Pradeep Bhatia

Background: Cannulation of the internal jugular vein (IJV) is traditionally performed in the supine position; however, during surgeries in the prone position, it may become necessary to obtain central venous access because of unexpected blood loss. Methods: This prospective, randomized, open-label, non-inferiority trial was conducted at an academic medical center between May 2024 and June 2025. A total of 192 adult patients requiring IJV cannulation were enrolled and randomly assigned to two groups: the supine (S) group and the prone (P) group. All procedures were performed using an ultrasound (USG)-guided short-axis, out-of-plane approach. The primary outcome was to compare first-attempt success between the supine and prone positions. Secondary outcomes included comparisons of access time, guidewire insertion time, catheterization time, number of attempts, and associated complications. Results: The first-attempt success rate was 90.62% in the supine position compared with 77.08% in the prone position (absolute risk difference, 13.54%; two-sided 90% CI, 4.95–22.13%), indicating that the non-inferiority of prone vs supine was not demonstrated. The prone group had considerably longer access, guidewire insertion, and catheterization times than the supine group ( P < 0.0001). However, despite these statistically significant differences, successful cannulation was achieved in both groups. The complication rates were similar across the two groups ( P = 0.688). Conclusion: In this study, USG-guided IJV cannulation in the prone position did not meet the pre-specified criterion for non-inferiority compared with the supine approach. It was nonetheless achievable in all patients in the hands of skilled practitioners, suggesting its use as a rescue option rather than as a comparable alternative.

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Background and Aims: Enhanced recovery after surgery (ERAS) is increasingly adopted in neuroanaesthesia, yet its application in endoscopic skull-base surgery remains unestablished. This prospective randomised study evaluated the effectiveness of ERAS in endoscopic skull-base surgeries. Methods: Sixty participants undergoing endoscopic skull-base surgery were randomised into either the ERAS group or the conventional anaesthetic technique (CAT) group. The primary objective was to compare the quality of post-operative recovery using the Quality of Recovery (QoR)-15 scoring system between the two groups at 24 hours post-operatively. The secondary objectives included comparing the days to ambulation, hospital stay, pain intensity, and patient satisfaction scores. Results: There was no significant difference in the mean QoR15 (± standard deviation) score between the groups [ERAS vs CAT, 98.40 ± 4.45 vs 96.56 ± 4.40, 95% confidence interval (-.45, 4.123), P = 0.114]. The days to ambulation showed a significant difference between ERAS and CAT (2.30 ± 0.535 vs 3.30 ± 0.915; P < 0.001), but the duration of hospital stay was not significantly different (ERAS vs CAT, 5.20 ± 0.761 vs 5.47 ± 0.86; mean difference = -0.26; P = 0.209). Pain scores were lower in the ERAS group from 1 to 12 hours after surgery ( P < 0.001), but no significant difference was observed from 18 to 24 hours. The ERAS group had lower patient satisfaction scores (1.63 ± 0.490 vs 2.00 ± 0.694; P = 0.022), with lower scores indicating greater satisfaction. Conclusion: ERAS offers early ambulation, reduced immediate post-operative pain, and higher patient satisfaction compared to CAT in endoscopic skull-base surgeries. However, it shows no difference in post-operative recovery and overall hospital stay compared to CAT.

Shalini Bala, Tanvi M Meshram, Pradeep Bhatia, Darshana Rathod, Manbir Kaur, Kamlesh Kumari. Journal of Minimally Invasive Surgery 2025;28:176-83. https://doi.org/10.7602/jmis.2025.28.4.176