BACKGROUND:Many serious adverse events in anaesthesia are retrospectively rated as preventable. Anonymous reporting of near misses to a critical incident reporting system (CIRS) can identify structural weaknesses and improve quality, but incidents are often underreported. METHODS:This prospective qualitative study aimed to identify conceptions of a CIRS and reasons for underreporting at a single Swiss centre. Anaesthesia cases were screened to identify critical airway-related incidents that qualified to be reported to the CIRS. Anaesthesia providers involved in these incidents were individually interviewed. Factors that prevented or encouraged reporting of critical incidents to the CIRS were evaluated. Interview data were analysed using the Framework method. RESULTS:Of 3668 screened airway management procedures, 101 cases (2.8%) involved a critical incident. Saturation was reached after interviewing 21 anaesthesia providers, who had been involved in 42/101 critical incidents (41.6%). Only one incident (1.0%) had been reported to the CIRS, demonstrating significant underreporting. Interviews revealed highly variable views on the aims of the CIRS with an overall high threshold for reporting a critical incident. Factors hindering reporting of cases included concerns regarding identifiability of the reported incident and involved healthcare providers. CONCLUSIONS:Methods to foster anonymity of reporting, such as by national rather than departmental critical incident reporting system databases, and a change in culture is required to enhance reporting of critical incidents. Institutions managing a critical incident reporting system need to ensure timely feedback to the team regarding lessons learned, consequences, and changes to standards of care owing to reported critical incidents. Consistent reporting and assessment of critical incidents is required to allow the full potential of a critical incident reporting system.

BACKGROUND:Atelectasis has been reported in 68 to 100% of children undergoing general anaesthesia, a phenomenon that persists into the recovery period. Children receiving recruitment manoeuvres have less atelectasis and fewer episodes of oxygen desaturation during emergence. The optimal type of recruitment manoeuvre is unclear and may be influenced by the airway device chosen. OBJECTIVE:We aimed to investigate the different effects on lung mechanics as assessed by the forced oscillation technique (FOT) utilising different recruitment strategies: repeated inflations vs. one sustained inflation and different airway devices, a supraglottic airway device vs. a cuffed tracheal tube. DESIGN:Pragmatic enrolment with randomisation to the recruitment strategy. SETTING:We conducted this single-centre trial between February 2020 and March 2022. PARTICIPANTS:Seventy healthy patients (53 boys) aged between 2 and 16 years undergoing general anaesthesia were included. INTERVENTIONS:Forced oscillations (5 Hz) were superimposed on the ventilator waveform using a customised system connected to the anaesthesia machine. Pressure and flow were measured at the inlet of the airway device and used to compute respiratory system resistance and reactance. Measurements were taken before and after recruitment, and again at the end of surgery. MAIN OUTCOME MEASURES:The primary endpoint measured is the change in respiratory reactance. RESULTS:Statistical analysis (linear model with recruitment strategy and airway device as factors) did not show any significant difference in resistance and reactance between before and after recruitment. Baseline reactance was the strongest predictor for a change in reactance after recruitment: prerecruitment Xrs decreased by mean (standard error) of 0.25 (0.068) cmH 2 O s l -1 per  1 cmH 2 O -1  s l -1 increase in baseline Xrs ( P  < 0.001). After correcting for baseline reactance, the change in reactance after recruitment was significantly lower for sustained inflation compared with repeated inflation by mean (standard error) 0.25 (0.101) cmH 2 O ( P  = 0.0166). CONCLUSION:Although there was no significant difference between airway devices, this study demonstrated more effective recruitment via repeated inflations than sustained inflation in anaesthetised children. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry: ACTRN12619001434189.

The ultrasound study of diaphragm function represents a valid method that has been extensively studied in recent decades in various fields, especially in intensive care, emergency, and pulmonology settings. Diaphragmatic function is pivotal in these contexts due to its crucial role in respiratory mechanics, ventilation support strategies, and overall patient respiratory outcomes. Dysfunction or weakness of the diaphragm can lead to respiratory failure, ventilatory insufficiency, and prolonged mechanical ventilation, making its assessment essential for patient management and prognosis in critical care and emergency medicine. While several studies have focused on diaphragmatic functionality in the context of intensive care, there has been limited attention within the field of anesthesia. The ultrasound aids in assessing diaphragmatic dysfunction (DD) by measuring muscle mass and contractility and their potential variations over time. Recent advancements in ultrasound imaging allow clinicians to evaluate diaphragm function and monitor it during mechanical ventilation more easily. In the context of anesthesia, early studies have shed light on the patho-physiological mechanisms of diaphragm function during general anesthesia. In contrast, more recent research has centered on evaluating diaphragmatic functionality at various phases of general anesthesia and by comparing diverse types of procedures or anatomical position during surgery. The objectives of this current review are to highlight the use of diaphragm ultrasound for the evaluation of diaphragmatic function during perioperative anesthesia and surgery. Specifically, we aim to examine the effects of anesthetic agents, surgical techniques, and anatomical positioning on diaphragmatic function. We explore how ultrasound aids in assessing DD by measuring muscle mass and contractility, as well as their potential variations over time. Additionally, we will discuss recent advancements in ultrasound imaging that allow clinicians to evaluate diaphragm function and monitor it during mechanical ventilation more easily.