Remimazolam for bronchoscopy sedation, and how often a Caesarean ends under general anaesthesia

The edition in brief

A prospective cohort of 9,989 Caesarean deliveries in 361 European centres found general anaesthesia in 14.8% overall and 54% of emergency cases, with conversion from neuraxial to general anaesthesia in 7.7%, including 6.1% of elective cases. A triple-blinded trial in 90 knee replacements found IPACK and a selective tibial nerve block gave the same morphine use, but 9% of tibial blocks also blocked the common peroneal nerve. A randomised trial of 185 sleeve gastrectomies found less intraoperative bleeding and higher postoperative haemoglobin with tranexamic acid, without thrombotic events, though transfusion was unchanged. The practice-changer is a meta-analysis of 16 randomised trials and 2,325 patients: remimazolam for bronchoscopy roughly halved respiratory depression and hypotension compared with propofol, midazolam and dexmedetomidine, with similar procedural success and faster recovery than midazolam or dexmedetomidine.