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

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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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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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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

We commend Gale et al. on their investigation into resident doctor stressors and wellbeing in years 2–5 of training [1]. This work complements a recent survey undertaken by the Severn Deanery Training Program Director and ST4+ resident representatives exploring anaesthesia resident doctors' welfare and burnout risk, alongside seeking feedback on how to improve the training experience. Our survey received

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We read with interest the article by Takahashi et al., who conducted the first systematic review and meta-analysis evaluating the association between subjective functional capacity and postoperative outcomes in non-cardiac surgery [1]. While cardiopulmonary exercise testing is the gold standard for objective functional capacity assessment, funding for staff and equipment limits its availability and

We read with interest the article by Taboada et al. examining the differences between flexible-tip bougie and stylet on first-pass success rate with hyperangulated videolaryngoscopy [1]. Their study describes a higher first-pass tracheal intubation success rate with a flexible-tip bougie; however, we were surprised by the low first-pass tracheal intubation success rate in the patients allocated to

SummaryIntroductionExtubation of the trachea in the operating theatre may increase the time spent there. Conversely, tracheal extubation in the post‐anaesthesia care unit may prolong the duration of anaesthesia and increase the incidence of complications. Our primary objective was to quantify the additional occupancy time associated with tracheal extubation in the operating theatre compared with the

SummaryIntroductionWomen undergoing induction of labour often utilise epidural analgesia. Obtaining consent for labour epidural presents a unique challenge for the obstetric anaesthetist, who must comply with the legal standards of consent. This study explores how women perceive the consent process for epidural analgesia during induction of labour.MethodsThis was a qualitative, single‐centre, interview‐based

SummaryIntroductionTonsillectomy, a common childhood surgery, is associated with difficult postoperative recovery. Previous reviews provided low‐grade evidence that honey may improve recovery. The BEE PAIN FREE study investigated whether honey alongside multimodal analgesia improved the recovery trajectory in children following tonsillectomy.MethodsA prospective randomised controlled trial was conducted

The trial by Taboada et al. [1] showed superior first-attempt tracheal intubation success with a flexible-tip bougie compared with a stylet when using a hyperangulated videolaryngoscope in patients who were critically ill. While the manoeuvrability of the bougie offers advantages, we believe that the results also highlight how adjustments in technique could improve stylet performance substantially

I read with interest the network meta-analysis examining the relative performance of modern videolaryngoscopes by de Carvalho et al. [1]. The authors' call to action includes identifying strategies to translate better glottic visualisation into improved tracheal intubation efficacy. This call is most compelling in emergency tracheal intubations by relatively inexperienced non-anaesthetists in out-of-hospital

I commend Drs Bamber and Lucas for their insightful commentary on the universal adoption of combined spinal–epidural techniques in labour analgesia [1]. Their points regarding patient-centric care and the balance between analgesia quality, onset time and complication risks, particularly postdural puncture headache, are pertinent [2]. Recent evidence and physiological insights into the dural puncture

SummaryIntroductionThe worldwide expansion in healthcare simulation training includes accelerated uptake in low‐resource settings. Until recently, no framework has specifically delineated the competencies underpinning effective facilitation practice in low‐resource settings. We describe the development of the Facilitation Behavioural Assessment Tool for simulation facilitation training and report reliability

In the systematic review and meta-analysis by Lim et al. [1], the conclusion that intravenous iron increases postoperative haemoglobin concentrations, particularly after orthopaedic surgery, is biologically plausible and well supported by the data. I commend the authors for their methodologically rigorous synthesis and for addressing a clinically relevant question that has received relatively little

We thank Drs Xu and Rong [1] and Drs Leslie and Stranix [2] for their comments regarding our systematic review and meta-analysis exploring the efficacy and safety of intrathecal diamorphine [3]. Drs Xu and Rong correctly highlighted that the figure we initially presented regarding the risk of bias assessment of the included trials was not derived from the Cochrane Collaboration's Risk of Bias tool

I write in response to von Ungern-Sternberg and Becke-Jakob's timely and courageous editorial on toxic leadership in anaesthesia departments [1]. As a specialist anaesthetist who has worked across health systems in both the UK and Australia, I found the piece to be not only resonant but also painfully familiar. The behaviours described – bullying, favouritism, passive-aggression and emotional detachment

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We appreciate the insightful commentary from Li et al. [1]. In our multicentre trial, the median time to loss of consciousness during induction of anaesthesia was 45 s and 25 s, for children aged 3–6 y receiving 0.3 mg.kg-1 remimazolam vs. 2.5 mg.kg-1 propofol, respectively [2]. Although the pharmacokinetic simulation from Li et al. suggests increased drug efficacy, our findings regarding time to loss

We read with great interest the article by Buiteman-Kruizinga et al. [1] which investigated the effect of individual components of mechanical ventilation on mechanical power and provided evidence that the respiratory rate may be the most attractive ventilator setting to adjust when targeting a lower mechanical power. The authors utilised data from three randomised clinical trials that involved patients

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We thank Fajardo-Campoverdi et al. for their letter [1] and appreciate the insightful comments regarding our study about the effect of rate reduction on the amount of mechanical power [2]. The authors raise an interesting point about the potential influence of the way of flow delivery, whether constant or decelerated, on mechanical power. We acknowledge that the method of inspiratory flow delivery

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SummaryIntroductionIntrathecal morphine provides effective postoperative analgesia, but there are concerns about potential pulmonary complications influencing peri‐operative management. We aimed to determine whether there is an association between intrathecal morphine administration and pulmonary complications after non‐obstetric surgery. We also aimed to determine whether there was a dose‐dependent

Heart failure is a frequent comorbidity in patients undergoing non-cardiac surgery and an acknowledged risk factor for postoperative mortality. The associations between stable chronic heart failure and postoperative outcomes have not been explored extensively. The aim of this study was to determine associations between stable chronic heart failure and its peri-operative management and postoperative

SummaryIntroductionRotational thromboelastometry (ROTEM®) is used widely in cardiac surgery. Reference ranges are derived from healthy volunteers but may not be interchangeable with those from patients undergoing cardiac surgery. Furthermore, sex and age seem to influence rotational thromboelastometry profiles. We performed a secondary analysis of two prospective observational study cohorts from a

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SummaryIntroductionGlucagon‐like peptide‐1 receptor agonists are known to delay gastric emptying; however, the association between glucagon‐like peptide‐1 receptor agonist use and peri‐operative pulmonary aspiration risk is not known. This systematic review and meta‐analysis aimed to summarise the evidence on whether glucagon‐like peptide‐1 receptor agonist exposure is associated with pulmonary aspiration

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SummaryIntroductionThe 7th National Audit Project of the Royal College of Anaesthetists revealed an increase in rates of tracheal intubation over the last decade, partially contributed to by the rise in people living with obesity. Notably, airway and respiratory complications were over‐represented in patients living with class 2 or 3 obesity (BMI ≥ 35 kg.m‐2). Hence, it is timely to evaluate if videolaryngoscopy

Discussions around the use of total intravenous anaesthesia (TIVA) when performing a rapid sequence induction (RSI) have increased recently due to the publication of a coroner's report [1], which highlighted “Lack of ‘updated’ national guidelines to support the use of TIVA for RSI” as one of the eight areas of concern within the reported case. A review of practice is pertinent, as we have seen developments

The multicentre trial by Fang et al. is the first controlled trial assessing both the efficacy and safety of remimazolam in children [1], providing useful data for paediatric sedation practice. However, we wish to explore a pharmacokinetic observation regarding the pharmacokinetic-temporal relationship between drug administration and loss of consciousness. While the Methods specify 60-s administration

We thank Dr Hansel for his interest and comments [1] related to our publication [2]. This discussion highlights the ongoing debate regarding dosing of intravenous lidocaine infusions and ongoing concerns with the lack of safety data. The aim of our observational pharmacokinetic study and dosing simulations was to improve the understanding of intravenous lidocaine pharmacokinetics and, ultimately, to

The study by Buiteman-Kruizinga et al. provides valuable insights into the determinants of mechanical power during mechanical ventilation [1]. The authors highlight the importance of limiting respiratory rate and peak pressures to reduce mechanical power and, potentially, ventilator-induced lung injury. We would like to discuss some aspects that merit further exploration. First, the study suggests

I read with interest the article by Gale et al. which identifies several factors that contribute to the high levels of stress and burnout among anaesthesia residents [1]. Burnout, as outlined by the World Health Organisation's International Classification of Diseases, is recognised as an occupational phenomenon and is characterised by three key domains: energy depletion; job-related negativity and

SummaryIntroductionThe optimal introducer for tracheal intubation with a hyperangulated blade videolaryngoscope for patients in the ICU remains uncertain. Both stylets and flexible‐tip bougies have been used, yet there is limited evidence on which is more efficacious.MethodsWe conducted a randomised controlled trial comparing flexible‐tip bougie vs. stylet using a hyperangulated blade videolaryngoscope

SummaryIntroductionPostoperative pulmonary complications are common and associated with significant morbidity and mortality; however, the optimal intra‐operative ventilation strategy to prevent postoperative pulmonary complications remains unclear. The aim of this study was to evaluate the effect of intra‐operative ventilation strategy, including tidal volumes, positive end‐expiratory pressure (PEEP)

SummaryIntroductionAnaemia in patients having surgery is associated with worse postoperative outcomes. Management with intravenous iron is an attractive therapeutic option, however, pre‐operative intravenous iron administration is challenging. Evidence from interventional trials suggests that the greatest benefit is after hospital discharge. As anaemia is common after surgery, this meta‐analysis aimed

Many patients are afraid of permanent cognitive impairment after general anaesthesia [1]. However, there is no uniform method to diagnose postoperative neurocognitive disorders extending beyond 1 month after surgery [2]. The gold standard is a time-consuming neuropsychological assessment [3]. We aimed to identify and validate internally the best predictive subset of neuropsychological assessment tests

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Flexible bronchoscopy is the gold standard for difficult airway management. Clinicians are using videolaryngoscopy increasingly because it is perceived to be easier to use with high success rates. We conducted this study to compare the success rates of the two techniques when used after failed direct laryngoscopy in children with difficult tracheal intubations.

SummaryIntroductionIntravenous lidocaine is a promising complementary strategy for sedation during surgical procedures. We performed a systematic review and meta‐analysis to compare intravenous lidocaine with placebo as an adjuvant to propofol‐based sedation in patients undergoing colonoscopy.MethodsWe searched MEDLINE, Embase and Cochrane databases for randomised controlled trials comparing sedation

We read the work of Buiteman-Kruzinga et al. [1] and believe that it adds to the evidence regarding the relevance of respiratory rate in the energy transfer of the ventilatory system. For viscoelastic bodies, cyclicity is probably the most important factor to explain the disruption of their initial conformation, which has already been extrapolated to clinical studies [2], and this study confirms this

When interpreted correctly, waveform capnography can prevent morbidity and mortality during airway management. However, misidentification of capnography as other waveforms (e.g. pressure or flow) continues to cause preventable deaths [1] and has been implicated in a Coroner's Regulation 28 report [2]. Non-standardised monitor displays increase the risk of human error, leading to clinical delays or

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SummaryIntroductionFew UK studies have explored the epidemiology of postoperative acute kidney injury after diverse types of elective major non‐cardiac surgery. Fewer still have compared postoperative acute kidney injury risk factors with conditions such as peri‐operative myocardial injury that might have similar pathophysiology. This study aimed to characterise postoperative acute kidney injury and

In UK hospitals, it is unclear how organisational structures are arranged to support effective implementation of peri-operative blood management practice strategies. The aim of this study was to conduct a national survey of organisations to describe local practices of peri-operative patient blood management and infrastructure availability in the UK.

SummaryIntroductionAs the global population ages, the demand for surgical interventions in older adults is rising. Older patients face increased risks due to age‐related physiological changes and comorbidities, making surgery and postoperative care challenging. This study aimed to assess short‐ and long‐term mortality, as well as patient‐centred outcomes such as days alive and at home 30 and 90 days

SummaryIntroductionAlcohol‐related liver disease is recognised as a major cause of liver‐related morbidity and mortality. Our aim was to report the prevalence of, and outcomes from, alcohol‐related liver disease after admission to ICUs in Scotland.MethodsWe performed a secondary data analysis using linked Scottish national databases of all adult general ICUs in Scotland. We compared emergency non‐surgical

SummaryIntroductionChronic postsurgical pain is recognised increasingly as a complication of caesarean delivery, with implications for a large cohort of patients. As interest in this area has grown, there has been more primary research into both the incidence and severity of pain. We aimed to synthesise all available evidence to evaluate the rate, features and severity of chronic postsurgical pain