Purpose of review: Optimal treatment requires a thorough understanding of all factors contributing to pain in the individual patient. In this review, we investigate the influence of cultural frameworks on pain experience and management. Recent Findings: The loosely defined concept of culture in pain management integrates a predisposing set of diverse biological, psychological and social characteristics shared within a group. Cultural and ethnic background strongly influence the perception, manifestation, and management of pain. In addition, cultural, racial and ethnic differences continue to play a major role in the disparate treatment of acute pain. Summary: A holistic and culturally sensitive approach is likely to improve pain management outcomes, will better cover the needs of diverse patient populations and help reduce stigma and health disparities. Mainstays include awareness, self-awareness, appropriate communication, and training.

Summary: Point‐of‐care gastric sonography offers an objective approach to assessing individual pulmonary aspiration risk before induction of general anaesthesia. We aimed to evaluate the potential impact of routine pre‐operative gastric ultrasound on peri‐operative management in a cohort of adult patients undergoing elective or emergency surgery at a single centre. According to pre‐operative gastric ultrasound results, patients were classified as low risk (empty, gastric fluid volume ≤ 1.5 ml.kg ^‐1 body weight) or high risk (solid, mixed or gastric fluid volume > 1.5 ml.kg ^‐1 body weight) of aspiration. After sonography, examiners were asked to indicate changes in aspiration risk management (none; more conservative; more liberal) to their pre‐defined anaesthetic plan and to adapt it if patient safety was at risk. We included 2003 patients, 1246 (62%) of which underwent elective and 757 (38%) emergency surgery. Among patients who underwent elective surgery, 1046/1246 (84%) had a low‐risk and 178/1246 (14%) a high‐risk stomach, with this being 587/757 (78%) vs. 158/757 (21%) among patients undergoing emergency surgery, respectively. Routine pre‐operative gastric sonography enabled changes in anaesthetic management in 379/2003 (19%) of patients, with these being a more liberal approach in 303/2003 (15%). In patients undergoing elective surgery, pre‐operative gastric sonography would have allowed a more liberal approach in 170/1246 (14%) and made a more conservative approach indicated in 52/1246 (4%), whereas in patients undergoing emergency surgery, 133/757 (18%) would have been managed more liberally and 24/757 (3%) more conservatively. We showed that pre‐operative gastric ultrasound helps to identify high‐ and low‐risk situations in patients at risk of aspiration and adds useful information to peri‐operative management. Our data suggest that routine use of pre‐operative gastric ultrasound may improve individualised care and potentially impact patient safety.

Summary: Introduction: Point‐of‐care gastric ultrasound is an emerging tool in peri‐operative practice. However, data on the technical challenges of gastric ultrasound, which are essential for optimised training, remain scarce. We analysed gastric ultrasound examinations performed after basic training to identify factors associated with difficulty. Methods: This was an analysis of data from a prospective observational study evaluating the potential impact of routine pre‐operative gastric ultrasound on peri‐operative management in adult patients undergoing elective or emergency surgery at a single centre. Before initiation, physicians received extensive structured training with at least 30 supervised gastric sonograms before independent practice. We then used regression models to identify factors associated with deviation from a predefined sonography algorithm, performance time and scan difficulty. Results: Seventy‐three trained physicians performed 2003 ultrasound scans. Median (IQR [range]) performance time was 5 (4–6 [1–20]) min, which was achieved after 20–27 scans following structured training. Patient characteristics associated with more difficult and longer duration scans were: increase in BMI per 5 kg.m ^‐2 (odds ratio (95%CI) 1.57 (1.35–1.83), p < 0.001 for difficulty and percentage change coefficient (95%CI) 1.03 (1.02–1.05), p < 0.001 for duration); and male sex (odds ratio (95%CI) 3.31 (2.28–4.88), p < 0.001 for difficulty and percentage change coefficient (95%CI) 1.08 (1.04–1.12), p < 0.001, for duration). Trauma surgery (odds ratio (95%CI) 3.26 (1.88–5.68), p < 0.001), ASA physical status of 3 or 4 (odds ratio (95%CI) 1.86 (1.21–2.88), p = 0.0049) and emergency surgery (odds ratio (95%CI) 1.86 (1.20–2.89), p = 0.006) were associated with deviation from the predefined sonography algorithm. Discussion: Approximately 50 scans are required to achieve a baseline performance of 5 min per gastric ultrasound. Future training programmes should focus on patients with obesity, male sex, higher ASA physical status and trauma.

Cardiovascular disease (CVD) remains a global health concern of paramount significance, claiming millions of lives each year

Purpose of Review: The implementation of shared decision-making (SDM) in acute pain services (APS) is still in its infancies especially when compared to other medical fields. Recent Findings: Emerging evidence fosters the value of SDM in various acute care settings. We provide an overview of general SDM practices and possible advantages of incorporating such concepts in APS, point out barriers to SDM in this setting, present common patient decisions aids developed for APS and discuss opportunities for further development. Summary: Especially in the APS setting, patient-centred care is a key component for optimal patient outcome. SDM could be included into everyday clinical practice by using structured approaches such as the “seek, help, assess, reach, evaluate” (SHARE) approach, the 3 “MAking Good decisions In Collaboration”(MAGIC) questions, the “Benefits, Risks, Alternatives and doing Nothing”(BRAN) tool or the “the multifocal approach to sharing in shared decision-making”(MAPPIN’SDM) as guidance for participatory decision-making. Such tools aid in the development of a patient–clinician relationship beyond discharge after immediate relief of acute pain has been accomplished. Research addressing patient decision aids and their impact on patient-reported outcomes regarding shared decision-making, organizational barriers and new developments such as remote shared decision-making is needed to advance participatory decision-making in acute pain services.

Healthcare institutions are currently under enormous financial, political and social pressure. Especially in the perioperative setting, various professional groups with differing agendas, dynamic teams, high-stress levels and diverging stakeholder interests are contributing to tension on a variety of levels. These players ask for guidance that goes beyond defined goals, clear structures or rules for process optimization. The impact of culture, which is influenced by core values, unspoken behaviours and practices, a shared purpose and implicit norms, has been often neglected. However, culture is a key factor in the search for optimal patient outcomes, quality of care, protection and long-time retention of staff, as well as economic success. In this review, we discuss important aspects to consider in building a great perioperative workplace, discuss indispensable adaptations in times of crisis and touch on urgently needed further investigations to optimize the art of developing, protecting, and cultivating a well-balanced culture.