Symptoms of depression are common among patients before surgery. Depression may be associated with worse postoperative pain and other pain-related outcomes. This review aimed to characterise the impact of pre-operative depression on postoperative pain outcomes. We conducted a systematic review of observational studies that reported an association between pre-operative depression and pain outcomes after

The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied complications of the airway and respiratory system during anaesthesia care including peri-operative cardiac arrest. Among 24,721 surveyed cases, airway and respiratory complications occurred commonly (n = 421 and n = 264, respectively). The most common airway complications were: laryngospasm (157, 37%); airway failure

Point-of-care haemoglobin measurement devices may play an important role in the antenatal detection of anaemia in pregnant people and may be useful in guiding blood transfusion during resuscitation in obstetric haemorrhage. We compared baseline haemoglobin variability of venous and capillary HemoCue® haemoglobin, and Masimo® Rad-67 Pulse CO-Oximeter haemoglobin with laboratory haemoglobin in people

Current guidance recommends that, in most circumstances, cardiopulmonary resuscitation should be attempted when cardiac arrest occurs during anaesthesia, and when a patient has a pre-existing ‘do not attempt cardiopulmonary resuscitation’ recommendation, this should be suspended. How this guidance is translated into everyday clinical practice in the UK is currently unknown. Here, as part of the 7th

It is commendable that O'Carroll et al. highlight the need for improvement in postnatal care and underpin the potential importance of anaesthesia on postpartum recovery, with the goal of identifying populations that may benefit most from targeted interventions to improve the postpartum recovery experience [1]. We previously highlighted the crucial role of obstetric anaesthetists in patient blood management

There is conflicting evidence regarding the association between epidural labour analgesia and risk of postpartum depression. Most previous studies were observational trials with limited ability to account for confounders. We aimed to determine if epidural analgesia was associated with a significant change in the incidence of postpartum depression in this randomised controlled trial. We enrolled women

There is growing evidence that, in patients with immediate hypersensitivity reactions to penicillins and cephalosporins, cross-sensitivity is related to similar side chains rather than to the common beta lactam ring [1, 2]. Cefazolin has unique side chains. Following the implementation of an algorithm allowing the administration of cefazolin to all patients with a history of penicillin allergy (except

The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest in the UK, a topic of importance to patients, anaesthetists and surgeons. Here we report the results of the 12-month registry, from 16 June 2021 to 15 June 2022, focusing on epidemiology and clinical features. We reviewed 881 cases of peri-operative cardiac arrest, giving an incidence of 3 in

We investigated the efficacy and safety of a bilateral anterior quadratus lumborum block in patients undergoing minimally invasive colorectal surgery. This was a two-centre, double-blind, prospective, randomised, placebo-controlled trial including 150 patients undergoing laparoscopic colorectal surgery (left- or right hemicolectomy, sigmoidectomy) who were enrolled in the institutional abdominal enhanced

The escalating epidemic of burnout in healthcare professionals affects provider well-being, patient care and sustainability of healthcare systems. The objective of this study was to determine the prevalence of burnout among anaesthesia care providers (consultants, trainees or nurse anaesthetists) in Switzerland and identify risk factors to develop strategies for prevention. This multicentre cross-sectional

The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest in the UK, a topic of importance to patients, anaesthetists and surgeons. We report the results of the 12-month registry phase, from 16 June 2021 to 15 June 2022, focusing on management and outcomes. Among 881 cases of peri-operative cardiac arrest, the initial rhythm was non-shockable in 723

Over 200 health journals call on the United Nations, political leaders and health professionals to recognise that climate change and biodiversity loss are one indivisible crisis and must be tackled together to preserve health and avoid catastrophe. This overall environmental crisis is now so severe as to be a global health emergency. The world is currently responding to the climate crisis and the nature

We aimed to test whether bilateral injection of bupivacaine 0.25% in the transversalis fascia plane reduced 24 h opioid dose after singleton caesarean section, under spinal anaesthesia with intrathecal morphine, compared with saline 0.9% injectate. We allocated randomly 52 women to bilateral injection of 20 ml saline 0.9% on arrival in the post-anaesthesia care unit and 54 women to bilateral injection

Kane et al. report results from 7th National Audit Project (NAP7) of the Royal College of Anaesthetists [1]. Their focus was on the incidence of potentially serious complications during non-obstetric anaesthesia practice, and it has robust and well-described data collection methods and case ascertainment. Because of the very high levels of engagement with the project, and because it contains solely

I read with interest the article by Javanmard-Emamghissi et al. examining the outcomes of patients at extreme risk of mortality undergoing emergency laparotomy, according to the National Emergency Laparotomy Audit (NELA) risk score [1]. I would like to draw attention to the ongoing evolution that is shared decision-making peri-operatively and the crusade to improve the trust in patient–physician relationships

Emergency airway management in children is challenging, with a high incidence of adverse events. Our recent prospective, observational study of non-theatre emergency airway management in adults, identified that adverse events occurred frequently, despite high use of videolaryngoscopy and high first-pass tracheal intubation success [1]. This study reports the paediatric case data collected for 42 days

Complications and critical incidents arising during anaesthesia due to patient, surgical or anaesthetic factors, may cause harm themselves or progress to more severe events, including cardiac arrest or death. As part of the 7th National Audit Project of the Royal College of Anaesthetists, we studied a prospective national cohort of unselected patients. Anaesthetists recorded anonymous details of all

We conducted a systematic review of the literature reporting phenylephrine-induced changes in blood pressure, cardiac output, cerebral blood flow and cerebral tissue oxygen saturation as measured by near-infrared spectroscopy in humans. We used the proportion change of the group mean values reported by the original studies in our analysis. Phenylephrine elevates blood pressure whilst concurrently inducing

Preparing injectable medicines is a complex process [1], frequently performed by anaesthetists (an average of about 10 drug administrations per case) [2] and with more steps on which human factors can apply than any other procedure anaesthetists carry out. Design changes are one way of reducing human factor influences [3] and the use of prefilled syringes could make medication errors 17 times less

The Royal College of Anaesthetists' 7th National Audit Project baseline survey assessed knowledge, attitudes, practices and experiences of peri-operative cardiac arrests among UK anaesthetists and Anaesthesia Associates. We received 10,746 responses, representing a 71% response rate. In-date training in adult and paediatric advanced life support was reported by 9646 (90%) and 7125 (66%) anaesthetists

Persistent postoperative opioid use (‘persistence’) is defined as the presence of an active prescription for opioids more than 90 days post-surgery [1]. Opioid-experienced patients are at high risk of developing persistence after surgery, with one study reporting 1.72 times greater odds of persistence in participants who used any opioid in the 12 months before surgery when compared with an opioid-naïve

We report the results of the Royal College of Anaesthetists' 7th National Audit Project organisational baseline survey sent to every NHS anaesthetic department in the UK to assess preparedness for treating peri-operative cardiac arrest. We received 199 responses from 277 UK anaesthetic departments, representing a 72% response rate. Adult and paediatric anaesthetic care was provided by 188 (95%) and

It is unclear if cardiopulmonary resuscitation is an aerosol-generating procedure and whether this poses a risk of airborne disease transmission to healthcare workers and bystanders. Use of airborne transmission precautions during cardiopulmonary resuscitation may confer rescuer protection but risks patient harm due to delays in commencing treatment. To quantify the risk of respiratory aerosol generation

In 2000, a randomised trial by Ronco et al. entitled Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure was published [1]. Behind the nondescript title lay some dramatic results. Four hundred and twenty-five patients admitted to the intensive care unit (ICU) with acute renal failure were allocated at random to receive renal replacement therapy with

We read the article by Akowuah et al. on prehabilitation in elective cardiac surgery with interest and commend the authors for successfully conducting a large-scale trial that includes both exercise and inspiratory muscle training [1]. We would like to address several considerations that might improve the generalisability of the study. The authors acknowledged the potential for observer bias in reporting

Cardiac surgery requiring cardiopulmonary bypass is associated with postoperative acute kidney injury and neurocognitive disorders, including delirium. Intra-operative inflammation and/or impaired tissue perfusion/oxygenation are thought to be contributors to these outcomes. It has been hypothesised that these problems may be ameliorated by the highly selective α2-agonist, dexmedetomidine. We tested

The current pandemic of surgical complications necessitates urgent and pragmatic innovation to reduce postoperative morbidity and mortality, which are associated with poor pre-operative fitness and anaemia. Exercise prehabilitation is a compelling strategy, but it has proven difficult to establish that it improves outcomes either in isolation or as part of a multimodal approach. Simulated altitude

Acute postoperative pain remains a critical treatment priority and has prompted a search for technologies and techniques to assist with intra-operative analgesic monitoring and management. Anaesthetists traditionally rely on clinical judgement to guide intra-operative analgesia, but several emerging technologies such as the nociception level index herald the possibility of routine intra-operative analgesia

The effects of oral dexamethasone on peripheral nerve blocks have not been investigated. We randomly allocated adults scheduled for forearm or hand surgery to oral placebo (n = 61), dexamethasone 12 mg (n = 61) or dexamethasone 24 mg (n = 57) about 45 min before lateral infraclavicular block. Mean (SD) time until first pain after block were: 841 (327) min; 1171 (318) min; and 1256 (395) min, respectively

Central to our work as anaesthetists is the safety of our patients, and a vital component of this is uninterrupted monitoring during all phases of anaesthesia and recovery. Current UK minimum monitoring standards are agreed on by consensus in the Association of Anaesthetists' guidelines and are updated regularly [1, 2]. Although the activity survey component of the Royal College of Anaesthetists' 7th

Desflurane has a high global warming potential when compared with other halogenated anaesthetics such as sevoflurane. For this reason, the World Federation of Societies of Anaesthesiologists (WFSA) issued guidelines to encourage the substitution of this gas with alternative options that have a lesser environmental impact, including the use of total intravenous anaesthesia (TIVA) [1]. Over the past

Accidental dural puncture during labour analgesia often leads to a post-dural puncture headache (PDPH) and, consequently, depression, neurological complications and chronic pain [1, 2]. Epidural blood patch (EBP), the gold standard treatment for PDPH, is not always successful and may not prevent complications [3]. The injection of prophylactic intravenous cosyntropin may decrease headaches by increasing

We thank our colleagues [1] for their support of the CT Angiography Consensus Guideline to support a clinical diagnosis of death using neurological criteria [2]. Since the 1970s the UK has championed a brain-based definition of death. Subsequent UK Codes of Practice clarified the functions whose loss would indicate that death has occurred: namely the capacity for consciousness and breathing. There

We are delighted that Martis et al. [1] agree that the findings of the PrEPS trial [2] add significantly to the body of research aiming to understand the role of prehabilitation in patients undergoing elective cardiac surgery. We did note an increase in the proportion of adverse events which occurred in the prehabilitation group compared with standard care. This was both in relation to the total number

We thank Xue et al. [1] for their interest in our article [2] and we are happy to address their queries. First, both groups had the same local anaesthesia and sedation regimen made up of superior laryngeal nerve block, tracheal block and remifentanil sedation. The only difference was that the entry point for anaesthesia was a piece of gauze impregnated with 5% lidocaine in the fibreoptic group and

We read with interest the article by Harrogate et al. assessing peri-operative tobacco cessation interventions which shows that peri-operative smoking cessation interventions are superior to usual care, in particular when they are intensive and span the pre-operative and postoperative periods [1]. Their review bridges several decades including more recent trials examining the effectiveness of electronic

Plain language summaries (also described as lay summaries) aim to make scientific research more accessible to a wider audience (including patients, caregivers and the general public) by describing research findings in clear, concise language that avoids technical jargon [1, 2]. Plain language summaries can enhance knowledge and understanding of research, increase participation in clinical trials and

Patients who require emergency laparotomy are defined as high risk if their 30-day predicted risk of mortality is ≥ 5%. Despite a large difference in the characteristics of patients with a mortality risk score of between 5% and 50%, these outcomes are aggregated by the National Emergency Laparotomy Audit (NELA). Our aim was to describe the outcomes of the cohort of patients at extreme risk of death

The procedure-specific postoperative pain management (PROSPECT) working group develops evidence-based pain management recommendations. PROSPECT methodology is unique and rigorous. However, several limitations were recognised that needed to be addressed, and several new factors were identified that improved PROSPECT methodology. The aim of this article is to present updated PROSPECT methodology for

We thank Drs Buchanan and Scott [1] for commenting on our review [2] and the opportunity to reply. They point out that clinical examination has several uses in airway management, including diagnosis of endobronchial intubation, pneumothorax and bronchospasm, but mistakenly suggest we discourage using clinical signs during the intubation sequence. In fact, our systematic review is silent about these

The NHS is facing a massive backlog in elective surgical cases after the COVID-19 pandemic, with an estimated seven million people in the UK currently awaiting an elective procedure. Effective pre-operative assessment can identify patients at risk of postoperative complications, facilitate shared decision-making discussions and guide resource allocation to improve patient outcomes. In June 2021, the Centre

We welcome the publication of the guideline by Thomas et al. [1]. It offers clear and comprehensive instructions on the indications, conduct and interpretation of 4-point CT angiography for ancillary testing to aid the confirmation of death by neurological criteria. However, the guideline does not include any specific comment on isolated infratentorial brain pathology or injury. The Faculty of Intensive

Kamga et al. [1] evaluated the performance of the Airtraq® (Prodol Meditec S.A., Vizcaya, Spain) videolaryngoscope for awake flexible nasal bronchoscopy in patients with an anticipated difficult airway. To differentiate the effect of one factor on the primary outcome in a randomised controlled trial, all other factors must be standardised to avoid potential bias. However, other than the limitations

We appreciate the insightful comments of Drs Cormier and Hyman [1] regarding our study [2]. Airway manoeuvres such as tongue traction and jaw thrust play an important role in successful fibrescopic tracheal intubation and the fact that not applying them may have prolonged the tracheal intubation time in our study has already been discussed in the limitations section. However, we would like to clarify

The Project for Universal Management of Airways (PUMA) guidelines for prevention of unrecognised oesophageal intubation [1] recommend universal use of videolaryngoscopy for tracheal intubation whenever feasible. Potential barriers to implementation of this recommendation relate to criticism that it may reduce the experience that anaesthetists gain in direct laryngoscopy techniques [2], as well as lack

We welcome the continuing discussion around the international consensus guideline for the prevention of unrecognised oesophageal intubation [1] as applied to cardiopulmonary resuscitation [2, 3]. Qureshi et al. share a vignette (unrelated to cardiopulmonary resuscitation) intended to highlight how adhering to the guideline might have caused harm. Yet the actions they advocate are entirely consistent

The growing body of evidence supporting the safety profile and success rates of videolaryngoscopy is likely to result in a wider range of these devices being made available for clinical use. The importance of human factors in anaesthesia with regard to improving patient safety has already been described by Kelly et al. [1]. Design is the most effective strategy to reduce errors and enhance patient

Dr Lyons [1] raises several questions about the consensus guidelines on prevention of unrecognised oesophageal intubation [2] and the Cochrane review of videolaryngoscopy vs. direct laryngoscopy [3]. He asks “Who is putting the tube in the oesophagus?” The answer is 3% of intubators who use direct laryngoscopy [4]. From review of numerous cases of fatal oesophageal intubation (https://www.universalairway

Whilst we wholly support the conclusion by Hansel et al. [1] that waveform capnography remains the reference standard and reaffirms the importance of the “no trace wrong place” campaign, we feel that the conclusions drawn regarding the utility of clinical tests in supporting tracheal intubation are not merited by the quality of data informing their systematic review. We suggest that the premise of

We appreciate the interest from Hajibandeh et al. [1] in the model that was developed to predict short-term mortality after an emergency laparotomy [2]. It was designed around a pragmatic set of commonly measured clinical variables to aid its transferability and ease of use. Collinearity can be a problem when selecting variables for a prediction model [3]. Among the continuous variables we considered

Choi et al. [1] compare tracheal intubation with a non-channelled Macintosh blade videolaryngoscope vs. a flexible intubation scope (fibrescope) in patients with neck immobilisation using a cervical collar. They conclude higher first attempt success, shorter time to intubation and less frequent use of airway manoeuvres with videolaryngoscopy. Two critical study design limitations, however, fundamentally

Tobacco smoking is associated with a substantially increased risk of postoperative complications. The peri-operative period offers a unique opportunity to support patients to stop tobacco smoking, avoid complications and improve long-term health. This systematic review provides an up-to-date summary of the evidence for tobacco cessation interventions in surgical patients. We conducted a systematic

Oxytocin is widely used to prevent atonic postpartum haemorrhage after caesarean delivery. Initial treatment failure rates are high and inadequate dosing may contribute. Excessive doses, however, are associated with serious adverse effects. The pharmacokinetic data from this context are sparse and there is a lack of data in the immediate postpartum minutes after an initiating bolus. The pharmacodynamic