Human ; Anesthesiologists ; Anesthesiology

Anesthesiology ; Forecasting

BACKGROUND

Nontechnical skills (NTS) such as communication, teamwork, leadership, situation awareness, and decision-making are crucial for patient safety in anesthesia practice. Despite growing recognition of their importance, implementation of structured NTS training in anesthesia education remains variable.

This scoping review aims to map the current landscape of NTS training approaches in anesthesia residency programs globally over the past decade (2015–2025) to identify implementation patterns, assessment methodologies, and gaps in existing programs.

Following Arksey and O’Malley’s framework and PRISMA guidelines, a systematic search was conducted across PubMed, Scopus, and Google Scholar. Studies focusing on NTS training in anesthesia education published between January 2015 and February 2025 were included. Two-phase study selection involved title/abstract screening followed by full-text review with standardized criteria. Data regarding training approaches, assessment methods, and outcomes were extracted and analyzed.

Ten studies from eight countries met the inclusion criteria. Simulation-based training was the predominant educational approach (7/10 studies), with the anesthetists’ NTS framework being the most commonly utilized assessment tool. Teamwork, situation awareness, and decision-making were the most frequently targeted skill domains. Significant variability was observed in implementation approaches, ranging from isolated workshops to longitudinally integrated curricula.

While progress has been made in incorporating NTS into anesthesia training, notable gaps persist in longitudinal integration, cultural adaptation, and standardized assessment. Future research should focus on developing structured, evidence-based curricula to enhance patient safety outcomes.

BACKGROUND AND OBJECTIVES

Neuraxial anesthesia, which includes techniques such as spinal anesthesia, traditional epidural, combined spinal-epidural (CSE), and dural puncture epidural (DPE), is considered the most effective, safe, and reliable method for providing pain relief during labor and delivery. The choice between DPE, CSE, and EPL depends on various factors, including the parturient’s labor, pain intensity, and preferences. This network meta-analysis (NMA) aimed to determine which analgesic technique among DPE, CSE, and pure epidural (EPL) techniques would be more effective in providing adequate analgesia and producing fewer adverse effects and/or complications for parturients undergoing labor.

In this study, the different analgesia techniques were assigned. DPE is assigned as group A, CSE as group B, and EPL as group C. This NMA combines direct and indirect evidence obtained from randomized controlled trials (RCTs). An electronic systematic search was done using electronic databases and online published RCTs. Critical appraisal of studies, collection, and extraction of data was facilitated by the primary investigator and a peer. A total of 31 journal articles were initially identified for screening and a total of 5 studies – 1 from database searches and 4 from citation chaining – were included in this meta-analysis after Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Outcome measures were pooled and analyzed using Review Manager Web version 5.4.1.

Among parturients, the likelihood of experiencing a rapid onset of analgesia was significantly greater among those on CSE, whereas the onset of DPE approximates that of EPL. Subsequent sensitivity analysis improved the onset of DPE over EPL, thus overall CSE > DPE > EPL. The odds of developing maternal hypotension were CSE > DPE. Overall, the comparative odds are as follows: CSE > EPL = DPE. The incidence of fetal bradycardia is almost equal for both interventions in studies comparing DPE versus CSE analgesia and DPE versus EPL although there is a greater likelihood of developing fetal bradycardia when parturients are on CSE > EPL, hence the comparative odds of developing fetal bradycardia are as follows: CSE > EPL = DPE.

Overall, these findings suggest that CSE may offer advantages for labor analgesia among parturients in labor, in terms of faster onset of analgesia, although potentially causing higher risk of maternal hypotension and fetal bradycardia when compared to DPE and EPL. Based on the results of the current NMA article, further studies are required to compare DPE, CSE, and EPL for labor analgesia, to fully evaluate the risks and benefits of each intervention, particularly in relation to maternal and fetal outcomes.

Achondroplasia is a rare genetic disorder that affects endochondral ossification resulting in decreased linear bone growth. It is a form of primary skeletal dysplasia that accounts for more than 90% of disproportionate short stature in humans with an incidence of approximately 1 in 15,000–1 in 40,000 live births. These patients present with a characteristic craniofacial appearance along with musculoskeletal, respiratory, and cardiac abnormalities that, when superimposed with the physiological changes of pregnancy, may complicate anesthetic management. The paucity of evidence-based recommendations and protocols for the anesthetic management of parturients with achondroplasia for cesarean delivery poses a challenge in the choice of anesthesia and warrant special anesthetic considerations. Knowing the intricate relationship between the existing anatomical and physiological changes in achondroplasia and pregnancy is crucial for favorable patient outcomes. This is a case report of a 26-year-old primipara with achondroplasia who had a cesarean delivery for malpresentation under spinal anesthesia.

Tetralogy of Fallot (TOF) is the most common type of cyanotic congenital heart disease. The physiologic consequences that accompany the disease increase the risk for perioperative complications, and mortality is increased in the mere 3% that survive into adulthood without correction. This case report highlights the anesthetic management of a rare case of uncorrected TOF in a 50-year-old female with two-pillow orthopnea, occasional palpitations, and exertional dyspnea who underwent a major gynecologic procedure. Thorough understanding and careful planning were performed to balance anesthesia, accounting for shifts brought about by the long-term hypoxia and decreased pulmonary blood flow, affording an uneventful perioperative course and recovery.

The implementation of enhanced recovery after surgery (ERAS) protocols has led to increased interest in nonintubated video-assisted thoracoscopic surgery (NIVATS), especially in patients with compromised pulmonary function. We present a case of a 62-year-old female with stage IIIA breast cancer and pulmonary bronchiectasis who underwent right-sided wedge resection via NIVATS. A two-level thoracic paravertebral block (TPVB) at T4 and T6 using 0.4% isobaric bupivacaine with epinephrine was performed, resulting in sensory block from T2 to T7. An intrathoracic vagal block with 0.5% bupivacaine was administered to prevent cough. Sedation was maintained with dexmedetomidine and remifentanil. Surgery lasted 83 minutes with no complications. Postoperatively, pain was minimal (NRS 0–2), the patient mobilized within 6 hours and was discharged the next day. This case highlights the feasibility and safety of TPVB-based NIVATS in a high-risk patient, aligning with ERAS goals of enabling early recovery, avoiding airway instrumentation and minimizing opioid use.

Shone’s complex is a rare congenital cardiac malformation characterized by four obstructive lesions affecting the left heart and aortic arch: supramitral membrane, parachute mitral valve, subaortic stenosis, and aortic coarctation, typically presenting in an incomplete form. We report the case of a 6-year-old female with a variant of Shone’s complex, which included subvalvular aortic stenosis, mitral valve stenosis, hypoplastic aortic arch, coarctation of the aorta, and patent ductus arteriosus. Surgical intervention is required in approximately 40% of cases, particularly when accompanied by early pulmonary arterial hypertension. The patient underwent surgical correction and subsequently required venoarterial extracorporeal membrane oxygenation. This report discusses the anesthetic management for a child with Shone’s complex, highlighting strategies to prevent postoperative complications, including heart failure, pneumonia, dysrhythmias, and postcoarctation syndrome.

Human ; Anesthesiologists ; Anesthesiology

Anesthesiology ; Forecasting