Sevoflurane ‐induced isoelectric EEG and burst suppression: differential and antagonistic effect of added nitrous oxide
The objective of this study was to investigate whether nitrous oxide influenced the ED50 of sevoflurane for induction of isoelectric electroencephalogram (ED50isoelectric) differently from its influence on the ED50 of sevoflurane for electroencephalogram burst suppression (ED50burst). In a prospective, randomised, double‐blind, parallel group, up–down sequential allocation study, 77 ASA physical status 1 and 2 patients received sevoflurane induction and, after tracheal intubation, were randomly allocated to receive sevoflurane with either 40% oxygen in air (control group) or 60% nitrous oxide in oxygen mixture (nit...
Source: Anaesthesia - March 7, 2017 Category: Anesthesiology Authors: B. Niu, J. Y. Xiao, Y. Fang, B. Y. Zhou, J. Li, F. Cao, Y. K. Tian, W. Mei Tags: Original Article Source Type: research

A randomised trial of peri ‐operative positive airway pressure for postoperative delirium in patients at risk for obstructive sleep apnoea after regional anaesthesia with sedation or general anaesthesia for joint arthroplasty
Summary Previous pilot work has established an association between obstructive sleep apnoea and the development of acute postoperative delirium , but it remains unclear to what extent this risk factor is modifiable in the ‘real world’ peri‐operative setting. In a single‐blind randomised controlled trial, 135 elderly surgical patients at risk for obstructive sleep apnoea were randomly assigned to receive peri‐operative continuous positive airway pressure (CPAP) or routine care. Of the 114 patients who completed the study, 21 (18.4%) experienced delirium. Delirium was equally common in both groups: 21% (12 ...
Source: Anaesthesia - March 1, 2017 Category: Anesthesiology Authors: J. W. Nadler, J. L. Evans, E. Fang, X. A. Preud'Homme, R. L. Daughtry, J. B. Chapman, M. P. Bolognesi, D. E. Attarian, S. S. Wellman, A. D. Krystal Tags: Original Article Source Type: research

A randomised crossover simulation study comparing the impact of chemical, biological, radiological or nuclear substance personal protection equipment on the performance of advanced life support interventions
This study compared the powered respiratory protective suit (PRPS ensemble) with a lightweight suit consisting of a SARATOGA® Multipurpose CBRN Protective Coverall Polyprotect 12 in conjunction with the Avon C50 Respirator/Avon CBRNF12CE filter canister and butyl rubber protective gloves (Polyprotect 12 ensemble). Thirty anaesthetists carried out a standardised resuscitation scenario either unprotected (control) or wearing the PRPS or Polyprotect 12 ensembles in a randomised, crossover simulation study. Treatment times for five simulated advanced life support interventions (application of monitoring; bag/mask ventilati...
Source: Anaesthesia - March 1, 2017 Category: Anesthesiology Authors: J. Schumacher, J. Arlidge, F. Garnham, I. Ahmad Tags: Original Article Source Type: research

When anaesthetics collide: antagonism of one agent by another?
(Source: Anaesthesia)
Source: Anaesthesia - February 28, 2017 Category: Anesthesiology Authors: J. J. Pandit Tags: Editorial Source Type: research

A randomised double ‐blind trial of phenylephrine and metaraminol infusions for prevention of hypotension during spinal and combined spinal–epidural anaesthesia for elective caesarean section
Summary Prophylactic vasopressor administration is commonly recommended to reduce maternal hypotension during spinal anaesthesia for caesarean section. Metaraminol has undergone limited investigation in obstetric anaesthesia for this purpose, particularly in comparison with phenylephrine. In this multicentre, randomised, double‐blind, non‐inferiority study, we compared prophylactic phenylephrine or metaraminol infusions, started immediately after spinal anaesthesia, in 185 women who underwent elective caesarean section. Phenylephrine was initially infused at 50 μg.min−1, and metaraminol at 250 μg.min−...
Source: Anaesthesia - February 28, 2017 Category: Anesthesiology Authors: N. J. McDonnell, M. J. Paech, N. A. Muchatuta, S. Hillyard, E. A. Nathan Tags: Original Article Source Type: research

Flow characteristics of Luer and non ‐Luer spinal needles
We examined the time to first appearance of simulated cerebrospinal fluid in the needle hub, as well as the amount of fluid collected over 120 s after the needle was introduced. The mean (SD) times to first appearance of fluid in the needle hub of Luer spinal needles varied from 0.36 (0.22) s for the 25‐G 90‐mm BD to 3.14 (0.72) s for the 27‐G 120‐mm B. Braun, and in the non‐Luer spinal needles from 0.22 (0.17) s for the 25‐G 90‐mm B. Braun to 2.99 (0.71) s for the 27‐G 120‐mm Pajunk. There was a significant difference in the time to first appearance of fluid in the needle hub between Luer and non‐Luer ...
Source: Anaesthesia - February 28, 2017 Category: Anesthesiology Authors: R. S. Monteiro, A. Pillai, S. W. Choi, D. Bogod, S. M. Yentis Tags: Original Article Source Type: research

The accuracy of timed maximum local anaesthetic dose calculations with an electronic calculator, nomogram, and pen and paper
Summary Forty anaesthetists calculated maximum permissible doses of eight local anaesthetic formulations for simulated patients three times with three methods: an electronic calculator; nomogram; and pen and paper. Correct dose calculations with the nomogram (85/120) were more frequent than with the calculator (71/120) or pen and paper (57/120), Bayes Factor 4 and 287, p = 0.01 and p = 0.0003, respectively. The rates of calculations at least 120% the recommended dose with each method were different, Bayes Factor 7.9, p = 0.0007: 14/120 with the calculator; 5/120 with the nomogram; 13/120 with pen and paper. The median (IQR...
Source: Anaesthesia - February 25, 2017 Category: Anesthesiology Authors: J. D. Walker, N. Williams, D. J. Williams Tags: Original Article Source Type: research

Pain Assessment in INTensive care (PAINT): an observational study of physician ‐documented pain assessment in 45 intensive care units in the United Kingdom
Summary Pain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTensive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect to published guidelines. This observational service evaluation considered all pain and analgesia‐related entries in patients’ records over a 24‐h period, in 45 adult intensive care units (ICUs) in London and the South‐East of England. Data were collected from 750 patients, refle...
Source: Anaesthesia - February 20, 2017 Category: Anesthesiology Authors: H. I. Kemp, C. Bantel, F. Gordon, S. J. Brett, , , H. C. Laycock Tags: Original Article Source Type: research

Transfusion in critical care – a UK regional audit of current practice
SummaryA consistent message within critical care publications has been that a restrictive transfusion strategy is non‐inferior, and possibly superior, to a liberal strategy for stable, non‐bleeding critically ill patients. Translation into clinical practice has, however, been slow. Here, we describe the degree of adherence to UK best practice guidelines in a regional network of nine intensive care units within Wessex. All transfusions given during a 2‐month period were included (n = 444). Those given for active bleeding or within 24 h of major surgery, trauma or gastrointestinal bleeding were excluded (n = 148). The ...
Source: Anaesthesia - February 18, 2017 Category: Anesthesiology Authors: J. O. M. Plumb, M. G. Taylor, E. Clissold, M. P. W. Grocott, R. Gill, Tags: Original Article Source Type: research

Heterogeneity in meta ‐analyses. Comparing apples and oranges?
(Source: Anaesthesia)
Source: Anaesthesia - February 17, 2017 Category: Anesthesiology Authors: S. W. Choi, D. M. H. Lam Tags: Statistically Speaking: methodological madness Source Type: research

Dr Thomas B Boulton OBE, TD, MD, FRCA, FDSRCS, 1925 –2016
(Source: Anaesthesia)
Source: Anaesthesia - February 16, 2017 Category: Anesthesiology Authors: M. E. Ward Tags: Obituary Source Type: research

An investigation into the effects of real vs. stimulated cases and level of experience on the distribution of visual attention during induction of general anaesthesia
Summary In anaesthesia, patient simulators have been used for training and research. However, insights from simulator‐based research may only translate to real settings if the simulation elicits the same behaviour as the real setting. To this end, we investigated the effects of the case (simulated case vs. real case) and experience level (junior vs. senior) on the distribution of visual attention during the induction of general anaesthesia. We recorded eye‐tracking data from 12 junior and 12 senior anaesthetists inducing general anaesthesia in a simulation room and in an actual operating room (48 recordings). Using a c...
Source: Anaesthesia - February 16, 2017 Category: Anesthesiology Authors: T. Grundgeiger, C. Kl öffel, S. Mohme, T. Wurmb, O. Happel Tags: Original Article Source Type: research

Haemodynamic changes to a midazolam –fentanyl–rocuronium protocol for pre‐hospital anaesthesia following return of spontaneous circulation after cardiac arrest
Summary Following the return of spontaneous circulation after out‐of‐hospital cardiac arrest, neurological dysfunction, airway or ventilatory compromise can impede transport to early percutaneous coronary intervention, necessitating pre‐hospital or emergency department anaesthesia to facilitate this procedure. There are no published reports of the ideal induction agents in these patients. We sought to describe haemodynamic changes associated with induction of anaesthesia using a midazolam (0.1 mg.kg−1), fentanyl (2 μg.kg−1) and rocuronium (1 mg.kg−1) regimen developed using expert opinion, and ad...
Source: Anaesthesia - February 14, 2017 Category: Anesthesiology Authors: M. Miller, C. Groombridge, R. Lyon Tags: Original Article Source Type: research

The erector spinae plane block: plane and simple
(Source: Anaesthesia)
Source: Anaesthesia - February 11, 2017 Category: Anesthesiology Authors: K. El ‐Boghdadly, A. Pawa Tags: Editorial Source Type: research

The analgesic efficacy of pre ‐operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair
Summary Laparoscopic ventral hernia repair is an operation associated with significant postoperative pain, and regional anaesthetic techniques are of potential benefit. The erector spinae plane (ESP) block performed at the level of the T5 transverse process has recently been described for thoracic surgery, and we hypothesised that performing the ESP block at a lower vertebral level would provide effective abdominal analgesia. We performed pre‐operative bilateral ESP blocks with 20–30 ml ropivacaine 0.5% at the level of the T7 transverse process in four patients undergoing laparoscopic ventral hernia repair. Me...
Source: Anaesthesia - February 10, 2017 Category: Anesthesiology Authors: K. J. Chin, S. Adhikary, N. Sarwani, M. Forero Tags: Original Article Source Type: research

Safe performance of peripheral regional anaesthesia: the significance of ultrasound guidance
(Source: Anaesthesia)
Source: Anaesthesia - February 10, 2017 Category: Anesthesiology Authors: P. Marhofer, G. Fritsch Tags: Editorial Source Type: research

Ultrasound ‐guided approach to nerves (direct vs. tangential) and the incidence of intraneural injection: a cadaveric study
This study evaluated the incidence of nerve puncture and intraneural injection based on the needle approach to the nerve (direct vs. tangential). Two expert operators in regional anaesthesia performed in‐plane ultrasound‐guided nerve blocks (n = 158) at different levels of the brachial plexus in cadavers, aiming either directly for the nerve (n = 77) or tangentially inferior to the nerve (n = 81). After reaching the outer limit of the nerve, the needle was intentionally advanced approximately 1 mm in both approaches, and 0.2–0.5 ml of saline was injected. Each operator classified (in real time) the needle tip and...
Source: Anaesthesia - February 9, 2017 Category: Anesthesiology Authors: L. A. Sermeus, X. Sala ‐Blanch, J. G. McDonnell, C. A. Lobo, B. J. Nicholls, G. J. Geffen, O. Choquet, G. Iohom, B. Jose Maria Galve, C. Hermans, M. Lammens Tags: Original Article Source Type: research

Effects of acute controlled changes in end ‐tidal carbon dioxide on the diameter of the optic nerve sheath: a transorbital ultrasonographic study in healthy volunteers
Summary Transorbital ultrasonographic measurement of the diameter of the optic nerve sheath is a non‐invasive, bed‐side examination for detecting raised intracranial pressure. However, the ability of the optic nerve sheath diameter to predict acute changes in intracranial pressures remains unknown. The aim of this study was to examine the dynamic changes of the optic nerve sheath diameter in response to mild fluctuations in cerebral blood volume induced by changes in end‐tidal carbon dioxide. We studied 11 healthy volunteers. End‐tidal carbon dioxide was controlled by a model‐based prospective end‐tidal targeti...
Source: Anaesthesia - February 8, 2017 Category: Anesthesiology Authors: M. Dinsmore, J. S. Han, J. A. Fisher, V. W. S. Chan, L. Venkatraghavan Tags: Original Article Source Type: research

Correction
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Tags: Correction Source Type: research

Metabolic oxygen requirements
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Authors: O. Sykes Tags: Correspondence Source Type: research

Paravertebral block and access to the paravertebral space – a reply
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Authors: I. Costache, C. J. L. McCartney Tags: Correspondence Source Type: research

Phrenic nerve block for thoracic surgery – a reply
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Authors: M. R. Blichfeldt ‐Eckhardt, C. Andersen, P. B. Licht, P. Toft, H. Ørding Tags: Correspondence Source Type: research

Phrenic nerve block for thoracic surgery
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Authors: C. G. C. Palmer, S. Jagannathan Tags: Correspondence Source Type: research

Cricoid pressure: release – or adjust?
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Authors: R. Lenoir Tags: Correspondence Source Type: research

Sugammadex and laryngospasm
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Authors: S. Greenaway, S. Shah, M. Dancey Tags: Correspondence Source Type: research

Right ‐ or left‐handed anaesthesia workstations – a reply
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Authors: N. Dill Tags: Correspondence Source Type: research

Right ‐ or left‐handed anaesthesia workstations – a safety issue
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Authors: J. W. Broadway, G. D. Bostock, I. K. Driver Tags: Correspondence Source Type: research

Fascia iliaca block for primary hip arthroplasty – a reply
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Authors: R. Kearns, A. Macfarlane, J. Kinsella, K. Anderson Tags: Correspondence Source Type: research

Fascia iliaca block for primary hip arthroplasty
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Authors: S. White, P. Stott Tags: Correspondence Source Type: research

Choice of intrathecal opioid for hip arthroplasty
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Authors: A. Cumberworth Tags: Correspondence Source Type: research

Standards for hip fracture anaesthesia – a reply
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Authors: I. K. Moppett, S. M. White, R. Griffiths Tags: Correspondence Source Type: research

Standards for hip fracture anaesthesia
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Authors: A. Skinner Tags: Correspondence Source Type: research

Postoperative blood sugars and use of starches – a reply
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Authors: M. Tien, Y. J. Lee, A. S. Habib Tags: Correspondence Source Type: research

Postoperative blood sugars and use of starches
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Authors: J. Patel, T. Fregen Tags: Correspondence Source Type: research

Issue Information – Editorial Board
(Source: Anaesthesia)
Source: Anaesthesia - February 7, 2017 Category: Anesthesiology Tags: Issue Information Source Type: research

The fate of manuscripts rejected from Anaesthesia
(Source: Anaesthesia)
Source: Anaesthesia - January 31, 2017 Category: Anesthesiology Authors: A. B. Docherty, A. A. Klein Tags: Editorial Source Type: research

Heart rate variability as a predictor of hypotension following spinal for elective caesarean section: a prospective observational study
Summary Post‐spinal hypotension remains a common and clinically‐important problem during caesarean section, and accurate pre‐operative prediction of this complication might enhance clinical management. We conducted a prospective, single‐centre, observational study of heart rate variability in 102 patients undergoing elective caesarean section in a South African regional hospital. We performed Holter recording for ≥ 5 min in the hour preceding spinal anaesthesia. The low‐frequency/high‐frequency ratio component of heart rate variability was compared, using a logistic regression model, with baseline heart rate...
Source: Anaesthesia - January 30, 2017 Category: Anesthesiology Authors: D. G. Bishop, C. Cairns, M. Grobbelaar, R. N. Rodseth Tags: Original Article Source Type: research

The application of three ‐dimensional printing technology in anaesthesia: a systematic review
Summary Three‐dimensional printing has rapidly become an easily accessible, innovative and versatile technology, with a vast range of applications across a wide range of industries. There has been a recent emergence in the scientific literature relating to its potential application across a multitude of fields within medicine and surgery; however, its use within anaesthesia has yet to be formally explored. We undertook a systematic review using MEDLINE and EMBASE databases of three‐dimensional printing in anaesthesia. We identified eight relevant articles. Due to the paucity of studies, we also completed a narrative re...
Source: Anaesthesia - January 27, 2017 Category: Anesthesiology Authors: I. Chao, J. Young, J. Coles ‐Black, J. Chuen, L. Weinberg, C. Rachbuch Tags: Review Article Source Type: research

Determination of the median effective dose (ED50) of spinal chloroprocaine in labour analgesia
Summary The primary goal of this study was to determine the median effective dose (ED50) of spinal chloroprocaine for labour analgesia. Thirty‐eight parturients requesting neuraxial analgesia were enrolled. Doses of 1% chloroprocaine were determined by the technique of up–down sequential allocation, with an initial dose of 20 mg and steps of 2 mg. The chloroprocaine spinal dose was given as the spinal component of a combined spinal‐epidural, which was then supplemented with an epidural dose of 7.5 μg sufentanil in 7 ml saline. Effective analgesia was defined as a score ≤ 10 mm within 15 min on a 100‐mm vi...
Source: Anaesthesia - January 19, 2017 Category: Anesthesiology Authors: M. Coppens, S. Anssens, A. Parashchanka, K. Roelens, E. Deschepper, S. De Hert, P. F. Wouters Tags: Original Article Source Type: research

The effect of remifentanil on propofol requirements to achieve loss of response to command vs. loss of response to pain
Summary When providing total intravenous anaesthesia, careful selection of end‐points is required in titrating dose to effect during induction. Although propofol and remifentanil have predominantly different pharmacodynamic effects, they are seen to interact in achieving loss of consciousness and analgesia. To highlight these differences, we performed a double‐blind, randomised controlled trial, comparing one group of patients receiving propofol alone (n = 42) with another group receiving remifentanil plus propofol (n = 46) as a target‐controlled infusion of remifentanil (Minto; 3 ng.ml−1). Propofol was also ti...
Source: Anaesthesia - January 17, 2017 Category: Anesthesiology Authors: H. B. Scott, S. W. Choi, G. T. C. Wong, M. G. Irwin Tags: Original Article Source Type: research

Correction
(Source: Anaesthesia)
Source: Anaesthesia - January 16, 2017 Category: Anesthesiology Authors: N. Chrimes Tags: Correction Source Type: research

Barriers to challenging senior anaesthetists ’ decisions
(Source: Anaesthesia)
Source: Anaesthesia - January 16, 2017 Category: Anesthesiology Authors: Y. Price Tags: Correspondence Source Type: research

Bootstrapping and resampling
(Source: Anaesthesia)
Source: Anaesthesia - January 16, 2017 Category: Anesthesiology Authors: T. Samuels Tags: Correspondence Source Type: research

Epidural securement device failure
(Source: Anaesthesia)
Source: Anaesthesia - January 16, 2017 Category: Anesthesiology Authors: M. Kamath Tags: Correspondence Source Type: research

Epidural pump malfunction – manufacturer's reply
(Source: Anaesthesia)
Source: Anaesthesia - January 16, 2017 Category: Anesthesiology Authors: G. D. Booth Tags: Correspondence Source Type: research

Epidural pump malfunction
(Source: Anaesthesia)
Source: Anaesthesia - January 16, 2017 Category: Anesthesiology Authors: T. Shah, T. Van Dam, A. Madamangalam Tags: Correspondence Source Type: research

Inadvertent carotid catheterisation
(Source: Anaesthesia)
Source: Anaesthesia - January 16, 2017 Category: Anesthesiology Authors: M. Charlesworth, A. D. Ashworth Tags: Correspondence Source Type: research

A method of recording electronic anaesthetic monitor data for research
(Source: Anaesthesia)
Source: Anaesthesia - January 16, 2017 Category: Anesthesiology Authors: S. M. White, J. Pateman Tags: Correspondence Source Type: research

Forcing functions and their consequences – a reply
(Source: Anaesthesia)
Source: Anaesthesia - January 16, 2017 Category: Anesthesiology Authors: S. A. Khan, S. Khan, H. Kothandan Tags: Correspondence Source Type: research

Forcing functions and their consequences
(Source: Anaesthesia)
Source: Anaesthesia - January 16, 2017 Category: Anesthesiology Authors: C. S. Webster, A. F. Merry Tags: Correspondence Source Type: research