Anesthesiology
Audio Summaries

Endovascular thrombectomy for patients with large-core ischaemic stroke presenting up to 24 h after onset (ATLAS): a systematic review and individual patient data meta-analysis with central imaging adjudication

The authors aimed to evaluate the efficacy and safety of endovascular thrombectomy in patients with large-core ischaemic stroke presenting within 24 hours of onset, a group often excluded from such treatments. Their systematic review and meta-analysis of individual patient data from six trials found that endovascular thrombectomy significantly improved functional outcomes and reduced mortality compared to medical management, although the benefits were less clear for patients with very large ischaemic core volumes (≥150 mL). Overall, the findings suggest that endovascular thrombectomy is beneficial for most patients with large-core ischaemic strokes, except in cases of extensive ischaemic changes presenting beyond 6 hours.

Enpatoran, a Toll-like receptor 7/8 inhibitor, in moderate-to-severe systemic lupus erythematosus: findings from Cohort B of a multicentre, international, double-blind, placebo-controlled dose-finding phase 2 trial

This study aimed to evaluate the efficacy and safety of enpatoran, a TLR7/8 inhibitor, in improving disease activity in patients with moderate-to-severe systemic lupus erythematosus (SLE) compared to placebo. Although enpatoran showed improved British Isles Lupus Assessment Group-based Composite Lupus Assessment (BICLA) response rates at various doses, the primary objective of demonstrating a statistically significant dose-response relationship was not achieved. Overall, enpatoran was well tolerated among participants.

Impact of introducing RTS,S/AS01_E malaria vaccine on mortality in young children in Ghana, Kenya, and Malawi: an observational evaluation of a cluster-randomised implementation programme

This study evaluates the impact of the RTS,S/AS01_E malaria vaccine on mortality rates in young children in Ghana, Kenya, and Malawi over a 46-month period following its introduction in 2019. The authors aimed to determine whether the vaccine significantly reduced overall mortality in children eligible for three doses compared to non-eligible children, finding a notable reduction in mortality, with approximately one in eight deaths averted in areas with moderate vaccine coverage. The results underscore the importance of accelerating malaria vaccine deployment in regions where malaria remains a leading cause of child mortality.

Individualised anaesthesia and analgesia in surgery: conceptual framework for improving postoperative pain

The authors explore the question of how to implement individualised anaesthesia and analgesia in surgical settings to improve postoperative pain management and patient outcomes. They argue that moving away from a one-size-fits-all approach requires comprehensive trials that consider various factors, including predictive risk, treatment options, and the alignment of patient and clinician values throughout the perioperative period. The study emphasizes the need for both clinical and ethical considerations in making personalized anaesthesia a reality.

The role of community-based blood pressure screening in improving hypertension care

The authors argue against the viewpoint that mass blood pressure screening detracts from hypertension care, positing instead that community-based screening can enhance hypertension detection, especially in underserved populations. They emphasize that such screening, when conducted with validated methods, can effectively identify individuals with elevated blood pressure and raise awareness about hypertension, ultimately supporting better management and control of the condition. The paper advocates for integrating community screening with primary care to address the global challenge of hypertension.

Shrinking pharmacological options in modern anaesthesia

The authors investigate the implications of the decreasing diversity of anaesthetic drugs in clinical practice, questioning how this trend affects patient care and clinical resilience. They argue that while standardization enhances safety, the reduction in pharmacological options may compromise adaptability and preparedness in anaesthesia, highlighting the need to maintain a range of agents for patient-centered care.

Ivermectin for Critically and Noncritically Ill Hospitalized Patients With COVID-19: Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP)

The authors aimed to determine whether ivermectin improves outcomes for critically and noncritically ill hospitalized patients with COVID-19. The study found that ivermectin did not significantly enhance organ support-free days or hospital survival compared to the control group in both critically and noncritically ill patients, suggesting that it is unlikely to provide clinical benefit in this population.

"We Talk About Everything": Experiences with Digital Health Communication in Palliative Care

The authors aimed to assess patient and caregiver experiences with digital communication tools in outpatient palliative care. Through qualitative interviews, they identified key themes, including the distinct roles of video and in-person visits, the potential for building trust via video, and the high engagement with patient portals despite usability challenges. The findings suggest a need for a flexible approach to care and advocate for improved digital tool usability and permanent telehealth extensions.

Long-term effects of colonoscopy screening on colorectal cancer incidence and mortality: a multicountry, population-based randomised controlled trial

This study aimed to evaluate the long-term effects of colonoscopy screening on colorectal cancer incidence and mortality over a 13-year follow-up period. The results indicated that screening significantly reduced the incidence of colorectal cancer but did not show a corresponding reduction in mortality, with both groups experiencing lower-than-expected mortality rates. The findings suggest that while colonoscopy screening is effective in lowering cancer incidence, its impact on mortality may be less pronounced than anticipated.

The environmental footprint and ecotoxicity of sevoflurane and propofol anaesthesia: a retrospective observational modelling study

The authors aimed to compare the environmental impact and water contamination potential of three anaesthetic strategies: total intravenous anaesthesia (TIVA) with propofol, target-controlled inhalational anaesthesia (TCIA) with sevoflurane, and manually optimised low-flow sevoflurane anaesthesia. Their findings indicate that TIVA with propofol resulted in significantly less water contamination and avoided the release of trifluoroacetic acid (TFA), while sevoflurane methods contributed to higher TFA emissions and its irreversible accumulation in the environment. These results highlight the importance of selecting anaesthetic practices that minimize ecological harm.