SummaryBackgroundDelirium is a common and potentially serious complication after major surgery. A previous history of depression is a known risk factor for experiencing delirium in patients admitted to the hospital, but the generalised risk has not been estimated in surgical patients.MethodsWe conducted a systematic review and meta‐analysis of studies reporting the incidence or relative risk (or relative

The 7th National Audit Project (NAP7) confirmed haemorrhage as a leading cause of maternal cardiac arrest[1]. In this audit of cardiac arrest in patients under the care of an anaesthetist, nearly half of the obstetric cases involved a general anaesthetic, and anaesthetic care was judged to be a key factor in 68% of cases. The specific drugs used for induction of anaesthesia were not recorded [1]. We

The current gold standard neuropsychological assessment for detecting postoperative neurocognitive disorders is too time-consuming, costly and burdensome to use in clinical practice. Brief screening instruments, such as the Montreal Cognitive Assessment (MoCA), are used frequently instead. However, previous research by our team suggested that the original MoCA is not suitable to detect postoperative

We read with interest the article by Ledda et al. [1], which highlights a drive to change from single-use to reusable gowns to be more environmentally sustainable. While laudable, we feel that it does not consider wider changes to our practice which could have an impact of greater magnitude. Standard practice in many UK centres is to wear a sterile gown for spinal anaesthesia to reduce the incidence

Ward and Illif ask whether there have been too many papers on the 7th UK National Audit Project (NAP7) and whether the “primary purpose” of the project has been lost [1]. NAP7 was a massive project during a pandemic. It is unsurprising that peri-operative cardiac arrest and its contributing factors have generated a large amount of information given this is the final common pathway for serious complications

The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest because of existing knowledge gaps in this important topic. This applies in particular to cardiology patients receiving anaesthetic care, because numbers, types and complexity of minimally invasive interventional procedures requiring planned and unplanned anaesthesia in the cardiac intervention

SummaryBackgroundThere is some evidence for systematic biases and failures of research integrity in the anaesthesia literature. However, the features of problematic trials and effect of editorial selection on these issues have not been well quantified.MethodsWe analysed 209 randomised controlled trials submitted to Anaesthesia between 8 March 2019 and 31 March 2020. We evaluated the submitted manuscript

In a study of 904 tracheal intubations in 809 children, Sasu et al. showed that using a C-MAC® videolaryngoscope (Karl Storz, Tuttlingen, Germany) reduced the incidence of poor glottic views from 13% to 4% [1]. They also found the modified six-grade Cormack and Lehane system ineffective for predicting the ease of videolaryngoscopic tracheal intubation. The primary outcome of this study was defined

We read with interest the article by Choi et al., which examines the association between acute kidney injury in patients who have had their angiotensin-converting enzyme inhibitors or angiotensin receptor-blocking drugs withheld or continued, respectively, pre-operatively [1]. We commend them on a well-designed study that paid great attention to relevant propensity matching. We want to comment on the

Most of the time, anaesthesia in the UK is practiced and delivered safely. However, emergencies or serious complications associated with anaesthesia do occur, with potentially devastating consequences for patients, their families and staff. Although anaesthetic emergencies are usually managed well, national reports consistently identify room for improvement. For example, despite high-profile cases

Nathanson et al. make a case for “career-long mandatory training” for rare but potentially fatal anaesthetic events and that this should be implemented and funded as a matter of urgency [1]. Despite having less than half the reported combined clinical years of anaesthesia experience of the sagacious authors, we echo their sentiment, with a particular focus on mandatory training for airway emergencies

In Europe, out-of-hospital cardiac arrests have an annual incidence rate of 7–17/10,000 per capita and in-hospital cardiac arrests have an annual incidence rate of 15–28/10,000 hospital admissions [1]. The incidence of in-hospital cardiac arrests in Sweden is 16/10,000 hospital admissions [2]. We conducted a study assessing if the incidence of peri-operative cardiac arrest had decreased in Sweden from

Ward and Iliff suggest there have been too many NAP7 papers [1], which makes it difficult to discern and retain key information [2]. All 12 papers went through our normal peer review processes and were judged by their own merit to have met or exceeded the standards required for publication. The series was spread over two years, with the reporting of the methods first (September 2022, 5200 downloads)

I read with interest the article regarding the clinical activity of anaesthesia associates, as reported to the 7th National Audit Project [1], which raises many questions about their current and future roles. Anaesthesia associates have a nationally defined scope of practice on qualification, published by the Royal College of Anaesthetists (RCoA) in 2016 [2]. This limits their supervision ratios to

We would like to thank and applaud the authors and contributors to the 7th National Audit Project (NAP7) for such a thorough investigation and Anaesthesia for its dissemination and sharing of content [1]. However, we must ask if the primary purpose of the project has been lost among the volume of papers (we think this is the 12th)? Having spoken to a number of colleagues, none of them admit to having

SummaryBackgroundThe i‐gel® Plus is a modified version of the i‐gel® supraglottic airway device. It contains a wider drainage port; a longer tip; ramps inside the breathing channel; and an additional port for oxygen delivery. There has been no prospective evaluation of this device in clinical practice.MethodsThis international, multicentre, prospective cohort study aimed to evaluate the performance

We read with interest the approach to hyperangulated videolaryngoscopy recommended by Perry and Chrimes [1], which involves advancement of the stylet/tracheal tube alongside the blade, followed by timely stylet tilting to minimise posterior arytenoid impingement and anterior tracheal wall abutment. While the steps outlined closely match our own ‘in-plane’ technique, it is important to highlight that

We congratulate Cook et al. on the publication of their important article [1] produced with data from the 7th National Audit Project (NAP7) from the Royal College of Anaesthetists [2]. The topic of anaesthesia associates remains highly controversial in UK anaesthesia and has suffered from a relative lack of objective data to inform discussion. We feel this documented window into the clinical activity

Functional capacity assessment before surgery identifies older adults at increased risk of functional decline after major surgery [1]. Increasing physical activity before surgery has shown efficacy to mitigate functional decline afterwards [2]. A key component necessary to initiate physical activity is motivation, defined as the processes that energises, orients and sustains behaviour. The COM-B model

SummaryBackgroundThe timing of elective surgery could affect clinical outcome because of diurnal rhythms of patient physiology as well as surgical team performance. Waiting times for elective surgery are increasing in many countries, leading to increasing interest in undertaking elective surgery in the evening or at night. We aimed to systematically review the literature on the effect of the timing

SummaryBackgroundThe VIDIAC score, a prospectively developed universal classification for videolaryngoscopy, has shown excellent diagnostic performance in adults. However, there is no reliable classification system for videolaryngoscopic tracheal intubation in children. We aimed to develop and validate a multivariable logistic regression model and easy‐to‐use score to classify difficult videolaryngoscopic

Approximately 1% of the UK population take oral corticosteroids for ≥ 28 days each year, for broadly two reasons: deficiency in corticosteroid requiring replacement; or therapeutic corticosteroid for inflammatory conditions. Acute deficiency can occur at times of physiological stress (e.g. surgery), potentially leading to major complications. The Association of Anaesthetists' 2020 consensus guideline

Opioid analgesic use before total hip or knee arthroplasty has been associated with worse postoperative outcomes. This pilot study aimed to examine the feasibility of a telehealth-based pharmacist-partnered opioid tapering intervention before elective primary hip or knee arthroplasty and its potential effectiveness compared with usual care.

Lotlikar recently demonstrated that the perceived usability of Macintosh-shaped videolaryngoscopes was inferior to direct laryngoscopes of the same profile [1]. While I fully agree that the design of tools used by our speciality is commonly overlooked and provides substantial opportunity to improve safety and efficiency, the comparison in this instance needs further context and is only a small part

SummaryBackgroundRe‐exploration following caesarean birth and the associated maternal morbidity has not been investigated in the UK. Our aims were to determine the national incidence and identify the associated risk factors.MethodsWe conducted a prospective observational case–control study across 194 UK consultant‐led maternity units in women whose caesarean birth was complicated by a re‐exploration

SummaryIntroductionThere is uncertainty about the optimal videolaryngoscope for awake tracheal intubation in patients with anticipated difficult airway. The use of channelled and unchannelled videolaryngoscopy has been reported, but there is a lack of evidence on which is the best option.MethodsWe conducted a randomised clinical trial to compare the efficacy of the C‐MAC D‐Blade® vs. Airtraq® in adult

Prolonged motor block regression following neuraxial anaesthesia should prompt careful evaluation for serious postpartum neurological injuries and complications such as vertebral column haematoma. The ability to perform straight leg raise against gravity 4 h after neuraxial anaesthesia has been recommended as a time threshold to trigger review [1]. However, using this time threshold, we observed a

SummaryBackgroundTracheal tube introducers are recommended in airway management guidelines and are used increasingly as videolaryngoscopy becomes more widespread. This systematic review aimed to summarise the published literature concerning tracheal tube introducer‐associated airway trauma.MethodsPubMed, EMBASE and CINAHL databases were searched using pre‐determined criteria. Two authors independently

Successful return to work after maternity leave is a global problem in all areas of work, including healthcare, as highlighted recently by Allen et al. [1]. In June 2020, the UK General Medical Council commissioned community research for induction of doctors, including those returning to work, and showed that the induction process was sometimes overlooked as employers were not aware of changes that

We thank Tokumine et al. for the valuable insights on the potential contribution of system leaks on the loss of sevoflurane [1]. If, as their findings convincingly suggest, the system leaks should be considered negligible, the question remains as to how the missing sevoflurane escaped the system [2]. Given that substantially higher systemic absorption is unlikely, incomplete capture by CONTRAfluran™

SummaryIntroductionThe objective of this document is to guide best practice to ensure the safety and dignity of transgender and gender‐diverse people in the peri‐operative period. While transgender and gender‐diverse people may have specific health needs in relation to gender dysphoria, their health requirements go beyond their gender identity. Most doctors will provide care to someone who is transgender