EM EVIDENCE — QUARTERLY REVIEW
Anaesthetics & ICU Evidence Rundown
Q3 2026 — JULY – SEPTEMBER 2026
State of the Science
Anaesthetics, Intensive Care & Perioperative Medicine
UK Edition — Quarterly Evidence Ebook
- 3 MONTHLY ISSUES
- 46 ITEMS REVIEWED
- 17 PRACTICE-CHANGE ITEMS
9
CLINICAL CHAPTERS
Jake Turner, EM Registrar — West Midlands • Curated with the assistance of AI (Perplexity). All content editorially reviewed.
September 2026
HOW TO USE THIS EBOOK
| Safety-critical or immediate practice change. | |
| High-impact evidence or guidance; discuss at departmental governance and consider local change. | |
| CHANGE WHEN GUIDELINE UPDATES | Evidence ahead of current NICE / RCoA / Association of Anaesthetists / ICS guidance. |
| Useful context; no immediate change required. |
Scope: primary-evidence, guideline and policy items from Anaesthetics & ICU Evidence Rundown Issues 6 (July), 7 (August) and 8 (September) 2026, organised by theme and de-duplicated where an item ran in more than one issue. MHRA notices, FOAMed secondary sources and core-revision pieces are excluded. Each entry is drawn from the published issue; where the issue gave no effect estimate, none is quoted. Read the primary paper before changing practice.
All items are tagged for Final FRCA revision relevance.
Contents — Q3 2026 State of the Science
Chapter 1 — Q3 2026 Quarter in Review
Executive summary and practice-change table
Chapter 2 — Airway Management
4 items
Chapter 3 — Regional Anaesthesia
4 items
Chapter 4 — Sepsis & ICU Resuscitation
2 items
Chapter 5 — Mechanical Ventilation & Respiratory Failure
5 items
Chapter 6 — Cardiovascular Critical Care
5 items
Chapter 7 — Perioperative Medicine
16 items
Chapter 8 — Renal & Metabolic
2 items
Chapter 9 — Neurocritical Care
1 items
Chapter 10 — Guideline & Policy Updates
7 items
CHAPTER 1
Q3 2026 — Quarter in Review
July – September 2026
Three monthly issues covered 46 items this quarter. Two themes dominated. First, a run of large null results that simplify practice: higher or individualised intraoperative MAP targets did not improve outcomes (15 RCTs, n=15,603), 48 hours of targeted temperature management was no better than 24 (ICECAP, n=1,900), conservative oxygen after ROSC made no difference to 180-day neurological outcome (LOGICAL, n=1,840), and bicarbonate did not prevent AKI in acidotic ICU patients (SODa-BIC). Second, institutional change in the UK: FICM became the College of Intensive Care Medicine, GPICS V3 and NICE QS216 set new standards, NAP8 opened, and the Ockenden Nottingham review placed obstetric anaesthesia under scrutiny.
- Perioperative: SNaPP (sugammadex vs neostigmine, pulmonary complications or death 19.0% vs 21.5%, NNT about 40); dapagliflozin halved AKI after cardiac surgery (28% vs 52%) without a 30-day clinical-outcome signal; SGLT-2 inhibitors to be withheld 3–4 days before elective surgery.
- Respiratory: the ATS 2026 respiratory support guideline supports HFNC over standard oxygen in acute hypoxaemic failure (intubation RR 0.76).
- Airway: PUMA foundation and extubation guidance, and videolaryngoscopy for double-lumen tubes (DOLVI).
Q3 2026 statistics: 3 issues • 46 items • 0 CHANGE TONIGHT • 17 CHANGE THIS MONTH • 4 CHANGE WHEN GUIDELINE UPDATES
Practice-change summary
| PRIORITY | ITEM | CHAPTER |
|---|---|---|
| CHANGE THIS MONTH | Higher intraoperative MAP targets do not improve outcomes in noncardiac surgery | Perioperative Medicine |
| CHANGE THIS MONTH | Lower FiO₂ during anaesthetic washout reduces postoperative atelectasis | Mechanical Ventilation & Respiratory Failure |
| CHANGE THIS MONTH | Early PENG Block for Prehabilitation in Femoral Neck Fractures | Regional Anaesthesia |
| CHANGE THIS MONTH | Enteral Magnesium Is Non-Inferior to IV Replacement in Stable ICU Patients | Renal & Metabolic |
| CHANGE THIS MONTH | NICE QS216: First National Quality Standard for Perioperative Care in Adults | Perioperative Medicine |
| CHANGE THIS MONTH | Dexamethasone 8 mg causes clinically significant hyperglycaemia in patients with diabetes | Perioperative Medicine |
| CHANGE THIS MONTH | Quick hits: sepsis mucolytics, GLP-1 agonists, thyroid disease and opioid-free cardiac anaesthesia | Guideline & Policy Updates |
| CHANGE THIS MONTH | SNaPP: Sugammadex modestly reduces postoperative pulmonary complications versus neostigmine | Perioperative Medicine |
| CHANGE THIS MONTH | Dapagliflozin reduces perioperative AKI after elective cardiac surgery, but not 30-day clinical outcomes | Perioperative Medicine |
| CHANGE THIS MONTH | Updated consent guidance: move from form-focused to conversation-focused practice | Perioperative Medicine |
| CHANGE THIS MONTH | Videolaryngoscopy improves double-lumen tube intubation outcomes | Airway Management |
| CHANGE THIS MONTH | ESAIC consensus on sustainable intensive care and volatile-agent sedation | Guideline & Policy Updates |
| CHANGE THIS MONTH | Joint RCoA/OAA response to the Ockenden maternity services review | Guideline & Policy Updates |
| CHANGE THIS MONTH | ATS 2026 guideline on HFNC, NIV and post-extubation respiratory support | Mechanical Ventilation & Respiratory Failure |
| CHANGE THIS MONTH | NAP8 registry opens for regional anaesthesia complications | Regional Anaesthesia |
| CHANGE THIS MONTH | PUMA guideline for tracheal extubation | Airway Management |
| CHANGE THIS MONTH | Perioperative SGLT-2 inhibitor cessation to reduce euDKA risk | Perioperative Medicine |
CHAPTER 2
Airway Management
4 items · Anaesthetics & ICU Evidence Rundown Issues 6–8
Airway output this quarter was guideline-heavy: the PUMA foundation guidance (assess, plan, prepare, perform) and a PUMA extubation guideline, a systematic review classifying videolaryngoscopes by design, and the DOLVI trial showing videolaryngoscopy improves double-lumen tube intubation.
BRITISH JOURNAL OF ANAESTHESIA, 2026; RANDOMISED CONTROLLED TRIAL; SAMPLE SIZE NOT STATED · ISSUE 7
Videolaryngoscopy improves double-lumen tube intubation outcomes
Double-lumen tube intubation is technically more challenging than single-lumen tube intubation because of the tube’s bulk and curvature. In the DOLVI randomised trial, videolaryngoscopy improved first-pass success and glottic visualisation, reduced procedural difficulty, and resulted in fewer malpositions confirmed by fibreoptic bronchoscopy than direct laryngoscopy. UK thoracic anaesthesia services should ensure that suitable videolaryngoscopy equipment is immediately available and should consider videolaryngoscopy as the default initial technique for double-lumen tube placement, while retaining fibreoptic bronchoscopy for confirmation and correction of malposition. The excerpt does not provide sample size, absolute effect estimates or details of operator experience, so the magnitude and generalisability of benefit cannot be assessed.
PUMA COLLABORATORS, ANAESTHESIA, 2026, CLINICAL GUIDELINE; SAMPLE SIZE NOT STATED · ISSUE 8
PUMA guideline for tracheal extubation
The PUMA guideline provides a structured framework for tracheal extubation, complementing the DAS intubation guidelines. It recommends pre-extubation risk stratification, preparation for extubation failure, optimisation of reversible factors, deliberate choice between awake and deep extubation, and a planned post-extubation oxygenation strategy. HFNC or NIV should be considered immediately after extubation in high-risk patients, with specific considerations for obesity, OSA, difficult or failed intubation, ICU patients and children. UK departments should use the framework when planning high-risk extubations and ensure that failure and reintubation are anticipated; the guideline should be read alongside local policies and applied with appropriate clinical judgement.
PUMA COLLABORATORS, ANAESTHESIA, 2026, GUIDELINE; SAMPLE SIZE NOT STATED · ISSUE 8
PUMA foundation guidelines for airway assessment and planning
The PUMA foundation guidelines provide a structured framework for airway management as a process rather than focusing solely on a specific technique. They standardise assessment, documentation and communication using a four-step model: Assess, Plan, Prepare and Perform, alongside structured risk stratification and defined communication expectations between anaesthetists, recovery staff and ICU teams. UK departments should review whether high-risk patients have a documented airway plan and consider using the framework to standardise airway documentation and handover. The guidance is intended to complement, rather than replace, existing DAS airway guidelines; the excerpt does not provide outcome data or a formal evidence grading of the recommendations.
Key numbers: Four-step model: Assess, Plan, Prepare, Perform; no sample size or outcome statistics stated
ANAESTHESIA; 2026; SYSTEMATIC REVIEW · ISSUE 8
Videolaryngoscope design determines intubation technique and outcomes
Videolaryngoscopes are not interchangeable, and device design has important implications for tube delivery and airway management. The review identifies two principal categories: channelled devices, which guide the tube, and non-channelled devices, which require standard tube-and-stylet insertion; blade geometry also varies between standard and hyperangulated designs. Hyperangulated blades may improve the glottic view but can hinder tube advancement, whereas standard-geometry devices retain a more conventional insertion technique. UK practice should incorporate device selection into pre-intubation planning, particularly for difficult-airway lists, with clinicians familiarising themselves with the specific technique required for each device.
Key numbers: Two principal categories: channelled and non-channelled; blade geometries include standard and hyperangulated.
CHAPTER 3
Regional Anaesthesia
4 items · Anaesthetics & ICU Evidence Rundown Issues 6–8
NAP8 opened its registry for regional anaesthesia complications, and every UK department should know how to report. Clinical items include early PENG block for fractured neck of femur, real-time ultrasound for thoracic epidurals, and regional-only anaesthesia for shoulder arthroscopy.
ANESTHESIA & ANALGESIA 2026 · RANDOMISED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL · ISSUE 6
Early PENG Block for Prehabilitation in Femoral Neck Fractures
Femoral neck fractures in older adults commonly cause severe pain and limit mobilisation before surgery. In this randomised, double-blind, placebo-controlled trial, early ultrasound-guided pericapsular nerve group (PENG) block reduced pain, enabled participation in prehabilitation physiotherapy, reduced preoperative opioid requirements and reduced postoperative opioid requirements compared with placebo. In UK practice, a trained anaesthetist, emergency physician or orthopaedic surgeon could consider delivering PENG block early in the hip-fracture pathway, subject to local governance, training and expertise. The reported analgesic benefit lasts 12–18 hours, but the excerpt provides no sample size or detailed adverse-event data, so implementation should remain locally supervised and evidence-aware.
Key numbers: 12–18-hour analgesic benefit; 20 mL of 0.25–0.375% levobupivacaine described for the technique; sample size not stated
RCOA / NAP8 STEERING GROUP, 2026; NATIONAL CASE REGISTRY; SAMPLE SIZE NOT STATED · ISSUE 8
NAP8 registry opens for regional anaesthesia complications
NAP8 is a national RCoA case registry covering complications of peripheral nerve blocks, central neuraxial blockade, local anaesthetic infiltration and perioperative nerve injury. The registry opened in July 2026 and aims to generate the largest UK dataset on complications of regional anaesthesia to date. Departments performing regional anaesthesia should register and report eligible cases through the NAP8 submission process, which is stated to take approximately 10 minutes per patient. This is a surveillance and audit initiative rather than comparative outcome evidence, so it will not yet define complication rates or establish preventive interventions.
Key numbers: Registry opened July 2026; approximately 10 minutes per eligible patient; no sample size stated
ANAESTHESIA 2026; RANDOMISED CONTROLLED TRIAL OF LOWER THORACIC EPIDURAL PUNCTURE · ISSUE 8
Real-time ultrasound guidance improves thoracic epidural insertion outcomes
In lower thoracic epidural insertion, this randomised controlled trial compared real-time ultrasound guidance with pre-procedural scanning followed by conventional needle insertion. Real-time guidance improved first-attempt success and reduced needle passes, skin punctures and procedure time; patient comfort was also improved. In UK practice, real-time ultrasound-guided thoracic epidural insertion should be regarded as a distinct technique requiring dedicated training, rather than simply scanning before puncture. It may be particularly useful when anatomical landmarks are unreliable, including obesity, scoliosis or previous spinal surgery. The excerpt provides no sample size or numerical effect estimates, so the magnitude and generalisability of benefit cannot be assessed from the available information.
Key numbers: No numerical results or sample size stated
REGIONAL ANESTHESIA AND PAIN MEDICINE. 2026. COMPARATIVE STUDY; DESIGN AND SAMPLE SIZE NOT STATED. · ISSUE 8
Regional anaesthesia alone versus combined general and regional anaesthesia for shoulder arthroscopy
In elective shoulder arthroscopy performed in the beach-chair position, regional anaesthesia alone using an interscalene block was associated with less intraoperative hypotension than combined general and regional anaesthesia. Shorter recovery times and higher same-day discharge rates were also reported, although no numerical results are provided in the excerpt. In UK practice, an RA-only technique with sedation may be considered where patient and team factors allow, with appropriate discussion among the anaesthetic and surgical teams. For combined general anaesthesia, attention should be paid to cerebral perfusion: arterial pressure monitoring at the level of the auditory meatus and targeting MAP at ear level may be appropriate. The study design, sample size and detailed haemodynamic outcomes are not stated, so the findings should inform rather than mandate practice.
Key numbers: No numerical results stated.
CHAPTER 4
Sepsis & ICU Resuscitation
2 items · Anaesthetics & ICU Evidence Rundown Issues 6–8
Two items: DigiSep, testing clinical metagenomics to shorten pathogen identification in sepsis, and a synthesis of the bicarbonate trials (BIHCA, SODa-BIC, BICAR-ICU) that supports restricting bicarbonate to severe acidaemia with AKI.
INTENSIVE CARE MEDICINE, 2026; GERMAN MULTICENTRE RCT ACROSS 15 CENTRES · ISSUE 6
DigiSep: clinical metagenomics-guided diagnosis in sepsis
Clinical metagenomics sequences microbial DNA from blood or bronchoalveolar samples and may identify pathogens more rapidly than standard culture-based microbiology. The DigiSep RCT compared metagenomics-guided management with standard microbiology in patients with sepsis or septic shock, assessing clinical outcomes, healthcare costs and health-related quality of life. The excerpt reports potential pathogen identification within 6–12 hours versus 24–72 hours for standard cultures, including detection of fungi, atypical bacteria, viruses and polymicrobial infections, but does not provide the trial’s outcome results. UK ICUs should regard this as an emerging diagnostic strategy rather than evidence to commission routinely; any adoption would require local evaluation of turnaround time, laboratory capability, antimicrobial stewardship impact and cost. Full results are needed before concluding that faster identification improves antibiotic de-escalation, ICU length of stay or mortality.
Key numbers: 15 centres; pathogen identification 6–12 hours versus 24–72 hours for standard cultures
BIHCA (JAMA, 2026; RCT; N=779) + SODA-BIC (NEJM, 2026; N=500) + BICAR-ICU (LANCET, 2018) · ISSUE 6
Sodium bicarbonate in the ICU: restrict use to severe acidaemia with AKI
This synthesis evaluates sodium bicarbonate in cardiac arrest and critically ill patients with metabolic acidosis. In BIHCA, bicarbonate during in-hospital cardiac arrest did not improve ROSC compared with control (39% vs 37%; not significant), while alkalosis and hypernatraemia occurred in 35% and 42%, respectively. SODa-BIC similarly found no improvement in MAKE30 when bicarbonate was used for metabolic acidosis with pH <7.30 in patients receiving vasopressors (40.2% vs 39.4%). For UK ICU practice, routine bicarbonate for acidosis or during ALS should be avoided; the remaining evidence-supported indication is narrow—pH ≤7.20 with AKI stage 2–3 and vasopressor use, based on the BICAR-ICU criteria—while specific indications such as TCA overdose, hyperkalaemic arrest and selected metabolic alkalosis remain distinct. This is a cross-trial synthesis, and the excerpt provides headline results rather than detailed methods, comparator treatment or subgroup estimates; BICAR-ICU’s RRT reduction was confined to the AKI stage 2–3 subgroup.
Key numbers: BIHCA: n=779; ROSC 39% vs 37% (not significant); alkalosis 35%; hypernatraemia 42%. SODa-BIC: n=500; MAKE30 40.2% vs 39.4%; pH <7.30. BICAR-ICU: pH ≤7.20; AKI stage 2–3; RRT reduced in the AKI stage 2–3 subgroup.
CHAPTER 5
Mechanical Ventilation & Respiratory Failure
5 items · Anaesthetics & ICU Evidence Rundown Issues 6–8
The ATS 2026 guideline on HFNC, NIV and post-extubation support is the key reference document of the quarter. Smaller trials questioned 100% FiO2 at anaesthetic washout, routine gastric residual volume monitoring, and in-bed cycling with amino acids (NEXIS, null).
BRITISH JOURNAL OF ANAESTHESIA 2026 · RANDOMISED CONTROLLED TRIAL · DOI: 10.1016/J.BJA.2026.04.056 · ISSUE 6
Lower FiO₂ during anaesthetic washout reduces postoperative atelectasis
Routine FiO₂ 100% during volatile-agent washout and pre-extubation pre-oxygenation may promote absorption atelectasis by removing alveolar nitrogen. In this randomised trial, patients received FiO₂ 100%, 70% or 40% during washout; the FiO₂ 100% group had significantly greater postoperative atelectasis on electrical impedance tomography than the FiO₂ 40% group. For suitable, non-obese and non-compromised patients, UK practice could consider FiO₂ 40–50% during washout rather than automatically using 100%, provided oxygenation remains adequate. Individualise for obesity, OSA, high-risk airways or difficult extubation, where the additional pre-oxygenation margin may outweigh the potential atelectasis risk; the reported outcome was EIT-measured atelectasis rather than clinical respiratory outcomes.
Key numbers: FiO₂ washout groups: 100%, 70% and 40%; greater atelectasis with 100% versus 40% on electrical impedance tomography.
JAMA, 2026 (DESIGN AND SAMPLE SIZE NOT STATED IN EXCERPT) · ISSUE 6
Routine gastric residual-volume monitoring does not improve outcomes in ventilated children
GASTRIC-PICU evaluated routine 4-hourly gastric residual-volume checks in mechanically ventilated PICU patients against symptom-driven monitoring. Routine monitoring did not improve feeding tolerance, ventilator-associated pneumonia rates or other reported outcomes. UK PICUs should consider removing routine gastric residual-volume checks from nursing observation charts and instead assess for clinical features of feeding intolerance. The excerpt does not provide the study design, sample size or detailed outcome data, so local implementation should remain aligned with paediatric critical-care feeding protocols.
Key numbers: Routine 4-hourly monitoring; no improvement in feeding tolerance, VAP rates or outcomes.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE (AJRCCM), 2026; RANDOMISED CONTROLLED TRIAL; SAMPLE SIZE NOT STATED. · ISSUE 7
NEXIS: in-bed cycling plus intravenous amino acids did not improve discharge walking distance
The NEXIS randomised trial evaluated combined in-bed cycling and intravenous amino acid supplementation versus usual care in critically ill patients. The intervention appeared safe, but did not significantly improve 6-minute walk distance at hospital discharge; ICU length of stay and ventilator-free days were also similar. In UK practice, the findings do not undermine early mobilisation and rehabilitation, including sitting out and walking when feasible, but suggest that passive in-bed cycling with amino acids alone is insufficient to prevent ICU-acquired weakness. Interpretation is limited because the excerpt does not report the sample size or numerical effect estimates, and the result applies to this combined intervention rather than to comprehensive rehabilitation programmes.
Key numbers: 6-minute walk distance at hospital discharge: no significant improvement; ICU length of stay and ventilator-free days: similar; sample size and numerical effect estimates not stated.
AMERICAN THORACIC SOCIETY / AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2026 — CLINICAL PRACTICE GUIDELINE BASED ON FOUR NETWORK META-ANALYSES (39, 42, 15 AND 52 RCTS; N=7,640, 4,763, 3,420 AND 9,840 RESPECTIVELY) · ISSUE 8
ATS 2026 guideline on HFNC, NIV and post-extubation respiratory support
This American Thoracic Society guideline synthesises evidence for noninvasive respiratory support across acute hypoxaemic and hypercapnic respiratory failure, preoxygenation before intubation and post-extubation care. For de novo acute hypoxaemic respiratory failure, HFNC was strongly recommended over standard oxygen, reducing intubation (RR 0.76, 95% CI 0.64–0.89) and mortality (RR 0.81, 95% CI 0.67–0.97); facemask NIV remained the strongly recommended treatment for acute hypercapnic respiratory failure, with reduced intubation and mortality versus standard oxygen (both RR 0.47). HFNC or facemask NIV was strongly recommended for preoxygenation, while NIV probably reduced peri-intubation hypoxaemia more than HFNC (RR 0.73, 95% CI 0.55–0.98); HFNC or NIV was also conditionally preferred over standard oxygen after extubation, with NIV preferred in high-risk patients. In UK practice, these recommendations broadly support existing FICM/ICS approaches, including HFNC for hypoxaemic failure and preoxygenation and NIV for hypercapnic failure, but helmet NIV evidence and the American framing require cautious local implementation alongside UK guidance and expertise.
Key numbers: Acute hypoxaemic failure: HFNC vs standard oxygen, intubation RR 0.76 (95% CI 0.64–0.89), mortality RR 0.81 (95% CI 0.67–0.97); helmet NIV intubation RR 0.22 (95% CI 0.11–0.43). Acute hypercapnic failure: NIV vs standard oxygen, intubation and mortality RR 0.47. Preoxygenation: NIV vs HFNC for peri-intubation hypoxaemia RR 0.73 (95% CI 0.55–0.98).
BRITISH JOURNAL OF ANAESTHESIA, 2026 — SYSTEMATIC REVIEW · ISSUE 8
Lung-protective ventilation strategies in adult cardiac surgery
A 2026 systematic review found substantial heterogeneity in ventilation strategies during adult cardiac surgery, with no single optimal approach confirmed. Continued ventilation during cardiopulmonary bypass, rather than apnoea, was associated with fewer postoperative pulmonary complications, while low tidal volume ventilation of 6–8 mL/kg ideal body weight with PEEP 5–8 cmH₂O reduced atelectasis; evidence for post-bypass recruitment manoeuvres was inconsistent. UK cardiac anaesthetic teams should consider standardising a lung-protective protocol using these parameters, where clinically feasible, and audit postoperative pulmonary complications. The findings support a pragmatic protocol-based approach, but the heterogeneity and inconsistent recruitment-manoeuvre evidence mean that the optimal strategy remains uncertain.
Key numbers: Low tidal volume 6–8 mL/kg ideal body weight; PEEP 5–8 cmH₂O; no sample size stated
CHAPTER 6
Cardiovascular Critical Care
5 items · Anaesthetics & ICU Evidence Rundown Issues 6–8
Post-cardiac-arrest care was reshaped by two large trials: ICECAP (no benefit from 48 versus 24 hours of targeted temperature management, n=1,900) and LOGICAL (conservative versus liberal oxygen after ROSC, no difference in 180-day neurological outcome, n=1,840). VExUS grading and long-term ECMO outcomes complete the chapter.
CRIT CARE MED 2026; SYSTEMATIC REVIEW/META-ANALYSIS; SAMPLE SIZE NOT STATED · ISSUE 6
VExUS Grading Predicts Venous Congestion-Related Organ Injury
VExUS combines IVC diameter with hepatic, portal and intrarenal Doppler assessment to identify venous congestion in critically ill patients. This systematic review/meta-analysis found that VExUS grades 2–3 reliably predicted acute kidney injury and poor outcomes. The findings support consideration of VExUS in perioperative fluid assessment, particularly after cardiac or major abdominal surgery, where venous congestion may contribute to end-organ injury. A key limitation is the IVC-gating approach: using IVC dilatation of ≥2 cm as an entry criterion may miss abnormal organ Doppler findings, so hepatic and portal Doppler should be assessed directly when congestion remains clinically suspected.
Key numbers: VExUS grade 2–3 predicted AKI and poor outcomes; IVC dilatation threshold ≥2 cm may miss organ Doppler abnormalities.
UNSPECIFIED SOURCE, 2026, GRADE-ASSESSED SYSTEMATIC REVIEW AND META-ANALYSIS; SAMPLE SIZE NOT STATED · ISSUE 7
Remimazolam versus propofol for cardiac surgery anaesthesia
A grade-assessed systematic review and meta-analysis compared remimazolam with propofol for induction and maintenance of cardiac surgery anaesthesia. Haemodynamics were reported as comparable overall, with fewer hypotension events with remimazolam, consistent with less haemodynamic suppression. In UK practice, this may inform drug selection for haemodynamically vulnerable cardiac surgical patients where remimazolam is available and benzodiazepine-based TIVA is appropriate. Interpretation is limited because the excerpt provides no sample size, journal, numerical effect estimates or details of the included studies; the finding should therefore complement rather than replace local formulary and cardiac anaesthesia protocols.
JAMA 2026; MULTICENTRE RANDOMISED CONTROLLED TRIAL; N=1,900 · ISSUE 8
ICECAP: 24 versus 48 hours of targeted temperature management after cardiac arrest
The ICECAP multicentre RCT evaluated 48 versus 24 hours of targeted temperature management at 33°C in adults with out-of-hospital cardiac arrest who achieved return of spontaneous circulation. Extending temperature management to 48 hours did not improve favourable neurological outcome at 6 months, 90-day mortality or ICU length of stay, while adverse events including arrhythmia and hypokalaemia were more frequent. For UK post-resuscitation practice, 24 hours of targeted temperature management at 33°C remains the standard; protocols prescribing 48 hours should be reviewed. The wider benefit of targeted temperature management compared with permissive normothermia remains debated, but active fever prevention below 37.7°C for 72 hours is stated as the minimum standard.
Key numbers: n=1,900; 33°C; 24 versus 48 hours; no difference in favourable neurological outcome at 6 months, 90-day mortality or ICU length of stay; arrhythmia and hypokalaemia higher with 48 hours; fever prevention <37.7°C for 72 hours
NEW ENGLAND JOURNAL OF MEDICINE, 2026 — RANDOMISED CONTROLLED TRIAL, N=1,840 · ISSUE 8
LOGICAL: Conservative versus liberal oxygen after ROSC
Oxygen therapy after return of spontaneous circulation (ROSC) must balance the risks of hypoxia and hyperoxia. In the LOGICAL trial, favourable neurological outcome at 180 days was 38.2% with conservative oxygen targeting SpO₂ 90–95%, compared with 39.7% with liberal oxygen targeting SpO₂ ≥96%; there was no difference in mortality or other secondary outcomes. UK practice should avoid both hyperoxia and hypoxia, with a pragmatic target of SpO₂ 94–98% and avoidance of prolonged SpO₂ below 94% or routine 100% oxygen once monitoring is established. The excerpt provides no confidence intervals or p-values, and the recommended 94–98% target is a pragmatic interpretation rather than a directly tested trial arm.
Key numbers: Favourable neurological outcome at 180 days: 38.2% versus 39.7%; n=1,840; conservative SpO₂ 90–95% versus liberal SpO₂ ≥96%.
CRITICAL CARE MEDICINE. 2026. LARGE COHORT STUDY. · ISSUE 8
Long-term mortality and functional outcomes after ECMO
Long-term outcomes after ECMO are important when discussing prognosis with patients and families. At long-term follow-up, 37.2% of adults receiving VV-ECMO for respiratory failure had died, while VA-ECMO for cardiac failure was associated with substantially higher long-term mortality. Survivors of both modalities had significant functional impairment at 6–12 months after discharge. In UK ECMO practice, incorporate these outcomes into patient selection, MDT decision-making, consent and withdrawal-of-treatment discussions, while recognising that the excerpt does not provide modality-specific VA-ECMO mortality or detailed functional outcome measures.
Key numbers: 37.2% long-term mortality after VV-ECMO; VA-ECMO had substantially higher long-term mortality; significant functional impairment at 6–12 months post-discharge.
CHAPTER 7
Perioperative Medicine
16 items · Anaesthetics & ICU Evidence Rundown Issues 6–8
The largest chapter. Higher or individualised intraoperative MAP targets did not improve outcomes; SNaPP found a modest reduction in pulmonary complications with sugammadex (ARD 2.5%, NNT about 40); dapagliflozin halved perioperative AKI after cardiac surgery without a clinical-outcome signal; and NICE QS216 set the first national perioperative quality standard. SGLT-2 inhibitor cessation and dexamethasone-related hyperglycaemia in diabetes are immediate safety points.
EUROANAESTHESIA 2026; SYSTEMATIC REVIEW AND META-ANALYSIS OF 15 RCTS, N=15,603. · ISSUE 6
Higher intraoperative MAP targets do not improve outcomes in noncardiac surgery
This systematic review and meta-analysis compared higher intraoperative MAP targets of 70–90 mmHg with routine MAP 65 in noncardiac surgery. Higher targets did not reduce AKI (RR 0.95, 95% CI 0.85–1.06), acute myocardial injury (RR 1.02, 95% CI 0.94–1.12) or in-hospital/30-day mortality (RR 1.00); a possible reduction in delirium (RR 0.73, p=0.04) remained inconclusive on trial sequential analysis. In UK practice, MAP 65 mmHg remains the primary target for elective noncardiac surgery, and routine vasopressor use to maintain MAP above 70–80 mmHg is not supported, although targets should be individualised in conditions such as severe aortic stenosis, cerebrovascular disease or impaired cerebral autoregulation. The findings do not imply that profound hypotension is safe: MAP below 60 mmHg for more than 5 minutes remains associated with harm, and the higher-target trials may not represent patients most likely to benefit.
Key numbers: 15 RCTs; n=15,603; higher MAP 70–90 vs 65; AKI RR 0.95 (95% CI 0.85–1.06); myocardial injury RR 1.02 (95% CI 0.94–1.12); mortality RR 1.00; delirium RR 0.73, p=0.04, inconclusive; MAP <60 mmHg for >5 minutes associated with harm.
BMC ANESTHESIOLOGY 2026 — SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS; SAMPLE SIZE NOT STATED · ISSUE 6
Opioid-free anaesthesia for VATS reduces PONV and chronic postoperative pain
Video-assisted thoracoscopic surgery (VATS) commonly uses multimodal analgesia, but opioid exposure may contribute to postoperative nausea and vomiting (PONV) and persistent pain. This systematic review and meta-analysis found that opioid-free anaesthesia (OFA), typically incorporating dexmedetomidine, ketamine, lidocaine and local or regional analgesia, significantly reduced PONV and chronic postoperative pain compared with opioid-based anaesthesia; intraoperative bradycardia was more frequent, while hypotension rates were similar. In UK practice, OFA may be considered for eligible elective VATS patients within a structured institutional protocol incorporating appropriate regional analgesia and non-opioid analgesics. The findings should be applied cautiously because OFA requires careful selection, particularly in patients with haemodynamic instability or significant bradyarrhythmia risk, and the excerpt provides no numerical effect estimates or sample size.
Key numbers: Significant reductions in PONV and chronic postoperative pain; higher intraoperative bradycardia with OFA; no difference in hypotension rates; sample size and numerical effect estimates not stated
NICE, 2026 — NATIONAL QUALITY STANDARD (QS216) · ISSUE 6
NICE QS216: First National Quality Standard for Perioperative Care in Adults
NICE QS216, published on 1 July 2026, is the first national quality standard for perioperative care in adults. It covers preoperative, intraoperative and postoperative care in secondary and tertiary settings, with emphasis on preoperative optimisation, frailty assessment, shared decision-making documentation and postoperative outcome monitoring. UK anaesthetic and surgical teams should review these quality statements against local practice, as quality standards may be used by the CQC and commissioners as inspection benchmarks. This is a quality standard rather than a clinical trial or treatment guideline, so it sets improvement priorities but does not provide comparative outcome estimates.
Key numbers: Published 1 July 2026; first national quality standard; secondary and tertiary settings
CPOC/APAGBI | 2026 | NATIONAL GUIDELINE · ISSUE 6
New national paediatric pre-operative guidance
CPOC/APAGBI 2026 provides the first comprehensive national guidance for pre-operative care in children and young people in England. It recommends formal assessment at least 2 weeks before the procedure, consideration of non-invasive haemoglobin measurement to reduce venepuncture, and individualised anaesthetic planning for neurodiverse or anxious children. UK paediatric anaesthetic services should review the full guidance and assess whether local pre-operative pathways and assessment processes reflect these requirements. The excerpt does not provide the guideline’s evidence grading or detail how the recommendations should be implemented across different surgical settings.
Key numbers: Formal assessment ≥2 weeks before the procedure.
OCKENDEN NOTTINGHAM REVIEW AND BARONESS AMOS FINAL REPORT; RCOA/OAA JOINT RESPONSES, 2026; UK MATERNITY SAFETY REPORTS · ISSUE 6
Ockenden Nottingham and Baroness Amos Reports: Implications for Obstetric Anaesthesia
The Ockenden Nottingham Review, published 24 June, and the Baroness Amos Final Report, published 30 June, both call for binding national maternity standards. They highlight inadequate anaesthetic presence during maternity emergencies and communication failures between teams. Obstetric anaesthesia leads should review 24-hour anaesthetic cover, audit emergency team communication protocols, and examine consent and communication regarding epidural provision and pain management for women from Black and Asian backgrounds. These are safety-report recommendations rather than trial evidence, and the anticipated binding government standards may further define the required service arrangements.
Key numbers: Reports published 24 June and 30 June 2026; no sample size or quantitative outcome stated.
THE LANCET, 2026 — THREE-PAPER EVIDENCE SERIES; N NOT STATED. · ISSUE 6
Postpartum haemorrhage: Lancet series on epidemiology, prevention and treatment
A three-paper Lancet series addresses the epidemiology, prevention, and diagnosis and treatment of postpartum haemorrhage (PPH), reported as affecting 1 in 25 deliveries globally, with UK rates of 14.6 per 1,000 births and higher risk among Black and Asian women. The series emphasises early anaesthetic involvement, oxytocin 10 IU IM/IV as first-line prophylaxis, prophylactic tranexamic acid before skin closure in high-risk caesarean births, and fibrinogen-directed haemostasis when ROTEM/TEG or fibrinogen concentration indicates deficiency. For UK practice, ensure early escalation, access to cell salvage for high-risk deliveries, and prompt TXA 1 g IV in established PPH, while avoiding FFP as the first-line fibrinogen replacement strategy. The excerpt provides series-level conclusions but no individual paper methods, effect estimates, confidence intervals, or detailed applicability assessment; local protocols should therefore remain aligned with current national guidance until formally updated.
Key numbers: 1 in 25 deliveries globally; UK PPH rate 14.6 per 1,000 births; oxytocin 10 IU IM/IV; TXA 1 g IV; fibrinogen threshold <2 g/L.
BRITISH JOURNAL OF ANAESTHESIA, 2026 — PREPLANNED SUBGROUP ANALYSIS OF THE PADDI TRIAL; PARENT TRIAL OVER 8,000 PATIENTS · ISSUE 6
Dexamethasone 8 mg causes clinically significant hyperglycaemia in patients with diabetes
The PADDI trial found no increase in surgical-site infections with intraoperative dexamethasone, but this preplanned analysis examined its glycaemic effects in patients with diabetes. Dexamethasone 8 mg IV at induction caused clinically significant hyperglycaemia, peaking 2–4 hours after administration and persisting into the postoperative period. In UK practice, dexamethasone should not routinely be withheld from diabetic patients when indicated for PONV prophylaxis, but glucose monitoring should be planned at 2–4 hours and postoperatively, with insulin sliding-scale or modified VRIII considered for higher-risk patients. The excerpt does not provide the diabetic subgroup size or the absolute glucose values, so the magnitude and generalisability of the effect cannot be assessed fully.
Key numbers: Dexamethasone 8 mg IV; hyperglycaemia peaked 2–4 hours post-administration; parent PADDI trial over 8,000 patients
LANCET RESPIRATORY MEDICINE 2026; MULTICENTRE RANDOMISED CONTROLLED PHASE 4 TRIAL; N~7,000 (ANZCA CLINICAL TRIALS NETWORK) · ISSUE 7
SNaPP: Sugammadex modestly reduces postoperative pulmonary complications versus neostigmine
In adults aged 40 years and over undergoing abdominal or thoracic surgery, the SNaPP trial compared sugammadex with neostigmine for reversal of rocuronium- or vecuronium-induced neuromuscular blockade. Postoperative pulmonary complications or death occurred in 19.0% with sugammadex versus 21.5% with neostigmine, an absolute risk difference of 2.5% and an NNT of approximately 40. The difference was mainly driven by atelectasis, with no meaningful differences in pneumonia, aspiration, unplanned ICU/HDU admission, days alive and at home at 30 days, or health-related quality of life at 3 months. NHS NICE guidance and the 2023 ASA guideline already favour sugammadex at different depths of block; this trial supports departmental governance and formulary review, although the modest benefit and relative cost should be considered. Quantitative neuromuscular monitoring and confirmation of a TOF ratio of at least 0.9 before extubation remain essential regardless of reversal agent.
Key numbers: POPC or death: 19.0% vs 21.5%; absolute risk difference 2.5%; NNT ~40; n~7,000
JAMA 2026 — RANDOMISED CLINICAL TRIAL; SAMPLE SIZE NOT STATED · ISSUE 7
Dapagliflozin reduces perioperative AKI after elective cardiac surgery, but not 30-day clinical outcomes
In this randomised trial, dapagliflozin 10 mg daily was started 1 day before elective cardiac surgery and compared with placebo, with AKI assessed during the first 7 postoperative days. AKI occurred in 28% of patients receiving dapagliflozin versus 52% with placebo, an absolute risk difference of 24% and an NNT of approximately 4; however, 30-day mortality, reoperation, atrial fibrillation and major adverse cardiac events were similar. This is potentially relevant to cardiac anaesthesia and perioperative renal-protection strategies, but does not currently justify changing UK practice: existing guidance to withhold SGLT2 inhibitors for 3–4 days before elective surgery may need revisiting only if these findings are replicated. The lack of improvement in clinical outcomes may reflect limited power, short follow-up, or AKI of relatively limited severity; implementation should therefore be discussed with cardiac surgical and nephrology colleagues rather than adopted routinely.
Key numbers: Dapagliflozin 10 mg/day started 1 day preoperatively; AKI 28% vs 52%; ARD 24%; NNT approximately 4; 30-day clinical outcomes similar
ASSOCIATION OF ANAESTHETISTS, ANAESTHESIA, 2026 — UPDATED GUIDELINE; N NOT STATED · ISSUE 7
Updated consent guidance: move from form-focused to conversation-focused practice
The Association of Anaesthetists has published its first major revision of consent guidance since 2017, reflecting the post-Montgomery legal and NHS context. The guideline emphasises discussion of material risks, including low-probability high-consequence risks such as dental damage, awareness and nerve damage, with adequate time for questions and reflection. Consent discussions should be documented as conversations rather than relying solely on a signed form; for elective anaesthesia, same-day consent is explicitly inadequate as the only consent event. UK departments should review pre-assessment and consent processes, including documentation, high-risk patients, patients with learning disabilities, refusal of interventions and airway-management plans; the excerpt does not provide outcome data or a formal evidence-grading framework.
Key numbers: 2015 Montgomery ruling; previous guidance 2017; updated guideline published 15 July 2026
BRITISH JOURNAL OF ANAESTHESIA, 2026 — SYSTEMATIC REVIEW AND META-ANALYSIS OF 10 RCTS · ISSUE 7
Individualised intraoperative blood pressure targets do not improve major postoperative outcomes
Individualised, goal-directed intraoperative blood pressure management was compared with conventional blood pressure targets in 10 randomised trials. No significant reduction was found in postoperative acute kidney injury, myocardial injury after non-cardiac surgery or mortality; a possible delirium benefit did not reach conventional significance thresholds and varied across trials. For current UK practice, maintaining MAP at or above 65 mmHg remains a pragmatic minimum, without strong evidence that more complex individualised targets improve outcomes in unselected patients. Patients with severe pre-existing hypertension, particularly baseline blood pressure above 180/110 mmHg, may require higher targets based on clinical judgement; the delirium signal warrants further investigation.
Key numbers: 10 RCTs; MAP ≥65 mmHg; baseline blood pressure >180/110 mmHg
BRITISH JOURNAL OF ANAESTHESIA, 2026 — SYSTEMATIC REVIEW; N NOT STATED · ISSUE 7
Genetic testing for butyrylcholinesterase deficiency may improve perioperative safety
Suxamethonium apnoea caused by butyrylcholinesterase deficiency is an important, potentially recurrent perioperative risk. This systematic review found that genotyping improves diagnostic accuracy and that pre-operative or post-event testing may identify at-risk patients before a subsequent anaesthetic and support family counselling. In UK practice, suspected deficiency should be clearly documented and communicated to the anaesthetic and surgical teams; consider discussion with biochemistry and avoid suxamethonium, using an alternative such as rocuronium with sugammadex where appropriate. The excerpt provides no quantitative diagnostic estimates or study-level sample size, so the evidence supports incorporation into diagnostic pathways rather than routine universal testing.
BRITISH JOURNAL OF ANAESTHESIA, 2026 — EVIDENCE REVIEW; SAMPLE SIZE NOT STATED. · ISSUE 8
Perioperative SGLT-2 inhibitor cessation to reduce euDKA risk
SGLT-2 inhibitors (dapagliflozin, empagliflozin and canagliflozin) can cause euglycaemic diabetic ketoacidosis (euDKA), in which substantial ketoacidosis may occur despite normal or near-normal blood glucose. The review recommends withholding these drugs for 3–4 days before elective surgery and investigating perioperative metabolic acidosis with blood or urine ketones rather than relying on glucose alone. UK practice should include SGLT-2 inhibitor screening during preoperative assessment, updating local medication guidance, and managing euDKA according to DKA protocols even when glucose is normal. This is an evidence review without a stated sample size, and reported cases include both major and minor surgery; local guidance should be aligned with pharmacy and surgical teams.
Key numbers: Withhold SGLT-2 inhibitors for 3–4 days before elective surgery; glucose may be normal or near-normal in euDKA.
BRITISH JOURNAL OF ANAESTHESIA, 2026 — EVIDENCE REVIEW; SAMPLE SIZE NOT STATED · ISSUE 8
Liberal clear-fluid fasting to 2 hours before elective surgery
This evidence review examined liberal preoperative clear-fluid fasting, allowing clear fluids until 2 hours before elective surgery. In non-urgent adult patients, permitting clear fluids up to 2 hours preoperatively was not associated with increased pulmonary aspiration risk and may reduce thirst, dehydration, preoperative anxiety, and adverse insulin responses to surgery. UK practice should align elective fasting policies with ERAS and RCoA guidance rather than applying routine nil-by-mouth-from-midnight instructions; carbohydrate-loading drinks 2 hours before major surgery are also supported by the review. The findings apply to non-urgent adult elective surgery and should not be extrapolated automatically to emergency cases or patients with specific aspiration-risk factors.
Key numbers: Clear fluids permitted up to 2 hours before elective surgery; sample size not stated
BRITISH JOURNAL OF ANAESTHESIA, 2026 — REVIEW. · ISSUE 8
Postoperative Hypotension After Non-Cardiac Surgery: Mechanisms and Management
Postoperative hypotension (MAP <65 mmHg) occurs in up to 30% of patients recovering from major non-cardiac surgery and is independently associated with AKI, myocardial injury (MINS), and 30-day mortality. Mechanisms include residual anaesthetic or neuraxial vasodilation, hypovolaemia, cardiac dysfunction, and inflammatory vasodilation; risk is higher in older patients, those with comorbidities, and those undergoing major intra-abdominal or orthopaedic surgery. In higher-risk patients, consider continuous non-invasive BP monitoring in recovery and early noradrenaline (0.05–0.1 micrograms/kg/min) rather than repeated fluid boluses when euvolaemia is established; 15-minute BP checks may miss transient hypotension. As this is a review and the reported associations do not establish causation, treatment should remain guided by clinical assessment and the likely mechanism of hypotension.
Key numbers: MAP <65 mmHg; up to 30%; noradrenaline 0.05–0.1 micrograms/kg/min; 15-minute BP checks.
BRITISH JOURNAL OF ANAESTHESIA, 2026 — COHORT STUDY · ISSUE 8
Pre-admission frailty predicts ICU mortality and functional decline
Pre-admission frailty, measured using the Clinical Frailty Scale (CFS), and functional dependency were independently associated with higher ICU mortality. Frail patients who survived ICU admission had worse functional trajectories, with substantially reduced post-ICU function compared with their pre-admission baseline. In UK practice, document CFS at ICU admission; a CFS of 5 or above should prompt early goals-of-care discussions and inform treatment intensity, rehabilitation planning and ceiling-of-care conversations. This is prognostic cohort evidence and does not mean that frailty alone should preclude ICU admission.
Key numbers: CFS 5+; no mortality estimate stated
CHAPTER 8
Renal & Metabolic
2 items · Anaesthetics & ICU Evidence Rundown Issues 6–8
Enteral magnesium was non-inferior to IV replacement in stable ICU patients, and SODa-BIC found no reduction in AKI with IV bicarbonate in acidotic ICU patients.
CRITICAL CARE MEDICINE 2026 · NON-INFERIORITY RCT · MCMASTER SCORE 6/7 · ISSUE 6
Enteral Magnesium Is Non-Inferior to IV Replacement in Stable ICU Patients
Hypomagnesaemia (serum magnesium <0.75 mmol/L) affects 40–65% of ICU patients and is associated with refractory hypokalaemia, atrial arrhythmias and prolonged ventilation. In this non-inferiority RCT, enteral magnesium administered via nasogastric tube achieved equivalent serum magnesium levels to intravenous replacement at 72 hours, with less need for IV access and fewer phlebitis events. For haemodynamically stable postoperative ICU patients with a nasogastric tube already in situ, enteral magnesium is a practical alternative to routine intravenous replacement. The findings should not be extrapolated to unstable patients, those without reliable enteral access, or situations requiring rapid correction; local replacement protocols should specify appropriate monitoring and dosing.
Key numbers: Serum magnesium <0.75 mmol/L; ICU prevalence 40–65%; non-inferiority assessed at 72 hours; standard IV magnesium sulphate 10–20 mmol over 60 minutes
NEW ENGLAND JOURNAL OF MEDICINE, 2026 — MULTICENTRE RANDOMISED CONTROLLED TRIAL; SAMPLE SIZE NOT STATED · ISSUE 8
SODa-BIC: Intravenous sodium bicarbonate does not prevent AKI in ICU metabolic acidosis
The SODa-BIC multicentre RCT evaluated intravenous sodium bicarbonate versus placebo in ICU patients with metabolic acidosis. In patients with pH <7.35, bicarbonate made no difference to AKI incidence or severity, mortality, renal replacement therapy requirement or hospital length of stay. UK ICU practice should therefore not use intravenous sodium bicarbonate for renoprotection in metabolic acidosis. This does not exclude use for specific indications such as severe hyperkalaemia; the excerpt does not provide the trial sample size, effect estimates or fuller eligibility criteria.
Key numbers: pH <7.35; no difference in AKI incidence or severity, mortality, renal replacement therapy requirement or hospital length of stay
CHAPTER 9
Neurocritical Care
1 items · Anaesthetics & ICU Evidence Rundown Issues 6–8
A mixed-methods review of how patients and families cope with ICU delirium, relevant to follow-up and communication.
CRITICAL CARE (LONDON) 2026; MIXED-METHODS SYSTEMATIC REVIEW · ISSUE 8
Psychosocial coping with ICU delirium in patients and families
This mixed-methods systematic review examined how patients and families cope with ICU delirium. Patients and families used information-seeking, explanation, reframing, maintaining hope, and social or professional support; delirium was associated with lasting psychological distress, including possible contribution to post-intensive care syndrome. UK ICU practice should make family communication an explicit part of delirium care: explain delirium early, involve relatives in reorientation, provide honest reassurance, and offer written information. The review supports communication-focused care, but the excerpt provides no quantitative estimate of psychological harm or evidence that a specific communication intervention improves outcomes.
CHAPTER 10
Guideline & Policy Updates
7 items · Anaesthetics & ICU Evidence Rundown Issues 6–8
A significant quarter for UK institutions: FICM became the College of Intensive Care Medicine, GPICS V3 updated UK intensive care standards, the Ockenden Nottingham review and the joint RCoA/OAA response set obstetric anaesthesia priorities, and NICE NG258 changed anaphylaxis tryptase sampling and referral.
NICE NG258 (2026) — GUIDELINE UPDATE; SAMPLE SIZE NOT STATED · ISSUE 6
NICE NG258: Three tryptase samples and mandatory allergy referral after anaphylaxis
NICE NG258 replaces CG134 and updates the assessment and follow-up of suspected or confirmed anaphylaxis, including perioperative reactions. It specifies three tryptase samples: 30–120 minutes after symptom onset, at 3–4 hours, and a baseline sample after more than 24 hours or at follow-up; observation should last at least 4–6 hours, with 24-hour admission for severe or incompletely treated reactions. Allergy referral is mandatory for all suspected or confirmed cases, with the suspected trigger, all agents administered, severity, treatment, tryptase results and referral confirmation documented in the anaesthetic record. UK departments should update perioperative anaphylaxis protocols and record templates, while recognising that this is a guideline update rather than evidence from a reported comparative study.
Key numbers: Three tryptase samples: 30–120 minutes, 3–4 hours, and baseline after >24 hours or at follow-up; observation 4–6 hours minimum; 24-hour admission for severe or incomplete response.
SURVIVING SEPSIS CAMPAIGN 2026 GUIDELINE; ANZCA 2026 GLP-1 PERIOPERATIVE GUIDANCE; OFACAR RCT, ANESTHESIOLOGY MAY 2026; ANAESTHESIA & INTENSIVE CARE MEDICINE REVIEW SERIES, JUNE 2026 · ISSUE 6
Quick hits: sepsis mucolytics, GLP-1 agonists, thyroid disease and opioid-free cardiac anaesthesia
The 2026 Surviving Sepsis Campaign guideline explicitly recommends against carbocisteine and hypertonic saline mucolytics in mechanically ventilated patients following harm signals, while recommending antibiotic de-escalation when susceptibilities are available and source control within 6 hours where feasible. Updated ANZCA guidance advises against routinely withholding GLP-1 agonists before surgery, although patients with clinical gastroparesis or significant gastrointestinal symptoms require individual assessment, extended fasting and consideration of rapid-sequence induction. The OFACAR randomised trial in cardiac surgery found fewer postoperative pulmonary complications with dexmedetomidine, ketamine and lidocaine-based opioid-free anaesthesia, but more bradycardia; the Anaesthesia & Intensive Care Medicine review series provides revision-focused coverage of thyroid, calcium, phaeochromocytoma and thyroid-surgery anaesthesia. These updates support local review of ventilator mucolytic practice, GLP-1 pathways and multimodal cardiac anaesthesia, but the heterogeneous evidence should not be treated as a single change to universal practice.
Key numbers: Mucolytics: carbocisteine gastrointestinal bleed RR 6.51; hypertonic saline bronchoconstriction RR 5.73. SSC: 129 statements, 46 new. Source control: within 6 hours where feasible.
FICM/CICM, 2026; ORGANISATIONAL ANNOUNCEMENT; N NOT STATED · ISSUE 7
FICM becomes CICM and FFICM becomes FCICM
On 1 July 2026, the Faculty of Intensive Care Medicine became the College of Intensive Care Medicine (CICM). The FFICM qualification was renamed FCICM, with examinations from October 2026 branded FCICM; existing certificates remain valid and enrolled trainees are to have their qualification renamed automatically. Departments and individuals should update relevant CVs, job descriptions, contracts and training documentation. This is an administrative rebranding rather than a change to clinical guidance.
ESAIC, 2026; CONSENSUS DOCUMENT; NO SAMPLE SIZE STATED · ISSUE 7
ESAIC consensus on sustainable intensive care and volatile-agent sedation
The ESAIC 2026 consensus addresses sustainability and environmental mitigation in intensive care, including energy use, PPE and drug waste, medication choices, and ethical frameworks. It highlights the environmental impact of volatile agents used for ICU sedation with AnaConDa/MIRUS systems: desflurane has a reported global warming potential of approximately 2,500 times that of CO2 over 100 years, compared with approximately 510 for isoflurane. The consensus recommends reflecting systems for volatile agents and minimising waste, with review alongside NHS England Green Plan requirements by ICU leads and pharmacists. This is a policy and sustainability consensus rather than an outcomes trial, so local implementation should consider available equipment, sedation requirements and wider departmental guidance.
Key numbers: Desflurane global warming potential approximately 2,500 times CO2 over 100 years; isoflurane approximately 510; published 14 July 2026.
ICS + 2026 + JAMES LIND ALLIANCE-STYLE RESEARCH PRIORITY-SETTING EXERCISE; N NOT STATED · ISSUE 7
ICS research priorities for UK intensive care
The ICS published 10 new James Lind Alliance-style research priorities for UK intensive care on 1 July 2026. The priorities include delirium prevention, post-intensive care syndrome, ICU rehabilitation and family involvement. UK intensive care departments could use these priorities to guide quality-improvement projects and local research agendas. They are agenda-setting priorities rather than evidence of treatment effectiveness, and the excerpt does not provide the prioritisation methodology or participant numbers.
Key numbers: 10 research priorities; 1 July 2026
RCOA/OAA, 2026, JOINT STATEMENT; N NOT STATED · ISSUE 7
Joint RCoA/OAA response to the Ockenden maternity services review
The RCoA and Obstetric Anaesthetists’ Association welcomed the Ockenden Report on Nottingham University Hospitals NHS Trust maternity services, published on 24 June 2026, and issued a joint response on 17 July 2026. The response highlights implications for obstetric anaesthesia, including maternity safety, obstetric anaesthesia presence and emergency teamworking. UK obstetric anaesthesia departments should review their local response to the Ockenden recommendations and assess whether current arrangements support safe emergency care. This is a joint organisational response rather than a study, and the excerpt does not provide outcome data or specific implementation standards.
Key numbers: Report published 24 June 2026; joint response issued 17 July 2026; n not stated
INTENSIVE CARE SOCIETY AND COLLEGE OF INTENSIVE CARE MEDICINE (ICS/CICM), 2026; CLINICAL SERVICE GUIDELINE · ISSUE 8
GPICS V3: updated UK standards for intensive care provision
GPICS V3 replaces GPICS V2 (2019) and updates UK minimum standards for intensive care unit infrastructure, workforce and clinical processes. It strengthens expectations for consultant-delivered care, multidisciplinary ward rounds, patient- and family-centred care, and ICU-to-rehabilitation pathways, including daily consultant-led ward rounds, structured family communication, delirium protocols and rehabilitation planning from day 1. UK intensive care units should audit local practice against GPICS V3 and incorporate relevant standards into policy, governance and quality-improvement work. This is a service-provision guideline rather than comparative clinical evidence, so local implementation should consider available resources and governance requirements.
Jake Turner, EM Registrar — West Midlands
Curated with the assistance of AI (Perplexity). All content editorially reviewed. Not a substitute for appraisal of the primary sources.
EM Evidence — emevidence.org — Anaesthetics & ICU Q3 2026 State of the Science