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AnaesthesiaLatest Evidence Newsletter

January 2017 (Quarterly)

    

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Lunchtime Drop-in SessionsAll sessions last one hour

Librarians on demand!Do you urgently need to find evidence to support your treatment of a patient? Would you like immediate information about a particular therapy, practice, condition, or other clinical need?

The Library can provide swift assistance with a range of our services, including literature searches and access to full text articles.

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For speedy article requests and other library services, email library@uhbristol.nhs.uk. If you specify your urgent need, we will prioritise this.

January (13.00)Tues 10th Literature SearchingWed 18th Critical AppraisalThurs 26th Statistics

February (12.00)Fri 3rd Literature SearchingMon 6th Critical AppraisalTue 14th StatisticsWed 22nd Literature Searching

March (13.00)Thurs 2nd Critical AppraisalFri 10th Interpreting StatisticsMon 13th Literature SearchingTues 21st Critical AppraisalWeds 29th Interpreting Statistics

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ContentsUpdates............................................................................................... 4New Guidance: AAGBI ......................................................................5Journals: Tables of Contents................................................................5

Anaesthesia.......................................................................................5Anesthesia & Analgesia.....................................................................7Anesthesiology..................................................................................9British Journal of Anaesthesia.........................................................13Current Opinion in Anaesthesiology...............................................16

Current Awareness Database Articles................................................19

Your Outreach Librarian- Jo HooperWhatever your information needs, the library is here to help. As your Outreach Librarian I

offer literature searching services as well as training and guidance in searching the evidence and critical appraisal – just email me at library@uhbristol.nhs.uk

Outreach: Your Outreach Librarian can help facilitate evidence-based practise for all in the oral and maxillofacial surgery team, as well as assisting with academic study and research.

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library@uhbristol.nhs.uk

Literature searching: We provide a literature searching service for any library member. For those embarking on their own research it is advisable to book some time with one of the librarians for a 1 to 1 session where we can guide you through the process of creating a

well-focused literature research and introduce you to the health databases access via NHS Evidence. Please email requests to library@uhbristol.nhs .

Updates

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Latest relevant Systematic ReviewsAnaesthetic interventions for prevention of awareness during surgery Anthony G Messina , Michael Wang , Marshall J Ward , Chase C Wilker , Brett B Smith , Daniel P Vezina and Nathan Leon PaceOnline Publication Date: October 2016

Deliberate hypotension with propofol under anaesthesia for functional endoscopic sinus surgery (FESS)Polpun Boonmak , Suhattaya Boonmak and Malinee LaopaiboonOnline Publication Date: October 2016

Peri-articular/intra-articular infiltration analgesia with local anaesthetic versus nerve block for postoperative pain and function in patients receiving major knee surgeryLihua Peng , Su Min , Xin Sun , Ke Wei , Jun Dong , Yuanyuan Liu and Li RenOnline Publication Date: October 2016

Combined femoral and sciatic nerve block versus femoral and local infiltration anesthesia for pain control after total knee arthroplasty: a meta-analysis of randomized controlled trialsSource: PubMed - 07 December 2016

How does a neuraxial block compare with general anesthesia in adults undergoing hip fracture surgery?Source: Cochrane Clinical Answers - 14 November 2016

How does neuraxial blockade compare with general anesthesia and systemic analgesia when used postoperatively?Source: Cochrane Clinical Answers - 08 November 2016

New Guidance: AAGBI

Managing Conflicts of Interest in the NHS: A Consultation22 December 2016Shortlist announced for the AAGBI Award for Innovation in Anaesthesia, Critical Care and Pain15 December 2016A good year for innovation in anaesthesia28 October 2016

Journals: Tables of Contents

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Click on the hyperlinked title (+ Ctrl) for contents. If you require any of the articles in full please email: library@uhbristol.nhs.uk

AnaesthesiaJanuary 2017; Volume 72, Issue 1

EditorialsWhat Anaesthesia is doing to combat scientific misconduct and investigate data fabrication and falsification (pages 3–4)A. A. KleinDesign counsel: the role of clinicians in the prototyping and standard setting of anaesthetic equipment (pages 5–8)T. MeekBeware the Trojan Horse – a timely reality check about re-using single-use devices (pages 8–12)P. Hopkins and S. PatelCan systematic reviews with sparse data be trusted? (pages 12–16)A. Afshari, J. Wetterslev and A. F. Smith

Original ArticlesEvidence for non-random sampling in randomised, controlled trials by Yuhji Saitoh (pages 17–27)J. B. Carlisle and J. A. LoadsmanPerformance of adjustable pressure-limiting (APL) valves in two different modern anaesthesia machines (pages 28–34)J. Thomas, M. Weiss, A. R. Schmidt and P. K. BuehlerGE Healthcare response: performance of adjustable pressure limiting (APL) valves in two different modern anaesthesia machines (pages 34–35)T. McCormickContamination of single-use bronchoscopes in critically ill patients (pages 36–41)B. A. McGrath, S. Ruane, J. McKenna and S. ThomasA prospective, cohort evaluation of major and minor airway management complications during routine anaesthetic care at an academic medical centre (pages 42–48)J. M. Huitink, P. P. Lie, I. Heideman, E. P. Jansma, R. Greif, N. van Schagen and A. SchauerCerebral oxygenation during changes in vascular resistance and flow in patients on cardiopulmonary bypass – a physiological proof of concept study (pages 49–56)N. H. Sperna Weiland, D. Brevoord, D. A. Jöbsis, E. M. F. H. de Beaumont, V. Evers, B. Preckel, Intelligence quotient scores at the age of 6 years in children anaesthetised before the age of 5 years (pages 57–62)I. J. de Heer, H. Tiemeier, S. E. Hoeks and F. WeberLaboratory evaluation of a novel anaesthesia delivery device (pages 63–72)A. Paul, J. N. Clark, I. E. Salama, B. J. Jenkins, N. Goodwin, A. R. Wilkes, P. F. Mahoney and J. E. HallA radiologic and anatomic assessment of injectate spread following transmuscular quadratus lumborum block in cadavers (pages 73–79)S. D. Adhikary, K. El-Boghdadly, Z. Nasralah, N. Sarwani, A. M. Nixon and K. J. ChinAn observational study of critical care physicians' assessment and decision-making practices in response to patient referrals (pages 80–92)M. Charlesworth, M. Mort and A. F. Smith

Guidelines

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AAGBI: Consent for anaesthesia 2017 : Association of Anaesthetists of Great Britain and Ireland (pages 93–105)S. M. Yentis, A. J. Hartle, I. R. Barker, P. Barker, D. G. Bogod, T. H. Clutton-Brock, A. Ruck Keene,

Review ArticleThe effect of inhaled nitric oxide in acute respiratory distress syndrome in children and adults: a Cochrane Systematic Review with trial sequential analysis (pages 106–117)O. Karam, F. Gebistorf, J. Wetterslev and A. Afshari

Statistically SpeakingFifty percent of anaesthetists are worse than average at understanding statistics and risk (pages 118–121)B. GibbisonClassifying variables (pages 122–123)S. W. Choi and D. M. H. Lam

CorrespondenceRetention of laryngoscopy skills in novices (page 124)D. JainRetention of laryngoscopy skills in medical students – a reply (pages 124–125)R. McCahonAbandoning first generation supraglottic airway devices in paediatric anaesthesia (pages 125–126)J. P. Montague and C. J. HalloranUltra-low dose spinal anaesthesia for hip fracture surgery (page 126)K. GodaiDuration of low-dose spinal anaesthesia for hip fracture surgery (pages 127–128)S. WhiteVascular access after axillary lymph node surgery (page 128)S. Wydall and E. AzizVascular access after axillary lymph node surgery – a reply (pages 128–129)A. BodenhamVascular access, cerebral air embolism and hyperbaric oxygen therapy (pages 129–130)P. Bothma and A. ObideyiDoes mannitol contribute to hypotension after parenteral paracetamol administration in critical care? (page 130)A. NairEngineering jargon (pages 130–131)A. Maddock‘Go-between’ study: walk times and talk times (page 131)J. T. A. Wedgwood‘Go-between’ study: walk times and talk times – a reply (pages 131–132)T. Cook, S. R. MacDougall-Davis and L. KettleyVisualising odds ratios (pages 132–133)T. L. Samuels

CorrectionCorrection (page 134)This article corrects:The ‘go-between’ study: a simulation study comparing the ‘Traffic Lights’ and ‘SBAR’ tools as a means of communication between anaesthetic staff 1 Vol. 71, Issue 7, 764–772,

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Anesthesia & AnalgesiaJanuary 2017; Volume 124, Issue 1

InfographicsFrom Contact to Contactless Pulse Oximetry: Can You Measure Me Now? Wanderer, Jonathan P.; Nathan, Naveen Anesthesia & Analgesia. 124(1):1, January 2017.

Editorial Trends and Challenges in Clinical Monitoring: Papers From the 2015 IAMPOV Symposium Bickler, Philip E.; Cannesson, Maxime; Shelley, Kirk H. Anesthesia & Analgesia. 124(1):2-3, January 2017.

Peripheral Nerve Catheters: Ready for a Central Role? Soffin, Ellen M.; YaDeau, Jacques T. Anesthesia & Analgesia. 124(1):4-6, January 2017.

Maybe the Wand Does Matter? Tung, Avery; Pittet, Jean-Francois Anesthesia & Analgesia. 124(1):7-8, January 2017

Implementation of Massive Transfusion Protocols in the United States: The Relationship Between Evidence and Practice Chang, Ronald; Holcomb, John B. Anesthesia & Analgesia. 124(1):9-11, January 2017.

Cardiovascular AnesthesiologyThe Association Between Preoperative Hemoglobin A1C and Postoperative Glycemic Variability on 30-Day Major Adverse Outcomes Following Isolated Cardiac Valvular Surgery Bardia, Amit; Khabbaz, Kamal; Mueller, Ariel; Anesthesia & Analgesia. 124(1):16-22, January 2017.

HemostasisThe Association Between Cyanosis and Thromboelastometry (ROTEM) in Children With Congenital Heart Defects: A Retrospective Cohort Study Laskine-Holland, Marie-Laure; Kahr, Walter H. A.; Crawford-Lean, Lynn; Anesthesia & Analgesia. 124(1):23-29, January 2017. Perioperative Echocardiography and Cardiovascular EducationCoronary Artery Fistula to Left Atrium Uncovered After Mitral Valve Replacement Renew, Johnathan R.; Ritter, Matthew J. Anesthesia & Analgesia. 124(1):30-32, January 2017.

Ambulatory Anesthesiology and Perioperative ManagementAssociation Between Perioperative Hyperglycemia or Glucose Variability and Postoperative Acute Kidney Injury After Liver Transplantation: A Retrospective Observational Study

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Yoo, Seokha; Lee, Ho-Jin; Lee, Hannah; Anesthesia & Analgesia. 124(1):35-41, January 2017.

Anesthetic Clinical PharmacologyTrends in Tramadol: Pharmacology, Metabolism, and MisuseMiotto, Karen; Cho, Arthur K.; Khalil, Mohamed A.;Anesthesia & Analgesia. 124(1):44-51, January 2017.

Preclinical PharmacologyCardiotoxic Antiemetics Metoclopramide and Domperidone Block Cardiac Voltage-Gated Na+ Channels Stoetzer, Carsten; Voelker, Marc; Doll, ThorbenAnesthesia & Analgesia. 124(1):52-60, January 2017.

Technology, Computing, and SimulationAdvanced Uses of Pulse Oximetry for Monitoring Mechanically Ventilated Patients Tusman, Gerardo; Bohm, Stephan H.; Suarez-Sipmann, Fernando Anesthesia & Analgesia. 124(1):62-71, January 2017.

Capturing Essential Information to Achieve Safe Interoperability Weininger, Sandy; Jaffe, Michael B.; Rausch, Tracy Anesthesia & Analgesia. 124(1):83-94, January 2017.

The Need to Apply Medical Device Informatics in Developing Standards for Safe Interoperable Medical Systems Weininger, Sandy; Jaffe, Michael B.; Goldman, Julian M. Anesthesia & Analgesia. 124(1):127-135, January 2017.Anesthesiologist as Physiologist: Discussion and Examples of Clinical Waveform Analysis Alian, Aymen A. Anesthesia & Analgesia. 124(1):154-166, January 2017.

Tissue Oximetry and Clinical Outcomes Bickler, Philip; Feiner, John; Rollins, MarkAnesthesia & Analgesia. 124(1):72-82, January 2017

Active and Passive Optical Imaging Modality for Unobtrusive Cardiorespiratory Monitoring and Facial Expression Assessment Blazek, Vladimir; Blanik, Nikolai; Blazek, Claudia R. Anesthesia & Analgesia. 124(1):104-119, January 2017.

Effects of Acute, Profound Hypoxia on Healthy Humans: Implications for Safety of Tests Evaluating Pulse Oximetry or Tissue Oximetry Performance Bickler, Philip E.; Feiner, John R.; Lipnick, Michael S. Anesthesia & Analgesia. 124(1):146-153, January 2017.Original Clinical Research Report Applying Computer Models to Realize Closed-Loop Neonatal Oxygen Therapy Morozoff, Edmund; Smyth, John A.; Saif, Mehrdad Anesthesia & Analgesia. 124(1):95-103, January 2017.A Comparison of Measurements of Change in Respiratory Status in Spontaneously Breathing Volunteers by the ExSpiron Noninvasive Respiratory Volume Monitor Versus the Capnostream... Williams, George W. II; George, Christy A.; Harvey, Brian C.

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Anesthesia & Analgesia. 124(1):120-126, January 2017.

AnesthesiologyJanuary 2017; Volume 126, Issue 1

This Month in: Anesthesiology Anesthesiology January 2017, Vol.126, A1-A2.

Science, Medicine, and the Anesthesiologist Anesthesiology January 2017, Vol.126, A19-A20.

Infographics in Anesthesiology Perioperative Medication Management Jonathan P. Wanderer; James P. Rathmell Anesthesiology January 2017, Vol.126, A21.

Anesthesiology CME Program Instructions for Obtaining Anesthesiology Continuing Medical Education (CME) Credit Anesthesiology January 2017, Vol.126, A17.

Editorial Views Preoperative Administration of Angiotensin-converting Enzyme Inhibitors or Angiotensin II Receptor Blockers: Do We Have Enough “VISION” to Stop It? Martin J. London, M.D. Anesthesiology January 2017, Vol.126, 1-3.

It’s About Time Sachin Kheterpal, M.D., M.B.A. Anesthesiology January 2017, Vol.126, 4-5.

Monkey in the Middle: Translational Studies of Pediatric Anesthetic Exposure Mark G. Baxter, Ph.D.; Maria C. Alvarado, Ph.D. Anesthesiology January 2017, Vol.126, 6-8. do

Vasopressin, Norepinephrine, and Vasodilatory Shock after Cardiac Surgery: Another “VASST” Difference? James A. Russell, A.B., M.D. Anesthesiology January 2017, Vol.126, 9-11. do

Innovative Disruption in the World of Neuromuscular Blockade: What Is the “State of the Art?” Mohamed Naguib, M.B., B.Ch., M.Sc., F.C.A.R.C.S.I., M.D.; Ken B. Johnson, M.D. Anesthesiology January 2017, Vol.126, 12-15.

Anesthesiology Reflections from the Wood Library-Museum Richter’s Anchor Pain Expeller: Nondoctor Analgesia from “Doctoring” Chili, Black, and Guinea Peppers Anesthesiology January 2017, Vol.126, 15.

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Perioperative Medicine Clinical Science

Withholding versus Continuing Angiotensin-converting Enzyme Inhibitors or Angiotensin II Receptor Blockers before Noncardiac Surgery: An Analysis of the Vascular events In noncardiac Surg... Pavel S. Roshanov, M.D., M.Sc.; Bram Rochwerg, M.D., M.Sc.; Ameen Patel, M.D.; Anesthesiology January 2017, Vol.126, 16-27.

Mask Ventilation during Induction of General Anesthesia: Influences of Obstructive Sleep Apnea Shin Sato, M.D.; Makoto Hasegawa, M.D.; Megumi Okuyama, M.D.; Junko Okazaki, M.D.Anesthesiology January 2017, Vol.126, 28-38.

Anesthesiology Reflections from the Wood Library-Museum Cocaine in the “Dental Delight” of the Doctors McKinley Anesthesiology January 2017, Vol.126, 38.

Perioperative Medicine Clinical Science Rapid Occurrence of Chronic Kidney Disease in Patients Experiencing Reversible Acute Kidney Injury after Cardiac Surgery David Legouis, M.D.; Pierre Galichon, M.D., Ph.D.; Aurélien Bataille, M.D.; Sylvie Chevret, M.D.Anesthesiology January 2017, Vol.126, 39-46.

Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery: A Retro... Vafi Salmasi, M.D.; Kamal Maheshwari, M.D., M.P.H.; Dongsheng Yang, M.A.; Edward J. Anesthesiology January 2017, Vol.126, 47-65.

Does Dexmedetomidine Have a Perineural Mechanism of Action When Used as an Adjuvant to Ropivacaine?: A Paired, Blinded, Randomized Trial in Healthy Volunteers Jakob H. Andersen, M.D.; Ulrik Grevstad, M.D., Ph.D.; Hanna Siegel, M.D.; Jørgen B. Dahl, M.D., Anesthesiology January 2017, Vol.126, 66-73. do

Perioperative Medicine Basic Science Isoflurane Anesthesia Has Long-term Consequences on Motor and Behavioral Development in Infant Rhesus Macaques Kristine Coleman, Ph.D.; Nicola D. Robertson, M.S.; Gregory A. Dissen, Ph.D.; Martha D. Neuringer, Anesthesiology January 2017, Vol.126, 74-84.

Critical Care Medicine Clinical Science Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery: The VANCS Randomized Controlled Trial Ludhmila Abrahao Hajjar, M.D., Ph.D.; Jean Louis Vincent, M.D., Ph.D.; Filomena Regina Barbosa Anesthesiology January 2017, Vol.126, 85-93.

Pilot Study of Propofol-induced Slow Waves as a Pharmacologic Test for Brain Dysfunction after Brain Injury Jukka Kortelainen, M.D., Ph.D.; Eero Väyrynen, Ph.D.; Usko Huuskonen, M.D.; Jouko Laurila, M.D., Anesthesiology January 2017, Vol.126, 94-103.

Extubation Failure in Brain-injured Patients: Risk Factors and Development of a Prediction Score in a Preliminary Prospective Cohort Study Thomas Godet, M.D., Ph.D.; Russell Chabanne, M.D.; Julien Marin, M.D.; Sophie Kauffmann, M.D.,

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Anesthesiology January 2017, Vol.126, 104-114.

Activated Protein C Drives the Hyperfibrinolysis of Acute Traumatic Coagulopathy Ross A. Davenport, Ph.D.; Maria Guerreiro, M.D.; Daniel Frith, Ph.D.; Claire Rourke, B.Sc.; Sean. Anesthesiology January 2017, Vol.126, 115-127.

Critical Care Medicine Basic Science Transient Receptor Potential Melastatin 2 Regulates Phagosome Maturation and Is Required for Bacterial Clearance in Escherichia coli Sepsis ZhanQin Zhang, M.Sc.; Ping Cui, M.Sc.; Kai Zhang, M.D.; QiXing Chen, Ph.D.; XiangMing Fang, M.D. Anesthesiology January 2017, Vol.126, 128-139

Ivabradine Attenuates the Microcirculatory Derangements Evoked by Experimental Sepsis Marcos L. Miranda, M.D., M.Sc.; Michelle M. Balarini, M.D., M.Sc.; Daniela S. Balthazar, B.Sc.; Anesthesiology January 2017, Vol.126, 140-149

Pain Medicine Basic Science Acquired Exchange Protein Directly Activated by Cyclic Adenosine Monophosphate Activity Induced by p38 Mitogen-activated Protein Kinase in Primary Afferent Neurons Contributes to Sustaini... Megumi Matsuda, M.D.; Kentaro Oh-hashi, Ph.D.; Isao Yokota, Ph.D., M.P.H.; Teiji Sawa, M.D., Ph.D.Anesthesiology January 2017, Vol.126, 150-162.

Anesthesiology Reflections from the Wood Library-Museum From “Hog Bean” to “Fowl Murder”: Liebig’s Henbane Advertising Card Anesthesiology January 2017, Vol.126, 162.

Education Images in Anesthesiology Images in Anesthesiology: Mirror Image: A Patient with Situs Inversus Totalis Kaitlin J. Herald, D.O.; Daniel A. Tolpin, M.D. Anesthesiology January 2017, Vol.126, 163. doi:10.1097/ALN.0000000000001250

Intraoperative Transesophageal Echocardiography Alters Surgical Plan for Laser Lead Extraction Sachin Bahadur, M.B.B.S., F.R.C.A.; Tyler L. Evans, D.O.; Vijay Patel, M.D.; Mary E. Arthur, M.D., Anesthesiology January 2017, Vol.126, 164.

Education Clinical Concepts and Commentary Anesthesia for Ophthalmic Artery Chemosurgery Jacques H. Scharoun, M.D.; Jung H. Han, M.D.; Y. Pierre Gobin, M.D.

Anesthesiology Reflections from the Wood Library-Museum Byzantine Ivory Scene of the Biblical Sleep of Adam and the Creation of Eve Anesthesiology January 2017, Vol.126, 172.

Education Review Article Current Status of Neuromuscular Reversal and Monitoring: Challenges and Opportunities Sorin J. Brull, M.D., F.C.A.R.C.S.I. (Hon); Aaron F. Kopman, M.D. Anesthesiology January 2017, Vol.126, 173-190.

Education Mind to Mind Mom’s Boyfriend Thomas Quigley, M.D.

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Anesthesiology January 2017, Vol.126, 191.

First Listen, Then Connect Christo Frangopoulos, M.D. Anesthesiology January 2017, Vol.126, 192-193.

Who Is Really the Communicator of Adverse Outcomes—And When? Jeffrey L. Kaufman, M.D. Anesthesiology January 2017, Vol.126, 194.

In Reply Bradley A. Fritz, M.D., M.S.C.I.; Michael S. Avidan, M.B.B.Ch., F.C.A.S.A. Anesthesiology January 2017, Vol.126, 194-195.

Complexities of Bleeding During Spine Surgery: It’ll Take Your (Mechanical) Breath Away Bhiken I. Naik, M.B.B.Ch.; Edward C. Nemergut, M.D.; Marcel E. Durieux, M.D., Ph.D. Anesthesiology January 2017, Vol.126, 195.

In Reply Woon-Seok Kang, M.D., Ph.D.; Tae-Hoon Kim, M.D.; Seong-Hyop Kim, M.D., Ph.D. Anesthesiology January 2017, Vol.126, 196.

Announcements Anesthesiology January 2017, Vol.126, 197.

British Journal of AnaesthesiaJanuary 2017; Volume 118, Issue 1

In This IssueBr. J. Anaesth. (2017) 118 (1): i6 doi:10.1093/bja/aew429 Extract

EDITORIALSH. C. Hemmings, Jr.A global vision for the British Journal of Anaesthesia Br. J. Anaesth. (2017) 118 (1): 1-2 Extract

G. L. Ludbrook Coordinated perioperative care—a high value proposition? Br. J. Anaesth. (2017) 118 (1): 3-5 Extract

K. Slim The egg-and-chicken situation in postoperative enhanced recovery programmes Br. J. Anaesth. (2017) 118 (1): 5-6 Extract

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J. R. SneydMaking sense of propofol sedation for endoscopy Br. J. Anaesth. (2017) 118 (1): 6-7 Extract

M. Lamperti Tracheal visualization during tracheostomy: the dark side of the moon or just the moon and mars Br. J. Anaesth. (2017) 118 (1): 8-10 Extract

REVIEW ARTICLESS. Hajibandeh, Editor's Choice: Effect of beta-blockers on perioperative outcomes in vascular and endovascular surgery: a systematic review and meta-analysis Br. J. Anaesth. (2017) 118 (1): 11-21 Abstract

V. Martinez,Editor's Choice: Non-opioid analgesics in adults after major surgery: systematic review with network meta-analysis of randomized trials Br. J. Anaesth. (2017) 118 (1): 22-31 Abstract

J. A. Wahr, Medication safety in the operating room: literature and expert-based recommendations Br. J. Anaesth. (2017) 118 (1): 32-43 AbstractJ. P. van den Berg, Pharmacokinetic and pharmacodynamic interactions in anaesthesia. A review of current knowledge and how it can be used to optimize anaesthetic drug administration Br. J. Anaesth. (2017) 118 (1): 44-57 Abstract

CARDIOVASCULARJ. Renner, Non-invasive assessment of fluid responsiveness using CNAP™ technology is interchangeable with invasive arterial measurements during major open abdominal surgery Br. J. Anaesth. (2017) 118 (1): 58-67 Abstract

C. J. C. Trepte, Electrical impedance tomography for non-invasive assessment of stroke volume variation in health and experimental lung injury Br. J. Anaesth. (2017) 118 (1): 68-76Abstract

CLINICAL PRACTICER. Kruisselbrink, Ultrasound assessment of gastric volume in severely obese individuals: a validation study Br. J. Anaesth. (2017) 118 (1): 77-82Abstract

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J. N. Darvall,

Chewing gum for the treatment of postoperative nausea and vomiting: a pilot randomized controlled trial Br. J. Anaesth. (2017) 118 (1): 83-89 Abstract

Safety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: a prospective cohort study Br. J. Anaesth. (2017) 118 (1): 90-99 doAbstract

M. Swart,Using predicted 30 day mortality to plan postoperative colorectal surgery care: a cohort study Br. J. Anaesth. (2017) 118 (1): 100-104 Abstract

N. N. Saied, Effect of anaesthesia type on postoperative mortality and morbidities: a matched analysis of the NSQIP database Br. J. Anaesth. (2017) 118 (1): 105-111 Abstract

CRITICAL CAREN. ArulkumaranAssociation between day and time of admission to critical care and acute hospital outcome for unplanned admissions to adult general critical care units: cohort study exploring the ‘weekend effect’ Br. J. Anaesth. (2017) 118 (1): 112-122 first published online December 7, 2016 Abstract OPEN ACCESS

M. A. Gillies, Intensive care utilization and outcomes after high-risk surgery in Scotland: a population-based cohort study Br. J. Anaesth. (2017) 118 (1): 123-131 Abstract

RESPIRATION AND THE AIRWAYB. A. McGrath, Assessment of scoring systems to describe the position of tracheostomy tubes within the airway – the lunar study Br. J. Anaesth. (2017) 118 (1): 132-138 Abstract

CORRESPONDENCEFu-Shan Xue, Assessing influence of thermal softened double-lumen endobronchial tube on postoperative airway injury and morbidity: a call for methodology clarification Br. J. Anaesth. (2017) 118 (1): 139-140

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J.-H. Bahk andReply Br. J. Anaesth. (2017) 118 (1): 140 Extract

Q. Ren, Pre-warming the double-lumen endobronchial tubes to facilitate intubation in incubator Br. J. Anaesth. (2017) 118 (1): 140-141 Extract

J.-H. Bahk Reply Br. J. Anaesth. (2017) 118 (1): 141: Extract

V. Moen, Strong ion and weak acid analysis in severe preeclampsia Br. J. Anaesth. (2017) 118 (1): 141 Extract

BOOK REVIEWSA. Taylor andPreparing to Pass the FRCA. C. Whymark Br. J. Anaesth. (2017) 118 (1): 143 Extract

K. O. PryorBasic Anesthesiology Examination Review. G. W. Williams and E. S. Williams Br. J. Anaesth. (2017) 118 (1): 143-144 Extract

Current Opinion in AnaesthesiologyFebruary 2017; Volume 30, Issue 1

Editorial introductions Current Opinion in Anaesthesiology. 30(1):v-vii, February 2017.Free Access

THORACIC ANESTHESIAEdited by Paul M. Heerdt

Anesthesia for nonintubated video-assisted thoracic surgery Sunaga, Hiroshi; Blasberg, Justin D.; Heerdt, Paul M. Current Opinion in Anaesthesiology. 30(1):1-6, February 2017.Abstract

Hemodynamic monitoring in thoracic surgical patients Raphael, Jacob; Regali, Lindsay A.; Thiele, Robert H.

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Current Opinion in Anaesthesiology. 30(1):7-16, February 2017. Abstract

New trends in interventional pulmonology Selzer, Angela Roberts; Murrell, Matthew; Shostak, Eugene Current Opinion in Anaesthesiology. 30(1):17-22, February 2017.Abstract

Lung regeneration: steps toward clinical implementation and use Calle, Elizabeth A.; Leiby, Katherine L.; Raredon, MichaSam B.; More Current Opinion in Anaesthesiology. 30(1):23-29, February 2017.Abstract

Current trends in anesthesia for esophagectomy Durkin, Chris; Schisler, Travis; Lohser, Jens Current Opinion in Anaesthesiology. 30(1):30-35, February 2017.Abstract

The endothelial glycocalyx and perioperative lung injury Brettner, Florian; von Dossow, Vera; Chappell, Daniel Current Opinion in Anaesthesiology. 30(1):36-41, February 2017.Abstract

Single-lung ventilation and oxidative stress: a different perspective on a common practice Heerdt, Paul M.; Stowe, David F. Current Opinion in Anaesthesiology. 30(1):42-49, February 2017.Abstract

Extracorporeal lung support Salna, Michael; Bacchetta, Matthew Current Opinion in Anaesthesiology. 30(1):50-57, February 2017.Abstract

CARDIOVASCULAR ANESTHESIAEdited by Alexander Zarbock Cardiac surgery-associated acute kidney injury: much improved, but still long ways to go Zarbock, Alexander Current Opinion in Anaesthesiology. 30(1):58-59, February 2017.

Epidemiology and pathophysiology of cardiac surgery-associated acute kidney injury Fuhrman, Dana Y.; Kellum, John A. Current Opinion in Anaesthesiology. 30(1):60-65, February 2017.Abstract

Diagnosis of cardiac surgery-associated acute kidney injury from functional to damage biomarkers Vandenberghe, Wim; De Loor, Jorien; Hoste, Eric A.J. Current Opinion in Anaesthesiology. 30(1):66-75, February 2017.Abstract

Prevention of cardiac surgery-associated acute kidney injury Meersch, Melanie; Zarbock, Alexander

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Current Opinion in Anaesthesiology. 30(1):76-83, February 2017.Abstract

Does fluid management affect the occurrence of acute kidney injury? Mårtensson, Johan; Bellomo, Rinaldo Current Opinion in Anaesthesiology. 30(1):84-91, February 2017.Abstract

Therapy of acute kidney injury in the perioperative setting Romagnoli, Stefano; Ricci, Zaccaria; Ronco, Claudio Romagnoli, Stefano; Ricci, Zaccaria; Ronco, Claudio Less Current Opinion in Anaesthesiology. 30(1):92-99, February 2017.Abstract

Long-term consequences of acute kidney injury in the perioperative setting Palant, Carlos E.; Amdur, Richard L.; Chawla, Lakhmir S. Current Opinion in Anaesthesiology. 30(1):100-104, February 2017.Abstract

Congenital heart surgery and acute kidney injury Webb, Tennille N.; Goldstein, Stuart L. Webb, Tennille N.; Goldstein, Stuart L. Less Current Opinion in Anaesthesiology. 30(1):105-112, February 2017.Abstract

Mortality and cost of acute and chronic kidney disease after cardiac surgery Lysak, Nicholas; Bihorac, Azra; Hobson, Charles Current Opinion in Anaesthesiology. 30(1):113-117, February 2017.Abstract

MORBID OBESITY AND SLEEP APNEAEdited by Frances Chung An update on the various practical applications of the STOP-Bang questionnaire in anesthesia, surgery, and perioperative medicine Nagappa, Mahesh; Wong, Jean; Singh, Mandeep; More Current Opinion in Anaesthesiology. 30(1):118-125, February 2017.Abstract

Preoperative evaluation and preparation of the morbidly obese patient Böhmer, Andreas B.; Wappler, Frank Current Opinion in Anaesthesiology. 30(1):126-132, February 2017.Abstract

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Influence of Anaesthesia on Mobilisation Following Hip Fracture Surgery: An Observational Study: Author(s): Ahmed I.; Khan M.A.; Allgar V.Source: Journal of Orthopaedics, Trauma and Rehabilitation; Jun 2017; vol. 22 ; p. 41-47Publication Date: Jun 2017Publication Type(s): Journal: ArticleAbstract:Background Anaesthetic technique can influence mortality and morbidity following hip fracture surgery. However, its influence on postoperative mobilisation is not clear. In this study, we evaluated the influence of anaesthetic technique on postoperative mobilisation. Methods In this prospective observational study, we included all consecutive patients who underwent surgery for hip fracture between 1 January 2012 and 31 December 2013 at our institution. Any patients who died prior to mobilisation or who could not be followed up after surgery were excluded. Data was collected on demographics, clinical characteristics, anaesthesia technique and surgical factors, and date and time of admission, operation, first mobilisation and discharge. Results Of the 1040 patients included in the analysis, 264 received general anaesthesia only (Group GA), 322 received general anaesthesia with regional anaesthesia (Group GARA), and 454 received central neuraxial blockade anaesthesia with or without sedation (Group CNB). There was no significant difference in age (p = 0.56), sex (p = 0.23), number of comorbidities (p = 0.06), residential status (p = 0.18), time to surgery (p = 0.10) and length of hospital stay (p = 0.30) between the three groups. There was a statistically significant difference in ASA grade (p = 0.01), implant type used (p = 0.04), grade of operating surgeon (p = 0.02) and grade of anaesthetist during surgery (p = 0.004) among the three groups. Patients in Group GARA had a median time-to-first mobilisation of 23.8 hours after surgery, compared to 24.1 hours in Group GA and 24.3 hours in Group CNB. This difference was not statistically significant after controlling for confounding factors (p = 0.45). Conclusion Our results show that anaesthetic technique does not influence time-to-first mobilisation after hip fracture surgery. Copyright © 2016 HK Orthopaedic Association and HK Orthopaedic CollegeDatabase: EMBASE

Intubation success rates of prehospital rapid sequence induction of anaesthesia by physicians versus paramedics.Author(s): Phelps, ScotSource: European journal of emergency medicine : official journal of the European Society for Emergency Medicine; Feb 2017; vol. 24 (no. 1); p. 76-77Publication Date: Feb 2017Publication Type(s): Journal ArticleDatabase: Medline

Brief isoflurane anaesthesia affects differential gene expression, gene ontology and gene networks in rat brain.Author(s): Lowes, Damon A; Galley, Helen F; Moura, Alessandro P S; Webster, Nigel RSource: Behavioural brain research; Jan 2017; vol. 317 ; p. 453-460Publication Date: Jan 2017Publication Type(s): Journal Article

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Abstract:Much is still unknown about the mechanisms of effects of even brief anaesthesia on the brain and previous studies have simply compared differential expression profiles with and without anaesthesia. We hypothesised that network analysis, in addition to the traditional differential gene expression and ontology analysis, would enable identification of the effects of anaesthesia on interactions between genes. Rats (n=10 per group) were randomised to anaesthesia with isoflurane in oxygen or oxygen only for 15min, and 6h later brains were removed. Differential gene expression and gene ontology analysis of microarray data was performed. Standard clustering techniques and principal component analysis with Bayesian rules were used along with social network analysis methods, to quantitatively model and describe the gene networks. Anaesthesia had marked effects on genes in the brain with differential regulation of 416 probe sets by at least 2 fold. Gene ontology analysis showed 23 genes were functionally related to the anaesthesia and of these, 12 were involved with neurotransmitter release, transport and secretion. Gene network analysis revealed much greater connectivity in genes from brains from anaesthetised rats compared to controls. Other importance measures were also altered after anaesthesia; median [range] closeness centrality (shortest path) was lower in anaesthetized animals (0.07 [0-0.30]) than controls (0.39 [0.30-0.53], p<0.0001) and betweenness centrality was higher (53.85 [32.56-70.00]% compared to 5.93 [0-30.65]%, p<0.0001). Simply studying the actions of individual components does not fully describe dynamic and complex systems. Network analysis allows insight into the interactions between genes after anaesthesia and suggests future targets for investigation. Copyright © 2016 Elsevier B.V. All rights reserved.Database: Medline

AAGBI: Safer pre-hospital anaesthesia 2017: Association of Anaesthetists of Great Britain and Ireland.Author(s): Lockey, D J; Crewdson, K; Davies, G; Jenkins, B; Klein, J; Laird, C; Mahoney, P F; Nolan, J; Pountney, A; Shinde, S; Tighe, S; Russell, M Q; Price, J; Wright, CSource: Anaesthesia; Jan 2017Publication Date: Jan 2017Publication Type(s): LetterAbstract:Pre-hospital emergency anaesthesia with oral tracheal intubation is the technique of choice for trauma patients who cannot maintain their airway or achieve adequate ventilation. It should be carried out as soon as safely possible, and performed to the same standards as in-hospital emergency anaesthesia. It should only be conducted within organisations with comprehensive clinical governance arrangements. Techniques should be straightforward, reproducible, as simple as possible and supported by the use of checklists. Monitoring and equipment should meet in-hospital anaesthesia standards. Practitioners need to be competent in the provision of in-hospital emergency anaesthesia and have supervised pre-hospital experience before carrying out pre-hospital emergency anaesthesia. Training programmes allowing the safe delivery of pre-hospital emergency anaesthesia by non-physicians do not currently exist in the UK. Where pre-hospital emergency anaesthesia skills are not available, oxygenation and ventilation should be maintained with the use of second-generation supraglottic airways in patients without airway reflexes, or basic airway manoeuvres and basic airway adjuncts in patients with intact airway reflexes. © 2017 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland.Database: Medline

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Duration of low-dose spinal anaesthesia for hip fracture surgery.Author(s): White, SSource: Anaesthesia; Jan 2017; vol. 72 (no. 1); p. 127-128Publication Date: Jan 2017Publication Type(s): LetterDatabase: Medline

Implications of the 2015 AAGBI recommendations for standards of monitoring during anaesthesia and recovery.Author(s): Checketts, M R; Jenkins, B; Pandit, J JSource: Anaesthesia; Jan 2017; vol. 72Publication Date: Jan 2017Publication Type(s): EditorialDatabase: Medline

What Anaesthesia is doing to combat scientific misconduct and investigate data fabrication and falsification.Author(s): Klein, A ASource: Anaesthesia; Jan 2017; vol. 72 (no. 1); p. 3-4Publication Date: Jan 2017Publication Type(s): EditorialDatabase: Medline

An introduction to predictive modelling of drug concentration in anaesthesia monitors.Author(s): DeCou, J; Johnson, KSource: Anaesthesia; Jan 2017; vol. 72Publication Date: Jan 2017Publication Type(s): Journal Article ReviewAbstract:A significant amount of anaesthetists' work involves the prediction of drug effects and interactions to produce a smooth general anaesthetic that minimises drug side effects and promotes rapid emergence. Successfully managing this process requires a basic understanding of drug effects, experience and inevitably some guesswork, since it is difficult (and in some cases impossible) to anticipate all relevant patient and surgical factors. Although data are generally available to allow calculation of plasma drug and effect site concentrations, this is often difficult to apply in complex clinical contexts, particularly when multiple drug types are used. In recent years, manufacturers have developed and incorporated into anaesthetic workstations technologies that use drug pharmacodynamic and pharmacokinetic data to predict drug effects and interactions. Such systems can predict the duration and effects of drugs during anaesthesia and assist the anaesthetist to understand complex drug interactions. With this information available, different drug types, doses and combinations may be tailored in a scientific way to maximise useful effects whilst minimising overdose and side-effects, particularly in high-risk patients. Examples are used to illustrate how such systems can be used in practice, and how drug effects and interactions can be simulated to "rehearse" an anaesthetic before any drugs are actually administered. At present only a small number of anaesthetic workstations use this technology, and as yet they are not able to manage all drugs used in anaesthetic practice. However, such systems have the potential to help anaesthetists manage the complexity of their work, and to

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provide information on predicted drug effects in a way that is useful and relevant to both experienced anaesthetists and trainees. © 2017 The Association of Anaesthetists of Great Britain and Ireland.Database: Medline

Performance of adjustable pressure-limiting (APL) valves in two different modern anaesthesia machines.Author(s): Thomas, J; Weiss, M; Schmidt, A R; Buehler, P KSource: Anaesthesia; Jan 2017; vol. 72 (no. 1); p. 28-34Publication Date: Jan 2017Publication Type(s): Journal ArticleAbstract:The ability to gently ventilate a patient's lungs using a self-inflating bag requires a properly working adjustable pressure-limiting (APL) valve. We compared the performance of the APL valves of the GE Aisys CS2 and the Draeger Fabius anaesthetic machines during closure and opening from 1-20 and from 20-1 cmH2 O, using standardised experimental baby and adolescent patient lung models. Airway pressures and inspiratory tidal volumes were measured using an ASL-5000 test lung and a GE Aisys CS2 near-patient spirometry sensors. In both lung models, the GE Aisys CS2 APL valves demonstrated non-linear behaviours for airway pressures and for inspiratory tidal volumes, with a sharp increase at set APL pressure levels of 8-10 cmH2 O. With further closure of the GE Aisys CS2 APL valves up to 20 cmH2 O, inspiratory tidal volumes decreased to ~50% of the highest values measured. Airway pressures in the Draeger Fabius APL valves demonstrated a near linear increase and decrease. Airway pressure values measured in the Draeger Fabius were never higher than those set by the APL valves, whereas in the GE Aisys CS2 , they considerably exceeded set pressures (by up to 27 cmH2 O). We conclude that the performance of the GE Aisys CS2 APL valve does not allow safe bag-assisted ventilation of a patient's lungs. © 2016 The Association of Anaesthetists of Great Britain and Ireland.Database: Medline

GE Healthcare response: performance of adjustable pressure limiting (APL) valves in two different modern anaesthesia machines.Author(s): McCormick, TSource: Anaesthesia; Jan 2017; vol. 72 (no. 1); p. 34-35Publication Date: Jan 2017Publication Type(s): Journal ArticleDatabase: Medline

Clinical experience with desflurane for paediatric anaesthesia outside the operating room.Author(s): Alonso, M; Builes, L; Morán, P; Ortega, A; Fernández, E; Reinoso-Barbero, FSource: Revista espanola de anestesiologia y reanimacion; Jan 2017; vol. 64 (no. 1); p. 6-12Publication Date: Jan 2017Publication Type(s): Journal ArticleAbstract:Desflurane has been used in paediatric patients for several surgical indications. This article analyses the efficacy and safety of desflurane for diagnostic-therapeutic procedures in remote areas far from operating room in a group of selected patients with no known associated respiratory disease. A retrospective analysis was performed on 2,072 general anaesthesia procedures stored in a computer database, in which desflurane was

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used in a Paediatric Pain Unit during the years 2013 and 2014. An analysis was also performed using the patient demographics, type of procedure, anaesthetic technique, type of airway management, patient cooperation, and incidence of anaesthetic complications. The study included 876 patients, with a mean age of 8.8 years. The main procedures were bone marrow aspirates (23%), lumbar punctures (20%), panendoscopies (15%), and colonoscopies (5%). Induction was intravenous with propofol (26%) or inhalation with sevoflurane in the remaining 74%. Maintenance consisted of remifentanil and desflurane at mean end tidal concentrations of 6.2±2.1%. The airway was managed through a nasal cannula or face mask in spontaneous ventilation. The effectiveness was 98%, and the incidence of side effects was 15%, which included agitation (6%), headache (4%), nausea-vomiting (3%), and laryngospasm (2%). The maintenance with desflurane (at concentrations close to the hypnotic-MAC in spontaneous ventilation) was effective, with a rapid recovery, and with a low incidence of adverse effects. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.Database: Medline

Regional or general anaesthesia for carotid endarterectomy.Author(s): Stoneham, Mark DSource: European journal of anaesthesiology; Jan 2017; vol. 34 (no. 1); p. 45-46Publication Date: Jan 2017Publication Type(s): Journal ArticleDatabase: Medline

Reply to: regional or general anaesthesia for carotid endarterectomy.Author(s): Unic-Stojanovic, DraganaSource: European journal of anaesthesiology; Jan 2017; vol. 34 (no. 1); p. 46-47Publication Date: Jan 2017Publication Type(s): Journal ArticleDatabase: Medline

Laboratory evaluation of a novel anaesthesia delivery device.Author(s): Paul, A; Clark, J N; Salama, I E; Jenkins, B J; Goodwin, N; Wilkes, A R; Mahoney, P F; Hall, J ESource: Anaesthesia; Jan 2017; vol. 72 (no. 1); p. 63-72Publication Date: Jan 2017Publication Type(s): Journal ArticleAbstract:Here, we describe proof of concept of a novel method for delivering volatile anaesthetics, where the liquid anaesthetic (sevoflurane or isoflurane) is formulated into an emulsion that is contained in a compact, lightweight device through which carrier gas flows. Release of anaesthetic is achieved by stirring of the formulation, allowing controlled and responsive release of anaesthetic at a variety of fixed flow rates between 0.5 l.min-1 and 5 l.min-1 , with ventilated, non-ventilated and draw-over breathing systems. Anaesthetic release was evaluated using target anaesthetic concentrations ranging from 0.5% v/v to 8% v/v to mimic those typically required for induction and maintenance of anaesthesia, and lower concentrations suitable for sedation. Under all conditions, output could be maintained within 0.1% v/v of the intended setting, and the device could deliver a

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controlled level of anaesthetic for at least 60 min, with compensation for different ambient temperatures (10-30 °C) and carrier gas flow rates. This device offers a simple, inexpensive method of delivering safe concentrations of volatile anaesthetics for a wide range of applications. © 2016 The Association of Anaesthetists of Great Britain and Ireland.Database: Medline

A global vision for the British Journal of Anaesthesia.Author(s): Hemmings, H CSource: British journal of anaesthesia; Jan 2017; vol. 118 (no. 1); p. 1-2Publication Date: Jan 2017Publication Type(s): EditorialDatabase: Medline

Abandoning first generation supraglottic airway devices in paediatric anaesthesia.Author(s): Montague, J P; Halloran, C JSource: Anaesthesia; Jan 2017; vol. 72 (no. 1); p. 125-126Publication Date: Jan 2017Publication Type(s): LetterDatabase: Medline

Local anaesthesia during endometrial ablation: a systematic review.Author(s): Reinders, Ima; Geomini, Pmaj; Timmermans, A; de Lange, M E; Bongers, M YSource: BJOG : an international journal of obstetrics and gynaecology; Jan 2017; vol. 124 (no. 2); p. 190-199Publication Date: Jan 2017Publication Type(s): Journal Article ReviewAbstract:Endometrial ablation has been widely implemented in the outpatient setting. Many different protocols of local anaesthesia during endometrial ablation are used and described. However, prospective studies to assess and evaluate these protocols appear to be scarce. To evaluate systematically the different local anaesthesia techniques in relation to pain perception during endometrial ablation. Medline and Embase were systematically searched and reference lists of selected articles were checked for missed publications. All types of studies reporting the performance of endometrial ablation under local anaesthesia in ten or more women were included. Data about the procedure, the protocol of local anaesthesia, the acceptability and side-effects were extracted. Twenty-five studies, involving 2013 women, were included. Applied anaesthesia techniques included intracervical, paracervical and intrauterine anaesthesia or a combination of these techniques. Women who received a combination of either intra- or paracervical anaesthesia and intrauterine injections reported significantly lower pain scores than those who received no local anaesthesia or intra- or paracervical anaesthesia alone (P = 0.000), but the quality of evidence is low. The acceptability of endometrial ablation under local anaesthesia was high (77-94%). Endometrial ablation under local anaesthesia is a safe, feasible and acceptable procedure. The combination of either intra- or paracervical anaesthesia with intrauterine injections seems to be promising, but has to be investigated more thoroughly. Systematic review of local anaesthesia techniques during endometrial ablation. © 2016 Royal College of Obstetricians and Gynaecologists.Database: Medline

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Training responsibly to improve global surgical and anaesthesia capacity through institutional health partnerships: a case study.Author(s): Macpherson, Laura; Collins, MaggieSource: Tropical doctor; Jan 2017; vol. 47 (no. 1); p. 73-77Publication Date: Jan 2017Publication Type(s): Journal Article ReviewAbstract:Urgent investment in human resources for surgical and anaesthesia care is needed globally. Responsible training and education is required to ensure healthcare providers are confident and skilled in the delivery of this care in both the rural and the urban setting. The Tropical Health and Education Trust (THET), a UK-based specialist global health organisation, is working with health training institutions, health professionals, Ministries of Health and Health Partnerships or 'links' between healthcare institutions in the UK and low- or middle-income country (LMIC) counterparts. These institutions may be hospitals, professional associations or universities whose primary focus is delivery of health services or the training and education of health workers. Since 2011, THET has been delivering the Health Partnership Scheme (HPS), a UK government-funded programme that provides grants and guidance to health partnerships and promotes the voluntary engagement of UK health professionals overseas. To date, the £30 million Scheme has supported peer-to-peer collaborations involving more than 200 UK and overseas hospitals, universities and professional associations across 25 countries in Africa, Asia and the Middle East. In this paper, we focus on four partnerships that are undertaking training initiatives focused on building capacity for surgery and anaesthesia. In order to do so, we discuss their role as a responsible and effective approach to harnessing the expertise available in the UK in order to increase surgical and anaesthesia capacity in LMICs. Specifically, how well they: (1) respond to locally identified needs; (2) are appropriate to the local context and are of high quality; and (3) have an overarching goal of making a sustainable contribution to the development of the health workforce through education and training. The HPS has now supported 24 training initiatives focused on building capacity for surgery and anaesthesia in 16 countries across sub-Saharan Africa, Asia and the Middle East. THET argues that these initiatives are both responsible and effective. The four partnerships featured in this paper have demonstrated not only their effectiveness in increasing health worker skills and knowledge, but have done so across a variety of surgical and anaesthesia disciplines and within different contexts. This wide reach and applicability of partnership initiatives adds even greater value to their use as responsible training interventions. One challenge that has faced these partnerships has been the capture of improvements to patient outcomes as a result of improved practice. To counteract the problems of data collection, partnerships are collecting anecdotal evidence of improvements at the patient outcome level. The interventions supported by THET have been able to demonstrate success in improving health worker skills and knowledge, and albeit to a lesser extent, in improving patient outcomes. The implementing partners are achieving these successes by training responsibly: responding to locally identified need, implementing projects that are appropriate to the local context and are of high quality, and establishing mechanisms that ensure self-sufficiency of the health worker training and education that is delivered. Greater investment in responsible training initiatives such as these are required to address the significant lack of access to appropriate and safe surgical and anaesthesia interventions when needed and the growing burden of disease. © The Author(s) 2016.

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Database: Medline

The role and limitations of EEG-based depth of anaesthesia monitoring in theatres and intensive care.Author(s): Hajat, Z; Ahmad, N; Andrzejowski, JSource: Anaesthesia; Jan 2017; vol. 72Publication Date: Jan 2017Publication Type(s): Journal Article ReviewAbstract:In this article we will look at some of the principles in processed EEG monitoring as applied to bispectral index (BIS). We outline why BIS should be regarded as a 'memory' monitor which in most circumstances reflects the depth of sedation or anaesthesia in particular patients. Its limitation in paralysed and non-paralysed patients must be understood in order for this monitor to be used safely. Finally, its emerging use in critical care will be explored. © 2017 The Association of Anaesthetists of Great Britain and Ireland.Database: Medline

Current practice in regional anaesthesia in South America: An online survey.Author(s): Corvetto, M A; Carmona, J; Vásquez, M I; Salgueiro, C; Crostón, J; Sosa, R; Folle, V; Altermatt, F RSource: Revista espanola de anestesiologia y reanimacion; Jan 2017; vol. 64 (no. 1); p. 27-31Publication Date: Jan 2017Publication Type(s): Journal ArticleAbstract:A survey was conducted in order to obtain a profile of the practice of regional anesthesia in South America, and determine the limitations of its use. After institutional ethics committee approval, a link to an online questionnaire was sent by e-mail to anaesthesiologists in Argentina, Bolivia, Chile, Colombia, Panamá, Paraguay, Perú, and Uruguay. The questionnaire was processed anonymously. A total of 1,260 completed questionnaires were received. The results showed that 97.6% of the anaesthesiologists that responded used regional anaesthesia in clinical practice, 66.9% performed peripheral nerve block (PNB) regularly, 21.6% used continuous PNB techniques, and 4.6% used stimulating catheters. The primary source of training was residency programs. As regards PNB, the most common performed were interscalene (52.3%), axillary (45.1%), femoral (43.2%), and ankle block (43%). As regards the localisation technique employed, 16% used paraesthesia, 44.2% used a peripheral nerve stimulator, and 18.1% ultrasound guidance. Regional anaesthesia and PNB are commonly used among South American anaesthesiologists. Considering that each country has its own profile for use, this profile should guide training in clinical practice, especially in residency programs. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.Database: Medline

Ultra-low dose spinal anaesthesia for hip fracture surgery.Author(s): Godai, KSource: Anaesthesia; Jan 2017; vol. 72 (no. 1); p. 126Publication Date: Jan 2017Publication Type(s): Letter

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Database: Medline

Response surface modelling of the pharmacodynamic interaction between propofol and remifentanil in patients undergoing anaesthesia.Author(s): Choe, SangMin; Choi, Byung-Moon; Lee, Yong-Hun; Lee, Soo-Han; Lee, Eun-Kyung; Kim, Ki-Seong; Noh, Gyu-JeongSource: Clinical and experimental pharmacology & physiology; Jan 2017; vol. 44 (no. 1); p. 30-40Publication Date: Jan 2017Publication Type(s): Journal ArticleAbstract:This study describes the pharmacodynamic interaction between propofol and remifentanil. Sixty patients who were scheduled for elective surgery under general anaesthesia (30 males/30 females) were enrolled. Patients were randomly allocated to receive one of 15 combinations of drug levels. Baseline electroencephalograms (EEGs) were recorded for 5 minutes prior to administering the drugs. Patients received a target-controlled infusion at one of four predefined doses of propofol (high, 3 μg/mL; medium, 1.5 μg/mL; low, 0.5 μg/mL; or no drug) and of remifentanil (high, 6 or 8 ng/mL; medium, 4 ng/mL; low, 2 ng/mL; or no drug). The occurrence of muscle rigidity, apnoea, and loss of consciousness (LOC) was monitored, and EEGs were recorded during the drug administration phase. Electroencephalographic approximate entropy (ApEn) and temporal linear mode complexity (TLMC) parameters at baseline and under steady state conditions were calculated off-line. Response surfaces were developed to map the interaction between propofol and remifentanil to the probability of occurrence for quantal responses (muscle rigidity, apnoea, LOC) and ApEn and TLMC measurements. Model parameters were estimated using non-linear mixed effects modelling. The response surface revealed infra-additive and synergistic effects for muscle rigidity and apnoea, respectively. The effects of the combined drugs on LOC and EEG parameters (eg, ApEn and TLMC) were additive. The C50 estimates of remifentanil (ng/mL) and propofol (μg/mL) were 9.11 and 130 000 for muscle rigidity, 8.99 and 6.26 for apnoea, 13.9 and 3.04 for LOC, 23.4 and 10.4 for ApEn, and 14.8 and 6.51 for TLMC, respectively. The probability of occurrence for muscle rigidity declined when propofol was combined with remifentanil. © 2016 John Wiley & Sons Australia, Ltd.Database: Medline

AAGBI: Consent for anaesthesia 2017: Association of Anaesthetists of Great Britain and Ireland.Author(s): Yentis, S M; Hartle, A J; Barker, I R; Barker, P; Bogod, D G; Clutton-Brock, T H; Ruck Keene, A; Leifer, S; Naughton, A; Plunkett, ESource: Anaesthesia; Jan 2017; vol. 72 (no. 1); p. 93-105Publication Date: Jan 2017Publication Type(s): LetterAbstract:Previous guidelines on consent for anaesthesia were issued by the Association of Anaesthetists of Great Britain and Ireland in 1999 and revised in 2006. The following guidelines have been produced in response to the changing ethical and legal background against which anaesthetists, and also intensivists and pain specialists, currently work, while retaining the key principles of respect for patients' autonomy and the need to provide adequate information. The main points of difference between the relevant legal frameworks

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in England and Wales and Scotland, Northern Ireland and the Republic of Ireland are also highlighted. © 2016 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland.Database: Medline

Oxygen supplementation before induction of general anaesthesia in horses.Author(s): van Oostrom, H; Schaap, M W H; van Loon, J P A MSource: Equine veterinary journal; Jan 2017; vol. 49 (no. 1); p. 130-132Publication Date: Jan 2017Publication Type(s): Journal ArticleAbstract:Hypoventilation or apnoea, caused by the induction of general anaesthesia, may cause hypoxaemia. Preoxygenation may lengthen the period before this happens. No scientific studies are published on preoxygenation in equine anaesthesia. To determine whether supplementation of oxygen at a flow rate of 15 l/min for 3 min via a nasal cannula before induction of general anaesthesia is effective in elevating the arterial partial pressure of oxygen (PaO2 ) directly after induction. Randomised, prospective clinical trial. A total of 18 American Society of Anesthesiologists physical status 1 or 2 adult horses undergoing elective anaesthesia were randomly allocated to one of 2 groups. The first group (control) received no oxygen supplementation before induction of general anaesthesia, whereas the second group (oxygen) did. All horses were anaesthetised with intravenous detomidine, butorphanol, ketamine, midazolam and isoflurane. Directly after induction (T = 0) and 30 min later (T = 30) an arterial blood sample was taken for blood gas analysis. At T = 30 an estimate of intrapulmonary shunt fraction (Qs/Qt) was calculated. At T = 0 arterial partial pressure of oxygen (PaO2 ) was significantly higher in the oxygen group compared with the control group (11.0 ± 2.6 kPa vs. 7.4 ± 1.6 kPa; mean ± s.d., P = 0.005) and at T = 30 differences were not statistically significant. Partial pressure of carbon dioxide (PaCO2 ) and Qs/Qt did not differ between groups. Supplementing oxygen by a nasal cannula before induction of general anaesthesia in horses is feasible and does effectively elevate the PaO2 immediately after induction. Future research is needed to determine whether supplementation of oxygen before induction of general anaesthesia in horses will affect outcomes. © 2015 EVJ Ltd.Database: Medline

Effect of anaesthesia type on postoperative mortality and morbidities: a matched analysis of the NSQIP database.Author(s): Saied, N N; Helwani, M A; Weavind, L M; Shi, Y; Shotwell, M S; Pandharipande, P PSource: British journal of anaesthesia; Jan 2017; vol. 118 (no. 1); p. 105-111Publication Date: Jan 2017Publication Type(s): Journal ArticleAbstract:The anaesthetic technique may influence clinical outcomes, but inherent confounding and small effect sizes makes this challenging to study. We hypothesized that regional anaesthesia (RA) is associated with higher survival and fewer postoperative organ dysfunctions when compared with general anaesthesia (GA). We matched surgical procedures and type of anaesthesia using the US National Surgical Quality Improvement database, in which 264,421 received GA and 64,119 received RA. Procedures were matched according to Current Procedural Terminology (CPT) and ASA physical status classification.

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Our primary outcome was 30-day postoperative mortality and secondary outcomes were hospital length of stay, and postoperative organ system dysfunction. After matching, multiple regression analysis was used to examine associations between anaesthetic type and outcomes, adjusting for covariates. After matching and adjusting for covariates, type of anaesthesia did not significantly impact 30-day mortality. RA was significantly associated with increased likelihood of early discharge (HR 1.09; P< 0.001), 47% lower odds of intraoperative complications, and 24% lower odds of respiratory complications. RA was also associated with 16% lower odds of developing deep vein thrombosis and 15% lower odds of developing any one postoperative complication (OR 0.85; P < 0.001). There was no evidence of an effect of anaesthesia technique on postoperative MI, stroke, renal complications, pulmonary embolism or peripheral nerve injury. After adjusting for clinical and patient characteristic confounders, RA was associated with significantly lower odds of several postoperative complications, decreased hospital length of stay, but not mortality when compared with GA. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.Database: Medline

Correction to: The 'go-between' study: a simulation study comparing the 'Traffic Lights' and 'SBAR' tools as a means of communication between anaesthetic staff (Anaesthesia, (2016), 71, 7, (764-772), 10.1111/anae.13464)Author(s): anonymousSource: Anaesthesia; Jan 2017; vol. 72 (no. 1); p. 134Publication Date: Jan 2017Publication Type(s): Journal: ErratumAbstract:Following a letter from Dr Wingfield published in this edition of the journal, the authors of MacDougall-Davis et al. [1] would like to correct an error of transposition. In Table 1, the talk times and their p values have been transposed with the exception of at the top of the table ('all messages(') where the times, but not the p value were transposed. The corrected Table 1 is below. The discussion of the (slightly surprising) finding that the Traffic Light system led go-betweens to walk down the corridor faster is therefore wrong and the following sentences require correction: "The Traffic Lights tool also significantly reduced message delivery time by reducing the 'walk time'" This should read: "The Traffic Lights tool also significantly reduced message delivery time by reducing the 'talk time'" This sentence should be deleted: "Of interest, the time the go-between took to walk to deliver the message was affected by the urgency of the message, but use of the Traffic Lights tool significantly reduced this time, particularly for emergency messages" Should be replaced by: "The Traffic Lights tool led to the time taken to articulate all types of message being reduced by > 20 s." Reference 1. MacDougall-Davis SR, Kettley L, Cook TM. The 'go-between' study: a simulation study comparing the 'Traffic Lights' and 'SBAR' tools as a means of communication between anaesthetic staff. Anaesthesia 2016; 71: 764-72. Table 1 Concordance of urgency between message recipient assessment and Traffic Light category, rating of clarity of message, accuracy of information transfer and times taken. Values are number or median (IQR [range]).(Table presented.). Copyright © 2016 The Association of Anaesthetists of Great Britain and Ireland.Database: EMBASE

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Care of the eye during anaesthesia and intensive careAuthor(s): O'Driscoll A.; White E.Source: Anaesthesia and Intensive Care Medicine; Jan 2017; vol. 18 (no. 1); p. 47-51Publication Date: Jan 2017Publication Type(s): Journal: ReviewAbstract:Perioperative eye injuries and blindness are rare but important complications of anaesthesia. The three causes of postoperative blindness are ischaemic optic neuropathy, central retinal artery thrombosis (these can exist in tandem and have been described as ischaemic oculopathies) and cortical blindness. This review aims to improve anaesthetists' knowledge of orbital anatomy, ocular physiology and the mechanisms of perioperative eye injuries to help reduce their occurrence. Copyright © 2016 Elsevier LtdDatabase: EMBASE

Anaesthesia for paediatric eye surgeryAuthor(s): Davies I.D.M.; Sale S.M.Source: Anaesthesia and Intensive Care Medicine; Jan 2017; vol. 18 (no. 1); p. 37-40Publication Date: Jan 2017Publication Type(s): Journal: ReviewAbstract:Local anaesthesia is often the technique of choice for ophthalmic procedures performed on adults; however, general anaesthesia is usually required for procedures on children. The majority of paediatric patients are fit and healthy but there is a minority in whom the presenting eye complaint is related to a congenital disorder, which may have significant bearing on the conduct of anaesthesia. Management of the airway and presentation of a quiescent eye for surgery are key considerations, while control of the oculocardiac reflex and intraocular pressure (IOP) are important both intraoperatively and postoperatively. IOP is affected by almost all aspects of general anaesthesia and should be considered when choosing an anaesthetic technique. Ocular surgery is emetogenic and without prophylaxis is associated with a high incidence of postoperative nausea and vomiting which should be addressed to prevent problematic increase in intraocular pressure. Most procedures are associated with mild to moderate postoperative pain and can usually be managed with simple analgesia. Pain, but also the use of opioid analgesia, is a risk factor for postoperative nausea and vomiting. Examination under anaesthesia, intraocular surgery, correction of squint and emergency ophthalmic surgery each presents its own challenge and all are discussed. Copyright © 2016 Elsevier LtdDatabase: EMBASE

Local anaesthesia for ocular surgeryAuthor(s): Rodgers H.; Craven R.Source: Anaesthesia and Intensive Care Medicine; Jan 2017; vol. 18 (no. 1); p. 41-43Publication Date: Jan 2017Publication Type(s): Journal: ReviewAbstract:Local anaesthesia is the technique of choice for a large number of ophthalmic procedures, including cataract surgery. For some procedures topical anaesthesia is sufficient; for more complex procedures a local anaesthetic block will be needed. Sharp needle techniques previously favoured, whilst still useful, have become less common than the cannula-based sub-Tenon's block. This provides favourable operating conditions with a lower risk of complications. Patients should be appropriately counselled regarding local

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anaesthesia early in their perioperative journey; combined with suitable preoperative assessment this provides high levels of patient satisfaction and limits interruptions to their usual routine. Copyright © 2016Database: EMBASE

General anaesthesia for ophthalmic surgeryAuthor(s): Pritchard N.C.B.Source: Anaesthesia and Intensive Care Medicine; Jan 2017; vol. 18 (no. 1); p. 33-36Publication Date: Jan 2017Publication Type(s): Journal: ReviewAbstract:Local anaesthesia for eye surgery is increasingly popular, but there will always be a need for general anaesthesia. Patients may refuse local anaesthesia, may be unable to keep still or lie flat for the duration of surgery or lack the mental facility to cooperate whilst awake. Young children and those with allergy to local anaesthetic also need general anaesthesia. Careful patient preparation is important before surgery. Glycaemic control in patients with diabetes, adjustments to warfarin or aspirin dosing, thromboembolic prophylaxis and preoperative fasting need to be considered. Eye surgery alone is rarely a true emergency, and surgery can usually wait until the patient's stomach is empty. Eye pathology requiring surgery is a feature of many medical conditions and syndromes. Many patients are elderly with ischaemic heart disease, hypertension, chronic obstructive pulmonary disease and renal impairment, which must be assessed before general anaesthesia. Systemic effects of ophthalmic medications, such as hypokalaemia caused by acetazolamide should be considered. A wide range of general anaesthetic techniques are suitable for eye surgery, but certain key points are relevant to specific operations. These include the oculo-cardiac reflex in strabismus and retinal surgery, the use of intraocular gas bubbles in vitreo-retinal operations, controlled hypotension in lacrimal, orbital and other oculoplastic procedures, and the high incidence of nausea after strabismus surgery. Total intravenous anaesthesia (TIVA) fulfils many of the requirements for the ideal anaesthetic technique for ophthalmic surgery. Blood pressure, heart rate and intraocular pressure are lowered. It is rapidly titratable and recovery is fast. Postoperative nausea is reduced and TIVA works well in patients with renal and hepatic disease. Remifentanil infusion allows nitrous oxide to be avoided and top-up doses of muscle relaxants to be minimized during ventilation. For most ophthalmic surgery, postoperative pain is mild and non-steroidal anti-inflammatory drugs work well. Intraoperative sub-Tenon's local anaesthetic is useful. Copyright © 2016Database: EMBASE

Ocular anatomy and physiology relevant to anaesthesiaAuthor(s): Presland A.; Price J.Source: Anaesthesia and Intensive Care Medicine; Jan 2017; vol. 18 (no. 1); p. 27-32Publication Date: Jan 2017Publication Type(s): Journal: ReviewAbstract:The orbit contains many delicate and vulnerable structures, but with a solid knowledge of the anatomy one can minimize the chance of complications and better understand how regional blocks work. This article discusses anatomy of the orbit and eye, and includes rudimentary ocular physiology. Copyright © 2016 Elsevier LtdDatabase: EMBASE

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Pathophysiology of respiratory disease and its significance to anaesthesiaAuthor(s): Kimber Craig S.; Fang L.Source: Anaesthesia and Intensive Care Medicine; Jan 2017; vol. 18 (no. 1); p. 10-15Publication Date: Jan 2017Publication Type(s): Journal: ReviewAbstract:Significant changes occur in the respiratory physiology of healthy patients during anaesthesia. In patients with underlying respiratory pathology, these changes in respiratory physiology may lead to clinical problems during the conduct of anaesthesia and the perioperative period. An understanding of the disease processes that can affect the lungs and pleura allows the anaesthetist to account for the potential complications of these conditions and manage the anaesthetic accordingly. Copyright © 2016 Elsevier LtdDatabase: EMBASE

Anaesthesia in the elderlyAuthor(s): Chambers D.J.; Allan M.W.B.Source: Anaesthesia and Intensive Care Medicine; Jan 2017; vol. 18 (no. 1); p. 22-26Publication Date: Jan 2017Publication Type(s): Journal: ReviewAbstract:Older people are undergoing increasingly complex surgery with much greater mortality and morbidity than the younger adult population. In this article, we discuss the physiological changes that take place in the older patient, and how these may affect anaesthetic technique. Perioperative risk in the elderly is discussed, with focus on emergency surgery and frailty. Copyright © 2016Database: EMBASE

Eye signs in anaesthesia and intensive care medicineAuthor(s): Bajekal R.; Bari F.Source: Anaesthesia and Intensive Care Medicine; Jan 2017; vol. 18 (no. 1); p. 44-46Publication Date: Jan 2017Publication Type(s): Journal: ReviewAbstract:Eye signs are of limited value in assessing the level of sedation or general anaesthesia. Horner's syndrome is an important complication of excessively high neuraxial block. Eye opening is part of the Glasgow Coma Scale, and pupil size and reaction have important implications in the intensive care setting. Copyright © 2016 Elsevier LtdDatabase: EMBASE

Exercise: Systematic ReviewsThere are 7 key steps that need to be taken when carrying out a Systematic Review. Can you put them in order?

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A. Quality assessment

B. Study selection

C. Synthesis

D. Data extraction

E. Define the question

F. Literature search

G. Writing up

For assistance with carrying out a systematic review search or a literature search, please email library@uhbristol.nhs.uk.