British journal of anaesthesia
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Preoperative fasting guidelines published in 2022 by the European Society of Anaesthesiology and Intensive Care represent a paradigm shift in the preoperative preparation of children undergoing general anaesthesia. Schmitz and colleagues report the results from a multi-institutional prospective cohort study to determine if application of the recent guidelines increased the risk of regurgitation and pulmonary aspiration. This study provides support for the concept of reducing real fasting times by allowing clear fluids until 1 h before induction of anaesthesia. Although the study cohort was large, further prospective multicentre studies with even greater sample sizes are warranted to provide definitive evidence for the safety of the new fasting rules.
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Despite recent high-quality international studies, the optimal sum and sequence of subjective and objective assessments that build the complex picture of fitness for surgery remains to be defined. Physicians' subjective assessment of patient fitness after a typical unstructured interview has poor prognostic accuracy in predicting the risk of major cardiovascular events after noncardiac surgery. How does self-reported fitness assessed by structured questionnaire compare as an indicator of perioperative cardiovascular risk? Here we discuss the latest evidence in this evolving and fundamental aspect of perioperative care.
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Technological innovation has greatly aided modern medicine, and anaesthesiology in particular, but also contributes to dehumanising influences that promote physician burnout and dissatisfaction among patients. Here we advocate for a profound reaffirmation of humanistic principles-empathy, compassion, and communication-in perioperative medicine. We propose adaptable strategies to bolster humanism in practice, such as curricular offerings, simulation training, role modelling, and recognition. As perioperative technologies continue to evolve, the threat of depersonalisation in anaesthetic care looms, making commitments to humanism a crucial precondition for healing in the communities in which we work and live.
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Chronic pain patients may be at an increased risk for drug overdoses as a result of comorbid psychiatric disorders and treatment with risk-increasing prescription medications, such as opioids. We aimed to characterise fatal drug overdoses and investigate factors associated with the deaths among individuals who had been treated pharmacologically for chronic pain. ⋯ This study shows the need for better identification of overdose and suicide risk in individuals treated for chronic pain. Extra caution is needed when treating complex comorbid disorders, especially with overdose risk-increasing medications.
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In the eyes-closed, awake condition, EEG oscillatory power in the alpha band (7-13 Hz) dominates human spectral activity. With eyes open, however, EEG alpha power substantially decreases. Less alpha attenuation with eyes opening has been associated with inattention; thus, we analysed whether reduced preoperative alpha attenuation with eyes opening is associated with postoperative inattention, a delirium-defining feature. ⋯ Preoperative awake, resting, EEG alpha attenuation with eyes opening might represent a neural biomarker for risk of postoperative attentional impairment. Further, eyes-opening alpha attenuation could provide insight into the neural mechanisms underlying postoperative inattention risk.