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Anaesthesia,Volume 73, Issue 4, Page 466-473, April 2018. (Source: Anaesthesia)
Source: Anaesthesia - January 10, 2018 Category: Anesthesiology Source Type: research

A randomised controlled trial comparing needle movements during combined spinal ‐epidural anaesthesia with and without ultrasound assistance
Summary Ultrasound assistance for neuraxial techniques may improve technical performance; however, it is unclear which populations benefit most. Our study aimed to investigate the efficacy of neuraxial ultrasound in women having caesarean section with combined spinal‐epidural anaesthesia, and to identify factors associated with improved technical performance. Two‐hundred and eighteen women were randomly allocated to ultrasound‐assisted or control groups. All the women had a pre‐procedure ultrasound, but only women in the ultrasound group had this information conveyed to the anaesthetist. Primary outcomes were first...
Source: Anaesthesia - January 10, 2018 Category: Anesthesiology Authors: A. Chin, B. Crooke, L. Heywood, R. Brijball, A. M. Pelecanos, W. Abeypala Tags: Original Article Source Type: research

Systematic review of benefits or harms of routine anaesthetist ‐inserted throat packs in adults: practice recommendations for inserting and counting throat packs
Summary Throat packs are commonly inserted by anaesthetists after induction of anaesthesia for dental, maxillofacial, nasal or upper airway surgery. However, the evidence supporting this practice as routine is unclear, especially in the light of accidentally retained throat packs which constitute ‘Never Events’ as defined by NHS England. On behalf of three relevant national organisations, we therefore conducted a systematic review and literature search to assess the evidence base for benefit, and also the extent and severity of complications associated with throat pack use. Other than descriptions of how to ins...
Source: Anaesthesia - January 10, 2018 Category: Anesthesiology Authors: V. Athanassoglou, A. Patel, B. McGuire, A. Higgs, M. S. Dover, P. A. Brennan, A. Banerjee, B. Bingham, J. J. Pandit Tags: Review Article Source Type: research

Big data, big problems: causation, confounders and cohorts
(Source: Anaesthesia)
Source: Anaesthesia - January 8, 2018 Category: Anesthesiology Authors: S. W. Choi, G. T. C. Wong Tags: Statistically Speaking: Demystifying Methods Source Type: research

A systematic review of outcomes in postoperative pain studies in paediatric and adolescent patients: towards development of a core outcome set
This study provides an evidence‐based foundation for the development of a core outcome set for paediatric postoperative pain studies. We searched ClinicalTrials.gov to identify relevant postoperative pain studies in children. The search yielded 300 registered trials. The following data were then extracted from each of the trials: phase of trial; study type; study design; sample size; all outcomes; whether the outcome was listed as primary, secondary, or tertiary; the measurement instrument for each reported outcome; the specific metric for each outcome; and the type of clinical procedure. Following screening, 134 studies...
Source: Anaesthesia - January 8, 2018 Category: Anesthesiology Authors: A. Ross, J. Young, R. Hedin, G. Aran, A. Demand, A. Stafford, J. Worley, M. Moore, M. Vassar Tags: Review Article Source Type: research

Prospective clinical trial registration: not sufficient, but always necessary
Anaesthesia, EarlyView. (Source: Anaesthesia)
Source: Anaesthesia - January 2, 2018 Category: Anesthesiology Source Type: research

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Anaesthesia, Ahead of Print. (Source: Anaesthesia)
Source: Anaesthesia - January 2, 2018 Category: Anesthesiology Source Type: research

Adherence to guidance on registration of randomised controlled trials published in Anaesthesia
Anaesthesia, EarlyView. (Source: Anaesthesia)
Source: Anaesthesia - January 1, 2018 Category: Anesthesiology Source Type: research

Journal response: prospective clinical trial registration – desirable, but not necessary
Anaesthesia, EarlyView. (Source: Anaesthesia)
Source: Anaesthesia - January 1, 2018 Category: Anesthesiology Source Type: research

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Anaesthesia, Ahead of Print. (Source: Anaesthesia)
Source: Anaesthesia - January 1, 2018 Category: Anesthesiology Source Type: research

Transnasal humidified rapid ‐insufflation ventilatory exchange (THRIVE) vs. facemask breathing pre‐oxygenation for rapid sequence induction in adults: a prospective randomised non‐blinded clinical trial
Summary Transnasal humidified rapid‐insufflation ventilatory exchange (THRIVE) can prolong apnoea time in adults. Therefore, THRIVE used for pre‐oxygenation in rapid sequence induction of anaesthesia could extend safe apnoea time during prolonged laryngoscopy and intubation. In this randomised controlled trial, we compared the lowest peripheral oxygen saturation (SpO2) during intubation when pre‐oxygenating with either traditional facemask or THRIVE. Eighty adult patients, undergoing rapid sequence induction of anaesthesia for emergency surgery, were randomly allocated to pre‐oxygenation with 100% oxygen with facem...
Source: Anaesthesia - January 1, 2018 Category: Anesthesiology Authors: Å. Lodenius, J. Piehl, A. Östlund, J. Ullman, M. Jonsson Fagerlund Tags: Original Article Source Type: research

Combined thoracic paravertebral and pectoral nerve blocks for breast surgery under sedation: a prospective observational case series
Summary Avoidance of general anaesthesia for breast surgery may be because of clinical reasons or patient choice. There is emerging evidence that the use of regional anaesthesia and the avoidance of volatile anaesthetics and opioid analgesia may have beneficial effects on oncological outcomes. We conducted a prospective observational case series of 16 breast cancer surgeries performed under thoracic paravertebral plus pectoral nerve block with propofol sedation to demonstrate feasibility of technique, patient acceptability and surgeon satisfaction. Fifteen out of 16 cases were successfully completed under sedation and regi...
Source: Anaesthesia - January 1, 2018 Category: Anesthesiology Authors: A. Pawa, J. Wight, D. N. Onwochei, R. Vargulescu, I. Reed, L. Chrisman, E. Pushpanathan, A. Kothari, K. El ‐Boghdadly Tags: Original Article Source Type: research

Have we reached the end for throat packs inserted by anaesthetists?
(Source: Anaesthesia)
Source: Anaesthesia - January 1, 2018 Category: Anesthesiology Authors: C. R. Bailey, R. Nouraie, J. M. Huitink Tags: Editorial Source Type: research

A before ‐and‐after observational study of a protocol for use of the C‐MAC videolaryngoscope with a Frova introducer in pre‐hospital rapid sequence intubation
Summary Results using videolaryngoscopy in pre‐hospital rapid sequence intubation are mixed. A bougie is not commonly used with videolaryngoscopy. We hypothesised that using videolaryngoscopy and a bougie as core elements of a standardised protocol that includes a drugs and a laryngoscopy algorithm would result in a high first‐pass tracheal intubation success rate. We employed videolaryngoscopy (C‐MAC) combined with a bougie (Frova intubating introducer) in an anaesthetist‐staffed helicopter emergency medical service. Data for adult tracheal intubation were collected prospectively as part of the airway registry of ...
Source: Anaesthesia - January 1, 2018 Category: Anesthesiology Authors: S. Ångerman, H. Kirves, J. Nurmi Tags: Original Article Source Type: research

An observational feasibility study of a new anaesthesia drug storage tray
Summary Drug errors in the anaesthetic domain remain a serious cause of iatrogenic harm. To help reduce this issue, we explored the potential safety impact of using a simple colour‐coded tray for anaesthetic drug preparation and storage. Over a six‐month period, three different trained researchers observed 30 cases at three NHS Trusts. Ten observations involved standard drug trays in ‘normal’ practice, and 20 observations, involved ‘Rainbow trays’ before and after their introduction. We conducted 20 semi‐structured interviews immediately after completing the Rainbow tray observation with the a...
Source: Anaesthesia - January 1, 2018 Category: Anesthesiology Authors: D. S. Almghairbi, L. Sharp, R. Griffiths, R. Evley, S. Gupta, I. K. Moppett Tags: Original Article Source Type: research

Adherence to guidance on registration of randomised controlled trials published in Anaesthesia
We examined the rates of prospective trial registration, the incidence of discrepancies in primary outcome measure(s) and sample sizes, and the citation metrics of all randomised controlled trials published in Anaesthesia over a 3‐year period (2014–2016). Of the 422 randomised controlled trials submitted during the study period, 115 (27.3%) were accepted for publication, of which 90 (78.3%) were patient studies, with the remaining 25 comprising manikin, simulation, volunteer, bench, cadaver and other non‐patient intervention studies. Of the accepted patient studies, 64 (71.1%) were prospectively registered with a...
Source: Anaesthesia - January 1, 2018 Category: Anesthesiology Authors: K. El ‐Boghdadly, M. D. Wiles, S. Atton, C. R. Bailey Tags: Original Article Source Type: research

Journal response: prospective clinical trial registration – desirable, but not necessary
(Source: Anaesthesia)
Source: Anaesthesia - January 1, 2018 Category: Anesthesiology Authors: J. J. Pandit, A. A. Klein Tags: Editorial Source Type: research

Prospective clinical trial registration: not sufficient, but always necessary
(Source: Anaesthesia)
Source: Anaesthesia - January 1, 2018 Category: Anesthesiology Authors: S. M. Smith, R. H. Dworkin Tags: Editorial Source Type: research

The comparative efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in adults. A Cochrane systematic review with meta ‐analysis and trial sequential analysis
Summary We compared the efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in adults. Our outcomes were: recovery time from second twitch to train‐of‐four ratio> 0.9; recovery time from post‐tetanic count 1–5 to train‐of‐four ratio> 0.9; and risk of composite adverse and serious adverse events. We searched for randomised clinical trials irrespective of publication status and date, blinding status, outcomes reported or language. We included 41 studies with 4206 participants. Time to reversal of neuromuscular blockade from second twitch to a train‐of‐four...
Source: Anaesthesia - December 27, 2017 Category: Anesthesiology Authors: A. ‐M. Hristovska, P. Duch, M. Allingstrup, A. Afshari Tags: Review Article Source Type: research

The comparative efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in adults. A Cochrane systematic review with meta ‐analysis and trial sequential analysis
Anaesthesia, EarlyView. (Source: Anaesthesia)
Source: Anaesthesia - December 27, 2017 Category: Anesthesiology Source Type: research

Definitions of anaesthetic technique and the implications for clinical research
Anaesthesia, EarlyView. (Source: Anaesthesia)
Source: Anaesthesia - December 27, 2017 Category: Anesthesiology Source Type: research

Exploring performance of, and attitudes to, Stop ‐ and Mock‐Before‐You‐Block in preventing wrong‐side blocks
Anaesthesia,Volume 73, Issue 4, Page 421-427, April 2018. (Source: Anaesthesia)
Source: Anaesthesia - December 27, 2017 Category: Anesthesiology Source Type: research

Working out wrong ‐side blocks
Anaesthesia,Volume 73, Issue 4, Page 407-420, April 2018. (Source: Anaesthesia)
Source: Anaesthesia - December 27, 2017 Category: Anesthesiology Source Type: research

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Anaesthesia, Ahead of Print. (Source: Anaesthesia)
Source: Anaesthesia - December 27, 2017 Category: Anesthesiology Source Type: research

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Anaesthesia,Volume 73, Issue 4, Page 421-427, April 2018. (Source: Anaesthesia)
Source: Anaesthesia - December 27, 2017 Category: Anesthesiology Source Type: research

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Anaesthesia,Volume 73, Issue 4, Page 407-420, April 2018. (Source: Anaesthesia)
Source: Anaesthesia - December 27, 2017 Category: Anesthesiology Source Type: research

Working out wrong ‐side blocks
(Source: Anaesthesia)
Source: Anaesthesia - December 27, 2017 Category: Anesthesiology Authors: I. K. Moppett, S. T. Shorrock Tags: Editorial Source Type: research

Working out wrong ‐site blocks
(Source: Anaesthesia)
Source: Anaesthesia - December 27, 2017 Category: Anesthesiology Authors: I. K. Moppett, S. T. Shorrock Tags: Editorial Source Type: research

Exploring performance of, and attitudes to, Stop ‐ and Mock‐Before‐You‐Block in preventing wrong side anaesthetic blocks
Summary We conducted an online survey to assess the career experiences of wrong side blocks, the practice of Stop‐Before‐You‐Block, the recently described method of Mock‐Before‐You‐Block and attitudes to these. Respondents were 208 anaesthetists across nine hospitals (173 consultants or Staff and Associate Specialist doctors'), representing 3623 years of collective anaesthetic practice. There had been a total of 62 wrong side blocks (by 51 anaesthetists and one current trainee). Predisposing factors for this were commonly ascribed to distractions (35 (69%), for example due to rushing or teaching), patient ...
Source: Anaesthesia - December 27, 2017 Category: Anesthesiology Authors: M. Hopping, A. F. Merry, J. J. Pandit Tags: Original Article Source Type: research

Definitions of anaesthetic technique and the implications for clinical research
(Source: Anaesthesia)
Source: Anaesthesia - December 27, 2017 Category: Anesthesiology Authors: R. A. Armstrong, R. Mouton Tags: Editorial Source Type: research

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review
Summary Elderly patients with hip fracture experience high morbidity and mortality, and are often undertreated for pain. Acute pain management in the elderly is challenging, with physiological frailty, medical comorbidities and cognitive impairment commonly compounding pain assessment and treatment. Guidelines outlining current best practice for acute pain management in the elderly now exist, but evidence suggests that practice remains variable and there continues to be scope for improvement. We conducted a narrative review of the literature to examine the challenges of acute pain management in the elderly, and to evaluate...
Source: Anaesthesia - December 26, 2017 Category: Anesthesiology Authors: A. Scurrah, C. T. Shiner, J. A. Stevens, S. G. Faux Tags: Review Article Source Type: research

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review
Anaesthesia, EarlyView. (Source: Anaesthesia)
Source: Anaesthesia - December 26, 2017 Category: Anesthesiology Source Type: research

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Anaesthesia, Ahead of Print. (Source: Anaesthesia)
Source: Anaesthesia - December 26, 2017 Category: Anesthesiology Source Type: research

The link between gastric volume and aspiration risk. In search of the Holy Grail?
(Source: Anaesthesia)
Source: Anaesthesia - December 19, 2017 Category: Anesthesiology Authors: P. Van de Putte, A. Perlas Tags: Editorial Source Type: research

The effect of pre ‐operative gastric ultrasound examination on the choice of general anaesthetic induction technique for non‐elective paediatric surgery. A prospective cohort study
Summary Ultrasound examination of the gastric antrum is a non‐invasive tool that allows reliable estimation of gastric contents. We performed this prospective cohort study in non‐elective paediatric surgery to assess whether gastric ultrasound may help to determine the best anaesthetic induction technique, whether rapid sequence or routine. The primary outcome was the reduction of inappropriate induction technique. A pre‐operative clinical assessment was performed by the attending anaesthetist who made a provisional plan for induction. Gastric ultrasound was performed in the semi‐recumbent and right lateral decubit...
Source: Anaesthesia - December 19, 2017 Category: Anesthesiology Authors: A. ‐C. Gagey, M. Queiroz Siqueira, C. Monard, S. Combet, B. Cogniat, F.‐P. Desgranges, P. Robinson, D. Chassard, L. Bouvet Tags: Original Article Source Type: research

Gastric ultrasound in the third trimester of pregnancy: a randomised controlled trial to develop a predictive model of volume assessment
Summary Bedside gastric ultrasonography can be performed reliably by anaesthetists to assess gastric content in the peri‐operative period. We aimed to study the relationship between gastric cross‐sectional area, assessed by ultrasound, and volumes of clear fluids ingested by pregnant women. We recruited 60 non‐labouring third‐trimester pregnant women in a randomised controlled and assessor‐blinded study. A standardised scanning protocol of the gastric antrum was performed in the 45° semirecumbent and 45° semirecumbent‐right lateral positions. Subjects were randomly allocated to drink one out of six pred...
Source: Anaesthesia - December 19, 2017 Category: Anesthesiology Authors: C. Arzola, A. Perlas, N. T. Siddiqui, K. Downey, X. Y. Ye, J. C. A. Carvalho Tags: Original Article Source Type: research

The association of pre ‐operative home accelerometry with cardiopulmonary exercise variables
Summary We investigated the association of pre‐operative activity, reported by the Duke Activity Score Index, Short Form‐12 and measured by an accelerometer worn at home, with five cardiopulmonary exercise variables: peak power; peak oxygen consumption; anaerobic threshold; and ventilatory equivalents for oxygen and carbon dioxide. Fifty patients scheduled for major surgery underwent a standard pre‐operative cardiopulmonary exercise test and wore a chest‐mounted triaxial accelerometer for a mean (SD) duration of 3.2 (0.4) days. The Duke Activity Score Index and six accelerometer variables were significantly co...
Source: Anaesthesia - December 12, 2017 Category: Anesthesiology Authors: H. W. Cui, G. S. Kirby, K. Surmacz, C. Hargrove, J. Griffiths, B. W. Turney Tags: Original Article Source Type: research

The association of pre ‐operative home accelerometry with cardiopulmonary exercise variables
Anaesthesia, EarlyView. (Source: Anaesthesia)
Source: Anaesthesia - December 12, 2017 Category: Anesthesiology Source Type: research

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Anaesthesia, Ahead of Print. (Source: Anaesthesia)
Source: Anaesthesia - December 12, 2017 Category: Anesthesiology Source Type: research

Peri ‐operative management of patients with type‐2 diabetes mellitus undergoing non‐cardiac surgery using liraglutide, glucose–insulin–potassium infusion or intravenous insulin bolus regimens: a randomised controlled trial
Summary In this open‐label multicentre randomised controlled trial, we investigated three peri‐operative treatment strategies to lower glucose and reduce the need for rescue insulin in patients aged 18–75 years with type‐2 diabetes mellitus undergoing non‐cardiac surgery. Patients were randomly allocated using a web‐based randomisation program to premedication with liraglutide (liraglutide group), glucose–insulin–potassium infusion (insulin infusion group) or insulin bolus regimen (insulin bolus group), targeting a glucose
Source: Anaesthesia - December 12, 2017 Category: Anesthesiology Authors: J. A. W. Polderman, S. C. J. Steen, B. Thiel, M. B. Godfried, P. L. Houweling, M. W. Hollmann, J. H. DeVries, B. Preckel, J. Hermanides Tags: Original Article Source Type: research

Intravenous dexamethasone for prophylaxis of postoperative nausea and vomiting after administration of long ‐acting neuraxial opioids: a systematic review and meta‐analysis
Summary Long‐acting neuraxial opioids provide excellent analgesia after surgery, but are associated with higher rates of postoperative nausea and vomiting. Dexamethasone effectively prevents postoperative nausea and vomiting after general anaesthesia, but its value in patients receiving long‐acting neuraxial opioids is undetermined. Therefore, the objective of this meta‐analysis was to assess the prophylactic anti‐emetic efficacy of intravenous (i.v.) dexamethasone in this population. The study methodology followed the PRISMA statement guidelines. The primary outcome was the need for rescue anti‐emetics during th...
Source: Anaesthesia - December 11, 2017 Category: Anesthesiology Authors: S. Grape, I. Usmanova, K. R. Kirkham, E. Albrecht Tags: Review Article Source Type: research

Pilot multi ‐centre randomised trial of the impact of pre‐operative focused cardiac ultrasound on mortality and morbidity in patients having surgery for femoral neck fractures (ECHONOF‐2 pilot)
Anaesthesia,Volume 73, Issue 4, Page 428-437, April 2018. (Source: Anaesthesia)
Source: Anaesthesia - December 11, 2017 Category: Anesthesiology Source Type: research

Intravenous dexamethasone for prophylaxis of postoperative nausea and vomiting after administration of long ‐acting neuraxial opioids: a systematic review and meta‐analysis
Anaesthesia,Volume 73, Issue 4, Page 480-489, April 2018. (Source: Anaesthesia)
Source: Anaesthesia - December 11, 2017 Category: Anesthesiology Source Type: research

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Anaesthesia,Volume 73, Issue 4, Page 428-437, April 2018. (Source: Anaesthesia)
Source: Anaesthesia - December 11, 2017 Category: Anesthesiology Source Type: research

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Anaesthesia,Volume 73, Issue 4, Page 480-489, April 2018. (Source: Anaesthesia)
Source: Anaesthesia - December 11, 2017 Category: Anesthesiology Source Type: research

Pilot multi ‐centre randomised trial of the impact of pre‐operative focused cardiac ultrasound on mortality and morbidity in patients having surgery for femoral neck fractures (ECHONOF‐2 pilot)
Summary Hip fracture surgery is common, usually occurs in elderly patients who have multiple comorbidities, and is associated with high morbidity and mortality. Pre‐operative focused cardiac ultrasound can alter diagnosis and management, but its impact on outcome remains uncertain. This pilot study assessed feasibility and group separation for a proposed large randomised clinical trial of the impact of pre‐operative focused cardiac ultrasound on patient outcome after hip fracture surgery. Adult patients requiring hip fracture surgery in four teaching hospitals in Australia were randomly allocated to receive focused car...
Source: Anaesthesia - December 11, 2017 Category: Anesthesiology Authors: D. J. Canty, J. Heiberg, Y. Yang, A. G. Royse, S. Margale, N. Nanjappa, D. Scott, A. Maier, D. I. Sessler, A. Chuan, A. Palmer, A. Bucknill, C. French, C. F. Royse Tags: Original Article Source Type: research

Between evidence and commerce – the case of sufentanil sublingual tablet systems
(Source: Anaesthesia)
Source: Anaesthesia - December 8, 2017 Category: Anesthesiology Authors: C. Bantel, H. C. Laycock Tags: Editorial Source Type: research

Pharmacokinetics and pharmacodynamics of sublingual sufentanil for postoperative pain management
Summary Achieving successful treatment of postoperative pain remains a challenge. Recently, a sufentanil sublingual tablet system has been developed for treatment of moderate‐to‐severe postoperative pain. The phenylpiperidine sufentanil is a potent analgesic that rapidly crosses the blood–brain barrier and selectively activates central μ‐opioid receptors. The system makes use of a hand‐held dispenser system, which contains forty 15‐μg sufentanil sublingual micro‐tablets. The patient can release one tablet at 20‐min intervals using a unique radiofrequency adhesive tag, which is wrapped around the p...
Source: Anaesthesia - December 8, 2017 Category: Anesthesiology Authors: T. Donk, S. Ward, R. Langford, A. Dahan Tags: Review Article Source Type: research