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BackgroundIntraoperative stimulation mapping (ISM) using electrocortical mapping (awake craniotomy, AC) or evoked potentials has become a solid option for the resection of supratentorial low-grade gliomas in eloquent areas, but not as much for high-grade gliomas. This meta-analysis aims to determine whether the surgeon, when using ISM and AC, is able to achieve improved overall survival and decreased neurological morbidity in patients with high-grade glioma as compared to resection under general anesthesia (GA).MethodsA systematic search was performed to identify relevant studies. Adult patients were included who had undergone craniotomy for high-grade glioma (WHO grade III or IV) using ISM (among which AC) or GA. Primary outcomes were rate of postoperative complications, overall postoperative survival, and percentage of gross total resections (GTR). Secondary outcomes were extent of resection and percentage of eloquent areas.ResultsReview of 2049 articles led to the inclusion of 53 studies in the analysis, including 9102 patients. The overall postoperative median survival in the AC group was significantly longer (16.87 versus 12.04 months; p < 0.001) and the postoperative complication rate was significantly lower (0.13 versus 0.21; p < 0.001). Mean percentage of GTR was significantly higher in the ISM group (79.1% versus 47.7%, p < 0.0001). Extent of resection and preoperative patient KPS were indicated as prognostic factors, whereas patient KPS and involvement of eloquent areas were identified as predictive factors.ConclusionsThese findings suggest that surgeons using ISM and AC during their resections of high-grade glioma in eloquent areas experienced better surgical outcomes: a significantly longer overall postoperative survival, a lower rate of postoperative complications, and a higher percentage of GTR.

We read with great interest the recent study by Naddi et al. in BMC Anesthesiology, which explores operator gender differences in major mechanical complications following central venous catheterization. The study identifies male operator gender as an independent risk factor for complications. However, our attempt to replicate these findings using Colombian data did not support this association. We caution against oversimplifying the influence of sex and gender on health outcomes, as numerous factors, including cultural norms, healthcare practices, and resource availability, significantly impact procedural outcomes. Differences in complication rates may reflect risk-taking behaviors and systemic healthcare disparities rather than inherent biological differences. We emphasize the need for a comprehensive approach to understand the multifaceted nature of central venous related complications. Replication studies across diverse populations are crucial for validating these findings and informing effective strategies for complication prevention and management.

ObjectiveSleep disruption occurs frequently in hospitalised patients. Given the potential of music intervention as a non-pharmacological measure to improve sleep quality, we aimed to assess and quantify current literature on the effect of recorded music interventions on sleep quality and quantity in the adult critical care and surgical populations.DesignSystematic review and meta-analysis.Data sourcesEmbase, MEDLINE Ovid, Cochrane Central, Web of Science and Google Scholar.Eligibility criteria for studiesRandomised controlled trials assessing the effect of music on sleep quality in critically ill and surgical patients.MethodsThe electronic databases were systematically searched from 1 January 1981 to 27 January 2020. Data were screened, extracted and appraised by two independent reviewers. Primary outcomes were sleep quality and quantity, assessed with validated tools. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Random effects meta-analysis was performed, and pooled standardised mean differences (SMDs) with 95% CIs were reported.ResultsFive studies (259 patients) were included in qualitative (risk of bias) and quantitative analysis (meta-analysis). Pooled data showed a significant effect of recorded music on subjective sleep quality in the critical care and surgical population (SMD=1.21 (95% CI 0.50 to 1.91), p<0.01, excluding one non-English study; SMD=0.87 (95% CI 0.45 to 1.29), p<0.01). The SMD of 1.21 corresponded to a 27.1% (95% CI 11.2 to 42.8) increase in subjective sleep quality using validated questionnaires. A significant increase in subjective sleep quantity of 36 min was found in one study. Objective measurements of sleep assessed in one study using polysomnography showed significant increase in deeper sleep stage in the music group.ConclusionsRecorded music showed a significant improvement in subjective sleep quality in some critical care and surgical populations. Therefore, its use may be relevant to improve sleep, but given the moderate potential for bias, further research is needed.PROSPERO registration numberCRD42020167783.

Music is a promising (adjunctive) treatment for both acute and chronic pain, reducing the need for pharmacological analgesics and their side effects. Yet, little is known about the effect of different types of music. Hence, we investigated the efficacy of five music genres (Urban, Electronic, Classical, Rock and Pop) on pain tolerance. In this parallel randomized experimental study, we conducted a cold pressor test in healthy volunteers ( n  = 548). The primary outcome was pain tolerance, measured in seconds. No objective (tolerance time) or subjective (pain intensity and unpleasantness) differences were found among the five genres. Multinomial logistic regression showed that overall genre preference positively influenced pain tolerance. In contrast, the music genres that participants thought would help for pain relief did not. Our study was the first to investigate pain tolerance at genre level and in the context of genre preference without self-selecting music. In conclusion, this study provides evidence that listening to a favored music genre has a significant positive influence on pain tolerance, irrespective of the kind of genre. Our results emphasize the importance of individual music (genre) preference when looking at the analgesic benefits of music. This should be considered when implementing music in the clinical setting.

The Quality of Recovery Score-40 (QoR-40) has been increasingly used for assessing recovery after patients undergoing surgery. However, a prediction model estimating quality of recovery is lacking. The aim of the present study was to develop and externally validate a clinical prediction model that predicts quality of recovery up to one week after surgery. The modelling procedure consisted of two models of increasing complexity (basic and full model). To assess the internal validity of the developed model, bootstrapping (1000 times) was applied. At external validation, the model performance was evaluated according to measures for overall model performance (explained variance ( R 2 )) and calibration (calibration plot and slope). The full model consisted of age, sex, previous surgery, BMI, ASA classification, duration of surgery, HADS and preoperative QoR-40 score. At model development, the R 2 of the full model was 0.24. At external validation the R 2 dropped as expected. The calibration analysis showed that the QoR-40 predictions provided by the developed prediction models are reliable. The presented models can be used as a starting point for future updating in prediction studies. When the predictive performance is improved it could be implemented clinically in the future.

Clinical practice guidelines (CPG) are statements that provide recommendations regarding the approach to different diseases and aim to increase quality while decreasing the risk of complications in health care. Numerous guidelines in the field of perioperative care have been published in the previous decade but their methodological quality and transparency are relatively unknown. To critically evaluate the transparency and methodological quality of published CPG in the preoperative assessment and management of adult patients undergoing elective surgery. Systematic review and methodological appraisal study. We searched for eligible CPG published in English or Spanish between January 1, 2010, and June 30, 2022, in Pubmed MEDLINE, TRIP Database, Embase, the Cochrane Library, as well as in representatives' medical societies of Anaesthesiology and developers of CPG. CPG dedicated on preoperative fasting, cardiac assessment for non-cardiac surgery, and the use of routine preoperative tests were included. Methodological quality and transparency of CPG were assessed by 3 evaluators using the 6 domains of the AGREE-II tool. We included 20 CPG of which 14 were classified as recommended guidelines. The domain of \"applicability\" scored the lowest (44%), while the domains \"scope and objective\" and \"editorial interdependence\" received the highest median scores of 93% and 97% respectively. The remaining domains received scores ranging from 44% to 84%. The top mean scored CPG in preoperative fasting was ASA 2017 (93%); among cardiac evaluation, CPG for non-cardiac surgery were CCS 2017 (91%), ESC-ESA 2014 (90%), and AHA-ACC 2014 (89%); in preoperative testing ICSI 2020 (97%). In the last ten years, most published CPG in the preoperative assessment or management of adult patients undergoing elective surgery focused on preoperative fasting, cardiac assessment for non-cardiac surgery, and use of routine preoperative tests, present moderate to high methodological quality and can be recommended for their use or adaptation. Applicability and stakeholder involvement domains must be improved in the development of future guidelines.

Cerebrospinal fluid (CSF) drainage and lavage are reported to reduce drug exposure after inadvertant intrathecal drug administration errors. This reviews aims to provide recommendations for this salvage technique, with regard to methodology, effectiveness and adverse events. Systematic review. A search in the databases of Embase, Medline, Web of Science, Cochrane Central Register of Randomized Trials and Google Scholar was performed in 2022. All reports of individual patient data with CSF drainage or lavage with a percutaneous lumbar access for an intrathecal drug error were included. The primary outcome is the description and count of CSF drainage or lavage, such as times and volume of drainage, volume of replacement and type of replacement fluid. Secondary outcomes are the effects, adverse events and overall outcome. 58 cases were found, of which 24 were paediatric cases. There was a large variance in methodology, with regard to volume t and type of replacement fluid. In 45% of the cases the intrathecal drug removal continued. The effects were specifically reported in 27 cases, all demonstrated drug removal based on drug concentrations in the CSF (n = 20) and clinical signs (n = 7). Adverse effects were sought for in 17 cases and found intracranial haemorrhage in 3 cases. No interventions were required for these adverse events and the only reported long-term sequelae in these three patients was short-term memory impairment up to 6 months after the event (n = 1). The overall outcome depended largely on the causative agent. This review shows that CSF drainage or lavage leads to intrathecal drug removal, but it is unsure if this intervention leads to improved overall patient outcome. Based on aggregated data from case reports, we provide recommendations that may guide clinicians. The risk-benefit ratio should be weighed on a case-to-case basis. •Intrathecal drug error continue to occur, despite many preventive measures.•CSF drainage or lavage is a viable option to remove drugs.•CSF drainage or lavage may limit the consequences of the drug error.•Adverse events are limited, but can be more severe than the drug error.•CSF drainage or lavage should be weighed on a case-to-case basis.

Perioperative music interventions are promising, with substantial beneficial effects on patients. However, adequate reporting is crucial for interpreting the outcomes and implementing the interventions. Our objective is to analyze the reporting quality of perioperative music interventions and to provide recommendations and a research agenda for future trials. This study utilized data from a systematic review, that was conducted as part of a separate previous analysis by Geensen, Dirven et al. For this analysis, a PROSPERO registration (CRD42023427138) was formalized. The Template for intervention Description and Replication (TiDieR) checklist was adapted and used. Nineteen intervention items were assessed, categorized in the aim, the core and the implementation. Due to narrowed inclusion criteria, ten music intervention studies were included. None of the studies completely reported all intervention items. The reporting of core intervention items were poorly described. Complete description of implementation items, such as fidelity and modifications, was scarce. Perioperative music studies often lack the complete reporting of essential intervention items. This hinders replicability, generalization of the results and might contribute to research waste. We recommend adequate reporting in future studies to avoid these problems, by using our adapted TIDieR checklist. •This is the first systematic review evaluating music intervention reporting using the TiDieR checklist.•Insufficient reporting was present in all included studies, impairing future implementation.•Potential to enhance reporting in tailoring and adherence assessments exists.•Our adapted checklist and research agenda are recommended for future research.

BackgroundAwake craniotomy with electrocortical and subcortical mapping (AC) has become the mainstay of surgical treatment of supratentorial low-grade gliomas in eloquent areas, but not as much for glioblastomas.ObjectiveThis retrospective controlled-matched study aims to determine whether AC increases gross total resections (GTR) and decreases neurological morbidity in glioblastoma patients as compared to resection under general anesthesia (GA, conventional).MethodsThirty-seven patients with glioblastoma undergoing AC were 1:3 controlled-matched with 111 patients undergoing GA for glioblastoma resection. The two groups were matched for age, gender, preoperative Karnofsky Performance Score (KPS), preoperative tumor volume, tumor location, and type of adjuvant treatment. Primary outcomes were extent of resection and the rate of postoperative complications. The secondary outcome was overall postoperative survival.ResultsAfter matching, there were no significant differences in clinical variables between groups. Extent of resection was significantly higher in the AC group: mean extent of resection in the AC group was 94.89% (SD = 10.57) as compared to 70.30% (SD = 28.37) in the GA group (p = 0.0001). Furthermore, the mean rate of late minor postoperative complications in the AC group (0.03; SD = − 0.16) was significantly lower than in the GA group (0.15; SD = 0.39) (p = 0.05). No significant differences between groups were found for the other subgroups of postoperative complications. Moreover, overall postoperative survival did not differ between groups (p = 0.297).ConclusionThese findings suggest that resection of glioblastoma using AC is associated with significantly greater extent of resection and less late minor postoperative complications as compared with craniotomy under GA without the use of surgery adjuncts. However, due to certain limitations inherent to our study design (selection bias) and the absence of the use of surgery adjuncts in the GA group, we advocate for a prospective study to further build upon this evidence and study the use of AC in glioblastoma patients.

Glioblastomas are mostly resected under general anesthesia under the supervision of a general anesthesiologist. Currently, it is largely unkown if clinical outcomes of GBM patients can be improved by appointing a neuro-anesthesiologist for their cases. We aimed to evaluate whether the assignment of dedicated neuro-anesthesiologists improves the outcomes of these patients. We also investigated the value of dedicated neuro-oncological surgical teams as an independent variable in both groups. A cohort consisting of 401 GBM patients who had undergone resection was retrospectively investigated. Primary outcomes were postoperative neurological complications, fluid balance, length-of-stay and overall survival. Secondary outcomes were blood loss, anesthesia modality, extent of resection, total admission costs, and duration of surgery. 320 versus 81 patients were operated under the anesthesiological supervision of a general anesthesiologist and a dedicated neuro-anesthesiologist, respectively. Dedicated neuro-anesthesiologists yielded significant superior outcomes in 1) postoperative neurological complications (early: p = 0.002, OR = 2.54; late: p = 0.003, OR = 2.24); 2) fluid balance (p<0.0001); 3) length-of-stay (p = 0.0006) and 4) total admission costs (p = 0.0006). In a subanalysis of the GBM resections performed by an oncological neurosurgeon (n = 231), the assignment of a dedicated neuro-anesthesiologist independently improved postoperative neurological complications (early minor: p = 0.0162; early major: p = 0.00780; late minor: p = 0.00250; late major: p = 0.0364). The assignment of a dedicated neuro-oncological team improved extent of resection additionally (p = 0.0416). GBM resections with anesthesiological supervision of a dedicated neuro-anesthesiologists are associated with improved patient outcomes. Prospective evidence is needed to further investigate the usefulness of the dedicated neuro-anesthesiologist in different settings.