A recent Anaesthetics digest,
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Study Type: Randomised controlled trial

Key Question: Does ultrasound-guided compression of the ipsilateral internal jugular vein (IJV) during guidewire advancement reduce catheter malposition during ultrasound-guided right infraclavicular subclavian venous catheterisation?

Key Findings:

• Catheter malposition occurred less often with IJV compression (6% vs. 13%; difference -6.9%, 95%CI -13.3 to -0.6%; OR 0.42, 95%CI 0.18–0.95; p=0.034).
• Catheterisation time was longer with compression (median 139 vs. 114 seconds; p<0.001), with no other significant differences in secondary outcomes.
• All malpositioned catheters were corrected successfully by guidewire reinsertion under maximal IJV compression.

Clinical Relevance: A simple, low-cost ultrasound manoeuvre may reduce a common and clinically relevant complication of subclavian catheterisation, relevant to UK anaesthetists placing central lines under ultrasound guidance in theatre or ICU.

Limitations: Single-centre, neurosurgical population with modest sample size limits generalisability to broader surgical/critical care settings.

Study Type: Systematic review (narrative synthesis)

Key Question: How does chronic postsurgical pain after caesarean delivery affect maternal quality of life across physical, psychological and functional domains over time?

Key Findings:

• 30 studies (n=28,295) showed chronic postsurgical pain associated with persistent interference in activity, sleep, mood and energy.
• Activity-related interference peaked earlier (54% at 3 months), while mood-related interference increased over time (53% at 6 months; 68% at 12 months); fatigue showed little improvement between 6–12 months.
• Postpartum depression was common (7–46% in the first year) and frequently co-occurred with chronic pain and fatigue.

Clinical Relevance: With rising caesarean rates across the NHS, this highlights the need for anaesthetists and maternity services to screen beyond pain intensity, addressing mood, fatigue and function to improve postpartum recovery pathways.

Limitations: Substantial heterogeneity in chronic postsurgical pain definitions, pain attribution and quality-of-life measures across included studies limits pooled quantitative conclusions.

Study Type: Systematic review and network meta-analysis (12 studies, n=2017)

Key Question: What is the minimal clinically important difference (MCID) for the ObsQoR-10 postpartum recovery score, and how robust are its psychometric properties?

Key Findings:

• Distribution-based MCID estimates ranged 6.7–8.7 points; anchor-based estimates (vaginal vs caesarean, planned vs unplanned caesarean) ranged 9.7–12.4 points.
• Recommended MCID: 7–10 points, with 7 as a conservative lower-bound threshold for clinical/research use.
• Moderate evidence supports sufficient validity, reliability, and responsiveness of ObsQoR-10 across the inpatient postpartum period.

Clinical Relevance: Provides UK anaesthetists and obstetric researchers a validated threshold to interpret ObsQoR-10 scores meaningfully and to power future trials evaluating peripartum analgesia/recovery interventions, supporting standardisation of patient-reported outcomes in NHS maternity research.

Limitations: MCID estimates varied widely between methods and studies, and anchor-based estimates had wide confidence intervals, limiting precision.

Study Type: Cross-sectional population-based analysis (French National Perinatal Survey, 2021)

Key Question: What is the prevalence and what are the risk factors for persistent genito-pelvic pain at 2 months after vaginal birth?

Key Findings:

• Persistent pain affected 12.8% (95% CI 11.8–13.8) of women overall, ranging from 5.9% with no perineal tear to 38.9% following obstetric anal sphincter injury (OASI).
• Perineal trauma severity strongly predicted pain (adjusted OR: 1st/2nd-degree tear 2.08; episiotomy 3.37; OASI 5.92 vs no tear).
• Other independent risk factors: primiparity (OR 1.50), operative birth (OR 1.43), poor antenatal psychological status (OR 2.05), negative birth experience (OR 2.03), and dissatisfaction with postpartum pain management (OR up to 3.11).

Clinical Relevance: Anaesthetists involved in intrapartum pain management and perineal trauma prevention strategies should note that postpartum pain management satisfaction is independently associated with persistent pain, highlighting a modifiable target for improving long-term maternal outcomes.

Limitations: Cross-sectional design precludes causal inference, and pain assessment relied on self-report without standardised pain scales or pre-pregnancy baseline data.

Study Type: Cross-sectional survey (descriptive, cohort-style self-report)

Key Question: How do US anaesthesiologists experience and recover from perioperative catastrophes in 2025, compared with the landmark 2012 survey?

Key Findings:

• 94.2% of 1,725 respondents (7.1% response rate) reported involvement in at least one perioperative catastrophe; 91.6% reported psychosocial symptoms and 72.5% physical symptoms afterwards.
• Perceived impairment in clinical performance was common (69.0% at 4 hours, 61.5% at 24 hours post-event); 19.7% never felt fully emotionally recovered—similar to 2012 rates.
• Nearly 25% considered leaving anaesthesiology following such an event; formal debriefing and institutional time off remained uncommon despite growth in peer-support programmes.

Clinical Relevance: Despite over a decade of increased focus on clinician wellbeing, outcomes after catastrophic perioperative events remain largely unchanged, highlighting a persistent gap relevant to NHS efforts on staff support, retention, and second-victim programmes amid ongoing anaesthetic workforce pressures.

Limitations: Very low response rate (7.1%) and voluntary self-selection introduce substantial risk of non-response and recall bias, limiting generalisability.

Study Type: Retrospective two-centre quality improvement evaluation with difference-in-differences analysis (intervention site vs contemporaneous external control).

Key Question: Does real-time, condition-specific clinical decision support (CDS) embedded in documentation workflows improve accuracy of ASA Physical Status classification by reducing under-grading?

Key Findings:

• At the intervention site, ASA PS ≥3 classification rose from 52.9% to 61.7% (aOR 1.42, 95% CI 1.38–1.45), versus a minimal rise at the control site (47.2% to 48.4%, aOR 1.05, 95% CI 1.03–1.07).
• Among patients with conditions specifically flagged by the later CDS iteration, ASA PS ≥3 assignment increased from 83.6% to 94.0% (aOR 3.54, 95% CI 3.34–3.76), suggesting a strong, condition-specific effect.
• Findings based on >538,000 anesthetics across both sites, supporting robustness of the observed signal.

Clinical Relevance: ASA PS under-documentation affects risk stratification, resource allocation, and benchmarking in UK anaesthetic practice; targeted CDS could improve coding accuracy without added clinician burden, relevant to NHS efforts on perioperative risk data quality and national audit (e.g., NELA, SNAP).

Limitations: Observational, non-randomised design limits causal inference, and improved documentation accuracy cannot be distinguished from potential upcoding bias.

Study Type: Prospective observational single-centre study

Key Question: Does i.v. lidocaine bolus and infusion during stable propofol-remifentanil anaesthesia alter raw EEG spectral activity, processed indices (BIS, SEF95), and nociception monitoring (SPI), and how do the timings of these changes relate?

Key Findings:

• Delta-band activity increased and beta-band activity decreased within 4–6 min of lidocaine bolus, with concurrent narrowing of alpha peak bandwidth/centre frequency and a small but significant rise in aperiodic slope—preceding any change in BIS or SEF95.
• BIS and SEF95 only decreased significantly 12–15 min into the infusion; SPI fell later still.
• Findings suggest lidocaine's anaesthetic-sparing effect is primarily antinociceptive rather than a direct hypnotic action.

Clinical Relevance: For UK anaesthetists using lidocaine infusions as part of multimodal/opioid-sparing strategies, standard depth-of-anaesthesia monitors (BIS) may lag behind true neurophysiological changes, risking misinterpretation of anaesthetic depth during titration.

Limitations: Small sample (n=20, all female breast surgery patients) limits generalisability and statistical power.

Study Type: Retrospective cohort study (multicentre registry analysis, propensity score-weighted)

Key Question: Does videolaryngoscopy improve first-attempt tracheal intubation success compared with direct laryngoscopy in neonates and infants in real-world practice?

Key Findings:

• VL was associated with *lower* first-attempt success than direct laryngoscopy (adjusted RR 0.89, 95% CI 0.83–0.96, P=0.001), despite better glottic visualisation (β 17.8, 95% CI 9.5–26.1).
• VL was associated with more than double the risk of desaturation (adjusted RR 2.18, 95% CI 1.57–2.79, P<0.001).
• Respiratory adverse event rates were similar between groups.

Clinical Relevance: Despite guideline recommendations, unstructured VL use in paediatric anaesthesia may not translate improved glottic view into better first-pass success or safety—relevant for UK departments implementing VL for neonatal/infant airway management without standardised training pathways.

Limitations: Observational design with residual confounding (e.g., operator experience, device selection) despite propensity weighting, and findings from Japanese practice may not generalise directly to UK settings.