Anaesthesia最新文献

{"title":"Consent for anaesthesia: guidelines from the Association of Anaesthetists","authors":"Andrew McLeod,&nbsp;David Bogod,&nbsp;James Brooks,&nbsp;Michael Devlin,&nbsp;Natalie Joseph-Williams,&nbsp;Rehana Iqbal,&nbsp;Nadine Montgomery-Allam,&nbsp;Felicity Plaat,&nbsp;Alex Ruck Keene,&nbsp;Cliff Shelton,&nbsp;Vinnie Sodhi,&nbsp;Michael Swart,&nbsp;Emma Wain,&nbsp;Hugo Wellesley,&nbsp;Jenny Westaway","doi":"10.1111/anae.70283","DOIUrl":"10.1111/anae.70283","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Guidelines on consent for anaesthesia were first issued by the Association of Anaesthetists in 1999 and last revised in 2017. These new guidelines respond to the changing ethical, legal and clinical landscape in which anaesthetists practice. Since 2017, the Montgomery judgment has changed medical consent practice. The General Medical Council standards on <i>decision-making and consent</i> and the National Institute for Health and Care Excellence guidance on <i>shared decision-making</i> also reinforce the need for high standards of patient advice and counselling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A Working Party, comprising representatives from professional societies, clinical and legal experts and public voice representatives, was established. Relevant new law and professional guidance was identified. A consensus process was not followed as the guidelines are based in law rather than academic opinion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The guidelines include a new section on peri-operative medicine and updated advice on the timing, mode, conduct and content of consent discussions. We emphasise the role of healthcare organisations in enabling good practice. We have aligned this guidance with contemporary advice from key organisations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>These guidelines focus on the law in England and Wales, but we also highlight the key differences in law across the devolved nations of the UK and Republic of Ireland. Although UK law and professional guidance have influence in other English-speaking nations, a limitation of these guidelines is that they cannot be strictly applied outside the jurisdiction of the UK and Ireland. A second limitation is that they do not evaluate the resource implications that accompany them, such as clinical time and resources as well as costs of litigation and complaint.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1549-1568"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70283","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring patient disability in the peri-operative period using the WHODAS 2.0 questionnaire: a systematic review","authors":"Romijn M. Boerlage,&nbsp;Daniël van Dartel,&nbsp;Jacqueline E. M. Vernooij,&nbsp;Nick J. Koning,&nbsp;Linda M. Posthuma,&nbsp;Cor J. Kalkman,&nbsp;Carine J. M. Doggen,&nbsp;Benedikt Preckel","doi":"10.1111/anae.70287","DOIUrl":"10.1111/anae.70287","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is recommended by peri-operative core outcome sets as a measure of disability. Despite its growing use, the effect of different surgical procedures on disability measured by WHODAS 2.0 remains poorly understood and heterogeneous reporting across studies limits direct comparison.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review to assess the effect of different surgical procedures on disability measured by WHODAS 2.0, and the reporting of disability endpoints in peri-operative medicine. The primary outcome was the difference in WHODAS 2.0 summary score before and after surgery. Disability scores were calculated as a metric between 0% (no disability) and 100% (complete disability).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-nine studies were included. Pre-operative disability ranged from 2% to 61%. In 21 studies, disability increased by 1% to 17% within 3 months of surgery, with little change between 6 and 12 months (0% to -2%). Studies of orthopaedic surgery generally reported high pre-operative disability (&gt; 35%) but also reductions in disability (10–37% reduction) within 3 months of surgery. In contrast, studies evaluating cancer surgery (n = 12) generally reported lower pre-operative disability (&lt; 20%) but small increases (1–8%) within 3 months of surgery. Cardiovascular surgical studies displayed pre-operative disability between 4% and 17% with a difference in disability of -8% to +3% 3 months after surgery. Three different thresholds to define disability and 13 different WHODAS 2.0 endpoints were used, measured at eight different time-points after surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The effect of surgical procedures on postoperative disability as measured by WHODAS 2.0 is influenced by the type of surgery. Orthopaedic surgery may decrease disability, whereas cancer surgery may be associated with persistent increases. Standardised reporting of disability endpoints is needed to enhance the quality and comparability of future studies using WHODAS 2.0.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1569-1580"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70287","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Issue Information – Editorial Board","authors":"","doi":"10.1111/anae.70154","DOIUrl":"10.1111/anae.70154","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1461-1462"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70154","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An audit and feedback intervention to reduce inappropriate citation of retracted anaesthetic and pain medicine publications","authors":"Michael C. Ferraro,&nbsp;Aidan G. Cashin,&nbsp;Amanda C. de C. Williams,&nbsp;Emma Fisher,&nbsp;Neil E. O'Connell","doi":"10.1111/anae.70303","DOIUrl":"10.1111/anae.70303","url":null,"abstract":"&lt;p&gt;Retraction of untrustworthy research is common in anaesthetic publications [&lt;span&gt;1, 2&lt;/span&gt;]. Articles may be retracted for honest error; data or image fabrication; or other intentional misconduct [&lt;span&gt;1&lt;/span&gt;]. Unfortunately, retraction of an article does not always stop its citation. Nearly half of systematic reviews and clinical practice guidelines that cite retracted randomised controlled trials are published after the retraction, and retracted systematic reviews continue to be cited frequently [&lt;span&gt;3, 4&lt;/span&gt;]. The citation of retracted articles contaminates the evidence ecosystem and may cause patient harm [&lt;span&gt;5&lt;/span&gt;]. While the International Committee of Medical Journal Editors (ICMJE) states that authors are responsible for checking that none of their references cite retracted articles except in the context of referring to the retraction, few journals include this guidance in their article submission instructions [&lt;span&gt;6&lt;/span&gt;]. This is a missed opportunity, as journals are well positioned to implement safeguards that uphold research integrity.&lt;/p&gt;&lt;p&gt;Targeted strategies to change journal policies, such as audit and feedback interventions, could address this gap. Audit and feedback involves assessing target performance, comparing it with a standard and delivering results to encourage improvement [&lt;span&gt;7&lt;/span&gt;]. Whether audit and feedback can improve journal policies on citation of retractions, and in turn, author practice, remains unknown. We aimed to evaluate the effect of an audit and feedback intervention on the inclusion of retraction-checking guidance in the leading speciality journals.&lt;/p&gt;&lt;p&gt;We conducted a pre-post audit and feedback study of the top 20 anaesthetic and pain journals (based on 2022 Journal Citation Reports Impact Factor). We assessed whether journals asked authors to check their reference lists for retracted studies and if the journals provided guidance on how to identify retractions. Each criterion was scored as present (1) or absent (0), with a total possible score of 2. Editors-in-chief were contacted via a single email as part of the feedback intervention. A tailored letter was constructed, including the journal score, comparison with other journals evaluated and guidance (including template text) to incorporate the ICMJE recommendations within the author guidelines of a journal. A follow-up audit was conducted 12 months after baseline.&lt;/p&gt;&lt;p&gt;The initial audit was completed in April 2024. Mean (SD) impact factor was 4.6 (2.6) for anaesthetic journals and 3.6 (1.5) for pain journals. Nine anaesthetic journals and 12 pain journals were ICMJE signatories. At baseline, 3/20 anaesthetic journals and 0/20 pain journals included recommendations to check references for retractions and 0/20 pain journals and 1/20 anaesthetic journals provided guidance on how to identify retractions. At 12-month follow-up in April 2025, 5/20 anaesthetic and 5/20 pain journals included recommendations to check references ","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1597-1599"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in peripheral nerve block utilisation in total knee arthroplasty: insights from Epic Cosmos","authors":"Richard K. Kim,&nbsp;Edward R. Mariano,&nbsp;Daniel M. Gessner","doi":"10.1111/anae.70342","DOIUrl":"10.1111/anae.70342","url":null,"abstract":"&lt;p&gt;Multimodal, opioid-sparing analgesia remains central to total knee arthroplasty (TKA), and peripheral nerve blocks are recommended in contemporary peri-operative care [&lt;span&gt;1&lt;/span&gt;]. However, national characterisation of trends in access to regional anaesthesia remains incomplete, as previous population-based utilisation studies have relied on administrative or commercial claims data rather than anaesthesia-specific, clinical electronic health record data [&lt;span&gt;2&lt;/span&gt;]. Epic is the leading USA electronic health record, used by almost nine in 10 acute care hospitals, and Epic Cosmos (Epic Systems Corporation, Verona, WI, USA) is a deidentified database of electronic health record data from &gt; 300 USA health systems that offers a novel opportunity to address this gap [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Using Epic Cosmos, we identified elective primary unilateral TKA cases in adults from 2018 to 2025 by Current Procedural Terminology (CPT®) coding. We did not include cases with other surgical codes on the same day, or missing surgeon or anaesthesia provider identifiers. The primary exposure was peripheral nerve block utilisation, defined by CPT codes 64447 or 64448, used in the USA for femoral nerve and adductor canal blocks as single-injection or catheter techniques, respectively. A sensitivity analysis was performed in a stable subset of sources contributing ≥ 100 TKA cases per year throughout 2018–2025. Reporting followed STROBE and RECORD guidance. Analysis used R (version 4.5.1, R Foundation for Statistical Computing, Vienna, Austria) with the tidyverse package.&lt;/p&gt;&lt;p&gt;Between 2018 and 2025, 1,453,385 elective primary unilateral TKA cases were performed; 625,493 (43.0%) patients had at least one nerve block code. Utilisation increased from 20,794/78,771 (26.4%) in 2018 to 140,042/285,928 (49.0%) in 2025. Annual cases and contributing sources also increased. Stratification by source TKA volume showed utilisation rates approximately doubled across both strata, suggesting higher overall utilisation was not simply a feature of higher-volume centres (Table 1).&lt;/p&gt;&lt;p&gt;We also found marked variation between health systems, surgeons and anaesthetists. Source-level analyses suggested rising overall utilisation was driven partly by a fall in the proportion of centres performing no blocks, combined with consistent activity among high-utilisation centres. During the COVID-19 period, overall TKA volume fell in keeping with other reports, but higher-volume centres maintained more stable activity – presumably through transitioning from inpatient to day surgery – and showed higher block utilisation [&lt;span&gt;4&lt;/span&gt;]. Low-volume centres experienced more pronounced volume disruption and lower block rates. At individual surgeon and anaesthetist levels, the proportion providing no blocks also fell, but the distribution remained bimodal: some clinicians blocked nearly all TKA patients and others none (Fig. 1). These findings suggest access to regional anaesthesia for TK","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1600-1602"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70342","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awake tracheal intubation in the era of videolaryngoscopy: an international survey of 4728 clinicians","authors":"Gerardo Cortese,&nbsp;Irene Steinberg,&nbsp;Luca Brazzi,&nbsp;Massimiliano Sorbello,&nbsp;Imran Ahmad,&nbsp;Sheila N Myatra,&nbsp;George Kovacs,&nbsp;J. Adam Law,&nbsp;Robert Greif","doi":"10.1111/anae.70291","DOIUrl":"10.1111/anae.70291","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Awake tracheal intubation is recommended for the anticipated difficult airway, but its application worldwide is poorly understood. We performed an international survey to understand more about the current global utilisation of awake tracheal intubation and barriers to its more widespread implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The online survey consisted of 34 multiple-choice questions and three open questions available for 13 months. Each participant agreed to anonymised data collection and analysis before undertaking the survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data were collected from 102 countries with 4728 responses. In total, 3190/4184 (76.2%) respondents stated that they were performing awake tracheal intubation independently and 2512/3035 (82.8%) used awake tracheal intubation for a combination of predicted anatomical difficulty and physiological risk. A decrease in awake tracheal intubation use was perceived by 1733/4204 (41.2%) following the widespread implementation of videolaryngoscopy. There were 2867/3695 (77.6%) respondents who felt that indications for awake tracheal intubation should be reassessed, although only 1844/3831 (48.1%) reported being familiar with awake tracheal intubation guidelines. Most used a combination of topical airway anaesthesia and systemic medications to facilitate awake tracheal intubation. There were 2521/3039 (83.0%) respondents who preferred to use a flexible endoscope, although a lack of skill in using flexible bronchoscopy was reported by 586/966 (60.7%) as limiting their confidence in awake tracheal intubation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Despite guidelines recommending use of awake tracheal intubation for the predicted difficult airway, its application is heterogeneous. Our data suggest that a lack of physician exposure to awake tracheal intubation, possibly associated with expanding use of videolaryngoscopy, may adversely impact clinician confidence in performing the procedure. Most respondents consider awake tracheal intubation to be a core skill for anaesthetists and, furthermore, videolaryngoscopy can be used to perform some awake tracheal intubations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1481-1488"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70291","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148451594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing inequities in the design and delivery of prehabilitation in the UK: case studies of challenges, complexities and good practice*","authors":"Charlotte Hadley,&nbsp;Xiubin Zhang,&nbsp;Hilary Stewart,&nbsp;Sophie Stanley,&nbsp;Ces Kulikowski,&nbsp;Andrea Partridge,&nbsp;Laura Wareing,&nbsp;Lisa Ashmore,&nbsp;Christopher Gaffney,&nbsp;Jo Rycroft Malone,&nbsp;Andrew Smith,&nbsp;Cliff Shelton","doi":"10.1111/anae.70286","DOIUrl":"10.1111/anae.70286","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Prehabilitation has become increasingly prominent in the context of cancer surgery. While prehabilitation offers significant benefits, it can also inadvertently broaden inequalities because it is often more accessible to some than others. To explore the connection between health inequalities and prehabilitation before cancer surgery, we designed a qualitative study based on case study methodology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Diverse prehabilitation services were purposively sampled. We conducted orientation interviews with service leads; semi-structured interviews with professionals, patients and carers; and observations of prehabilitation practice. These were conducted following topic guides informed by implementation science theory. We employed an inductive thematic approach to allow themes to emerge, highlighting connections between prehabilitation and health inequalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six prehabilitation services across England and Wales were included, comprising a combination of established and new services, urban and semi-rural settings and varied healthcare delivery models. We conducted 47 interviews with professionals, 47 interviews with patients (including eight with carers) and 28 observations of practice. We developed six themes, which illuminated how: patients' circumstances influence their ability to engage; the value of prehabilitation to patients depends on how it is introduced and understood; services can address, but also exacerbate, health inequalities; services may offer more and/or less than the prototypical prehabilitation model; services use and develop an incomplete evidence base; and services work with limited resources to provide the most benefit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our findings highlight that while prehabilitation is often presented as a simple concept in the literature, in practice it is a complex intervention that must integrate with other ongoing treatments (e.g. surgery, chemotherapy, radiotherapy) during an already challenging period in patients' lives. Our qualitative findings from real-world settings illustrate how and why disparities arise in practice and offer insights for more equitable prehabilitation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1510-1525"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70286","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicentre audit of the efficiency of hospital-wide central vacuum systems","authors":"Asmaa Haamid,&nbsp;Nawras Osman,&nbsp;Alexander Lang,&nbsp;Steven Chawk,&nbsp;Kenneth Barker","doi":"10.1111/anae.70307","DOIUrl":"10.1111/anae.70307","url":null,"abstract":"&lt;p&gt;Vacuum suction is a critical clinical tool used to maintain airway clearance; manage respiratory conditions; and facilitate drainage therapy and specialised wound care. Most hospitals provide wall-mounted suction ports connected to a central vacuum system. These systems include multiple pumps; backup units; and extensive pipework. While designed for reliability, they are prone to entrainment and leaks due to the high number of end ports, resulting in energy consumption even when suction is not used actively. Portable on-demand suction devices, powered by batteries or mains electricity or driven by compressed air or oxygen through a Venturi effect, offer an alternative that operates only when required and may reduce environmental impact and costs.&lt;/p&gt;&lt;p&gt;A prospective audit was conducted across three UK hospitals (Raigmore Hospital, Inverness; Aberdeen Royal Infirmary, Aberdeen and Sheffield Children's Hospital, Sheffield). The data collected focused on equipment usage, with no patient interaction and included the number of suction ports for each ward and the frequency and duration of suction use. Electrical consumption was inferred from logbooks and kW ratings of pumps. Carbon emissions were calculated using UK government greenhouse gas conversion factors [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Across all hospitals, high-acuity areas such as operating theatres, endoscopy and ICUs reported daily suction use. In contrast, low-acuity wards showed substantial underutilisation. For example, single episodes of suction use of &lt; 30 s over the course of a month were reported in medical wards with ≤ 26 wall ports. Similar patterns were observed across the audited hospitals, indicating systemic overprovision of central vacuum system infrastructure (Table 1). Most suction procedures last &lt; 3 min, with many lasting &lt; 30 s. Usage for 3 min represents just 0.2% of a 24-h period, meaning the system remains clinically unused for 99.8% of the day while pumps maintain a continuous negative pressure.&lt;/p&gt;&lt;p&gt;Compressor logbooks at Raigmore Hospital revealed intermittent operation of 3 kW motors on a ‘duty cycle’ – sequentially running whenever the vacuum pressure falls to a lower limit. Even with minimal clinical demand, negative pressure must be maintained across the entire pipe network. Average weekly energy use was logged at 490.5 kWh, giving an annual total of 25,506 kWh which emits 4515 kg of carbon dioxide equivalent (CO&lt;sub&gt;2&lt;/sub&gt;e) and equates to 1300 tonnes of CO&lt;sub&gt;2&lt;/sub&gt;e emissions across the UK.&lt;/p&gt;&lt;p&gt;Annual financial costs for running the Raigmore Hospital central vacuum system pumps amount to £7396 ($9941, €8551) for electricity, not including maintenance. Based on 123,000 acute beds across the UK [&lt;span&gt;2&lt;/span&gt;], the potential annual green dividend of reviewing central vacuum system provision is &gt; £2.0 million ($2.69 million, €2.31 million). For new build hospitals, a current stage 4 tender for a 450-bed hospital lists the central vacuum installation ","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1593-1594"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of gender on career progression in academic anaesthesia","authors":"Gianni R. Lorello,&nbsp;Amber Brooks,&nbsp;Julie K. Silver","doi":"10.1111/anae.70422","DOIUrl":"10.1111/anae.70422","url":null,"abstract":"&lt;p&gt;Despite changes in global sociocultural, geopolitical and legal climates, many organisations continue to publicly project their commitment to equity, diversity and inclusion, potentially acting as academic currency by attracting learners, faculty and donors whose values and beliefs align with these social justice principles. From the outside, healthcare and academic institutions may portray a polished appearance, presenting leaders in their respective fields and inclusive representation on websites and social media. However, behind closed doors, socially marginalised people continue to experience inequities, discrimination and harassment, while people from dominant groups often continue to benefit. Inequities persist, even despite evidence that diversity increases physician well-being [&lt;span&gt;1&lt;/span&gt;] and improves patient care [&lt;span&gt;2&lt;/span&gt;]. These inequities can occur across many levels: individual; interpersonal; organisational; professional and medical communities; and governmental and public policy.&lt;/p&gt;&lt;p&gt;The work by Allen et al. provides a contemporary understanding of gender equity initiatives within anaesthesia while highlighting strategies to advance gender equity across leadership positions [&lt;span&gt;3&lt;/span&gt;]. The state-of-the-art methodology systematically identified 18 studies implementing strategies aimed at improving gender equity within anaesthesia. The authors categorised all included publications according to Cook's framework for classifying study purposes within the medical education spaces, and deductively analysed publications according to Stufflebeam's framework, highlighting context, input, process and outcomes [&lt;span&gt;3&lt;/span&gt;]. Individual-level interventions included mentorship and sponsorship [&lt;span&gt;3&lt;/span&gt;]. Organisation-level interventions included curricula tailored towards professional development; policies; and equity, diversity, and inclusion leadership roles [&lt;span&gt;3&lt;/span&gt;]. The authors concluded that success metrics, including representation and well-being, should be assessed continuously, policies focusing on diversity and leadership roles should be introduced and that programmatic costs and context should be iteratively evaluated.&lt;/p&gt;&lt;p&gt;We celebrate the work that provides us with a contemporaneous understanding of gender equity initiatives within anaesthesia leadership. In this editorial, we provide complementary information to the findings of Allen et al. by focusing on organisational, professional medical community and government/public policy levels.&lt;/p&gt;&lt;p&gt;Governmental and public policy decisions impact gender equity. For instance, research priorities reflect both the political and scientific values of those responsible for decision-making [&lt;span&gt;4&lt;/span&gt;], often under funding research within the humanities and social sciences, and topics such as gender, sexuality and reproductive health [&lt;span&gt;20&lt;/span&gt;]. In addition, gender disparities exist in grant success and funding success, whereby women in general ","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1477-1480"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy and precision of continuous, non-invasive blood pressure devices: a systematic review and meta-analyses","authors":"Stefanie Lischker,&nbsp;Gunther J. Pestel,&nbsp;Irene Schmidtmann,&nbsp;Eva-Verena Griemert","doi":"10.1111/anae.70250","DOIUrl":"10.1111/anae.70250","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Reliable continuous non-invasive blood pressure monitoring technology should support clinicians to maintain blood pressure within appropriate limits peri-operatively. Previous studies have shown conflicting results regarding measurement accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This systematic review and six meta-analyses evaluated the accuracy and precision of non-invasive continuous arterial blood pressure measurement technologies (volume clamp technology, applanation tonometry and photoplethysmography) compared with invasive arterial measurement in adults. We analysed pooled bias (mean difference between non-invasive and invasive measurement), standard deviation and limits of agreement. In each meta-analysis, mean arterial pressure (MAP), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were analysed separately. Acceptability was defined according to Association for the Advancement of Medical Instrumentation® (AAMI) criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-five studies were included: two meta-analyses for volume clamp technology (ClearSight™, CNAP™); three meta-analyses for applanation tonometry (T-Line™, Vasotrac™ and N-CAT™); and one meta-analysis for photoplethysmography technology. For volume clamp technologies, none met AAMI criteria for bias and SD in relation to MAP, SBP and DBP. T-Line, Vasotrac and N-CAT met the AAMI criteria for bias for MAP (2.53 mmHg, 0.36 mmHg, -0.37 mmHg), SBP (-0.07 mmHg, 1.20 mmHg, -3.68 mmHg) and DBP (3.09 mmHg, 1.09 mmHg, 0.84 mmHg), respectively. In terms of standard deviation, only N-CAT (MAP 6.97 mmHg, SBP 7.14, mmHg, DBP 6.55 mmHg) met AAMI criteria for all blood pressure parameters. Photoplethysmography technology met AAMI criteria for bias (MAP -0.09 mmHg, SBP 0.49 mmHg, DBP -0.26 mmHg) and standard deviation (MAP 6.86 mmHg, DBP 6.38 mmHg).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Overall, the AAMI criteria for bias and SD were not fulfilled for most of the devices tested and wide limits of agreement are of concern. One applanation tonometry device (N-CAT) shows promise. Clinicians should be aware of the lack of interchangeability with invasive blood pressure management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1581-1592"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70250","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}