The edition · Anaesthesiology
Theatre air purifiers did not cut surgical infections in 107,000 operations
The ORACLE trial stopped for futility, a 44-hospital study shows a good videolaryngoscopic view does not guarantee an easy tube, and opioid use disorder roughly doubled postoperative respiratory complications.
The edition in brief
Today's anaesthesiology edition. In ORACLE, 68 operating rooms were randomised in four-week blocks to active or sham supplemental air sterilisation across 107,334 analysed operations; the trial stopped for futility, with the 30-day composite of wound infection, infection-related complications or death at 8.1% versus 8.2% in inpatients. A prospective study of 5,302 videolaryngoscopic intubations in 44 hospitals found tube delivery was difficult or failed in 6.3% even with more than 75% of the glottis visible, and easy in a quarter of poor views. A meta-analysis of 40 studies associated pre-existing opioid use disorder with higher odds of postoperative pain (OR 2.87) and respiratory complications (OR 2.10). An AI-driven decision-support prompt for patients with cognitive impairment did not change delirium rates or best-practice adherence, though fewer than one in five patients had a documented delirium assessment. The pearl covers continuing buprenorphine around surgery.
A good videolaryngoscopic view did not guarantee an easy intubation
Document videolaryngoscopic intubation by blade, view and tube delivery; a good view did not reliably mean an easy intubation.
Opioid use disorder was linked to double the odds of respiratory complications after surgery
Identify opioid use disorder before surgery, continue maintenance therapy, plan multimodal analgesia and watch for respiratory complications.
An AI delirium prompt changed neither delirium nor anaesthetic practice
A non-interruptive AI prompt did not change delirium care; routine screening and clear ownership of prevention steps matter more.
Keep buprenorphine going through surgery
Continue buprenorphine around surgery and plan analgesia around it rather than stopping it.
ORACLE: supplemental theatre air sterilisation did not reduce surgical infections
Supplemental air sterilisation in operating rooms did not reduce surgical infections; direct resources to wound-level prevention instead.
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