Central venous pressure has been a key component of haemodynamic monitoring for several decades, but its clinical utility is still debated. While central venous pressure has been used traditionally to assess intravascular volume status and fluid responsiveness, mounting evidence suggests that its absolute value alone is an unreliable predictor of such states. This narrative review explores the historical

There have been few other areas of medical practice in the last two decades that have evolved at the same pace as transcatheter heart valve interventions. As well as providing peri-operative care, anaesthetists are core members of ‘Heart Teams’, who plan the care of and manage patients with valvular heart disease. This review aims to summarise core information on these procedures for anaesthetists

Approximately 30,000 emergency laparotomies are performed each year across the UK. Over half are in patients aged ≥ 65 y, with a third of this group living with frailty. The association between frailty and 90-day mortality following surgery is well documented, but the longer-term mortality risk has been studied less extensively, despite clear implications for person-centred care. This study aimed to

SummaryIntroductionTracheal tube introducers facilitate tracheal intubation and include stylets and static/dynamic bougies. There is uncertainty over the most efficacious introducer with hyperangulated videolaryngoscopy.MethodsWe evaluated five introducers. Thirty anaesthetists intubated a manikin 10 times with a reusable C‐MAC® D‐blade videolaryngoscope using five introducers in two airway setups

BACKGROUND Heparin is the standard anticoagulant used during Cardiopulmonary Bypass (CPB). However, there are problems with heparin, including immunogenicity and variability of effect, that make a search for an alternative desirable. We have reported that dabigatran anticoagulation provides adequate conditions for CPB in a rabbit model. We used a sheep model of CPB in this current study to assess the

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Multiple trials have shown the advantages of videolaryngoscopy over direct laryngoscopy for tracheal intubation in the operating theatre. However, the effectiveness of universal videolaryngoscopy in real-world operating theatre settings remains uncertain.

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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

BACKGROUND Vulnerability to perioperative neurocognitive disorder (PND) and the mechanisms initiating PND, which may serve as targets for prevention, are incompletely understood. We hypothesized that sevoflurane can induce persistent upregulation of the hypothalamic-pituitary-adrenal (HPA) axis, inflammation, and behavioral deficits in young adult male rats by stimulating hypothalamic arginine vasopressin

BACKGROUND Perioperative hyperglycemia is associated with adverse patient outcomes including surgical site infections. This study examined whether an automated insulin dosing reminder is associated with a lower risk for postoperative hyperglycemia and other secondary and safety outcomes in patients at high risk for intraoperative hyperglycemia. METHODS We conducted a pragmatic trial using a sequential

Polyneuropathy remains a diagnostic and clinical challenge, with limited understanding of the mechanisms underlying painful and nonpainful phenotypes. While previous studies have examined various characteristics of these patients, the temporal and spatial dynamics of endogenous pain modulation remains not fully elucidated. In this study, offset analgesia (OA) and spatial summation of pain (SSp) were

Chronic overlapping pain conditions (COPCs) affect a wide population and incur a substantial disease burden including comorbid mental disorders. Although these comorbidities have been extensively documented, the longitudinal trajectories of their onset, particularly for those with three or more conditions, have been rarely studied. We conducted retrospective cohort studies to identify statistically

BACKGROUND Sepsis-associated encephalopathy causes irreversible cognitive dysfunction, yet no effective pharmacological treatments are available. The hippocampus is particularly vulnerable to sepsis-induced damage, and impairments in hippocampal synaptic plasticity, particularly late-phase long-term potentiation (L-LTP), are implicated in cognitive dysfunction. Brain-derived neurotrophic factor (BDNF)

BACKGROUND Malignant hyperthermia (MH) is a life-threatening pharmacogenetic disorder triggered by certain anesthetics, characterized by muscle rigidity, elevated body temperature, and hypermetabolic crisis. This condition is primarily associated with genetic mutations in ryanodine receptor 1 (RYR1), which encodes the pivotal calcium release channel in the sarcoplasmic reticulum of skeletal muscle

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

SummaryIntroductionChildren with difficult airways are at high risk of complications. Alternative techniques to direct laryngoscopy for tracheal intubation include videolaryngoscopy, flexible bronchoscopy and the hybrid technique of simultaneous videolaryngoscopy and flexible bronchoscopy. This analysis aimed to compare the first‐attempt success of each technique and assess the complications associated

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BACKGROUND Postoperative delirium (POD), emergence delirium (ED), and postoperative cognitive dysfunction (POCD) are disorders of the neuropsychiatric spectrum affecting the elderly during the postoperative period, potentially sharing a common pathophysiological pathway. Disrupted sleep postoperatively correlates with both POD and POCD, revealing overlapping risk factors. This study investigates the

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

Pain is one of the primary indicators of a bone fracture and serves both a functional and practical role in guiding recovery. However, fracture pain can persist long after the fracture itself has clinically healed. The neural and molecular mechanisms that drive acute pain postfracture, and how these mechanisms are pathologically usurped to trap patients into persistent, debilitating, and often difficult

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An abstract is unavailable.

An abstract is unavailable.

An abstract is unavailable.

An abstract is unavailable.

nary quality improvement (QI) initiative that proactively educated parents about the importance of optimal opioid disposal practices and provided a home opioid disposal kit before discharge after pediatric ambulatory surgery. METHODS: Opioid disposal behaviors were assessed during a brief telephone interview pre- (Phase I) and post-implementation (Phase II) after surgery. For each phase, we aimed to

Small fiber neuropathy (SFN) is defined by dysfunction or degeneration of Aδ and C fibers, causing impaired temperature perception and spontaneous neuropathic pain. We performed microneurography (MNG) to analyze C-nociceptor properties in 19 patients with SFN. C-nociceptors were classified as mechanosensitive or mechano-insensitive, and either "normal," "hyperactive," or "hypoactive." Results were

Theoretical and empirical work underscores the role of postsurgical acute pain severity and psychosocial factors in the development of chronic postsurgical pain (CPSP). However, evidence on how psychosocial changes in response to acute pain influence CPSP development in adolescents is limited. In this 6-month longitudinal study, adolescents undergoing spinal fusion were assessed presurgery, monitored

A paradoxical heat sensation (PHS) is the feeling of warmth when the skin is cooled. Paradoxical heat sensation is a pathological sign associated with neuropathy, eg, diabetic polyneuropathy (DPN). The aim of this study was to examine whether specific characteristics in the sensory nervous system are associated with PHS and to evaluate whether PHS is a predictor of thermal sensory loss or neuropathy

Sleep problems and disorders are prevalent in individuals with chronic musculoskeletal pain (CMP). Yet, previous reviews have struggled to draw precise conclusions due to inconsistent terminology and definitions of sleep problems and disorders. This review analyzed 225 studies to map terminology and definitions for sleep problems and disorders in CMP research. The included studies provided 326 definitions

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

We thank Makar et al. [1] and Hsu et al. [2] for their thoughtful comments on our article [3] and appreciate the opportunity to clarify and contextualise our findings. As noted, the first-pass tracheal intubation success rate in the stylet group of our study was 83%, which Makar et al. [1] found surprisingly low. However, this figure aligns closely with data from large-scale, high-quality studies conducted

BACKGROUND Postoperative delirium is a common and serious complication following non-cardiac surgery. A possible precipitating factor may be perioperative hemodynamic changes, with subsequent changes in brain perfusion. This study aims to investigate whether intraoperative hypotension, perioperative average blood pressure, or blood pressure variability are associated with postoperative delirium. METHODS

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