Summary The World Health Organisation recommends that all anaesthetised patients receive F I O 2 0.8 during surgery to reduce the risk of surgical site infections but did not consider the effect this might have on other clinical outcomes. A Cochrane systematic review concluded that insufficient evidence exists for routinely administering high oxygen concentrations intra‐operatively to reduce surgical site infections, and that doing so might increase mortality. A feasibility trial was conducted looking at the feasibility of controlling intra‐operative F I O 2 and measuring systemic redox state. Here we explore further clinical outcomes from this study regarding postoperative complications and cognitive recovery. Twenty‐eight adult patients undergoing major abdominal surgery for cancer resection were randomly allocated to receive either conservative (F I O 2 = 0.3, n = 8), typical (F I O 2 = 0.55, n = 10) or recommended (F I O 2 = 0.8, n = 10) oxygen throughout anaesthesia. Rates of radiologically reported atelectasis, cognitive recovery and infective postoperative morbidity were all collected up to 7 days after surgery. Total intensive care unit length of stay was also recorded. Higher F I O 2 levels were associated with lower rates of atelectasis ‐ 6 (75%) versus 8 (80%) versus 3 (30%) for F I O 2 = 0.30 versus 0.55 versus 0.80, respectively; p = 0.045. Postoperative cognitive recovery scores (0.7 (3.1) versus −0.1 (2.5) versus −1.8 (3.3), p = 0.277), Postoperative Morbidity Survey infection scores (5 (71%) versus 5 (56%) versus 3 (33%), p = 0.307) and intensive care unit length of stay (3 (2–4) versus 2.5 (2.00–3.75) versus 3 (2.00–5.25) days, p = 0.870) did not differ between groups. Changing the administered intra‐operative oxygen concentration may alter postoperative clinical outcomes, and adequately powered clinical studies are urgently needed to investigate the impact of this.
Summary Heat and moisture exchange filters are routinely used in anaesthesia to provide passive humidification and protect the breathing circuit. We report a case of a 3‐year‐old patient where a complete circuit obstruction due to a defective heat and moisture exchange filter occurred. This resulted in a total inability to ventilate the patient's lungs, initially attributed to bronchospasm, followed by the need for cardiopulmonary resuscitation. Manufacturing defects resulting in such critical incidents are rare but remain an important potential differential when managing difficulty in ventilation. This incident underscores the need to maintain a high index of suspicion for equipment malfunction when difficulty in ventilation arises, even in the presence of plausible clinical causes. Automated anaesthetic machine checks do not assess circuit patency; therefore, manual verification, such as the two‐bag test, remains essential following any circuit change. This case also illustrates how human factors and system gaps can align to permit equipment defects to reach the patient, while effective teamwork and crisis management can help to mitigate harm. Routine inclusion of circuit patency testing, simulation‐based training and rigorous manufacturing quality control are suggested for preventing recurrence and enhancing patient safety in anaesthetic practice.
Summary Total intravenous anaesthesia is a core safety standard for absolute indications, such as malignant hyperthermia susceptibility, yet little is known about institutional readiness to deliver total intravenous anaesthesia for obstetric patients. We conducted a national cross‐sectional service evaluation of all 19 Irish maternity units via the Irish Society of Obstetric Anaesthesia network. Responses were received from 13/19 units, representing over 80% of the national birth activity. Most units (8/13) reported reliable access to target‐controlled infusion pumps and processed electroencephalography monitoring (12/13), but 5/13 had fewer than one target‐controlled infusion pump per obstetric theatre and 4/13 lacked an immediate backup pump. No unit had a written protocol for obstetric total intravenous anaesthesia, and 7/13 reported no resident training. Reported total intravenous anaesthesia use for obstetric general anaesthesia was low (0% in 8/13 units). Lack of exposure (11/13) and institutional preference for volatile agents (10/13) were the most common barriers. Readiness to deliver total intravenous anaesthesia for obstetric patients without delay is variable across Irish maternity units. Given that total intravenous anaesthesia remains mandatory in certain high‐risk patient groups, including those susceptible to malignant hyperthermia, deficiencies in equipment redundancy, monitoring, training and governance are patient safety concerns which should be addressed.
SUMMARY The contribution of e‐bike and e‐scooter injuries to peri‐operative activity across a trauma network is poorly characterised. We conducted a prospective cohort study across 24 London hospitals from 30/03/2026 to 12/04/2026 to measure the proportion of urgent and emergency operations associated with these injuries and describe the peri‐operative resource use. Thirty‐one patients underwent one operation each, accounting for 31/3327 (0.9%) urgent and emergency operations. E‐bikes were involved in 26/31 (84%) injuries. Median operative duration was 153 (110–221 [19–405]) min; 7/31 (23%) operations occurred out of hours and 3/31 (10%) required immediate life‐ or limb‐saving surgery. Orthopaedics accounted for 26/31 (84%) cases. Six of 31 patients (19%) required postoperative critical care and 7/31 (23%) spent at least 1 week in hospital. Most patients (22/31; 71%) presented to trauma units. Exploratory estimates for the included ambulance, emergency department, theatre, hospital stay and major haemorrhage components were £224,658–£373,820 under low‐ and high‐cost assumptions, respectively. Theatre time was the largest component. These injuries accounted for a small proportion of operations, but some patients required immediate surgery, out‐of‐hours operating or critical care. Their occurrence across trauma units and major trauma centres supports including both settings and peri‐operative outcomes in future surveillance. Longer, seasonally representative surveillance and more complete follow‐up are needed to estimate annual operative workload and costs.
