Anesthesiology, September 21 edition

This PRISMA-based systematic review and meta-analysis included 12 randomized controlled trials involving 890 adults undergoing spine surgery. Locoregional anesthesia was associated with lower pain at 24 hours, substantially reduced analgesic consumption, and fewer nausea or vomiting complications than general anesthesia, although substantial heterogeneity limited conclusions about the best technique.

Impact: The study synthesizes randomized evidence directly relevant to opioid-sparing perioperative care in spine surgery. Its findings support broader consideration of regional techniques while appropriately highlighting uncertainty caused by heterogeneous interventions and outcome definitions.

Clinical Implications: Locoregional techniques may be incorporated into multimodal analgesia pathways for selected spine procedures and patients. Clinicians should avoid assuming that all regional techniques are equivalent and should select approaches based on surgical level, expertise, contraindications, and monitoring resources.

Future Directions: Future trials should use standardized pain, opioid-consumption, functional-recovery, and complication outcomes, with procedure-specific comparisons and adequate reporting of blinding, coanalgesics, and long-term recovery.

This 2025 anonymous survey of 1,725 U.S. anesthesiologists found that perioperative catastrophes remain common and are associated with substantial physical, psychosocial, and work-performance consequences. Formal debriefing and institutionally supported time off were uncommon, and nearly one-quarter of respondents had considered leaving anesthesiology because of such an event.

Impact: The study updates landmark evidence on the second-victim experience in anesthesiology and links clinician well-being to patient safety and workforce sustainability. Its large sample and longitudinally comparable instrument make the persistent support gap difficult for institutions to dismiss.

Clinical Implications: Hospitals should develop routine, nonpunitive post-event debriefing, confidential peer support, rapid access to mental health services, and flexible temporary duty relief after perioperative catastrophes. These interventions should be integrated into patient-safety systems rather than offered only informally or at the individual clinician’s initiative.

Future Directions: Prospective longitudinal studies should evaluate standardized institutional response bundles, identify clinicians at highest risk for persistent distress, and measure patient-safety, retention, sick-leave, and mental-health outcomes after implementation.

This retrospective review evaluated 888 anesthesia encounters in 237 infants younger than 12 months undergoing retinoblastoma diagnosis or localized treatment in an ophthalmology clinic. No anesthesia-related readmissions occurred within 24 hours, and most cases used a laryngeal mask airway, providing substantial real-world safety data for a vulnerable population.

Impact: The large number of repeated anesthetic encounters addresses an important evidence gap for anesthesia outside the operating room in infants. The findings can inform staffing, airway planning, recovery protocols, and decisions about clinic-based care for selected pediatric oncology procedures.

Clinical Implications: In appropriately equipped centers with experienced pediatric anesthesia teams, brief non-opioid-requiring retinoblastoma procedures may be safely performed in an ophthalmology clinic. The results should not be extrapolated to longer procedures, emergency cases, infants with major comorbidities, or settings without immediate airway and resuscitation capabilities.

Future Directions: Multicenter prospective registries should characterize respiratory events, hemodynamic instability, unplanned admissions, neurodevelopmental considerations, and outcomes in infants with significant comorbidities across different clinic-based anesthesia models.