Rapid Sequence

A recent coroner’s report in the UK concluded that a healthy patient died as a result of unrecognised oesophageal intubation. This did not seem to be the result of misinterpretation of a flat end-tidal carbon dioxide trace, but an apparent omission to check the capnograph after intubation and to perform clinical checks of tracheal tube position. This podcast accompanies a new editorial from Pandit...

Parachute (or ‘helicopter’) research is the practice of conducting primary research within a host country and subsequently publishing findings with inadequate recognition of local researchers, staff and/or supporting infrastructure. The aim is that these recommendations will be broadly applicable within academic publishing; of use to international researchers at the point of study or partnership c...

In the UK, the Getting It Right First Time (GIRFT) programme was established by the Department of Health and Social Care as an initiative to investigate variation in healthcare delivery and patient outcomes between hospital Trusts in England. Variation between Trusts is unwarranted unless justified by patient case-mix, patient preference, equivocal evidence of effectiveness of a particular patient...

Robust evidence is needed to enable clinicians and policymakers to minimise VTE risk in patients with SARS-CoV-2 infection. Ideally, such evidence would stratify the risk of VTE against both the duration of time between infection and surgery and presence or absence of symptoms. This study aimed to determine the VTE rate in patients with SARS-CoV-2 infection, stratified by current or prior infectio...

This international prospective cohort study analysed data on > 96k patients from > 1500 hospitals in > 100 countries. They found that the overall postoperative pulmonary complication rate for all patients was 2.0%, which alone is useful to know. Perhaps more strikingly, and following adjustment for various measured confounders, patients who isolated had a 20% increased risk of postoperative pulmon...

The WHO has developed a list of aerosol-generating procedures that healthcare organisations throughout the world have used as a framework for development of their guidelines. Supraglottic airways are used in the majority of the approximately 2.7 million general anaesthetics performed in the UK each year. In a UK survey in October 2020, 40% of responding hospitals reported that supraglottic airway...

Intra-operative hypotension frequently complicates anaesthesia and has been extensively associated with myocardial injury, acute kidney injury, stroke and death. The iHypE study aimed to describe the incidence of intra-operative hypotension in older patients and define both the intended blood pressure treatment threshold, and the clinically applied treatment threshold for intra-operative hypotensi...

Tonight’s discussion is all about a new Association of Anaesthetists guideline on regional analgesia for lower leg trauma and the risk of acute compartment syndrome . Pain resulting from lower leg injuries and consequent surgery can be severe. There is a range of opinion on the use of regional analgesia and its capacity to obscure the symptoms and signs of acute compartment syndrome. There is, how...

During the COVID-19 pandemic, there has been considerable focus on the escalation of critical care capacity, capability and delivery. Early in the first wave, NAP7 was postponed and, as part of assessing when anaesthetic and peri-operative services might have returned to a stable baseline and thus be ready for starting NAP7, the authors of this new paper undertook a series of national surveys in o...

This guideline updates and replaces the 5th edition of the Standards of Monitoring published in 2015 . The aim of this document is to provide guidance on the minimum standards for monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the UK and Ireland, but it is recognised that these g...

Welcome to this Anaesthesia Journal Podcast which is all about the the 7th UK National Audit Project (NAP7) , and more specifically, the challenges of defining, studying and learning from peri‐operative cardiac arrest. With the discovery of general anaesthesia came the issue of cardiac arrest during anaesthesia. It is thought to occur rarely, ranging from 2-13 per 10,000 anaesthetics and there is...

Welcome to the first ever Anaesthesia Reports live broadcast – what will hopefully be the first of many - where we chat with the authors of their reports about the interesting scenarios they have encountered in their own clinical practice. This session was chaired by Dr Maryann Turner, who is an editor of Anaesthesia Reports and a paediatric anaesthetist based in Sydney. Dealing with a predicted d...

There is much debate over the role of respiratory particles in guidelines for preventing transmission of COVID-19. Larger particles are traditionally called ‘droplets’ and are deemed to travel only 1-2 metres from an infected patient before falling to the ground. Aerosols are smaller particles and stay floating in the air for prolonged periods, spread further, may accumulate in poorly ventilated s...

Today we published a new editorial which outlines the principles laid out in the recently released document from the Royal College of Anaesthetists, the Association of Anaesthetists and the Faculty of Intensive Care Medicine on resumption of planned surgical services. The resumption of planned healthcare in 2021 is both a necessity and an opportunity, but it will require co‐ordination at all level...

Malignant hyperthermia (MH) is a rare anaesthetic emergency. It has been estimated to occur in between 1:10,000 and 1:150,000 general anaesthetics, though there is much uncertainity about the precision of these estimates. The Association of Anaesthetists has not previously published full MH guidelines. In the absence of any recent guidelines published in a peer reviewed journal, rather than simply...

Today we will explore our exciting new publication that examines the timing of surgery after SARS-CoV-2 infection.  With us today we have Joana Simoes, Dmitri Nepogodiev and Aneel Bhangu who are co-authors of the paper. They were interviewed by Ben Morton, who is an Editor of Anaesthesia. The authors are representatives from the NIHR Global Health Research Unit on Global Surgery, a collaborative t...

“When we get it right for girls and women, everyone benefits."  On #InternationalWomensDay2021 we were delighted to publish a special issue of 17 free to access articles all about the importance of women's health in peri-operative care.   For this podcast, Seema Agarwal and Helen Laycock were joined by Ed Mullins and Alana Flexman to discuss some of the most important themes from the issue. 

With us today we have Dr Jane Quinlan from Oxford and Dr Nicholas Levy from Bury St. Edmunds, who are co-authors of a new international multidisciplinary consensus statement on the prevention of opioid‐related harm in adult surgical patients . Their aim was to provide balanced guidance on the safe peri‐operative use of opioids in adults. The guidance should assist healthcare professionals and hosp...

Armstrong et al. conducted an initial systematic review and meta‐analysis of 24 observational studies published by 31 May 2020, which included 10,150 patients, finding that mortality was 41.6%, with evidence that this was decreasing as the pandemic progressed . This new updated meta-analysis seems to show that any fall in mortality rate between June and September appears to have flattened or plate...

T he direct reporting of awareness in maternity patients (DREAMY) study was a multicentre, prospective cohort study that aimed to establish the incidence, risk‐factors and sequelae of AAGA in obstetrics. A secondary study was embedded within it with the aim of describing general anaesthesia practice in obstetric patients in the UK. We were joined live by authors Dr Peter Odor and Professor Nuala L...

This podcast is taken from the second live broadcast to support our 2021 regional anaesthesia supplement. The chairs, Laura Duggan and Ed Mariano, discuss innovations in regional anaesthesia with six more of our authors.

This podcast is taken from the first live broadcast to support our 2021 regional anaesthesia supplement. The chairs, Ki-Jinn Chin and Kariem El-Boghdadly, discuss the fundamentals of regional anaesthesia with six of our authors. 

This month's podcast is taken from our first ever live broadcast with Professor Sir Jeremy Farrar (@JeremyFarrar) and Professor Tim Cook (@doctimcook). Mike Charlesworth (@Miko_Charleswor) and Louise Savic (@LouiseSavic) ask questions all about their new paper, which discusses everything to do with the COVID-19 vaccines. Enjoy!

This month, Mike Charlesworth speaks with Iain Moppett and Ciara O’Donnell about the new Association of Anaesthetists guideline for the management of hip fracture. The full paper is available now and free for all to read and download forever. 

This month, Mike Charlesworth is joined by the lead authors, Irwin Foo and Jaideep Pandit. If you have an opinion either way, use lidocaine infusions yourself or know of their use in your hospital, this one is for you! You can read the free papers here and here !