Day care anaesthesia: Journals & articles

Abstract
Purpose: Postpartum rectus abdominis diastasis (PP-RAD) is a condition that may cause abdominal wall insufficiency, affecting daily life. When conservative treatments are unsuccessful, surgical intervention may be necessary. This study aimed to assess the safety and effectiveness of minimal incision repair of rectus abdominis diastasis (MIRRAD) as day-case surgery in women with PP-RAD.

Methods: This study included 33 female patients aged 20-50 years with PP-RAD and an inter-rectus distance (IRD) of ≥ 3 cm. All patients had previously undergone conservative treatment without satisfactory outcomes. Each patient received the MIRRAD procedure as day-case surgery apart from one who stayed overnight due to nausea. Follow-up evaluations were conducted at 4 h, 1 week, 1 month, and 1 year after surgery.

Results: The average inter-rectus distance (IRD) was 4.4 cm, with a mean diastasis length of 15 cm. Of the 33 patients included, 2 did not attend the 1 year follow-up leaving 31 for final analysis. Of these, 30 had one or more concomitant hernias. The mean operation time was 67 min. At the 1 year follow-up, 87% of patients were satisfied with the results, and 90% said they would undergo the procedure again if necessary. No surgical site infection was reported, and recovery was generally smooth. Thirty of the 31 patients were discharged within 4 to 6 h after surgery, while one patient stayed overnight.

Conclusion: MIRRAD appears to be a safe and effective surgical option for PP-RAD, particularly in cases without significant excess skin. Further studies with larger populations and longer follow-up are needed to confirm these findings and establish standard patient selection criteria.

Abstract in English, French
Purpose: Dosing and types of local anesthetic agents for spinal anesthesia in ambulatory settings vary significantly. We sought to conduct a network meta-analysis to evaluate the effect of the type and dose of local anesthetic on outcomes in patients undergoing ambulatory surgery.

Methods: After PROSPERO registration (CRD42023399356), we searched various databases for randomized controlled trials (RCTs) evaluating adult patients undergoing daycare surgery under spinal anesthesia. Most included trials focused on patients undergoing knee arthroscopy, while other covered procedures were perineal, lower abdominal, and limb surgeries. Unfortunately, we could not include trials on arthroplasty surgery owing to the lack of RCTs in this area. We used Confidence in Network Meta-Analysis (CINeMA) to assess the confidence in the estimates, and we used surface under the cumulative ranking curve (SUCRA) to determine the probability rank order. The primary outcome was the time to discharge. Intraoperative effectiveness of anesthetic, sensory, and motor blockade duration; time to first micturition; time to ambulation; and adverse effects such as urinary retention and transient neurologic symptoms (TNS) were the secondary outcomes.

Results: Overall, this study included 44 trials comprising 3,299 patients, each comprising 11 distinct agents (2-chloroprocaine, articaine, high-dose bupivacaine, low-dose bupivacaine, lidocaine, high-dose levobupivacaine, low-dose levobupivacaine, mepivacaine, prilocaine, high-dose ropivacaine, and low-dose ropivacaine). Low- to moderate-certainty evidence showed that 2-chloroprocaine, lidocaine, and mepivacaine were superior for discharge readiness, while 2-chloroprocaine ranked highest for other outcomes (sensory and motor block duration, time to first ambulation, and spontaneous voiding).

Conclusions: Evidence supports 2-chloroprocaine for short-duration spinal anesthesia in the ambulatory setting.

Abstract
Background Spinal anesthesia is a suitable technique for ambulatory surgery, offering benefits such as rapid recovery and minimal complications. The choice of local anesthetic is a key factor in achieving a rapid turnover in an ambulatory surgery unit. This study compares the safety and effectiveness of hyperbaric prilocaine and hyperbaric bupivacaine in an ambulatory setting. Methods A total of 114 patients undergoing ambulatory surgery were randomly allocated to receive either hyperbaric prilocaine (20mg/mL) or hyperbaric bupivacaine (5mg/mL). Time to first walk, time to discharge, and perioperative complications were compared. Results Eighty-nine patients were analyzed: the median time to first unassisted ambulation was significantly reduced by 41 minutes in the prilocaine group, and the average discharge time was reduced by 29 minutes. Hypotension was the most frequently observed complication, occurring in 17.4% of the prilocaine group and 16.3% of the bupivacaine group, with no statistically significant difference. There was no statistically significant difference between the two groups in other perioperative complications studied. Conclusion Hyperbaric prilocaine is a safe and effective alternative to hyperbaric bupivacaine for ambulatory surgery, offering a rapid onset and intermediate duration, resulting in earlier patient discharge. Improving the perioperative times can make the ambulatory unit more efficient and contribute to cost reduction.

Abstract
Objective: We assessed whether Penthrox (methoxyflurane) can provide better pain relief for elective, outpatient interventional procedures compared with other methods of pain control.

Design: Systematic review.

Data sources: Cochrane Central Register of Controlled Trial, MEDLINE, Emcare, Embase, ClinicalTrials.gov and the Cumulative Index to Nursing and Allied Health Literature were searched from inception to 6 November 2023.

Eligibility criteria: All published studies including randomised controlled trials (RCTs), cohort studies and case-control studies investigating Penthrox for pain relief, during and/or after an interventional procedure, were included.

Data extraction and synthesis: Two independent reviewers identified eligible studies and retrieved data. Risk of bias was assessed using Cochrane Collaboration Risk of Bias V.2.0 and Risk of Bias in Non-randomised Studies of Interventions (ROBINS I) tools. A meta-analysis was not possible due to heterogeneity.

Results: The literature search yielded 1189 records. 12 studies were eligible for inclusion: 5 RCTs and seven non-randomised studies of interventions (NRSIs). Penthrox was used for a range of procedures across five medical specialities: gastroenterology, gynaecology, haematology, orthopaedics and urology. Two RCTs showed a significant reduction in intraprocedural pain when Penthrox was compared with placebo. However, three RCTs where Penthrox was compared with either placebo or intravenous sedation showed no significant differences in pain or comfort level. Similarly, the NRSIs showed variable results. Most patients were satisfied (63% to >98%; seven studies) with Penthrox, and seven out of eight studies reported that the majority of participants would use it again (46.8%-95%; eight studies). No serious adverse events were reported.

Conclusion: Penthrox (methoxyflurane) shows promise as an analgesic for invasive, elective interventional procedures in the outpatient setting, although the relative benefits appear to vary depending on intervention and comparator pain control measures. There is a pressing need for robustly conducted, large, generalisable multicentre RCTs to evaluate the effectiveness of Penthrox.

Abstract
Background: Children often experience anxiety and pain during minor surgical procedures, prompting the search for effective pain management strategies beyond traditional pharmaceutical approaches. This study aims to evaluate the efficacy of virtual reality (VR) as a pain reduction method in pediatric outpatient surgical interventions compared to the standard use of nitrous oxide. The research questions explore pain reduction levels, patient preferences, enjoyment during VR use, and the time limit of the VR application.

Methods: The study employs a randomized controlled trial design, utilizing VR technology and nitrous oxide in separate groups in 100 children at the age from 6 to 15 undergoing minor surgical procedures. Outcomes are monitored directly after the intervention and two weeks following the procedure. The primary outcome measure is the pain level, assessed using visual face and visual analog scales. Secondary outcomes are the fun and/or fear experienced during the intervention, the willingness to undergo the same procedure again (if necessary), and whether there is a time limit with the VR application compared to nitrous oxide. The study also considers adverse events and safety measures.

Discussion: The study aims to address a significant research gap in pediatric pain management strategies, as it is the first randomized controlled trial designed to compare pain levels using VR versus a control group with nitrous oxide analgosedation in children undergoing minor surgical procedures. Preliminary evidence suggests VR may offer a viable alternative to traditional pain management methods, as VR technology could be an effective distraction and pain management tool for pediatric patients undergoing outpatient surgical procedures.

Abstract
In the evolving landscape of ambulatory surgery, wide-awake local anesthesia no tourniquet (WALANT) surgery has emerged as a preferred approach due to its efficacy, cost-effectiveness, and patient satisfaction. This paradigm shift places the patient at the center of intraoperative communication, requiring a significant change in the dialogue within the operating room (OR). Traditional conversations, which often exclude the unconscious patient, must evolve to accommodate and prioritize the psychological comfort of the conscious patient. This article examines the impact of language, tone, and conversation content on the patient experience during WALANT. We propose a communication framework that emphasizes empathy, reassurance, and patient inclusion to reduce anxiety and increase patient compliance. By analyzing common OR dialogues and their potential impact on awake patients, we identify specific phrases and words that may exacerbate patient stress or discomfort. Alternatives are suggested to foster a more positive and inclusive environment. Our recommendations are based on extensive clinical experience and supported by relevant literature, highlighting the critical role of mindful communication in improving clinical outcomes and patient satisfaction in WALANT.

Abstract
Background: Preservative-free chloroprocaine is a promising spinal anesthetic for ambulatory surgeries, offering a short duration of action and minimal side effects, which promote faster recovery and discharge. Thus, this study aimed to compare chloroprocaine hydrochloride to the widely used bupivacaine as a spinal anesthetic in ambulatory anorectal surgeries. We hypothesized that chloroprocaine will lead to quicker recovery and discharge, supporting its use in the ambulatory surgical setting.

Methods: In this double-blind randomized controlled trial, 110 patients were randomized to 1% chloroprocaine or 0.75% bupivacaine treatment groups. Due to the inability to place a spinal anesthetic, five patients were excluded (one in chloroprocaine and four in bupivacaine groups). The co-primary endpoints were recovery time (defined as the time of motor and sensory function return), and time discharge criteria were met. The secondary endpoint was the onset of transient neurological symptoms (TNS).

Results: The chloroprocaine group had a significantly shorter time to meet discharge criteria (191.4±6.6 min) than the bupivacaine group (230.9±9.4 min; p=<0.001). There were no significant differences between interventions for recovery time. No TNS were recorded within 24 hours after the procedure for both groups.

Conclusion: Our study demonstrated a significantly reduced time to meeting discharge criteria with chloroprocaine compared with bupivacaine without an increased risk of TNS. Our results support the use of chloroprocaine for spinal anesthesia in ambulatory anorectal surgeries.

Trial registration number: NCT03324984.

Keywords: Acute Pain; Anesthesia, Spinal; REGIONAL ANESTHESIA.

Abstract
Purpose of review: To evaluate the current trends, safety, and feasibility of same-day discharge (SDD) in ambulatory cardiac procedures, with a focus on percutaneous coronary interventions (PCI). This review also discusses the impact of technological advancements and explores future directions for expanding the scope of SDD in more complex cardiac procedures.

Recent findings: Recent studies have demonstrated that SDD after PCI is both well tolerated and effective for appropriately selected patients, with outcomes comparable with those of patients who remain hospitalized overnight. Advancements in PCI technology, including improved stent designs, smaller sheath sizes, and the adoption of the transradial approach, have significantly enhanced the feasibility of SDD. Enhanced recovery after surgery (ERAS) pathways, adapted for ambulatory settings, further improve patient safety, particularly as more complex procedures are attempted. However, challenges remain in determining SDD eligibility, particularly in settings with limited emergency care capabilities.

Summary: SDD is a viable and cost-effective option for low-risk patients undergoing PCI and other ambulatory cardiac procedures. The successful implementation of SDD requires careful patient selection, adherence to standardized protocols, and vigilant postprocedural monitoring. Future research should focus on refining patient selection tools, expanding the scope of SDD to include more complex procedures, and enhancing postdischarge monitoring through advanced technologies. Multidisciplinary collaboration and ongoing education are essential to support the well tolerated and effective adoption of SDD in ambulatory cardiac care.

Abstract
Propofol anesthesia may impact a patient's sleep quality in the immediate postprocedure timeframe. We describe a 24-year-old man presenting for gastrostomy-jejunostomy tube replacement who reported debilitating sleep-onset disturbances after 3 previous anesthetic exposures for the same procedure. Review of the patient's records revealed the recurring use of propofol infusion. We proposed using dexmedetomidine infusion to potentially avoid another extended sleep disturbance. Following a dexmedetomidine-centered plan, the patient reported experiencing his usual sleep pattern without side-effects for 5 consecutive days postprocedure. This case highlights the potential for propofol-induced sleep disturbance in the ambulatory setting, which may be avoided with dexmedetomidine administration.

Abstract
Background: Ambulatory surgery is often followed by the development of nausea and/or vomiting (N/V). Although risk factors for postoperative nausea and vomiting (PONV) are frequently discussed, the distinction between PONV and postdischarge nausea and vomiting (PDNV) is unclear. This is especially troublesome given the potential consequences of postdischarge nausea and vomiting (PDNV), which include major discomfort and hospital readmission.

Methods: In this retrospective cohort study, data from 10,231 adult patients undergoing ambulatory ophthalmology or otolaryngology procedures with general anesthesia were collected and analyzed. Binary and multinomial logistic regression was used to assess the association between patient and anesthetic characteristics (including age, body mass index (BMI), American Society of Anesthesiologists Physical Status (ASA P/S) classification, current smoker status, and intra- and postoperative opioid usage) and the odds ratios of experiencing only PDNV, only PONV, or both PONV and PDNV, as compared to not experiencing N/V at all.

Results: We found that 17.8% of all patients developed N/V (PONV and/or PDNV). Patients who experienced PONV had a 2.79 (95% confidence interval 2.24-3.46) times greater risk of reporting PDNV. Binary logistic regression found that younger age, opioid use, and female sex were associated with an increased likelihood of experiencing any N/V. Increased use of nitrous oxide and a higher ASA P/S class was associated with elevated likelihood of PONV, but not PDNV or PONV plus PDNV.

Conclusions: Patients experiencing N/V in the PACU are observed to develop PDNV disproportionately by a factor of 2.79. The patients have distinct predictors, indicating important opportunities for care improvements beyond current guidelines.

Abstract
Purpose: Total joint arthroplasty (TJA), particularly for the hip and knee, is one of the most commonly performed surgical procedures. The advancement/evolution of surgical and anesthesia techniques have allowed TJA to be performed on an ambulatory/same-day discharge basis. In this Continuing Professional Development module, we synthesize the perioperative evidence that may aid the development of successful ambulatory TJA pathways.

Source: We searched MEDLINE, Embase, CENTRAL, and the Cochrane Database of Systematic Reviews for ambulatory or fast-track TJA articles. In the absence of direct evidence for the ambulatory setting, we extrapolated the evidence from the in-patient TJA literature.

Principal findings: Patient selection encompassing patient, medical, and social factors is fundamental for successful same-day discharge of patients following TJA. Evidence for the type of intraoperative anesthesia favours neuraxial technique for achieving same day discharge criteria and reduced perioperative complications. Availability of short-acting local anesthetic for neuraxial anesthesia would affect the anesthetic choice. Nonetheless, modern general anesthesia with multimodal analgesia and antithrombotics in a well selected population can be considered. Regional analgesia forms an integral part of the multimodal analgesia regime to reduce opioid consumption and facilitate same-day hospital discharge, reducing hospital readmission. For ambulatory total knee arthroplasty, a combination of adductor canal block with local anesthetic periarticular infiltration provided is a suitable regional analgesic regimen.

Conclusion: Anesthesia for TJA has evolved as such that same-day discharge will become the norm for selected patients. It is essential to establish pathways for early discharge to prevent adverse effects and readmission in this population. As more data are generated from an increased volume of ambulatory TJA, more robust evidence will emerge for the ideal anesthetic components to optimize outcomes.

Abstract
What other guidelines are available on this topic: Since the publication of the SAMBA Consensus Statement for perioperative blood glucose management in the ambulatory setting in 2010, several recent guidelines have been issued by the American Diabetes Association (ADA), the American Association of Clinical Endocrinologists (AACE), the Endocrine Society, the Centre for Perioperative Care (CPOC), and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) on DM care in hospitalized patients; however, none are specific to ambulatory surgery.

How does this guideline differ from the previous guidelines: Previously posed clinical questions that were outdated were revised to reflect current clinical practice. Additional questions were developed relating to the perioperative management of patients with DM to include the newer therapeutic interventions.

Abstract
Background: The suitability of ambulatory surgery for patients with obstructive sleep apnea (OSA) remains controversial. This systematic review and meta-analysis aimed to evaluate the odds of perioperative adverse events in patients with OSA undergoing ambulatory surgery, compared to patients without OSA.

Methods: Four electronic databases were searched for studies published between January 1, 2011 and July 11, 2023. The inclusion criteria were: adult patients with diagnosed or high-risk of OSA undergoing ambulatory surgery; perioperative adverse events; control group included; general and/or regional anesthesia; and publication on/after February 1, 2011. We calculated effect sizes as odds ratios using a random effects model, and additional sensitivity analyses were conducted.

Results: Seventeen studies (375,389 patients) were included. OSA was associated with an increased odds of same-day admission amongst all surgery types (OR 1.94, 95% CI 1.46-2.59, I2:79%, P < 0.00001, 11 studies, n = 347,342), as well as when only orthopedic surgery was considered (OR 2.68, 95% CI 2.05-3.48, I2:41%, P < 0.00001, 6 studies, n = 132,473). Three studies reported that OSA was strongly associated with prolonged post anesthesia care unit (PACU) length of stay (LOS), while one study reported that the association was not statistically significant. In addition, four studies reported that OSA was associated with postoperative respiratory depression/hypoxia, with one large study on shoulder arthroscopy reporting an almost 5-fold increased odds of pulmonary compromise, 5-fold of myocardial infarction, 3-fold of acute renal failure, and 5-fold of intensive care unit (ICU) admission.

Conclusions: Ambulatory surgical patients with OSA had almost two-fold higher odds of same-day admission compared to non-OSA patients. Multiple large studies also reported an association of OSA with prolonged PACU LOS, respiratory complications, and/or ICU admission. Clinicians should screen preoperatively for OSA, optimize comorbidities, adhere to clinical algorithm-based management perioperatively, and maintain a high degree of vigilance in the postoperative period.

Abstract
Background: As higher acuity procedures continue to move from hospital-based operating rooms (HORs) to free-standing ambulatory surgery centers (ASCs), concerns for patient safety remain high. We conducted a contemporary, descriptive analysis of anesthesia-related liability closed claims to understand risks to patient safety in the free-standing ASC setting, compared to HORs.

Methods: Free-standing ASC and HOR closed claims between 2015 and 2022 from The Doctors Company that involved an anesthesia provider responsible for the claim were included. We compared the coded data of 212 free-standing ASC claims with 268 HOR claims in terms of severity of injury, major injuries, allegations, comorbidities, contributing factors, and financial value of the claim.

Results: Free-standing ASC claims accounted for almost half of all anesthesia-related cases (44%, 212 of 480). Claims with high severity of injury were less frequent in free-standing ASCs (22%) compared to HORs (34%; P = .004). The most common types of injuries in both free-standing ASCs and HORs were dental injury (17% vs 17%) and nerve damage (14% vs 11%). No difference in frequency was noted for types of injuries between claims from free-standing ASCs versus HORs--except that burns appeared more frequently in free-standing ASC claims than in HORs (6% vs 2%; P = .015). Claims with alleged improper management of anesthesia occurred less frequently among free-standing ASC claims than HOR claims (17% vs 29%; P = .01), as well as positioning-related injury (3% vs 8%; P = .025). No difference was seen in frequency of claims regarding alleged improper performance of anesthesia procedures between free-standing ASCs and HORs (25% vs 19%; P = .072). Technical performance of procedures (ie, intubation and nerve block) was the most common contributing factor among free-standing ASC (74%) and HOR (74%) claims. Free-standing ASC claims also had a higher frequency of communication issues between provider and patient/family versus HOR claims (20% vs 10%; P = .004). Most claims were not associated with major comorbidities; however, cardiovascular disease was less prevalent in free-standing ASC claims versus HOR claims (3% vs 11%; P = .002). The mean ± standard deviation total of expenses and payments was lower among free-standing ASC claims ($167,000 ± $295,000) than HOR claims ($332,000 ± $775,000; P = .002).

Conclusions: This analysis of medical malpractice claims may indicate higher-than-expected patient and procedural complexity in free-standing ASCs, presenting patient safety concerns and opportunities for improvement. Ambulatory anesthesia practices should consider improving safety culture and communication with families while ensuring that providers have up-to-date training and resources to safely perform routine anesthesia procedures.

Abstract
Background: The amount of same-day surgery has increased markedly worldwide in recent decades, but there remains limited evidence on chronic postsurgical pain in this setting.

Methods: We assessed pain 90 days after ambulatory surgery in an international, multicentre prospective cohort study of patients ≥45 years old with comorbidities or ≥65 years old. Pain was assessed using the Brief Pain Inventory. Chronic postsurgical pain was defined as a change ≥1 in self-rated average pain at the surgical site between baseline and 90 days, and moderate to severe chronic postsurgical pain as a score ≥4 in self-rated average pain at the surgical site at 90 days. Risk factors for chronic postsurgical pain were identified using multivariable logistic regression.

Results: Between November 2021 and January 2023, a total of 2054 participants were included, and chronic postsurgical pain occurred in 12% of participants, of whom 93.1% had new chronic pain at the surgical site (i.e., participants without pain prior to surgery). Moderate to severe chronic postsurgical pain occurred in 9% of overall participants. Factors associated with chronic postsurgical pain were: active smoking (OR 1.82; 95% CI 1.20 to 2.76), orthopaedic surgery (OR 4.7; 95% CI 2.24 to 9.7), plastic surgery (OR 4.3; 95% CI 1.97 to 9.2), breast surgery (OR 2.74; 95% CI 1.29 to 5.8), vascular surgery (OR 2.71; 95% CI 1.09 to 6.7), and ethnicity (i.e., Hispanic/Latino ethnicity OR 3.41; 95% CI 1.68 to 6.9 and First Nations/Native persons OR 4.0; 95% CI 1.05 to 15.4).

Conclusions: Persistent postsurgical pain after same-day surgery is common, usually moderate to severe in nature, and occurs mostly in patients without chronic pain prior to surgery.

Abstract
Ulnar nerve release is often performed under general anaesthesia. Wide Awake Local Anaesthesia No Tourniquet (WALANT) is a new anaesthetic method increasingly used by hand surgeons in an outpatient setting. It has advantages such as the possibility to shift surgical interventions out of the regular surgical theatre settings into an outpatient clinical setting, no risk of complications or side effects resulting from regional and general anesthesia and decreased costs. The use of WALANT has not been investigated extensively in elbow surgery. This study aims to evaluate clinical outcomes after ulnar nerve release under WALANT 27 patients with ulnar nerve release for cubital tunnel syndrome were included. The primary outcome was the presence of (remaining) symptoms after ulnar nerve release. Data was extracted from medical records. 13 out of 27 patients had (mild) remaining symptoms after ulnar nerve release, and 1 complication (superficial wound infection) was seen. Ulnar nerve release under WALANT is safe and effective in patients with primary ulnar nerve entrapment that have failed conservative therapy.

Abstract
The landscape of ambulatory surgery is changing, and tonsillectomy with or without adenoidectomy is one of the most common pediatric surgical procedures performed nationally. The number of children undergoing tonsillectomy on an ambulatory basis continues to increase. The 2 most common indications for tonsillectomy are recurrent throat infections and obstructive sleep-disordered breathing. The most frequent early complications after tonsillectomy are hemorrhage and ventilatory compromise. In areas lacking a dedicated children's hospital, these cases are managed by a nonpediatric specialized anesthesiologist and general otolaryngology surgeon. In response to requests from our members without pediatric fellowship training and/or who care for pediatric patients infrequently, the Pediatric Committee of the Society for Ambulatory Anesthesia (SAMBA) developed a position statement with recommendations for the safe perioperative care of pediatric patients undergoing tonsillectomy with and without adenoidectomy in freestanding ambulatory surgical facilities. This statement identifies children that are more likely to experience complications and to require additional dedicated provider time that is not conducive to the rapid pace and staffing ratios of many freestanding ambulatory centers with mixed adult and pediatric practices. The aim is to provide health care professionals with practical criteria and suggestions based on the best available evidence. When high-quality evidence is unavailable, we relied on group consensus from pediatric ambulatory specialists in the SAMBA Pediatric Committee. Consensus recommendations were presented to the Pediatric Committee of SAMBA.

Abstract
Purpose: We sought to develop and validate an Anticipated Surveillance Requirement Prediction Instrument (ASRI) for prediction of prolonged postanesthesia care unit length of stay (PACU-LOS, more than four hours) after ambulatory surgery.

Methods: We analyzed hospital registry data from patients who received anesthesia care in ambulatory surgery centres (ASCs) of university-affiliated hospital networks in New York, USA (development and internal validation cohort [n = 183,711]) and Massachusetts, USA (validation cohort [n = 148,105]). We used stepwise backwards elimination to create ASRI.

Results: The model showed discriminatory ability in the development, internal, and external validation cohorts with areas under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI], 0.82 to 0.83), 0.82 (95% CI, 0.81 to 0.83), and 0.80 (95% CI, 0.79 to 0.80), respectively. In cases started in the afternoon, ASRI scores ≥ 43 had a total predicted risk for PACU stay past 8 p.m. of 32% (95% CI, 31.1 to 33.3) vs 8% (95% CI, 7.9 to 8.5) compared with low score values (P-for-interaction < 0.001), which translated to a higher direct PACU cost of care of USD 207 (95% CI, 194 to 2,019; model estimate, 1.68; 95% CI, 1.64 to 1.73; P < 0.001) The effects of using the ASRI score on PACU use efficiency were greater in a free-standing ASC with no limitations on PACU bed availability.

Conclusion: We developed and validated a preoperative prediction tool for prolonged PACU-LOS after ambulatory surgery that can be used to guide scheduling in ambulatory surgery to optimize PACU use during normal work hours, particularly in settings without limitation of PACU bed availability.

Keywords: ambulatory surgery; postoperative length of stay; prediction model.

Abstract
Balanced anesthesia relies on the simultaneous administration of different drugs to attain an anesthetic state. The classic triad of anesthesia is a combination of a hypnotic, an analgesic, and a neuromuscular blocker. It is predominantly the analgesic pillar of this triad that became more and more supported by adjuvant therapy. The aim of this approach is to evolve into an opioid-sparing technique to cope with undesirable side effects of the opioids and is fueled by the opioid epidemic. The optimal strategy for balanced general anesthesia in ambulatory surgery must aim for a transition to a multimodal analgesic regimen dealing with acute postoperative pain and ideally reduce the most common adverse effects patients are faced with at home; sore throat, delayed awakening, memory disturbances, headache, nausea and vomiting, and negative behavioral changes. Over the years, this continuum of "multimodal general anesthesia" adopted many drugs with different modes of action. This review focuses on the most recent evidence on the different adjuvants that entered clinical practice and gives an overview of the different mechanisms of action, the potential as opioid-sparing or hypnotic-sparing drugs, and the applicability specifically in ambulatory surgery.

Abstract
The number of patients with congenital heart disease (CHD) undergoing ambulatory surgery is increasing. Deciding whether a CHD patient is suitable for an ambulatory procedure is still challenging. Several factors must be considered, including the type of planned procedure, the complexity of the underlying pathology, the American Society of Anesthesiologists' Physical Status classification of the patient, and other patient-specific factors, including comorbidity, chronic complications of CHD, medication, coagulation disorders, and issues related to the presence of a pacemaker (PM) or cardioverter-defibrillator. Numerous studies reported higher perioperative mortality and morbidity rates in surgical patients with CHD than non-CHD patients. However, most of these studies were conducted in a cohort of hospitalized patients and may not reflect the ambulatory setting. The current review aims to provide the anesthesiologist with an overview and practical recommendations on selecting and managing a CHD patient scheduled for an ambulatory procedure.

Abstract
Regional anaesthesia (RA) has an important and ever-expanding role in ambulatory surgery. Specific practices vary depending on the preferences and resources of the anaesthesia team and hospital setting. It is used for various purposes, including as primary anaesthetic technique for surgery but also as postoperative analgesic modality. The limited duration of action of currently available local anaesthetics limits their application in postoperative pain control and enhanced recovery. The search for the holy grail of regional anaesthetics continues. Current evidence suggests that a peripheral nerve block performed with long-acting local anaesthetics in combination with intravenous or perineural dexamethasone gives the longest and most optimal sensory block. In this review, we outline some possible blocks for ambulatory surgery and additives to perform RA. Moreover, we give an update on local anaesthesia drugs and adjuvants, paediatric RA in ambulatory care and discuss the impact of RA by COVID-19.

Abstract
Purpose of review: The aim of this article is to briefly review the pediatric ambulatory surgery landscape, identify two of the most common comorbidities affecting this population, examine the influence of pediatric obesity and sleep disordered breathing (SDB)/obstructive sleep apnea (OSA) on perioperative care, and provide information that can be used when formulating site specific criteria for ambulatory surgical centers.

Recent findings: Most pediatric surgeries performed are now ambulatory, a majority of which take place outside of academic centers. Children with comorbidities such as obesity and SDB/OSA are undergoing surgical or diagnostic procedures which were previously deemed unacceptable for ambulatory surgery. The increase in pediatric ambulatory surgery coupled with a recent shortage of pediatric anesthesiologists means many children will receive anesthesia care from general clinicians who care for children intermittently and may be unfamiliar with the perioperative risks these comorbidities can present.

Summary: Our pediatric ambulatory surgical population is anticipated to demonstrate increasing rates of obesity and SDB/OSA. Bringing attention to potential perioperative complications associated with these comorbidities provides a stronger foundation upon which to formulate criteria for individual ambulatory centers. It allows for targeted anesthetic management, influences provider assignments and/or staffing ratios, and informs scheduling times. For anesthesiologists who do not practice pediatric anesthesia daily, knowing what to anticipate plays a significant role in the ability to eliminate surprises and care for these patients safely.

Abstract
Purpose of review: The volume of office-based surgery (OBS) has surged over the last 25-30 years, however patients with increasing comorbidities are being considered for procedures in office locations. This review focuses on office-based surgery outcomes, financial incentives driving this change, and controversies.

Recent findings: Healthcare economics appear to drive the push towards OBS with improved reimbursements, but there are rising out-of-pocket costs impacting patients. Plastic surgery has low complications, but procedures like buttock augmentation are associated with mortality. In ophthalmology, emerging controversial literature investigates the impact of anesthesia type on and whether anesthesia providers impact ophthalmology outcomes. Dental anesthesia continues to suffer occasional wrong-sided surgeries. Vascular interventions are being driven towards offices due to reimbursements, and may be safely performed. Meta-analyses of ear, nose, and throat in-office surgeries have low complication rates.

Summary: The reported safety supports the proper selection of patients for the proper procedure in the right location. Anesthesiologists need to develop and implement safe and efficient systems to optimize patient outcomes in outpatient office settings. Further research and uniform standardized outcomes tracking are needed in the emerging specialties performing office-based surgery.

Abstract
Purpose of review: We review current evidence about organizational structures, patient selection criteria, safety measures, economic considerations, quality management, and staffing challenges in ambulatory anesthesia. The focus is on the facilitators and barriers related to the peri-interventional period and the potential concepts and innovations for further development of ambulatory anesthesia services.

Recent findings: Recent findings shed light on organizational structures in ambulatory anesthesia, including hospital-based centers, freestanding ambulatory centers, and office-based practices. Patient selection for ambulatory anesthesia involves a two-step process, considering both surgical and anesthetic factors. Safety measures, such as standardized guidelines and scoring systems, aim to ensure patient well being during the perioperative course. Economic considerations pose challenges due to the complexities of managing operating room efficiency and the variations in reimbursement systems. Quality management in ambulatory anesthesia emphasizes the need for outcome studies and patient-centered quality indicators. Staffing requirements necessitate highly skilled professionals with both technical and nontechnical skills, and structured education and training are essential.

Summary: Ambulatory anesthesia is gaining importance due to advancements in surgical techniques and periinterventional care. The review highlights the need for addressing challenges related to organizational structures, patient selection, patient safety, economic considerations, quality management, and staffing in ambulatory anesthesia. Understanding and addressing these factors are crucial for promoting the further development and improvement of ambulatory anesthesia services.

Abstract
Background and aims: Chloroprocaine is a short-acting local anaesthetic agent for spinal anaesthesia (SA) that has been used in day care surgeries due to its faster recovery characteristics and faster discharge rates compared to other local anaesthetics. This study aimed at finding out its efficacy for the same as compared to general anaesthesia (GA).

Material and methods: This observational study was conducted on 60 patients belonging to the American Society of Anaesthesiologists (ASA) physical status I and II who underwent short elective urological procedures (<60 min) under GA (group GA) as per standard of care in our hospital (n = 30) and SA (group SA) with 50 mg 1% isobaric 2-Chloroprocaine (n = 30). Time taken to meet the discharge criteria, modified Aldrete score and modified post anaesthesia discharge score in each group were noted. The cost of the anaesthetic procedure, anaesthetic procedural time, hemodynamics, supplemental analgesia, complications related to the procedure were noted and compared.

Results: Patient characteristics and duration of surgery were comparable. Time taken by group SA was significantly higher than group GA to meet the discharge criteria. Cost of GA [2624.76 (166.16) units] was significantly more than SA [1561.63 (81.32) units, P < 0.05]. There was no requirement of supplemental analgesia in group SA and no hemodynamic instability or complications in either group.

Conclusion: GA is significantly better as compared to SA with 50 mg 1% isobaric 2-Chloroprocaine as an anesthetic technique in day care urology surgeries in terms of faster recovery and faster discharge rate but is costlier.

Abstract
Background: Worldwide, there is an increasing trend of performing more complex operations in a day care setting, usually driven by economic considerations. Provision of appropriate pain relief is still inadequate in this setting. Poor pain control and adverse effects of opioids provided for pain control are common reasons for readmission, with human and economic consequences. The aim of this review was to develop evidence-based protocol for pain management of day surgery in a resource limited setting.

Method: After formulating the key questions, scope, and eligibility criteria for the articles to be included, advanced search strategy of electronic sources from data bases and websites was conducted. Screening of literatures was conducted with proper appraisal checklist. This review was reported in accordance with preferred reporting items for systematic reviews and meta-analysis (PRISMA) 2020 statement.

Results: A total of 333 articles were identified from data bases and websites using an electronic search. 45 articles were removed for duplication and 87 studies were excluded after reviewing titles and abstracts. At the screening stage, 73 articles were retrieved and evaluated for eligibility. Finally, 40 studies met the eligibility criteria and were included in this systematic review.

Conclusion: Day surgery encourages patients to mobilize soon after surgery and empowers them to manage their own pain. Thus, preoperative patient education and high-quality perioperative pain management are paramount. With increasing healthcare demands for more day-case procedures, multi-modal analgesic techniques in the perioperative period with good extension of analgesia into the postoperative discharge period are essential.

Abstract
Background and aims: Early recovery is desirable after day care surgery. Intravenous lidocaine has anti-inflammatory, anti-hyperalgesic, and analgesic effects and by reducing postoperative pain, nausea, vomiting, and duration of postoperative ileus and hospital stay, might be a useful adjuvant to improve recovery after gynecological laparoscopic surgery.

Material and methods: Fifty female patients, aged 18-55 years, undergoing gynecological laparoscopic surgery were randomly allocated to two groups. In Group L, patients received intravenous lidocaine 1.5 mg/kg at induction of anesthesia followed by infusion of 2 mg/kg/hour until the completion of surgery and in Group NS, patients received normal saline infusion. The Global QoR-40 score at 24 hours, pain score in PACU and at 24 hours, nausea/vomiting, PADSS score in PACU and analgesic consumption over 24 hours were assessed and data were analyzed using SPSS version 17 software.

Results: Demographic data were comparable in both groups. The mean Global QoR-40 score in Group L was 197.30 ± 2.3 versus 178.74 ± 6.02 in Group NS (P < 0.001). The mean time to attain PADSS ≥9 was 50 min shorter in Group L than in Group NS (P < 0.001). Nausea, vomiting, and anti-emetic requirement were also significantly reduced in Group L as compared to Group NS (P = 0.005) as was the mean pain score over 24 h (P < 0.001) and the total analgesic consumption over the first 24 h after surgery (P < 0.005).

Conclusion: Intraoperative intravenous lidocaine infusion resulted in an improved overall Quality of Recovery in patients undergoing ambulatory gynecological surgery.

Abstract
Purpose of review: With an expected rise in day care procedures with enhanced recovery programs, the use of specific regional anaesthesia can be useful. In this review, we will provide insight in the used regional block and medication so far known and its applicability in a day care setting.

Recent findings: Regional anaesthesia has been improved with the aid of ultrasound-guided placement. However, it is not commonly used in the outpatient setting. Old, short acting local anaesthetics have found a second life and may be especially beneficial in the ambulatory setting replacing more long-acting local anaesthetics such as bupivacaine.To improve efficiency, a dedicated block room may facilitate the performance of regional anaesthesia. However, cost-efficacy for improved operating time, patient care and hospital efficiency has to be established.

Summary: Regional anaesthesia has proven to be beneficial in ambulatory setting. Several short acting local anaesthetics are favourable over bupivacaine in the day care surgery. And if available, there are reports of the benefit of an additional block room used in a parallel (monitored) care of patients.

Abstract
Background and aims: The patient's satisfaction can be considered as a unique indicator of the quality of healthcare provided. The advantages of patient satisfaction surveys rely heavily on using standardized, psychometrically tested data collection approaches. There is a lack of a proper, psychometrically robust instrument to evaluate the patient's perioperative satisfaction following all types of anesthesia in daycare facility. Hence, this study aimed to develop a Daycare Anesthesia Satisfaction (DAS) questionnaire to measure the patient's satisfaction with the experience of daycare anesthesia services.

Material and methods: A preliminary pool of questions was generated from research literature, expert consultations, and pilot tested on patients. The internal consistency and reliability of the preliminary questionnaire was evaluated by calculating Cronbach's alpha, intraclass correlation coefficient (ICC), and feasibility with the formation of a final 27-item questionnaire. In the next step, the questionnaire was distributed to a larger group of patients in the phase 2 of postanesthesia care unit (PACU). The results were subjected to confirmatory factor analysis to determine the goodness of fit of the questions under each domain.

Results: The internal consistency of the preliminary questionnaire as measured by Cronbach's alpha was 0.929. Intraclass correlation coefficient measured for test-retest reliability was 0.97 (95% confidence interval [CI]). Feasibility was confirmed, as 75% of the patients could fill the questionnaire within 15 min. In the second step of confirmatory factor analysis (CFA), questionnaire has been shown to have goodness of fit with Bentler's comparative fit index (CFI) of 0.99 that is greater than the suggested cutoff of 0.90. The root mean square error of approximation (RMSEA) of 0.09 is also close to the suggested cutoff of 0.06.

Conclusion: This systematically developed and validated, 27-item DAS questionnaire can be tentatively recommended to be used to measure patient's satisfaction with day care anesthesia services following all types of surgical procedures, under various types of anesthesia.

This Best Practice & Research Clinical Anaesthesiology issue highlights anesthesia for ambulatory surgery and several related topics. Many other areas also deserve equal interest, and we hope to highlight those over time, as AS is here to stay and continues growing as a subspecialty.

The American Journal of Critical Care (AJCC) is the American Association of Critical-Care Nurses' (AACN's) preeminent peer-reviewed publication for communicating advances in critical care research. This bimonthly journal’s mission is to create a space for our readers and members of AACN to engage with original research and innovation in critical care.

The American Journal of Respiratory and Critical Care Medicine publishes high-quality original papers, reviews, and clinical trials in respiratory, critical care, and sleep medicine to foster advances in translational research and clinical practice.

‘Anaesthesia, Pain & Intensive Care’, is an international, peer reviewed journal. Registered by Pakistan Medical & Dental Council and recognized by Higher Education Commission of Pakistan.

Anaesthesia and Intensive Care is an international journal publishing timely, peer reviewed articles that have educational value and scientific merit for clinicians and researchers associated with anaesthesia, intensive care medicine, and pain medicine. It is the official journal of the Australian Society of Anaesthetists, the Australian and New Zealand Intensive Care Society and the New Zealand Society of Anaesthetists.

Anaesthesia and Intensive Care is an international journal publishing timely, peer reviewed articles that have educational value and scientific merit for clinicians and researchers associated with anaesthesia, intensive care medicine, and pain medicine. It is the official journal of the Australian Society of Anaesthetists, the Australian and New Zealand Intensive Care Society and the New Zealand Society of Anaesthetists.

Anaesthesia and Intensive Care Medicine is a continually updated, evidence-based, learning resource for trainees. Mapped to the curriculum of both the Primary and Final Fellowship of the Royal College of Anaesthetists (FRCA) examinations, Anaesthesia and Intensive Care Medicine provides high calibre and concise articles designed to help you pass the FRCA exams.

Anaesthesia, Critical Care & Pain Medicine (formerly Annales Françaises d'Anesthésie et de Réanimation) publishes in English the highest quality original material, both scientific and clinical, on all aspects of anaesthesia, critical care & pain medicine.

Official journal of the Polish Society of Anaesthesiology and Intensive Therapy. The journal is addressed chiefly to anaesthesiologists. However, due to the wide range of subjects it tackles (i.e. issues associated with anaesthesia, intensive therapy, resuscitation, pain research and management, emergency medical care, and perioperative medicine) and the interdisciplinary character of its articles it is also aimed at physicians with other specialisms.

Annals of Intensive Care is an online peer-reviewed journal aimed at publishing high-quality review articles and original research papers on intensive care medicine. It is intended for all critical care providers (attending physicians, fellows, residents, nurses, and physiotherapists) seeking to update their own knowledge to ensure they provide the best care for their patients.

Burns aims to foster the exchange of information among all engaged in preventing and treating the effects of burns. The journal focuses on clinical, scientific and social aspects of these injuries and covers the prevention of the injury, the epidemiology of such injuries and all aspects of treatment including development of new techniques and technologies and verification of existing ones. Regular features include clinical and scientific papers, state of the art reviews and descriptions of burn-care in practice.

Critical Care is a high quality, peer-reviewed, international clinical medical journal that aims to improve the care of critically ill patients by acquiring, discussing, distributing, and promoting evidence-based information relevant to intensivists. The journal publishes commentaries, reviews, and research in all areas of intensive care and emergency medicine.

Critical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines.

Critical Care Clinics updates you on the latest trends in patient management, keeps you up to date on the newest advances, and provides a sound basis for choosing treatment options. Published four times a year—in January, April, July, and October—each issue focuses on a single topic in critical care, including cardiac emergencies, sepsis, infectious diseases, shock and trauma, neurologic problems, toxicology, pulmonary disorders, intensive care procedures, and patient observation. Critical Care Clinics is also an ideal resource for those in the fields of anesthesia, emergency medicine, and respiratory medicine.

Critical Care Explorations is the official open access journal of the Society of Critical Care Medicine. The journal rapidly evaluates and disseminates new data and analyses that stimulate further innovation and inquiry toward optimal care of the critically ill adult or child. The journal publishes basic and translational science reports, clinical investigations, narrative and systematic reviews, meta-analyses, quality improvement studies, predictive modelling studies, advances in therapies and monitoring, implementation science reports, methodological and technical advances, and health services research related to critical illness at all life stages.

The official journal of the Society of Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient.

The mission of CRITICAL CARE NURSE, a bimonthly peer-reviewed journal, is to provide critical care and acute care nurses with accurate, relevant, and useful information concerning the bedside care of critically and acutely ill patients and to keep critical and acute care nurses informed on issues that affect their practice. By reading any issue of CRITICAL CARE NURSE, critical care and acute care nurses should benefit through increased knowledge concerning critical and acute care nursing practice and be able to use this knowledge to care for patients and their families in a more effective manner.

In the fields of anaesthesia and critical care, ways of thinking can change so quickly that most textbooks have difficulty keeping up. Published bi-monthly, each issue gives you access to the most current and vital account of what's going on in these critical areas.

Published bimonthly and featuring 13 key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.

The Egyptian Journal of Critical Care Medicine is the official Journal of the Egyptian College of Critical Care Physicians, the most authoritative organization of Egyptian physicians involved in the multi-professional field of critical care medicine.

The journal is intended to provide a peer-reviewed source for multidisciplinary coverage of general acute and intensive care medicine and its various subcategories including cardiac, pulmonary, neuro, renal as well as post-operative care.

The journal is proud to have an international multi-professional editorial board in the broad field of critical care that will assist in publishing promising research and breakthrough reports that lead to better patients care in life threatening conditions, and bring the reader a quick access to the latest diagnostic and therapeutic approaches in monitoring and management of critically ill patients.

​The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned narrative reviews by an authority in a field of interest to those working in anaesthesiology, pain, emergency medicine or intensive care. Editorials, commissioned commentaries and book reviews also included.

Published on behalf of the European Society of Anaesthesiology and Intensive Care.

Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM), and publishes original articles dealing with all aspects of clinical practice, research, education and experiences in emergency medicine.

Original articles are published under the following sections: Original Research, Paediatric Emergency Medicine, Disaster Medicine, Education and Training, Ethics, International Emergency Medicine, Management and Quality, Medicolegal Matters, Prehospital Care, Public Health, Rural and Remote Care, Technology, Toxicology and Trauma. Accepted papers become the copyright of the journal.

Emergency and Critical Care Medicine is an open access, peer-reviewed, international medical journal dedicated to improving the quality of care by publishing basic and clinical cutting-edge findings in emergency, critical care and related medical specialties.

Contributions are welcome from emergency and critical care professionals and researchers, with research areas including but not limited to the followings: cardiopulmonary resuscitation, acute cardiovascular diseases, stroke, shock, acute respiratory failure, infection, trauma, out-of-hospital emergency medical services, emergency, critical care, disaster management, toxicology, organ dysfunction, artificial intelligence, life-supporting devices, etc.

We publish the following article types: original articles, reviews, case reports, meta-analysis, comments, methodologies, perspectives/viewpoints, editorials, images, news, communications, letters to the editor, etc.

Emergency and Critical Care Medicine is an official journal of Shandong University, funded by the “High-level New Journal of 2019 Action Plan for the Excellence of China Science and Technology Journals” project, supported by Chinese Society of Emergency Medicine as well as Chest Pain Branch of China International Exchange and Promotive Association for Medical and Health Care.​​

EJAIC is an official publication of the European Society of Anaesthesiology and Intensive Care (ESAIC). The journal has rapid electronic publication of peer-reviewed, high scientific quality content and is open to experimental studies with clinical relevance, confirmation studies, pilot studies, and study protocols.

Indian Journal of Critical Care Medicine (ISSN 0972-5229) is specialty periodical published monthly, under the auspices of Indian Society of Critical Care Medicine. Journal encourages research, education and dissemination of knowledge in the fields of critical care medicine and emergency medicine.

Intensive Care Medicine is the publication platform for the communication and exchange of current work and ideas in intensive care medicine. It is intended for all those who are involved in intensive medical care, physicians, anaesthetists, surgeons, paediatricians, as well as those concerned with pre-clinical subjects and medical sciences basic to these disciplines.

An official journal of the European Society of Intensive Care Medicine (ESICM), Intensive Care Medicine Experimental (ICMx) is an open access journal specifically dedicated to translational research, aimed at bringing discoveries, potential novel treatments and improved diagnostics closer to the bedside of a critically ill patient.

The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice.

The Journal of Emergency and Critical Care Medicine (JECCM, J Emerg Crit Care Med, Online ISSN: 2521-3563) is an open-access, peer-reviewed online journal, aiming to improve the care of patients with emergency and critical illness by acquiring, discussing, distributing, and promoting evidence-based information relevant to emergency physicians and intensivists. It publishes original articles, editorials, technical notes, case reports and reviews covering all aspects of emergency and critical care medicine, including but not limited to, trauma, anaesthesiology, respiratory failure, sepsis, cardiovascular disease, healthcare-associated infections prevention, end-of-life care and etc.

Journal of Intensive Care is an open access journal encompassing all aspects of intensive care medicine, such as intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control and organ dysfunction. In addition, the journal encourages submissions considering the different cultural aspects of intensive care practice.

Journal of Intensive Care Medicine (JICM) is a peer-reviewed bi-monthly journal offering medical and surgical clinicians in adult and paediatric intensive care state-of-the-art, broad-based analytic reviews and updates, original articles, reports of large clinical series, techniques and procedures, topic-specific electronic resources, book reviews, and editorials on all aspects of intensive/critical/coronary care.

Journal of Intensive Medicine is an open-access peer-reviewed journal that publishes high-quality review papers and original research articles related to the latest trends and advances covering all aspects of intensive care medicine.

This journal aims to provide a forum for communication among all practitioners involved in intensive care.

The Journal of Pediatric Intensive Care is an English multidisciplinary peer-reviewed international journal publishing articles in the field of pediatric intensive care. Journal of Pediatric Intensive Care is written for the entire intensive care team: pediatric intensivist, pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are followed in neonatal and pediatric intensive care units.

The Journal of the Intensive Care Society (JICS) strives to disseminate clinically and scientifically relevant peer-reviewed research, evaluation, experience and opinion to all staff working in the field of intensive care medicine.

The Journal of Tissue Viability is the official publication of the Tissue Viability Society and is a quarterly journal concerned with all aspects of the occurrence and treatment of wounds, ulcers and pressure sores including patient care, pain, nutrition, wound healing, research, prevention, mobility, social problems and management.

Critical Care Explorations is the official open access journal of the Society of Critical Care Medicine. The journal rapidly evaluates and disseminates new data and analyses that stimulate further innovation and inquiry toward optimal care of the critically ill adult or child. The journal publishes basic and translational science reports, clinical investigations, narrative and systematic reviews, meta-analyses, quality improvement studies, predictive modelling studies, advances in therapies and monitoring, implementation science reports, methodological and technical advances, and health services research related to critical illness at all life stages.

Medicina Intensiva is the journal of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC) and of Pan American and Iberian Federation of Societies of Intensive and Critical Care Medicine. Medicina Intensiva has become the reference publication in Spanish in its field. The journal mainly publishes Original Articles, Reviews, Clinical Notes, Consensus Documents, Images, and other information relevant to the specialty. All works go through a rigorous selection process. The journal accepts submissions of articles in English and in Spanish languages. The journal follows the publication requirements of the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE).

Pediatric Critical Care Medicine is the official journal of the Society of Critical Care Medicine​ and the World Federation of Pediatric Intensive and Critical Care Societies, and it is devoted to research and clinical care of critically ill or injured infants, children, and adolescents.

Resuscitation is a monthly international and interdisciplinary medical journal. The papers published deal with the aetiology, pathophysiology and prevention of cardiac arrest, resuscitation training, clinical resuscitation, and experimental resuscitation research, although papers relating to animal studies will be published only if they are of exceptional interest and related directly to clinical cardiopulmonary resuscitation. Papers relating to trauma are published occasionally but the majority of these concern traumatic cardiac arrest.

Resuscitation Plus, a companion title to the respected Resuscitation, is an open access quarterly international and interdisciplinary medical journal. The papers published deal with the aetiology, pathophysiology and prevention of cardiac arrest, resuscitation training and simulation, clinical resuscitation, and experimental resuscitation research. Animal studies relating to cardiopulmonary resuscitation and post-resuscitation and papers relating to traumatic cardiac arrest and haemorrhagic shock are encouraged. Systematic reviews, narrative reviews, scoping reviews, case reports and methods papers relating to cardiopulmonary resuscitation are also encouraged.

Trauma Case Reports is the only open access, online journal dedicated to the publication of case reports in all aspects of trauma care and accident surgery. Includes case reports on all aspects of trauma management, surgical procedures for all tissues, resuscitation, anaesthesia and trauma and tissue healing.

Trends in Anaesthesia and Critical Care aims to be a leading biomedical review journal, providing reviews and comment on highly topical subjects and the latest breakthroughs in basic, clinical and translational research. This includes basic and clinical research aimed at understanding disease processes and clinical practice of importance to anaesthesia and critical care.

A distinctive blend of practicality and scholarliness makes the American Journal of Emergency Medicine a key source for information on emergency medical care. Covering all activities concerned with emergency medicine, it is the journal to turn to for information to help increase the ability to understand, recognize and treat emergency conditions. Issues contain clinical articles, case reports, review articles, editorials, international notes, book reviews and more.

Annals of Emergency Medicine, the official journal of the American College of Emergency Physicians, is an international, peer-reviewed journal dedicated to improving the quality of care by publishing the highest quality science for emergency medicine and related medical specialties. Annals publishes original research, clinical reports, opinion, and educational information related to the practice, teaching, and research of emergency medicine. In addition to general emergency medicine topics, Annals regularly publishes articles on out-of-hospital emergency medical services, paediatric emergency medicine, injury and disease prevention, health policy and ethics, disaster management, toxicology, and related topics. The journal welcomes submissions from international contributors and researchers of all specialties.

BMC Emergency Medicine is an open access, peer-reviewed journal that considers articles on all urgent and emergency aspects of medicine, in both practice and basic research. In addition, the journal covers aspects of disaster medicine and medicine in special locations, such as conflict areas and military medicine, together with articles concerning healthcare services in the emergency departments.

Since 1999 the Canadian Journal of Emergency Medicine is the publication platform for the communication and exchange of current work and ideas inspiring excellence in emergency medical care; it is an essential resource for emergency physicians in rural, urban or academic settings that reflect the growing interest in emergency medicine, both as a medical discipline and an expanding field for research. It is one of the top journals in its field and is the respected official journal of the Canadian Association of Emergency Physicians.

This practical journal is devoted to helping pediatricians and emergency physicians provide the best possible care for their young patients. Each topical issue focuses on a single condition frequently seen. Cogently written review articles synthesize practical new advances in the field giving you the authoritative guidance on disease process, diagnosis, and management you need to achieve the best results.

Critical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines.

​The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned narrative reviews by an authority in a field of interest to those working in anaesthesiology, pain, emergency medicine or intensive care. Editorials, commissioned commentaries and book reviews also included.

Published on behalf of the European Society of Anaesthesiology and Intensive Care.

Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM), and publishes original articles dealing with all aspects of clinical practice, research, education and experiences in emergency medicine.

Original articles are published under the following sections: Original Research, Paediatric Emergency Medicine, Disaster Medicine, Education and Training, Ethics, International Emergency Medicine, Management and Quality, Medicolegal Matters, Prehospital Care, Public Health, Rural and Remote Care, Technology, Toxicology and Trauma. Accepted papers become the copyright of the journal.

Emergency and Critical Care Medicine is an open access, peer-reviewed, international medical journal dedicated to improving the quality of care by publishing basic and clinical cutting-edge findings in emergency, critical care and related medical specialties.

Contributions are welcome from emergency and critical care professionals and researchers, with research areas including but not limited to the followings: cardiopulmonary resuscitation, acute cardiovascular diseases, stroke, shock, acute respiratory failure, infection, trauma, out-of-hospital emergency medical services, emergency, critical care, disaster management, toxicology, organ dysfunction, artificial intelligence, life-supporting devices, etc.

We publish the following article types: original articles, reviews, case reports, meta-analysis, comments, methodologies, perspectives/viewpoints, editorials, images, news, communications, letters to the editor, etc.

Emergency and Critical Care Medicine is an official journal of Shandong University, funded by the “High-level New Journal of 2019 Action Plan for the Excellence of China Science and Technology Journals” project, supported by Chinese Society of Emergency Medicine as well as Chest Pain Branch of China International Exchange and Promotive Association for Medical and Health Care.​​

Emergency Medicine Clinics of North America updates those in the fields of anesthesia, critical care, and emergency medicine on the latest trends in patient management, providing a sound basis for choosing the best treatment options. Published four times a year - in February, May, August, and November - each issue covers a single topic in emergency medicine, including cardiac, paediatric, neurological, thoracic, and orthopaedic emergencies, as well as trauma and toxicology.

Emergency Medicine International is a peer-reviewed, Open Access journal that provides a forum for doctors, nurses, paramedics and ambulance staff. The journal publishes original research articles and review articles related to prehospital care, disaster preparedness and response, acute medical and paediatric emergencies, critical care, sports medicine, wound care, and toxicology.

The Official Journal of the Italian Society of Internal Medicine, Internal and Emergency Medicine (IEM) is an independent, international, English-language, peer-reviewed journal designed for internists and emergency physicians. IEM publishes a variety of manuscript types including Original investigations, Review articles, Letters to the Editor, Editorials and Commentaries.

The International Journal of Emergency Medicine is a high-quality Open Access journal which aims to bring to light the various clinical advancements and research developments attained over the world, thus helping the specialty forge ahead. It is directed towards physicians and medical personnel undergoing training or working within the field of Emergency Medicine. Disciplines covered include interesting clinical cases, the latest evidence-based practice and research developments in Emergency Medicine, including emergency pediatrics. The International Journal of Emergency Medicine focuses on the practice of Emergency Medicine in a variety of settings, from urban emergency departments and rural clinics in the developing world, to humanitarian and disaster situations. It aims to shed light on international advances in practice, education and research, with a single common goal: to reduce suffering and promote excellence in patient care worldwide.

Journal of the American College of Emergency Physicians Open (JACEP Open) is the official Open Access journal of the American College of Emergency Physicians (ACEP). Complementing ACEP’s flagship journal, Annals of Emergency Medicine, JACEP Open welcomes high quality reports representing the full spectrum of emergency care. JACEP Open presents works in the open access format freely available and accessible to the international emergency medicine community. The journal welcomes submissions from international contributors and provides a forum for work products of ACEP subcommittees. JACEP Open is owned by the American College of Emergency Physicians. The Journal is published by Wiley and is available online only.

Since 1999 the Canadian Journal of Emergency Medicine is the publication platform for the communication and exchange of current work and ideas inspiring excellence in emergency medical care; it is an essential resource for emergency physicians in rural, urban or academic settings that reflect the growing interest in emergency medicine, both as a medical discipline and an expanding field for research. It is one of the top journals in its field and is the respected official journal of the Canadian Association of Emergency Physicians.

The Journal of Cardiovascular Emergencies is an official Journal of the Transylvannian Association of Transvascular Therapy and Transplantation Kardiomed, Tirgu Mures, Romania, and is published quarterly.

The Journal of Cardiovascular Emergencies aims to publish top quality papers related to acute conditions in any cardiovascular pathology.

The journal focuses mainly on recent advances in the field of diagnosis and treatment of the most common causes of cardiovascular emergencies, including acute coronary syndromes, acute heart failure, acute aortic diseases, pulmonary embolism, peripheral arterial diseases or cardiac arrhythmia. Interdisciplinary approaches will be extremely welcomed, presenting new advances in the approach of different other pathologies (i.e. stroke) from the cardiovascular perspective.

Journal of Emergencies Trauma, and Shock (JETS) is the official journal of INDUSEM. It is also the Official Journal of The World Academic Council of Emergency Medicine and the OPUS12 Network.

JETS encourages research, education and dissemination of knowledge in the fields of Emergency Medicine, Traumatolgy and Shock Resuscitation thus promoting translational research by striking a synergy between basic science, clinical medicine and global health.

The Journal of Emergency and Critical Care Medicine (JECCM, J Emerg Crit Care Med, Online ISSN: 2521-3563) is an open-access, peer-reviewed online journal, aiming to improve the care of patients with emergency and critical illness by acquiring, discussing, distributing, and promoting evidence-based information relevant to emergency physicians and intensivists. It publishes original articles, editorials, technical notes, case reports and reviews covering all aspects of emergency and critical care medicine, including but not limited to, trauma, anaesthesiology, respiratory failure, sepsis, cardiovascular disease, healthcare-associated infections prevention, end-of-life care and etc.

The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine.

Resuscitation is a monthly international and interdisciplinary medical journal. The papers published deal with the aetiology, pathophysiology and prevention of cardiac arrest, resuscitation training, clinical resuscitation, and experimental resuscitation research, although papers relating to animal studies will be published only if they are of exceptional interest and related directly to clinical cardiopulmonary resuscitation. Papers relating to trauma are published occasionally but the majority of these concern traumatic cardiac arrest.

Resuscitation Plus, a companion title to the respected Resuscitation, is an open access quarterly international and interdisciplinary medical journal. The papers published deal with the aetiology, pathophysiology and prevention of cardiac arrest, resuscitation training and simulation, clinical resuscitation, and experimental resuscitation research. Animal studies relating to cardiopulmonary resuscitation and post-resuscitation and papers relating to traumatic cardiac arrest and haemorrhagic shock are encouraged. Systematic reviews, narrative reviews, scoping reviews, case reports and methods papers relating to cardiopulmonary resuscitation are also encouraged.

The primary topics of interest in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (SJTREM) are the pre-hospital and early in-hospital diagnostic and therapeutic aspects of emergency medicine, trauma, and resuscitation. Contributions focusing on dispatch, major incidents, etiology, pathophysiology, rehabilitation, epidemiology, prevention, education, training, implementation, work environment, as well as ethical and socio-economic aspects may also be assessed for publication.

The Visual Journal of Emergency Medicine publishes image-based case discussions representing the entire core curriculum and subspecialties of clinical emergency medicine. Images include clinical photos, EKGs, ultrasound images, plain radiographs, and representative CT and MR images.

Each image-based case will include a question and answer set.

Published in a mobile optimized online format, the journal provides a multidisciplinary clinical and educational publishing opportunity for emergency physicians, emergency medicine and other residents, fellows, emergency nurses, physician assistants, EMTs, paramedics, and clinicians in related fields. All submissions are peer-reviewed.

Wilderness & Environmental Medicine, the official journal of the Wilderness Medical Society, is a peer-reviewed quarterly journal devoted to original scientific and technical contributions furthering research and medical practice related to remote, isolated, austere, or environmentally challenging environments and exposures. The journal is intended for clinicians, researchers, practitioners, and others interested in human health, safety, and performance in conditions often defined by natural extremes and/or limited access to resources. Examples of broad areas of interest include: mountaineering, altitude (ground and air-based), aquatic (immersion, drowning, and diving), thermal stress (heat, cold, and humidity-complicated), trauma, biological hazards (plant, animal, and infectious agents), military medicine, global health (travel, disaster, and climate change), search and rescue (standard and emerging technologies), unusual environmental stressors (natural and manufactured), and community leadership (education, standards, and best practice).

World Journal of Emergency Medicine (WJEM, ISSN 1920-8642, CN 33-1408/R) is an international peer-reviewed bimonthly journal sponsored by Zhejiang University and the Second Affiliated Hospital of Zhejiang University School of Medicine and published by the Zhejiang University Press. WJEM publishes articles of interest to both clinicians and researchers involving emergency medicine around world. It focuses on content relevant to clinical practice and research, laboratory studies, medical education about emergency medicine.

World Journal of Emergency Surgery is an open access, peer-reviewed journal that encompasses all aspects of clinical and basic research related to traumatic and non-traumatic emergency surgery and its allied subjects. Topics of interest include, but are not limited to: emergency surgery, acute care surgery, trauma surgery, intensive care, trauma management and resuscitation.