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.
Purpose of review Prehabilitation is increasingly used before thoracic surgery to increase physiological reserve, but whether improved functional capacity translates into better postoperative outcomes remains uncertain. This review examines the physiological rationale, recent evidence, and appropriate role of prehabilitation in noncardiac thoracic surgery. Recent findings Preoperative exercise and multimodal programs consistently improve functional capacity, including 6-min walk distance and cardiopulmonary fitness. Thoracic-specific meta-analyses suggest reductions in postoperative pulmonary complications and hospital stay; however, individual randomized trials remain heterogeneous, and a recent fragility analysis of prehabilitation trials in cancer surgery showed that statistically positive complication outcomes typically hinged on a single event. Functional improvement does not necessarily mediate reductions in complex postoperative morbidity, and similar medium-term recovery may be achievable with postoperative rehabilitation. Optimal patient selection remains uncertain. Summary Prehabilitation can increase physiological reserve, but it cannot neutralize the multidimensional stress of major noncardiac thoracic surgery. A risk-adapted approach is preferable to universal implementation. Prehabilitation should exploit an existing oncologically acceptable waiting period, avoid delaying definitive surgery, and be integrated with early postoperative rehabilitation.
PURPOSE OF REVIEW Truncal blocks are increasingly used in ambulatory pathways, although evidence predominantly concerns short-term inpatient outcomes. This review evaluates clinically important, procedure-specific benefits over realistic multimodal comparators. RECENT FINDINGS Benefits are small and comparator-dependent. Trials comparing laparoscopic transversus abdominis plane and rectus sheath blocks with wound infiltration were neutral; quadratus lumborum block showed no clinically important superiority. Erector spinae plane block provides early analgesic signals, but heterogeneity and negative multicentre evidence limit generalizability. Evidence for pectoral and serratus plane blocks remains heterogeneous. Paravertebral block is more consistently effective but requires expertise, additional time, antithrombotic precautions, and observation. Only two randomized trials prespecified day-case or discharge endpoints. SUMMARY Truncal blocks supplement multimodal analgesia rather than replace general anesthesia, except for selected small, superficial abdominal wall procedures. Transversus abdominis plane block has the largest, heterogeneous evidence base, but benefits over optimized infiltration are often small or absent. Evidence on discharge, recovery at home, and rebound pain remains insufficient. Despite efficacy in major breast surgery, paravertebral block is less suitable for routine day-case pathways because of procedural and monitoring requirements. Current evidence does not support recommending routine truncal blocks for intraoperative and postoperative analgesia in ambulatory surgery.
