BACKGROUND The 3rd Sprint National Anaesthesia Project (SNAP-3) aims to describe the impact of frailty, multimorbidity, and delirium, and their management, on outcomes after surgery within the older surgical population. Causal diagrams, such as directed acyclic graphs (DAGs), are a useful tool for visually representing relationships between variables and for clarifying the causal assumptions underlying

BACKGROUND Older surgical patients experience longer hospital stays and a higher risk of morbidity and mortality than their younger counterparts. Frailty (19.6% of cohort) and multimorbidity (63.1% of cohort) increase these risks. The 3rd Sprint National Anaesthesia Project (SNAP-3) describes the impact of frailty and multimorbidity on postoperative outcomes. METHODS We conducted a prospective observational

Patient frailty and intraoperative hypotension are both independent predictors of poor postoperative outcomes. A recent paper by Daum and colleagues demonstrates that these factors work in concert to increase patient risk as frail patients are more likely to experience frequent hypotension during surgery. Frailty and hypotension are appealing as modifiable risk factors amendable to interventions already

BACKGROUND Chronic pain disproportionately affects women, but the reasons for this disparity are unclear. METHODS We investigated this from a genetic perspective using data from the UK Biobank, focusing on multi-site chronic pain, which is highly heritable and manifests a sex bias. RESULTS Genome-wide association studies (GWAS) revealed that women have approximately 4500 sex-specific causal loci for

BACKGROUND Preoperative fasting regimens designed to minimise the risk of pulmonary aspiration have undergone significant changes, but unequivocal evidence of the safety of reducing clear fluid fasting has been lacking. We compared the risk of pulmonary aspiration in children using three different recommendations for clear fluid fasting. METHODS In this prospective multicentre cohort study, centres

BACKGROUND It is fundamental for patient safety that medical devices are correctly and competently applied. Shift work, especially in anaesthesia, poses challenges to provide timely comprehensive learning opportunities. Because personnel shortages encourage cuts to staff education, self-directed learning might alleviate these difficulties. METHODS We conducted a single-centre, noninferiority, randomised

BACKGROUND Accumulating evidence suggests that glial mechanisms are pivotal in regulating chronic pain. Our previous findings revealed that the interactions between spinal microglia and astrocytes are crucial for burn-induced pain hypersensitivity. However, the mechanisms underlying burn-induced peripheral sensitisation remain incompletely understood. METHODS Sensory neurone-satellite glial cell (SGC)

BACKGROUND There are models to predict intraoperative hypotension from arterial pressure waveforms. Selection bias in datasets used for model development and validation could impact model performance. We aimed to evaluate how selection bias affects the predictive performance of a deep learning (DL)-based model and a model using only mean arterial pressure (MAP) as input (MAP-only model). METHODS We

BACKGROUND Preoperative iron deficiency anaemia is a common risk factor for worse postoperative outcomes. However, the influence of preoperative iron deficiency without anaemia on postoperative outcomes after hip and knee arthroplasty is uncertain. METHODS We used the Fast-track Center for Hip and Knee Replacement Database registry from eight Danish departments for this prospective cohort study. Anaemia

BACKGROUND A longitudinal examination of postoperative depression is important for risk assessment. We aimed to explore the prevalence and trajectory of depression in older surgical patients, before surgery, and at 30, 90, and 180 days after surgery, associated risk factors, and clinical outcomes. METHODS This prospective cohort study assessed 307 male and female surgical patients aged ≥65 yr in two

BACKGROUND Postdural puncture headache (PDPH) is a common complication of neuraxial anaesthesia in obstetrics. Although epidural blood patch (EBP) remains the most effective treatment, less invasive alternatives are being explored. We assessed the efficacy and safety of tetracosactide, a synthetic adrenocorticotropic hormone analogue, for treating established PDPH in postpartum patients. METHODS A

BACKGROUND We evaluated a national, multidisciplinary in situ simulation-based team training intervention in New Zealand public hospitals. We hypothesised that outcomes for surgical patients and staff perceptions of teamwork and observed teamwork behaviours would improve after the intervention. METHODS In a stepped-wedge cluster trial, all New Zealand's 20 District Health Boards were semi-randomised

The perioperative management of patients using glucagon-like peptide 1 receptor agonists remains a topic of debate. While several multisociety statements have been published recently, the recommendations vary significantly in terms of medication management and preoperative fasting protocols for these patients. This document represents a multidisciplinary consensus statement led by the Society for Perioperative

Genetically predicted higher levels of the anti-inflammatory cytokine interleukin-1 receptor antagonist (IL1-Ra) might reduce the risk of developing epidural-related maternal fever, a phenomenon that occurs exclusively in women having epidural analgesia in labour. We hypothesised that in women having epidural analgesia, the absence of specific alleles that lower circulating levels of IL1-Ra would be

Respiratory muscle training may improve ventilatory efficiency (VE/VCO2 slope), a strong predictor of postoperative pulmonary complications. We hypothesised that multimodal prehabilitation, incorporating high-intensity respiratory muscle training, before lung resection would reduce postoperative complications and length of hospital stay.

A recent retrospective study examined a composite of postoperative pulmonary complications after neostigmine or sugammadex for reversal of neuromuscular block in patients undergoing interventional pulmonology and bronchoscopic procedures. This study reviewed the electronic medical records of 8557 patients across hospitals within a single health system, finding an increased risk of a composite of postoperative

A large international prospective pragmatic study (EUROFAST), analysing more than 306 900 anaesthetic procedures across 31 centres, compared the incidence of pulmonary aspiration in children after three different clear fluid fasting regimens: traditional fasting (≥2 h before induction of anaesthesia), ≥1 h fasting before induction and sip-til-send. EUROFAST provided further evidence supporting the

BACKGROUND Dexmedetomidine, an α-2 adrenoreceptor agonist, is commonly administered during cancer surgery as an adjuvant sedative because of its general anaesthetic agent-sparing effects. We investigated the association between ADRA2 gene expression and dexmedetomidine on oncological outcomes after surgery for clear cell renal cell carcinoma (RCC). METHODS We conducted an in silico analysis using a

BACKGROUND Anaesthesia contributes to greenhouse gas emissions and can play a crucial role in reducing the carbon footprint of the global healthcare sector. The aim of this systematic review is to identify which departmental interventions influence estimated carbon dioxide (CO2) equivalent emissions of anaesthesia and to quantify their reductions. METHODS A systematic literature search was conducted

Dexmedetomidine is seen as a promising agent for the prevention of postoperative delirium after cardiac surgery, but the largest study (DECADE) paradoxically suggested an increased risk of delirium.

Cancer places a significant burden on patients and healthcare systems. Dexmedetomidine, an α2 adrenergic agonist commonly used in anaesthesia, has potential effects on cancer biology. We systematically reviewed and analysed the impact of intraoperative dexmedetomidine on postoperative survival and tumour recurrence in patients with cancer.

BACKGROUND Pharmacokinetic-pharmacodynamic (PK-PD) models of remimazolam and their covariate relationships are useful for understanding drug disposition and predicting drug effects. Although clinical studies have shown that remimazolam induction doses decline with advancing age, this property is not reflected in existing models. The purpose of this investigation was to develop a PK-PD model for remimazolam

Peripheral nerve blocks (PNBs), either single-shot injection or continuous catheter infusion, are increasingly used in total knee arthroplasties (TKAs). Although recent data show equivalence between both modalities in immediate perioperative analgesia, comparative data on longer-term outcomes such as chronic opioid use are scarce.

BACKGROUND The terms fast-track (FT) and enhanced recovery after surgery (ERAS) are often mistakenly used interchangeably. Fast-track cardiac anaesthesia focuses on perioperative strategies, whereas ERAS (or enhanced recovery programme [ERP]) encompasses a wider range of strategies designed to enhance overall recovery. Evidence is needed to demonstrate the additive value of ERP above FT in cardiac

BACKGROUND Time to emergence from general anaesthesia is highly variable between individuals. This variability has been attributed to individual differences in anaesthetic sensitivity. However, this hypothesis has not been verified experimentally. We explicitly test this hypothesis by quantifying emergence from anaesthesia repeatedly in the same individuals over time. METHODS Genetically identical

Identifying surgical patients at the end of life (EOL) is the first step in integrating palliative and perioperative practices. Palliative prognostic tools (PPTs) are established frameworks from palliative care that assess patients at risk of early death. We conducted a systematic review investigating PPTs in adult surgical populations, their role in surgical decision-making, and their association

As the global population ages and older patients undergo surgery, understanding the association between frailty and postoperative outcomes is crucial to informed decision-making and patient care. There is a lack of research assessing the association between frailty and long-term outcomes in patients admitted to ICUs after surgery.

Enhanced recovery pathways (ERPs) are designed to improve patient outcomes after elective surgery. Our primary aim was to examine whether shorter hospital stay, as a surrogate ERP outcome, was associated with higher 30-day emergency readmission rates for colonic and rectal surgery in England. A secondary aim was to assess how hospital trust compliance with a specific postoperative care bundle, drinking

Chronic pain is one of the most common causes of disability, profoundly impacting quality of life and mental health, and associated with detrimental economic sequelae. The provision of pain services within the UK National Health Service was noted to be inadequate before the COVID-19 pandemic, and services have been further challenged because of its impact. The Faculty of Pain Medicine commissioned

Postoperative pain has many unwanted consequences as it delays immediate recovery and may be a factor leading to chronification of pain. Although many studies have shown a link between acute postoperative pain and persistent pain, many other factors may play a role. Maurice-Szamburski and colleagues have shown that acute postoperative pain is not directly associated with the occurrence of chronic pain