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Cata, Rita Cataldo, Paul Cathcart, Xavier Cathelineau, James Catto, Alberto Caviglia, Valentina Ceccarelli, Valerio Cellini, Elisabetta Cerutti, Seçil Çetin, Praveen Chahar, Chu Ann Chai, Palesa Motshabi Chakane, Venu Chalasani, Benjamin Challacombe, Ramandeep Chalokia, Christos Chamos, Albert Kam Ming Chan, Kimberely Chan, Kittipong Chaowarat, Kapil Chaudhary, Lucas Arrais Chaves Nascimento, Yue Che, Joseph G Cheaib, Enrico Checcucci, Karen Chen, Kenneth Chen, Pinxia Chen, Yu-Chen Chen, But Sing Maxime Cheng, Giuseppe Chiacchio, Ijeoma Chibuzo, Sarah Chieveley-Williams, Mallikarjuna Chiruvella, Ken Chow, George Christodoulides, Paul H. 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Deshbhratar, Brecht Devos, Andrew Deytrikh, Ankita Dhir Bhasin, Bert Dhondt, Stefano Di Bari, Ida Di Giacinto, Fabrizio Di Maida, Giulia Di Marco, Mariana Dias Capinha, Jorge Díaz-Méndez, Andrew Dickinson, Dovile Diktanaite, Colin P.N. Dinney, Jeson R. Doctor, Lachlan Dodds, Anna Dodi, Ella Doerge, Scott Donnellan, Ned Douglas, Desiree Louise Draeger, Nici Markus Dreger, Giovanni Drocchi, Michael J. Droller, Danelo Estienne du Plessis, Chantal Ducret, Lorenzo Dugato, Philip Dundee, Richard Dutton, Benjamin Eddy, Christopher Eden, Luisa Egen, Martin Lukas Egger, Sarah Einerhand, Berk Yasin Ekenci, Ahmed Mohamed Aly El-Assmy, Kariem El-Boghdadly, Mostafa Nasr Mohamed Elgamal, Ahmed Elsherbiny Elkarta, Sandy Elmer, Ramzy Elnabarawy, Ines Elsemann, Samar Elshahat Abd Elaziz Saleh, Dean Elterman, Dominique A. Engel, Daniel Stephan Engeler, Simon Udo Engelmann, Thomas Enzmann, Ismail Eralp, Francesco Esperto, Irene Esposito, Tara Etherington, Wouter Everaerts, Osama Ezzat, Faith N.F. Factora, Fabian Falkenbach, Andrea Falvo, Christian Daniel Fankhauser, Pouriya Faraj Tabrizi, Gabriel Faria-Costa, Christian Thomas Favoccia, Marissa Ferguson, Stefania Ferretti, Vincenzo Ficarra, Stefanie Fiechter, Deborah Fimognari, Damien Finniss, Neil Fleshner, Decio Maria Folchini, Thomas Roshan Fonseka, Patrice Forget, Yves Fradet, Antonio Franco, Martin Franko, Henrik Fredrich, Pedro FS Freitas, Andreas Frey, Mark Frydenberg, Vittorio Fulcoli, Marc Alain Furrer, Andrew Gabrielson, Pier Paolo Gaglioti, Antonio Galfano, Sebastian Gallina, Giacomo Gallo, Sophia Gallo, Venkata Ganesh, Gauri Raman Gangakhedkar, Herney Andres Garcia-Perdomo, Giulia Garelli, Rakesh Garg, Moritz Gatscher, Vineet Gauhar, Aikaterini Gavra-Papaspyrou, Gaetano Gazzè, Bart Geboers, Natalie George, G Georgiadis, Daniel Gerber, Michelle Gerstman, Sammy Isabella Gharbieh, Samrad Ghavimi, Surjyendu Ghosh, Gianluca Giannarini, Philipp Gild, Inderbir Gill, Robyn Gillies, Ed Girgis, Nicola Giudici, Maximilian Glienke, Sidney Glina, Sanjith Gnanappiragasam, Jeremy Goad, Benjamin YS Goh, Hebe Gomes, Fernando Gómez, Seraina Gomez, Juan Gómez Rivas, Julio Cesar Gonzalez Brambila, Paavan Gorur, Vijaya Gottumukkala, Christopher Goßler, Niels Graafland, Arthur Grabsky, Markus Graefen, Michelle Anja Helene Graemiger, Matthieu Gratton, Christian Gratzke, Carmen Gravina, Isabella Greco, Gerard Grobler, Tobias Gross, Nico C Grossmann, Antonio Andrea Grosso, Robert große Siemer, Camilla Marisa Grunewald, Salvatore Guaglianone, Alessandro Guercio, A. 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Inman, Mariachiara Ippolito, Joseph Ischia, Claire Ishak, Samina Ismail, Kittikan Itthisan, Ranganathan Iyer, Kouji Izumi, Wolfgang Jaeger, Jitendra Jagtap, Salman Jamil, Nicholas Jansen, Jonas Jarczyk, Edouard Jarry, Saqib Javed, Claudio Jeldres, Anong Jenia, Pocharapong Jenjitranant, Stephan Jenzer, Pascal Jerney, Estíbaliz Jiménez-Alcaide, Varagorn Jirajan, Lydia Johns Putra, Ricardo Jordão Duarte, Manu Joris, Pierre Joubert, Patrick Juliebø-Jones, Mona Kafka, Yamini Kailash, Arveen Kalapara, Sebastian Kälble, Christos E Kalfountzos, Lia Mayumi Kubota Kamada, Gokul Vignesh Kandaswamy, Jada Kapoor, Guram Karazanashvili, Nino Karazanashvili, Sunaina Tejpal Karna, Alexander Kaserer, Cordelia Kaspar, Wassim Kassouf, Madlen Marie Elisabeth Kasten, Stamatios Katsimperis, Andreas Katsios, Christopher Kauffman Ortega, Ernest Kaufmann, Tatsushi Kawada, Jamie Kearsley, Nicola Keller, Brian Daniel Kelly, Timothy Kenyon-Smith, Zoe Keon-Cohen, Claudia Kesch, Ali Ahsan Khalid, Azhar Khan, Mohamed Shamim Khan, Sardar MJ Khan, Shahid Khan, Hau Chun Khoo, Kittinut Kijvikai, Lawrence H. 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Stein, Daniel Steiner, Giuseppe Stella, Arnulf Stenzl, Christian Stief, Jordi Stira, Elena Stojkova Gafner, Konrad Stephan Jakob Straub, Kay Stricker, Kevin Stritt, Johann Stuby, Moe Thiha Swe, Firtantyo Adi Syahputra, Madiha Syed, Diaa-Eldin Taha, Yanni Tan, Marco Tanello, Vincent Tang, Songyos Tangmesang, Simon Tanguay, Manisa Tangvipattanapong, Yiloren Tanidir, Stefano Tappero, Melina Tatalias, Cesar Antonio Tavares Da Rocha, Francesco Tedesco, Bernardo Lobão Afonso Teixeira, Riccardo Tellini, Patrick Teloken, Catherine Temelcos, Heidi Tempest, Beatriz Tena, N Tenke, Pierre Tennstedt, Jeremy Yuen-Chun Teoh, Clara Tesche, Antonio Testa, Stefanie Thaler, George Thalmann, Nutdanai Thammasaksit, Thanathorn Thampravit, Dinh Phuong Thao, Shankaran Thevarajah, Benjamin Thomas, Christian Thomas, Ramesh Thurairaja, Marco Ticonosco, Ho Yee Tiong, Ko Ko Zayar Toe, Musliu Adetola Tolani, Raymond Tong, Werner Tonnetzer, Giulia Torregiani, Fabio Traunero, Peter Trebo, Emanuela Trenti, Monica Trivedi, Richard Truse, Dimitar Mihaylov Tsarov, Arman Tsaturyan, Stephan Tschirdewahn, Christopher Tschung, Andrea Tubaro, Gabriele Tuderti, Karl Tully, Rafal Turo, Filippo Maria Turri, Alexander Tzabazis, Lazaros Tzelves, Mohsin Uddin, Martin H. Umbehr, Vanessa Upadek, Ronald James Urry, Massimo Valerio, Anthony Van Baelen, Michael R. van Balken, Eva Van Bos, Siska van Bruwaene, Astrid Van Daela, Roderick van den Bergh, Antoine G van der Heijden, Andre van der Merwe, Henk G. van der Poel, Koene van der Sloot, Danielle Charlotte Van Diepen, Charles Van Praet, Bas WG van Rhijn, Stijn Van Vugt, Joris Vangeneugden, Matthias Vanneste, Mihai Dorin Vartolomei, Nikhil Vasdev, Antonio Vavallo, Francesca Vedovo, Hans Veerman, Ian Vela, Marina Vendrell Jordà, Pieter Verleyen, Lodewikus P. Vermeulen, Malte W. Vetterlein, Ralf Veys, Fabio Carvalho Vicentini, Alvaro Vidal-Faune, Matheus Vieira dos Santos, Silvia Viganò, Antoni Vilaseca, Gianluca Villa, Wit Viseshsindh, Michiel Vlaming, Jonathan Vollemaere, Alessandro Volpe, Yannic Volz, Maximilian Ferry von Bargen, Markus von Deimling, Thilo Caspar von Groote, Friedrich Von Rundstedt, Thomas Adrian von Rütte, Franz Von Stauffenberg, Charlotte S. Voskuilen, Srinivas Vourganti, Florian Wagenlehner, Aziz Wajahat, Anjana Sagar Wajekar, Margarete Teresa Walach, Anna Lucy Walsh, Thomas J. Walton, Jochen Walz, William Wang, Ziting Wang, Tomofumi Watanabe, Chinnawat Wattana, Laurent-Michel Wattier, Kittisak Weerapolchai, Mirja Wegge, Christopher Weight, Laurence Weinberg, Sylvia Weis, Raphael Weiss, Johann Wendler, Madeleine Wengi, Mike Wenzel, Samuel Weprin, Lukas Alex Wernli, Frederik Wessels, Niklas Westhoff, Robin Weston, Katy-Louise Whelan, Lucas R. Wiegand, Laura Wiemer, Carl J. Wijburg, Isabella Williams, Simon Williams, Susan Willis, Alexander Winter, Oliver Wiseman, Esther Mk Wit, JAlfred Witjes, Solomon Woldu, Chris Ho-Ming Wong, Piyapong Wongjittraporn, Henry Woo, Dixon Teck Sing Woon, Thomas Stefan Wort, Fiona Wu, Michael Wu, Wen-Jeng Wu, Patrick Y. Wuethrich, Christoph Würnschimmel, Yves Wyss, Jennifer Xu, Evanguelos Xylinas, Takafumi Yanagisawa, Tet Yap, Omid Yassaie, John Yaxley, Hsin-Chih Yeh, Wie Sein Yeoh, Yuyi Yeow, Leubet Yirga, Daniel ZP Yong, Joseph Zabell, Zainal Abiddin Zainal Adwin, Carlo Zaraca, Stefano Zaramella, Homi Zargar, Fabio Zattoni, Alan Javier Zazú, Michel Zbinden, Tereza Zdobinska, Pascal Zehnder, Claudia Zelger, Barbora Zemlickova, Logan Zemp, Kenji Zennami, Yuhao Zhang, Valentin Zumstein European Urology Open Science, 2026 Surgical complications remain a major source of preventable morbidity, mortality, and health care expenditure, but existing frameworks such as the Clavien-Dindo classification and Comprehensive Complication Index are clinician-centred and intervention-focused and fail to capture cumulative patient-centred outcomes. This protocol outlines the Complications After Major and Minor Urological Surgery (CAMUS) initiative, a global, multiphase effort to redefine complication reporting, risk stratification, and outcome measurement in urological surgery. CAMUS aims to address these limitations via an integrated, seven-arm programme combining retrospective and prospective data analysis, consensus development, and digital infrastructure design. Arm 1 has assembled a retrospective data set of 130 034 major urological procedures from 180 centres across 33 countries, the largest of its kind. Arms 2 and 3 have completed Delphi surveys with physicians ( n = 1113) and pilot nursing participants ( n = 20) and has generated consensus on novel grading domains and highlighted the importance of multidisciplinary perspectives. Arm 4 will incorporate patient-reported outcomes and behavioural economics methods to quantify subjective burdens, while arm 5 will develop the CAMUS Intraoperative and Postoperative Risk and Difficulty Estimation Index (IPRADES) for surgical risk and difficulty prediction. Arms 6 and 7 will build a secure e-database and dictionary and prospectively validate the system using >2000 new cases. Statistical methods include multivariable regression, meta-analysis of individual patient data, and machine-learning approaches to model predictors of morbidity and mortality. Outputs will be benchmarked internationally to facilitate both clinician- and patient-driven definitions of complication severity. Ultimately, CAMUS will deliver a reproducible, patient-inclusive classification system with broad applicability to clinical practice, audits, education, and policy. By integrating more than 130 000 procedures with global Delphi consensus, CAMUS represents the most comprehensive complication classification initiative undertaken in surgery. Its outputs are expected to improve transparency, standardise reporting, and inform patient-centred risk stratification worldwide.
PractIce pattern of INtraoperative FlUid therapy in elective major gastrointeStinal cancer surgEries in India (I-INFUSE): A multicentre observational study Sohan Lal Solanki, Reshma Ambulkar, Virinchi Sanapala, Kalpana Balakrishnan, Rishikesh S. Bhatti, Deepa Chakrabarti, Jyotsna Goswami, Indira Gurajala, Hemlata Hemlata, Anuja Jain, Sofia Jaswal, Anjum Khan Joad, Kamal Kajal, Jyotirmay Kirtania, Lakshmi Kumar, Tapas Mandal, Indubala Maurya, Nitasha Mishra, Kusuma Parikh, Anjali Pingle, Namrata Ranganath, Seshadri Ramkiran, Basanth Kumar Rayani, Sandeep Sahu, Priyanka Sethi, Shagun Bhatia Shah, Jyoti Sharma, Koilada Shiv Kumar, Praveen Talawar, Raj Tobin, Sanjay Upadhye, Jigeeshu V. Divatia Indian Journal of Anaesthesia, 2026 Background and Aims: Intraoperative fluid therapy is crucial in optimising outcomes after major abdominal surgeries. However, clinical practices vary widely due to uncertainty of appropriate choice of fluid, amount, rate and strategy of fluid administration, and factors like preoperative fluid deficits and intraoperative losses in major abdominal surgeries. Methods: Institutional ethics committee approvals were taken, and this multicentric study was registered with the Clinical Trials Registry-India. In the 3-month observation period, 810 patients undergoing major gastrointestinal (GI) cancer surgery across 30 centres in India were included. Data collected included patient demographics, surgical and anaesthetic details, types and volumes of fluids administered intraoperatively, haemodynamic monitoring, blood loss, transfusions, postoperative complications measured by Clavien–Dindo (CD) classification and Comprehensive Complication Index (CCI), and 30-day readmission. Along with the descriptive statistics, multivariate regression analyses were done to identify predictors outcomes with significance set at P < 0.05. Results: The mean intraoperative fluid administration was 5.34 {standard deviation(SD)}ml/kg/h, and the mean total volume administered was 2648.5 (SD: 1486.6) mL. Postoperative complication rates graded CD ≥3 were observed in 7.9% of patients. Multivariate analysis revealed that lower preoperative serum albumin, higher fluid administration rates, greater blood loss, and intraoperative blood transfusions were independently associated with increased postoperative morbidity and higher CCI scores. Minimally invasive surgery correlated with shorter hospital stays. Conclusion: Fluid therapy practices in major GI cancer surgeries and the mean fluid administration rate of 5.34 (SD: 2.51) mL/kg/h in the intraoperative period at Indian cancer centres align largely with recent international consensus guidelines.
Beyond Binary Mortality Endpoints: The T-MOD PD Framework (Timing–Mechanism–Opportunity–Disease) for Phenotype-Specific Root Cause Analysis of Mortality after Pancreatoduodenectomy A Retrospective Observational Cohort Study Amir M. Parray, Niket Shah, Sohan Lal Solanki, Vandana Agarwal, Nitin Sudhakar Shetty, Suyash Kulkarni, Manish S. Bhandare, Vikram Chaudhari, Shailesh V. Shrikhande Annals of Surgery, 2026 Objective: To evaluate the T-MOD PD (Timing–Mechanism–Opportunity–Disease) framework for classifying mortality after pancreatoduodenectomy (PD) , focusing on preventability and rescue opportunities. Background: Pancreatoduodenectomy mortality (2–10%) is reported as binary endpoints, obscuring distinctions between surgery-related and systemic causes and limiting targeted quality improvement. Methods: Retrospective analysis of 1,727 consecutive PDs (2014–2024) at a high-volume centre. All 58 deaths (3.4%) were independently adjudicated across four axes: Timing (T1–T3), Mechanism (M1–M3), Opportunity (O1–O4), and Disease (D1–D3). Deaths were categorized as surgery-attributable potentially preventable (SAPM), surgery-attributable non-preventable (SANPM), or non-surgery-attributable mortality (NSAM). Results: Striking phenotypic clustering emerged: 38% of deaths (22/58) converged in T1M1O1D1 (early, surgery-related, strategically modifiable, resectable disease), with 19% (11/58) in T2M1O1D1. Together, these postoperative pancreatic fistula (POPF)-driven phenotypes accounted for 57% of mortality. Domain analysis revealed 66% early deaths (T1), 74% surgery-related mechanisms (M1), and critically, 72% potentially modifiable opportunities (O1: 72%; O2: 22%; O3: 2%; O4: 3%). Overall, 74% were classified as SAPM. Timeline reconstruction identified median 72-hour delays in recognition and escalation despite warning signs at postoperative day 5–6, with 22-day median interval from clinically relevant POPF diagnosis to death, suggesting 35–40% preventability in the dominant phenotype. Perfect interobserver agreement was achieved (κ=1.0). Conclusions: T-MOD PD provides reproducible mortality phenotyping revealing 72% of deaths are potentially modifiable, with dominant phenotypes sharing POPF pathways and identifiable rescue delays, enabling phenotype-specific quality improvement.
A Prospective Observational Study on Compliance with Enhanced Recovery Pathways and Their Impact on Postoperative Outcomes Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Sohan Lal Solanki, Virinchi Sanapala, Reshma P. Ambulkar, Vandana Agarwal, Avanish P. Saklani, Amita Maheshwari Journal of Gastrointestinal Cancer, 2025 Enhanced recovery pathways have been shown to improve postoperative morbidity and reduce hospital stay across various surgical settings. However, the implementation of Enhanced Recovery After Surgery (ERAS) pathways in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is often challenging and varies between institutions. We evaluated the impact of ERAS compliance on postoperative outcomes and return to intended oncological therapy (RIOT). All consecutive patients operated for CRS-HIPEC between May 2021 and August 2023 were included in the study. Compliance with 30 ERAS components was collected. Postoperative complications were categorized using the Clavien-Dindo (CD) classification. Patients were followed for 30 days post-surgery to assess readmissions and delays in RIOT. Pearson correlation analysis evaluated the relationship between ERAS compliance and CD grading, length of hospital stay, readmissions, and RIOT delays. Logistic regression analysis was done to evaluate the association between percentage compliance to ERAS components and postoperative morbidity and length of hospital stay. Among 150 patients, the average compliance to ERAS components was 77.6%. There was a significant negative correlation between ERAS compliance and postoperative morbidity ( r = − 0.512, p < 0.001) and RIOT ( r = − 0.469, p < 0.001). Compliance with preoperative ( r = − 0.222, p = 0.006) and postoperative factors ( r = − 0.533, p < 0.001) significantly impacted postoperative morbidity and RIOT. Patients with less than 71.6% compliance had higher morbidity ( χ 2 = 19.55; p < 0.001), longer hospital stays ( χ 2 = 4.73; p = 0.03), and delayed RIOT ( χ 2 = 12.70; p < 0.001). There is significant association between increase in percentage compliance to ERAS components and reduced major postoperative complications (OR 0.79; 95% CI 0.72–0.87; p = 0.001) and reduced length of hospital stay (OR 0.89; 95% CI 0.84–0.95; p = 0.001). Higher compliance is linked with reduction in postoperative morbidity, shorter hospital stays, and timely RIOT. These findings reinforce the safety profile of ERAS pathway in CRS-HIPEC. However, multicenter studies are needed to support these findings. Clinical Trial Registry of India (CTRI/2021/02/031151)
Impact of Prehabilitation in Major Gastrointestinal Oncological Surgery: a Systematic Review Reshma Ambulkar, Aditya Kunte, Sohan Lal Solanki, Veer Thakkar, Bhakti Deshmukh, Pankaj Singh Rana Journal of Gastrointestinal Cancer, 2025 BACKGROUND: Patients undergoing major gastrointestinal oncologic surgeries often present with frailty, sarcopenia, anemia, and comorbidities that reduce physiological reserves and impair recovery. Prehabilitation is a proactive, multidisciplinary approach designed to optimize patient's health before surgery, thereby enhancing their capacity to tolerate surgical stress. Evidence indicates that prehabilitation can lead to shorter hospital stays, reduced intensive care admissions, a lower incidence of postoperative complications, and improved long-term quality of life. METHODS: This systematic review is aimed at comprehensively evaluating the current evidence on prehabilitation in gastrointestinal and hepatopancreatobiliary (HPB) surgeries, examining its components, mechanisms of benefit, and barriers to implementation. It also explores the effectiveness of multimodal prehabilitation programs and highlights areas for future research. A systematic search of "PubMed/MEDLINE," "Google Scholar," "Scopus," "Cochrane Library," "ClinicalTrials.gov," and "POPLINE" databases was conducted using a combination of Medical Subject Headings (MeSH) and keywords, including Prehabilitation, Anemia Correction, Nutrition Therapy, Physical Exercise, Gastrointestinal Cancer Surgeries, Hepato-Pancreato-Biliary Surgeries, Rehabilitation, and Postoperative Outcomes. Studies involving gastrointestinal cancer patients undergoing surgery, published between 1960 and June 2024, were included. RESULTS: Multimodal prehabilitation programs demonstrated significant improvements in functional capacity, reductions in postoperative complications, shorter lengths of stay, and enhanced recovery. However, the strength of evidence varied by cancer type, with robust data supporting prehabilitation in colorectal surgeries and more limited evidence for HPB and upper gastrointestinal surgeries. Home-based programs showed mixed results, with adherence challenges potentially undermining their effectiveness. Inpatient supervised programs were more effective but associated with higher costs. CONCLUSION: Prehabilitation holds promise as a transformative strategy in the perioperative care of gastrointestinal cancer patients. While it improves functional and clinical outcomes, significant barriers such as implementation costs, patient adherence, and variability in program design must be addressed. Future research should focus on tailoring prehabilitation for different cancer types, developing cost-effective models, and conducting high-quality trials to establish standardized guidelines. Integrating prehabilitation into routine clinical practice can significantly enhance surgical outcomes and patient quality of life.
A randomised comparison of transverse abdominal plane block versus thoracic epidural analgesia on postoperative opioid consumption for colorectal enhanced recovery after surgery programme (OPIATE study) Reshma Ambulkar, Sohan Lal Solanki, Bindiya Salunke, Pavithra PS, Supriya Gholap, Ashwin L Desouza, Sumitra G Bakshi, Vandana Agarwal Journal of Perioperative Practice, 2025 Background: The transverse abdominis plane block is increasingly being used as a less-invasive alternative to thoracic epidural analgesia for effective pain management. This study aimed to compare transverse abdominis plane block with opioid-based thoracic epidural analgesia in terms of postoperative opioid consumption. Methods: Patients in the thoracic epidural analgesia group received a continuous infusion of 0.1% levobupivacaine with 2mcg/ml of fentanyl, while those in the transverse abdominis plane group received 6-hourly boluses of 0.4ml/kg of 0.25% levobupivacaine. The primary objective was to compare the average fentanyl consumption, measured as intravenous fentanyl equivalents, over 72 hours. Results: Data of 35 patients were analysed. Fentanyl consumption at the end of 72 hours was significantly lower in the transverse abdominis plane group (median [interquartile range] 495 mcg (255, 750), and mean (95% confidence interval) 717.35mcg (403.54–1031.16)) compared to the thoracic epidural analgesia group (median [interquartile range] 760mcg (750, 760), and mean (95% confidence interval) 787mcg (746.81–827.19)) with a p value of 0.010. Pain scores at rest and during movement were comparable between the groups ( p > 0.05). However, the median pain scores during movement were significantly lower in the thoracic epidural analgesia group at 60 and 72 hours ( p ⩽ 0.05). Conclusion: Multimodal analgesia with transverse abdominis plane resulted in lower opioid consumption over 72 hours compared to thoracic epidural analgesia.
All India Difficult Airway Association 2025 Guidelines for the management of unanticipated difficult airway in adults under general anaesthesia Sheila N. Myatra, Amit P. Shah, Venkateswaran Ramkumar, Pankaj Kundra, Apeksh Patwa, Sumalatha R. Shetty, Dilip K. Pawar, Rakesh Garg, Syed M. Ahmed, Jeson R. Doctor, Sohan L. Solanki, Rakesh Kumar, Sabyasachi Das, Jigeeshu V. Divatia Indian Journal of Anaesthesia, 2025 The All India Difficult Airway Association 2025 Adult guideline provides guidance for the management of an unanticipated difficult airway under general anaesthesia. The American Heart Association (AHA) Class of Recommendation and Level of Evidence was used. In addition, for interventions where the evidence was absent or weak, a Delphi process among airway experts was convened to generate expert consensus statements. The most significant difference from the 2016 guidelines is providing guidance for a failed supraglottic airway (SGA) insertion, tracheal intubation, face mask ventilation, or other strategies commonly used as part of the primary airway plan under general anaesthesia, not restricting to a failed intubation. Airway assessment should be routinely performed to identify an anatomical as well as the physiologically difficult airway. Peri-intubation oxygenation with pre-oxygenation and apnoeic oxygen with nasal oxygen (10–15 L/min) or high-flow nasal oxygen increases the safe apnoea time. Videolaryngoscopy and adjuncts such as stylets and bougies improve first pass intubation success. Tracheal tube position should be confirmed by waveform capnography. If the primary airway plan fails, activate ‘Code D’ as the hospital emergency code to call for help. Airway rescue should then be attempted with any of the three devices (tracheal tube, SGA, or face mask), and switching promptly between them as needed, with no hierarchy, until effective ventilation and adequate oxygen saturation (SpO₂) are achieved. Optimise patient position, ensure neuromuscular blockade, and consider changing the tools, technique, or operator. Allow up to three failed attempts with these devices provided the SpO 2 remains ≥95%. Complete ventilation failure (ventilation using a tracheal tube, SGA, and face mask have all failed, even if oxygenation may be maintained) is the trigger to perform an emergency cricothyroidotomy , preferably by a surgical approach. Team debriefing, team support, patient and family counselling, and documentation are paramount after encountering an unanticipated difficult airway.
Expert consensus for difficult airway management in the absence of clear evidence using a Delphi method Amit P. Shah, Prashant Nasa, Syed Mansoor Ahmed, Jigeeshu V. Divatia, JesonR Doctor, et al. Indian Journal of Anaesthesia, 2025 value of greater than or equal to 0.05 indicating stability. Twenty-three experts completed four Delphi rounds conducted from 27 December 2024 to 25 January 2025. Of the 26 statements considered, 23 (88%) achieved both consensus and stability. Of note, the statement regarding the maximum number of attempts permitted for supraglottic airway insertion in adults to mitigate airway management-related complications did not achieve consensus among experts; however, the Steering Committee voted unanimously for a maximum of three attempts. From the 23 statements that achieved expert consensus and the statement that received the maximum vote during the adjudication process by the Steering Committee, 24 expert clinical statements were drafted. Future research is necessary to evaluate the impact of these clinical practice statements and to address the remaining uncertainties.
Economic and geographical disparities in global contribution to open access publishing in anaesthesiology: A bibliometric analysis Eric Slawka, Juan Jose Guerra-Londono, Rachel S. Hicklen, Sohan Lal Solanki, Daniel Cukierman, Jie Tian, Juan P. Cata Indian Journal of Anaesthesia, 2025 Background and Aims: Open access (OA) publishing improved the reach of scientific discoveries, particularly among researchers in lower-income countries. However, OA publishing still has a global imbalance. This bibliometric analysis evaluates anaesthesia OA journals to explore geographical and economic disparities in publication volume. Methods: We queried the Directory of Open Access Journals for OA anaesthesia-related journals between 2014 and 2024. Data from the included journals were analysed using Scopus, from which we extracted the year of publication and the corresponding author’s affiliation. Additional metrics were obtained from each journal website. Countries were then categorised by income level and geographical region. Results: Thirty-four anaesthesiology OA journals were analysed, encompassing 27,634 publications from 120 countries. The leading contributors were India (23.96%), the USA (14.98%) and China (6.54%). Low-income countries accounted for 0.37% of total publications, followed by upper-middle-income (17.97%), lower-middle-income (29.07%), and high-income (52.54%) countries. The geographical distribution of publication volume was as follows: Southeast Asia (25.38%), Europe (23.18%), Western Pacific (18.92%), Americas (23.91%), Eastern Mediterranean (8.03%) and Africa (0.59%). Nineteen journals required a mean article processing charge (APC) of US $2,164.89, accounting for 51.89% of the total publications. India ranked first in non-APC journals, while the USA led in APC journals . Conclusion: While OA publishing enhances accessibility for readers, it still presents challenges for authors, particularly in economically disadvantaged countries. Significant geographical and economic disparities exist in OA publication volume, likely due to limited investment and structural barriers in lower-income countries.
