BACKGROUND Prehabilitation after major surgery may enhance physiological reserve and reduce postoperative morbidity. However, its efficacy after oncological surgery remains uncertain. OBJECTIVE To identify and evaluate the effects of prehabilitation on postoperative complications in adults undergoing elective surgery for malignancy, compared with standard peri-operative care. DESIGN Systematic reviews and meta-analysis of randomised controlled trials (RCTs). Cochrane Risk of Bias Tool and Grading of Recommendations, Assessment, Development, and Evaluation were used and this meta-analysis (PROSPERO-CRD420251116873) was written according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA). DATA SOURCES Central, Medline, Embase and Scopus were systematically searched from inception to 9 September 2025. ELIGIBILITY CRITERIA Eligible studies met the following criteria: (P) adults undergoing elective major oncological surgery; (I) nature of prehabilitation (physical exercise, nutritional support, psychological preparation); (C) standard peri-operative management; (O) postoperative complications within 30 days or before discharge, defined by the Clavien–Dindo classification and (S) RCTs only. RESULTS Eighty–one RCTs (8145 patients) were included in this network meta–analysis. Compared with usual care, isolated nutrition reduced the number of patients with complications with an odds ratio (OR) of 0.39 and a 95% confidence interval (CI) of 0.23 to 0.68. The combination of nutrition, exercise, and psychological prehabilitation produced a larger reduction (OR 0.19, 95% CI 0.08 to 0.46) (low–certainty evidence). Isolated nutrition also decreased the global number of complications (OR 0.61, 95% CI 0.41 to 0.90) (low–certainty evidence). Nutrition or exercise interventions were most likely to reduce length of stay, with mean differences of −1.59 days (95% CI −2.38 to −0.80) and −1.20 days (95% CI −1.84 to −0.58), respectively (very low–certainty evidence). Among patients undergoing abdominal cancer surgery, isolated nutrition (OR 0.36, 95% CI 0.19 to 0.69) and combined nutrition, exercise, and psychological prehabilitation (OR 0.18, 95% CI 0.07–0.47) showed greater benefit. No significant effects were observed for hospital mortality or health?related quality of life. CONCLUSION Prehabilitation, particularly nutritional and multimodal programs integrating exercise, diet and psychological support, reduces postoperative complications in oncology patients, especially after abdominal surgery, despite some uncertainty in our estimates.
BACKGROUND Exposure to second-hand smoke (SHS) from parents increases paediatric peri-operative respiratory risk, yet peri-operative screening and counselling are rarely implemented. OBJECTIVE To assess whether a single brief counselling session delivered during the paediatric ambulatory surgery pathway increases parental awareness of SHS harms and influences short-term self-reported behaviour. DESIGN Prospective observational before–after study with 30-day follow-up. SETTING Single-centre tertiary-level university hospital ambulatory surgery unit, Liège, Belgium; data collected from 7 November 2024 to 27 March 2025. PATIENTS Parents who self-reported active tobacco use and whose child was scheduled for elective paediatric ambulatory surgery at the University Hospital of Liège, Belgium. Of 43 eligible dyads, 31 parents consented and completed baseline and immediate postintervention questionnaires; 26 completed 30-day follow-up. INTERVENTION One standardised ~15-min counselling session by a certified tobacco counsellor covering types of smoke exposure, health and anaesthetic risks and practical measures to reduce household exposure. MAIN OUTCOME MEASURES Primary outcome was change in a summed awareness score (six items, 0 to 10 each; total 0 to 60) from precounselling to immediate postcounselling. Secondary outcomes included item-level changes, session acceptability and self-reported behavioural change at 30 days. RESULTS A brief peri-operative counselling session markedly improved parental awareness of SHS. At 30 days, self-reported behavioural change remained modest. The awareness score was exploratory and not formally validated. Randomised studies with objective exposure measures and longer follow-up are needed. CONCLUSION A single brief peri-operative counselling session improved parental awareness of SHS harms, with limited short-term impact on self-reported behaviour. TRIAL REGISTRATION NCT07144982. Approved by the Comité d’Ethique Hospitalo-Facultaire Universitaire de Liège; President: Professor D. Ledoux; IRB number: 707 (Belgian ref. B7072024000085; internal ref. 2024/327).
BACKGROUND Despite improvements, the incidence of hemidiaphragmatic paralysis following interscalene brachial plexus block (ISB) is still significant at 20–40%. OBJECTIVES We tested the hypothesis whereby the use of a low volume of ropivacaine 0.1% reduces the incidence of hemidiaphragmatic dysfunction (compared with the same volume of ropivacaine 0.5%), while providing sufficient analgesia following arthroscopic shoulder surgery. DESIGN Randomised controlled trial. SETTING A tertiary university hospital. PATIENTS Sixty patients undergoing shoulder arthroscopy under general anaesthesia. INTERVENTION Ultrasound-guided ISB with 7 ml of ropivacaine 0.1% or ropivacaine 0.5%. MAIN OUTCOME MEASURES The primary outcome was the incidence of hemidiaphragmatic dysfunction (a decrease in diaphragm excursion >25% of baseline) 30 min after ISB. The secondary outcomes included hemidiaphragmatic paralysis (a decrease in diaphragm excursion >75% of baseline), spirometry variables and postoperative analgesia. RESULTS Hemidiaphragmatic dysfunction occurred in 7/30 (23%) patients in the experimental group and in 29/30 (97%) patients in the control group, P < 0.001; relative risk (95% CI): 0.24 (0.13 to 0.46). Hemidiaphragmatic paralysis occurred in one patient in the experimental group and 25 of the patients in the control group ( P < 0.001). The median [IQR range] decrease (%) in forced vital capacity was −17 [−23 to −5] in the experimental group and −29 [−42 to −6] in the control group; P = 0.039). The difference in the median duration of effective analgesia between the experimental and control groups was not significant (9.8 h and 15.5 h, respectively; P = 0.23; Log-rank test; mean (95%CI) difference in restricted mean survival time: -3.2 h (-6.4 to 0.2); ( P = 0.061), but more patients required morphine postoperatively in the experimental group (10/30 vs. 3/30; P = 0.028). CONCLUSIONS ISB with 7 ml of ropivacaine 0.1% is associated with a lower incidence of hemidiaphragmatic dysfunction, when compared with the same volume of ropivacaine 0.5%, but at the cost of potentially less effective postoperative analgesia. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04173364
BACKGROUND The increasing prevalence of burnout among healthcare professionals has an impact on providers’ well being, the quality of patient care and the long-term sustainability of healthcare systems. OBJECTIVES The primary objectives of this study were to assess the prevalence of burnout among anaesthetists in the German-, French- and Italian-speaking regions of Switzerland and to identify key risk factors that could serve as targets for prevention. DESIGN Cross-sectional survey study. SETTING Thirty-three anaesthesia departments across Switzerland. PARTICIPANTS Trainees and board-certified anaesthetists. METHODS An online questionnaire was sent to participants. Burnout was assessed with the Maslach Burnout Inventory, and the questionnaire also included items related to workplace and personal risk factors. RESULTS Across all analysed regions of Switzerland 245/454 (54 (95% confidence interval (CI), 49 to 59)% of respondents were at high risk of burnout, and 69/454 (15 (95% CI, 12 to 19)% met the criteria for burnout syndrome. The prevalence of high burnout risk and burnout syndrome was highest in the German-speaking region, with 190/302 (63 (95% CI, 57 to 68)% of anaesthetists at high risk and 60/302 (20 (95% CI, 16 to 25)% meeting the criteria for burnout syndrome. Logistic regression analysis showed moderate evidence of a sex difference, with male anaesthetists having nearly twice the odds of experiencing burnout syndrome compared with female anaesthetists. The odds of burnout syndrome were significantly lower in regions outside of the German-speaking part of Switzerland. CONCLUSION Anaesthetists in Switzerland experience a significant prevalence of burnout, which varies across linguistic-cultural regions, with the highest prevalence in the German-speaking cohort. Males are at greater risk of experiencing burnout.
BACKGROUND The Swiss Anaesthesia QUAlity (A-QUA) programme, launched by the Swiss Society for Anaesthesiology and Peri-operative Medicine (SSAPM), is a nationwide quality initiative, monitoring anaesthesia processes, events and outcomes. To describe the structure, participation, and data quality of the programme A-QUA, particularly the part 2 registry (case-related anaesthesia data), and illustrate its analytical potential using descriptive statistics and procedure case studies. DESIGN Observational, retrospective analysis of routine data from 2017 to 2024. SETTING Public and private Swiss anaesthesia providers, including all SSAPM-accredited teaching and nonteaching hospitals. PATIENTS All patients receiving anaesthesia from participating providers. INTERVENTIONS None. MAIN OUTCOME MEASURES Hospital and clinic participation, case volume, data completeness, results of plausibility checks, patient characteristics, anaesthesia techniques, durations, peri-operative events and postoperative care. RESULTS By the end of 2024, the A-QUA part 2 registry contained 2 045 026 cases from 54 centres in all Swiss language regions (61% German, 35% French, 4% Italian speaking). Most originated from large teaching hospitals (74%), with smaller contributions from small and medium-sized teaching (17%) and nonteaching (8.8%) hospitals. Median age was 56 years; 52% were women; 66% ASA l to ll. General anaesthesia (including combined) accounted for 74% of cases, regional anaesthesia alone for 18%, and monitored anaesthesia care for 8.5%. Median anaesthesia and surgical durations were 122 and 53 min, respectively. Plausibility checks identified recurrent preventable errors. Case studies of the five most frequent procedures revealed regional and hospital variation in anaesthesia choice, timing, and postoperative destination. CONCLUSIONS A-QUA is a robust, validated programme for national anaesthesia quality monitoring in Switzerland, enabling benchmarking, targeted quality improvement and peri-operative research through continuous, standardised data collection.
BACKGROUND Situational awareness (SA) is a critical nontechnical skill for intensive care unit (ICU) physicians, underpinning safe decision-making and patient safety. Despite its importance, evidence regarding how SA is assessed and improved in ICU practice remains fragmented. OBJECTIVE(S) To map the existing evidence on interventions and assessment methods for SA among physicians in adult ICUs, and to evaluate their reported effectiveness. DESIGN Scoping review of randomised controlled trials, quasi-experimental studies, cross-sectional studies, and qualitative studies, conducted in accordance with PRISMA-Scr guidelines. DATA SOURCES MEDLINE, Web of Science, Scopus, and PsycINFO were searched from inception to July 2024. Reference lists and supplementary searches were performed. ELIGIBILITY CRITERIA We included studies involving ICU physicians, residents and medical students working in adult ICUs that assessed or intervened on SA. Exclusions included studies limited to paediatric/neonatal ICUs, non-ICU staff, inter-unit handovers, reviews, opinion pieces and nonpeer-reviewed literature. RESULTS From 991 records, 11 studies were included. Simulation-based training consistently improved SA and team co-ordination, while lecture-based training alone was largely ineffective. Crew resource management (CRM) courses increased self-reported awareness but had mixed effects on outcomes. Technological tools (e.g. dashboards, 3D visualisations) showed promise in enhancing early recognition of clinical deterioration and supporting decision-making. SA assessment was most frequently performed using the Situation Awareness Global Assessment Technique (SAGAT), though this remains impractical for real-time ICU use. Methodological quality was generally moderate, with small sample sizes and heterogeneity limiting quantitative synthesis. CONCLUSIONS Simulation-based interventions and novel technological tools appear most effective in enhancing SA among ICU physicians, whereas CRM and didactic methods yield mixed results. The lack of validated, ICU-specific SA assessment tools represents a critical gap. Future research should focus on scalable, team-based training models, context-appropriate assessment instruments, and integration of technological decision-support to strengthen SA and improve patient safety.
BACKGROUND Patient blood management (PBM) has been shown to improve patient outcomes and optimise resource use. However, the systematic collection and analysis of patient-reported outcome measures (PROMs) remains challenging, limiting their integration into PBM pathways and into value-based healthcare (VBHC) strategies. OBJECTIVE(S) This study aims to evaluate the feasibility and adherence to an automated VBHC digital tool for PROMs collection in a population of cardiac surgical patients, within the context of PBM implementation. DESIGN A single-centre, pragmatic, prospective feasibility study. SETTING A tertiary Portuguese hospital considering data from 1 March to 6 September 2024. A total of 12 professionals were actively involved in the patient journey design. PATIENTS A total of 221 patients (65.2% men, mean age 66.7 ± 9.9 years) with a scheduled cardiothoracic surgery were included. Main outcome measures: Percentage of planned interactions successfully completed. RESULTS A two-phase digital PROMs journey was implemented in less than 2 months. A total of 638 interactions were completed by 221 patients, resulting in a global completion proportion of 72.1%. 36-Item Short Form Survey Instrument (SF-36) and BPI questionnaires, completed by 77% of patients, results at 90 days compared to results at initial evaluation (SF-36 physical: t = -0.424, P = 0.681; mental: Z = 33.0, P = 1.000; Brief Pain Inventory (BPI) Pain Severity and Interference: Z = 23.0, P = 0.646). The PHQ-9, completed by 76% of patients, identified five severe and nine moderately severe depression cases. Educational content had a 73.9% reading completion proportion across 303 views. CONCLUSIONS We showed the feasibility of implementing a digital tool to monitor patient PROMs, along with its adoption by patients and health professionals. This strategy has the potential to contribute to improving healthcare professionals’ motivation, access to real-world data, personalised monitoring, and allowing for faster implementation of corrective actions, with an impact on patients’ outcomes and costs.
BACKGROUND The Pringle manoeuvre, which involves intermittent clamping of the hepatic pedicle, is a common surgical strategy employed to reduce blood loss during liver resection. Although its impact on intra-operative glucose levels has been documented, its contribution to postoperative hyperglycaemia remained an untested hypothesis. OBJECTIVES The primary aim of this study was to determine whether hepatic vascular clamping was associated with increased postoperative hyperglycaemia within 24 h after liver surgery. Secondary aims included examining the association between postoperative hyperglycaemia and infectious complications and length of hospital stay. DESIGN A retrospective observational cohort study. SETTING Single tertiary university hospital. The study period extended from January 2020 to June 2022. PATIENTS The study sample comprised 163 adult patients who underwent elective liver resection. Patients were grouped according to the intra-operative use of the Pringle manoeuvre: 107 patients underwent clamping (Pringle group), while 56 patients did not undergo clamping (No-Pringle group). No patients were excluded, and data were complete for all individuals included. MAIN OUTCOME MEASURES The primary outcome was the occurrence of postoperative hyperglycaemia, defined as blood glucose at least 10.0 mmol l −1 (180 mg dl −1 ) within 24 h after surgery. Secondary outcomes included postoperative infectious complications and length of hospital stay. RESULTS Postoperative hyperglycaemia occurred in 55.1% of patients in the Pringle group compared to 23.2% in the No-Pringle group ( P < 0.001). Hepatic clamping was independently associated with postoperative hyperglycaemia (adjusted odds ratio 2.91, 95% confidence interval 1.06 to 8.92). As secondary findings, a higher incidence of postoperative infections was observed in the Pringle group (23.4 vs. 5.4%, P = 0.007), and the median hospital length of stay was longer (4 [2 to 8] vs. 2 [1 to 6] days, P = 0.003). CONCLUSIONS The Pringle manoeuvre was associated with increased postoperative hyperglycaemia within 24 h after liver surgery. These findings underscore the necessity for proactive intra-operative and postoperative glucose control strategies as an integral component of peri-operative management in hepatic surgery.
Endoscopic pharyngolaryngeal surgery requires access to the base of tongue, pharynx, larynx, trachea and/or upper oesophagus using a rigid or flexible endoscope for diagnostic or therapeutic surgical management of benign or malignant disease. The anaesthetist must deliver a safe and effective shared airway management strategy. This strategy is aimed at optimising the surgical view and access to pathology, whilst avoiding airway obstruction, maintaining oxygenation, facilitating carbon dioxide clearance, and minimising the risk of airway fire. Various strategies exist to achieve this depending on the location, size and nature of the pathology, patient anatomy and comorbidities, and operating team experience. One such approach is apnoeic oxygenation using high-flow nasal oxygen. Over the last decade, this has become a widely adopted ‘tubeless’ anaesthetic technique; nevertheless, it cannot be used in all patients, for all pathologies, by all operating teams. Though our understanding of the physiological principles continues to evolve, it is clear that to deliver this technique optimally, there are several important considerations that the surgical, nursing and anaesthetic teams must be aware of. A collaborative team-based approach to case selection and planning is essential. This must be paired with an appreciation of the limitations of the technique and the need to have an immediately deliverable rescue oxygenation strategy in place. This article provides an overview of the likely physiological mechanisms, the benefits, the limitations, the alternatives and the important considerations involved in the safe and effective use of apnoeic oxygenation with high-flow nasal oxygen to facilitate endoscopic pharyngolaryngeal surgery.
BACKGROUND Anaesthesia is central to obstetric care, yet contemporary data on clinical practices, particularly concerning general anaesthesia (GA) for caesarean section (CS), remain scarce. Given evolving guidelines and technologies, an updated understanding of real-world anaesthetic management is needed. OBJECTIVE Our aim was to evaluate current anaesthetic practices in obstetric care in Germany, focusing on the use of GA for CS, perioperative management, and adherence to guideline recommendations. DESIGN Nationwide, anonymised, cross-sectional questionnaire survey. SETTING The questionnaire targeted both experienced obstetric anaesthesiologists and other anaesthesiologists regularly working in obstetric anaesthesia in German hospitals. PARTICIPANTS We analysed 567 completed questionnaires from anaesthesiologists actively involved in obstetric care, representing 171 geographic locations and institutions covering approximately half of all annual births in Germany. MAIN OUTCOME MEASURES Contraindications for neuraxial procedures, estimated GA rates, perioperative management strategies, and conformity with guidelines. RESULTS The survey yielded 29 984 individual responses. Neuraxial anaesthesia was strongly preferred over GA (Likert score 4.8/5), with a median GA rate of 5 [5 to 10]%. Postoperative nausea and vomiting prophylaxis was provided by 89.4% of respondents. Platelet thresholds for neuraxial anaesthesia were more liberal than in previous surveys, with reliance on individual risk-benefit assessment instead of fixed numerical thresholds. For GA induction, propofol has largely replaced thiopental, but suxamethonium remains the favoured neuromuscular blocking agent (71.7%). Balanced anaesthesia with sevoflurane predominated (84%), while nitrous oxide use has declined sharply (2.1%). Gaps in guideline adherence were noted regarding the timing of antibiotic prophylaxis, the use of active warming and intraoperative red blood cell salvage. Compared with international practice, postoperative analgesia was mainly opioid-based, with regional techniques underused (23%). CONCLUSIONS Despite progress towards guideline adherence, substantial gaps persist between recommendations and clinical practice in German obstetric anaesthesia. Improvement opportunities include better implementation of evidence-based perioperative strategies and greater use of regional analgesic techniques postoperatively.
BACKGROUND Septic shock is characterised by sepsis-induced hypotension refractory to fluid resuscitation efforts. Further treatment often requires mechanical ventilation, typically requiring the use of sedatives to provide analgesia, sedation and anxiolysis. One sedative, dexmedetomidine, is an α2 agonist that has demonstrated potential in improving haemodynamic and clinical outcomes in recent randomised controlled trials. However, support for these claims has been inconsistent across individual studies. OBJECTIVE This meta-analysis aimed to assess the efficacy of dexmedetomidine in comparison to other sedatives. DESIGN Systematic review of randomised controlled trials with meta-analyses. DATA SOURCES The search was performed across five electronic databases (Embase, PubMed, Scopus, MEDLINE and clinicaltrials.gov) from inception up to June 2025. ELIGIBILITY CRITERIA We included randomised controlled studies that utilised adult patients diagnosed with septic shock and receiving sedation with dexmedetomidine or any other. Excluded types of studies included non-RCTs, animal studies, paediatric cases, procedural sedation, trials without reported outcomes and studies that do not report desired outcomes. RESULTS Our meta-analysis included eight randomised controlled trials ( n = 702 patients), which revealed that dexmedetomidine significantly decreased the day-2 Sequential Organ Failure Assessment (SOFA) score ( P = 0.009) and the incidence of acute kidney injury (AKI) ( P = 0.004). Importantly, dexmedetomidine significantly increased the duration of hospital stay ( P = 0.01) and the incidence of hypotension ( P = 0.04). There were non-significant decreases in 28-day mortality ( P = 0.08), duration of mechanical ventilation ( P = 0.28), duration of intensive care unit (ICU) stay ( P = 0.74), delirium incidence ( P = 0.60), bradycardia incidence ( P = 0.14), 24-h serum IL-6 levels ( P = 0.18), 24-h serum CRP levels ( P = 0.44) and 24-h serum lactate levels ( P = 0.93). CONCLUSION Dexmedetomidine may improve early organ dysfunction; however, evidence for long-term clinical benefits remains limited.
Preoperative fasting has long been a cornerstone of perioperative care, primarily aimed at minimising the risk of pulmonary aspiration during anaesthesia. The historical ‘nil per os from midnight’ policy, once universally adopted, has undergone considerable re-evaluation in recent decades. Growing evidence supporting the safety of shorter fasting intervals, particularly for clear liquids, have led to the revision of fasting guidelines worldwide. Despite these updated recommendations, prolonged preoperative fasting remains common in clinical practice. Contributing factors include outdated protocols, miscommunication, logistical constraints, operating room scheduling, too low priority and variability in guideline implementation. Such practices not only diminish patient comfort but may also lead to metabolic disturbances, with children being especially susceptible. This narrative review explores the rationale, evolution, and current guidelines surrounding preoperative fasting. Both pharmacological and non-pharmacological strategies, such as the use of gastric ultrasound, rapid sequence induction, and gastric tubes, are discussed. The emerging impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) is also highlighted. By synthesising current evidence, this review aims to provide clinicians with a practical, evidence-based framework for optimising fasting practices and improving perioperative outcomes.
The 4th National Audit Project of the Royal College of Anaesthetists reported an incidence of major airway complications of 1 in 22 000 general anaesthetics. A decade later, the 7th National Audit Project reported on peri-operative cardiac arrests; a third of these were cardiovascular, and a quarter were airway related. To assess airway management complications throughout our hospital and identify specific areas for improvement. Single-centre prospective observational audit from October to December 2023. Data was collected using a QR code linked to a web collection tool, Google Form. A large academic adult tertiary referral centre. Patients who required airway management, elective and emergency, across the hospital, including our main operating theatres, remote anaesthesia sites, postanaesthetic care unit, intensive care unit, emergency department and wards. The incidence of complications of airway management. There were 63 airway complications recorded in 48 patients, an overall incidence of 3.4%. Airway complications were noted to have a higher incidence in emergency compared to elective airway management (5.4 vs. 2.2%, P = 0.002). Locations outside the operating theatres (emergency department, intensive care unit and wards) had a higher complication rate compared to theatre and remote anaesthesia sites (16.2 vs. 2.5%, P < 0.001). Patients whose airway was managed on the wards were twice as likely to experience a complication compared to those in our emergency department and three times as likely as patients in our intensive care unit (31 vs. 16 vs. 10.2%, P = 0.19). This is a snapshot of airway management experience across a single tertiary centre. Emergency airway management and locations outside the operating theatre had a higher complication rate with hypotension (SBP < 65 mmHg) being the most frequent physiological event followed by hypoxia (SpO 2 < 90%). Despite its limitations, we recommend using a QR code-linked web collection tool, as it allowed us to collect anonymised data on a significant number of patients over a short period. The study was discussed with the Institutional Review Board, and approval (registration number CA2023/226) was provided by the Clinical Audit Committee.
Baclofen is a gamma-aminobutyric acid (GABA)-B receptor agonist used to treat neurological spasticity. Several cases of baclofen intoxication have been reported with neurological symptoms. While numerous reports describe oral baclofen toxicity, the neurological consequence of intrathecal overdose remain poorly characterised. We describe an electroencephalogram (EEG) post-anoxic encephalopathy pattern following intrathecal BACLOFEN injection to treat spasticity in an intensive care unit in September 2024.
BACKGROUND:Pre-operative anxiety is present in most day surgery patients and is associated with increased postoperative pain. However, most anaesthetists do not objectively evaluate pre-operative anxiety. Both Surgical Fear Questionnaire (SFQ) and Anxiety Numeric Rating Scale (ANRS) are tools that can be used for standardised anxiety assessment. OBJECTIVE:To compare the SFQ and ANRS in assessing pre-operative anxiety and predicting postoperative pain; to identify predictive factors for high pre-operative anxiety. STUDY DESIGN:Secondary analysis of a multicentre prospective observational study. SETTING:Three Portuguese ambulatory surgery units.PATIENTS Two hundred and ninety-six patients underwent open inguinal hernia repair between September 2018 and March 2020. INTERVENTION:Patients were assessed for pre-operative anxiety using the SFQ and ANRS before surgery. Postoperative evaluations were conducted at 24 h, 7 days, 3 months and 1 year. MAIN OUTCOME MEASURES:Pre-operative anxiety and postoperative pain, Global Surgery Recovery Index and patient satisfaction. RESULTS:Two hundred and fifty-four patients completed the 12-month follow-up, with 260 men and 31 women analysed. The mean pre-operative SFQ score was 21.6 ± 15.8, with cutoffs of 20/24 for predicting acute/chronic pain. The mean pre-operative ANRS score was 3.7 ± 2.5, with an optimal cutoff of 4. Patients with SFQ at least 21 had worse postoperative outcomes at all time points (P < 0.03). The SFQ could predict pain at least 4 at all analysed time points while the ANRS could only predict pain 1 year after surgery. Independent predictors of high pre-operative anxiety included younger age, female sex, BMI less than 30 and pre-operative pain score at least 4. CONCLUSION:Pre-operative anxiety evaluation allows for the identification of patients at a high risk for postoperative complications. Both instruments demonstrated some ability to predict postoperative pain and might be valuable in the pre-operative setting, with the SFQ showing better performance. TRIAL REGISTRATION:NCT03499730.
BACKGROUND:Anaesthesia is central to obstetric care, yet contemporary data on clinical practices, particularly concerning general anaesthesia (GA) for caesarean section (CS), remain scarce. Given evolving guidelines and technologies, an updated understanding of real-world anaesthetic management is needed. OBJECTIVE:Our aim was to evaluate current anaesthetic practices in obstetric care in Germany, focusing on the use of GA for CS, perioperative management, and adherence to guideline recommendations. DESIGN:Nationwide, anonymised, cross-sectional questionnaire survey. SETTING:The questionnaire targeted both experienced obstetric anaesthesiologists and other anaesthesiologists regularly working in obstetric anaesthesia in German hospitals. PARTICIPANTS:We analysed 567 completed questionnaires from anaesthesiologists actively involved in obstetric care, representing 171 geographic locations and institutions covering approximately half of all annual births in Germany. MAIN OUTCOME MEASURES:Contraindications for neuraxial procedures, estimated GA rates, perioperative management strategies, and conformity with guidelines. RESULTS:The survey yielded 29 984 individual responses. Neuraxial anaesthesia was strongly preferred over GA (Likert score 4.8/5), with a median GA rate of 5 [5 to 10]%. Postoperative nausea and vomiting prophylaxis was provided by 89.4% of respondents. Platelet thresholds for neuraxial anaesthesia were more liberal than in previous surveys, with reliance on individual risk-benefit assessment instead of fixed numerical thresholds. For GA induction, propofol has largely replaced thiopental, but suxamethonium remains the favoured neuromuscular blocking agent (71.7%). Balanced anaesthesia with sevoflurane predominated (84%), while nitrous oxide use has declined sharply (2.1%). Gaps in guideline adherence were noted regarding the timing of antibiotic prophylaxis, the use of active warming and intraoperative red blood cell salvage. Compared with international practice, postoperative analgesia was mainly opioid-based, with regional techniques underused (23%). CONCLUSIONS:Despite progress towards guideline adherence, substantial gaps persist between recommendations and clinical practice in German obstetric anaesthesia. Improvement opportunities include better implementation of evidence-based perioperative strategies and greater use of regional analgesic techniques postoperatively.
BACKGROUND:Situational awareness (SA) is a critical nontechnical skill for intensive care unit (ICU) physicians, underpinning safe decision-making and patient safety. Despite its importance, evidence regarding how SA is assessed and improved in ICU practice remains fragmented. OBJECTIVES:To map the existing evidence on interventions and assessment methods for SA among physicians in adult ICUs, and to evaluate their reported effectiveness. DESIGN:Scoping review of randomised controlled trials, quasi-experimental studies, cross-sectional studies, and qualitative studies, conducted in accordance with PRISMA-Scr guidelines. DATA SOURCES:MEDLINE, Web of Science, Scopus, and PsycINFO were searched from inception to July 2024. Reference lists and supplementary searches were performed. ELIGIBILITY CRITERIA:We included studies involving ICU physicians, residents and medical students working in adult ICUs that assessed or intervened on SA. Exclusions included studies limited to paediatric/neonatal ICUs, non-ICU staff, inter-unit handovers, reviews, opinion pieces and nonpeer-reviewed literature. RESULTS:From 991 records, 11 studies were included. Simulation-based training consistently improved SA and team co-ordination, while lecture-based training alone was largely ineffective. Crew resource management (CRM) courses increased self-reported awareness but had mixed effects on outcomes. Technological tools (e.g. dashboards, 3D visualisations) showed promise in enhancing early recognition of clinical deterioration and supporting decision-making. SA assessment was most frequently performed using the Situation Awareness Global Assessment Technique (SAGAT), though this remains impractical for real-time ICU use. Methodological quality was generally moderate, with small sample sizes and heterogeneity limiting quantitative synthesis. CONCLUSIONS:Simulation-based interventions and novel technological tools appear most effective in enhancing SA among ICU physicians, whereas CRM and didactic methods yield mixed results. The lack of validated, ICU-specific SA assessment tools represents a critical gap. Future research should focus on scalable, team-based training models, context-appropriate assessment instruments, and integration of technological decision-support to strengthen SA and improve patient safety.
BACKGROUND:Effective analgesia in laparoscopic surgery remains challenging due to visceral pain and postoperative nausea. NMDA-receptor antagonists such as esketamine may enhance peri-operative analgesia, mitigate opioid related side effects, and it also shows potent antiemetic properties. OBJECTIVES:This meta-analysis evaluated whether intra-operative esketamine improves postoperative pain and other outcomes in adults undergoing laparoscopic procedures. STUDY DESIGN:The study followed PRISMA guidelines and was registered with PROSPERO (Registration No: CRD420251039241). The search for studies was carried out in the PubMed, Embase, Scopus and the Cochrane Library from inception to 1 March 2025. ELIGIBILITY CRITERIA:Eleven RCTs (n = 1036 patients) met inclusion criteria. Outcomes included postoperative pain scores (0-6 h, 12-24 h), opioid consumption, PONV and adverse effects. Data were pooled using standard techniques. Evidence certainty was assessed by GRADE methodology. RESULTS:Esketamine significantly reduced pain scores at 0 to 6 h (MD = -0.32, 95% CI: -0.40 to -0.25, P < 0.001) and 12 to 24 h (SMD = -1.07, 95% CI: -1.22 to -0.91, P < 0.001). It lowered the risk of requiring rescue analgesia by 38% (risk ratio = 0.62, 95% CI: 0.38 to 1.00, P = 0.05) and reduced PONV incidence by 26% (OR = 0.74, 95% CI: 0.56 to 0.97, P = 0.03). No significant differences were found in emergence time, postanaesthesia care unit stay or cumulative 24-h opioid consumption. Heterogeneity was substantial for some outcomes. Evidence certainty was moderate to low. CONCLUSION:With a low to very low level of certainty, esketamine appears to improve early postoperative pain control and selected recovery parameters (enhancement of analgesia with both reduced rescue analgesia needs and reduced PONV) in laparoscopic surgery without increasing adverse events. It represents a valuable adjunct in multimodal analgesia, though standardised dosing. However, considerable heterogeneity in esketamine dosing, mode of administration and background analgesic regimens across included trials limits definitive conclusions and highlights the need for standardised, high-quality randomised trials.
BACKGROUND:Septic shock is characterised by sepsis-induced hypotension refractory to fluid resuscitation efforts. Further treatment often requires mechanical ventilation, typically requiring the use of sedatives to provide analgesia, sedation and anxiolysis. One sedative, dexmedetomidine, is an α2 agonist that has demonstrated potential in improving haemodynamic and clinical outcomes in recent randomised controlled trials. However, support for these claims has been inconsistent across individual studies. OBJECTIVE:This meta-analysis aimed to assess the efficacy of dexmedetomidine in comparison to other sedatives. DESIGN:Systematic review of randomised controlled trials with meta-analyses. DATA SOURCES:The search was performed across five electronic databases (Embase, PubMed, Scopus, MEDLINE and clinicaltrials.gov) from inception up to June 2025. ELIGIBILITY CRITERIA:We included randomised controlled studies that utilised adult patients diagnosed with septic shock and receiving sedation with dexmedetomidine or any other. Excluded types of studies included non-RCTs, animal studies, paediatric cases, procedural sedation, trials without reported outcomes and studies that do not report desired outcomes. RESULTS:Our meta-analysis included eight randomised controlled trials (n = 702 patients), which revealed that dexmedetomidine significantly decreased the day-2 Sequential Organ Failure Assessment (SOFA) score (P = 0.009) and the incidence of acute kidney injury (AKI) (P = 0.004). Importantly, dexmedetomidine significantly increased the duration of hospital stay (P = 0.01) and the incidence of hypotension (P = 0.04). There were non-significant decreases in 28-day mortality (P = 0.08), duration of mechanical ventilation (P = 0.28), duration of intensive care unit (ICU) stay (P = 0.74), delirium incidence (P = 0.60), bradycardia incidence (P = 0.14), 24-h serum IL-6 levels (P = 0.18), 24-h serum CRP levels (P = 0.44) and 24-h serum lactate levels (P = 0.93). CONCLUSION:Dexmedetomidine may improve early organ dysfunction; however, evidence for long-term clinical benefits remains limited.
