countries −0.21). The emotional domain of QoR was improved from PODs 1 to 3, whereas the other domains were only improved on POD 1. Lower postoperative anxiety (SMD: −0.48, P =0.003) and depression (SMD: −0.72, P =0.001) scores were also observed with ketamine/esketamine use. Furthermore, pain severity was reduced on PODs 1 and 2, with no difference in the risk of adverse events or length of stay. This meta-analysis demonstrated that ketamine/esketamine use in the perioperative period is associated with improved early subjective QoR, pain severity, and psychological symptoms without an increase in the likelihood of adverse events. PROSPERO (CRD42023477580). [ABSTRACT FROM AUTHOR]

Big data in paediatric anaesthesia allows the evaluation of morbidity and mortality of anaesthesia in a large population, but also the identification of rare critical events and of their causes. This is a major step to focus education and design clinical guidelines. Moreover, they can help trying to determine normative data in a population with a wide range of ages and body weights. The example of blood pressure under anaesthesia will be detailed. Big data studies should encourage every department of anaesthesia to collect its own data and to benchmark its performance by comparison with published data. The data collection processes are also an opportunity to build collaborative research networks and help researchers to complete multicentric studies. Up to recently, big data studies were only performed in well developed countries. Fortunately, big data collections have started in some low and middle income countries and truly international studies are ongoing. [ABSTRACT FROM AUTHOR]

The increased availability of large clinical datasets together with increasingly sophisticated computing power has facilitated development of numerous risk prediction models for various adverse perioperative outcomes, including acute kidney injury (AKI). The rationale for developing such models is straightforward. However, despite numerous purported benefits, the uptake of preoperative prediction models into clinical practice has been limited. Barriers to implementation of predictive models, including limitations in their discrimination and accuracy, as well as their ability to meaningfully impact clinical practice and patient outcomes, are increasingly recognised. Some of the purported benefits of predictive modelling, particularly when applied to postoperative AKI, might not fare well under detailed scrutiny. Future research should address existing limitations and seek to demonstrate both benefit to patients and value to healthcare systems from implementation of these models in clinical practice. [ABSTRACT FROM AUTHOR]

The use of peripheral regional anaesthesia continues to increase, yet the evidence supporting its use and impact on relevant outcomes often lacks scientific rigour, especially when considering the use of specific blocks for a particular surgical indication. In this narrative review, we consider the relevant literature in a 10-yr period from 2013. We performed a literature search (MEDLINE and EMBASE) for articles reporting randomised controlled trials and other comparative trials of peripheral regional anaesthetic blocks vs systemic analgesia in adult patients undergoing surgery. We evaluated measures of effective treatment and complications. A total of 128 studies met our inclusion criteria. There remains variability in the technical conduct of blocks and the outcomes used to evaluate them. There is a considerable body of evidence to support the use of interscalene blocks for shoulder surgery. Saphenous nerve (motor-sparing) blocks provide satisfactory analgesia after knee surgery and are preferred to femoral nerve blocks which are associated with falls when patients are mobilised early as part of enhanced recovery programmes. There are additional surgical indications where the efficacy of cervical plexus, intercostal nerve, and ilioinguinal/iliohypogastric nerve blocks have been demonstrated. In the past 10 yr, there has been a consolidation of the evidence indicating benefit of peripheral nerve blocks for specific indications. There remains great scope for rigorous, multicentre, randomised controlled trials of many peripheral nerve blocks. These would benefit from an agreed set of patient-centred outcomes. [ABSTRACT FROM AUTHOR]

The article focuses on providing a straightforward framework for anesthesiologists to follow when administering anesthesia to patients with autism spectrum disorder (ASD). Topics include practical strategies for preoperative assessment, intraoperative management, and postoperative care tailored to the unique needs of individuals with ASD.

Transplantation is a definitive treatment of choice in suitable patients with end-stage organ failure. Approximately 5000 heart transplants and 4000 lung transplants are performed globally every year. Survival after heart transplant is almost twice in comparison to lung transplant. Due to deficiency in donor pool, number of patients on waiting list are increasing every year. Recipient selection should be done carefully as it massively impacts the outcome. Anaesthesia management for heart and lung transplant is quite demanding. In this article, we will review the various challenges encountered by an anaesthetist during the pre-, intra-, and postoperative period. The postoperative complications and its management will also be discussed briefly. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the survival rate, postoperative complications, and walking ability in cemented hemiarthroplasty (HA) for displaced femoral neck fractures according to the anaesthesia method. We conducted a retrospective study of a multicentre group (the TRON group). Three hundred fifty-eight patients who underwent cemented HA between 2015 and 2019 were selected; 289 patients of ≥75 years of age with no missing data were included. Patient background factors were matched and patients were assigned to spinal anaesthesia (SA) and general anaesthesia (GA) groups. The primary outcome was death at any time during the follow-up period. Secondary outcomes included postoperative complications and walking ability assessed using the Parker mobility score (PMS). Overall survival was evaluated using the Kaplan–Meier method, and differences were compared using the log-rank test. The incidence of each complication and PMS were compared between the two groups using Fisher's exact test. Overall survival during follow-up was significantly higher in the SA group in comparison to the GA group (p = 0.037). In the SA and GA groups, the survival rate at 3 months postoperatively was 98.4% and 95.5%, respectively. The incidence of postoperative pneumonia was significantly higher in the GA (p = 0.012), and PMS at 3 months postoperatively was significantly higher in the SA group (p = 0.016). The survival rate of elderly patients who underwent cemented HA was better in the SA group. General anaesthesia in cemented HA may be associated with lower life expectancy, increased incidence of pneumonia, and decreased walking ability. [ABSTRACT FROM AUTHOR]

To investigate the effect of hypoxaemia, hypotension and hypercapnia, among others, on quality of recovery from general anaesthesia in horses. Retrospective, single-centre study. A sample of 1226 horses that underwent general anaesthesia between June 2017 and June 2021. Horses and ponies weighing > 200 kg, aged > 6 months, anaesthetized using a xylazine- or medetomidine-isoflurane balanced anaesthesia protocol and presenting a complete anaesthetic record were included. Data were extracted from the clinic record system and from the original anaesthesia records. Recoveries were divided into 'good' and 'bad' based on the available recovery scores. Influence of hypoxaemia [PaO 2 < 60 mmHg (7.99 kPa)], hypotension (mean arterial pressure < 70 mmHg for at least 15 minutes) and hypercapnia [PaCO 2 > 60 mmHg (7.99 kPa)], anaesthesia protocol, body weight, age, breed, sex, American Society of Anesthesiologists status, type of procedure, emergency or nonemergency, duration of anaesthesia, positioning, times spent in lateral and sternal recumbency during recovery, time until standing and nonassisted or assisted recovery on the assigned recovery score (good/bad) were investigated using generalized linear regression analysis (p < 0.05). Hypoxaemia and prolonged duration of anaesthesia were significantly associated with a bad recovery score. No other factors had a significant influence on recovery quality. Hypoxaemia and prolonged anaesthesia duration have a negative effect on quality of anaesthetic recovery in horses. Clinically, this highlights the importance of keeping anaesthetic time as short as possible and to monitor oxygenation and treat hypoxaemia as soon as possible. [ABSTRACT FROM AUTHOR]

Anaesthetists play a key role in the management of patients in the cardiac catheterization laboratory (cath lab), both for elective and emergency procedures. Safe and effective provision of anaesthesia relies on a thorough appreciation of the setup of the cath lab and an understanding of the ever-increasing range of procedures carried out in the angiography suite. This article provides an overview of general considerations for working in this challenging environment within the hospital, as well as outlining key cardiology subspecialties and their requisites for the anaesthetist: electrophysiology, structural, interventional, devices and mechanical circulatory support. [ABSTRACT FROM AUTHOR]

The article focuses on anesthesia considerations for pediatric neurosurgery, specifically addressing common neurosurgical procedures performed in children. Topics covered include anesthetic approaches and considerations tailored to the unique challenges posed by various neurosurgical interventions in the pediatric population.

Major tracheobronchial surgery has many anaesthetic challenges. These include airway management, one lung ventilation, maintaining optimal surgical exposure, and appropriate patient selection. Tracheobronchial surgery is typically performed in specialist centres, yet the strategies for dealing with central airway obstruction and bronchoscopy under general anaesthesia are of broader importance. An intra-thoracic airway obstruction presents difficulties different from those of an extra-thoracic airway obstruction as positive pressure ventilation can cause distal gas trapping and volutrauma. Sharing the airway with the surgical team requires good communication and teamwork, along with knowledge of techniques to manage emergency situations. Preoperative assessment of the patient with airway obstruction can provide a guide as to the challenges likely to be encountered. Thought must also be given to the possible palliative nature of the procedure. This article describes anaesthetic techniques for bronchoscopy with airway stenting, laser therapy, inhaled foreign body, and tracheal and carinal resection. [ABSTRACT FROM AUTHOR]

The article focuses on general considerations in anaesthesia for paediatric neurosurgery.Topics discussed include recent advances in neurosurgery, neuromonitoring, and neurointensive care, emphasizing the need for anaesthesiologists to possess knowledge in basic neurophysiology of the developing brain and the effects of drugs on cerebral hemodynamics for optimal care.

The article focuses on the significant impact of simulation training on patients' safety in anaesthesia and perioperative medicine, emphasizing its effectiveness in both technical and non-technical skills training. Topics discussed include the proven positive outcomes of interprofessional simulation, enabling multispecialty and multiprofessional education, leading to enhanced patient safety in the field.

The American Statistical Association has highlighted problems with null hypothesis significance testing and outlined alternative approaches that may 'supplement or even replace P -values'. One alternative is to report the false positive risk (FPR), which quantifies the chance the null hypothesis is true when the result is statistically significant. We reviewed single-centre, randomised trials in 10 anaesthesia journals over 6 yr where differences in a primary binary outcome were statistically significant. We calculated a Bayes factor by two methods (Gunel, Kass). From the Bayes factor we calculated the FPR for different prior beliefs for a real treatment effect. Prior beliefs were quantified by assigning pretest probabilities to the null and alternative hypotheses. For equal pretest probabilities of 0.5, the median (inter-quartile range [IQR]) FPR was 6% (1–22%) by the Gunel method and 6% (1–19%) by the Kass method. One in five trials had an FPR ≥20%. For trials reporting P -values 0.01–0.05, the median (IQR) FPR was 25% (16–30%) by the Gunel method and 20% (16–25%) by the Kass method. More than 90% of trials reporting P -values 0.01–0.05 required a pretest probability >0.5 to achieve an FPR of 5%. The median (IQR) difference in the FPR calculated by the two methods was 0% (0–2%). Our findings suggest that a substantial proportion of single-centre trials in anaesthesia reporting statistically significant differences provide limited evidence of real treatment effects, or, alternatively, required an implausibly high prior belief in a real treatment effect. PROSPERO (CRD42023350783). [ABSTRACT FROM AUTHOR]

The microcirculation describes the network of the smallest vessels in our cardiovascular system. On a microcirculatory level, oxygen delivery is determined by the flow of oxygen-carrying red blood cells in a given single capillary (capillary red blood cell flow) and the density of the capillary network in a given tissue volume (capillary vessel density). Handheld vital videomicroscopy enables visualisation of the capillary bed on the surface of organs and tissues but currently is only used for research. Measurements are generally possible on all organ surfaces but are most often performed in the sublingual area. In patients presenting for elective surgery, the sublingual microcirculation is usually intact and functional. Induction of general anaesthesia slightly decreases capillary red blood cell flow and increases capillary vessel density. During elective, even major, noncardiac surgery, the sublingual microcirculation is preserved and remains functional, presumably because elective noncardiac surgery is scheduled trauma and haemodynamic alterations are immediately treated by anaesthesiologists, usually restoring the macrocirculation before the microcirculation is substantially impaired. Additionally, surgery is regional trauma and thus likely causes regional, rather than systemic, impairment of the microcirculation. Whether or not the sublingual microcirculation is impaired after noncardiac surgery remains a subject of ongoing research. Similarly, it remains unclear if cardiac surgery, especially with cardiopulmonary bypass, impairs the sublingual microcirculation. The effects of therapeutic interventions specifically targeting the microcirculation remain to be elucidated and tested. Future research should focus on further improving microcirculation monitoring methods and investigating how regional microcirculation monitoring can inform clinical decision-making and treatment. [ABSTRACT FROM AUTHOR]

The article delves into the impact of the COVID-19 pandemic on the management of Upper Respiratory Tract Infections (URTI) in children, focusing on areas within anaesthesia, paediatrics, and perioperative care. It explores the complications associated with COVID-19, the adaptation of care protocols, and the considerations in managing URTI cases in the context of the pandemic's challenges.

The article delves into the connection between anesthesia and peripartum cardiomyopathy during pregnancy, examining the risks, implications, and potential associations between the two. It explores the impact of anesthesia on peripartum cardiomyopathy, the incidence rates, and underlying mechanisms, while referencing various studies and sources in the field to investigate this relationship further.

Obstructive sleep apnoea (OSA) and perioperative respiratory adverse events are significant risks for anaesthesia in children undergoing adenotonsillectomy. Upper airway collapse is a crucial feature of OSA that contributes to respiratory adverse events. A measure of upper airway collapsibility to identify undiagnosed OSA can help guide perioperative management. We investigated the utility of pharyngeal closing pressure (P CLOSE) for predicting OSA and respiratory adverse events. Children scheduled for elective adenotonsillectomy underwent in-laboratory polysomnography 2–12 weeks before surgery. P CLOSE measurements were obtained while the child was anaesthetised and breathing spontaneously just before surgery. Logistic regression was used to assess the predictive performance of P CLOSE for detecting OSA and perioperative respiratory adverse events after adjusting for potential covariates. In 52 children (age, mean [standard deviation] 5.7 [1.8] yr; 20 [38%] females), airway collapse during P CLOSE was observed in 42 (81%). Of these, 19 of 42 (45%) patients did not have OSA, 15 (36%) had mild OSA, and eight (19%) had moderate-to-severe OSA. All 10 children with no evidence of airway collapse during the P CLOSE measurements did not have OSA. P CLOSE predicted moderate-to-severe OSA (odds ratio [OR] 1.71; 95% confidence interval [CI]: 1.2–2.8; P =0.011). All children with moderate-to-severe OSA could be identified at a P CLOSE threshold of –4.0 cm H 2 O (100% sensitivity), and most with no or mild OSA were ruled out (64.7% specificity; receiver operating characteristic/area under the curve=0.857). However, there was no significant association between respiratory adverse events and P CLOSE (OR 1.0; 95% CI: 0.8–1.1; P =0.641). Measurement of P CLOSE after induction of anaesthesia can reliably identify moderate or severe OSA but not perioperative respiratory adverse events in children before adenotonsillectomy. ANZCTR ACTRN 12617001503314. [ABSTRACT FROM AUTHOR]

The past century, especially the past decade, has seen re-examination and evolution in our views about sex, gender, race, and ethnicity. The British Journal of Anaesthesia is part of an ongoing effort in research and medical publishing, and in health and education more generally, to improve diversity, inclusion, and equity. This editorial highlights the contributions and evolution of the Journal in these areas from its origin until today. [ABSTRACT FROM AUTHOR]

Flow-directed, balloon-tipped pulmonary artery catheters allow measuring cardiac output and other haemodynamic variables including intracardiac pressures. We propose classifying pulmonary artery catheters by generations and specifying additional measurement modalities. Based on the method used to measure cardiac output, pulmonary artery catheters can be classified into three generations: first-generation using intermittent pulmonary artery thermodilution; second-generation using a thermal filament for automated pulmonary artery thermodilution; and third-generation combining thermal filament-based automated pulmonary artery thermodilution and pulmonary artery pulse wave analysis. Each of these pulmonary artery catheter generations can include additional measurements, such as continuous mixed venous oxygen saturation, right ventricular ejection fraction and end-diastolic volume, and right ventricular pressure. This classification should help define indications for pulmonary artery catheters in clinical practice and research. [ABSTRACT FROM AUTHOR]

Clinical studies suggest that anaesthesia exposure early in life affects neurobehavioural development. We designed a non-human primate (NHP) study to evaluate cognitive, behavioural, and brain functional and structural alterations after isoflurane exposure during infancy. These NHPs displayed decreased close social behaviour and increased astrogliosis in specific brain regions, most notably in the amygdala. Here we hypothesise that resting-state functional connectivity MRI can detect alterations in connectivity of brain areas that relate to these social behaviours and astrogliosis. Imaging was performed in 2-yr-old NHPs under light anaesthesia, after early-in-life (postnatal days 6–12) exposure to 5 h of isoflurane either one or three times, or to room air. Brain images were segmented into 82 regions of interest; the amygdala and the posterior cingulate cortex were chosen for a seed-based resting-state functional connectivity MRI analysis. We found differences between groups in resting-state functional connectivity of the amygdala and the auditory cortices, medial premotor cortex, and posterior cingulate cortex. There were also alterations in resting-state functional connectivity between the posterior cingulate cortex and secondary auditory, polar prefrontal, and temporal cortices, and the anterior insula. Relationships were identified between resting-state functional connectivity alterations and the decrease in close social behaviour and increased astrogliosis. Early-in-life anaesthesia exposure in NHPs is associated with resting-state functional connectivity alterations of the amygdala and the posterior cingulate cortex with other brain regions, evident at the juvenile age of 2 yr. These changes in resting-state functional connectivity correlate with the decrease in close social behaviour and increased astrogliosis. Using resting-state functional connectivity MRI to study the neuronal underpinnings of early-in-life anaesthesia-induced behavioural alterations could facilitate development of a biomarker for anaesthesia-induced developmental neurotoxicity. [ABSTRACT FROM AUTHOR]

Plastic reconstructive surgeries involving flap reconstruction and microvascular anastomosis are technically demanding. Comorbidities such as diabetes, arterial insufficiency, anaemia and immunosuppression are common and increase the risk of ischaemia/reperfusion injury and vascular thrombosis. The anaesthetic goals are optimizing flap perfusion, improving flap survival and facilitating patients' recovery. Intraoperatively, haemodynamic stability is maintained with goal-directed fluid therapy and judicious use of vasopressors. To minimize vasoconstriction, measures to maintain normothermia, adequate analgesia, sympatholytic regional anaesthesia and anti-emetic prophylaxis are employed. Prophylaxis for systemic venous thromboembolism and anastomotic thrombosis can be achieved with low-molecular-weight or unfractionated heparin and/or aspirin. Protocol-driven postoperative care with flap perfusion monitoring can reduce complications and facilitate recovery. [ABSTRACT FROM AUTHOR]

The article focuses on the challenges and solutions related to safe obstetric anesthesia in low- and middle-income countries, specifically in Africa. Topics include the impact of anesthesia on maternal and neonatal outcomes after caesarean delivery, prevention and management of spinal hypotension, utilization of essential anesthesia techniques, documentation practices, and strategies for post-caesarean delivery analgesia in resource-limited settings.

To retrospectively evaluate the feasibility of a propofol infusion for anaesthetic maintenance in guinea pigs. Retrospective case series. Client-owned guinea pigs undergoing general anaesthesia. Anaesthetic records of guinea pigs anaesthetized between March 2015 and March 2018 were reviewed. Animals administered a propofol infusion for > 20 minutes were identified and evaluated. Procedure performed, pre-anaesthetic medication, preoperative and intraoperative respiratory rate (f R) and heart rates (HRs), total amount of propofol administered, total anaesthesia and recovery times were extracted from the records and analysed using descriptive statistics and Pearson correlation tests. Data are reported as mean (range). Records of 14 animals meeting the criteria were identified. Following drug combinations were administered for premedication: butorphanol 0.43 (0.3–0.5) mg kg–1, medetomidine 0.1 (0.05–0.2) mg kg–1 and midazolam 1 (0.5–2) mg kg–1 (n = 3); methadone 0.33 (0.25–0.5) mg kg–1, medetomidine 0.07 (0.01–0.1) mg kg–1 and midazolam 0.66 (0.5–1) mg kg–1 (n = 3); butorphanol 0.5 mg kg–1, medetomidine 0.05 mg kg–1 and ketamine 5 mg kg–1 (n = 2); buprenorphine 0.01 mg kg–1, medetomidine 0.07 (0.04–1) mg kg–1 and ketamine 4 (3–5) mg kg–1 (n = 3); butorphanol 0.5 mg kg–1, alfaxalone 1 mg kg–1 and midazolam 0.5 mg kg–1 (n = 1); and methadone 0.38 (0.25–0.5) mg kg–1, medetomidine 0.08 (0.06–1) mg kg–1 with midazolam 0.75 (0.5–1) mg kg–1 (n = 2). Preoperative and intraoperative HRs were 240 (160–300) and 170 (140–200) beats minute–1, respectively. Preoperative and intraoperative f R were 63 (50–86) and 37 (18–80) breaths minute–1, respectively. The propofol infusion rate was 0.45 (0.17–0.80) mg kg–1 minute–1. Total anaesthesia and recovery times were 60 (25–145) and 17 (8–60) minutes, respectively. A slight correlation was found between total propofol dose infused and recovery time (r = 0.58). Propofol infusions may be a useful alternative to inhalant anaesthetics. [ABSTRACT FROM AUTHOR]

To discover the prevalence of endotracheal tube (ETT) constriction and rostral and caudal mispositioning in anaesthetized cats and dogs, and to identify associated risk factors. Retrospective analysis. A total of 146 cats and 670 dogs. Computed tomography images of the head/neck/thorax from orotracheally intubated cats and dogs were visually assessed for constriction or mispositioning of the ETT. If constriction was present, measurements of the cross-sectional area (CSA) of the ETT lumen at constricted and un-constricted locations were compared. Location and cause of constriction were noted and the expected increase in resistance to gas flow was calculated. Animal information was collected from clinical records. Normality of continuous variables was assessed via the Shapiro–Wilk test. Chi-square tests examined associations between variables. Kendall's tau-b test was performed between measured ETT size and degree of constriction. The ETT extended rostrally beyond incisors in 52% of cases; the connector was within the oral cavity in 19% of cases. The ETT extended beyond the first rib in 25.5% of cases. The prevalence of ETT constriction was 22.7%. Median reduction in CSA was 7.68% (0.14–64.19%). Median increase in resistance assuming laminar and turbulent flow was 16.5% (0.3–680%) and 21% (0.3–1200%), respectively. The most common cause of constriction was the presence of a radiotherapy mouth gag. Significant associations existed between presence of constriction and rostral mispositioning, and caudal mispositioning and extreme brachycephaly. Increased severity of constriction was more likely in smaller ETT. Constriction and mispositioning of ETT occurred very commonly in this population. Checking the ETT within the oral cavity for constriction and mispositioning is recommended. Radiotherapy mouth gags increase the risk of ETT compression. Smaller ETT are at greater risk of severe constriction. Brachycephalic dogs are at particular risk of caudal mispositioning. [ABSTRACT FROM AUTHOR]