Anaesthesia最新文献

{"title":"Disability after non-cardiac surgery – patient-centred outcomes and resource utilisation after non-cardiac surgery (PACORUS): a prospective multicentre cohort study*","authors":"Alexandra Stroda,&nbsp;Jan Larmann,&nbsp;Andrea Icks,&nbsp;Mark Coburn,&nbsp;Marc Moritz Berger,&nbsp;Alexander Mathes,&nbsp;Robert Werdehausen,&nbsp;Sarah Thaler,&nbsp;Sebastian Ziemann,&nbsp;Claudia Neumann,&nbsp;Sebastian Roth,&nbsp;René M'Pembele,&nbsp;Theresa Tenge,&nbsp;Celine Bußhoff,&nbsp;Madeleine Rallis,&nbsp;Giovanna Lurati Buse,&nbsp;the PACORUS-D Investigators","doi":"10.1111/anae.70248","DOIUrl":"10.1111/anae.70248","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The Standardised Endpoints in Perioperative Medicine Initiative recommends the 12-item WHO Disability Assessment Schedule (WHODAS) 2.0 to measure postoperative functional impairment. However, evidence describing long-term postoperative disability, particularly at 1 year, remains limited. This study aimed to: describe disability up to 1 year after non-cardiac, non-neurosurgical procedures; examine associations between periprocedural risk, postoperative complications and new-onset disability; and evaluate associations between social support, delirium, and frailty and postoperative disability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a prospective, multicentre cohort study. The primary endpoint was new onset clinically significant disability (an increase in WHODAS 2.0 score ≥ 5% points from baseline to a final score ≥ 35%) or death at 1 year. Independent variables included: periprocedural risk; postoperative complications; frailty; and patient-reported social support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 1081 patients were included: 726 (67%) male, median (IQR) [range] age 67 (60–75 [50–101]) y. New onset clinically significant disability was present in 139/1081 (12.9%) patients at 1 year and in 238/1066 (22.3%) patients at 30 days. Periprocedural risk (adjusted odds ratio (aOR) 1.05, 95%CI 1.03–1.07, per percent in American College of Surgeons National Surgical Quality Improvement Program score) and postoperative complications of all grades were associated with 1-year new onset clinically significant disability. New onset (1 year) clinically significant disability was not associated with social support: OR 0.87, 95%CI 0.54–1.39 for moderate; and OR 0.76, 95%CI 0.47–1.24 for strong social support. Frailty was strongly associated with new onset clinically significant disability after 1 year (aOR 3.97, 95%CI 2.54–6.21).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>One year after non-cardiac surgery, 13% of surviving patients experienced a new onset clinically significant disability. Postoperative complications, even those of low severity, were associated with new onset postoperative disability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1497-1509"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70248","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216021","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":"Optimal intrathecal morphine dosing for revision hip arthroplasty: an observational study","authors":"Shalini Patel,&nbsp;Vassia Paschou,&nbsp;Jane Quinlan,&nbsp;Ben Kendrick,&nbsp;Nicolas Suarez","doi":"10.1111/anae.70305","DOIUrl":"10.1111/anae.70305","url":null,"abstract":"&lt;p&gt;Around 2–10% of primary total hip arthroplasties fail and require revision due to: infection; component wear; loosening; dislocation; persistent pain; or periprosthetic fracture [&lt;span&gt;1&lt;/span&gt;]. The rise in life expectancy has contributed to an increasing demand for revision procedures. Revision surgery is more complex than primary surgery, involving greater surgical trauma; increased blood loss; and less predictable improvements in pain and function. However, there is little information on optimal anaesthetic and analgesic strategies.&lt;/p&gt;&lt;p&gt;The PROSPECT guidelines for primary total hip arthroplasty recommend intrathecal morphine to improve pain control and reduce postoperative opioid requirements [&lt;span&gt;2&lt;/span&gt;]. However, this may increase adverse effects and risk. Whilst 100–200 μg intrathecal morphine appears effective and safe in primary total hip arthroplasty, evidence in revision surgery is limited [&lt;span&gt;3&lt;/span&gt;]. Our study evaluated analgesic efficacy and adverse effects of intrathecal morphine in revision total hip arthroplasty.&lt;/p&gt;&lt;p&gt;This retrospective observational study was conducted between April 2023 and April 2024 at the Nuffield Orthopaedic Centre, Oxford, UK, a high-volume revision arthroplasty centre. All adults undergoing revision total hip arthroplasty were included. Patients receiving continuous sedative or epidural opioid infusions postoperatively were not studied. Ethical approval was not required but Caldicott Guardian approval was obtained. The mode of anaesthesia was recorded, including intrathecal or regional anaesthesia. Doses of intrathecal morphine were then stratified into four dose groups (100 μg, 150 μg, 200 μg and 250 μg). Primary outcomes were total opioid consumption in the first 24 h (oral morphine equivalents) and highest pain scores at rest and movement during the first four 12-h postoperative periods. Pain scores were recorded using routinely collected verbal descriptors on a 4-point scale (0 = none; 1 = mild; 2 = moderate; 3 = severe), which is standard for our institution. Secondary outcomes were anti-emetic, chlorphenamine and naloxone use in the first 24 h. Between-group comparisons were performed with Mann–Whitney U or χ&lt;sup&gt;2&lt;/sup&gt; tests; multiple groups were compared using the Kruskal–Wallis test with post-hoc Dunn's testing.&lt;/p&gt;&lt;p&gt;Of 201 patients undergoing revision total hip arthroplasty, 16 (79.6%) were not included due to postoperative epidural or intravenous opioid infusions, leaving 185 for analysis (Table 1). In total, 174 (94.1%) patients received concurrent general anaesthesia. Among the 51 (27.6%) patients who did not receive a spinal, 32 (63%) received a peripheral nerve block and 13 (10%) received both spinal anaesthesia and a block. The most common blocks were the fascia iliaca (n = 24) and femoral nerve (n = 13) blocks.&lt;/p&gt;&lt;p&gt;Intrathecal anaesthesia was administered to 134 patients (72.4%), of whom 107 (79.9%) received intrathecal morphine at a median (IQR [range]) dose of 200 (13","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1603-1604"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70305","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522267","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":"Use of cat litter for denaturing high volumes of discarded medications: a cost-saving approach from veterinary medicine","authors":"Scarlett Tankard,&nbsp;Cliff Shelton,&nbsp;Sarah Wheatly","doi":"10.1111/anae.70314","DOIUrl":"10.1111/anae.70314","url":null,"abstract":"&lt;p&gt;The amount of waste generated by the NHS is increasing and is estimated to reach 200,000 tonnes annually by 2029/2030 [&lt;span&gt;1&lt;/span&gt;]. Clinical waste is processed using: high-temperature incineration; alternative treatment, which disinfects waste using heat or steam; or offensive waste pathways, where waste is treated through energy-from-waste facilities or sent to landfill. These processes generate greenhouse gases and incur financial costs estimated at £26.6–36.1 m (US$35.2–47.7 m, €30.9–41.9 m) per waste stream in 2024/2025 [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Safe waste management is legally mandated [&lt;span&gt;3&lt;/span&gt;] and appropriate waste segregation reduces financial and environmental burdens. By 2026, all NHS providers should achieve clinical waste segregation targets of 20% high-temperature, 20% alternative treatment and 60% offensive [&lt;span&gt;1&lt;/span&gt;]. In anaesthesia, non-hazardous medicinal waste can be placed in blue-lidded containers (‘blue-stream waste’) which undergo municipal incineration in waste-to-energy facilities, offering more sustainable and cheaper disposal [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Some NHS Trusts, including ours, use blue open-top cardboard boxes lined with plastic bags for blue-stream waste. However, colleagues have expressed concerns about the accessibility of discarded propofol, which has potential for misuse. Anecdotal reports suggest that some expel waste propofol directly into the bag to reduce accessibility. Inappropriate disposal of propofol may make spillage more likely, with a risk of toxicity to aquatic life [&lt;span&gt;5&lt;/span&gt;]. The volume of surplus propofol is likely to be greater when total intravenous anaesthesia is used.&lt;/p&gt;&lt;p&gt;Controlled drugs may also be discarded via blue-stream waste once denatured. ‘Denaturing’ refers here to rendering them irretrievable, rather than the biological definition which implies molecular changes [&lt;span&gt;6&lt;/span&gt;]. Current practice at our Trust involves commercial denaturing kits, which cost approximately £5.00 (US$6.63, €5.79) per 500-ml container [&lt;span&gt;7&lt;/span&gt;]. Though controlled drugs are often prepared in small volumes, remifentanil and epidural preparations create larger volumes of waste. Our obstetric unit uses denaturing kits on a single-patient basis for these infusions.&lt;/p&gt;&lt;p&gt;In veterinary medicine, alternative approaches to denaturing, including sawdust or absorbent cat litter, are sanctioned by UK Government guidance [&lt;span&gt;8&lt;/span&gt;]. The latter is already used in some NHS settings (personal communication, Ann Woolridge, CEO Independent Safety Services, 19 June 2026). To explore reducing the cost of denaturing, and thereby potentially expand its use to propofol without additional cost, we designed a bench experiment to evaluate whether cat litter could render propofol and controlled drugs irretrievable.&lt;/p&gt;&lt;p&gt;We acquired four commercially available cat litters: wood chip (Cat's Best Original, Cat's Best, Rosenberg, Germany); wood pellets (Wood Pellet Non-Clumping Cat Litter, Pet","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1605-1606"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726345","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 ‘Great Theatre Turn-off’: what do we need to do?","authors":"Kenneth Barker,&nbsp;Graeme Dunn,&nbsp;Michael Ralph","doi":"10.1111/anae.70309","DOIUrl":"10.1111/anae.70309","url":null,"abstract":"&lt;p&gt;In addressing the massive contribution of healthcare to imminent climate collapse, low-value care is a primary target, as around 20% of healthcare spend does not actually result in improvements in health [&lt;span&gt;1, 2&lt;/span&gt;]. If an activity does not benefit our patients, then why should we continue with it? Most clinical teams will be addressing wasteful clinical care, but attention should also be focused on operational waste, including the systems and infrastructure of our hospitals. In particular, the need for certain 24/7 facilities should be challenged, given ever-changing clinical practice.&lt;/p&gt;&lt;p&gt;Infrastructure systems provide surgical operating theatres and the wider hospital with many essential tools and conditions to ensure optimal safe and efficient operating and patient care, and most of these systems have been in place for decades. Inevitably, clinical practice changes in response to new technology or improvement evidence, but the pace of change is often not matched by revision of building or infrastructure regulations. Hospital design, therefore, needs regular review and matching with clinical demand in order to avoid waste.&lt;/p&gt;&lt;p&gt;Some infrastructure systems have local protocols for set-back or switch-off, but others remain switched on permanently despite limited use, utilising energy unnecessarily and contributing to the carbon footprint of the NHS. The specific systems are heating, ventilation and air conditioning; 7-bar air; central vacuum systems; and anaesthetic gas scavenging systems. Consideration should also be given to water use, lighting and general space heating, and even allocation of floor space in the form of anaesthetic rooms. A summary of recommendations is shown in Table 1.&lt;/p&gt;&lt;p&gt;Heating, ventilation and air conditioning is regulated by Health Technical Memorandum 03-01 and Scottish Health Technical Memorandum 03-01 [&lt;span&gt;9, 10&lt;/span&gt;], which describe energy control strategies for air handling units, including out-of-hours automated switch off. This is controlled by building management systems, with temperature, humidity and occupancy control measures in place to protect equipment and anticipate daytime activity. Where ultra-clean ventilation is present, this should also be linked to the building management systems and local air handling units as ‘&lt;i&gt;there is no aerobiological benefit in keeping the ultra-clean ventilation terminal fans running when the theatre is not in use, it results in wasted energy&lt;/i&gt;’ [&lt;span&gt;9, 10&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The regulations recommending automatic switch-off have been in place for many years, but newly constructed facilities are still being delivered without this control, meaning that the potential for energy savings up to 70% is not realised [&lt;span&gt;3&lt;/span&gt;]. Automation of older existing plant can be more challenging, but there may be a case for upgrading to newer equipment given the carbon and financial savings, and short return on initial investment. Estimating the potential savings ac","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1473-1476"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148675371","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":"A good death in intensive care","authors":"Mike Charlesworth,&nbsp;Matt Makin","doi":"10.1111/anae.70304","DOIUrl":"10.1111/anae.70304","url":null,"abstract":"&lt;p&gt;A key goal of admitting a patient to ICU is to improve survival. Survival can mean many things [&lt;span&gt;1&lt;/span&gt;], but most clinicians think instinctively about hospital mortality; discharge home; quality of recovery; and prolongation of life. Achieving these outcomes can come with significant costs, including delirium; loss of control; dependence; invasive procedures; and functional decline [&lt;span&gt;2-4&lt;/span&gt;]. Alongside balancing these benefits and burdens is sometimes the need to provide a good dying experience. Increasingly, ICU is recognised not only as a place of rescue, but also as a place where compassion, dignity and comfort can be provided at the end of life. Around 20% of patients admitted to ICU will die during their stay [&lt;span&gt;5&lt;/span&gt;], and transitioning care to focus on symptom-based management precedes most deaths [&lt;span&gt;6&lt;/span&gt;]. End-of-life care is a central component of modern intensive care practice rather than a failure of it.&lt;/p&gt;&lt;p&gt;Considering this, the work by Donaldson et al. provides a timely insight into patient experience on the ICU [&lt;span&gt;7&lt;/span&gt;]. The authors used a mixed methods approach to explore the experiences of 26 survivors of ICU admission. The accounts make for difficult reading but will come as little surprise to clinicians working in critical care. Participants described hallucinations; fear; loss of autonomy; and the psychological burden of prolonged dependence on life-sustaining technologies. One described being reduced to “&lt;i&gt;a thing on the bed, rather than a person&lt;/i&gt;”. Some participants also described ICU as a place of safety and compassionate care. The study concluded that, for patients with a low likelihood of survival, admission to ICU may risk a negative dying experience. These are, necessarily, the reflections of those who survived, imagining a death they did not undergo, and this is the most important caveat of their work. Two fictitious examples here (Boxes 1 and 2) help illustrate how this tension may manifest in practice.&lt;/p&gt;&lt;p&gt;Neither Mrs A nor Mr B could have described their experiences during the final stages of illness, so suffering may remain partially hidden from clinicians and relatives alike. Mrs A entered hospital expecting curative surgery, yet complications led to prolonged technological dependence and chronic critical illness (Box 1). Rather than a single terminal event, her dying became extended and highly medicalised, with risks of psychological suffering, moral distress among staff and complicated bereavement. Conflict, mistrust and loss of autonomy complicate decision-making, and although there are opportunities throughout for palliative and symptom-focused care, clinicians will recognise how difficult these situations become.&lt;/p&gt;&lt;p&gt;The trajectory of Mr B was shorter (Box 2), with rapid transition from apparent health to dependence on advanced technology, leaving little opportunity to discuss acceptable outcomes beforehand (Box 2). Withdrawal of extracorporeal support may b","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1469-1472"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70304","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148451603","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":"Management of major thoracic trauma: a narrative review","authors":"Navniel Kaur,&nbsp;Sophie Lewis,&nbsp;Hollie Jenkinson,&nbsp;Christopher Keegan,&nbsp;Nikhil Misra,&nbsp;Simon Neequaye,&nbsp;Simon Scott,&nbsp;Tim Astles,&nbsp;Ben Morton","doi":"10.1111/anae.70284","DOIUrl":"10.1111/anae.70284","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Traumatic thoracic injuries are a leading cause of morbidity and mortality worldwide, not only as a direct consequence of the injury itself, but also due to development of secondary insults such as infection; acute kidney injury; acute respiratory distress syndrome; and shock. The thorax houses vital structures, and even seemingly trivial trauma may result in catastrophic damage particularly in children or older patients. This review aims to highlight important considerations in diagnosis and management of major thoracic injuries and the crucial role of appropriate supportive interventions such as airway control, ventilation strategies and optimal pain management to aid in recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We undertook a narrative review of the contemporary literature. We synthesised evidence related to mechanisms of thoracic trauma and initial assessment and diagnosis of major thoracic injuries. We also highlight key considerations in chest wall, pulmonary, cardiac and diaphragmatic injuries; supportive management strategies for patients with thoracic trauma; and special considerations in older patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thoracic injuries are broadly classified by the mechanism of trauma (blunt, penetrating or blast) or by the anatomical structure involved. Initial assessment and diagnosis follows general trauma principles. Depending on the injuries sustained, surgical intervention may be indicated. Equally important is appropriate supportive management. Older patients are often overlooked as a high-risk group and a lower threshold for specialised trauma care or critical care services is recommended in this cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>A multidisciplinary approach is key in management of patients with thoracic trauma due to their numerous needs, ranging from surgical intervention and critical care support to physiotherapy and rehabilitation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1535-1548"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70284","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388660","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":"Remimazolam vs. propofol anaesthesia for delirium in older patients recovering from lung resections: a randomised non-inferiority trial","authors":"Wei Wang,&nbsp;Fengping Zhang,&nbsp;Yi Ge,&nbsp;Yunyun Zhang,&nbsp;Daniel I. Sessler,&nbsp;Jingxiang Wu,&nbsp;Dongliang Mu,&nbsp;Yuwei Qiu","doi":"10.1111/anae.70290","DOIUrl":"10.1111/anae.70290","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Remimazolam tosylate is an ultra-short-acting benzodiazepine sedative and anaesthetic. The related drug, midazolam, is associated with delirium but it remains unclear whether remimazolam also promotes delirium. We tested the primary hypothesis that remimazolam is non-inferior to propofol for delirium in patients during the initial 3 days after lung resection surgery. Secondary outcomes were the proportion of delirium-positive assessments; duration of stay in the post-anaesthesia care unit; and hospital and Mini-mental State Examination scores at 30 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We randomly allocated patients aged ≥ 65 y to remimazolam or propofol anaesthesia for lung resection surgery. Delirium was assessed by trained assessors blinded to trial treatment using the Confusion Assessment Method in the post-anaesthesia care unit and twice daily for 3 postoperative days. Our non-inferiority margin was a 10% absolute difference in the incidence of postoperative delirium.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The modified intent-to-treat population included 455 patients. Delirium occurred in 108/227 (48%) patients allocated to the remimazolam group and 71/228 (31%) in those allocated to the propofol group (risk ratio 1.53, 95%CI 1.21–1.94). The absolute risk difference was 16.5% (95%CI 7.7–25.3%) which considerably exceeded our non-inferiority margin; therefore, non-inferiority was not established. Emergence delirium was more frequent in patients allocated to remimazolam (105/227 (46%) vs. 64/228 (28%); risk ratio 1.65, 95%CI 1.28–2.12), whereas delirium after post-anaesthesia care unit discharge was uncommon and similar between groups (9/227 (4%) vs. 12/228 (5%); risk ratio 0.75, 95%CI 0.32–1.75). Delirium-positive assessments occurred in 129/1377 (9%) patients allocated to the remimazolam group and 102/1440 (7%) in those allocated to the propofol group (risk ratio 1.36, 95%CI 0.96–1.91).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Remimazolam was not non-inferior to propofol for postoperative delirium in older patients having lung resection surgery and provoked more emergence delirium.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1526-1534"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70290","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148459634","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":"Sugammadex interference with serum progesterone measurement: an in-vitro study","authors":"Tamblyn Devoy,&nbsp;Theresa Larkin,&nbsp;Miles Allan,&nbsp;Kevin Mantik,&nbsp;Monika McShane,&nbsp;Natalie A. Smith","doi":"10.1111/anae.70292","DOIUrl":"10.1111/anae.70292","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Sugammadex may interfere with serum progesterone immunoassays, potentially rendering measured concentrations and resulting recommendations unreliable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We investigated the effect of a range of sugammadex concentrations on serum progesterone concentrations in samples from pre-menopausal female volunteers. Samples were spiked with sugammadex concentrations (15–120 μM), corresponding to clinical doses between 2 mg.kg^-1 and 19 mg.kg^-1. Total progesterone concentrations in each sample were determined using the routine electrochemiluminescence immunoassay method. A subgroup of 15 samples underwent further testing using liquid chromatography–tandem mass spectroscopy, comparing baseline with sugammadex 120 μM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-five participants provided blood samples. Increasing concentrations of sugammadex were associated with lower measured serum progesterone, with an approximate 10% reduction with each doubling of sugammadex concentration (F(2,30) = 4.86, p = 0.015). Overall, progesterone concentrations decreased by a mean (SD) of 34.6% (12.4%) between control samples and those spiked with sugammadex 120 μM (p = 0.015). In contrast, liquid chromatography–tandem mass spectroscopy showed no statistically significant biochemical change in progesterone concentrations between baseline and sugammadex 120 μM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Sugammadex produced a dose-dependent reduction in the progesterone concentrations when measured by immunoassay techniques, but not by liquid chromatography–tandem mass spectroscopy. This suggests that an immunoassay interference occurs across clinically relevant doses. Progesterone results from routine laboratory testing should be interpreted with caution in the presence of sugammadex.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1489-1496"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70292","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618230","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 analysis of 7-bar surgical air provision and use across NHS Scotland","authors":"Katharine Dunn,&nbsp;Lydia Robb,&nbsp;Steven Chawk,&nbsp;Colin McKie,&nbsp;Kenneth Barker","doi":"10.1111/anae.70308","DOIUrl":"10.1111/anae.70308","url":null,"abstract":"&lt;p&gt;Historically, surgical air powered a range of surgical tools, particularly in orthopaedics. Advances in technology have enabled widespread adoption of battery-operated and electric cable tools, reducing reliance on compressed air. Scottish Health Technical Memorandum 02-01 states that surgical air is only required where air-driven surgical tools are used [&lt;span&gt;1&lt;/span&gt;]. With decreasing clinical use, decommissioning of existing surgical 7-bar air plants may be appropriate where standalone systems are installed. However, many sites have combined 7 and 4-bar medical air plants, making decommissioning difficult. In new-build hospitals, consideration should be given to replacing 7-bar systems with modern alternative tools or local cylinder supply where necessary.&lt;/p&gt;&lt;p&gt;We investigated the use of surgical air across NHS Scotland to assess whether centralised piped systems remain necessary.&lt;/p&gt;&lt;p&gt;Surgical air (7-bar) was used to power tools in several surgical specialities. The configuration of plant varies from combined systems, typical in small to medium hospitals, where compressed air is generated at 9–10-bar and then regulated to 7 and 4-bar, to separate systems used where consumption justifies independent plants. Higher pressure systems consume more energy with an approximately 7% increase in energy use per additional bar of pressure meaning approximately 21% higher energy consumption for 7- vs. 4-bar systems [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;An overview of compressed air systems at 29 acute hospitals in NHS Scotland revealed that 24 sites have combined medical air systems, two have separate 7- and 4-bar compressed air systems and three provide 4-bar systems only. One hospital recently decommissioned its 7 bar air plant in favour of local cylinder provision for the only identified clinical use in orthopaedics.&lt;/p&gt;&lt;p&gt;Analysis of clinical use found that 28/36 orthopaedic surgeons report no use of 7-bar air for hand tools, with others indicating only occasional or limited use and, of those, all were willing to trial battery or electric alternatives. Cement mixing remains the main indication for 7-bar air, but accounts for just 30 s of use per cement mix. This equates to 4 min of use for an arthroplasty list of four cases or 0.28% utilisation. Measurement of one Venturi cement mixing vacuum pump driven by 7-bar air revealed an average flow rate of 20 l.min&lt;sup&gt;-1&lt;/sup&gt;, meaning that cylinder supply of 80–100 l.day&lt;sup&gt;-1&lt;/sup&gt; of compressed air should suffice. Use in plastic surgery was limited to dermatomes and drills, estimated at 5–10 min per case (0.35–0.7% utilisation), but with a number of units already using electric alternatives. There was no use of 7-bar tools in cardiothoracic or neurosurgery, with all centres now using electric tools and a mix of air and mains tools in oral and maxillofacial surgery. Dental services utilise a separate system of a lower standard compared with surgical use [&lt;span&gt;3&lt;/span&gt;] and most clinics are supplied by local com","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1595-1596"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70308","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148522334","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 as a high-acuity, low-occurrence event: is widespread videolaryngoscopy to blame?","authors":"Jan Hansel,&nbsp;Marko Zdravkovic","doi":"10.1111/anae.70302","DOIUrl":"10.1111/anae.70302","url":null,"abstract":"&lt;p&gt;Awake tracheal intubation, defined as the placement of a tracheal tube in an awake, spontaneously breathing patient, either by means of a flexible bronchoscope and/or videolaryngoscope, is a risk-mitigation strategy in patients with predicted features of difficult airway management [&lt;span&gt;1&lt;/span&gt;]. Numerous guidelines endorsed by professional societies advocate for awake tracheal intubation in the context of predicted difficulty [&lt;span&gt;2-4&lt;/span&gt;] and the Difficult Airway Society (DAS) has published dedicated guidelines on the topic [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Cortese et al. conducted an international survey of 4728 clinicians from 102 countries, assessing contemporary practice patterns and perceptions surrounding awake tracheal intubation in the era of widespread videolaryngoscopy [&lt;span&gt;5&lt;/span&gt;]. The survey follows similar recent projects conducted at national level [&lt;span&gt;6, 7&lt;/span&gt;], providing an important international perspective on practice of awake tracheal intubation. A few themes and ongoing questions relating to training curricula, indications and standardisation of awake tracheal intubation emerge, which we explore in more detail.&lt;/p&gt;&lt;p&gt;Awake tracheal intubation was perceived as a core skill for any anaesthetist by 97% of survey respondents [&lt;span&gt;5&lt;/span&gt;]. However, depending on regional factors, such as patient case-mix, procedural delegation and availability of alternate approaches, the procedure can move quickly into the category of ‘high acuity, low occurrence’ events for some, akin to emergency front-of-neck airway situations (Fig. 1). Indeed, only 76% of respondents reported performing awake tracheal intubation clinically, leaving a skill gap for a number of anaesthetists. The gap is likely larger, as ‘performing awake tracheal intubation clinically’ does not equal ‘performing awake tracheal intubation with sufficient frequency to maintain proficiency’. Similar trends have been observed for other anaesthesia and critical care techniques, with thoracic epidurals and percutaneous tracheostomies serving as comparable examples [&lt;span&gt;8, 9&lt;/span&gt;]. These procedures have in some settings led to subspecialisation, where only a handful of clinicians in a given department perform them with sufficient frequency to maintain competence. Were such an approach taken with awake tracheal intubation, there are obvious ramifications to both individual clinician skill retention and overall service provision. Emergency awake tracheal intubation becomes even more relevant outside of regular working hours when skilled staff may not be available to deliver the appropriate intervention.&lt;/p&gt;&lt;p&gt;International curricula for postgraduate training in anaesthesia variably refer to awake tracheal intubation as a core skill. In the UK, the 2021 curriculum of the Royal College of Anaesthetists expects a fully qualified anaesthetist to be able to perform fibreoptic tracheal intubation independently, with further key capabilities including performing awake trac","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 11","pages":"1464-1468"},"PeriodicalIF":7.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70302","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521963","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}