Acute care – an important component of the continuum of care for HIV and tuberculosis in developing countries
(Source: Anaesthesia)
Source: Anaesthesia - November 21, 2016 Category: Anesthesiology Authors: P. Bock, H. Cox Tags: Editorial Source Type: research

Intensive care medicine in rural sub ‐Saharan Africa
Summary We undertook an audit in a rural Ugandan hospital that describes the epidemiology and mortality of 5147 patients admitted to the intensive care unit. The most frequent admission diagnoses were postoperative state (including following trauma) (2014/5147; 39.1%), medical conditions (709; 13.8%) and traumatic brain injury (629; 12.2%). Intensive care unit mortality was 27.8%, differing between age groups (p
Source: Anaesthesia - November 20, 2016 Category: Anesthesiology Authors: M. W. D ünser, R. M. Towey, J. Amito, M. Mer Tags: Original Article Source Type: research

An evaluation of inpatient morbidity and critical care provision in Zambia
Summary The aim of this study was to objectively measure demand for critical care services in a southern African tertiary referral centre. We carried out a point prevalence study of medical and surgical admissions over a 48‐h period at the University Teaching Hospital, Lusaka, recording the following: age; sex; diagnosis; Human Immunodeficiency Virus (HIV) status and National Early Warning Score. One‐hundred and twenty medical and surgical admissions were studied. Fifty‐four patients (45%) had objective evidence of a requirement for critical care review and potential or probable admission to an intensive care unit, a...
Source: Anaesthesia - November 20, 2016 Category: Anesthesiology Authors: P. J. Dart, J. Kinnear, M. D. Bould, S. L. Mwansa, Z. Rakhda, D. Snell Tags: Original Article Source Type: research

Correction
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Tags: Correction Source Type: research

Comparing fibreoscopy with the Pentax Airway Scope for awake orotracheal intubation
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: F. S. Xue, G. Z. Yang, C. Sun Tags: Correspondence Source Type: research

Cortical reflex myoclonus
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: K. Kawabata, T. Suzuki, N. Otsuka, M. Ishii Tags: Correspondence Source Type: research

Eye protection in anaesthesia
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: J. Schumacher, E. St ößlein, A. Brinker Tags: Correspondence Source Type: research

Is a judicial change needed to protect organ donation?
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: I. R. Barker Tags: Correspondence Source Type: research

AAGBI safe vascular access guidelines – a reply
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: A. Bodenham Tags: Correspondence Source Type: research

A complication of a femoral arterial catheter
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: A. Mahmood, G. Lau Tags: Correspondence Source Type: research

Another cardiopulmonary exercise testing machine fault
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: S. S. O'Neill, R. A. Hartley, M. Nachiappan, O. W. Pratt Tags: Correspondence Source Type: research

Sciatic nerve block and enhanced recovery after total knee arthroplasty – a reply
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: E. Albrecht, S. Grape, M. Baeriswyl, K. R. Kirkham Tags: Correspondence Source Type: research

Sciatic nerve block and enhanced recovery after total knee arthroplasty
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: C. G. C. Palmer, S. Jagannathan Tags: Correspondence Source Type: research

Interscalene catheters for shoulder surgery – a reply
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: M. Fredrickson, P. Leightley, A. Wong, M. Chaddock, A. Abeysekera Tags: Correspondence Source Type: research

Interscalene catheters for shoulder surgery
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: J. Cooper Tags: Correspondence Source Type: research

Supraclavicular or interscalene brachial plexus block for rotator cuff repair?
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: S. Reilly, M. Sahni, S. Jagannathan Tags: Correspondence Source Type: research

Incidental finding of a tracheal fragment from a Frova intubating catheter
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: S. A. Michlig Tags: Correspondence Source Type: research

Apnoeic oxygenation in pregnancy – a reply
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: A. Pillai Tags: Correspondence Source Type: research

Apnoeic oxygenation in pregnancy
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: A. Jones Tags: Correspondence Source Type: research

Airway topical anaesthesia for awake fibreoptic intubation – a reply
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: N. Pirlich, J. A. Lohse, R. R. Noppens Tags: Correspondence Source Type: research

Abandoning cricoid pressure – a reply
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: J. Turnbull, A. Patel, V. Athanassoglou, J. J. Pandit Tags: Correspondence Source Type: research

Cricoid pressure and the law
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: D. M. Levy Tags: Correspondence Source Type: research

Abandoning cricoid pressure
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: S. Kannan Tags: Correspondence Source Type: research

Complete relinquishing of anaesthetic conscientiousness, optimisation and nuance (CRAC ‐ON) trial
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Authors: N. Chrimes Tags: Special Article Source Type: research

Issue Information – Editorial Board
(Source: Anaesthesia)
Source: Anaesthesia - November 13, 2016 Category: Anesthesiology Tags: Issue Information Source Type: research

A cadaver study comparing three fibreoptic ‐assisted techniques for converting a supraglottic airway to a cuffed tracheal tube
Summary After rescuing an airway with a supraglottic airway device, a method to convert it to a cuffed tracheal tube is often needed. The best method to do this has never been directly studied. We compared three techniques for conversion of a standard LMA® Unique airway to a cuffed endotracheal tube using a fibrescope. The primary endpoint was time to intubation, with secondary endpoints of success rate, perceived difficulty and preferred technique. We also investigated the relationship between level of training and prior training and experience with the techniques on the primary outcome. The mean (95% CI) time to intu...
Source: Anaesthesia - November 10, 2016 Category: Anesthesiology Authors: B. L. Olesnicky, A. Rehak, W. B. Bestic, J. T. Brock, L. Watterson Tags: Original Article Source Type: research

The impact of critical event checklists on medical management and teamwork during simulated crises in a surgical daycare facility
Summary Although the incidence of major adverse events in surgical daycare centres is low, these critical events may not be managed optimally due to the absence of resources that exist in larger hospitals. We aimed to study the impact of operating theatre critical event checklists on medical management and teamwork during whole‐team operating theatre crisis simulations staged in a surgical daycare facility. We studied 56 simulation encounters (without and with a checklist available) divided between an initial session and then a retention session several months later. Medical management and teamwork were quantified via pe...
Source: Anaesthesia - November 1, 2016 Category: Anesthesiology Authors: T. C. Everett, P. J. Morgan, R. Brydges, M. Kurrek, D. Tregunno, L. Cunningham, A. Chan, D. Forde, J. Tarshis Tags: Original Article Source Type: research

Helping experts and expert teams perform under duress: an agenda for cognitive aid research
(Source: Anaesthesia)
Source: Anaesthesia - November 1, 2016 Category: Anesthesiology Authors: S. D. Marshall Tags: Editorial Source Type: research

Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia ‐induced atelectasis in infants: a randomised, controlled trial
Summary Atelectasis occurs in the majority of children undergoing general anaesthesia. Lung ultrasound has shown reliable sensitivity and specificity for diagnosing anaesthesia‐induced atelectasis. We assessed the effects of a recruitment manoeuvre on atelectasis using lung ultrasound in infants undergoing general anaesthesia. Forty infants, randomly allocated to either a recruitment manoeuvre group or a control group, received volume‐controlled ventilation with 5 cmH2O positive end‐expiratory pressure. Lung ultrasound examination was performed twice in each patient, the first a minute after starting mechanical venti...
Source: Anaesthesia - November 1, 2016 Category: Anesthesiology Authors: I. ‐K. Song, E.‐H. Kim, J.‐H. Lee, S. Ro, H.‐S. Kim, J.‐T. Kim Tags: Original Article Source Type: research

Can systematic reviews with sparse data be trusted?
(Source: Anaesthesia)
Source: Anaesthesia - November 1, 2016 Category: Anesthesiology Authors: A. Afshari, J. Wetterslev, A. F. Smith Tags: Editorial Source Type: research

Classifying variables
(Source: Anaesthesia)
Source: Anaesthesia - October 31, 2016 Category: Anesthesiology Authors: S. W. Choi, D. M. H. Lam Tags: Statistically Speaking: methodological madness Source Type: research

Complications after emergency laparotomy beyond the immediate postoperative period – a retrospective, observational cohort study of 1139 patients
Summary Mortality and morbidity occur commonly following emergency laparotomy, and incur a considerable clinical and financial healthcare burden. Limited data have been published describing the postoperative course and temporal pattern of complications after emergency laparotomy. We undertook a retrospective, observational, multicentre study of complications in 1139 patients after emergency laparotomy. A major complication occurred in 537/1139 (47%) of all patients within 30 days of surgery. Unadjusted 30‐day mortality was 20.2% and 1‐year mortality was 34%. One hundred and thirty‐seven of 230 (60%) deaths occurred b...
Source: Anaesthesia - October 31, 2016 Category: Anesthesiology Authors: L. T. Tengberg, M. Cihoric, N. B. Foss, M. Bay ‐Nielsen, I. Gögenur, R. Henriksen, T. K. Jensen, M.‐B. Tolstrup, L. B. J. Nielsen Tags: Original Article Source Type: research

Tracheal extubation of the adult intensive care patient with a predicted difficult airway – a narrative review
Summary Management of the difficult airway is an important, but as yet poorly‐studied, component of intensive care management. Although there has been a strong emphasis on prediction and intubation of the difficult airway, safe extubation of the patient with a potentially difficult airway has not received the same attention. Extubation is a particularly vulnerable time for the critically ill patient and, because of the risks involved and the consequences of failure, it warrants specific consideration. The Royal College of Anaesthetists 4th National Audit Project highlighted differences in the incidence and consequences o...
Source: Anaesthesia - October 31, 2016 Category: Anesthesiology Authors: D. J. Sturgess, K. B. Greenland, S. Senthuran, F. A. Ajvadi, A. Zundert, M. G. Irwin Tags: Review Article Source Type: research

The impact of didactic read ‐aloud action cards on the performance of cannula cricothyroidotomy in a simulated ‘can't intubate can't oxygenate’ scenario
Summary Significant benefits have been demonstrated with the use of peri‐operative checklists. We assessed whether a read‐aloud didactic action card would improve performance of cannula cricothyroidotomy in a simulated ‘can't intubate, can't oxygenate’ scenario. A 17‐step action card was devised by an expert panel. Participants in their first 4 years of anaesthetic training were randomly assigned into ‘no‐card’ or ‘card’ groups. Scenarios were video‐recorded for analysis. Fifty‐three participants (27 no‐card and 26 card) completed the scenario. The number of steps omitted w...
Source: Anaesthesia - October 31, 2016 Category: Anesthesiology Authors: R. Harvey, L. Foulds, T. Housden, K. A. Bennett, D. Falzon, A. F. McNarry, C. Graham Tags: Original Article Source Type: research

Calling the patient's own name facilitates recovery from general anaesthesia: a randomised double ‐blind trial
In conclusion, using the patient's name may be an easy and effective method to facilitate recovery from general anaesthesia. (Source: Anaesthesia)
Source: Anaesthesia - October 27, 2016 Category: Anesthesiology Authors: Y. S. Jung, H. Paik, S. ‐H. Min, H. Choo, M. Seo, J.‐H. Bahk, J.‐H. Seo Tags: Original Article Source Type: research

Laboratory evaluation of a novel anaesthesia delivery device
Summary 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 fro...
Source: Anaesthesia - October 27, 2016 Category: Anesthesiology Authors: A. Paul, J. N. Clark, I. E. Salama, B. J. Jenkins, N. Goodwin, A. R. Wilkes, P. F. Mahoney, J. E. Hall Tags: Original Article Source Type: research

Fifty percent of anaesthetists are worse than average at understanding statistics and risk
(Source: Anaesthesia)
Source: Anaesthesia - October 22, 2016 Category: Anesthesiology Authors: B. Gibbison Tags: Statistically Speaking Source Type: research

Impact of spinal anaesthesia vs. general anaesthesia on peri ‐operative outcome in lumbar spine surgery: a systematic review and meta‐analysis of randomised, controlled trials
Summary Lumbar spinal surgery is most commonly performed under general anaesthesia. However, spinal anaesthesia has also been used. We aimed to systematically review the comparative evidence. We only included randomised, controlled trials in this meta‐analysis and calculated the risk ratio or standardised mean difference for haemodynamics, blood loss, surgical time, analgesic requirement, nausea and/or vomiting, and length of hospital stay. Eight studies with a total of 625 patients were included. These were considered to be at high risk of bias. Compared with general anaesthesia, the risk ratio (95% CI) with spinal anae...
Source: Anaesthesia - October 21, 2016 Category: Anesthesiology Authors: T. Meng, Z. Zhong, L. Meng Tags: Review Article Source Type: research

The effect of inhaled nitric oxide in acute respiratory distress syndrome in children and adults: a Cochrane Systematic Review with trial sequential analysis
In conclusion, there is insufficient evidence to support inhaled nitric oxide in any category of critically ill patients with acute respiratory distress syndrome despite a transient improvement in oxygenation, since mortality is not reduced and it may induce renal impairment. (Source: Anaesthesia)
Source: Anaesthesia - October 20, 2016 Category: Anesthesiology Authors: O. Karam, F. Gebistorf, J. Wetterslev, A. Afshari Tags: Review Article Source Type: research

A little less conversation
(Source: Anaesthesia)
Source: Anaesthesia - October 20, 2016 Category: Anesthesiology Authors: S. W. Choi, D. M. H. Lam Tags: Statistically Speaking Source Type: research

Beware the Trojan Horse – a timely reality check about re‐using single‐use devices
(Source: Anaesthesia)
Source: Anaesthesia - October 17, 2016 Category: Anesthesiology Authors: P. Hopkins, S. Patel Tags: Editorial Source Type: research

Cerebral oxygenation during changes in vascular resistance and flow in patients on cardiopulmonary bypass – a physiological proof of concept study
Summary Despite a rise in blood pressure, cerebral oxygenation decreases following phenylephrine administration, and we hypothesised that phenylephrine reduces cerebral oxygenation by activating cerebral α1 receptors. We studied patients on cardiopulmonary bypass during constant flow. Phenylephrine raised mean arterial pressure (α1‐mediated) from mean (SD) 69 (8) mmHg to 79 (8) mmHg; p = 0.001, and vasopressin raised mean arterial pressure (V1 mediated) from 69 (8) mmHg to 83 (6) mmHg; p = 0.001. Both drugs elicited a comparable decrease in cerebral oxygenation from 61 (7)% to 60 (7)%; p = 0.023 and 61 (8)% t...
Source: Anaesthesia - October 16, 2016 Category: Anesthesiology Authors: N. H. Sperna Weiland, D. Breevoord, D. A. J öbsis, E. M. F. H. Beaumont, V. Evers, B. Preckel, M. W. Hollmann, S. Dieren, B. A. J. M. Mol, R. V. Immink Tags: Original Article Source Type: research

Contamination of single ‐use bronchoscopes in critically ill patients
Summary Disposable bronchoscopes such as the Ambu aScopeTM 3 are marketed as ‘single use’ The risks of contamination from prolonged device storage before possible re‐use are unknown. Following clinical bronchoscopy in patients whose lungs were mechanically ventilated, 20 aScopeTM 3's bronchoscopes received a standard ‘social clean’ and were then stored. Subsequent paired saline flush and swab samples were taken at time zero, and at 24 h and 48 h. Positive microbiological cultures were obtained from at least one time point from 16 of the 20 bronchoscopes. Pathogens considered at high risk of causin...
Source: Anaesthesia - October 16, 2016 Category: Anesthesiology Authors: B. A. McGrath, S. Ruane, J. McKenna, S. Thomas Tags: Original Article Source Type: research

Potential for hypoxic gas mixture delivery using a Flexima 2 anaesthetic machine
(Source: Anaesthesia)
Source: Anaesthesia - October 12, 2016 Category: Anesthesiology Authors: C. Turnbull, T. Dexter Tags: Correspondence Source Type: research

Cap mount confusion in a DARTM HME Filter
(Source: Anaesthesia)
Source: Anaesthesia - October 12, 2016 Category: Anesthesiology Authors: S. Sanderson, A. Ball Tags: Correspondence Source Type: research

Tracheal tube pilot balloon fault – a reply
(Source: Anaesthesia)
Source: Anaesthesia - October 12, 2016 Category: Anesthesiology Authors: S. Murphy Tags: Correspondence Source Type: research

Tracheal tube pilot balloon fault
(Source: Anaesthesia)
Source: Anaesthesia - October 12, 2016 Category: Anesthesiology Authors: C. Burlinson, M. Sange Tags: Correspondence Source Type: research

Discontinuation of Enk Atomiser
(Source: Anaesthesia)
Source: Anaesthesia - October 12, 2016 Category: Anesthesiology Authors: D. Sirota Tags: Correspondence Source Type: research

Abandoning cricoid pressure – 2
(Source: Anaesthesia)
Source: Anaesthesia - October 12, 2016 Category: Anesthesiology Authors: M. T. Gwinnutt, J. A. Gwinnutt Tags: Correspondence Source Type: research

Can linear cognitive aids always be used in anaesthesia?
(Source: Anaesthesia)
Source: Anaesthesia - October 12, 2016 Category: Anesthesiology Authors: A. Blanie, D. Benhamou Tags: Correspondence Source Type: research