Daily Anesthesiology Research Analysis

INTRODUCTION: International guideline recommendations vary on the use of sterile gowns during spinal anaesthesia. There is limited evidence of benefit for their routine use and debate about environmental, financial and clinical costs and benefits. Updated, evidence-informed, consensus-based recommendations on the essential infection prevention measures for single-shot spinal anaesthesia are required to balance the need to maintain high standards of infection prevention with proportionate and sustainable practice. METHODS: A comprehensive literature review was undertaken to explore: the risk of infective sequelae; time to establish anaesthesia; infection prevention recommendations for the clinician performing the procedure and the assistant; and attitudes to infection prevention. This formed the basis for the development of statements and recommendations, which were considered in a modified three-round Delphi process. RESULTS: In total, 239 academic articles were identified, with 39 selected for full-text review. The review informed the development of 10 statements and 11 recommendations. Thirty-two professional experts and one patient representative completed all three rounds of the Delphi process. Consensus was reached on eight statements and 11 recommendations, including that the routine use of a sterile gown when performing single-shot spinal anaesthesia for uncomplicated adult patients (i.e. immunocompetent and/or for whom the procedure is expected to be neither difficult nor prolonged), should not be considered mandatory; two statements did not reach consensus. DISCUSSION: This consensus statement defines the essential aseptic measures for single-shot spinal anaesthesia in uncomplicated adult patients. While the routine use of sterile gowns should not be considered mandatory, core aseptic practices such as effective hand hygiene and facemask use are essential. These recommendations support a proportionate, sustainable approach to infection prevention. Clinicians may use this guidance to inform safe, evidence-aligned and environmentally responsible anaesthetic practice. WHAT WE DID: We looked at research papers about infection prevention during spinal anaesthesia (an injection in the back used to make part of the body numb). We reviewed the evidence about infection risk, how long it takes to give the anaesthetic and what safety steps doctors and assistants should take. Using this information, we wrote a set of statements and recommendations. A group of experts and one patient then took part in several rounds of voting to agree on the final guidance. WHY DID WE DO IT: Different international guidelines give different advice about whether doctors should wear sterile gowns when giving spinal anaesthesia. There is not much clear evidence showing that gowns help prevent infection. There are also concerns about the cost, waste and environmental impact of using extra equipment. We wanted to create clear and balanced recommendations that keep patients safe while also being practical and sustainable. WHAT WE FOUND: After reviewing the evidence and discussing it with experts, most of the group agreed on the final recommendations. They agreed that wearing a sterile gown is not always necessary when giving a single spinal injection to adult patients with straightforward conditions. However, other important safety steps must still be followed, such as cleaning hands well and wearing a face mask. These steps help prevent infection while avoiding unnecessary use of equipment. The recommendations aim to support safe care while also being mindful of cost and the environment.

The last specific international European recommendations regarding the management of cardiogenic shock (CS) regardless of the etiology were issued over 10 years ago. We present herein recommendations for the management of CS in adults, developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of from the French Intensive Care Society [Société de Réanimation de Langue Française (SRLF)] and the French Society of Cardiology [Société Française de Cardiologie (SFC)], with the participation of the French Society of Anesthesia and Intensive Care [Société Française d'Anesthésie et de Réanimation (SFAR)], and the French Society of Thoracic and Cardiovascular Surgery [Société Française de Chirurgie Thoracique et Cardio-Vasculaire (SFCTCV)]. The recommendations covered six fields of application: CS teams and expert centers, symptomatic medical management, etiological management, organ support, temporary circulatory support and de-escalation and early post-CS management. Twenty-three "Patient Intervention Comparator Outcome" (PICO) questions were identified, leading to 41 recommendations regarding management of CS in adult patients. Seven recommendations were scored with high level of evidence (Grade 1), 11 with moderate level of evidence (Grade 2) and 17 with low level of evidence (Expert opinion). In 6 cases, the experts were not able to give an answer. All of the recommendations obtained strong agreement from the expert committee. The experts highlight the fact that optimal management of CS requires organization including a structured, multidisciplinary shock team and regional referral network, applying standardized protocols for diagnosis and staging. Early etiological treatment-such as culprit-lesion revascularization or urgent valve intervention-is central to improve outcomes. Hemodynamic support should prioritize norepinephrine as first-line vasopressor and privilege selective inotrope use. Temporary mechanical circulatory support (Impella, VA-ECMO) should be reserved for carefully selected patients following discussion by the expert team.

BACKGROUND: Up to 20% of total knee arthroplasty (TKA) patients experience significant postoperative pain that delays recovery and increases risk of chronic pain. Early identification of high-risk patients may allow for timely targeted interventions. Prior studies on postoperative pain trajectories have been limited by small cohorts and restricted methodology. This exploratory study characterized postoperative pain archetypes using machine learning and developed a perioperative predictive model to identify patients at higher risk for postoperative pain. METHODS: This single-center retrospective study analyzed 17,200 primary unilateral TKAs (2021-2024), randomly divided into 80% training (n=13,760) and 20% testing (n=3,440) sets. Pain scores (Numeric Rating Scale (NRS) 0-10) collected 0-72 hours postoperatively were modeled using long short-term memory with contrastive learning and K-means clustering. Least Absolute Shrinkage and Selection Operator regression was applied to 107 preoperative and intraoperative variables for feature selection, and selected variables were used to train an eXtreme Gradient Boosting (XGBoost) model. Model performance was assessed using accuracy and area under the receiver operating characteristic curve (ROC-AUC). RESULTS: Two distinct pain archetypes were identified on the training set: a "low pain" (n=7,082) and "high pain" cluster (n=6,678). The high pain cluster had higher mean postoperative NRS scores, greater cumulative pain burden, higher opioid consumption, and more chronic pain consultations. XGBoost predicted high-pain cluster membership with 64% accuracy and ROC-AUC of 0.68, with key predictors included younger age, ambulatory surgery, higher mode of tolerable NRS score, genicular block, and higher Patient-Reported Outcomes Measurement Information System-10 pain scores. Clustering using NRS data from only the first 12 or 24 postoperative hours showed moderate concordance with 72-hour results (61.3% and 62.4%, respectively). CONCLUSIONS: Machine learning identified distinct postoperative pain trajectories after TKA, and early pain data predicted later pain patterns. Incorporating early pain profiles into perioperative care may support proactive, individualized pain management.