Pub Date : 2026-03-17DOI: 10.1016/j.bja.2026.02.010
Craig Lyons
Airway management should be accompanied by comprehensive documentation, both to inform other healthcare professionals of what has occurred and to inform future care. Videolaryngoscopy is increasingly used instead of direct laryngoscopy to perform tracheal intubation. The relationship between the laryngeal view obtained and ease of tube placement has become uncoupled. Current issues include uncertainties around how best to describe the view obtained on videolaryngoscopy and what that view means for intubation success.
{"title":"Documenting videolaryngoscopy and tracheal intubation: time to blend old ways with the new?","authors":"Craig Lyons","doi":"10.1016/j.bja.2026.02.010","DOIUrl":"https://doi.org/10.1016/j.bja.2026.02.010","url":null,"abstract":"Airway management should be accompanied by comprehensive documentation, both to inform other healthcare professionals of what has occurred and to inform future care. Videolaryngoscopy is increasingly used instead of direct laryngoscopy to perform tracheal intubation. The relationship between the laryngeal view obtained and ease of tube placement has become uncoupled. Current issues include uncertainties around how best to describe the view obtained on videolaryngoscopy and what that view means for intubation success.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"303 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478653","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}
Pub Date : 2026-03-17DOI: 10.1016/j.bja.2026.01.025
Florian Lammers-Lietz,Levent Akyuez,Diana Boraschi,Friedrich Borchers,Jeroen de Bresser,Sreyoshi Chatterjee,Marta M Correia,Nikola M de Lange,Thomas Bernd Dschietzig,Soumyabrata Ghosh,Insa Feinkohl,Izabela Ferreira da Silva,Marinus Fislage,Anna Fournier,Jürgen Gallinat,Daniel Hadzidiakos,Sven Hädel,Fatima Halzl-Yürek,Stefanie Heilmann-Heimbach,Maria Heinrich,Jeroen Hendrikse,Per Hoffmann,Jürgen Janke,Ilse M J Kant,Angelie Kraft,Roland Krause,Jochen Kruppa-Scheetz,Simone Kühn,Gunnar Lachmann,Markus Laubach,Christoph Lippert,David K Menon,Rudolf Mörgeli,Anika Müller,Henk-Jan Mutsaerts,Markus Nöthen,Peter Nürnberg,Kwaku Ofosu,Malte Pietzsch,Sophie K Piper,Tobias Pischon,Jacobus Preller,Konstanze Scheurer,Reinhard Schneider,Kathrin Scholtz,Peter H Schreier,Arjen J C Slooter,Emmanuel A Stamatakis,Clarissa von Haefen,Simone J T van Montfort,Edwin van Dellen,Hans-Dieter Volk,Simon Weber,Janine Wiebach,Anton Wiehe,Jeanne M Winterer,Alissa Wolf,Norman Zacharias,Claudia Spies,Georg Winterer,
BACKGROUNDPostoperative delirium (POD) affects ∼20% of older surgical patients. It is associated with poor clinical outcome and increased mortality. We aimed to identify the major POD risk factors and to develop and validate a multivariate algorithm for individual POD risk prediction and risk evaluation in the very early postoperative period.METHODSBioCog is a prospective cohort study conducted in the anaesthesiology departments of two tertiary care centres in Germany and The Netherlands. Patients aged ≥65 yr with no preoperative dementia (Mini-Mental Status Examination ≥24) undergoing surgery with an expected duration of at least 60 min were enrolled and screened for POD according to DSM 5 until the seventh postoperative day. Clinical, neuropsychological, neuroimaging data, and blood were measured before and after surgery. We evaluated several models by sequentially adding blocks of variables. Gradient-boosted trees (GBT) with nested cross-validation were used for POD prediction. Model accuracy (area under the receiver-operating curve, AUC) and calibration were assessed (Brier score).RESULTSOut of 929 patients, 184 (20%) experienced POD. A GBT algorithm using both preoperative data, characteristics of the intervention, and postoperative changes in laboratory parameters achieved the highest AUC (0.83, [0.79-0.86]) with a Brier score of 0.12 (0.12-0.13).CONCLUSIONSModels combining preoperative with precipitating factors during surgery predict POD with high accuracy. This suggests that the resulting algorithms eventually may become useful to support clinical decision-making.CLINICAL TRIAL REGISTRATIONNCT02265263.
{"title":"Prediction and risk evaluation of delirium after surgery in older patients: development and internal validation of an algorithm from the prospective BioCog cohort study.","authors":"Florian Lammers-Lietz,Levent Akyuez,Diana Boraschi,Friedrich Borchers,Jeroen de Bresser,Sreyoshi Chatterjee,Marta M Correia,Nikola M de Lange,Thomas Bernd Dschietzig,Soumyabrata Ghosh,Insa Feinkohl,Izabela Ferreira da Silva,Marinus Fislage,Anna Fournier,Jürgen Gallinat,Daniel Hadzidiakos,Sven Hädel,Fatima Halzl-Yürek,Stefanie Heilmann-Heimbach,Maria Heinrich,Jeroen Hendrikse,Per Hoffmann,Jürgen Janke,Ilse M J Kant,Angelie Kraft,Roland Krause,Jochen Kruppa-Scheetz,Simone Kühn,Gunnar Lachmann,Markus Laubach,Christoph Lippert,David K Menon,Rudolf Mörgeli,Anika Müller,Henk-Jan Mutsaerts,Markus Nöthen,Peter Nürnberg,Kwaku Ofosu,Malte Pietzsch,Sophie K Piper,Tobias Pischon,Jacobus Preller,Konstanze Scheurer,Reinhard Schneider,Kathrin Scholtz,Peter H Schreier,Arjen J C Slooter,Emmanuel A Stamatakis,Clarissa von Haefen,Simone J T van Montfort,Edwin van Dellen,Hans-Dieter Volk,Simon Weber,Janine Wiebach,Anton Wiehe,Jeanne M Winterer,Alissa Wolf,Norman Zacharias,Claudia Spies,Georg Winterer, ","doi":"10.1016/j.bja.2026.01.025","DOIUrl":"https://doi.org/10.1016/j.bja.2026.01.025","url":null,"abstract":"BACKGROUNDPostoperative delirium (POD) affects ∼20% of older surgical patients. It is associated with poor clinical outcome and increased mortality. We aimed to identify the major POD risk factors and to develop and validate a multivariate algorithm for individual POD risk prediction and risk evaluation in the very early postoperative period.METHODSBioCog is a prospective cohort study conducted in the anaesthesiology departments of two tertiary care centres in Germany and The Netherlands. Patients aged ≥65 yr with no preoperative dementia (Mini-Mental Status Examination ≥24) undergoing surgery with an expected duration of at least 60 min were enrolled and screened for POD according to DSM 5 until the seventh postoperative day. Clinical, neuropsychological, neuroimaging data, and blood were measured before and after surgery. We evaluated several models by sequentially adding blocks of variables. Gradient-boosted trees (GBT) with nested cross-validation were used for POD prediction. Model accuracy (area under the receiver-operating curve, AUC) and calibration were assessed (Brier score).RESULTSOut of 929 patients, 184 (20%) experienced POD. A GBT algorithm using both preoperative data, characteristics of the intervention, and postoperative changes in laboratory parameters achieved the highest AUC (0.83, [0.79-0.86]) with a Brier score of 0.12 (0.12-0.13).CONCLUSIONSModels combining preoperative with precipitating factors during surgery predict POD with high accuracy. This suggests that the resulting algorithms eventually may become useful to support clinical decision-making.CLINICAL TRIAL REGISTRATIONNCT02265263.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"187 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478652","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}
Pub Date : 2026-03-12DOI: 10.1016/j.bja.2026.01.027
Roisin McCarthy,Liam Maher,Angela O'Dea
BACKGROUNDDefinitive airway management simulators are widely used for training and evaluating airway management techniques. However, the extent and quality of their validation remain unclear. In this systematic review, we aimed to identify and evaluate studies assessing the validity of airway simulators used in anaesthesia and airway training.METHODSA comprehensive and systematic literature search was conducted across PubMed, Embase, and Cochrane Library databases up to September 2025, following PRISMA guidelines. Studies were included if they evaluated at least one domain of simulator validity. Methodological quality was assessed using the Joanna Briggs Institute checklist and each simulator was assigned a Level of Recommendation. The review protocol was registered with PROSPERO (CRD420251108102).RESULTSFrom 939 studies screened, 17 articles met the inclusion criteria, and 29 different simulators were included. Validation domains varied widely, with most studies assessing only one or two domains. Predictive validity, linking simulator performance to clinical outcomes, was rarely evaluated. High-fidelity simulators, such as ORSIM® and SimMan®, demonstrated the most comprehensive validation across multiple domains. Validation quality did not consistently correlate with simulator fidelity, and several low-fidelity models demonstrated short-term skill transfer comparable with more complex systems.CONCLUSIONSDefinitive airway simulators are commonly used for training and device evaluation yet are rarely subjected to robust validation. These findings highlight the urgent need for a unified validation framework and higher-quality research to ensure simulators used in airway management accurately reflect clinical realities. This has critical implications for educators, training bodies, and institutions relying on simulators for competency development and device assessment.SYSTEMATIC REVIEW PROTOCOLPROSPERO (CRD420251108102).
{"title":"Validation status of definitive airway management simulators: a systematic review.","authors":"Roisin McCarthy,Liam Maher,Angela O'Dea","doi":"10.1016/j.bja.2026.01.027","DOIUrl":"https://doi.org/10.1016/j.bja.2026.01.027","url":null,"abstract":"BACKGROUNDDefinitive airway management simulators are widely used for training and evaluating airway management techniques. However, the extent and quality of their validation remain unclear. In this systematic review, we aimed to identify and evaluate studies assessing the validity of airway simulators used in anaesthesia and airway training.METHODSA comprehensive and systematic literature search was conducted across PubMed, Embase, and Cochrane Library databases up to September 2025, following PRISMA guidelines. Studies were included if they evaluated at least one domain of simulator validity. Methodological quality was assessed using the Joanna Briggs Institute checklist and each simulator was assigned a Level of Recommendation. The review protocol was registered with PROSPERO (CRD420251108102).RESULTSFrom 939 studies screened, 17 articles met the inclusion criteria, and 29 different simulators were included. Validation domains varied widely, with most studies assessing only one or two domains. Predictive validity, linking simulator performance to clinical outcomes, was rarely evaluated. High-fidelity simulators, such as ORSIM® and SimMan®, demonstrated the most comprehensive validation across multiple domains. Validation quality did not consistently correlate with simulator fidelity, and several low-fidelity models demonstrated short-term skill transfer comparable with more complex systems.CONCLUSIONSDefinitive airway simulators are commonly used for training and device evaluation yet are rarely subjected to robust validation. These findings highlight the urgent need for a unified validation framework and higher-quality research to ensure simulators used in airway management accurately reflect clinical realities. This has critical implications for educators, training bodies, and institutions relying on simulators for competency development and device assessment.SYSTEMATIC REVIEW PROTOCOLPROSPERO (CRD420251108102).","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"60 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446994","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}
Pub Date : 2026-03-10DOI: 10.1016/j.bja.2026.02.009
Alex Barroso, Başak Ceyda Meco, Vanessa Moll, Christian S. Guay, Finn M. Radtke, the Safe Brain Society
The perioperative period represents both a major driver of healthcare costs and a substantial source of largely preventable neurological harm. Postoperative delirium affects up to 50–70% of specifically vulnerable surgical cohorts, but adoption of physiologically aligned, low-cost preventive strategies is often delayed until supported by large definitive trials. In contrast, reactive and costly treatments are frequently implemented despite weaker evidentiary standards. This inverted evidence hierarchy creates perverse economic incentives that perpetuate patient harm and inefficient resource utilisation. Patient-Centred Precision Care seeks to address this gap by integrating evidence-based protocols with real-world outcome verification through the Safe Brain Initiative’s structured framework. Shifting from reactive treatment to proactive prevention is not only ethically imperative, but also economically necessary for the long-term sustainability of healthcare systems.
{"title":"Responsibility cannot be abdicated: a mandate for Patient-Centred Precision Care in perioperative brain health","authors":"Alex Barroso, Başak Ceyda Meco, Vanessa Moll, Christian S. Guay, Finn M. Radtke, the Safe Brain Society","doi":"10.1016/j.bja.2026.02.009","DOIUrl":"https://doi.org/10.1016/j.bja.2026.02.009","url":null,"abstract":"The perioperative period represents both a major driver of healthcare costs and a substantial source of largely preventable neurological harm. Postoperative delirium affects up to 50–70% of specifically vulnerable surgical cohorts, but adoption of physiologically aligned, low-cost preventive strategies is often delayed until supported by large definitive trials. In contrast, reactive and costly treatments are frequently implemented despite weaker evidentiary standards. This inverted evidence hierarchy creates perverse economic incentives that perpetuate patient harm and inefficient resource utilisation. Patient-Centred Precision Care seeks to address this gap by integrating evidence-based protocols with real-world outcome verification through the Safe Brain Initiative’s structured framework. Shifting from reactive treatment to proactive prevention is not only ethically imperative, but also economically necessary for the long-term sustainability of healthcare systems.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"37 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147392366","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}
Pub Date : 2026-03-06DOI: 10.1016/j.bja.2026.02.008
André A J Van Zundert
Blue- or green-dominant ambient lighting is increasingly used in hybrid operating theatres to optimise surgical visualisation, but it can unintentionally compromise anaesthetic safety. Emerging experimental evidence and clinical observations indicate that such lighting degrades colour discrimination and impairs recognition of International Organization for Standardization (ISO)-standard colour-coded medication labels, thereby increasing the risk of drug misidentification. This reflects broader human factors mismatch between evolving theatre design and safety standards developed for conventional white-light environments. Mitigation strategies should include localised white lighting at the anaesthetic workstation, enhanced label design, and lighting-independent technologies such as machine-readable drug labelling. A systematic re-evaluation of how theatre innovations impact the entire perioperative team is essential to future-proof anaesthetic safety in modern interventional suites.
{"title":"When optimising the operating theatre compromises anaesthetic safety: ambient lighting, human performance, and medication error risk.","authors":"André A J Van Zundert","doi":"10.1016/j.bja.2026.02.008","DOIUrl":"https://doi.org/10.1016/j.bja.2026.02.008","url":null,"abstract":"Blue- or green-dominant ambient lighting is increasingly used in hybrid operating theatres to optimise surgical visualisation, but it can unintentionally compromise anaesthetic safety. Emerging experimental evidence and clinical observations indicate that such lighting degrades colour discrimination and impairs recognition of International Organization for Standardization (ISO)-standard colour-coded medication labels, thereby increasing the risk of drug misidentification. This reflects broader human factors mismatch between evolving theatre design and safety standards developed for conventional white-light environments. Mitigation strategies should include localised white lighting at the anaesthetic workstation, enhanced label design, and lighting-independent technologies such as machine-readable drug labelling. A systematic re-evaluation of how theatre innovations impact the entire perioperative team is essential to future-proof anaesthetic safety in modern interventional suites.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"6 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147371028","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}
Pub Date : 2026-03-05DOI: 10.1016/j.bja.2026.02.007
Davide Chiumello,Aartik Sarma
Ventilator-induced lung injury can be mitigated with a lung-protective ventilation strategy that includes ventilation with low tidal volumes. Mortality in acute respiratory distress syndrome (ARDS) remains higher in females than in males, and females with ARDS are less likely to receive lung-protective ventilation compared with males because of their shorter height and greater error when body height is visually estimated. In addition, lung-protective ventilation might be less effective in females because of differences in respiratory physiology not accounted for by the formula commonly used to assess body weight, and because of several clinically important sex-specific differences in extrapulmonary biology and management of critical illness.
{"title":"Lung-protective mechanical ventilation is not sex neutral.","authors":"Davide Chiumello,Aartik Sarma","doi":"10.1016/j.bja.2026.02.007","DOIUrl":"https://doi.org/10.1016/j.bja.2026.02.007","url":null,"abstract":"Ventilator-induced lung injury can be mitigated with a lung-protective ventilation strategy that includes ventilation with low tidal volumes. Mortality in acute respiratory distress syndrome (ARDS) remains higher in females than in males, and females with ARDS are less likely to receive lung-protective ventilation compared with males because of their shorter height and greater error when body height is visually estimated. In addition, lung-protective ventilation might be less effective in females because of differences in respiratory physiology not accounted for by the formula commonly used to assess body weight, and because of several clinically important sex-specific differences in extrapulmonary biology and management of critical illness.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"4 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147368359","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":"Paediatric difficult intubations and the impact of timing of weekend versus weekday cases. Response to Br J Anaesth 2026; 136: 365-6.","authors":"Christy J Crockett,Judit Szolnoki,Sabina Khan,Angela C Lee,Alexander Kaizer,Patrick Olomu,Melissa Brooks Peterson, ","doi":"10.1016/j.bja.2026.01.044","DOIUrl":"https://doi.org/10.1016/j.bja.2026.01.044","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"14 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147359066","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}
Pub Date : 2026-03-04DOI: 10.1016/j.bja.2026.02.006
Marcus J Schultz,Edda Tschernko,Lucy J Modra,Susanne Eberl
Females with acute respiratory distress syndrome (ARDS) face disproportionate harm from mechanical ventilation because of smaller functional lung volumes. This biological vulnerability demands sex-specific approaches. Yet disparities extend beyond physiology. Predicted bodyweight formulas systematically overestimate lung capacity in females, creating algorithmic bias linked to mortality. Females receive less aggressive treatment for ARDS than men but achieve similar survival, suggesting either resilience in women or overtreatment in men. Critical care research underrepresents females and rarely performs sex-disaggregated analyses. Addressing these interconnected problems requires refining clinical protocols, mandating sex-stratified trial analyses, and auditing treatment patterns to distinguish appropriate individualisation from bias.
{"title":"The triple burden of sex disparities in critical care mechanical ventilation.","authors":"Marcus J Schultz,Edda Tschernko,Lucy J Modra,Susanne Eberl","doi":"10.1016/j.bja.2026.02.006","DOIUrl":"https://doi.org/10.1016/j.bja.2026.02.006","url":null,"abstract":"Females with acute respiratory distress syndrome (ARDS) face disproportionate harm from mechanical ventilation because of smaller functional lung volumes. This biological vulnerability demands sex-specific approaches. Yet disparities extend beyond physiology. Predicted bodyweight formulas systematically overestimate lung capacity in females, creating algorithmic bias linked to mortality. Females receive less aggressive treatment for ARDS than men but achieve similar survival, suggesting either resilience in women or overtreatment in men. Critical care research underrepresents females and rarely performs sex-disaggregated analyses. Addressing these interconnected problems requires refining clinical protocols, mandating sex-stratified trial analyses, and auditing treatment patterns to distinguish appropriate individualisation from bias.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147359065","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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