A recent Anaesthetics digest,
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Study Type: Clinical practice guideline (international, multidisciplinary consensus process).

Key Question: How should clinicians assess risk and plan strategy for tracheal extubation and other forms of airway management discontinuation to minimise adverse events?

Key Findings:

• Risk evaluation should address hypoxaemia, aspiration and airway stimulation risk, incorporating baseline patient factors and any changes since intubation, alongside team/situational factors.
• Planned extubation should be elective wherever possible, allowing control over timing, environment and resources; deferral is advised if this meaningfully reduces risk.
• "Conversion" techniques (using a continuous guide to maintain/restore ventilation, e.g. airway exchange catheter) are preferred over "replacement" techniques when the airway is considered at risk.

Clinical Relevance: Provides UK/international consensus-based, actionable recommendations (graded per AHA classification) directly applicable to NHS perioperative and critical care practice, supporting structured extubation planning and reducing preventable airway-related harm.

Limitations: As a consensus guideline rather than primary research, recommendations are based on expert opinion and literature review rather than new empirical outcome data.

Study Type: Systematic review (diagnostic accuracy focus)

Key Question: How accurate, reliable and clinically useful are existing classification tools for documenting videolaryngoscopy findings?

Key Findings:

• 13 studies evaluated 7 tools (including Cormack-Lehane, POGO, VIDIAC, PeDiAC); most reported only inter-rater reliability or concordance, not diagnostic accuracy.
• Accuracy/performance data existed for just 3 tools (Cormack-Lehane, VIDIAC, PeDiAC); Cormack-Lehane showed only limited performance.
• Empirically derived thresholds were absent for most tools, and overall risk of bias was high, particularly regarding reference standard and study flow/timing.

Clinical Relevance: UK anaesthetists rely on videolaryngoscopy classification for airway documentation and future planning, yet this review shows most commonly used scoring systems lack validated accuracy—highlighting the need for caution when using these tools to guide airway management decisions or handover communication.

Limitations: High risk of bias across included studies and sparse accuracy data limit confidence in the generalisability of any single classification tool.

Study Type: Clinical practice guideline (expert consensus, international multidisciplinary working group)

Key Question: What organisational, environmental, educational and cultural foundations must be established to enable safe and effective airway management across all clinical contexts?

Key Findings:

• Consensus recommendations were generated via structured methodology, combining literature review with international advisory group input (airway operators, assistants, human factors experts), with discrepancies reconciled and recommendations graded using AHA classification.
• Key foundational domains identified: clinical environment/system design, availability of functional equipment and monitoring, practitioner training in both procedural and behavioural (non-technical) skills, and a fair, just, no-blame safety culture.
• Human factors input is recommended to optimise interactions between systems, equipment and practitioners affecting individual and team performance.

Clinical Relevance: Provides a structured framework directly applicable to NHS departments for auditing and improving departmental readiness (equipment, training, culture) ahead of individual airway management episodes, supporting patient safety initiatives such as NAP4-driven change.

Limitations: As a consensus-based guideline rather than primary research, recommendations rely on expert opinion and literature synthesis rather than direct outcome data.

Study Type: Narrative review

Key Question: What is the current and emerging role of remote patient monitoring (RPM) across the perioperative pathway?

Key Findings:

• Wearable devices now capture multiple biosignals with acceptable accuracy, enabling monitoring beyond the hospital setting.
• Preoperative RPM is being explored for risk prediction and prehabilitation; postoperative RPM (ward-based and post-discharge) may enable earlier detection of deterioration.
• Large clinical trials are ongoing but outcome data are not yet mature; the review speculates on a future "perioperative care navigator" role integrating AI-supported decision-making.

Clinical Relevance: For UK anaesthetists, RPM could support NHS priorities around early discharge, ward-based deterioration detection, and prehabilitation pathways, though implementation and workforce implications remain uncertain.

Limitations: As a narrative review, it lacks systematic methodology and definitive outcome data, relying on ongoing trials for future validation.

Study Type: Systematic review and meta-analysis of RCTs (105 studies identified, 39 pooled quantitatively).

Key Question: Do perioperative mechanical ventilation strategies during cardiac surgery with cardiopulmonary bypass (CPB) reduce mortality and pulmonary complications?

Key Findings:

• Maintaining ventilation during CPB reduced postoperative pulmonary complications (RR 0.87; 95% CI 0.79–0.96; P=0.005; I²=0%; 15 studies).
• Postoperative non-invasive respiratory support showed a non-significant mortality reduction (4.1% vs 6.4%; RR 0.60; 95% CI 0.34–1.08; P=0.09; 5 studies).
• Pressure- vs volume-controlled ventilation and adaptive support vs conventional postoperative ventilation showed no outcome benefit.

Clinical Relevance: Supports considering continued ventilation during CPB as a low-risk, evidence-backed strategy to reduce pulmonary morbidity in UK cardiac surgical practice, though other ventilation modalities lack proven benefit.

Limitations: Marked heterogeneity in ventilation protocols and timing across trials limits certainty and generalisability of pooled estimates.

Study Type: Post hoc secondary analysis of two multicentre RCTs (iPROVE trials)

Key Question: Does intraoperative antiemetic-dose corticosteroid administration reduce postoperative pulmonary complications after major abdominal or thoracic surgery?

Key Findings:

• Unadjusted analysis showed lower severe pulmonary complication rates with corticosteroids (9.3% vs 14.0%, P=0.002), but this association disappeared after adjustment for confounders (OR 0.86, 95% CI 0.62–1.18, P=0.347).
• Corticosteroid administration was associated with a modest improvement in PACU PaO2/FiO2 ratio (adjusted mean difference 19.9 mmHg, 95% CI 0.64–39.1, corrected P=0.043).

Clinical Relevance: Routine antiemetic-dose corticosteroids should not be relied upon for pulmonary protection in major surgery pathways, though the small oxygenation benefit may inform PACU monitoring expectations within UK enhanced recovery protocols.

Limitations: This is a non-randomised, post hoc comparison of corticosteroid use within trials not designed to test this hypothesis, so residual confounding cannot be excluded despite weighting.

Study Type: Editorial

Key Question: How can international clinical practice guidelines in anaesthesia, perioperative medicine, pain medicine, and critical care be systematically compared to address inconsistencies in recommendations?

Key Findings:

• Guidelines and consensus statements often diverge across countries and societies despite overlapping evidence bases, due to differences in methodology, evidence appraisal, resources, patient populations, policy, and stakeholder priorities.
• BJA is launching a new series to systematically compare and synthesise international guidance using structured appraisal frameworks (e.g., AGREE).

Clinical Relevance: UK anaesthetists frequently reconcile conflicting international guidance (e.g., NICE vs European/US societies); this series aims to clarify sources of divergence and support more coherent, evidence-based practice and research prioritisation.

Study Type: Systematic review (qualitative synthesis, Thomas and Harden approach)

Key Question: How is translational simulation currently applied, processed, and implemented to explore or improve multidisciplinary anaesthetic care, and with what outcomes?

Key Findings:

• 149 studies (>3300 staff, 37 countries) reviewed; 113 resulted in structural or procedural changes, mainly identifying latent safety threats and refining protocols.
• Nine process domains encompassing 90 distinct translational processes were identified; focus was skewed towards crisis management, with limited use of contemporary safety frameworks (e.g., Safety-II).
• Reported patient outcome improvements are largely signals, not causal evidence, given predominance of quasi-experimental designs; successful implementation depended on executive sponsorship and governance integration.

Clinical Relevance: Translational simulation is increasingly used as a practical systems-engineering tool in anaesthesia departments, including within NHS quality and safety governance structures, but its evidence base and methodological rigour require further development before wider adoption for routine (not just crisis) perioperative care.

Limitations: Findings are constrained by heterogeneous, largely quasi-experimental primary studies, limiting causal inference about patient outcome benefits.