We read with interest the article by Agarwal et al. highlighting the findings of the 7th National Audit Project (NAP7), particularly for adult patients experiencing intra-operative cardiac arrest during cardiology procedures [1]. The overrepresentation of these patients relative to the broader NAP7 cohort, their inferior outcomes in terms of both initial arrest and hospital survival, and the prevalence

We thank Hulst et al. [1] and Levy et al. [2] for their comments on our work [3]. Peri-operative use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has gained much attention recently. We acknowledge the significance of power calculations in trial design to minimise type 2 error. It is essential to recognise, however, that power can be considered adequate with a smaller sample size if the

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SummaryIntroductionRetrospective studies suggest that inhalational volatile anaesthetic agents may contribute to an increased risk of metastasis and reduction in survival rates when used during cancer surgery. This relationship may vary between cancer types due to different tumour biology and differences in surgical procedures. This study aimed to investigate the relationship between the type of anaesthetic

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SummaryIntroductionIron deficiency, with or without anaemia, is common during the peri‐operative period. It has been hypothesised that pre‐operative iron deficiency is associated with an increased incidence of postoperative infection. We designed the CARIPO prospective observational study to assess the incidence of postoperative infection in patients with and without iron deficiency undergoing a variety

SummaryIntroductionCognitive impairment is a significant healthcare problem globally and its prevalence is projected to affect over 150 million people worldwide. Survivors of critical illness are impacted frequently by long‐term neurocognitive dysfunction regardless of presenting illness, but the mechanisms are poorly understood. The goal of this review was to synthesise the existing evidence regarding

SummaryIntroductionGeneral anaesthesia and regional anaesthesia are used for hip and knee arthroplasty but their impact on long‐term outcomes remains unclear. This study aimed to compare one‐year clinical outcomes and healthcare utilisation in patients receiving general or regional anaesthesia for hip or knee arthroplasty.MethodsUsing data from the TriNetX Global Collaborative Network, we conducted

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We write in to response to the comments provided by Orrock and Ward [1] and Inoue et al. [2] on our article [3]. In our preliminary research, we did not conduct a strict randomised controlled trial. Instead, we recruited 15 volunteers to evaluate the comfort, visual satisfaction and overall satisfaction of using different laryngoscopes for tracheal intubation. We acknowledge the difficulty of blinding

We wish to respond to recent correspondence [1, 2] regarding our article [3]. We believe that the risk of unblinding in our study is minimal, despite different puncture sites, as the interventions were performed on anaesthetised patients and postoperative care providers were not present during administration. While we used standard measures like postoperative pain score, total analgesic consumption

Elective orthopaedic surgery comprises a significant amount of the UK NHS elective workload. With an ageing population, the demand for these services is expected to increase [1]. A cohort study of patients aged > 60 y undergoing elective orthopaedic surgery showed that more than half of all patients had some form of neurocognitive disorder five years after surgery, and this was major in 16.8% [2].

We appreciate Drs Wright and Sudan's interest [1] in the consensus guidelines for preventing unrecognised oesophageal intubation [2] and agree with the principle of ‘precision intubation’, a process that should be deliberate, careful and appropriately paced. As such, we support their view that tracheal tube cuff inflation should be performed under vision, and removal of the videolaryngoscope blade

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Zang et al. compared the quality of labour analgesia using dural puncture epidural (DPE) versus combined spinal–epidural (CSE) techniques [1]. In an accompanying editorial, George and Landau assert that the superior labour analgesia provided by the CSE over standard epidurals is undeniable [2]. They suggest that anaesthetists who do not universally adopt CSE are disadvantaging their patients [2]; we

Patients who are older are increasingly presenting for major cancer surgery. Postoperative complications are common after major surgery and are expensive for the patient (prolonged inpatient stay, increased hospital readmissions and inability to return to premorbid function) and healthcare institutions. Prehabilitation is reported to have substantial promise in reducing postoperative complications

We read with interest the study by Nersessian et al., in which they showed that semaglutide use was associated with increased residual gastric content in patients having surgery [1]. They call for urgent revision of current societal guidelines recommending a 1-week pre-operative discontinuation interval of semaglutide in patients undergoing elective procedures under anaesthesia [1]. It is salutary

Sharing data from clinical studies is now recognised to be an important part of the research process [1]. Since many research results cannot be replicated [2, 3], there has been growing interest in making study documents available [4, 5] in order to make reproduction of existing results, detection of false results, and replication of findings and synthesis into larger meta-studies easier. Randomised

SummaryIntroductionInterventional radiology procedures and endoscopies are performed commonly worldwide, often necessitating pharmacological sedation to optimise patient comfort. It is unclear to what extent non‐anaesthetists should provide procedural sedation.MethodsWe studied adult patients who previously lived independently and underwent a non‐ambulatory interventional radiology or gastroenterology

We read with interest the study by Nersessian et al., which explores the relationship between peri-operative semaglutide use and increased residual gastric content as assessed by gastric ultrasound [1]. This prospective study contributes to the emerging literature on GLP-1 receptor agonists (GLP-1 RAs) and delayed gastric emptying, raising important considerations for peri-operative management [2]

It is recommended that people receiving treatment for diabetes, renal disease, cardiovascular conditions and glucocorticoid deficiency are advised on how to manage their condition should they develop acute illness in the community [1, 2]. For people receiving treatment for renal disease or cardiovascular conditions, this relates predominantly to new onset or worsening of diarrhoea and vomiting, whereas

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The number of tracheal intubation attempts required to reach proficiency in videolaryngoscopy with hyperangulated blades is unknown. Understanding this training requirement might guide training for clinicians who perform laryngoscopy. We therefore performed a planned sub-analysis of a randomised controlled trial comparing tracheal intubation success with videolaryngoscopy vs. direct laryngoscopy to

SummaryIntroductionHigh‐flow nasal oxygenation has been shown to improve oxygenation during induction of anaesthesia in parturients who are not obese. However, data on the efficacy of high‐flow nasal oxygen in parturients living with obesity are lacking. This study investigated the effects of high‐flow nasal oxygenation on pre‐oxygenation and apnoea oxygenation during tracheal intubation in parturients

SummaryIntroductionAcute kidney injury develops frequently after nephrectomy, causing increased hospital duration of stay and mortality. Both propofol and volatile anaesthetic agents are thought to have renoprotective effects. We investigated whether the type of maintenance anaesthetic (propofol or desflurane) affected the incidence of acute kidney injury after nephrectomy.MethodsThis single‐centre

SummaryIntroductionRegional anaesthesia provides important clinical benefits to patients but is underutilised. A barrier to widespread adoption may be the focus of regional anaesthesia research on novel techniques rather than evaluating and optimising existing approaches. Research priorities in regional anaesthesia identified by anaesthetists have been published, but the views of patients, carers and

SummaryIntroductionEvidence on patient experiences with pain in hospitals and its impact on post‐discharge outcomes is limited. This study investigated the prevalence of pain in hospitals, patient characteristics associated with pain management adequacy, and the link between pain experiences, care ratings, readmission and emergency department visits after discharge.MethodsWe conducted a retrospective

The optimal position, for much of non-infant airway management is often described colloquially as ‘the sniffing position’ or ‘sniffing the morning air’ [1]. The literature also includes the terms ‘drinking a (full) pint (of beer)’; ‘last orders’; ‘sniff for smoke’; ‘win with the chin’ [2-4]; and we find many use the term ‘first pint position’. These terms are either arcane or arguably trivialising

SummaryIntroductionRemimazolam is an ultra‐short‐acting benzodiazepine sedative drug. This study aimed to compare the efficacy and safety of remimazolam with propofol for induction and maintenance of general anaesthesia in children undergoing elective surgery.MethodsChildren (aged 3–6 y, ASA physical status 1 or 2, BMI 14–25 kg.m‐2) undergoing elective surgery under general anaesthesia with tracheal

While the study of Urmale Kusse et al. [1] makes a valuable contribution to the topic, I believe that several aspects warrant further discussion. First, the sample size was based on a randomised controlled trial investigating postoperative analgesia in patients undergoing laparoscopic cholecystectomy [2]. The trial compared rectus sheath block with rectus sheath block and erector spinae plane block

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We read with interest the study by Ding et al. [1]. The application of augmented reality technology to medical procedures is a promising advancement, and we concur with the authors' perspective on its potential to reduce occupational health risks in medical professions, while also enhancing procedural safety and accuracy. We have a concern about the study's data on Macintosh and videolaryngoscopes

We congratulate Nathanson et al. for their timely editorial [1], and share their regret that lives continue to be lost to preventable errors. Twenty years ago, the death in similar circumstances of Elaine Bromiley led to the creation of the charity we now represent. The reasons why skilled and conscientious practitioners make such errors are well-established. We know that human beings under stress

The guidelines from the Project for Universal Management of Airways for preventing unrecognised oesophageal intubation is a comprehensive and vital piece of work [1]. There is an important emphasis on shared communication regarding tracheal tube placement and a simple, sequential, process to follow in the absence of sustained exhaled carbon dioxide. However, we believe there are additional simple steps

Nathanson et al. [1], supported by Kane et al. in a subsequent letter [2], call for mandatory standards of training for rare anaesthetic events and mandatory safety preparedness. Their implicit assumption is that, with more training, anaesthetists will become less error-prone, performance will improve and, therefore, outcomes from uncommon, life-threatening peri-operative events will also improve.

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SummaryIntroductionPoint‐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.MethodsThis was an analysis of data from a prospective

Patients undergoing major surgery frequently experience major uncontrolled bleeding. The aim of this systematic review and meta-analysis was to evaluate the clinical efficacy of using viscoelastic haemostatic assays to manage peri-operative bleeding in elective surgery.

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The Sequential Organ Failure Assessment (SOFA) score was developed to describe the morbidity of patients who are critically ill [1] and is still used widely. However, some of the original score constituents no longer align with contemporary critical care clinical practice. Proposals to update the score including the addition and/or update of SOFA score constituents are yet to be evaluated [2]. The

The dural puncture epidural technique is a modification of the combined spinal-epidural technique. Data comparing the two techniques are limited. We performed this randomised study to compare the quality of labour analgesia following initiation of analgesia with the dural puncture epidural vs. the combined spinal-epidural technique.

Sodium-glucose co-transporter 2 inhibitors are a novel class of antihyperglycaemic drugs used in the management of type 2 diabetes, that improve glycaemic control, cardiovascular outcomes and promote weight loss. They are also approved for the treatment of heart failure and chronic kidney disease in patients with or without diabetes. This narrative review discusses the peri-operative effects and implications

The letter by Waite et al. highlights the need for sterile gowns in spinal anaesthesia [1]. Our local survey of 202 anaesthetists found that 178 (88%) would consider omitting a sterile gown if guidelines allowed. Currently, a number of anaesthetists reported that they do not use sterile gowns for elective and emergency obstetric spinal anaesthetics (20 (10%) and 63 (31%), respectively). The ‘rapid

Climate hazards are associated with health disparities, creating vicious cycles that disproportionately impact marginalised groups [1]. There is increasing interest in healthcare sustainability, including in anaesthesia, with the National Health Service (NHS) committed to ‘net zero’ carbon emissions by 2040. Peri-operative healthcare sustainability interventions can broadly be divided into four categories

We congratulate Urmale Kusse et al. [1] on their recent study that found that the analgesic effect following erector spinae plane block was superior to that of the rectus sheath block in midline abdominal surgeries. However, there are three points that I would like to discuss further with the authors. First, three primary endpoints were established but it was not clearly stated whether their conclusion

Anaesthetic training has always had patient safety as part of the curriculum. However, there is limited emphasis on what happens when things do not go to plan. Our aims were to understand the impact of involvement in patient safety incidents on anaesthetic trainees in our region, to describe the range of support currently offered and put forward suggestions for improvement.

In the UK, approximately 70% of surgical procedures are undertaken as day-cases. Little information exists about recovery from day-case surgery, yet international data highlights patients are at risk of developing significant longer-term health problems including chronic post-surgical pain and persistent postoperative opioid use. The Patient-reported Outcomes, Postoperative Pain and pain relief after

Different sedation regimens have been used to facilitate awake tracheal intubation, but the evidence has not been synthesised robustly, particularly with respect to clinically important outcomes. We conducted a systematic review and network meta-analysis to determine the sedation techniques most likely to be associated with successful tracheal intubation, a shorter time to successful intubation and

Fibrinogen is essential for haemostasis and can fall to critically low levels in acute haemorrhage [1]. The long turnaround time for laboratory Clauss fibrinogen has led to interest in point-of-care viscoelastic haemostatic assays to identify hypofibrinogenemia. The ROTEM® Delta and Sigma devices (Werfen, Warrington, UK) offer the FIBTEM assay to assess fibrinogen contribution to clot strength in whole

Margiotta and Plaat offer an argued rationale on how general anaesthesia should be conducted for the obstetric patient who has bled extensively, suggesting that high-dose opioids may be in regular use and arguing that lower doses should be used [1]. Regarding NAP7, which the authors refer to, we offer some clarification. In NAP7, of the 28 cases of obstetric peri-operative cardiac arrest [2], six involved

We read with great interest the systematic review by Meewisse et al. on the effect of time of day on outcomes in elective surgery [1]. They postulate that timing of elective surgery could affect clinical outcome due to diurnal rhythms of patient physiology as well as surgical team performance. They found that evening/night-time elective surgery is associated with a higher risk of mortality compared

Semaglutide is a long-acting glucagon-like peptide-1 receptor agonist known to delay gastric emptying. Despite a growing body of evidence, its peri-operative safety profile remains uncertain, particularly with regard to the risk of increased residual gastric content and aspiration of gastric contents during anaesthesia. We hypothesised that semaglutide interruption of ≤ 10 days before elective surgical

Each year, approximately 3000–3500 patients undergo carotid endarterectomy in the UK, and over 150,000 worldwide [1, 2]. It is thought that the selection of anaesthetic method – whether cervical plexus block, general anaesthesia or a mix of both – can impact haemodynamic parameters differently and the oxygenation and perfusion of the brain and heart. This variability may have an impact on the risk

There is compelling evidence to support the superiority of videolaryngoscopes over direct laryngoscopes for several adult tracheal intubation outcomes [1-3]. However, questions remain regarding this superiority in certain scenarios [4], including whether the results apply to experienced anaesthetists. We aimed to establish whether videolaryngoscopy increases the likelihood of a successful first tracheal

We commend Griffiths et al. [1] for their work on managing intrathecal catheters after inadvertent dural puncture in obstetric patients. These evidence-based recommendations complement and enhance previous guidelines published in Anaesthesia [2]. The recommendation for early removal of intrathecal catheters is particularly noteworthy, as it corresponds with recent findings in the field. We previously

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Iron deficiency is present in up to 75% of patients presenting for colorectal cancer surgery. It is unclear whether iron deficiency without anaemia is associated with worse postoperative outcomes. We hypothesised that, in adults without anaemia undergoing surgery for colorectal cancer, iron deficiency would be associated with worse postoperative outcomes relative to an iron-replete state.