The edition · Anaesthesiology
Regional anaesthesia cuts chronic postsurgical pain by about a quarter; in real-world infant intubation, videolaryngoscopy did worse on first attempt
A network meta-analysis of 158 trials supports blocks to prevent chronic postsurgical pain, a Japanese registry finds videolaryngoscopy linked to lower first-pass success and more desaturation in neonates and infants, UK societies publish a day-surgery consensus, and meta-analyses revisit ventilation on bypass and hydroxyethyl starch in surgical patients.
The edition in brief
A network meta-analysis of 158 randomised trials (18,794 patients) found regional anaesthesia reduced chronic postsurgical pain against no block (RR 0.73, 95% CI 0.67 to 0.80), with effects up to 12 months, including after mastectomy, thoracotomy, VATS and knee arthroplasty; neuraxial techniques outperformed peripheral ones after thoracic surgery. Certainty was low, and long-term opioid use did not differ. In 3250 intubations of neonates and infants in the Japanese J-PEDIA registry, videolaryngoscopy was associated with lower first-attempt success than direct laryngoscopy (adjusted RR 0.89, 0.83 to 0.96) and more desaturation (RR 2.18), despite better glottic views. UK anaesthesia and day-surgery associations published a Delphi consensus on patient selection, comorbidities including frailty, obesity and sleep apnoea, techniques and discharge. A meta-analysis of cardiac surgery ventilation trials found continuing ventilation during cardiopulmonary bypass reduced pulmonary complications (RR 0.87, 0.79 to 0.96). A meta-analysis of 114 surgical trials found no increase in acute kidney injury with HES 130/0.4 (RR 1.02, 0.91 to 1.16), though regulatory warnings remain in force. The practical message: offer a regional technique where chronic pain risk is high, and train deliberately before relying on videolaryngoscopy in small infants.
Videolaryngoscopy was linked to lower first-attempt success and more desaturation in infant intubation
In real-world infant intubation, videolaryngoscopy was associated with lower first-pass success and more desaturation; structured training is needed before routine first-line use.
UK societies publish a consensus on day-surgery anaesthesia for adults and children
Select day-surgery patients by optimised physiology rather than blanket exclusions, and design anaesthesia and discharge for same-day home.
Continuing ventilation during cardiopulmonary bypass reduced pulmonary complications
Ventilating during cardiopulmonary bypass reduced pulmonary complications across 15 trials; consider it as a unit standard.
Hydroxyethyl starch did not increase kidney injury in surgical patients across 114 trials
Short perioperative use of HES 130/0.4 was not associated with kidney injury in 114 surgical trials, but regulatory warnings stand and it remains contraindicated in sepsis.
Protect the first attempt in infant intubation
Prepare oxygenation, position and an abort plan before the first attempt; the laryngoscope matters less than the set-up.
Regional anaesthesia reduced chronic postsurgical pain by about a quarter across 158 trials
Plan a regional technique for breast, thoracic and knee surgery; it reduced chronic postsurgical pain by about a quarter for up to a year.
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