{"title":"A German perspective on hybrid diagnosis-related group.","authors":"Frank Vescia, Tim Deegener","doi":"10.1097/ACO.0000000000001570","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001570","url":null,"abstract":"<p><strong>Purpose of review: </strong>In Germany, the introduction of hybrid diagnosis-related groups (DRGs) represents an effort to reduce the proportion of inpatient care and thereby lower healthcare costs for statutory health insurance funds.</p><p><strong>Recent findings: </strong>At the same time, a system of incentives is being introduced to promote outpatient treatment. This shift leads to financial losses in the hospital sector, while potentially generating financial gains for providers in the statutory outpatient care sector; however, the current political and regulatory environment does not support stable investment in sector-specific remuneration - neither in the private practice sector nor within hospitals. Whether the anticipated cost savings for health insurance funds will actually be realised remains uncertain.</p><p><strong>Summary: </strong>The implementation of hybrid DRGs carries the risk that patients with significant comorbidities may receive less reliable perioperative care. The broader impact on patient outcomes and overall care quality has yet to be determined.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A comprehensive airway evaluation for head and neck surgery: from prediction to strategy.","authors":"Gerardo Cortese, Luigi La Via, Johannes M Huitink","doi":"10.1097/ACO.0000000000001567","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001567","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review discusses airway management in head and neck surgery, highlighting the shift from prediction-based assessment to strategy-based planning and risk stratification, and offers a model for comprehensive evaluation and management in this complex patient population.</p><p><strong>Recent findings: </strong>Traditionally, the literature has focused on risk stratification rather than binary prediction of complexity, encompassing anatomical, disease-specific, functional and radiological parameters. Recent advances include context-sensitive planning, algorithm-driven airway checklists to identify complexity, team-directed approaches, and cognitive aids designed to facilitate rapid access to primary and alternative plans. New technologies such as dual endoscopy and high-flow nasal oxygen have expanded the clinician's toolkit, offering tailored methods to treat different challenges both patient (obstructed/bleeding airways) and surgery related (laser procedures/shared 'field of action'), thereby improving safety. Postoperative airway management and extubation planning have also been reinforced to reduce complications.</p><p><strong>Summary: </strong>Safe airway management during head and neck surgery requires careful preoperative evaluation, a tailored approach, and effective interdisciplinary collaboration. The integration of new technologies and evidence-based strategies has contributed to improving both safety and outcomes.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Improving anesthesia safety: a human factors approach to feedback and system constraints.","authors":"Eliot Grigg","doi":"10.1097/ACO.0000000000001561","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001561","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this article is to discuss a structured approach to medication safety strategies for anesthesia.</p><p><strong>Key findings: </strong>The unique way that anesthesiologists interact with medications presents both vulnerabilities and opportunities to address medication safety. Much of the historical progress in anesthesia safety has involved the design of the anesthesia machine and airway management tools, while the medication delivery workflow has been largely unchanged. Using lessons from the anesthesia machine, human factors engineering, and design, there is an opportunity to make anesthesia medication handling safer.</p><p><strong>Summary: </strong>Deconstructing the anesthesia medication workflow with a failure mode and effects analysis and strategically employing constraints, automation, and simplification can yield additional safety gains for anesthesia.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The future of anesthesia education: incorporating technology for safer practices.","authors":"Soojie Yu, Layne M Bettini, Monica W Harbell","doi":"10.1097/ACO.0000000000001559","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001559","url":null,"abstract":"<p><strong>Purpose of review: </strong>Although effective patient safety education is critical to reducing medical errors, little guidance exists on best practices for patient safety curricula. This review explores the current state of patient safety education in anesthesiology and highlights emerging technologies as tools to enhance and personalize education.</p><p><strong>Recent findings: </strong>Despite formal mandates from accrediting bodies, patient safety education in anesthesiology lacks standardization in content, delivery, and assessment. Structured clinical training, simulation, and quality improvement projects are common teaching strategies, but novel approaches such as immersive reality (IR), artificial intelligence (AI)-powered agents, gamification, and mobile platforms are gaining traction. AI shows promise in tailoring instruction and identifying high-risk learners, and IR offers tools for both technical and nontechnical skills training.</p><p><strong>Summary: </strong>Patient safety education in anesthesiology is evolving with technology. AI and digital tools provide adaptive and interactive learning experiences that may help address current limitations in fixed, generalized curriculum structure and accessibility. However, these innovations require robust validation and thoughtful integration into educational frameworks to realize their full potential.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The narrow airway: from high-frequency jet ventilation to flow-controlled ventilation.","authors":"Alberto Grassetto, Joshua H Atkins","doi":"10.1097/ACO.0000000000001558","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001558","url":null,"abstract":"<p><strong>Purpose of review: </strong>Management of the narrow airway during surgical procedures poses significant challenges, requiring techniques that ensure optimal gas exchange while providing adequate surgical access. This review synthesizes the current understanding, comparing the established role of high-frequency jet ventilation (HFJV) with the advancements offered by flow-controlled ventilation (FCV) in the context of upper airway surgery.</p><p><strong>Recent findings: </strong>Recent clinical experience and studies have highlighted the potential advantages of combining a narrow-bore cuffed tube with FCV in terms of surgical access and visibility, enhanced ventilation and gas exchange, reduced complications, and improved safety during laryngeal and tracheal surgery, particularly in patients with significant airway narrowing.</p><p><strong>Summary: </strong>While HFJV remains a valuable technique for providing surgical access and facilitating ventilation in specific scenarios, FCV represents a potentially advantageous alternative by actively managing both inspiration and expiration and providing airway protection. Further large prospective comparative trials are needed to fully evaluate the safety and efficacy of FCV compared to HFJV during upper airway surgery.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Using Safety-I, II, and III to level up patient safety.","authors":"Aubrey Samost-Williams, Karolina Brook","doi":"10.1097/ACO.0000000000001560","DOIUrl":"10.1097/ACO.0000000000001560","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review provides clinicians with an introduction to the theories underlying safety-I, II, and III. These are concepts that have recently been adapted to healthcare and are growing in popularity among patient safety experts. Clinicians will be encountering patient safety interventions and analyses rooted in these theories, making an understanding of the safety science behind them important.</p><p><strong>Recent findings: </strong>There is a growing body of literature analyzing safety-I, II, and III in healthcare as well as multiple recently published applied case studies.</p><p><strong>Summary: </strong>Safety-I, II, and III are complementary ways of considering how accidents occur and how systems can build safety. Safety-I assumes that accidents occur through linear chains of events, prompting searches for root causes of accidents. Safety-II is grounded in resilience engineering and posits that accidents occur due to variability, but variability can also be protective as people prevent harm from reaching patients. Safety-III assumes that safety emerges from the interactions of the people, software, and hardware in the system as they work to control their behavior within safe bounds. These three unique lenses on safety offer different lessons learned from accidents and different strategies to promote patient safety.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Interventional pulmonology: anesthetic management and beyond.","authors":"Diana Anca, Eugene Shostak, Julien Fessler","doi":"10.1097/ACO.0000000000001516","DOIUrl":"10.1097/ACO.0000000000001516","url":null,"abstract":"<p><strong>Purpose of review: </strong>Interventional pulmonology procedures and techniques advanced at a fast pace in the last decade and intersect pulmonology, interventional radiology, and thoracic surgery for the diagnosis, staging, and treatment of lung diseases. Given the complexity of both procedures and patients, anesthesiologists are an integral part of the team, and familiarity with procedure steps, risks and complications is very important, as it is close collaboration with the proceduralists.</p><p><strong>Recent findings: </strong>Due to the complexity of procedures, such as robotic bronchoscopy, lung ablations, and patients, specific ventilatory strategies need to be employed. Recent advancements in robotic bronchoscopy and intraoperative 3D imaging allow the precise localization of lung nodules. Another major advancement is the pulsed electrical energy ablation into the nodule, inducing cell death. Our anesthetic approach must be tailored to these techniques to minimize atelectasis and risk of fire.</p><p><strong>Summary: </strong>Due to the complexity of new procedures, interventional pulmonology necessitates a careful, patient-tailored, anesthetic approach. The recent advancements in robotic bronchoscopy, lung markings and pulse electrical ablations require specific anesthetic techniques, and knowledge of the procedure steps, risks is crucial. Departments might create interventional pulmonology, bronchoscopy anesthesia teams to improve patient safety and team satisfaction.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"397-403"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luigi La Via, Christian Zanza, Manfredi Tesauro, Francesca Rubulotta, Raymond Planinsic, Yaroslava Longhitano
{"title":"The liver reconditioning in critical care medicine.","authors":"Luigi La Via, Christian Zanza, Manfredi Tesauro, Francesca Rubulotta, Raymond Planinsic, Yaroslava Longhitano","doi":"10.1097/ACO.0000000000001544","DOIUrl":"10.1097/ACO.0000000000001544","url":null,"abstract":"<p><strong>Purpose of review: </strong>Machine perfusion has emerged as a transformative alternative to static cold storage in liver transplantation, necessitating a comprehensive review of current evidence. This article examines recent advances in preservation techniques, therapeutic applications, and future directions of machine perfusion technologies.</p><p><strong>Recent findings: </strong>Clinical trials demonstrate superior outcomes with machine perfusion compared with conventional preservation, particularly for marginal and donation after circulatory death grafts. Different protocols - hypothermic, subnormothermic, and normothermic perfusion - show specific advantages in various clinical settings. Technology enables therapeutic interventions like defatting steatotic livers and administering cell-based therapies. Advanced monitoring systems allow real-time graft function assessment, supporting evidence-based acceptance decisions. Novel developments include artificial intelligence applications, new perfusion solutions, and blockchain technology for standardization.</p><p><strong>Summary: </strong>Machine perfusion represents a significant advancement in liver transplantation, though implementation challenges remain regarding infrastructure, training, and costs. The technology's ability to optimize marginal grafts and enable therapeutic interventions may expand the donor pool. Future research should focus on standardizing protocols, developing cost-effective solutions, and validating emerging technologies for widespread clinical adoption.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"523-532"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Magnesium sulfate and sugammadex: implications for routine practice.","authors":"Thomas Fuchs-Buder, Denis Schmartz, Benoît Plaud","doi":"10.1097/ACO.0000000000001507","DOIUrl":"10.1097/ACO.0000000000001507","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Magnesium sulfate (MgSO4) enhances neuromuscular blockade; it may accelerate onset, prolong clinical duration, and delay neuromuscular recovery. In addition, MgSO4 administration shortly after neuromuscular recovery may lead to the recurrence of neuromuscular blockade. This review aimed to assess the efficacy and safety of sugammadex in both scenarios.</p><p><strong>Recent findings: </strong>Compelling evidence suggests that the dosing and timing of sugammadex administration remain unchanged whether the neuromuscular blockade is induced by rocuronium alone or results from magnesium pretreatment before rocuronium administration. Furthermore, particular caution is required when MgSO4 is administered shortly after recovery from neuromuscular blockade, as the reduced safety margin may lead to the reappearance of neuromuscular blockade. Sugammadex may also counteract this recurrence, provided that the initial neuromuscular blockade was induced by a steroidal neuromuscular blocking agent such as rocuronium or vecuronium.</p><p><strong>Summary: </strong>In both clinical scenarios, sugammadex-induced reversal is rapid and reliable.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":"38 4","pages":"349-352"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nonoperating room anesthesia: opportunities for continued excellence.","authors":"Richard D Urman","doi":"10.1097/ACO.0000000000001519","DOIUrl":"10.1097/ACO.0000000000001519","url":null,"abstract":"","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":"38 4","pages":"382"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}