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.

Click on the article title to read more.

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

SummaryBackgroundPatients 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.MethodsWe searched PubMed/MEDLINE and Embase databases for randomised controlled trials according to pre‐determined

Click on the article title to read more.

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

SummaryBackgroundThe 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.MethodsTerm parturients requesting labour epidural

SummaryIntroductionSodium‐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

Click on the article title to read more.

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

SummaryBackgroundAnaesthetic 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.MethodsAn

SummaryBackgroundIn 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

SummaryBackgroundDifferent 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

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

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.

Click on the article title to read more.

Click on the article title to read more.

SummaryBackgroundIntra‐operative cardiac arrest is a rare but life‐threatening event. Over the past two decades, various initiatives have improved the care of patients undergoing surgery at our quaternary teaching hospital in Brazil. We aimed to evaluate the epidemiology of intra‐operative cardiac arrest and associated 30‐day mortality over an 18‐year period. A secondary aim was to identify associated

Click on the article title to read more.

The use of erector spinae plane block and rectus sheath block for postoperative analgesia in midline abdominal procedures is becoming more common. However, the most effective and appropriate method remains unclear. We aimed to compare the postoperative analgesic effecacy of ultrasound-guided bilateral erector spinae plane blocks with rectus sheath blocks for midline abdominal surgery in a low- and

Type A aortic dissection repair is one of the most common emergency cardiac surgical procedures undertaken in the UK and has a high mortality. Early diagnosis and prompt surgery by an expert cardiac surgical team is crucial. Little is known about the patient's journey from first symptoms until surgery.

Tracheal intubation is performed frequently by medical professionals in the fields of anaesthesia, intensive care and emergency medicine. However, existing laryngoscopes are neither ideal nor ergonomically designed [1]; intubating the trachea with a direct laryngoscope, such as Macintosh and Miller laryngoscopes, requires the operator to bend the waist to nearly 40° and position their face near the

The American Society of Anesthesiologists advises clear fluid intake for elective patients up to 2 h before surgery. Jelly, although a solid food, is primarily composed of water, and the precise fasting time for this substance is not clearly defined [1, 2]. The aim of this study was to investigate the effect of water and jelly ingestion on cross-sectional area of the gastric antrum, when assessed by

Skilled facilitators are essential to drive effective simulation training in healthcare. Competency-based frameworks support the development of facilitation skills but, to our knowledge, there are no frameworks that specifically address context-sensitive priorities developed with practitioners working in low-resource settings.

SummaryIntroductionFlexible bronchoscopes have become essential in the operating theatre environment and in critical care. This narrative review compared single‐use and reusable flexible bronchoscopes with a focus on safety, efficacy, cost‐effectiveness and environmental impact.MethodsWe searched MEDLINE, Embase and PubMed databases for studies related to flexible bronchoscopes for airway management

We thank Murphy et al. [1] for their interest in our study [2] and for furthering the discussion on timely assessment for prolonged motor blockade after neuraxial anaesthesia. Their concerns about the potential unintended consequence of delaying anaesthetic review from the guideline recommendation of 4–6 h are valid, and we would like to take this opportunity to clarify this matter and our stance on

Click on the article title to read more.

Anaesthetists of all grades who work on a labour ward are likely to be involved in the insertion or management of an intrathecal catheter after inadvertent dural puncture at some point in their careers. Although the use of intrathecal catheters after inadvertent dural puncture in labour has increased in popularity over recent decades, robust evidence on best practice has been lacking.

Click on the article title to read more.

Critical care beds are a limited resource, yet research indicates that recommendations for postoperative critical care admission based on patient-level risk stratification are not followed. It is unclear how prioritisation decisions are made in real-world settings and the effect of this prioritisation on outcomes.

Nearly half of adult patients undergoing surgery experience moderate or severe postoperative pain. Inadequate pain management hampers postoperative recovery and function and may be associated with adverse outcomes. This multidisciplinary consensus statement provides principles that might aid postoperative recovery, and which should be applied throughout the entire peri-operative pathway by healthcare

We read with great interest the article by Grape et al. [1]. The authors conducted a meta-analysis that included meta-regression and trial sequential analysis, providing a comprehensive synthesis of 12 prospective, randomised controlled trials comparing intrathecal diamorphine with controls across various surgical procedures [1]. We identified a concern that may compromise the quality of this meta-analysis

We read with interest the article by Shippam et al. analysing the time to motor block regression after neuraxial anaesthesia [1]. The detection of serious complications after central neuraxial blockade is challenging, not only because these complications are rare, but also because in obstetric anaesthesia there is a huge volume of work conducted out of hours [2] and in the postnatal period, distractions

We thank Xue et al. [1] for their interest in our study reporting findings from a universal paediatric videolaryngoscopy implementation programme. We systematically mapped the glottic view using a recognised six-stage glottic view grading [2-4] that has been prospectively evaluated specifically for glottic view grading with videolaryngoscopy and comprises the most relevant reported glottic landmarks

Postoperative delirium (POD) remains one of the most prevalent neurological complications after surgery [1] and pre-existing cognitive impairment is a leading risk factor [1, 2]. Consequently, early identification of high-risk patients through pre-operative cognitive assessment is essential. Usually, the evaluation of cognitive status is performed by trained neuropsychologists, using a standardised

I would like to thank to Marshall for their response [1] on the topic of usability between videolaryngoscopy and direct laryngoscopy [2], as well as for an extended analysis of the system usability scale including its limitations when comparing medical devices. However, I would like to clarify that the focus on usability is not intended to question the complexity of the devices themselves. Rather,

We thank Chen et al. [1] for their interest in our study [2], in which we found that opioid-free versus opioid-inclusive propofol anaesthesia reduced the incidence of postoperative nausea and vomiting (PONV) during the first 48-h postoperatively (5% vs. 24%; odds ratio 0.17, 95%CI 0.08–0.35; number needed to treat 5.3; p < 0.001). Opioid-free anaesthesia was also associated with a reduced need for

We read with great interest the article by Wang et al. [1]. They concluded that opioid-free propofol anaesthesia reduced postoperative nausea and vomiting (PONV) in patients undergoing thyroid and parathyroid surgery. However, we have several concerns about this trial. The primary outcome of this study was the incidence of PONV, defined as a composite outcome that encompasses the rates of nausea, retching

Acute post-surgical pain is managed inadequately in many patients undergoing surgery. Several prognostic risk prediction models have been developed to identify patients at high risk of developing moderate to severe acute post-surgical pain. The aim of this systematic review was to describe and evaluate the methodological conduct of these prediction models.

Milder DA, Milder TY, Liang SS, Kam PCA. Glucagon-like peptide-1 receptor agonists: a narrative review of clinical pharmacology and implications for peri-operative practice. Anaesthesia 2024; 79: 735-47. https://doi.org/10.1111/anae.16306 In the above article, there is an error in Table 3. The withhold time for dulaglutide should read 270 h, not 27 h. The authors apologise for the error.

Li X-F, Jin L, Yang J-M, Luo Q-S, Liu H-M, Yu H. Effect of ventilation mode on postoperative pulmonary complications following lung resection surgery: a randomised controlled trial. Anaesthesia 2022; 77: 1219-27. https://doi.org/10.1111/anae.15848 In the above article, there is an error in the Results on page 1221, which states ‘fifty-eight’ instead of ‘fifty-six’, and should read as follows: “Fifty-six

Click on the article title to read more.

SummaryBackgroundPoor wellbeing and stress in UK anaesthetic trainees impacts significantly on clinical performance, workforce retention and patient care. This study aimed to provide an overview of the evidence in this field and to explore the factors affecting wellbeing and stress in UK anaesthetic trainees.MethodsMEDLINE, Embase, PsycINFO, and ERIC were searched, in addition to organisational websites

Click on the article title to read more.

The noise within train is a paradox; while harmful to passenger health, it is useful to operators as it provides insights into the working status of vehicles and tracks. Recently, methods for identifying defects based on interior noise signals are emerging, among which representation learning is the foundation for deep neural network models to understand the key information and structure of the data

Click on the article title to read more.

Delirium is a common and potentially serious complication after major surgery. A previous history of depression is a known risk factor for experiencing delirium in patients admitted to the hospital, but the generalised risk has not been estimated in surgical patients.

The 7th National Audit Project (NAP7) confirmed haemorrhage as a leading cause of maternal cardiac arrest[1]. In this audit of cardiac arrest in patients under the care of an anaesthetist, nearly half of the obstetric cases involved a general anaesthetic, and anaesthetic care was judged to be a key factor in 68% of cases. The specific drugs used for induction of anaesthesia were not recorded [1]. We