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Summary: Peri‐operative medication safety is complex. Avoidance of medication errors is both system‐ and practitioner‐based, and many departments within the hospital contribute to safe and effective systems. For the individual anaesthetist, drawing up, labelling and then the correct administration of medications are key components in a patient's peri‐operative journey. These guidelines aim to provide pragmatic safety steps for the practitioner and other individuals within the operative environment, as well as short‐ to long‐term goals for development of a collaborative approach to reducing errors. The aim is that they will be used as a basis for instilling good practice. [ABSTRACT FROM AUTHOR]

This decision, and any subsequent surgery and anaesthesia, should be undertaken by senior staff in consultation with obstetric, neonatology, midwifery and obstetric anaesthetic teams. Identifying research priorities in anaesthesia and peri-operative care: final report of the joint National Institute of academic Anaesthesia/James Lind Alliance research priority setting partnership. Keywords: anaesthesia; complications; pre-natal EN anaesthesia complications pre-natal 143 146 4 01/10/23 20230201 NES 230201 Surgery for non-obstetric issues occurs in up to 1:100 pregnancies and can be an anxiety-provoking experience for the mother and healthcare staff, with concerns for maternal and fetal well-being [[1]]. Neurodevelopmental outcomes after prenatal exposure to anaesthesia for maternal surgery: a propensity-score weighted bidirectional cohort study. [Extracted from the article]

Summary: The Earth's mean surface temperature is already approximately 1.1°C higher than pre‐industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three‐stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high‐, middle‐ and low‐income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists' education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re‐evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references. [ABSTRACT FROM AUTHOR]

Breastfeeding has many health benefits for the mother and infant. Women who are breastfeeding may require anaesthesia or sedation. Concerns regarding the passage of drugs into breast milk may lead to inconsistent advice from professionals. This can sometimes result in the interruption of feeding for 24 hours or longer after anaesthesia, or expressing and discarding ('pumping and dumping') breast milk; this may contribute to early cessation of breastfeeding. However, there are data regarding the transfer of most anaesthetic drugs into breast milk. We advise that breastfeeding is acceptable to continue after anaesthesia and should be supported as soon as the woman is alert and able to feed, without the need to discard breast milk. We provide evidence-based information on the pharmacokinetics of drugs commonly used during anaesthesia so that professionals can undertake a risk-benefit discussion with the woman. We advise the development of local policies that aid logistical planning and guide staff to facilitate breastfeeding during the woman's hospital stay. [ABSTRACT FROM AUTHOR]

We reviewed the literature on management of general and regional anaesthesia in pregnant women with anticipated airway difficulty. We identified 138 publications comprising 158 cases; these either described equipment or techniques for the provision of general anaesthesia, or the management of women with regional analgesia or anaesthesia, with the aim of avoiding general anaesthesia. Most of the former group described women requiring caesarean section alone, or in combination with other surgery, which was sometimes airway-related. Management techniques were largely similar to those in non-obstetric patients requiring surgery who have airway difficulties, although suggested differences related to physiological changes of pregnancy and avoidance of nasal intubation. In the reports discussing regional anaesthesia, consideration was often given to the possible requirement for urgent out-of-hours anaesthetic intervention, and the predicted difficulty of management of general anaesthesia should it be required. In a number of reported cases, multidisciplinary planning led to the conclusion that elective caesarean section should be performed in order to avoid emergency airway management. Based on this literature review, we advise antenatal planning that includes: assessment of the patient's clinical characteristics; consideration of the equipment and personnel available to provide safe airway management out-of-hours; and elective caesarean section should these be lacking. If general anaesthesia is required, a risk assessment must be made as to the probability of safe airway management after the induction of anaesthesia, and awake tracheal intubation should be used if this cannot be assured. Decision aids are provided to illustrate these points. Online appendices include a comprehensive compendium of case reports on the management of a number of rare syndromes and airway conditions. [ABSTRACT FROM AUTHOR]

Audio recording consent discussions, and giving a copy of the recording to the patient to keep, might improve the consent process and reduce the risk of misunderstandings, complaints or medicolegal claims. However, there may be concerns over confidentiality and how being recorded could affect the consent discussion. We ascertained the views of 50 postnatal women and 100 maternity staff (25 anaesthetists, 25 obstetricians and 50 midwives) on making audio recordings of consent discussions. There was a wide range of opinions, with women and staff similarly supportive of audio recording overall, but the women were more supportive of recording than the staff when asked if they were against it, or whether they would support recording the discussion if the patient requested it; and less concerned than the staff regarding the potential disadvantages of audio recording. There were no significant differences in the views between anaesthetists, obstetricians and midwives. [ABSTRACT FROM AUTHOR]

There has been an increase in the number of units providing anaesthesia for magnetic resonance imaging and the strength of magnetic resonance scanners, as well as the number of interventions and operations performed within the magnetic resonance environment. More devices and implants are now magnetic resonance imaging conditional, allowing scans to be undertaken in patients for whom this was previously not possible. There has also been a revision in terminology relating to magnetic resonance safety of devices. These guidelines have been put together by organisations who are involved in the pathways for patients needing magnetic resonance imaging. They reinforce the safety aspects of providing anaesthesia in the magnetic resonance environment, from the multidisciplinary decision making process, the seniority of anaesthetist accompanying the patient, to training in the recognition of hazards of anaesthesia in the magnetic resonance environment. For many anaesthetists this is an unfamiliar site to give anaesthesia, often in a remote site. Hospitals should develop and audit governance procedures to ensure that anaesthetists of all grades are competent to deliver anaesthesia safely in this area. [ABSTRACT FROM AUTHOR]

The article presents the consensus statement from the International Fragility Fracture Network Delphi on the principles of anaesthesia for hip fracture patients. It mentions that anaesthesia is an important part of multidisciplinary care of hip fracture patients. It offers information on the Fragility Fracture Network (FFN), organization for parctitioners, whoare interested in improving the standards of care for fragility fractures.

We analysed data from the electronic rota system CLWRota, covering 2,689,962 anaesthetic sessions between 01/01/2014 and 31/12/2015, in 91 UK Trusts, in order to investigate trainees' supervision. There were 8209 trainee attachments analysed, during which 618,695 sessions were undertaken by trainees. The number of supervised sessions per week that trainees worked varied considerably (median (IQR [range]) 2.6 (1.6-3.6 [0-10]) for all grades combined), with senior trainees more likely than junior trainees to be supervised for fewer than the three sessions per week mandated by the Royal College of Anaesthetists. The number of supervised sessions was unrelated to Trusts' size, suggesting that trainees in smaller hospitals receive the same level of supervision as in larger teaching hospitals. Analysis of a dataset of this size should be a good reflection of the delivery of anaesthesia training in the UK. [ABSTRACT FROM AUTHOR]

We report a case study of cranial trepanation in a male subject 30 to 40 years of age from the Nefteprovod II burial ground in the Anzhevsk archeological site. This burial dates back to the Late Bronze Age, in particular the Karasuk culture located in the Minusinsk Basin on the Yenisei River and on the upper reaches of the Ob River. The left parietal bone had an opening with evident signs of bone healing, as well as signs of inflammatory reaction from both bone plates of the calvarium. The strongest signs of inflammation were located around the trepanation opening at the exocranium, suggesting that it occurred after, rather than before, the operation. Although trepanation was the main cause for the development of the changes noted in the preceding texts, there are no reasons to believe that the subject died from complications arising from infection after trepanation. The patient survived and later died for reasons that may never be determined. Medical necessity was the most likely justification for trepanation. Immersion in altered states of consciousness may also have been a necessary part of the trepanation process as a mode of sedation, along with other shamanic practices, such as consumption of psychotropic substances or ecstatic dance. These data, together with reports of other ante mortem burials, raised questions about the application of anaesthesia and possible techniques of cranial trepanation. These issues and possible postoperative complications are discussed in the following text. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Previous guidelines on consent for anaesthesia were issued by the Association of Anaesthetists of Great Britain and Ireland in 1999 and revised in 2006. The following guidelines have been produced in response to the changing ethical and legal background against which anaesthetists, and also intensivists and pain specialists, currently work, while retaining the key principles of respect for patients' autonomy and the need to provide adequate information. The main points of difference between the relevant legal frameworks in England and Wales and Scotland, Northern Ireland and the Republic of Ireland are also highlighted. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Position, Position, Position: Terminology During Stomach Ultrasound in Pregnant Women" in the 2016 issue.

Background and purpose Although several recent studies have implicated RYR1 mutations as a common cause of various myopathies and the malignant hyperthermia susceptibility ( MHS) trait, many of these studies have been limited to certain age groups, confined geographical regions or specific conditions. The aim of the present study was to investigate the full spectrum of RYR1-related disorders throughout life and to use this knowledge to increase vigilance concerning malignant hyperthermia. Methods A retrospective cohort study was performed on the clinical, genetic and histopathological features of all paediatric and adult patients in whom an RYR1 mutation was detected in a national referral centre for both malignant hyperthermia and inherited myopathies (2008-2012). Results The cohort of 77 non-related patients (detection rate 28%) included both congenital myopathies with permanent weakness and 'induced' myopathies such as MHS and non-anaesthesia-related episodes of rhabdomyolysis or hyper CKemia, manifested throughout life and triggered by various stimuli. Sixty-one different mutations were detected, of which 24 were novel. Some mutations are present in both dominant ( MHS) and recessive modes (congenital myopathy) of inheritance, even within families. Histopathological features included an equally wide spectrum, ranging from only subtle abnormalities to prominent cores. Conclusions This broad range of RYR1-related disorders often presents to the general paediatric and adult neurologist. Its recognition is essential for genetic counselling and improving patients' safety during anaesthesia. Future research should focus on in vitro testing by the in vitro contracture test and functional characterization of the large number of RYR1 variants whose precise effects currently remain uncertain. [ABSTRACT FROM AUTHOR]