Background: The concept of enhanced recovery after surgery (ERAS) spread to different surgical specialties to minimize surgical stress response, improve patient outcomes, and reduce the length of hospital stay (LOS). This study aimed to describe the early experience with an evidence-based ERAS pathway for anterior cervical discectomy and fusion (ACDF). Methods: This is a cohort study of retrospectively collected data. The ERAS pathway was created based on available evidence for anterior cervical spine surgery. Patients were followed up to postoperative day 30. Patient data were collected from a database, including demographics, pain score, postoperative complications, and LOS. Compliance with pathway elements was also noted. Results: Thirty-two patients were cared for under the pathway (n = 32). The median LOS was 44 hours, 26 minutes [interquartile range (IQR) 41–46 hours]. Reasons for extended stay longer than 48 hours in six patients included pain (n = 2), dyspnea (n = 1), and dysphagia (n = 3). The median LOS for the six patients who required extended stay was 73 hours [IQR 64 hours 30 minutes–81 hours]. Overall pathway compliance was 83.49%. The median number of ERAS process elements delivered to each patient was 15. There were no complications requiring readmission. Conclusion: The ERAS pathway for ACDF represents an opportunity for safe, prompt discharge. The ERAS pathway can be associated with minimal complications and no readmissions within 30 days of surgery. Further comparative studies are required to confirm the potential benefits of ERAS and the reduction in LOS. Key message: Implementing ERAS protocols helps improve patient experience and outcomes, and reduces cost and LOS.

Background: Central venous cannulation (CVC) is integral to pediatric critical care. While the right internal jugular vein (Rt IJV) remains a conventional site, its anatomical challenges in pediatric patients necessitate the exploration of alternatives. This study aimed to compare the efficacy and safety of the supraclavicular approach for left internal jugular vein (Lt IJV) cannulation against the traditional Rt IJV method, emphasizing both clinical outcomes and patient comfort. Materials and methods: A randomized controlled trial (RCT) was conducted at a tertiary care institution over 4 years (January 2019 to December 2022). Among 200 pediatric patients requiring CVC, 100 were randomized to the supraclavicular Lt IJV technique and 100 to the conventional Rt IJV approach. The primary outcome was the success rate of cannulation on the first attempt. Secondary outcomes encompassed mean attempts to success, time to successful cannulation, and complication incidence. Results: The supraclavicular Lt IJV technique demonstrated a higher success rate on the first attempt compared to the conventional Rt IJV method. Additionally, patients undergoing the supraclavicular approach experienced fewer dressing disturbances and reported increased satisfaction, pointing to the method's potential to enhance patient comfort and adherence. Conclusion: The supraclavicular approach for Lt IJV cannulation presents a viable and potentially superior alternative to the traditional Rt IJV method in pediatric patients. Given its advantages in both procedural success and patient satisfaction, this technique holds promise to influence future guidelines and reshape pediatric CVC practices.

GLP-1 receptor agonists (GLP-1 RAs) are used for the management of type 2 diabetes mellitus and also for weight loss. They are effective in reducing blood sugar levels in diabetic patients and have demonstrated significant results in overweight or obese patients, thus becoming increasingly popular. Delayed gastric emptying in patients taking GLP-1 RAs can lead to an increased risk of aspiration of gastric contents, even with adequate fasting. Several case reports have described aspiration of gastric contents and the presence of solid food on esophagogastroscopy. Stopping these drugs for extended periods can alter glycemic control. Intubating patients for procedures that can be done under sedation can lead to added cost, clinical risks, and procedure time. Various anesthesia societies have issued interim guidelines until further studies regarding the safety of these drugs in the perioperative period are available.

Pregnancy and its resultant physiologic changes cause the gallbladder volume to double, the emptying rate to slow, and motility impairment, resulting in saturation of cholesterol, which contributes to the ideal environment for gallstone formation. Gallstones can lodge in the common bile duct (CBD) and hence can cause choledocholithiasis. A case of cholelithiasis in the second trimester of pregnancy was complicated by choledocholithiasis and abdominal pain. Treatment was safely achieved using endoscopic retrograde cholangiopancreatography (ERCP), which was done under total intravenous anesthesia (TIVA).

Aim and background: Congenital tracheal stenosis is usually diagnosed during infancy because of respiratory distress. It presents as both inspiratory and expiratory stridor and is often associated with cardiopulmonary abnormalities. Undiagnosed tracheal stenosis without associated symptoms can lead to unanticipated difficult intubation and escalate to an airway emergency. Case description: We present a case of a 47-year-old female who was being evaluated for a renal transplant. A computerized tomography scan of the chest reported significant luminal compromise of the trachea at the level of the thyroid gland, with a maximum dimension of 7–8 mm in the sagittal plane. In the operating theatre, after confirming adequate face mask ventilation, a muscle relaxant (atracurium) was given as per body weight. Laryngoscopy was done using a size 3.5 McCoy, and the view according to the modified Cormack–Lehane was grade 2a. A size 6.0 mm internal diameter (ID) endotracheal tube, which has an outer diameter (OD) of 8.2 mm, was placed comfortably in the trachea. A size 6.5 tube (ID 6.5 mm, OD 8.9 mm) was found to be snugly fitting. The airway pressures were within the normal range during volume control ventilation. At the end of surgery, the trachea was extubated, and the patient was comfortable. Conclusion: There are no established airway management guidelines for such patients. In patients already diagnosed with tracheal stenosis, careful assessment and planning for intubation are essential for the smooth conduct of anesthesia. Clinical significance: A detailed history and careful inspection of available thoracic imaging can help in foreseeing unanticipated difficult intubations like tracheal stenosis.

This study shows that when providing ropivacaine analgesia via a popliteal sciatic perineural catheter after moderately painful foot or ankle surgery, a continuous infusion is required to maximize infusion benefits. Furthermore, the addition of patient-controlled bolus doses allows for a lower continuous basal rate and decreased local anesthetic consumption, extending the duration of infusion benefits in an ambulatory setting with a limited local anesthetic reservoir. A continuous popliteal sciatic nerve block (PSNB) with a perineural local anesthetic infusion has been shown to provide multiple benefits after moderately painful orthopedic procedures of the foot, including decreased pain, opioid use, and opioid-related adverse effects.

Patients with hypertrophic cardiomyopathy (HCM) pose a considerable anesthetic challenge as the outflow tract obstruction can be worsened by various conditions, which may be worsened by the concurrent occurrence of a difficult airway such as retrosternal goiter. Additionally, these patients pose a higher incidence of ischemic heart disease, which may further increase the risk of anesthesia and surgery. Successful anesthetic management in patients with HCM and goiter involves a multidisciplinary approach with the goal of maintaining stable hemodynamics with minimal LVOT obstruction, securing a definitive airway, and preventing postoperative complications. Here, we successfully managed a patient with HCM and retrosternal goiter posted for noncardiac surgery.

Background: Burnout among healthcare professionals, particularly anesthesiologists, is a critical concern due to its impact on job performance, patient safety, and overall well-being. Anesthesiologists are uniquely vulnerable due to the high-stress nature of their work, long hours, and the critical decisions they must make. Objective: This study aims to examine the prevalence of burnout among anesthesiologists, identify key factors contributing to their burnout, and explore the coping strategies employed to mitigate these effects. Methods: A comprehensive survey was conducted among 130 anesthesiologists across various settings, including academic hospitals, private practices, and surgical centers. The survey included validated burnout assessment tools—Maslach burnout inventory (MBI), questions on work-related stressors, and inquiries about personal and institutional coping strategies. Results: Preliminary findings indicate a significant prevalence of burnout, with high levels of emotional exhaustion, depersonalization, and reduced personal accomplishment. Key contributing factors include excessive workload, work-life imbalance, and lack of support. Coping strategies varied widely, with some anesthesiologists relying on personal resilience and others benefiting from institutional support programs. Conclusion: The study highlights the pressing issue of burnout among anesthesiologists and underscores the need for targeted interventions. Strategies to reduce burnout should focus on addressing the identified contributing factors and enhancing support systems both at the personal and institutional levels.