Introduction: Standard preoperative fasting guidelines may not be applicable to patients with co-morbidities such as diabetes mellitus due to delayed gastric emptying. Point-of-care ultrasonography allows assessment of Gastric Residual Volume (GRV) and may help predict the risk of pulmonary aspiration. Aim: To compare GRV in fasting diabetic and non-diabetic patients undergoing elective surgery using ultrasonography. Materials and Methods: The present prospective observational study was conducted over a period of 18 months, from January 2020 to June 2021 at Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, included 30 diabetic patients with a disease duration of ≥10 years (Group D) and 30 nondiabetic patients (Group ND) undergoing elective surgery under General Anaesthesia (GA). Preoperative gastric ultrasonography was performed to assess antral dimensions and gastric contents in the Right Lateral (RL) and Semi-Sitting (SS) positions, and GRV was calculated. Gastric aspirate volume obtained via an orogastric tube was also recorded. Data were analysed using independent t-tests and Chi-square or Fisher’s exact tests with Statistical Package for Social Sciences (SPSS) version 21.0. Results: Groups ND and D were comparable with respect to sex (p=0.426), age (55.6±5.6 vs. 57.8±3.8 years), and Body Mass Index (BMI) (22.2±1.8 vs. 21.6±1.8 kg/m²; p=0.189), but differed significantly in American Society of Anesthesiologists (ASA) physical status (ND: ASA I; D: ASA II; p<0.0001). Qualitative antral grading differed significantly between the groups in both the RL (empty/fluid/solid: 83.3/16.7/0% vs. 26.7/63.3/10%; p<0.0001) and SS positions (96.7/3.3/0% vs. 53.3/46.7/0%; p=0.0002). Diabetic patients had significantly higher antral Cross-Sectional Area (CSA) and calculated GRV in both the RL position (CSA: 10.9±0.9 vs. 6.7±1.9 cm²; GRV: 112.2±12.2 vs. 53.2±30.1 mL) and the SS position (CSA: 8.3±1.8 vs. 4.3±1.4 cm²; GRV: 180.2±5.8 vs. 164.7±10 mL) (all p<0.0001). Gastric aspirate volume was significantly higher in diabetic patients (8.4±4.8 vs. 1.6±2.4 mL; p<0.0001). A significant correlation was observed between aspirated gastric volume and calculated GRV in the RL position in both diabetic (r=0.633) and nondiabetic patients (r=0.874) (p≤0.0002). Conclusion: Diabetic patients demonstrated significantly higher antral CSA, GRV, and aspirated gastric volume compared to non-diabetic patients, indicating an increased risk of pulmonary aspiration. Bedside gastric ultrasonography is a useful tool for assessing gastric volume and may aid in guiding safer anaesthetic management in this high-risk population.

This review article discusses the most common umbilical cord vessel anomalies and umbilical cord emergencies, as well as their implications on anesthetic management. Umbilical cord anomalies and emergencies pose significant risks to both the fetus and the mother. Fetal complications can include fetal heart tone issues, hypoxia, preterm delivery, unexpected neonatal ICU admissions, exsanguination, and fetal demise. Maternal complications can include emergency cesarean delivery and postpartum hemorrhage. Recognition of these anomalies and their potential complications is essential to the proper management of these patients. Anesthesia providers must be familiar with and available for patients with various umbilical cord pathologies to provide safe and effective care for the best maternal and neonatal outcomes if umbilical cord emergencies arise. Coordinated efforts should be in place for multidisciplinary emergency response systems.

Robotic-assisted bronchoscopy (RAB) is an emerging diagnostic and interventional technology which integrates thin-slice CT-based virtual airway reconstruction, precise navigation, and stable robotic manipulation.It has been shown to offer clear advantages in the management of peripheral pulmonary lesions. With the rapid increase in clinical adoption in China, standardized guidance is required to ensure safe and effective use. Based on multidisciplinary expert discussions and a systematic review of the literature, this consensus summarizes key principles for the clinical application of RAB, encompassing technical foundations, indications and contraindications, procedural workflow, anesthesia and perioperative management, imaging integration, complication prevention, telemedicine application, and requirements for facilities and personnel training. The consensus emphasizes the importances of selecting appropriate patient, standardizing preprocedural planning and intraoperative navigation, optimizing anesthesia and ventilation to reduce CT-to-body divergence, and using multimodal imaging in a rational way to enhance lesion confirmation and procedural accuracy. In addition, it highlights the importance of structured emergency preparedness, device contingency management, and competency-based team training, while acknowledging current limitations and future development directions of RAB. These recommendations aim to support the safe, consistent, and evidence-informed integration of RAB into clinical practice, as well as to promote its standardized development in China.

Objective — to analyze current data on anesthetic management techniques for abdominal delivery in pregnant women with morbid obesity. The review was conducted by searching PubMed, Google Scholar, and eLibrary databases from January 1, 2000, to August 31, 2024, using the keywords: pregnancy, obesity, body mass index, cesarean section, anesthesia, and complications. The search yielded 724 references. 655 references were excluded from the review due to their description of pregnancy management and spontaneous labor in obese patients. The literature review included 69 references. Inclusion criteria: design (clinical studies in all peer-reviewed journals without language or national restrictions); subjects (pregnant women with obesity grade II or higher). This review examines anesthesia techniques for cesarean section in pregnant women depending on the severity of obesity. The analysis revealed a wide range of neuraxial and general anesthesia techniques, each with its own advantages and disadvantages, and none is “perfect.” Anesthetic management of abdominal delivery in pregnant and postpartum women with morbid obesity requires a personalized, multidisciplinary approach. The review data suggest that further research is needed to personalize anesthesia for cesarean section in obese patients.

This review discusses the anesthetic management of patients with movement disorders, including those undergoing nonneurologic surgery, those undergoing deep brain stimulation surgery, and the perioperative care of individuals with deep brain stimulators. Safe anesthesia in patients with movement disorders aims to preserve baseline neurologic function and prevent perioperative worsening of symptoms. Key elements include identifying the specific movement disorder, understanding functional limitations and comorbidities, and managing chronic medications regardless of the surgical procedure. In deep brain stimulation surgery, anesthetic practice has evolved from predominantly "awake" techniques to a patient-centered approach that may involve awake surgery, monitored sedation, or general anesthesia. Technological advances such as high-resolution imaging, robotic assistance, and intraoperative computed tomography or MRI have improved targeting accuracy and expanded the feasibility and safety of asleep deep brain stimulation. Additionally, anesthesiologists increasingly care for patients with existing deep brain stimulation systems, which requires vigilance to prevent electromagnetic interference or electrical conduction that could impair device function or harm brain tissue near the electrodes. Anesthetic care for patients with movement disorders spans a broad clinical spectrum, from routine surgery to deep brain stimulation implantation and subsequent procedures in patients with implanted devices. Optimal outcomes depend on multidisciplinary collaboration, individualized anesthetic planning, and meticulous perioperative management to minimize neurologic and device-related complications.

Anesthetic Management of a Patient with Multidrug Allergy and Limited Anesthetic Options Undergoing Multilevel Lumbar Fusion Surgery

Retained placenta is a significant cause of postpartum hemorrhage (PPH) and maternal morbidity. Despite its clinical importance, limited data exists on the safety and effectiveness of different anesthetic techniques for manual removal of placenta (MROP). This study aimed to assess anesthesia-related outcomes and complications in a large tertiary care center with 20,000 to 22,000 annual deliveries. A retrospective cohort study was conducted on women who underwent MROP in the operating room between January 2018 and September 2024. Institutional Review Board approval was obtained prior to data collection. Patient demographics, risk factors, anesthetic techniques, and clinical outcomes were collected and analyzed. During the study period, there were 130,338 vaginal deliveries at our institution. Among 1,366 women (1.05%) undergoing MROP, 860 required placental revision and 506 underwent manual placental removal. Vacuum-assisted delivery was performed in 99 cases (22%). Neuraxial anesthesia was the predominant modality (81.9%), with spinal anesthesia most frequently used (73.7%) and 25.7% subsequently converted to epidural anesthesia. General anesthesia (GA) (16.6%) and sedation (1.5%) were less commonly employed. Women receiving GA had significantly higher risks of blood transfusion (RR 6.0 for RBC, RR 19.5 for FFP, p < 0.0001), longer hospitalization (4.1 ± 2.3 vs. 3.5 ± 3.4 days, p < 0.002), and increased need for ICU/PACU monitoring (RR 20.9, p < 0.0001). Difficult intubation occurred in three cases, with one reported case of aspiration. No hysterectomies were required. Neuraxial anesthesia was the preferred method for MROP, demonstrating a low failure rate. In contrast, GA was associated with increased morbidity, including higher transfusion requirements, prolonged hospitalization, and greater need for intensive monitoring. The occurrence of airway complications in GA cases underscores the importance of optimizing anesthetic management. Minimizing the use of GA, when feasible, may contribute to improved patient outcomes in MROP procedures.

Neonates comprise a special population of patients undergoing surgery, and the presence of congenital defects further complicates their anaesthetic management. This report describes a neonate born with Arnold-Chiari malformation and a ruptured myelomeningocele, who was later found to also have a double-outlet right ventricle. This report outlines the careful selection of anaesthetic agents and perioperative strategies tailored to the patient's compounded neurologic and cardiac congenital defects while catering to the surgical requirements. The patient underwent repair of the MMC under total intravenous anaesthesia induced with midazolam, ketamine and atracurium and maintained with a combination of dexmedetomidine and fentanyl. The combination of dexmedetomidine and fentanyl appears to be a viable option for neonates with rigid perioperative haemodynamic goals and a need for neuroprotection. We report the safe use of dexmedetomidine for total intravenous anaesthesia pending more robust evidence in this patient population.

Sacrococcygeal teratomas (SCT), although rare, are the most common teratomas found in neonates. Anesthetic management of neonates undergoing SCT resection surgery is challenging, given the risk of massive hemorrhage and high mortality rate. The primary aim of this single center retrospective study was to analyze neonates undergoing SCT resection over the last decade and report on perioperative outcomes, including blood product transfusion practices. The secondary aim was to describe patient and tumor characteristics that might place neonates undergoing SCT resection surgery at elevated risk for morbidity and mortality. Retrospective chart review of neonates who underwent sacrococcygeal teratoma resection at Boston Children's Hospital between January 2012 and April 2024. Demographic data, tumor characteristics, transfusion data, perioperative respiratory and hemodynamic data, and 30-day outcomes were collected. Descriptive statistics for patient and tumor characteristics are reported. Univariate analyses using Fisher's exact test and the Wilcoxon rank sum test were used for analysis of transfusion data and clinically significant postoperative events. Seventeen patients were identified. The median age at the time of surgery was day of life 4 with a median weight of 3.3 kg. Thirty-nine percent of neonates experienced a clinically significant postoperative event within 30 days of surgery, defined as a composite outcome event. One patient died within 30 days of surgery. Fifty-nine percent of neonates received an intraoperative blood transfusion. The median transfusion volume of RBCs was 24.8 mL/kg (0, 43). Those transfused had a larger median tumor volume [947.3 cm3 (interquartile range: 354.2, 2048)] and tumor volume-to-weight ratio [0.31 (0.10, 0.77)] compared to those who were not transfused [48.6 cm3 (24.2, 367.5)] and [0.02 (0.01, 0.07)] respectively. The median duration of anesthesia in transfused patients was 7.8 h (6.4, 9.2) versus 5.8 h (3.7, 6.7) in patients not transfused. Although more neonates with non-cystic tumors got transfused (70% vs. 30%), there was no statistically significant difference in median volume of red blood cells transfused intraoperatively for cystic [28.1 mL/kg (0, 40)] versus non-cystic tumors [24.8 mL/kg (0, 60)]. Neonates undergoing SCT surgery had a high rate of blood transfusion (59%), replacing on average over a quarter of their blood volume, and a high composite adverse outcome rate (39%). Predictors of blood product transfusion include immature tumors, gestational age less than 37 weeks, larger median tumor volume, greater tumor volume-to-weight ratio, higher intraoperative estimated blood loss, and longer time under anesthesia. Predictors of clinically significant postoperative events within 30 days of surgery include Altman type 2 tumors, gestational age less than 37 weeks, and longer anesthesia times.

Introduction: Severe traumatic brain injury (sTBI) frequently coexists with polytrauma and often necessitates damage control neurosurgery (DCNS), where rapid decompression and temporary stabilization take precedence over definitive reconstruction. Within this context, anesthetic management must balance cerebral protection with ongoing resuscitation, yet high-quality DCNS-specific evidence remains limited. Materials and Methods: A comprehensive search of PubMed, Scopus, and Google Scholar (2015–2025) was conducted using MeSH terms and keywords related to neurotrauma, anesthesia, intracranial pressure, and perioperative management. Studies were included if they examined anesthetic or hemodynamic strategies in severe TBI or DCNS and reported relevant clinical or physiologic outcomes. Results: Nineteen articles addressing perioperative strategies for optimizing DCNS outcomes were analyzed. Discussion: Preoperative care emphasizes hemodynamic stabilization and permissive hypertension, damage control resuscitation including massive transfusion protocols, optimization of cerebral perfusion pressure (CPP) and neuromonitoring, and the use of hyperosmolar therapy. Transexamic acid can be used in sTBI safely but with unclear improvement in outcomes. Intraoperatively, propofol-based total intravenous anesthesia is generally preferred over volatile agents due to favorable effects on intracranial pressure (ICP), cerebral blood flow (CBF), autoregulation, and emergence. While historically contraindicated, ketamine and etomidate are now increasingly used as hemodynamically protective induction agents. Analgesic and sedative strategies prioritize dexmedetomidine and carefully titrated opioids to minimize respiratory depression and reduce postoperative complications. CPP and ICP-directed management relies on individualized blood pressure targets, vasopressor selection, lung-protective ventilation, and strict temperature control. Conclusions: Emerging evidence has suggested the benefit of DCNS for patient survival. Overall, perioperative care is guided largely by physiology and extrapolation, highlighting the need for standardized protocols.

Noble gases xenon (Xe) and argon (Ar) emerge as promising therapeutic agents. Extensive studies have validated their efficacy across various models of organ injury, positioning them as novel candidates for clinical translation in critical care and perioperative medicine. Xe and Ar exert protective effects through multiple mechanisms, including activation of hypoxia-inducible factor-1 (HIF-1) pathway, inhibition of regulated cell death pathways, such as apoptosis, necroptosis, ferroptosis, and pyroptosis, and suppression of pro-inflammatory signaling. By modulating these key signaling pathways, Xe and Ar have been shown to improve outcomes in neurological, cardiac, renal, and hepatic systems across diverse models of ischemia-reperfusion injury, traumatic brain injury, and systemic inflammation. Clinically, Xe has shown efficacy in anesthesia, neonatal neuroprotection, and cardiac arrest management. Ar, with greater availability and lower costs, holds promise for broader clinical use but remains in the early stage of translational research. Xe and Ar represent novel biologically active gases with the potential to provide promising therapies in perioperative and clinical care medicine. Overcoming current limitations, such as a lack of standardized delivery systems and optimized dosing strategies, is key to uncovering their clinical application.

This case report describes the perioperative management of a massive solitary fibrous tumour of the pleura in a 77-year-old woman undergoing thoracotomy. The tumour, occupying a substantial portion of the right hemithorax, posed significant challenges regarding airway management, haemodynamic stability, and postoperative recovery. A comprehensive anaesthetic strategy was employed, including advanced monitoring, lung isolation, multimodal analgesia, and preemptive planning for potential complications. Careful intraoperative coordination minimised blood loss and maintained haemodynamic stability, avoiding the need for transfusion. Postoperative analgesia was effectively managed with a thoracic epidural catheter, facilitating early mobilisation and respiratory recovery. The patient experienced a favourable postoperative course and was discharged home on the seventh day. This case underscores the importance of individualised anaesthetic planning and multidisciplinary collaboration when managing large intrathoracic tumours.

Anaesthesia for cervical cerclage: a national survey of current practice among Obstetric Anaesthetists' Association (OAA) members in the United Kingdom (2025).

Cannabis is one of the most common psychoactive substances used worldwide, and its use is increasing. Modern products vary widely in tetrahydrocannabinol (THC) concentrations and usage routes, creating challenges for anesthesia providers. This review summarizes current evidence on the pharmacology, pharmacokinetics, physiologic effects, and perioperative considerations of cannabis to help guide safe anesthetic management of cannabis-using patients. Cannabis contains over 100 phytocannabinoids, chiefly psychoactive Δ9-THC and nonpsychoactive cannabidiol (CBD), which act on cannabinoid type-1 (CB1) and type-2 (CB2) receptors. Chronic use downregulates CB1 signaling, contributing to tolerance, dependence, and withdrawal. Cannabis exerts widespread physiologic effects, including neuropsychiatric complications, cardiovascular changes, respiratory issues, delayed gastric emptying, appetite stimulation, and reproductive endocrine disruption. Cannabis use has been associated with increased propofol requirements, possibly via cytochrome P450 enzyme induction and CB1 receptor downregulation. It may also alter responses to opioids, ketamine, and gabapentinoids, and chronic users often report higher postoperative pain. Cannabis use influences anesthetic dosing, airway and cardiovascular stability, and postoperative pain control. Thorough preoperative assessment, individualized anesthetic planning, and vigilant monitoring are essential, and further research is needed to establish evidence-based perioperative guidelines.

Certified Registered Nurse Anesthetists (CRNAs), desig- nated in the U.S. Army as military occupational specialty 66F, are advanced practice registered nurses who deliver autonomous anesthesia and pain management across a spec- trum of clinical and operational environments. Trained at the masters and doctoral levels, CRNAs manage the perioperative continuum of care — performing preanesthetic evaluations, formulating anesthetic plans, administering an- esthesia, and ensuring postoperative recovery. Their ability to practice independently in austere, resource-limited envi- ronments makes them indispensable to Army medicine and a cornerstone of military readiness

Pulmonary hydatid disease (PH) remains a significant health challenge in children from endemic regions. The anesthetic and surgical management of PH is complex, particularly in the presence of ruptured cysts, which pose risks such as airway obstruction and anaphylaxis. A 10-year retrospective cohort study was conducted on children ≤ 18 years undergoing surgery for PH at our tertiary care center between January 2012 and December 2022. Data were collected from medical records, operative notes, and imaging reports. There were 37 cases with diagnosis of pulmonary hydatid disease in last decade, we have included 28 children with complete records. Three had bilateral disease, totaling 31 procedures. Ruptured cysts were noted in 12 cases. Common symptoms included cough, fever, and hemoptysis. One lung ventilation (OLV) was achieved in 96% of cases with DLT (45%), Arndt blocker (33%) and Fogarty blocker (13%) commonly used. Complications included desaturation (75%), transient bradycardia (29%), and three major perioperative events, all in children with ruptured cysts. The mean OLV duration was longer in complicated cases (3.42 vs. 2.3 h, p = 0.019). Postoperative air leaks occurred in 10 children, with three requiring re-surgery. All patients were extubated on-table, with mean length of stay of 7 days and no long-term morbidity or mortality. OLV is critical in minimizing spillage and facilitating surgical management in pediatric PH. The incidence of intraoperative complications was higher in those with bilateral Pulmonary hydatid disease. The duration of One Lung Ventilation (OLV) and hospital stay was prolonged in those with complicated pulmonary hydatid cyst.

Cerebellopontine Angle (CPA) tumours are uncommon intracranial neoplasms that can present significant anaesthetic challenges, particularly in pregnant patients. The physiological, hormonal, and anatomical changes of pregnancy can mask neurological symptoms, delay diagnosis, and complicate both surgical and anaesthetic management. The authors report a rare case of a 22-year-old primigravida at 14 weeks of gestation who presented with progressive blurring of vision and left-sided tinnitus. Magnetic Resonance Imaging (MRI) revealed a large left CPA lesion compressing the fourth ventricle. She had a history of Ventriculoperitoneal (VP) shunt placement for hydrocephalus two weeks prior. The patient was subsequently planned for an elective left retromastoid suboccipital craniotomy. The procedure was performed under Total Intravenous Anaesthesia (TIVA) using propofol and dexmedetomidine, with continuous neurophysiological monitoring to preserve cranial nerve function. Muscle relaxants were avoided following intubation to facilitate Electromyographic (EMG) monitoring. Haemodynamic stability and foetal heart rate were maintained throughout the eight-hour procedure. The patient was electively ventilated overnight, extubated on the first Postoperative Day (POD) without neurological deficits, and postoperative imaging confirmed complete tumour excision. She later delivered a healthy male infant at 36 weeks via elective caesarean section. The present case highlights the successful perioperative management of a large CPA tumour during early pregnancy, where the timing of surgery, meticulous use of TIVA without muscle relaxants, and continuous foetal and cranial nerve monitoring ensured favourable maternal and foetal outcomes.

Beckwith-Wiedemann Syndrome (BWS) is a complex overgrowth disorder characterised primarily by macroglossia, omphalocele, and gigantism, along with a range of anatomical and metabolic abnormalities such as neonatal hypoglycaemia, embryonal tumours, visceromegaly, naevus flammeus, and anal dimple. Airway management in paediatric patients poses a significant challenge for anaesthesiologists. Anaesthetic management in patients with BWS is demanding because macroglossia may cause difficult mask ventilation, intubation, and extubation. These patients often require repeated anaesthetic exposure for the correction of macroglossia and associated abnormalities, and their perioperative management can be taxing for anaesthesiologists. Therefore, the anaesthetic management of children with BWS is particularly challenging due to the combination of age-related physiological limitations and disease-specific abnormalities. Here, the authors present the case of a five-month-old female infant diagnosed with BWS, with macroglossia, naevus flammeus, and an anal dimple, who underwent surgical reduction of macroglossia. The patient also demonstrated additional systemic findings including non-obstructing hydrocephalus, syringohydromyelia, hepatosplenomegaly, and enlarged kidneys on imaging, further increasing the complexity of anaesthetic care. Given the likelihood of a difficult airway, comprehensive preoperative evaluation, meticulous preparation, and well-structured backup strategies for airway management, endotracheal intubation, and intraoperative haemodynamic management are critical to navigating the anaesthetic complexities in patients with BWS. In addition, vigilant postoperative monitoring is essential due to the risk of airway obstruction and hypoglycaemia. The present case underscores the importance of multidisciplinary coordination and individualised anaesthetic planning to ensure safe perioperative outcomes.

Management of anaesthesia for transfemoral transcatheter aortic valve implantation: an Italian interdisciplinary consensus statement.

Obesity is a growing public health issue associated with increased peri-induction risk during general anesthesia, particularly airway-related complications. Substantial variability in national and international guidelines may contribute to heterogeneous clinical practice. This study aimed to describe anesthetic induction practices in patients with obesity in France and to explore the influence of body mass index and obesity-related comorbidities on the decision for or against rapid sequence induction. This nationwide declarative survey used an anonymous online questionnaire distributed to French anesthesiologists between May and December 2024. Using standardized theoretical clinical scenarios, induction strategies were classified as rapid sequence induction or conventional induction, as reported by participants. Data were analyzed descriptively, with group comparisons performed using Pearson's chi-square test. Of the 665 responses collected, 652 were analyzed, revealing wide variability in practices. For a body mass index of 43kg/m2, 57% of participants would not perform rapid sequence induction. Among respondents, 33% regarded a body mass index threshold of ≥40kg/m2 as appropriate for initiating rapid sequence induction, whereas 24% did not define any specific threshold. Rapid sequence induction was primarily selected for patients with daily gastroesophageal reflux disease, gastroesophageal reflux disease associated with a hiatal hernia, or a history of bariatric surgery. Anesthesiologist experience was associated with differences in the choice of induction sequence (p=0.003). Considerable heterogeneity remained in the calculation of neuromuscular blocking agent doses: 28% of practitioners used total body weight for non-depolarizing agents. Apneic oxygenation remained underused, with 32% of respondents reporting that they never used it. This nationwide survey highlights substantial variability in anesthetic induction practices for patients with obesity, reflecting the absence of consensus. These findings underscore the need for further evidence to inform future recommendations and optimize anesthetic management in this high-risk population.