The two most commonly used airway management techniques during general anaesthesia are supraglottic airway devices and tracheal tubes. This new study compares their use for elderly patients undergoing low risk surgery with a composite of postoperative pulmonary complications as the primary outcome.  It is a fascinating trial for many reasons and we expect there will be much discussion amongst anaesthetists. Join Prof Mike Irwin and the authors to find out why they did it and a summary of the...

Surgical decision-making after SARS-CoV-2 infection is influenced by the presence of comorbidity, infection severity and whether the surgical problem is time-sensitive. This new paper utilised the OpenSAFELY database to look at practices and outcomes in England, and suggests that some patients can be safely operated within 2 weeks from infection. This podcast goes deeper into the associated issues and implications for clinicians, patients and hospitals. 

Detailed contemporary knowledge of the characteristics of the surgical population, national anaesthetic workload, anaesthetic techniques and behaviours are essential to monitor productivity, inform policy and direct research themes. Every 3–4 years, the Royal College of Anaesthetists, as part of its National Audit Projects (NAP), performs a snapshot activity survey in all UK hospitals delivering anaesthesia, collecting patient-level encounter data from all cases under the care of an...

This new paper from the AERATOR group examines the science around aerosol generation and awake tracheal intubation (ATI). Their study was performed on a single day during an ATI course on 12 anaesthetic trainees. They show that ATI without sedation generates high concentrations of respiratory aerosol. Professor Ross Hofmeyr talks to the authors about their study, its clinical implications and what the future holds for research in this area. 

We caught up with Dr Fiona Kelly, lead author of a new guideline from the Association of Anaesthetists and the Difficult Airway Society on human factors in anaesthesia. The guideline and narrative review were published and launched live at the Winter Scientific Meeting in London today and there are several actions that we can all take today to impact patient care.  Time to place less reliance on individual and team excellence to deliver high-quality patient care? We think so. Both papers are...

Pre-operative anaemia is common in patients undergoing non-cardiac surgery and associated with an increased risk of blood transfusion, hospital length of stay and postoperative complications. This podcast is all about a new secondary analysis of the PREVENTT study. We are delighted to be joined in Australia by three of the papers authors, Professor Toby Richards, Dr Anastazia Keegan and Professor Lachlan Miles. The aim of their analysis was to determine whether specific iron deficiency...

Today, we were joined by three authors (Dr Alopi Patel, Dr Michelle Kars and Prof Ed Mariano) of a new paper which is all about how to use social media to get published. This forms part of a new series of articles called Reviewer Recommendations, which is very much a ‘how to’ guide for authors and readers. Enjoy!

Today we will be discussing this new paper which describes and validates a new anaesthetic complexity score, which is is a clinician-designed, real-world tested model of case complexity in anaesthetics. It is inclusive of, but distinct from, patient and surgical risk.  The paper is of interest because of the methods used and also the potential implications for increasing efficiency and productivity in theatre. Joining us today we have authors Dr Elliott Ridgeon, Dr Katy Wilson and Dr Ahmed...

The Editors of Anaesthesia acknowledge the EDI problems we face in anaesthesia and medicine as a whole. Without taking action to address these problems, these issues will persist. This newly published position statement is from the Editors of Anaesthesia, including the Editor-in-Chief. For this podcast, the principal authors join Association of Anaesthetists CEO Nicky de Beer to discuss why and how the statement was written as well as its implications for the present and future.

Climate change is a real and accelerating existential danger. Urgent action is required to halt its progression, and everyone can contribute. Pollution mitigation represents an important opportunity for much needed leadership from the health community, addressing a threat that will directly and seriously impact the health and well-being of current and future generations. Inhalational anaesthetics are a significant contributor to healthcare-related greenhouse gas emissions and minimising...

There is very limited evidence about the relative effectiveness of emergency surgery vs. non-emergency surgery strategies for patients with common acute conditions. This lack of evidence means that there is likely to be considerable practice variation in the NHS in England. The ESORT study, which was published last night, aimed to compare the effectiveness of emergency surgery or not for five acute abdominal conditions. Joining us this morning we have three authors of this excellent new...

This new guideline provides an update to the previously published consensus statement on SARS-CoV-2 infection, COVID-19 and timing of elective surgery to assist policymakers, administrative staff, clinicians and patients. It focuses on the omicron variant, which is now strongly dominant in many countries. However, the principles may also be of relevance to future variants. To set the paper in its context, Rose Kearsley speaks with authors Scarlett McNally, Tim Cook and Kariem El-Boghdadly....

Joining us today we have the authors of a new paper reporting the effect of a text message intervention on burnout in trainee anaesthetists. First we have Emily Larson who is a Senior Advisor at The Behavioural Insights Team. Emily has worked on reducing burnout and increasing wellbeing with physicians, educators and children. We also have Dr Alix Brazier who is also a Senior Advisor at The Behavioural Insights Team and currently leads BIT’s work applying behavioural insights to improve...

There were more applications for higher specialty training posts in anaesthesia in the UK starting in August 2021 than in previous years, with approximately two-thirds being unsuccessful. This new national survey is all about recruitment to higher specialty training in anaesthesia in the UK during the COVID-19 pandemic. Joining Dr C Hughes was Dr C Holt, Dr J Subramaniam, Dr N Durrant and Dr S Edwardson. Their results suggest that junior anaesthetic doctors in the UK negatively perceived...

What better way to see in any new year than with a brand-new Anaesthesia Special Supplement! This year, it is all about the peri-operative and critical care management of the brain, which has been guest edited by Dr Jugdeep Dhesi and Professor Alana Flexman. Joining us also were journal Editors Professor Iain Moppett and Dr Matt Wiles. Topics include: Chronic SDH Peri-operative neurocognitive disorders COVID-19-associated delirium Mode of anaesthesia for mechanical thrombectomy Status...

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, Young and Davies which highlights the main lessons that can be learned from this tragic...

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 conceptualisation; and increase awareness of this issue among the general readership of academic...

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 management approach or intractable resource constraints. This new paper used the Hospital...

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 infection. The authors found that SARS-CoV-2 infection was independently associated with an increased...

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 pulmonary complications. The risk climbed to 31% more in those isolating ≥ 8 days, which is...

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 removal, even in low COVID-19 risk pathways, is restricted exclusively to the operating theatre...

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 hypotension in UK anaesthetic practice. The main finding was that intra-operative hypotension is...

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, however, very little high quality evidence to inform practice. These guidelines were developed,...

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 order to track activity during the second wave of the pandemic. Their work describes and...

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 guidelines may also be of use in other areas of the world. For this podcast, Tanya Selak joined...