Laurence Weinberg, Michael Keane, Paul Barach, Reginald Edward
{"title":"The 0.00015 degree problem: learning from the environmental debates around desflurane.","authors":"Laurence Weinberg, Michael Keane, Paul Barach, Reginald Edward","doi":"10.1111/anae.70201","DOIUrl":"https://doi.org/10.1111/anae.70201","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTIONDelirium is a frequent complication of critical illness and remains an important cause of short- and long-term morbidity for patients admitted to ICUs. Delirium is associated with prolonged mechanical ventilation; extended ICU and hospital stay; and longer-term health issues. Development is associated with patient (e.g. severe physiological derangement); clinical (e.g. sedation); and environmental factors (e.g. loss of day/night variation and sleep deprivation). This review provides an overview of the current understanding of ICU delirium and its implications for critical care practice.METHODSWe undertook a narrative review of the contemporary literature and synthesised evidence related to epidemiology, pathophysiology, risk factors, diagnostic tools and preventive and therapeutic strategies, with an aim of developing a practical resource for clinicians.RESULTSDelirium impacts approximately one-third of patients admitted to general ICUs, with higher rates among older adults and those requiring mechanical ventilation. Diagnosis relies on clinical assessment supported by validated instruments, each with limitations for the critically ill population. Pharmacological interventions have not shown consistent benefit to prevent or treat delirium. In contrast, multicomponent non-pharmacological approaches (e.g. optimal sedation, early mobilisation, re-orientation, sleep hygiene and family engagement) are associated with a reduced incidence of delirium and improved functional outcomes. Delirium contributes to the long-term psychological and cognitive burden of critical illness and structured follow-up and ICU diaries may support recovery.DISCUSSIONDelirium in the ICU is common and important for patients and multidisciplinary critical care providers. The most effective strategies for prevention and management are non-pharmacological and require co-ordinated, multidisciplinary delivery. Sustained improvements in outcomes require consistent implementation of evidence-based care bundles and better integration of follow-up services for survivors.
{"title":"Critical care delirium: prevention, identification and management: a narrative review.","authors":"Stephanie Kieswick,Ben Gibbison","doi":"10.1111/anae.70192","DOIUrl":"https://doi.org/10.1111/anae.70192","url":null,"abstract":"INTRODUCTIONDelirium is a frequent complication of critical illness and remains an important cause of short- and long-term morbidity for patients admitted to ICUs. Delirium is associated with prolonged mechanical ventilation; extended ICU and hospital stay; and longer-term health issues. Development is associated with patient (e.g. severe physiological derangement); clinical (e.g. sedation); and environmental factors (e.g. loss of day/night variation and sleep deprivation). This review provides an overview of the current understanding of ICU delirium and its implications for critical care practice.METHODSWe undertook a narrative review of the contemporary literature and synthesised evidence related to epidemiology, pathophysiology, risk factors, diagnostic tools and preventive and therapeutic strategies, with an aim of developing a practical resource for clinicians.RESULTSDelirium impacts approximately one-third of patients admitted to general ICUs, with higher rates among older adults and those requiring mechanical ventilation. Diagnosis relies on clinical assessment supported by validated instruments, each with limitations for the critically ill population. Pharmacological interventions have not shown consistent benefit to prevent or treat delirium. In contrast, multicomponent non-pharmacological approaches (e.g. optimal sedation, early mobilisation, re-orientation, sleep hygiene and family engagement) are associated with a reduced incidence of delirium and improved functional outcomes. Delirium contributes to the long-term psychological and cognitive burden of critical illness and structured follow-up and ICU diaries may support recovery.DISCUSSIONDelirium in the ICU is common and important for patients and multidisciplinary critical care providers. The most effective strategies for prevention and management are non-pharmacological and require co-ordinated, multidisciplinary delivery. Sustained improvements in outcomes require consistent implementation of evidence-based care bundles and better integration of follow-up services for survivors.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"6 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTIONQuality indicators are essential for benchmarking, quality assurance and driving improvement in healthcare. Many indicators exist for peri-operative care but their relevance and evidence base vary. This systematic review updates a review published 10 years ago. It seeks to identify available structure and process indicators, and assess the level of evidence supporting them, with a view to informing the development of a core indicator set.METHODSMEDLINE, Embase, CINAHL and the Cochrane Library were searched. English-language studies in adults were included, alongside grey literature from: clinical, professional and governmental organisations; quality standards; and guidelines.RESULTSThere were 657 included studies and grey literature sources, alongside indicators from a previously published review. Of a total 615 indicators (324 process indicators, 248 structure indicators and 43 indicators which were not defined clearly but relevant to process or structure), we identified 380 new indicators. Evidence supported 505 (82%) indicators, while 110 (18%) lacked clear evidence. This compared with 47% and 53%, respectively, in the previous review. Only 71 (12%) of the indicators were evaluated for validity. Inconsistencies were noted in definitions, with varying target thresholds reported for the same indicators. Many indicators were developed without the involvement of patients or carers.DISCUSSIONThere is a need for standardisation in the development and naming of peri-operative quality indicators. Clear reporting, validation and patient involvement would improve their credibility and utility. Rationalising the current large, overlapping number of indicators is essential to enhance usability and ensure meaningful improvement in peri-operative care.
{"title":"Quality indicators for structure and process in peri-operative care: a systematic review.","authors":"Sarah Kelly,Paige Cunnington,Harry Dunn,Isla Kuhn,Graham Martin,Mary Dixon-Woods,Oliver Boney,S Ramani Moonesinghe,Kristina Wanyonyi-Kay","doi":"10.1111/anae.70185","DOIUrl":"https://doi.org/10.1111/anae.70185","url":null,"abstract":"INTRODUCTIONQuality indicators are essential for benchmarking, quality assurance and driving improvement in healthcare. Many indicators exist for peri-operative care but their relevance and evidence base vary. This systematic review updates a review published 10 years ago. It seeks to identify available structure and process indicators, and assess the level of evidence supporting them, with a view to informing the development of a core indicator set.METHODSMEDLINE, Embase, CINAHL and the Cochrane Library were searched. English-language studies in adults were included, alongside grey literature from: clinical, professional and governmental organisations; quality standards; and guidelines.RESULTSThere were 657 included studies and grey literature sources, alongside indicators from a previously published review. Of a total 615 indicators (324 process indicators, 248 structure indicators and 43 indicators which were not defined clearly but relevant to process or structure), we identified 380 new indicators. Evidence supported 505 (82%) indicators, while 110 (18%) lacked clear evidence. This compared with 47% and 53%, respectively, in the previous review. Only 71 (12%) of the indicators were evaluated for validity. Inconsistencies were noted in definitions, with varying target thresholds reported for the same indicators. Many indicators were developed without the involvement of patients or carers.DISCUSSIONThere is a need for standardisation in the development and naming of peri-operative quality indicators. Clear reporting, validation and patient involvement would improve their credibility and utility. Rationalising the current large, overlapping number of indicators is essential to enhance usability and ensure meaningful improvement in peri-operative care.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"54 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lloyd R Turbitt,Edward R Mariano,Kariem El-Boghdadly
INTRODUCTIONThe Plan A blocks framework was proposed in 2019 with the aim of promoting a small number of versatile, high-value regional anaesthetic techniques to build core competencies among all anaesthetists. Clinical practice, educational curricula and academic understanding have evolved since then. We aimed to provide a pragmatic and clinically focused narrative review on the current understanding of Plan A blocks and to explore their implementation and signpost future directions.METHODSWe conducted a focused literature search for articles of relevance to Plan A blocks. We also searched online resources, including websites of societies and institutions, for evidence relevant to our primary area of interest.RESULTSPlan A blocks have influenced the Royal College of Anaesthetists' curriculum and inspired several international consensus projects defining core blocks for adult and paediatric practice. Delphi studies have supported the inclusion of interscalene brachial plexus, axillary brachial plexus, femoral and sciatic nerve blocks as key techniques. Despite wide dissemination, challenges hindering clinical practice change persist, including resource limitations; lack of confidence; and variable access to structured training. Emerging educational technologies such as simulation, artificial intelligence-assisted ultrasound interpretation and augmented reality offer promise, but remain limited by cost and fidelity.DISCUSSIONThe Plan A blocks framework has become an established concept and is accepted widely as a pragmatic, scalable strategy. Although barriers remain to clinical practice change, ensuring widespread competence in Plan A blocks and implementation into clinical pathways should improve patient access to regional anaesthesia globally.
{"title":"Plan A blocks in regional anaesthesia: a narrative review.","authors":"Lloyd R Turbitt,Edward R Mariano,Kariem El-Boghdadly","doi":"10.1111/anae.70182","DOIUrl":"https://doi.org/10.1111/anae.70182","url":null,"abstract":"INTRODUCTIONThe Plan A blocks framework was proposed in 2019 with the aim of promoting a small number of versatile, high-value regional anaesthetic techniques to build core competencies among all anaesthetists. Clinical practice, educational curricula and academic understanding have evolved since then. We aimed to provide a pragmatic and clinically focused narrative review on the current understanding of Plan A blocks and to explore their implementation and signpost future directions.METHODSWe conducted a focused literature search for articles of relevance to Plan A blocks. We also searched online resources, including websites of societies and institutions, for evidence relevant to our primary area of interest.RESULTSPlan A blocks have influenced the Royal College of Anaesthetists' curriculum and inspired several international consensus projects defining core blocks for adult and paediatric practice. Delphi studies have supported the inclusion of interscalene brachial plexus, axillary brachial plexus, femoral and sciatic nerve blocks as key techniques. Despite wide dissemination, challenges hindering clinical practice change persist, including resource limitations; lack of confidence; and variable access to structured training. Emerging educational technologies such as simulation, artificial intelligence-assisted ultrasound interpretation and augmented reality offer promise, but remain limited by cost and fidelity.DISCUSSIONThe Plan A blocks framework has become an established concept and is accepted widely as a pragmatic, scalable strategy. Although barriers remain to clinical practice change, ensuring widespread competence in Plan A blocks and implementation into clinical pathways should improve patient access to regional anaesthesia globally.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"6 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Aquatic toxicity of propofol vs. remimazolam: an in-silico comparison.","authors":"Chia-Hao Ho,Cheng-Wei Lu","doi":"10.1111/anae.70199","DOIUrl":"https://doi.org/10.1111/anae.70199","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"66 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Incidence of peri-operative peripheral nerve injuries associated with general and regional anaesthesia.","authors":"Eanna O'Sullivan,Pawandeep Sarai","doi":"10.1111/anae.70193","DOIUrl":"https://doi.org/10.1111/anae.70193","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"52 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A bench experiment to investigate the time available to replace a near-depleted E-size nitrous oxide cylinder when using a 'mobile manifold' supply system.","authors":"Scarlett Tankard,Cliff Shelton","doi":"10.1111/anae.70202","DOIUrl":"https://doi.org/10.1111/anae.70202","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"34 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The B-APNEIC score as a reliable tool to guide clinical practice: a reply.","authors":"Venkatesan Thiruvenkatarajan,Anil Roy,Tharun Kathiravan","doi":"10.1111/anae.70197","DOIUrl":"https://doi.org/10.1111/anae.70197","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"188 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute kidney injury after propofol or sevoflurane anaesthesia for colorectal cancer surgery: a secondary analysis.","authors":"Micael Taavo,Robert Frithiof,Mats Enlund,Stephanie Franzén","doi":"10.1111/anae.70198","DOIUrl":"https://doi.org/10.1111/anae.70198","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"55 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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