Purpose of review Thoracic surgery requiring one-lung ventilation (OLV) remains one of the most challenging settings in perioperative respiratory care. During OLV, anesthesiologists must continuously balance two frequently competing goals: maintaining adequate gas exchange despite a markedly reduced ventilated lung volume while simultaneously minimizing ventilator-induced lung injury (VILI) through lung-protective ventilation. Despite widespread adoption of lower tidal volume ventilation, postoperative pulmonary complications (PPCs) remain frequent. This review summarizes contemporary concepts in mechanical ventilation during noncardiac thoracic surgery, focusing on ventilatory modes, individualized ventilator settings, mechanical and chemical power, and perioperative respiratory support strategies. Recent findings Recent randomized trials and meta-analyses suggest that individualized approaches to positive end-expiratory pressure and driving pressure may improve intraoperative respiratory mechanics and oxygenation during OLV, although consistent reductions in PPCs remain unproven. Mechanical power has emerged as a potentially important determinant of VILI, whereas chemical power represents a novel framework integrating hyperoxia, oxidative stress, and carbon dioxide management. Emerging ventilatory approaches, such as flow-controlled ventilation, have shown promising physiological effects during OLV, but their impact on patient-centered outcomes remains to be established. In addition, perioperative respiratory support bundles incorporating postoperative high-flow nasal oxygen may further contribute to perioperative lung protection. Summary Contemporary thoracic ventilation is evolving from isolated ventilatory variables toward individualized perioperative respiratory management concepts. Although physiological benefits are increasingly demonstrated, robust evidence linking these approaches to improved patient-centered outcomes remains limited. Future studies should clarify the roles of individualized ventilation, mechanical and chemical power, and postoperative respiratory support within integrated perioperative respiratory care pathways.
Purpose of review The management of patients before, during, and after surgical procedures on the thorax is influenced by a rapidly expanding set of guidelines that are only partially overlapping. The review is intended for clinicians who are interested in understanding how publication date influences their recommendations, and the points of agreement and divergence between sources. Recent findings Across the preoperative, intraoperative, and postoperative phases, the reviewed documents converge strongly on core process measures. These measures encompass multimodal opioid-sparing analgesia, a single chest drain, early ambulation, and the avoidance of reflex ICU admission. However, there is less consistency in the numerical thresholds, including exercise-testing cut-offs, transfusion triggers, and drain-removal volumes. The most recent documents demonstrate a shift toward more permissive values and an increasing emphasis on frailty, sarcopenia, and patient-reported outcomes. Summary The core enhanced recovery after surgery process measures have been demonstrated to be reliable. However, it is imperative for clinicians to ascertain the underlying guideline generation for any numerical threshold before its implementation. A significant number of intraoperative decisions are still made based on expert opinion rather than guideline-grade evidence, underscoring the necessity for future trials and consensus on patient-centered outcome measurement.
Purpose of review This review integrates recent literature on paediatric laryngotracheal surgery, focusing on surgical techniques, anaesthetic management and ventilation strategies in the shared-airway setting. Its scope includes common airway pathologies, evolving reconstructive options and contemporary perioperative approaches, aiming to provide a practical, multidisciplinary framework for clinicians. Recent findings Recent evidence highlights a shift toward lesion-specific reconstruction, including expanded endoscopic techniques, posterior cricoid split with rib grafting and refined indications for single-stage reconstruction versus cricotracheal resection. Anaesthetic practice is moving toward adaptive ventilation strategies – spontaneous ventilation, high-flow nasal oxygen-assisted apnoea, supraglottic jet ventilation and controlled ventilation – selected according to physiology and surgical phase. Emphasis on first-attempt airway success, preoxygenation and multidisciplinary coordination reflects growing recognition of the high-risk nature of these procedures. Summary Paediatric laryngotracheal surgery demands meticulous planning, flexible airway strategies and close surgeon–anaesthetist collaboration. Individualised ventilation, careful oxygenation and postoperative vigilance remain central to optimising outcomes. The evolving trend toward personalised, physiology-protective management underscores the need for teams proficient in multiple airway techniques.
Purpose of review: Electroconvulsive therapy (ECT) is an effective and widely practiced treatment. As stigma surrounding the technique continues to diminish, it has become a therapeutic option for a broad range of psychiatric disorders, including in older and frail patients. With ECT increasingly delivered in ambulatory or remote settings, anesthesiologists and psychiatrists must remain aware of the potential cardiopulmonary complications that may arise during the procedure. Recent findings: Although high-quality evidence is still limited, recent studies, often using heterogeneous methodologies, consistently underline the cardiopulmonary complications inherent to ECT and their rare but tragic result. However, no consensus has yet emerged regarding optimal anesthetic management or prevention strategies. Summary: ECT is a safe and efficient therapeutic option, even for patients with significant comorbidities, and should be performed by well-trained multidisciplinary teams. Serious cardiopulmonary complications remain a rare event, but clinicians should be prepared to anticipate and manage them promptly to minimize morbidity and mortality.
