Andreas Nilsson

Optimising pain management during subcutaneous venous port (SVP) implantation is essential for patient‐centred cancer care. However, evidence‐based approaches to minimise intraoperative pain remain underexplored. This trial evaluated the clinical effectiveness and safety of the propofol‐alfentanil patient‐controlled sedation (PCS) technique as an adjunct to local anaesthesia (LA) for pain reduction during SVP implantation. Adult cancer patients at two Swedish anaesthesia departments received either LA + PCS or LA alone for SVP implantation. The primary outcome was the maximum intraoperative pain score on an 11‐point numeric rating scale (NRS). Safety outcomes included respiratory, haemodynamic and insertion‐related complications. Secondary outcomes assessed patient satisfaction and procedural measurements. A total of 340 patients (median age 70 [interquartile range, [IQR] 61–76], 51.8% male) were recruited between January 2023 and November 2024. Median intraoperative NRS pain scores were similar between groups (2 [0–3] vs. 2 [0–3], p = 0.292), with pain scores ≥ 4 reported in 22.9% (LA + PCS) and 22.2% (LA) (OR 0.96; 95% CI 0.57–1.60; p = 0.872). Hypoxia or obstructed airway occurred in 2/166 (1.2%) patients in the LA + PCS group and none in the LA group. Patient satisfaction was high in both groups (10 [10–10], p = 0.102). Optimal procedural conditions were reported more frequently with LA + PCS (96.4% vs. 82.0%; OR 5.84; 95% CI 2.36–14.44; p < 0.001), without affecting perioperative workflow. Propofol‐alfentanil PCS does not significantly reduce intraoperative pain in patients during SVP implantation. Its routine use for pain reduction cannot be recommended. However, PCS may reasonably be offered to patients who prefer procedural sedation. Editorial Comment: This randomised clinical trial found that adding patient‐controlled sedation with propofol‐alfentanil to standard local anaesthesia for subcutaneous venous port implantation does not have an impact on pain scores or patient satisfaction. Additional studies focusing on patients experiences and safety are recommended before implementing propofol‐alfentanil patient‐controlled sedation. Trial Registration: EudraCT number: 2021‐003821‐31; ClinicalTrials.gov identifier: NCT 05688384.

Background: Patient-controlled sedation (PCS) is an efficient and cost-saving method for sedation during flexible bronchoscopy (FB) in the presence of anaesthetic staff, but no data is available for PCS in a non-anaesthesiologist environment. Methods: This descriptive study describes PCS with propofol in a non-anaesthesiologist setup during outpatient FB procedures, including transbronchial biopsy, transbronchial needle aspiration, cryotherapy/biopsy and/or multistation endobronchial ultrasound, and endoscopic ultrasound with bronchoscope. Results: 287 procedures were completed. The median (range) duration for the procedures were 45 (10–105) minutes. The median (range) total propofol dose administered was 201 (55–570) mg, and 61 procedures (21%) required bolus doses of alfentanil. Desaturation occurred during 21% of the procedures and was resolved spontaneously (59%) or by using a jaw thrust (41%). No evidence was found that alfentanil contributed to desaturation (p=0.081). Inconsistent results were shown regarding the impact of alfentanil on the reduction of cough. The post-procedural assessment revealed high score of satisfaction and feasibility. 3 (1%) procedures were cancelled due to insufficient sedation. No prolonged recovery with need of overnight stay was reported. The direct costs for sedation were 180 USD/procedure. Conclusion: PCS with propofol and the presence of trained non-anaesthesiologists during outpatient FB has shown to result in high procedure feasibility and satisfaction without compromising patient safety or increasing the risk for unhandled respiratory adverse events. The method reduces costs for sedation and offers the possibility to increase patient turn over due to no prolonged recovery

Background: Patient-controlled sedation (PCS) is a documented method for endoscopic procedures considered to facilitate early recovery. Limited data have been reported, however, on its use during flexible bronchoscopy (FB). Methods: This study hypothesized that PCS with propofol during FB would facilitate early recovery, with similar bronchoscopist and patient satisfaction compared with nurse-controlled sedation (NCS) with midazolam. A total of 150 patients were randomized 1:1:1 into a control group (premedication with morphine-scopolamine and NCS with midazolam), PCS-MS group (premedication with morphine-scopolamine and PCS with propofol), and PCS-G group (premedication with glycopyrronium and PCS with propofol). Results: The procedures included transbronchial biopsy, transbronchial needle aspiration, cryotherapy/biopsy, and/or multistation endobronchial ultrasound. FB duration values in median (range) were 40 (10 to 80), 39 (12 to 68), and 44 (10 to 82) minutes for the groups NCS, PCS-MS, and PCS-G, respectively. An overall 81% of the patients in the combined PCS groups were ready for discharge (modified Post Anaesthetic Discharge Scoring System, score 10) 2 hours after bronchoscopy compared with 40% in the control group (PP=0.0002) at 2 hours. Bronchoscopists’ and patients’ satisfaction scores were high in all groups. Postdischarge quality scores showed no differences among the groups. Conclusion: PCS with propofol during FB is feasible, as it shortened recovery time without compromising procedure conditions for bronchoscopists or patients. A rapid postsedation stabilization of vital signs facilitates surveillance before the patient leaves the hospital.

Background: Inadequate communication between professionals in operating theaters results in impaired medical performance or even in critical events. Interprofessional case seminars, however, can enhance team communication by promoting a deeper understanding of complex situations. Our aim was to evaluate how an interprofessional case seminar using a dual professional focus case in anesthesiology was perceived by the participants. Method: A case seminar was held for 20 nurse anesthetists enrolled in a postgraduate course and for six anesthesiology residents. Transcripts of the case were distributed in advance for individual study and group discussion. The evaluation was based on the responses provided by participants who completed a semistructured questionnaire and from the perceptions of a professional observer. Results: Twenty participants completed the questionnaire; 53% of the respondents had previous experience with case methodology, and 89 different statements were obtained. Of these, 48% were positive and 11% were negative. The remaining 40% of the statements related to previous experiences with case methodology and to suggested improvements. The positive statements proposed that case methodologies are suitable for sensitive issues and beneficial for meetings and exchanges between different professionals. Negative statements focused instead on lack of time, overly large groups, too much speculation, and inadequate preparation or presentations by the participants. Conclusion: Interprofessional case seminars using a dual professional focus may be suitable for postgraduate education in anesthesia. This technique may improve interprofessional communication and may call attention to the importance of soft issues, such as ethics, communication, organization, and leadership in addition to that of the medical dimension. Keywords: interprofessional learning, interprofessional communication, case discussion, case method, Keywords: interprofessional learning, interprofessional communication, case discussion, case method,