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.
Purpose of review This narrative review aims to summarize and assess recent research in sustainable anesthesia and patient safety. Recent findings Recent evidence characterizing volatiles as per- and polyfluoroalkyl substances, supports transitioning towards intravenous anesthesia where clinically appropriate. Potential ecotoxicity caused by propofol is minimal, and total intravenous anesthetic techniques are safe and effective. Reusable anesthetic equipment, such as laryngeal mask airways, breathing circuits, and patient warming devices, reduces greenhouse gas emissions and does not impact patient safety when proper sanitation protocols are followed. Virtual preoperative anesthetic consultations reduce greenhouse gas emissions, and recent randomized controlled trials found no difference in the accuracy of anesthetic assessment between virtual and in-person consultations. Finally, as extreme weather events continue to increase in frequency and intensity, we highlight the importance of climate-resilient systems in anesthesia. Summary New literature in sustainable anesthesia emphasizes the importance of transitioning to intravenous anesthesia, using reusable equipment such as patient warming devices, virtual preoperative anesthesia consultations, and climate resiliency.
PURPOSE OF REVIEW:Medical devices like physiologic monitors, anesthesia machines, and ventilators, are designed by biomedical engineers but used by clinicians. Advanced medical technology can be incorporated into clinical practice safely, but addressing alarm fatigue, resilience, automation complacency, and clinician wellbeing will help to maintain and improve patient safety. RECENT FINDINGS:The operating room is designed for efficient patient care but consideration is rarely given to the safety and well-being of clinicians. An increasing frequency of medical alarms is associated with greater rates of alarm fatigue and burnout. This extends to clinical alerts generated by electronic health records. The usability of a clinical decision support system also affects physicians' willingness to act on alerts. Automation complacency occurs when a clinician allows a system to act without considering its limitations or the possibility of a malfunction. Each of these factors may cause a problem to go unnoticed, leading to delays in diagnosis or treatment. Solutions include clinician training and consideration of ergonomics and human factors early in the design process. SUMMARY:A better understanding of human factors and ergonomics in anesthesia can improve usability and reliability of new technology, thus improving patient safety. These interventions present opportunities for potential research.
PURPOSE OF REVIEW:Patients with a tracheostomy or total laryngectomy are a distinct and high-risk population for perioperative airway emergencies. This review examines the recognition and management of acute airway emergencies in these patients, with emphasis on intraoperative hazards, equipment selection, and complications unique to the surgically altered airway. RECENT FINDINGS:The anatomical distinction between a tracheostomy and a total laryngectomy stoma remains widely underappreciated, with national registry data reporting a 26% mortality rate when oral intubation is attempted in laryngectomy patients. Common emergencies such as tube obstruction, accidental decannulation, and hemorrhage can be fatal. Intraoperative hazards including endobronchial tube migration, circuit disconnection, and inadvertent cannulation of a tracheoesophageal puncture tract represent an underrecognized category of harm. Structured algorithms, simulation-based training, and multidisciplinary quality improvement programs demonstrate measurable reductions in adverse events. SUMMARY:Patients with neck stomas are at risk for life-threatening airway compromise requiring prompt identification of airway anatomy and appropriate equipment. Clinicians must be prepared for complications like tube obstruction, tube migration, circuit instability, and bleeding. Preventing harm requires the use of cognitive aids, structured protocols, simulation-based training, and ongoing quality improvement programs.
