A rude surgeon doubled the odds of proceeding, and 21 mm is the number to remember

The edition in brief

Six anaesthetic societies produced consensus guidance on aseptic practice for single-shot spinal anaesthesia, reviewing 239 articles and running a three-round Delphi with 32 experts and a patient representative. Consensus was reached on eight statements and all 11 recommendations, including that routine sterile gowns should not be considered mandatory for uncomplicated adults, while hand hygiene and facemask use remain essential. A target trial emulation in the Japanese national claims database compared 244,212 patients having major orthopaedic surgery under general plus regional anaesthesia against 435,462 under general anaesthesia alone; after propensity weighting, the combined group had a slightly better admission-to-discharge Barthel Index change (mean difference 0.73, 95% CI 0.57-0.88), shorter postoperative stay (-1.40 days, -1.45 to -1.35) and lower in-hospital mortality (hazard ratio 0.85, 0.76-0.96). A randomised, triple-masked trial in 50 patients found that adding a continuous erector spinae plane block to a single-injection block after percutaneous nephrolithotomy changed neither pain (estimated difference 0.25, 95% CI -1.0 to 1.5) nor oxycodone use. In a blinded crossover study across two centres, 79 anaesthesiology residents facing clinically ambiguous simulated cases were more likely to proceed with surgery when the standardised surgeon was uncivil (odds ratio 2.25, 95% CI 1.07-4.74), with no measurable fall in their performance scores. And in 192 adults at raised risk of difficult airway management, interincisor distances below 21 to 23 mm marked the point at which Macintosh videolaryngoscopy began to fail; mouth opening fell after induction in 51% of patients.