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Background: Previous studies have shown that dexamethasone has a positive effect on postoperative pain control, opioid consumption, nausea, and vomiting and length of hospital stay after arthroplasty surgery. Purpose/Hypothesis: The purpose of this study was to assess whether adding perioperative dexamethasone to our current pain regimen after hip arthroscopy is more effective than a placebo. It was hypothesized that dexamethasone would reduce postoperative pain, reduce opioid consumption, improve subjective pain and nausea scores, and reduce the number of vomiting events. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 50 patients requiring unilateral elective hip arthroscopy were randomized to receive intravenous dexamethasone immediately before induction of anesthesia and at 8 am on the first postoperative day (2 ×12 mg) or a placebo (sodium chloride 0.9%). The patient, the surgeons, the treating anesthesiologist, and the involved nursing and physical therapy personnel were blinded to group assignment. The primary outcome was postoperative pain, and secondary outcomes were opioid consumption and nausea scores—assessed using a translated revised version of the American Pain Society Patient Outcome Questionnaire 6 hours postoperatively and on days 1 and 2—and vomiting events. A clinical follow-up was performed 12 weeks postoperatively to assess adverse events. Results: The mean age at inclusion was 29 years in both groups. Postoperative pain levels did not differ significantly in most instances. Opioid requirements during the hospitalization in the dexamethasone group were significantly lower than those in the placebo group (31.96 ± 20.56 mg vs 51.43 ± 38 mg; P =.014). Significantly fewer vomiting events were noted in the dexamethasone group (0.15 ± 0.59 vs 0.65 ± 0.91; P =.034). Descriptive data and surgical parameters did not differ significantly. Conclusion: Perioperative intravenous dexamethasone significantly reduced postoperative opioid consumption by 40% without compromising pain level and safety, as no corticosteroid-related side effects were observed. Dexamethasone may be a valuable adjuvant to a multimodal systemic pain regimen after hip arthroscopy. Registration: NCT04610398 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

The article focuses on the utilization of clinical hypnosis in the practice of anesthesiology, offering a practical guide for anesthetists to incorporate hypnosis into their clinical approach effectively. Topics covered include the benefits of hypnosis in anesthesia, practical techniques for induction and deepening, and considerations for incorporating hypnosis into preoperative and postoperative care.

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.

Processed electroencephalographic indices such as the Patient State Index (PSi) have been proposed as a method of monitoring the depth of general anaesthesia. However, in order to establish the validity of PSi, it is necessary to compare its accuracy to other techniques, such as the isolated forearm technique (IFT). 30 ASA (American Society of Anaesthesiologists classification) I–III patients were administered standard propofol-sevoflurane anaesthesia with PSi monitoring. Before each dose of muscle relaxant, the forearm contralateral to the intravenous cannula was isolated for 30 minutes. PSi, hand movements, and exhaled sevoflurane concentrations were recorded during the induction of anaesthesia, intubation, throughout the surgical procedure, prior to extubation, and patients' responses to commands were classified as positive or negative. The Brice questionnaire was used to assess intraoperative awareness after the patient regained consciousness. All patients completed the study without memory of the surgery or IFT commands, 53.3% of patients showed a response to IFT commands during intubation. PSi values ranged around 26 (23.5; 30) in IFT non-responders and 33.5 (26; 42) in responders (p = 0.15). The best cut-off value for PSi to predict IFT response was 55, with a sensitivity of 60% and specificity of 85.2%, which led to the conclusion that PSi is not a fully reliable tool for monitoring the depth of anaesthesia. [ABSTRACT FROM AUTHOR]

Background: Surgical correction of tracheobronchomalacia (TBM) has evolved greatly over the past decade, with select pediatric institutions establishing dedicated surgery and anesthesia teams to navigate the complexities and challenges of surgical airway repairs. Although anesthetic techniques have evolved internally over many years to improve patient safety and outcomes, many of these methods remain undescribed in literature. Technique: In this article, we describe the intraoperative negative pressure suction test. This simulates the negative pressure seen in awake and spontaneously breathing patients, including the higher pressures seen during coughing which induce airway collapse in patients with TBM. Also known as the Munoz maneuver in surgical literature, this test has been performed on over 300 patients since 2015. Discussion: The negative pressure suction test allows for controlled intraoperative assessment of surgical airway repairs, replaces the need for risky intraoperative wake‐up tests, increases the chances of a successful surgical repair, and improves anesthetic management for emergence and extubation. We provide a guide on how to perform the test and videos demonstrating its efficacy in intraoperative airway evaluation. Conclusions: As surgeries to repair TBM become more prevalent in other pediatric institutions, we believe that pediatric patients and anesthesia providers will benefit from the insights and methods described here. [ABSTRACT FROM AUTHOR]

Aims: To compare anaesthesia‐related outcomes between patients monitored by newly recruited nurse anaesthetists and those monitored by newly recruited anaesthesiologists. Design: This was a retrospective study. Methods: We conducted a retrospective study that collected demographic information on newly recruited nurse anaesthetists and anaesthesiologists between 2017 and 2022 and recorded information on patients within 6 months of monitoring. Postoperative pain, emergency agitation, nausea, and vomiting were designated anaesthesia‐related outcomes. Propensity score matching was used to adjust for covariates. The study adhered to the STROBE guidelines. Results: The study's statistical analysis included 4483 patients monitored by 22 newly recruited nurse anaesthetists and 4959 patients monitored by 23 newly recruited anaesthesiologists. Compared with patients monitored by newly trained anaesthesiologists, the patients monitored by nurse anaesthetists were younger (42.07 ± 20.00 vs. 47.39 ± 18.45 years, p < 0.001) and had a lower body mass index (23.56 ± 4.46 vs. 24.19 ± 4.25, p < 0.001). Patients monitored by anaesthesiologists had a greater proportion of women (61.62% vs. 59.25%, p < 0.001), a high proportion of ASA III and ASA IV (17.1% vs. 8.88%, p < 0.001), and a longer mean surgery duration (78.65 ± 59.01 vs. 70.70 ± 60.65 min, p < 0.001). After propensity score matching was used to adjust for covariates, no statistically significant differences were found in the prevalence of postoperative pain, emergency agitation, or postoperative nausea and vomiting between the two groups (p < 0.05). Conclusion: Nurse anaesthetists monitoring alone during anaesthesia maintenance is feasible and safe. The two groups had no significant differences in the incidence of postoperative pain, emergency agitation, or postoperative nausea and vomiting. Relevance to Clinical Practice: The shortage of anaesthesiologists leads to heavy work burden and high incidence of occupational burnout among anaesthesiologists. The study found that it was safe for nurse anaesthetists to perform anaesthetic monitoring alone in the operating room under the supervision of the attending anaesthesiologist and did reduce the burden of anaesthesiologists' work. The results of the current study contribute to the expansion of occupational categories for nurse anaesthetists in countries where anaesthesiologists are in short supply. It provides new ideas for hospital administrators and policy‐makers to formulate medical and nursing service policies. [ABSTRACT FROM AUTHOR]

To explore the current status of anesthesia research activity in Japan, we analyzed the number of abstracts presented at the Japanese Society of Anesthesiologists (JSA) annual meetings by several factors including gender, society branches, and subspecialty categories. The number of abstracts at JSA annual meetings has declined sharply since 2016 with no gender gap. A decrease in the neurological field predated the overall decline, but other subspecialty categories showed a similar decline. Although the Tokyo, Tokai-Hokuriku, and Kyushu branches were responsible for more than half of the reduction, the trend was similar among all branches. In a survey regarding academic activities of university hospital residents and faculty, Ph.D. aspirants' rate was only 20–30%. Residents had never presented an abstract at scientific conferences and never published any papers at nearly 40% and 30% of the university hospitals, respectively. Our survey suggests that junior anesthetists are losing interest in research. Senior faculty and mentors must redouble efforts to embed and encourage research in departments and by anesthetists in training. If a revival of anesthesia research in Japan does not occur then a service only specialty awaits. [ABSTRACT FROM AUTHOR]

Obesity is associated with many significant physiological changes. These considerations are important to surgery, especially in urological procedures. Obese patients often undergo surgical procedures and are at higher risk of complications. This investigation reviews physiological and anaesthesia considerations for obese and morbidly obese patients. In addition, urological surgeries and procedures should be considered for these higher risk patients. Clinical anaesthesiologists must use detailed assessment and, when appropriate, consultation in developing safe anaesthesia plans for these patients. Newer technologies have improved safety related to airway management, advanced airway devices, and regional anaesthesia with ultrasound-guided nerve blocks, which can reduce the need for opioids postoperatively. Recent developments in drug and monitoring technologies have also been developed and can be effective for obese and morbidly obese patients undergoing urological procedures and perioperative surgery, thus improving the likelihood of safety in this higher risk population. [ABSTRACT FROM AUTHOR]

Pediatric difficult airway management is more challenging for an anesthesiologist due to anatomical and physiological differences as compared to adults. Moreover, the familiarity with the use of difficult airway equipment in adults does not equate to proficiency for the same in children. So, here we are presenting the management of a unique case of a difficult airway due to postburn neck contracture in a 4-year-old child, which was managed successfully with the help of a video laryngoscope after the failure attempt with a flexible fiberoptic bronchoscope. [ABSTRACT FROM AUTHOR]

Background: To investigate the knowledge, attitudes, and practice (KAP) toward postoperative cognitive dysfunction (POCD) among anesthesiologists in China. Methods: This cross-sectional study was conducted nationwide among Chinese anesthesiologists between December 2022 and January 2023. The demographic information and KAP scores of the respondents were collected using a web-based questionnaire. The mean KAP dimension scores ≥ 60% were considered good. Results: This study enrolled 1032 anesthesiologists (51.2% male). The mean total scores of knowledge, positive attitude, and positive practice were 9.3 ± 1.2 (max 12), 34.8 ± 3.3 (max 40), and 30.6 ± 6.7 (max 40), respectively. The knowledge items with correctness scores < 60% were "the anesthetic drugs that tend to cause POCD" (23.3%) and "Treatment of POCD" (40.3%). Multivariable analysis showed that ≥ 40 years old, master's degree or above, intermediate professional title (i.e., attending physician), senior professional title (i.e., chief physician), and working in tertiary hospitals were independently associated with adequate knowledge. Multivariable analysis showed that the attitude scores, middle professional title, and ≥ 16 years of experience were independently associated with good practice. Conclusions: These results suggest that Chinese anesthesiologists have good knowledge, favorable attitudes, and good practice toward POCD. Still, some points remain to be improved (e.g., the drugs causing POCD and managing POCD) and should be emphasized in training and continuing education. Trial registration: ChiCTR2200066749. [ABSTRACT FROM AUTHOR]

Patient Blood Management (PBM) as a multidisciplinary practice and a standard of care for the anemic surgical patient is playing an increasingly important role in reducing transfusions and optimizing both clinical outcomes and costs. The success of PBM implementation depends on staff awareness and involvement in this approach. The main objective of our study was to explore physicians' perceptions of the conditions for implementing PBM in hospitals and the main obstacles they face in detecting and treating anemic patients undergoing elective surgery. This cross-sectional descriptive study includes 113 Romanian health units, representing 23% of health units with surgical wards nationwide. A 12-item questionnaire was distributed to the participants in electronic format. A total of 413 questionnaires representing the perceptions of 347 surgeons and 66 anesthesia and intensive-care specialists were analyzed. Although a lack of human resources was indicated by 23.70% of respondents as the main reason for not adhering the guidelines, the receptiveness of medical staff to implementing the PBM standard was almost 90%. In order to increase adherence to the standard, additional involvement of anesthesia and intensive-care physicians would be necessary from the perception of 35.70% of the responders: 23.60% of surgeons and 18.40% of hematologists. [ABSTRACT FROM AUTHOR]

Craniotomies are intricate neurosurgical procedures susceptible to post‐operative complications, among which surgical site infections (SSIs) are particularly concerning. This study sought to elucidate the potential risk factors and pathogenetic characteristics associated with SSIs following craniotomy procedures in a clinical setting. A retrospective study was conducted from May 2020 to May 2023, examining patients subjected to elective or emergency craniotomies. The cohort underwent post‐operative surveillance for SSIs, facilitating patient classification into SSI and Non‐SSI groups based on infection occurrence. Data collection encapsulated demographic and clinical parameters, including American Society of Anesthesiologists (ASA) classifications, and operative factors. SSIs were diagnosed via an integrated approach combining clinical symptoms, microbiological culture findings and pertinent laboratory tests. A rigorous statistical methodology employing IBM's SPSS version 27.0 was utilised for data analysis. In a univariate analysis, significant risk factors for post‐craniotomy SSIs were identified, with patients aged over 60 displaying a pronounced susceptibility. Moreover, surgeries exceeding a duration of 4 h heightened infection risks. Elevated ASA grades denoted an increased prevalence of SSIs, as did emergency procedures and higher National Nosocomial Infections Surveillance scores. Multivariate analysis pinpointed epidural/subdural drainage as a protective measure against SSIs, whereas emergency surgeries, operative times beyond 4 h and subsequent surgeries within the hospital stay amplified infection risks. Notably, coagulase‐negative Staphylococcus dominated the identified pathogens at 28.09%, followed by Escherichia coli (17.98%), Klebsiella pneumoniae (10.11%) and Staphylococcus aureus (11.24%), underscoring the need for diverse prophylactic measures. SSIs following craniotomies present a multifaceted challenge influenced by a confluence of patient‐related, operative and post‐operative determinants. Understanding these risk factors is paramount in refining surgical protocols and post‐operative care strategies to mitigate SSI incidence. [ABSTRACT FROM AUTHOR]

In this study, drop form flow examinations, which form the basis of IV applications used for therapeutic purposes, were performed. Fluid Intravenous (IV) is the practice of administering fluids into a vein. In IV applications, flow must be monitored in order to follow and control the treatment process. For this purpose, the fluid can be converted into drop form with a simple mechanism and the flow rate and volume data can be calculated by the drop counting method. Examining drop form flow processes and analyzing microdrops correctly increases the accuracy in calculating flow data and, most importantly, increases the quality of treatment in IV applications. In the scope of this study, the formation processes of microdrops and the affecting parameters were analyzed. Along with microdrop analysis, error evaluation of the drop counting method and evaluation of measurement techniques were carried out to ensure a healthy and accurate measurement process. System tests and verification were carried out with optical systems, one of the measurement techniques. As a result, this study was carried out on the importance of monitoring systems and measurement parameters in IV applications. [ABSTRACT FROM AUTHOR]

Cardiac surgery-associated acute kidney injury (CS-AKI) is common and is associated with increased risk for postoperative morbidity and mortality. Our recent survey of the Society of Cardiovascular Anesthesiologists (SCA) membership showed 6 potentially renoprotective strategies for which clinicians would most value an evidence-based review (ie, intraoperative target blood pressure, choice of specific vasopressor agent, erythrocyte transfusion threshold, use of alpha-2 agonists, goal-directed oxygen delivery on cardiopulmonary bypass [CPB], and the "Kidney Disease Improving Global Outcomes [KDIGO] bundle of care"). Thus, the SCA's Continuing Practice Improvement Acute Kidney Injury Working Group aimed to provide a practice update for each of these strategies in cardiac surgical patients based on the evidence from randomized controlled trials (RCTs). PubMed, EMBASE, and Cochrane library databases were comprehensively searched for eligible studies from inception through February 2021, with search results updated in August 2021. A total of 15 RCTs investigating the effects of the above-mentioned strategies on CS-AKI were included for meta-analysis. For each strategy, the level of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Across the 6 potentially renoprotective strategies evaluated, current evidence for their use was rated as "moderate," "low," or "very low." Based on eligible RCTs, our analysis suggested using goal-directed oxygen delivery on CPB and the "KDIGO bundle of care" in high-risk patients to prevent CS-AKI (moderate level of GRADE evidence). Our results suggested considering the use of vasopressin in vasoplegic shock patients to reduce CS-AKI (low level of GRADE evidence). The decision to use a restrictive versus liberal strategy for perioperative red cell transfusion should not be based on concerns for renal protection (a moderate level of GRADE evidence). In addition, targeting a higher mean arterial pressure during CPB, perioperative use of dopamine, and use of dexmedetomidine did not reduce CS-AKI (a low or very low level of GRADE evidence). This review will help clinicians provide evidence-based care, targeting improved renal outcomes in adult patients undergoing cardiac surgery.

Jiechu Wang,1– 3,&ast; Yao Yu,1,&ast; Ya Gao,1– 3,&ast; Tingting Wan,1– 3 Zhukai Cong,1– 3 Zhengqian Li,1– 3 Yang Zhou,1– 3 Xiaoxiao Wang,4 Luyang Feng,1– 3 Yongzheng Han,1– 3 Jing Zhang,1– 3 Yinyin Qu,1– 3 Xiangyang Guo1– 3 1Department of Anesthesiology, Peking University Third Hospital, Beijing, 100191, People’s Republic of China; 2Beijing Center of Quality Control and Improvement on Clinical Anesthesia, Peking University Third Hospital, Beijing, 100191, People’s Republic of China; 3Anesthesia and Perioperative Medicine Branch of China International Exchange and Promotive Association for Medical and Health Care (CPAM), Beijing, 100191, People’s Republic of China; 4Research Center for Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiangyang Guo; Yinyin Qu, Department of Anesthesiology, Peking University Third Hospital, North Garden Road 49, Haidian District, Beijing, 100191, People’s Republic of China, Email puthmzk@hsc.pku.edu.cn; quyinyin@bjmu.edu.cnBackground: Malignant hyperthermia (MH) is a hypermetabolic syndrome with high mortality rates. Early detection and prompt intravenous administration of dantrolene are crucial for effective management of MH. However, there is currently a lack of comprehensive nationwide surveys on the availability of dantrolene and anesthesiologists’ understanding of MH in China.Methods: A nationwide survey was conducted between January 2022 and June 2022. Online questionnaires on the cognition of MH among anesthesiologists in China were sent through social platforms to anesthesiologists in mainland China. Data regarding participants’ perception of MH-related knowledge, availability of domestic dantrolene, and reported MH cases were collected in this study.Results: Responses were collected from a total of 11,354 anesthesiologists representing 31 provinces across the Chinese mainland. Among the 11 scoring questions, the highest accuracy rates were observed for the question regarding therapeutic drugs for MH (99.3%) and the characteristics of MH (98.0%). Conversely, the question pertaining to the earliest clinical signs of MH had the lowest accuracy rate (23.5%). Significant variations were observed in the scores among different professional titles (P=0.003), academic degree (P< 0.001), hospital classification (P< 0.001), and urban hierarchy (P< 0.001). Of the respondents, 919 (8.1%) anesthesiologists reported dantrolene availability in their hospitals, and 631 (5.6%) indicated unclear. A total of 136 hospitals in this survey reported at least one previous case of MH.Conclusion: Mainland China faces challenges such as insufficient experience in diagnosing and treating MH, as well as difficulty in obtaining dantrolene. To improve the public awareness of MH, it is imperative to establish and promote a refined MH training system. Additionally, a streamlined and rapid dantrolene linkage emergency system should be implemented to ensure prompt access to the drug.Keywords: malignant hyperthermia, dantrolene, China, anesthesiologists, survey

Aims: This study aimed to determine whether lateral femoral wall thickness (LWT) < 20.5 mm was associated with increased revision risk of intertrochanteric fracture (ITF) of the hip following sliding hip screw (SHS) fixation when the medial calcar was intact. Additionally, the study assessed the association between LWT and patient mortality. Methods: This retrospective study included ITF patients aged 50 years and over treated with SHS fixation between 2019 and 2021 at a major trauma centre. Demographic information, fracture type, delirium status, American Society of Anesthesiologists grade, and length of stay were collected. LWT and tip apex distance were measured. Revision surgery and mortality were recorded at a mean follow-up of 19.5 months (1.6 to 48). Cox regression was performed to evaluate independent risk factors associated with revision surgery and mortality. Results: The cohort consisted of 890 patients with a mean age of 82 years (SD 10.2). Mean LWT was 27.0 mm (SD 8.6), and there were 213 patients (23.9%) with LWT < 20.5 mm. Overall, 20 patients (2.2%) underwent a revision surgery following SHS fixation. Adjusting for covariates, LWT < 20.5 mm was not independently associated with an increased revision or mortality risk. However, factors that were significantly more prevalent in LWT < 20.5 mm group, which included residence in care home (hazard ratio (HR) 1.84; p < 0.001) or hospital (HR 1.65; p = 0.005), and delirium (HR 1.32; p = 0.026), were independently associated with an increased mortality risk. The only independent factor associated with increased risk of revision was older age (HR 1.07; p = 0.030). Conclusion: LWT was not associated with risk of revision surgery in patients with an ITF fixed with a SHS when the calcar was intact, after adjusting for the independent effect of age. Although LWT < 20.5 mm was not an independent risk factor for mortality, patients with LWT < 20.5 mm were more likely to be from care home or hospital and have delirium on admission, which were associated with a higher mortality rate. Cite this article: Bone Jt Open 2024;5(2):123–131.

Abstract Background Anesthesiologists are vulnerable to work-related musculoskeletal disorders (WMSDs) due to sustained repetitive movements and awkward postures. This study aimed to assess the prevalence of WMSDs among anesthesiologists and to evaluate its association with ergonomic risk factors. Methods A convenience sample of 380 Egyptian anesthesiologists were invited to participate in this cross-sectional study through an electronic questionnaire. Data were collected from May to August 2022 and involved questions about participants’ demographic, health, and work-related characteristics; the ergonomic risks and perceived hazards; and the musculoskeletal complaints during the past 12 months and 7 days - using Nordic Musculoskeletal Questionnaire (NMQ). Descriptive, bivariate, and multivariate statistical analyses were used to estimate the prevalence of MSD and identify its determinants in the studied sample. Results A total of 215 anesthesiologists were included in this study, with a 56.8% response rate, 66% males with an average age of 38 (± 0.7) years. 21% were resident physicians, 47% were specialists, and 32% were consultants. The 12-month prevalence of MSD among anesthesiologists was 71.6% (95% CI: 65.6– 77.7%). Multivariate analysis showed that the main determinants of MSD among the studied sample were age of 45-years and older (OR: 3.22, 95% CI: 1.21–8.52, p = 0.018), regular physical exercise (OR: 0.25, 95% CI: 0.10–0.65, p = 0.005), insufficient rest time between procedures (OR: 2.25, 95% CI: 1.15–4.41, p = 0.018), and three or more awkward postures of the trunk (OR: 3.55, 95% CI: 1.43–8.82, p = 0.006). Conclusions The study highlights a high prevalence of WMSDs among Egyptian anesthesiologists, linked to advancing age, lack of regular exercise, insufficient rest between procedures, and frequent awkward postures. Addressing these ergonomic risk factors through targeted workplace interventions is crucial for promoting the overall well-being of anesthesiologists and ensuring the provision of safe anesthesia services.

This review discusses the challenges of implementing enhanced recovery after surgery (ERAS) programs in South Korea. ERAS is a patient-centered perioperative care approach that aims to improve postoperative recovery by minimizing surgical stress and complications. While ERAS has demonstrated significant benefits, its successful implementation faces various barriers such as a lack of manpower and policy support, poor communication and collaboration among perioperative members, resistance to shifting away from outdated practices, and patient-specific risk factors. This review emphasizes the importance of understanding these factors to tailor effective strategies for successful ERAS implementation in South Korea’s unique healthcare setting. In this review, we aim to shed light on the current status of ERAS in South Korea and identify key barriers. We hope to encourage Korean anesthesiologists to take a leading role in adopting the ERAS program as the standard for perioperative care. Ultimately, our goal is to improve the surgical outcomes of patients using this proactive approach.

Aims: Proper preoperative planning benefits fracture reduction, fixation, and stability in tibial plateau fracture surgery. We developed and clinically implemented a novel workflow for 3D surgical planning including patient-specific drilling guides in tibial plateau fracture surgery. Methods: A prospective feasibility study was performed in which consecutive tibial plateau fracture patients were treated with 3D surgical planning, including patient-specific drilling guides applied to standard off-the-shelf plates. A postoperative CT scan was obtained to assess whether the screw directions, screw lengths, and plate position were performed according the preoperative planning. Quality of the fracture reduction was assessed by measuring residual intra-articular incongruence (maximum gap and step-off) and compared to a historical matched control group. Results: A total of 15 patients were treated with 3D surgical planning in which 83 screws were placed by using drilling guides. The median deviation of the achieved screw trajectory from the planned trajectory was 3.4° (interquartile range (IQR) 2.5 to 5.4) and the difference in entry points (i.e. plate position) was 3.0 mm (IQR 2.0 to 5.5) compared to the 3D preoperative planning. The length of 72 screws (86.7%) were according to the planning. Compared to the historical cohort, 3D-guided surgery showed an improved surgical reduction in terms of median gap (3.1 vs 4.7 mm; p = 0.126) and step-off (2.9 vs 4.0 mm; p = 0.026). Conclusion: The use of 3D surgical planning including drilling guides was feasible, and facilitated accurate screw directions, screw lengths, and plate positioning. Moreover, the personalized approach improved fracture reduction as compared to a historical cohort. Cite this article: Bone Jt Open 2024;5(1):46–52.

Israel is a young country with a rather young system of medical education. This educational review serves to illuminate the similarities and differences in the training of a pediatric Anesthesiologist in both Israel and Palestine. [ABSTRACT FROM AUTHOR]

The article discusses the need for global quality improvement programs in the field of pediatric anesthesia. It highlights the efforts of Wake Up Safe (WUS), a US-based program, in improving patient safety in high-income countries (HICs) and large urban centers in middle-income countries (MICs). However, the article suggests that WUS should expand its focus to include low-income countries (LICs) and poor parts of MICs, as anesthesia-related mortality rates in these countries are significantly higher. The article emphasizes the importance of tailoring quality improvement programs to fit local problems, organizational frameworks, and resources. It also suggests specific targets for collaboration with LICs, such as strengthening academic anesthesiology and supporting pediatric anesthesia fellowship trained physicians in Sub-Saharan Africa. The article concludes by highlighting the potential impact of QI collaborations on improving patient safety in LICs and the need for a customized approach to address the unique challenges faced by these countries. [Extracted from the article]

This document discusses the benefits and drawbacks of videolaryngoscopy as a technique for tracheal intubation. Videolaryngoscopy has been shown to improve success rates on the first attempt, provide a better view of the glottis, and reduce complications such as esophageal intubation and hypoxemia. However, there are also drawbacks to consider, such as a learning curve for novice operators, longer setup times, higher costs, and limited availability in some healthcare settings. The COVID-19 pandemic has accelerated the adoption of videolaryngoscopy due to its safety features. Guidelines recommend its routine use, but there are barriers to widespread adoption, including limited availability, lack of knowledge and training, and resistance to change. A multifaceted approach is needed to overcome these barriers and ensure the safe and effective use of videolaryngoscopy. [Extracted from the article]

Palatoglossal bands are one of the very rare congenital anomaly with very few documented cases worldwide. They can present with feeding difficulties or respiratory distress which requires immediate surgical intervention. The management of such patient is a challenge to any anaesthesiologist because of inability to perform conventional laryngoscopy, associated cardiac or digital anomalies and non-availability of pediatric flexible fibreoptic bronchoscope. We will discuss here the management of an infant who presented at one year of age with cough, recurrent upper respiratory tract infections, poor weight gain and feeding difficulties. [ABSTRACT FROM AUTHOR]

Anesthesiologists have a significant responsibility to provide care at all hours of the day, including nights, weekends, and holidays. This call burden carries a significant lifestyle constraint that can impact relationships, affect provider wellbeing, and has been associated with provider burnout. This quality improvement study analyzes the effects of a dynamic call marketplace, which allows anesthesiologists to specify how much call they would like to take across a spectrum of hypothetical compensation levels, from very low to very high. The system then determines the market equilibrium price such that every anesthesiologist gets exactly the amount of desired call. A retrospective analysis compared percentage participation in adjusting call burden both pre- and post-implementation of a dynamic marketplace during the years of 2017 to 2023. Additionally, a 2023 post-implementation survey was sent out assessing various aspects of anesthesiologist perception of the new system including work-life balance and job satisfaction. The dynamic call marketplace in this study enabled a more effective platform for adjusting call levels, as there was a statistically significant increase in the percentage of anesthesiologists participating in call exchanged during post- compared to pre-implementation (p < 0.0001). The satisfaction survey suggested agreement among anesthesiologists that the dynamic call marketplace positively affected professional satisfaction and work-life balance. Further, the level of agreement with these statements was most prevalent among middle career stage anesthesiologists (11–20 years as attending physician). The present system may target elements with the capacity to increase satisfaction, particularly among physicians most at risk of burnout within the anesthesia workforce. [ABSTRACT FROM AUTHOR]

Temporary pacing wires are often used following cardiac surgery to optimise the heart rhythm. Although setting and checking temporary pacemakers is typically undertaken by anaesthetists, intensivists, and nursing staff who care for post-cardiac surgical patients, almost all patients with temporary pacing wires are transferred to the ward with the pacing wires left in situ, where surgical, often junior, staff become responsible for temporary pacing wire management. Thus, knowledge is required not only of temporary pacing wire indications, types, and positioning at surgery, but also of practical skills in performing a pacing check, setting the pacemaker, and troubleshooting common problems. The available literature targets clinicians well-versed in temporary pacing wire management. However, this paper provides a practical 'how to' for surgical staff managing temporary pacing wires in a non-critical care environment. [ABSTRACT FROM AUTHOR]

(1) Background: Patients' comorbidities play an immanent role in perioperative risk assessment. It is unknown how Charlson Comorbidity Indices (CCIs) from different sources compare. (2) Methods: In this prospective observational study, we compared the CCIs of patients derived from patients' self-reports and from physicians' assessments with hospital administrative data. (3) Results: The data of 1007 patients was analyzed. Agreement between the CCI from patients' self-report compared to administrative data was fair (kappa 0.24 [95%CI 0.2–0.28]). Agreement between physicians' assessment and the administrative data was also fair (kappa 0.28 [95%CI 0.25–0.31]). Physicians' assessment and patients' self-report had the best agreement (kappa 0.33 [95%CI 0.30–0.37]). The CCI calculated from the administrative data showed the best predictability for in-hospital mortality (AUROC 0.86 [95%CI 0.68–0.91]), followed by equally good prediction from physicians' assessment (AUROC 0.80 [95%CI 0.65–0.94]) and patients' self-report (AUROC 0.80 [95%CI 0.75–0.97]). (4) Conclusions: CCIs derived from patients' self-report, physicians' assessments, and administrative data perform equally well in predicting postoperative in-hospital mortality. [ABSTRACT FROM AUTHOR]

Background: Comprehensive anesthesia preparation by means of the anamnesis and physical examination is considered an essential part of the quality criteria for anesthesia. Especially due to the shortage of specialists, there are usually long waiting times in anesthesia outpatient departments and patients must frequently return in cases of missing or pending findings. Telemedicine already offers alternatives in the context of video communication. These alternatives are now particularly prominent due to the currently existing COVID-19 pandemic and the resulting recommendations for digitalization. Objectives: This comparative cross-sectional study was carried out to show via a patient survey which patient groups are suitable for a telemedical anesthesia preparation and whether the patients are already technically sufficiently equipped. Material and methods: For this purpose, a total of 2080 patients (1030 before and 1050 during the pandemic) were interviewed using a questionnaire. For matched paired analyses, 630 pairs were formed according to their age and gender. Results: Before and after the pandemic, there was an increase in the percentage of patients already using video communication in their daily lives (30.4% vs. 41.8%). Before the pandemic, 31.7% of patients indicated that they considered this concept of communication to be a practical and appropriate method for an educational conversation and after the pandemic this number increased to 46.6%. For the majority of patients personal contact with a local anesthesiologist was important (80.7% before vs. 67.4% during the pandemic). The number of patients who had the necessary technical equipment for video communication also increased as a result of the COVID-19 pandemic (50.4% vs. 58.2%). Discussion: Almost half of the patients already seem to be open to a telemedical preoperative evaluation. As digitalization progresses, older generations are more likely to recognize the benefits and be able to own and use the necessary technology in the near future. User acceptance should be the central goal of concept development. This must be followed by a randomized controlled study to evaluate the potentials but also the problems in the perioperative process. [ABSTRACT FROM AUTHOR]

Introduction: Stimulant use during pregnancy is a growing concern, particularly in the USA and Europe. This article explores anesthesia challenges in pregnant patients with substance abuse, optimizing analgesic treatment, and addressing newborns of addicted mothers. Understanding substance use differences is crucial for managing complications and providing long-term care. Aim: Investigate anesthesia management, analgesic optimization, and care for newborns of drug-addicted pregnant patients. Material and methods: A comprehensive literature review included articles from PubMed (from January 2009 to December 2021) and relevant Polish, English, and German literature. Results and discussion: Opioid use by pregnant women, especially in North America, raises concerns for maternal and child health. The incidence of newborns with withdrawal syndrome is rapidly increasing. Anesthesia challenges arise in managing pregnant patients with addiction, including analgesia optimization and reducing neonatal abstinence syndrome risk. Individualized approaches like regional anesthesia minimize systemic opioids and neonatal withdrawal symptoms. Medication-assisted therapy, e.g., buprenorphine and me- thadone, reduces illicit opioid use and improves outcomes for mother and baby. Collaborative care among providers is essential. Conclusions: Managing drug-addicted pregnant women requires a multidisciplinary approach. Anesthesia providers play a crucial role in ensuring safety and pain control. [ABSTRACT FROM AUTHOR]

Background: There have been few reports showing the relationship between blood pressure (BP) measured at clinics preoperatively and BP measured before anesthetic intubation/induction. The purpose of this study was to examine the relationship between BP measured at different times and settings preoperatively and BP measured before intubation/induction. Methods: A total of 182 patients who underwent general anesthesia between March 2021 and April 2022 in a university hospital were examined. In addition to self-reported BP asked on an anesthetic examination sheet completed by each patient, BPs were measured three times, before, during, and after preoperative examination by the anesthesiologist. The derived parameter was compared with BP measured before intubation at the time of general anesthesia induction. Results: The systolic BP in the intra-examination period had the most significant correlation with pre-intubation systolic BP (r = 0.5230, p < 0.0001, 95% CI = 0.4050 to 0.6238). On Bland–Altman analysis, the intra-examination systolic BP seemed to be similar and showed better agreement with pre-intubation systolic BP than other measured BPs, with a mean bias of 2.2 mmHg and the narrowest 95% limits of agreement (-33.7 to + 38.1 mmHg). Conclusions: The preoperative systolic BP value measured during the examination by the anesthesiologist was found to be closely related to pre-intubation systolic BP measured in the operating room. Higher BP during the preoperative examination may be a result of anxiety-induced stress or white-coat hypertension. Measuring BP during the anesthesiologist's examination may be useful for predicting hypertension in the pre-intubation period. [ABSTRACT FROM AUTHOR]

A shift in practice by anaesthetists away from anaesthetic gases with high global warming potential towards lower emission techniques (e.g. total intravenous anaesthesia) could result in significant carbon savings for the health system. The purpose of this qualitative interview study was to understand anaesthetists' perspectives on the carbon footprint of anaesthesia, and views on shifting practice towards more environmentally sustainable options. Anaesthetists were recruited from four hospitals in Western Sydney, Australia. Data were organised according to the capability–opportunity–motivation model of behaviour change. Twenty-eight anaesthetists were interviewed (July−September 2021). Participants' age ranged from 29 to 62 years (mean 43 years), 39% were female, and half had completed their anaesthesia training between 2010 and 2019. Challenges to the wider use of greener anaesthetic agents were identified across all components of the capability–opportunity–motivation model: capability (gaps in clinician skills and experience, uncertainty regarding research evidence); opportunity (norms, time, and resource pressures); and motivation (beliefs, habits, responsibility and guilt). Suggestions for encouraging a shift to more environmentally friendly anaesthesia included access to education and training, implementing guidelines and audit/feedback models, environmental restructuring, improving resource availability, reducing low value care, and building the research evidence base on the safety of alternative agents and their impacts on patient outcomes. We identified opportunities and challenges to reducing the carbon footprint of anaesthesia in Australian hospitals by way of system-level and individual behavioural change. Our findings will be used to inform the development of communication and behavioural interventions aiming to mitigate carbon emissions of healthcare. [ABSTRACT FROM AUTHOR]

BACKGROUND: The junction between medial one third and lateral two third of the supraorbital margin presents with supraorbital notch, which may be sometimes bridged into foramen. The precise location and morphological variations of the supraorbital notch are important while performing surgeries and for treating intractable cases of migraine. AIM OF THE STUDY: The present study aimed in studying these possible variations and to calculate mean distance of the supraorbital notch from the midline. METHODS: The study has been conducted in the Department of Anatomy, of Government Medical College, Kadapa, Andhra Pradesh. RESULTS: 45% skulls showed bilateral supraorbital notch while, 39% skulls showed bilateral supraorbital foramen, 16% skulls showed the presence of unilateral supraorbital notch, where the other side notch is bridged into foramen. The average distance of the supraorbital notch from nasal midline was 24mm on right side and 25mm on left side. CONCLUSION: The knowledge of these morphological variations of the supraorbital notch are important for physicians, surgeons, cosmetic and maxillofacial dentists and anesthetists. [ABSTRACT FROM AUTHOR]

Temporomandibular joint (TMJ) ankylosis is defined as bony or fibrous adhesion of the anatomic joint components accompanied by a limitation in opening the mouth. Airway management is a grueling task and has confronted anesthesiologists ever since. The challenge is even more exaggerated when it is a pediatric patient. We present a case series of five pediatric patients with TMJ ankylosis with age 7 years or less, who were posted for its corrective surgery. Although all patients belonged to the pediatric age group, the challenges faced and techniques employed to overcome them were different partly because of different age groups and partly the nature of the airway, with tailoring of each technique accordingly. Pediatric airway management is no less than waging a war as all necessary skills and expertise are put to the test. It combines fortuity with skills. We have to be prepared for the worst in any unforeseen scenario. [ABSTRACT FROM AUTHOR]

Background: The differences between tracheostomy and total laryngectomy are frequently misunderstood by healthcare professionals. Insufficient knowledge can potentially result in life‐threatening consequences in the event of an emergent airway situation. Methods: A seven‐question assessment of providers' anatomical knowledge and airway management was completed prior to and following a standardized one‐hour didactic lecture. Results: Forty‐six participants completed the pre‐ and post‐assessment. There were 20 (43.5%) ENT ICU/IMC Staff (EBU), 20 (43.5%) Florida Surgical Center Staff (FSC), and 6 (13%) Anesthesia providers (Anes). Pre‐lecture score average was 44.7% across all providers, significantly improving to 83.8% post‐lecture (p < 0.001). Nursing staff from the Otolaryngology ICU, and OR staff, had significant improvement in knowledge base (p < 0.001). Anesthesia providers showed improvement, but the difference was not statistically significant (p = 0.052). Conclusions: Didactic lectures are a simple and low‐cost option with significant potential in improving provider knowledge on these critical topics and improve patient care by non‐otolaryngology providers. [ABSTRACT FROM AUTHOR]

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Patients with severe calcific native aortic valve stenosis (AS) who require valve replacement have two options, surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). TAVR was approved in late 2011 for extremely high-risk patients and was subsequently approved for high-risk (2012), intermediate-risk (2016), and low-risk (2019) patients. In 2019, TAVR procedures surpassed SAVR procedures for the first time in the United States. The approach to anesthesia for this procedure has also evolved. Initially, general anesthesia (GA) was preferred, but currently, conscious sedation (CS) is favored. This review aims to clarify the indications and contraindications for both approaches, as well as the advantages of one approach over the other. Recent studies show that conscious sedation has better outcomes in terms of all-cause mortality, procedure complications such as stroke, myocardial infarction, infection requiring antibiotics, acute kidney injury, and the need for inotropes or vasopressors. [ABSTRACT FROM AUTHOR]

Background: In spite of the global implementation of surgical safety checklists to improve patient safety, patients undergoing surgical procedures remain vulnerable to a high risk of potentially preventable complications and adverse outcomes. The present study was designed to explore the surgical teams' perceptions of patient safety culture, capture their perceptions of the risk for adverse events, and identify themes of interest for quality improvement within the surgical department. Methods: This qualitative study had an explorative design with an abductive approach. Individual semi-structured in-depth interviews were conducted between 10/01/23 and 11/05/23. The participants were members of surgical teams (n = 17), general and orthopedic surgeons (n = 5), anesthesiologists (n = 4), nurse anesthetists (n = 4) and operating room nurses (n = 4). Middle managers recruited purposively from general and orthopedic surgical teams in two tertiary hospitals in Norway, aiming for a maximum variation due to gender, age, and years within the specialty. The data material was analyzed following Braun and Clarke's method for reflexive thematic analysis to generate patterns of meaning and develop themes and subthemes. Results: The analysis process resulted in three themes describing the participants' perceptions of patient safety culture in the surgical context: (1) individual accountability as a safety net, (2) psychological safety as a catalyst for well-being and safe performance in the operating room, and (3) the importance of proactive structures and participation in organizational learning. Conclusions: This study provided an empirical insight into the culture of patient safety in the surgical context. The study highlighted the importance of supporting the individuals' competence, building psychological safety in the surgical team, and creating structures and culture promoting a learning organization. Quality improvement projects, including interventions based on these results, may increase patient safety culture and reduce the frequency of adverse events in the surgical context. [ABSTRACT FROM AUTHOR]

Background: Airway management is a crucial skill for many clinicians. Besides mastering the technical skills of establishing a patent airway, human factors including leadership and team collaboration are essential. Teaching these human factors is often challenging for instructors who lack dedicated training. Therefore, the European Airway Management Society (EAMS) developed the Teach-the-Airway-Teacher (TAT) course. Methods: This online post-course survey of TAT-course participants 2013–2021 investigated the impact of the TAT-course and the status of airway management teaching in Europe. Twenty-eight questions e-mailed to participants (using SurveyMonkey) assessed the courses' strengths and possible improvements. It covered participants' and workplace details; after TAT-course considerations; and specifics of local airway teaching. Data were assessed using Excel and R. Results: Fifty-six percent (119/213) of TAT-participants answered the survey. Most were anaesthetists (84%), working in university level hospitals (76%). Seventy-five percent changed their airway teaching in some way, but 20% changed it entirely. The major identified limitation to airway teaching in their departments was "lack of dedicated resources" (63%), and the most important educational topic was "Teaching non-technical skills" (70%). "Lecturing " was considered less important (37%). Most surveyed anaesthesia departments lack a standardized airway teaching rotation. Twenty-one percent of TAT-participants rated their departmental level of airway teaching overall as inadequate. Conclusions: This survey shows that the TAT-course purpose was successfully fulfilled, as most TAT-course participants changed their airway teaching approach and did obtain the EAMS-certificate. The feedback provided will guide future TAT-course improvements to advance and promote a comprehensive approach to teaching airway management. [ABSTRACT FROM AUTHOR]

The article discusses the impact and controversies surrounding the 2014 Guidelines for the management of labor issued by American College of Obstetricians and Gynecologists, highlighting unresolved issues regarding dysfunctional labor and rising cesarean section rates. Despite calls for revision, the new Guidelines fail to address concerns, offering unbalanced assessments and contradictory recommendations, raising questions about their evidence-based nature.

Background: Workplace gender-based mistreatment (GBM) refers to negative or harmful behaviors directed towards employees. In healthcare settings, this can lead to job dissatisfaction and underperformance and potentially compromise patient outcomes. The aim of this study was to examine workplace GBM among European anesthesiologists and produce the first European GBM Rank in Anesthesiology. Methods: We conducted a secondary analysis from a worldwide cross-sectional survey database consisting of a 46-item questionnaire exploring, among other outcomes, gender bias attributable to workplace attitudes. The survey completion rate was 80.8%. All respondents were selected from European countries. Associations between mistreatment and the remaining variables were analyzed using univariate and multivariable logistic regression analyses. A generalized linear mixed model was then used to quantify the impact of mistreatment in each European country. Statistical significance was set at P < 0.05. Results: This study included 5,795 respondents from 43 European countries. The independent predictors of GBM were as follows: female gender, younger age, perceiving gender as a disadvantage for leadership, and perceiving gender as a disadvantage for research. The full model was statistically significant, indicating an ability to distinguish between those who experienced GBM and those who did not (P < 0.001). Thus, 26 European countries were ranked based on the prevalence of mistreatment, with Italy showing the best performance (lowest prevalence). Conclusions: The aim of our study was to provide preliminary insight into GBM in anesthesiology in Europe, function as a key benchmark for gender equity, and chart the evolution of disparities over time. [ABSTRACT FROM AUTHOR]

Summary: Current guidance recommends that, in most circumstances, cardiopulmonary resuscitation should be attempted when cardiac arrest occurs during anaesthesia, and when a patient has a pre‐existing 'do not attempt cardiopulmonary resuscitation' recommendation, this should be suspended. How this guidance is translated into everyday clinical practice in the UK is currently unknown. Here, as part of the 7th National Audit Project of the Royal College of Anaesthetists, we have: assessed the rates of pre‐operative 'do not attempt cardiopulmonary resuscitation' recommendations via an activity survey of all cases undertaken by anaesthetists over four days in each participating site; and analysed our one‐year case registry of peri‐operative cardiac arrests to understand the rates of cardiac arrest in patients who had 'do not attempt cardiopulmonary resuscitation' decisions pre‐operatively. In the activity survey, among 20,717 adults (aged > 18 y) undergoing surgery, 595 (3%) had a 'do not attempt cardiopulmonary resuscitation' recommendation pre‐operatively, of which less than a third (175, 29%) were suspended. Of the 881 peri‐operative cardiac arrest reports, 54 (6%) patients had a 'do not attempt cardiopulmonary resuscitation' recommendation made pre‐operatively and of these 38 (70%) had a clinical frailty scale score ≥ 5. Just under half (25, 46%) of these 'do not attempt cardiopulmonary resuscitation' recommendations were formally suspended at the time of anaesthesia and surgery. One in five of these patients with a 'do not attempt cardiopulmonary resuscitation' recommendation who had a cardiac arrest survived to leave hospital and of the seven patients with documented modified Rankin Scale scores before and after cardiac arrest, four remained the same and three had worse scores. Very few patients who had a pre‐existing 'do not attempt cardiopulmonary resuscitation' recommendation had a peri‐operative cardiac arrest, and when cardiac arrest did occur, return of spontaneous circulation was achieved in 57%, although > 50% of these patients subsequently died before discharge from hospital. [ABSTRACT FROM AUTHOR]

This document provides summaries of several research studies related to anesthesia and perioperative care. The studies cover a range of topics, including predicting hypotension after general anesthesia, administering spinal anesthesia in patients with raised intracranial pressure, the use of ondansetron to reduce complications during Caesarean section, comparing doses of dexamethasone for postoperative pain relief, and the utilization of ultrasound in the perioperative period. The studies offer valuable insights into these areas and highlight the potential benefits of certain interventions and techniques. [Extracted from the article]

Background and Aims: The opportunities to work for early-career anaesthesiologists are in various sectors such as teaching institutes, private practice, and corporate hospitals in India or abroad. The primary aim of the survey was to determine whether early-career anaesthesiologists wanted to work in India or abroad. The secondary objectives were to determine the proportion of early-career anaesthesiologists who wished to pursue further studies and what degree they wanted to pursue. Methods: A validated questionnaire containing questions related to career preferences was circulated by social media among early-career anaesthesiologists via Google Forms. The survey questionnaire focussed on whether the respondents wanted to work in India or abroad or pursue further studies. The survey results were tabulated in an Excel sheet. Descriptive statistics were used to analyse the data, and the Chi-square test was applied where appropriate. Age-group preferences and gender preferences were also analysed. Results: A total of 684 responses were received. The mean (SD) age of the respondents was 31.4 (2.8) years. Among the respondents, 64.1% were female, and 35.9% were male. Of the respondents, 309 (72.5%) were in a job, 50 (11.7%) were pursuing Society-recognised fellowships, and the rest were pursuing super-specialisation degrees or University-recognised fellowships. Two hundred and eighty-six respondents (75.5%) wanted to study outside India. Only 155 (36.6%) had career guidance from immediate contacts or mentors. Conclusion: Early-career anaesthesiologists want to pursue further degrees and fellowships after their graduation in anaesthesiology. Career guidance is an important aspect of anaesthesiology training. [ABSTRACT FROM AUTHOR]