Alcohol consumption is associated with dose-dependent health loss secondary to long-term intake. In this scoping review, we sought to synthesize the literature on the association between the dose of preoperative alcohol consumption and postoperative outcomes. We included studies with adults undergoing cardiac and major noncardiac surgery reporting the dose of preoperative alcohol and postoperative outcomes. We searched MEDLINE, Embase®, and Cochrane Databases for Controlled Trials and Systematic Reviews. Outcomes were mortality, intensive care unit (ICU) admission, length of stay (LOS), delirium, surgical site infection (SSI), major cardiac and renal events, and postoperative pulmonary complications (PPCs). We assessed risk of bias (ROB) using the Newcastle–Ottawa Scale (cohort) and Joanna Briggs Institute tool (cross-sectional). We registered the protocol at PROSPERO (CRD42023474001). Of 9,591 references, we included 23 studies, and 7 exhibited high ROB. When consumed regularly, alcohol was associated with an increase in postoperative mortality (three of six studies), ICU admission (two of three studies), LOS (four of six studies), delirium (one of four studies), SSI (five of nine studies), and PPCs (one of three studies). No meaningful change in the results emerged when the high-ROB studies were removed. No consistent threshold of alcohol consumption was evident, though some studies implied an association with a dose of ≥ 2 drinks equivalents·day−1. Renal (one study) and cardiac complications (three studies) were not linked with preoperative alcohol consumption. The association between alcohol dose and postoperative complications is inconsistent across observational studies.
In this study, we aimed to evaluate the incidence and anticipation rate of difficult airways in adult nonobstetric patients undergoing general anesthesia at a single tertiary–quaternary Australian hospital, and to review the predictors of difficult airways and the impact of videolaryngoscopy (VL) on glottic visualization in unanticipated difficult airway cases. We conducted a retrospective observational study over a 6-month period. We included 5,293 adult patients who underwent general anesthesia with airway instrumentation. Data was extracted from anesthetic records. Difficult airways were defined according to the Canadian Airway Focus Group criteria. Cases of difficult airways were classified as anticipated or unanticipated on the basis of preoperative airway assessments. Of 5,293 patients, 207 (4
Limited evidence exists to inform opioid selection in patients in the intensive care unit (ICU) receiving mechanical ventilation, and current guidelines treat opioids as interchangeable. We sought to describe temporal trends in, and factors associated with, the choice of first opioid infusion in critically ill patients. We conducted a historical cohort study of patients receiving mechanical ventilation (MV) in ICUs in Alberta, Canada, 2013–2019. We included patients who received a first continuous infusion of fentanyl, hydromorphone, or morphine. We assessed temporal trends and used a multilevel multinomial logistic regression model to identify patient-level factors associated with opioid choice, as well as ICU-level variability using the adjusted median odds ratio (aMOR). Among 17,898 admissions in 20 ICUs who met inclusion criteria, fentanyl was the most frequent initial opioid infusion (78.6
Despite considerable effort, concerns over the quality of the outcomes of resuscitation preference conversations continue. In part, the problem relates to inadequate attention to conversation complexity and the development of oversimplified guides. We aimed to develop a more nuanced understanding of the complexity of real-world resuscitation preference conversations that examines the multiple challenges encountered. We used Charmazian-constructivist grounded theory to analyze 106 clinical notes from a data set of 366 detail-rich resuscitation preference conversation narratives. Sampling was purposive and focused on maximum variation. Rigor was enhanced through iterative data collection and analysis and constant comparison. All conversations could be described as one of five typologies (standard or middle ground, fighter, conflict or conflicted, avoidance or deferral, and wrong conversation) and two modifiers (re-exploration and health care team concerns about preference) that provide insights into the patients’ rationale for decision-making. We also identified 28 conversation foci, which appeared necessary to address, when present, to continue with the conversations (e.g., denial or family conflict). Conversations also benefited from the expression of health care team concern with choice, when needed. Addressing what-if and what-next provided additional nuance on how to proceed postresuscitation, especially for challenging conversations. The strategy of structuring and engaging with various conversation foci and typologies as they arise, and the importance of exploring what-if and what-next are important additions to the literature and existing guides. Our findings add to existing resources in ways that can hopefully be used to improve clinical practice and training.
We aimed to evaluate the phase-dependent agreement between continuous noninvasive blood pressure monitoring using ClearSight™ (Edwards Lifesciences Corp., Irvine, CA, USA) and invasive arterial pressure (IAP) across distinct intraoperative phases of transcatheter aortic valve replacement (TAVR). We conducted a single-centre observational study at a tertiary academic hospital performing TAVR. We included 21 patients undergoing TAVR, contributing 987 paired invasive and noninvasive blood pressure measurements. We recorded noninvasive blood pressure monitoring using ClearSight concurrently with standard IAP monitoring as part of routine clinical care. We analyzed repeated paired measurements using Bland–Altman methods extended with linear mixed-effects modeling, with additional sensitivity analyses performed to assess robustness. We compared invasive and ClearSight-derived systolic, mean, and diastolic pressures. ClearSight underestimated systolic and mean pressures and overestimated diastolic pressure. After excluding outliers identified by quantile–quantile plot diagnostics, mean biases (IAP minus ClearSight) were +14 mm Hg (systolic), +6 mm Hg (mean), and −3 mm Hg (diastolic). Limits of agreement narrowed after outlier removal, and intraclass correlation coefficients improved (systolic, 0.69 to 0.72; mean, 0.65 to 0.68; diastolic, 0.59 to 0.63). Phase-specific analysis showed the widest disagreement during induction/stabilization, improved accuracy during valve deployment, and the best agreement, particularly for mean arterial pressure, after protamine administration, when vascular tone and hemodynamic stability were restored. ClearSight showed phase-dependent agreement with IAP during TAVR, typically underestimating systolic and mean pressures, with improved agreement during hemodynamic stability, most notably after protamine. These findings support ClearSight as an adjunct rather than a replacement for invasive arterial monitoring during TAVR. Broader validation studies are warranted.
Diagnosing acute respiratory distress syndrome (ARDS) traditionally relies upon chest radiography or computed tomography for radiologic criteria. Recent recommendations have proposed lung ultrasonography (LUS) as an alternative modality; however, the evidence supporting its utility remains uncertain. We sought to conduct a systematic review to evaluate the diagnostic accuracy of LUS for ARDS. We searched MEDLINE, CINAHL, Embase®, and the Web of Science™ from inception through 16 May 2025, for original studies comparing the diagnostic accuracy of LUS to computed tomography or chest x-ray for ARDS diagnosis. We performed a diagnostic meta-analysis assessing lung ultrasound for ARDS, assessed the risk of bias of included studies using the QUADAS-2 tool, and rated the certainty of evidence using GRADE methodology. Our systematic review included 22 studies comparing LUS with a reference test using different scanning protocols and diagnostic thresholds, with variable interrater reliability. We included 13 studies in the meta-analysis (n = 1,999 patients, of which 618 [30.9 CRD42023468933 ); first submitted 5 October 2023.
The introduction of combined cerebral monitoring using near-infrared spectroscopy (NIRS) and processed electroencephalography (pEEG) in cardiac surgery has led to changes in intraoperative management. We aimed to determine the incidence of four intraoperative states defined by the combined use of pEEG and NIRS and whether these states were associated with postoperative complications. We conducted a prospective observational single-centre cohort study of adult patients scheduled for cardiac surgery. Bilateral cerebral NIRS and frontal pEEG were continuously recorded during the intraoperative period. The primary endpoint was the incidence of four states: cerebral desaturation and Patient State Index (PSi) < 25 and/or suppression ratio (SR) > 0 (State 1), cerebral desaturation combined with PSi ≥ 50 and SR = 0 (State 2), cerebral desaturation with normal pEEG activity (State 3), and normal cerebral saturation with PSi < 25 and/or SR > 0 (State 4). We developed logistic regression models to predict postoperative delirium and longer time of persistent organ dysfunction (TPOD). Of the 148 patients included in this analysis, 95 NCT04643834 ); registered 25 November 2020.
PURPOSE:We sought to determine the effective initiation volume of ropivacaine 0.1% with sufentanil 0.3 μg·mL-1 in 90% of patients (EV90) for labour epidural analgesia using the dural puncture epidural (DPE) technique. METHODS:In this biased-coin up-and-down sequential allocation study of labour analgesia, we included patients with a singleton pregnancy who were nulliparous; who had an American Society of Anesthesiologists Physical Status II-III classification, a numerical rating scale (NRS) pain score > 5, and cervical dilation < 5 cm; and who requested labour analgesia. We used a 25 G Whitacre needle to puncture the dura mater and initiated labour analgesia with epidural ropivacaine 0.1% with sufentanil 0.3 μg·mL-1, omitting a lidocaine test dose. The initiation volume for the first parturient was 12 mL and was modified for the next parturient per the study design (groups 12, 14, 16, 18, and 20 with an initiation volume of 12, 14, 16, 18, and 20 mL, respectively). We defined effective analgesia as an NRS ≤ 3 at 20 min and assessed sensory blockade levels, Bromage scores, and maternal or neonatal adverse effects. RESULTS:We analyzed data from 40 participants. The estimated EV90 was 18 mL (95% confidence interval [CI], 14 to 18) with isotonic regression. The proportion of patients with the highest sensory block level reaching or exceeding T6 was 0/2 (0%), 0/4 (0%), 2/15 (13%), and 1/19 (5%) in groups 12, 14, 16, and 18, respectively. One patient who received 18 mL experienced hypotension but did not require vasopressor treatment. CONCLUSIONS:When using the DPE technique to initiate labour analgesia without a lidocaine test dose, the EV90 of ropivacaine 0.1% with sufentanil 0.3 μg·mL-1 was 18 mL (95% CI, 14 to 18). STUDY REGISTRATION:ChiCTR.org.cn ( ChiCTR2300074502 ); first submitted 8 August 2023.
Retrospective evidence suggests that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with retained gastric contents (RGC) after standard 8-hr fasting, possibly increasing aspiration risk. The primary aim of this study was to compare the incidence of RGC on upper endoscopy after appropriate preoperative fasting in patients taking GLP-1 RAs vs patients not taking GLP-1 RAs. We conducted prospective observational study of 256 patients scheduled for elective endoscopy involving stomach visualization. The primary outcome was RGC, defined as solid content or liquid-only content > 1.5 mL·kg−1 body weight. Control patients followed standard 8-hr fasting, while patients taking GLP-1 RAs were instructed to hold this medication 1 week prior and were limited to a preprocedural 24-hr clear liquid diet. We measured RGCvia suctioning whenever possible and recorded subjective physician impressions. Secondary outcomes included aspiration events, procedure abortion, and conversion to general anesthesia. We evaluated the differences between groups using two-sample t tests or Wilcoxon rank-sum test for continuous and ordinal variables and Chi square tests or Fisher’s exact test for categorical variables. We analyzed potentially confounding variables via logistic regression. There was no statistically significant difference in the incidence of RGC between patients taking GLP-1 RAs (8
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for the management of type 2 diabetes mellitus and obesity. Nevertheless, their known effect of delaying gastric emptying raises perioperative concerns, particularly regarding the risk of pulmonary aspiration. There is limited evidence to guide fasting practices in this population. Our aim was to evaluate the association between preoperative fasting duration and the presence of retained gastric contents (RGC) in patients receiving GLP-1 RAs who underwent esophagogastroduodenoscopy (EGD). We conducted a multicentre retrospective cohort study involving 337 patients from five Henry Ford Health System hospitals who underwent elective EGD between January 2018 and December 2023. Eligible patients were actively taking or had recently discontinued a GLP-1 RA within 90 days prior to the procedure. The primary outcome was the presence of RGC, defined as any small, moderate, or large amount of food or gastric material explicitly reported by the endoscopist in the EGD report. For regression analyses, fasting duration for solids was dichotomized at the cohort’s median value (15 hr). We performed multivariable logistic regression to evaluate the association between preoperative fasting duration, the timing of GLP-1 RA suspension, and the presence of RGC, adjusting for clinically relevant covariates. The overall prevalence of RGC was 8.4
The COVID-19 pandemic placed unprecedented demands on critical care clinicians, exacerbating preexisting burnout concerns. Burnout affects clinicians, their patients, and the broader health care system, with evidence suggesting differential impacts across disciplines. In this study, we sought to examine burnout dimensions among critical care clinicians in Alberta, Canada and explore factors that supported their wellbeing or prevented burnout. We used a convergent parallel mixed-methods study design, collecting qualitative and quantitative data within the same survey. The survey, including the Maslach Burnout Inventory—Health Services Survey for Medical Personnel (MBI-HSS MP), the Short Professional Quality of Life (ProQOL) questionnaire, and two open-ended questions, was completed by 243 clinicians (43
Insufficient resources and dynamic infection control policies during the COVID-19 pandemic necessitated that frontline health care providers (HCPs) make frequent ethical decisions about the allocation of scarce supplies, space, and clinician time to patient care activities. We aimed to understand the process, nature, and impact of these resource allocation decisions. Using a qualitative case study approach, we developed an understanding of the decision-making of frontline intensive care unit (ICU) HCPs during the pandemic. We conducted 25 semistructured interviews with multidisciplinary HCPs employed in a community ICU in Ontario, Canada. We then extracted data related to resource allocation decisions and analyzed it within-case, using conventional (inductive) content analysis. Ethical decisions about resource allocation were ubiquitous for all types of HCPs within critical care practice. The constraints imposed by the pandemic and multiple provincial and organizational policies formed the context that necessitated these decisions. Health care providers drew upon a range of values in their decision-making, typically prioritizing HCP safety and patient well-being. Resulting actions included prioritizing clinical tasks, establishing boundaries, and modifying practice patterns. Although these situations commonly evoked stress and frustration among HCPs, feelings of self-efficacy, resourcefulness, and team cohesion were also described. Institutional policies and pragmatic limitations meant that HCPs in a community ICU in Ontario, Canada needed to make frequent ethical decisions about the allocation of scarce resources during the pandemic. These frequent decisions highlight the degree to which resource allocation is an inherent part of critical care. There is opportunity for targeted professional development to support allocation practices during adverse circumstances.
Protocol registration is essential for preventing selective reporting bias in systematic reviews, yet deviations from registered protocols remain common across medical fields. We sought to evaluate the prevalence of protocol registration and assessed concordance between registered protocols and published systematic reviews in high-impact anesthesiology journals, hypothesizing that undeclared deviations would be prevalent. We conducted a cross-sectional analysis of systematic reviews published in 2025 in first-quartile anesthesiology journals according to Journal Citation Reports (Clarivate, London, UK). We searched PubMed® in July 2025 to identify eligible studies. Two reviewers independently assessed concordance between registered protocols and published reviews using a standardized 22-item extraction form covering eligibility criteria; the Population, Intervention, Comparison, Outcome, and Study Design (PICOS) framework; search methods; risk assessment tools; and planned analyses. We recorded agreement as binary outcome, with explicit acknowledgement of deviations noted. Of 172 identified systematic reviews, we included 114 after excluding nonregistered studies and those with post hoc registration. All 114 (100 https://osf.io/ksezg ); first submitted 10 July 2025.
