Despite decades of efforts to optimize procedure-specific pain management, up to 60% of surgical patients still experience moderate to severe pain and opioid-related adverse effects. Current guidelines primarily rely on standardised dosing protocols rather than individual patient characteristics, offering limited support for tailoring opioid therapy to patient-specific needs. This systematic review aimed to identify studies on decision support tools for adjusting perioperative systemic opioid dosing as individualised postoperative pain management and evaluate their effects on postoperative outcomes.

Optimising pain management during subcutaneous venous port (SVP) implantation is essential for patient-centred cancer care. However, evidence-based approaches to minimise intraoperative pain remain underexplored. This trial evaluated the clinical effectiveness and safety of the propofol-alfentanil patient-controlled sedation (PCS) technique as an adjunct to local anaesthesia (LA) for pain reduction during SVP implantation. Adult cancer patients at two Swedish anaesthesia departments received either LA + PCS or LA alone for SVP implantation. The primary outcome was the maximum intraoperative pain score on an 11-point numeric rating scale (NRS). Safety outcomes included respiratory, haemodynamic and insertion-related complications. Secondary outcomes assessed patient satisfaction and procedural measurements. A total of 340 patients (median age 70 [interquartile range, [IQR] 61-76], 51.8% male) were recruited between January 2023 and November 2024. Median intraoperative NRS pain scores were similar between groups (2 [0-3] vs. 2 [0-3], p = 0.292), with pain scores ≥ 4 reported in 22.9% (LA + PCS) and 22.2% (LA) (OR 0.96; 95% CI 0.57-1.60; p = 0.872). Hypoxia or obstructed airway occurred in 2/166 (1.2%) patients in the LA + PCS group and none in the LA group. Patient satisfaction was high in both groups (10 [10-10], p = 0.102). Optimal procedural conditions were reported more frequently with LA + PCS (96.4% vs. 82.0%; OR 5.84; 95% CI 2.36-14.44; p < 0.001), without affecting perioperative workflow. Propofol-alfentanil PCS does not significantly reduce intraoperative pain in patients during SVP implantation. Its routine use for pain reduction cannot be recommended. However, PCS may reasonably be offered to patients who prefer procedural sedation. EDITORIAL COMMENT: This randomised clinical trial found that adding patient-controlled sedation with propofol-alfentanil to standard local anaesthesia for subcutaneous venous port implantation does not have an impact on pain scores or patient satisfaction. Additional studies focusing on patients experiences and safety are recommended before implementing propofol-alfentanil patient-controlled sedation. Trial Registration: EudraCT number: 2021-003821-31; ClinicalTrials.gov identifier: NCT05688384.

Pancreatic surgical procedures are technically challenging and associated with a high level of surgical stress and postoperative pain. The most common surgical intervention in the pancreas is a pancreatoduodenectomy seconded by a distal pancreas resection and total pancreatectomy. Optimal pain management is crucial for ensuring early mobilization and has been shown to reduce the length of hospital stay and the incidence of postoperative complications. The optimal strategy, however, remains a matter of controversy, and the advantages and harms related to the use of different analgesic interventions remain unclear.

Seizure duration during electroconvulsive therapy (ECT) correlates with treatment efficacy and may be influenced by depth of anaesthesia. The Patient State Index (PSi), derived from processed EEG, offers a potential method to monitor depth of anaesthesia during ECT. This study examined the correlation between pre-ictal PSi and EEG-seizure duration.

The ratio of arterial oxygen partial pressure to fraction of inspired oxygen (PaO/FiO, hereafter P/F ratio) is a key component of the Sequential Organ Failure Assessment (SOFA) score. It reflects the severity of hypoxaemic respiratory failure. The ongoing revision of the SOFA score requires data-driven cutoffs for P/F ratio as well as rational criteria for respiratory support. In this study, we aimed to determine the optimal P/F ratio cutoffs for determining respiratory failure categories in the revised SOFA score and examined whether advanced respiratory support should be a prerequisite for the most severe categories.

Although clinical trials are fundamental to advancing evidence-based practice, significant heterogeneity in outcome reporting poses a considerable challenge to the validity of systematic reviews. This inconsistency impedes the ability to compare, synthesise and interpret research findings effectively. In the field of paediatric airway management, this issue is particularly relevant because of the low incidence of critical events and the related high morbidity and mortality. The issue of inadequate and variable outcome reporting in clinical trials has been widely acknowledged, necessitating initiatives to enhance the quality of future research.

Mechanical ventilation of severely ill obese patients can be difficult due to altered physiology, and clinical guidelines are lacking. This study aimed to investigate current practices for mechanical ventilation of obese patients in a Danish ICU.

Reversal of rocuronium-induced neuromuscular blockade (NMB) is possible with either neostigmine or sugammadex to prevent residual NMB. In adults, sugammadex provides faster reversal and has fewer side effects compared to neostigmine, even when combined with glycopyrrolate. In elderly patients, rocuronium has a longer onset time and duration of action; however, little is known about the reversal of rocuronium-induced NMB with either sugammadex or neostigmine and the recovery of muscle function postoperatively. The aim of this study was to determine the time to full recovery of neuromuscular function, defined as Train of Four ratio (TOF) ≥ 0.9 after reversal with either neostigmine 50 μg kg or sugammadex 2 mg kg in elderly patients aged 75 years or above undergoing total intravenous anaesthesia with rocuronium-induced moderate NMB. We hypothesised that sugammadex 2 mg kg provides a shorter time to TOF ≥ 0.9 compared to neostigmine 50 μg kg.

Despite developments in advanced life support, outcomes after out-of-hospital cardiac arrest (OHCA) remain poor. Levosimendan, a calcium-sensitizing inodilator commonly used in heart failure, has shown beneficial effects in several experimental models and anecdotal clinical cases of cardiac arrest. The Levosimendan in Cardiac Arrest (LeiCA) pilot trial will evaluate levosimendan as an adjunct to advanced life support in refractory OHCA.

Shedding of the endothelial glycocalyx may be a pathophysiological mechanism in septic shock, to which intravenous (IV) fluid therapy may contribute. We aimed to investigate the effects of restrictive versus standard IV fluid therapy on glycocalyx shedding in adult intensive care unit (ICU) patients with septic shock. In this preplanned sub-study of the CLASSIC trial, ICU patients with septic shock were randomized to restrictive or standard IV fluid therapy at one Danish and one Swedish ICU between February 2020 and October 2021. Plasma markers of glycocalyx shedding were measured at four timepoints: within the first hour after randomization (T0), the following morning (T1), the morning after (T2), at ICU discharge or up to 90 days after randomization (T3). The primary outcome was the change in plasma hyaluronan levels from T0 to T1. A total of 54 patients were included, below the planned sample size of 200, leading to important differences between groups. Mean hyaluronan levels decreased by 11 ng/mL (95% CI 35-41) more in the restrictive group compared to the standard group from T0 to T1. The interaction effect between group and time was non-significant (p value: 0.872). In this underpowered sub-study we found no statistically significant difference in endothelial glycocalyx shedding between adult ICU patients with septic shock randomized to restrictive versus standard IV fluid therapy. We consider these findings hypothesis-generating; further research is needed to confirm these results. EDITORIAL COMMENT: In this substudy of the CLASSIC trial, glycocalyx degredation products and related substances were measured serially in sepsic study participants randomized to restrictive or usual fluid treatment protocols. No differences between treatment glycocalyx degredation product and related substance levels were observed. Trial Registration: ClinicalTrials.gov identifier: NCT04282252.

This study investigates the impact of active external warming on afterdrop in simulated accidental hypothermia, compared to the effect of passive warming measures.

Critical emergency medicine (CrEM) is one of four subspecialty pillars within anesthesiology and intensive care medicine, as defined by the Scandinavian Society of Anesthesiology and Intensive Care Medicine (SSAI). Despite its recognized clinical relevance, a comprehensive definition of CrEM has until now been lacking. The aim of this study was to establish a consensus-based definition of CrEM and delineate its core components, competencies, and operational domains.

The use of single-use laryngeal masks has increased in recent decades; yet, their climate and environmental impacts remain poorly understood. This study aimed to compare the climate impacts of reusable and single-use laryngeal masks.

This systematic review aims to clarify how combining short- and long-acting local anaesthetics (LA) affects onset time and duration in peripheral nerve blocks.

Many patients admitted to the intensive care unit (ICU) experience dysglycemia, i.e., hyperglycemia, hypoglycemia, and high glycemic variability, which are linked to poor outcomes. Early identification of patients at risk could potentially improve prevention and management. We aimed to report overall incidences of dysglycemia and investigate early identifiable predictors.

Epidural analgesia is an effective postoperative pain treatment reducing the administration of systemic opioids and improving postoperative outcomes. Evidence suggests that epidural analgesia improves pain management, improves physical function, reduces nausea and sedation, and patients have a better recovery. Still studies have shown ward nurses lack education in epidural pain treatment. Our study investigated ward nurses' use of in situ epidural catheter for pain treatment when patients experience breakthrough pain. Furthermore, we explored if educational programs are available, and the barriers experienced by ward nurses when treating breakthrough pain in patients with an epidural catheter.