Daily ReportOct 7, 2026
Anesthesiology, October 7 edition
We read 37 papers and selected 3.
Summary
Today’s most impactful anesthesiology research addressed preventable neuraxial medication errors, real-world implementation of lung-protective ventilation, and delirium prevention with intraoperative dexmedetomidine. Together, these studies span patient-safety systems, large-scale practice assessment, and randomized perioperative pharmacology.
Research Themes
- Neuraxial medication safety and human factors
- Implementation of lung-protective intraoperative ventilation
- Pharmacological prevention of postoperative delirium
Selected Articles
1. Neuraxial Medication Administration Errors During Anaesthesia and Perioperative Management, Consequences, Contributing Human and Systemic Factors and Their Prevention: A Systematic Review.
This systematic review identified 50 reports involving 54 patients with neuraxial medication administration errors. The most severe outcomes—irreversible paraplegia or quadriplegia and death—were mainly associated with accidental bolus administration of antiseptic solutions. Human and Systemic Factors Analysis Classification System (HFACS) analysis identified modifiable skill-based, identification, supervision, organizational, and workflow failures.
Impact: The paper converts rare but catastrophic medication incidents into a structured safety framework and identifies concrete institutional targets for prevention. Its novel harm classification and HFACS analysis support system-level improvements rather than relying solely on individual vigilance.
Clinical Implications: Institutions should separate and clearly label neuraxial medications, antiseptics, and routinely used equipment; strengthen storage and checking procedures; standardize neuraxial drug administration protocols; and use multidisciplinary incident review and competency-based training. High-risk antiseptic errors warrant particular attention because they can cause permanent neurological injury or death.
Key Findings
- Fifty reports involving 54 patients were identified; 38 events involved the epidural route and 16 involved the intrathecal route.
- Four patients developed irreversible paraplegia or quadriplegia and four patients died; the most severe events were mainly caused by accidental antiseptic administration.
- HFACS identified modifiable skill-based errors, object or medication misidentification, inadequate supervision, organizational deficiencies, resource problems, and task-execution failures.
Methodological Strengths
- Broad database searching from 1981 through 2025 across multiple databases and languages.
- Integration of a novel five-level harm scale with the HFACS framework to link outcomes with modifiable causal factors.
Limitations
- The evidence base consisted primarily of published incident reports and included only 54 patients, limiting incidence estimation and causal inference.
- Reporting and publication bias are likely, and the novel harm scale has not yet undergone external validation.
Future Directions: Prospective international registries should measure the incidence of neuraxial medication errors, validate the harm scale, and evaluate interventions such as standardized storage, barcode verification, pre-procedure time-outs, and simulation-based training.
INTRODUCTION: This systematic review aimed to investigate neuraxial administration errors, examine their contributing factors, and evaluate clinical outcomes using a novel harm scale. METHODS: The author searched PubMed, Web of Science, Scopus, EBSCOhost, and Google Scholar for reports from 1981 to 2025 in any language. Exclusions were reviews, overdose incidents, and non-neuraxial administrations. Harm was classified using a novel five-level scale, and contributing factors were identified using the Human and Systemic Factors Analysis Classification System (HFACS). RESULTS: The search revealed 50 reports (54 patients), mainly involving the epidural route (38 vs 16 intrathecal), non-obstetric patients (35 vs 17 obstetric), and female gender (73%). Medications were grouped into nine divisions: IV fluids/total parenteral nutrition/insulin, anticholinergics, antiseptics, antiemetics, anticoagulants, non-steroidal anti-inflammatory drugs, opioids, Syntocinon, and others.
2. Intraoperative ventilation settings in Germany: an observational multicentre cross-sectional study.
This pragmatic prospective multicentre study assessed intraoperative ventilation settings across Germany before and after a Delphi-developed educational pocket card. More than 2,000 operating rooms were evaluated in each phase, and most departments already adhered to lung-protective ventilation recommendations; the intervention produced little overall change but may have helped departments with poor baseline performance.
Impact: The study provides unusually broad, real-world evidence on how anesthesiology recommendations are implemented across an entire national healthcare system. Its largely negative intervention result is informative because it shows that simple education has limited marginal benefit when baseline adherence is already high.
Clinical Implications: Routine auditing should identify departments with low adherence to recommended tidal volumes, driving pressures, and fresh gas flows. In high-performing settings, further gains may require targeted feedback, electronic decision support, local quality-improvement teams, and equipment or workflow changes rather than education alone.
Key Findings
- More than 240 of 1,148 German anesthesiology departments participated, with data collected from 2,198 operating rooms before and 2,106 after the intervention.
- Most anesthesiologists already followed current lung-protective ventilation recommendations, so no major improvement occurred across the entire cohort.
- The Delphi-developed pocket card appeared most likely to benefit departments whose baseline ventilation practice substantially deviated from recommendations.
Methodological Strengths
- Prospective national multicentre design with a very large number of operating-room observations.
- Pragmatic before-and-after assessment linked to a clearly described Delphi-based educational intervention.
Limitations
- Participation was voluntary, representing 21% of anesthesiology departments and creating potential selection bias.
- The before-and-after design cannot establish that observed changes were caused by the pocket-card intervention, and patient outcomes were not the primary focus.
Future Directions: Future studies should use cluster-randomized implementation designs, link ventilation settings to postoperative pulmonary outcomes, and test targeted electronic feedback or audit-and-feedback strategies in departments with low baseline adherence.
PURPOSE: Intraoperative lung protective ventilation and, in inhalational anesthesia, minimal fresh gas flow (FGF) are recommended. It remains unclear how these recommendations are transferred to clinical routine. We aimed to assess corresponding anesthesia practices in Germany and raise awareness of optimal ventilation settings. METHODS: We performed a pragmatic prospective observational national cross-sectional assessment of intraoperative ventilation settings in Germany, followed by an educational intervention and follow-up assessment. The intervention consisted of a pocket card designed in a Delphi-process. The patient-centred primary endpoint was tidal volume (V
3. Intraoperative Dexmedetomidine and Postoperative Delirium After Head and Neck Cancer Surgery with Free-Flap Reconstruction: A Secondary Analysis of a Randomized Placebo-Controlled Trial.
In this secondary analysis of a randomized, double-blind, placebo-controlled trial, intraoperative dexmedetomidine was associated with a lower incidence of delirium during the first five postoperative days after free-flap head and neck cancer surgery. Delirium occurred in 14.9% of patients receiving dexmedetomidine versus 34.7% receiving placebo, with an adjusted odds ratio of 0.31 and no apparent increase in perioperative adverse events.
Impact: The study provides clinically actionable randomized evidence for a potentially modifiable anesthetic factor in a population at high risk for postoperative delirium. The magnitude of the observed association supports prospective confirmation and may inform multimodal delirium-prevention protocols.
Clinical Implications: For major head and neck cancer surgery with free-flap reconstruction, intraoperative dexmedetomidine may be considered as part of a delirium-reduction strategy, while monitoring for bradycardia, hypotension, and sedation. Routine adoption should await adequately powered primary trials in broader surgical populations.
Key Findings
- Postoperative delirium during the initial five days occurred in 7 of 47 patients receiving dexmedetomidine (14.9%) versus 17 of 49 receiving placebo (34.7%).
- After adjustment for age, preoperative Mini-Mental State Examination score, and operative time, dexmedetomidine was associated with lower odds of delirium (adjusted odds ratio 0.31, 95% confidence interval 0.10-0.92).
- No apparent increase in perioperative adverse events was observed with intraoperative dexmedetomidine.
Methodological Strengths
- Underlying study used randomized, double-blind, placebo-controlled allocation.
- Delirium was evaluated in a clinically high-risk, well-defined surgical population with adjustment for important baseline and procedural factors.
Limitations
- This was a secondary analysis of a single-centre trial with a small sample, so it may be underpowered for safety outcomes and subgroup analyses.
- The delirium-focused analysis may not have been the original primary endpoint, and generalizability to other operations and patient populations is uncertain.
Future Directions: Large multicentre randomized trials should confirm the delirium effect, define optimal dosing and timing, assess longer-term cognitive outcomes, and compare dexmedetomidine with other components of multimodal delirium-prevention bundles.
BACKGROUND: Postoperative delirium is common after major head and neck cancer surgery. We investigated whether intraoperative dexmedetomidine infusion was associated with a lower incidence of postoperative delirium in patients undergoing head and neck cancer surgery requiring free-flap reconstruction. METHODS: This was a delirium-focused secondary analysis of a single-centre, randomized, double-blind, placebo-controlled trial. Adult patients with head and neck cancer scheduled for elective surgery requiring free-flap reconstruction under general anaesthesia were randomly assigned to receive intraoperative dexmedetomidine infusion at 0.3 μg kg