The edition · Anaesthesiology
Videolaryngoscopy did not raise first-attempt success in infants, and relative blood pressure drops track with postoperative pneumonia
A Japanese airway registry finds videolaryngoscopy linked to lower first-attempt success in neonates and infants, a 151,036-patient cohort ties relative falls in blood pressure to pneumonia, and a European cohort puts general anaesthesia at 14.8% of Caesarean deliveries.
The edition in brief
In a retrospective registry cohort of 3,250 intubation encounters in neonates and infants, videolaryngoscopy was associated with a lower probability of first-attempt success than direct laryngoscopy (adjusted risk ratio 0.89, 95% CI 0.83 to 0.96) and a higher risk of desaturation (adjusted risk ratio 2.18), despite better glottic views, suggesting an efficacy-effectiveness gap. In 151,036 adults having non-cardiac surgery, a fall of 20% or more from baseline mean arterial pressure was more consistently associated with 30-day pneumonia than absolute thresholds (sub-distribution hazard ratio 1.108 for any episode). A single-centre cohort of 4,358 cardiac surgery patients linked lower oxygen delivery on bypass to higher 30-day mortality (adjusted OR 1.16 per 10 ml/min/m2 decrease). A 31-country cohort of 9,989 Caesarean deliveries found general anaesthesia in 14.8%, including 54.0% of emergency cases.
General anaesthesia for Caesarean delivery across Europe: 14.8% overall, 54% in emergencies
Plan for possible conversion to general anaesthesia even in elective Caesarean deliveries under neuraxial block, and keep airway equipment and a plan ready.
Relative blood pressure falls, not fixed thresholds, track with postoperative pneumonia
Consider recording the preoperative baseline blood pressure and noting relative falls during surgery, bearing in mind this is an association from observational data.
Lower oxygen delivery on cardiopulmonary bypass went with higher 30-day mortality
Discuss indexed oxygen delivery targets with the perfusion team, recognising this is single-centre observational evidence and no target has been tested.
Record the baseline blood pressure before induction
Write down a considered baseline blood pressure on the chart before induction.
Videolaryngoscopy in infants: better view, but lower first-attempt success in real-world registry data
Consider structured training and a standard technique for videolaryngoscopy in infants, and watch saturation during attempts; this single registry does not justify abandoning the device.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for anaesthesiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free