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Perioperative immediate hypersensitivity reactions are rare. Subsequent allergy investigation is complicated by multiple simultaneous drug exposures, the use of drugs with potent effects and the many differential diagnoses to hypersensitivity in the perioperative setting. The approach to the investigation of these complex reactions is not standardized, and it is becoming increasingly apparent that collaboration between experts in the field of allergy/immunology/dermatology and anaesthesiology is needed to provide the best possible care for these patients. The EAACI task force behind this position paper has therefore combined the expertise of allergists, immunologists and anaesthesiologists. The aims of this position paper were to provide recommendations for the investigation of immediate‐type perioperative hypersensitivity reactions and to provide practical information that can assist clinicians in planning and carrying out investigations. [ABSTRACT FROM AUTHOR]

Healthcare's environmental sustainability is increasingly an area of research and advocacy focus. The Australian and New Zealand College of Anaesthetists (ANZCA) has produced a professional document, PS64, Statement on Environmental Sustainability in Anaesthesia and Pain Medicine Practice, and a background paper, PS64 BP. The purpose of the statement is to affirm ANZCA's commitment to environmental sustainability and support anaesthetists in promoting environmentally sustainable work practices. This article presents the main features of PS64 and its background paper, and the associated supporting evidence. The healthcare sector is highly interconnected with activities that emit pollution to air, water and soils, considerably adding to humanity's collective ecological footprint. As anaesthetists, we are uniquely high-carbon doctors due to our work anaesthetising with greenhouse gases (particularly desflurane and nitrous oxide) and our exposure and contribution to large amounts of resource and energy use and waste generation in operating theatres. Discussion is made of the improving research base of anaesthetic life-cycle assessments--that is, cradle-tograve studies of how much energy, water and so on a product or process requires throughout its entire life. Thereafter, reducing, reusing and recycling as well as water use are examined. Ongoing research efforts within environmentally sustainable anaesthesia are highlighted. Environmentally sustainable anaesthesia requires scholarship, health advocacy, leadership, communication and collaboration. The focus is placed on practical initiatives within PS64 and the background paper that can be achieved by all anaesthetists striving towards more sustainable healthcare practices that reduce waste, reap financial benefits and improve health. [ABSTRACT FROM AUTHOR]

John Davies Thomas (1844-1893) described a two-ounce drop-bottle for chloroform in 1872 while he was a resident medical officer at University College Hospital, London. After working as a ship's surgeon, he settled in Australia. In May 1875, Thomas presented a paper on the mortality from ether and chloroform at a meeting of the Medical Society of Victoria in Melbourne, Victoria. Surveys conducted in Europe and North America had established that the mortality from chloroform was eight to ten times higher than that from ether. At that time, chloroform was the most widely administered anaesthetic in Australia. Thomas' paper was published in The Australian Medical Journal and reprinted by the Medical Society of Victoria for distribution to hospitals in the Colony of Victoria. Later that year, Thomas moved to Adelaide, South Australia, where he may have been influential at the Adelaide Hospital in ensuring that ether was administered more often than chloroform. It does not appear that Thomas' papers on anaesthesia had a significant effect on the conduct of anaesthesia in Victoria or New South Wales. [ABSTRACT FROM AUTHOR]

Abstract: Background: The use of non‐human primates (NHPs) in research remains a major societal concern with public expectations that appropriate anaesthetics and analgesics are used to minimize any pain or distress caused to animals undergoing invasive procedures. A literature review was conducted to examine the reporting of anaesthesia and analgesia methods used in non‐human primates undergoing surgical procedures, with recovery from anaesthesia. Methods: A total of 397 papers from peer‐review journals published between 2010 and 2015 were examined. Results: Only 25.9% of papers reported the analgesic regimen used, with carprofen and buprenorphine the 2 most widely used agents. Reporting of the anaesthetic regimens was included in 49.9% of papers. Ketamine and isoflurane were the most frequently used anaesthetic agents. Conclusions: Anaesthetic and analgesic regimens administered to NHPs remain poorly reported. This lack of detailed descriptions of protocols does little to reassure the public or regulatory authorities that appropriate high standards of perioperative care are employed. [ABSTRACT FROM AUTHOR]

Background and Aims: Intrathecal bupivacaine is used for anaesthesia and analgesia but is associated with hypotension. Ropivacaine is an alternative drug that may have fewer cardiotoxic and neurotoxic events. This meta-analysis investigated whether intrathecal ropivacaine is associated with reduced hypotension as compared to bupivacaine. Methods: The meta-analysis is registered in the International Prospective Register of Systematic Reviews (PROSPERO). The databases PubMed, Cinahl Plus, Google Scholar, and Scopus were searched, and papers from January 1980 to January 2023 were deemed eligible and filtered using predetermined inclusion and exclusion criteria. The primary outcome was the incidence of hypotension. Secondary outcomes were the duration of sensory block, duration of motor block, incidence of bradycardia, ephedrine usage, and duration of analgesia. Jadad scores were used to evaluate the quality of the papers. RevMan statistical software® utilised inverse variance and a random effect model to calculate the standardised mean difference with 95% confidence intervals for continuous variables and the Mantel--Haenszel test and the random effect model to calculate the odds ratio for dichotomous variables. Results: Thirty-three papers, including 2475 patients in total, were included. The Jadad score was between 1 and 5. The incidence of hypotension was significantly higher with intrathecal bupivacaine than with ropivacaine (P = 0.02). The duration of sensory block (P < 0.001) and motor block (P < 0.001) was prolonged with intrathecal bupivacaine. The duration of analgesia favoured intrathecal bupivacaine (P = 0.003). Conclusion: Intrathecal ropivacaine has a reduced incidence of hypotension and a reduced duration of sensory block compared to bupivacaine. [ABSTRACT FROM AUTHOR]

Adequate patient positioning is of paramount importance in neurosurgery. Complications related to the position are common and make up for more than 16% of the claims towards anaesthesiologists and neurosurgeons. This paper aims to provide the anaesthesiologist with a practical guide to avoid common pitfalls related to the patient positioning process. We performed a systematic review of the medical literature for the identification, screening, and inclusion of articles. The bibliographic search was conducted on June 1st, 2021 by two of the authors. In this review, we included articles indexed by MEDLINE, Cochrane Library, or Google Scholar. We retrieved a total of 5706 unique papers from our initial search. However, after the initial screening, 5363 papers were removed is not related to our research leaving a total of 343 papers. We examined the full text of all the 343 articles including 68 of them in the final qualitative analysis. In this review we examine the most common neurosurgical positions: supine, sitting, lateral, park-bench, prone, jack-knife, and knee-chest. For each of them, the proper positioning and related complications are described. Particular attention is given to the prevention and management of these complications, providing a practical guide for clinicians. [ABSTRACT FROM AUTHOR]

Background: Individuals with obesity frequently present for anaesthesia and surgery. Good communication during the preoperative consultation can optimise the provision of relevant health information and guide improvement of health status preoperatively. Methods: We planned a systematic literature review to assess existing guidelines and evidence of effectiveness for how anaesthetists should communicate with patients who have obesity in the preoperative period about perioperative risks and weight management. Database searches used keywords related to perioperative weight loss conversations. We found no papers that directly addressed our aim. The literature identified as most relevant was analysed in the form of a narrative review. Results: The majority of suggestions for weight loss conversations came from primary care. Four primary themes potentially relevant to anaesthetists were identified: barriers to such conversations, communication tools, language and communication and specific recommendations. Identified barriers included lack of skills, training, poor remuneration, pessimism and time constraints for clinicians. Established discussion tools including the '5A's' approach (Assess, Advise, Agree, Assist, Arrange) and motivational interviewing may hold promise to improve preoperative conversations. The papers highlighted a need for empathetic language, including use of patient-specific language where possible. Conclusions: There are currently no published guidelines for how anaesthetists could most effectively discuss weight in the perioperative period with patients who have obesity. Much of the literature for obesity communication is based on the primary care setting. The perioperative period may represent an increased time of receptiveness for patients. Guidelines for discussions about weight management and associated perioperative risk are suggested. [ABSTRACT FROM AUTHOR]

Aim: Our aim was to summarise the evidence about flexible bronchoscopy for paediatric airway foreign body aspiration cases. Methods: We searched the PubMed database from 1 January 2001 to 9 October 2021 for peer‐review papers published in English on the use, and success rates, of flexible bronchoscopy as the first‐line treatment for foreign body aspiration cases. This process identified 243 potential papers. Results: We studied 23 papers comprising 2588 cases of foreign body aspiration and flexible bronchoscopy successfully removed the foreign bodies in 87.1% of cases. Complication rates were low in the 983 patients studied in 18 papers. The foreign bodies were organic materials in 78.3% of 1371 patients and mainly lodged in the right bronchial tree in 50.5% of 1402 patients. General anaesthesia was used before flexible bronchoscopy in 14/23 studies and laryngeal mask airways were mostly used in 10/23 studies to secure the airway during the procedure. Ancillary equipment was used to assist the foreign body removal in 57.3% of 1808 cases and these were usually baskets. Conclusion: Flexible bronchoscopy was a feasible and safe therapeutic procedure for selected foreign body aspiration cases. Future studies need to focus on comparing the clinical outcomes of flexible and rigid bronchoscopies. [ABSTRACT FROM AUTHOR]

Problem identification: Perioperative emergencies, although infrequent, may lead to significant morbidity and mortality associated with anaesthesia and/or surgery. Human factor errors account for between 43 to 65 per cent of sentinel events in the perioperative environment. Cognitive aids were introduced to reduce a user's cognitive workload and assist in adherence to key interventions during emergencies. Despite the availability of these aids, implementation of their use remains low. This integrative literature review will identify the barriers to and facilitators of the implementation of cognitive aids during perioperative emergencies. Literature search: An electronic database search of EBSCO databases (CINAHL Complete, Health Source: Nursing/Academic Edition, MEDLINE, MEDLINE Complete), Pubmed and Scopus were conducted to obtain contemporary literature. Duplicates were removed and inclusion and exclusion criteria were applied. A total of 14 articles were identified for inclusion. Data evaluation and synthesis: Included articles were critically analysed and appraised using the JBI critical appraisal tools to assess for the methodological quality of the research, and the National Health and Medical Research Council (NHMRC) evidence hierarchy to assess for reliability and validity. A data extraction table (literature matrix) was used to record the article's author, date of publication, research title, population, study design, level of evidence, key findings, implications for practice and limitations. This aided in synthesis of the selected studies, thematic analysis and drawing conclusions. Implications for practice: Strong design and staff education were identified as facilitators of cognitive aid implementation while poor design and lack of organisational support were identified as barriers to cognitive aid implementation. Nursing leaders and educators have a vital role to play in gaining organisational support to provide staff education and training and develop appropriately designed cognitive aids. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) is making giant strides in the medical domain, and the field of anaesthesia is not untouched. Enhancement in technology, especially AI, in many fields, including medicine, has proven to be far superior, safer and less erratic than human decision-making. The intersection of anaesthesia and AI holds the potential for augmenting constructive advances in anaesthesia care. AI can improve anaesthesiologists' efficiency, reduce costs and improve patient outcomes. Anaesthesiologists are well placed to harness the advantages of AI in various areas like perioperative monitoring, anaesthesia care, drug delivery, post-anaesthesia care unit, pain management and intensive care unit. Perioperative monitoring of the depth of anaesthesia, clinical decision support systems and closed-loop anaesthesia delivery aid in efficient and safer anaesthesia delivery. The effect of various AI interventions in clinical practice will need further research and validation, as well as the ethical implications of privacy and data handling. This paper aims to provide an overview of AI in perioperative monitoring in anaesthesia. [ABSTRACT FROM AUTHOR]

This document is a summary of a search conducted on various databases to find relevant articles on the topic of metamizole (also known as dipyrone) and its use in dogs and cats for pain relief. The search yielded three relevant papers, which were reviewed to assess the effectiveness and safety of metamizole for postoperative pain management in cats and dogs. The studies found that metamizole may help reduce postoperative pain levels in healthy cats and dogs undergoing ovariohysterectomy, but it was not effective as the sole analgesic in dogs. The studies did not find any evidence of higher incidence of side effects with metamizole use. However, the studies had limitations such as small sample sizes and lack of detail on randomization and blinding techniques. The document emphasizes that the application of this evidence should consider multiple factors and individual circumstances. The authors encourage library patrons to contribute to the evidence base by sharing their information needs or writing knowledge summaries. The document concludes with a disclaimer stating that the opinions expressed in the summaries are those of the authors and not necessarily reflective of the views of the organization. [Extracted from the article]

The Australian and New Zealand College of Anaesthetists (ANZCA) recently reviewed and updated the guideline on equipment to manage a difficult airway. An ANZCA-established document development group, which included representatives from the Australasian College for Emergency Medicine and the College of Intensive Care Medicine of Australia and New Zealand, performed the review, which is based on expert consensus, an extensive literature review, and bi-nationwide consultation. The guideline (PG56(A) 2021, https://www.anzca.edu.au/getattachment/02fe1a4c-14f0-4ad1-8337-c281d26bfa17/PS56-Guideline-on-equipment-to-manage-difficult-airways) is accompanied by a detailed background paper (PG56(A)BP 2021, https://www.anzca.edu.au/getattachment/9ef4cd97-2f02-47fe-a63a-9f74fa7c68ac/PG56(A)BP-Guideline-on-equipment-to-manage-difficult-airways-Background-Paper), from which the current recommendations are reproduced on behalf of, and with the permission of, ANZCA. The updated 2021 guideline replaces the 2012 version and aims to provide an updated, objective, informed, transparent, and evidence-based review of equipment to manage difficult airways. [ABSTRACT FROM AUTHOR]

BACKGROUND: Succinylcholine is a commonly used muscle relaxant in anaesthesia that is associated with significant side effects, including muscle fasciculations and postoperative myalgia. Succinylcholine is used to facilitate tracheal intubation, especially in emergency situations when the risk of aspiration of gastric contents is present. AIM AND OBJECTIVE: This research paper investigates the effect of administering magnesium sulfate in conjunction with propofol induction on succinylcholine-induced fasciculations and myalgia. MATERIAL & METHODS: A total of 80 adult patients scheduled for elective surgery under general anaesthesia were divided into two groups (group I and II). The group I patients were treated with magnesium sulphate (40 mg/kg weight) in 10 ml volume while Group II patients were pretreated with normal saline (0.9% in 10 ml volume). They were given slowly intravenously over a period of 10 mim. Then Anesthesia was induced with fentanyl 1.5 mcg/kg and propofol 2 mg/kg, followed by administration of succinylcholine 2 mg/kg intravenously. Muscle fasciculation and Myalgia were observed after 24 hours of surgery. They were graded as nil, mild, moderate and severe. RESULTS: The overall incidence of muscle fasciculation in group I was 52.5% while it was 100% in group II. In group I, 22.5%,12 % mild and moderate muscle fasciculation were developed and no severe cases of fasciculation were observed. While in group II, 52.5% moderate, 40 % mild and 7.5% severe muscle fasciculation were observed. Postoperative myalgia was observed after 24 hrs, and it was observed that patients of Group I were not showing any sign and symptoms of myalgia while in group II, 12.5% were mild, 7.5% were moderate and 80% were negative for myalgia. CONCLUSION: The study found that the administration of magnesium sulfate significantly reduced both the incidence and severity of succinylcholine-induced fasciculations and myalgia, suggesting a beneficial role for magnesium sulfate in anesthesia protocols. [ABSTRACT FROM AUTHOR]

In 2016 the World Health Organization recommended intra-operative ventilation with 80% inspired oxygen to reduce surgical site infection rates, based upon a meta-analysis of 15 randomised controlled trials, of which two were by Mario Schietroma's research group. Five trials by this group have been retracted for duplication, plagiarism, statistical error and lack of ethical approval. We analysed 40 papers by this group: 24 randomised controlled trials (5064 participants) and 16 observational studies (1847 patients). There was evidence that data integrity was compromised in 38 out of the 40 analysed papers. The distribution of baseline characteristics in randomised controlled trials was unlikely, p = 1.5 × 10-8 : continuous variables within trials were heterogeneous, p = 1.9 × 10-9 , and categorical variables were homogeneous, p = 8.5 × 10-20 . Effects of interventions varied less than expected between studies: for categorical variables, for instance postoperative wound infection, p < 1 × 10-7 , and for continuous variables, for instance HLA-DR concentration, p = 0.00001. Of 184 calculable p values, for baseline variables or results, 179 (98%) were incorrect, ranging from three orders of magnitude too small to 10 orders of magnitude too large. Twenty-one graphs occurred 81 times in 23 out of 40 papers. Liberal peri-operative oxygen did not reduce surgical site infection in a meta-analysis of 20 trials that excluded seven trials by Mario Schietroma and colleagues (odds ratio (95%CI) 0.89 (0.73-1.08); p = 0.23). An update by the World Health Organization has now excluded trials of liberal oxygen by Schietroma's group, four of which have not been retracted. We conclude that Mario Schietroma's work should not inform practice until investigated. [ABSTRACT FROM AUTHOR]

Sedation is common during digestive endoscopy to provide comfort and pain relief for patients. However, the use of sedation in endoscopy also poses potential risks, and recent issues have been raised regarding its safety and administration. This literature review paper will discuss the most recent developments in the field of sedation in digestive endoscopy, including the adverse events that might be associated with sedation and how to manage it, the legal issues associated with administration, the impact of COVID-19 on sedation practices, and sedation in special situations. It will also touch upon the current guidelines and recommendations for sedation, including the importance of patient selection and monitoring and the need for training and certification for endoscopists administering sedation. The review will also analyse studies evaluating the safety and efficacy of various sedation techniques, including propofol, midazolam, and others. It will examine the benefits and drawbacks of these agents. [ABSTRACT FROM AUTHOR]

The British Journal of Anaesthesia (BJA) had an eventful 2021, following what was a cataclysmic 2020 for the whole world. Despite the tragic challenges of multiple waves of the COVID-19 pandemic and the unparalleled burdens this created for everyone working in anaesthesia and critical care, the BJA underwent a major transformation during 2021. The BJA strongly supported research and education relevant to the pandemic, and to the broader missions of anaesthesia, critical, and pain medicine. Innovations to the BJA in 2021 included a special section on COVID-19 and the Anaesthetist; a new open access journal in the BJA stable; creation of a new social media editor position; new webinar and author interview series; transition to a new manuscript management system; and a move away from paper to electronic publication. [ABSTRACT FROM AUTHOR]

This systematic review and meta‐analysis analysed whether pain and disruptive behaviour can be decreased by the use of computerized local dental anaesthesia (CDLA) in children. The literature was screened to select randomized clinical trials that compared computerized and conventional anaesthesia. The primary outcome was pain perception during anaesthesia; the secondary, disruptive behaviour. The risk of bias of individual papers and the quality of the evidence were evaluated. After search, 8389 records were found and 20 studies remained for the qualitative and quantitative syntheses. High heterogeneity was detected for both outcomes. For the pain perception, the overall analysis showed a standard mean difference of −0.78 (−1.31, −0.25) favouring CDLA; however, when only studies at low risk of bias were analysed (subgroup analysis), there was no difference between the two techniques [−0.12(−0.46, 0.22)]. For disruptive behaviour, no differences were detected for continuous [−0.26 (−0.68, 0.16)] or dichotomous data [0.81 (0.62, 1.06)]. The quality of evidence was judged as low for pain perception and very low for disruptive behaviour. It is concluded that there is no difference in the pain perception and disruptive behaviour in children subjected to computerized or conventional dental local anaesthesia. Notwithstanding, the quality of the available evidence is low. [ABSTRACT FROM AUTHOR]

This paper reviews the history of the College of Anaesthetists of South Africa (CASA), starting with the establishment of the College of Physicians and Surgeons of South Africa (CPSSA), the subsequent formation of the Faculty of Anaesthetists as part of the College of Surgeons of South Africa (FFACSSA), to its present form as the CASA. This review includes major milestones achieved over the years, including international recognition, key role players involved, development of examinations, medals and awards given as well as individuals honoured by the CASA. [ABSTRACT FROM AUTHOR]

In this paper, we investigate the effect of sedation using low-dose propofol on patient reported outcome measures (PROMS) in patients undergoing cataract surgery. This is a randomised, single-blinded observational prospective study. Patients undergoing elective cataract surgery using peribulbar anaesthesia over consecutive cataract lists were selected for this trial. Patients were randomised to receive either no sedation or low-dose propofol (20 to 30 mg followed by 10 mg increments until the patient developed slurred speech alone) prior to the administration of local anaesthesia. Pain, satisfaction, anxiety, needle recall, pulse, and blood pressure (BP) were measured. A total of 97 patients were included, 50 of whom received propofol. There were 4 senior surgeons and anaesthetists. There were no ocular or systemic complications and all patients had uncomplicated surgery. Anxiety (p = 0.026), needle recall (p < 0.001), difference in systolic BP (p = 0.043), and pulse (p = 0.046) were dependent on patient age (p < 0.001) and the use of propofol (p = 0.007). Lower pain was associated with propofol (p = 0.008), as well as lower anxiety (p = 0.002), and increased patient age (p = 0.014). The administration of propofol was significantly associated with lower needle recall (p < 0.001), pre- to post-operative difference in systolic BP (p = 0.029), and mean BP (p = 0.044). Low-dose propofol given immediately prior to administration of local anaesthesia was associated with reduced pain and needle recall, as well as lower BP. [ABSTRACT FROM AUTHOR]

Objective: Little is known about the epidemiology of medical emergencies occurring in the intensive care unit (ICU). The aim of this study is to draw attention to the importance of auditing emergency events in the ICU. We hypothesised that emergency events occurring in the ICU would be clustered during periods of decreased medical and nursing attention and would occur in patients who had a higher illness severity and a greater risk of death. Methods: A retrospective observational cohort study was carried out in a 36-bed tertiary intensive care unit. The data capture all intensive care patients admitted to the ICU from 1 January to 1 December 2020. The number of emergency events occurring during each clock hour was correlated with ICU shift staffing patterns. In-hospital mortality and illness severity scores for patients experiencing emergency events were compared with those for all other ICU patients. Results: Serious medical emergencies were most frequent during the day, specifically during the morning ICU round (30% of all such events occurred between 08:00 and 12:00 hours), and there were peaks of incidence in the hour following each nursing and medical shift handover (following shift change times at 08:00, 15:00 and 21:00 hours). Agitation-related emergency events were least frequent during the periods of nursing day shift and afternoon shift overlap (07:00–08:00 hours and 13:00–15:00 hours). Patients who experienced serious medical emergency events in the ICU had a higher in-hospital mortality rate (28.3%) compared with the overall ICU mortality of 10.5% (OR = 4.89, 95% CI: 3.04–7.86). Conclusions: Patients who deteriorate suddenly in the ICU have greater illness severity and a significantly increased risk of death. The incidence of serious emergency events correlates with patterns of ICU staffing and work routines. This has implications for rostering, clinical workflow and education program design. What is known about the topic? Some common quality assurance indicators may underrepresent the true incidence of critical events or their impact on ICU team workload, given that often only adverse outcomes are captured Our study is significant because it captures all such workload. What does this paper add? By identifying periods of peak internal emergency activity, our study demonstrates the utility of collecting internal ICU emergency data for purposes of roster coordination. What are the implications for practitioners? We propose consistent senior medical presence and minimised non-essential interruptions during the hours of peak activity. Our method is easily reproducible and our findings, although from a single centre, are broadly generalisable, given that we discuss their similarity with other published works. [ABSTRACT FROM AUTHOR]

Vasectomy is considered a permanent form of contraception for men that can help reduce reproductive inequality. Its underutilisation in the context of the threats it may pose to perceptions of traditional masculinity has been closely investigated, but the lived experience of the procedure itself has been largely overlooked. This paper examines the experience of having a vasectomy in Israel, focusing on the recommended form of anaesthesia. Drawing on 15 semi-structured interviews with Israeli men who have experienced vasectomy, we found that the choice of anaesthesia has a significant impact on the meaning and experience of vasectomy. Unlike the widespread use of local anaesthesia during vasectomy in other countries, vasectomy in Israel is performed almost exclusively under twilight sedation administered intravenously. Based on our findings, we argue that framing vasectomy as an operation that requires sedation is related to views of masculinity and reproduction. Our data suggest that vasectomy in Israel is constituted as a potentially traumatic event, and anaesthesia is employed to protect patients from feelings of embarrassment and discomfort. We conclude that the prevailing method of sedation perpetuates the silencing and marginalisation of vasectomy as a contraceptive method, and consequently, its very limited accessibility in Israel. [ABSTRACT FROM AUTHOR]

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Summary: The dedication of the international anaesthetic community to reducing the environmental impact of healthcare is important and to be celebrated. When this is underpinned by robust science, it has the potential to make a real difference. However, volatile anaesthetic agents have been widely promoted in the medical literature as damaging to the climate, leading to a drive to remove them from clinical practice. This is based on notional 'CO2‐equivalent' values created using the simple emission metric known as the global warming potential. Here, we assert that when proper consideration is given to the science of climate change, volatile anaesthetic gas emissions cannot be simply equated to real carbon dioxide emissions, and that their climate impact is vanishingly small. This paper gives anaesthetists a framework to make informed choices founded on climate science and calls for attention to be refocused on the urgent need to reduce the real carbon dioxide emissions associated with healthcare. [ABSTRACT FROM AUTHOR]

Introduction: The human species shows a great variability. The differences involve culture, customs, appearance but they also come to include some biological or physiological aspects which have a potential bearing on the course of diseases and the effects of treatment. Over the recent years, the increasing globalisation and improved travel opportunities have resulted in a growing mass mobility. The arrival of people representing other ethnicities may pose a challenge to doctors traditionally offering treatment to individuals within ethnically homogenous societies. Aim: The paper aims to present a comprehensive summary of state-of-the-art knowledge on race-related differences which may be of great importance for patient management in anaesthesiological setting. Material and methods: This paper is based on the available literature. Results and discussion: A literature review reveals a number of anatomical, pharmacokinetic and pharmacodynamic differences between the races. Moreover, particular ethnic groups show dissimilarities in the prevalence of some diseases requiring modifications in anaesthesiological management. Conclusions: Prior to the commencement of treatment, patient’s ethnicity and the consequent differences in terms of physiology should be recognised and considered in the treatment to ensure it is conducted appropriately and safely. [ABSTRACT FROM AUTHOR]

The psychological impact (second victim effect) of in-theatre critical incidents is increasingly recognised. Different styles of psychological support programme have recently been published, including some utilising 'near in time' peer support. Most of these programmes either target their support to individuals, or focus on one vocational group rather than the multidisciplinary team. However, the in-theatre team consists of different craft groups who nonetheless function as a single team and are therefore 'peers'. This paper sets out the design and implementation of a critical incident peer response programme at Waikato Hospital, New Zealand, which provides peer-led group psychological first aid to full theatre teams. The programme is administered by trained representatives from multiple in-theatre craft groups including nurses, midwives, anaesthetic technicians, recovery room nurses, surgeons and anaesthetists. It emphasises team education and peer support, and has a wholly welfare focus. The programme has voluntary participation but mandatory activation triggers so that individuals do not need to seek support actively at a time when they may not recognise the need to do so. The programme is becoming embedded in the Waikato Hospital theatre culture so that participating in psychological support is normalised following a critical event. This framework is shared in the hope that it will assist other hospitals to develop welfare interventions to support full theatre teams. [ABSTRACT FROM AUTHOR]

Achieving a good understanding of the socio-technical system in critical or emergency situations is important for patient safety. Research in humancomputer interaction in the field of anesthesia or surgery has the potential to improve usability of the user interfaces and enhance patient safety. Therefore eyetracking is a technology for analyzing gaze patterns. It can also measure what is being perceived by the physician during medical procedures. The aim of this review is the applicability of eye-tracker in the domain of simulated or real environments of anesthesia, surgery or intensive care. We carried out a literature research in PubMed. Two independent researchers screened the titles and abstracts. The remaining 8 full-papers were analyzed based on the applicability of eye-trackers. The articles contain topics like training of surgeons, novice vs. experts or the cognitive workload. None of the publications address our goal. The applicability or limitations of the eye-tracker technology were stated incidentally. [ABSTRACT FROM AUTHOR]

Sub-Saharan Africa faces high rates of maternal mortality and there is an urgent need to reduce this. Shortfalls in access to safe surgery and anaesthetic care result in avoidable maternal death. Providing quality training to anaesthesia providers is of key importance to reduce mortality. This mixed-methods prospective study incorporated workplace observations of anaesthesia for Caesarean section, a paper-based questionnaire and semi-structured, face-to-face interviews in Felege Hiwot Referral Hospital in Ethiopia. A total of 67 Caesarean section cases under spinal anaesthesia provided by 12 non-physician anaesthetists were observed and a 92% (n = 11) response rate to questionnaires obtained. Deficiencies were observed in communication, pre-operative assessment, spinal height evaluation and application of lateral tilt, while interviews revealed anaesthesia provider perceptions of hierarchy within the surgical team and deficiency in anticipation of potential complications. This study suggests that focusing on communication and anticipation of complications could aid providers in preventing and preparing for complications. [ABSTRACT FROM AUTHOR]

Introduction. The paper describes the process of editing and validating documents on the basis of which a patient gives their informed consent for anaesthesia before surgery. Our objective was to adapt such documents to plain language standards, thanks to which they will be more accessible to an average patient. Material and methods. Two documents were drafted: Information about anaesthesia and Informed consent for anaesthesia. Within the editing process, we applied the principles of Plain Polish worked out for the Polish language. Results. Similar documents available in Polish medical institutions were collected. For the comparison of the texts, the readability formula – Plain Language Index (PLI) – recently available in Poland was used. This algorithm assesses 10 properties of the style and, based on these, it measures the simplicity of the text. Conclusions. Both documents which we designed obtained the standard of plain language (PLI 50% and more). They turned out to be the most accessible out of all the texts examined. [ABSTRACT FROM AUTHOR]

Extended scope of practice (ESoP) and advanced scope of practice (ASoP) physiotherapy roles have been in place in the UK for over 20 years. However, interest in these types of services appears to be only just evolving within Australia. Although ESoP and/or ASoP cardiorespiratory roles in intensive care units (ICU) may be perceived to be more achievable in large metropolitan teaching hospitals, at least 67% of Australian ICUs provide physiotherapy services. Very little has been published on the practicalities (e.g. training pathways, evidence for use and guidelines) of developing advanced or extended scope cardiorespiratory physiotherapy services within Australian ICUs. This report describes the development and implementation of a physiotherapy-led bronchoscopy service from a regional hospital perspective. What is known about the topic?: Although ESoP and ASoP physiotherapy roles are well established in the UK, such services appear to be only just evolving in Australia. Clarity on the definitions of extended and advanced physiotherapy roles have been articulated by the Australian Physiotherapy Association. However, there is a paucity of evidence published on the practicalities of establishing advanced or extended scope cardiorespiratory physiotherapy services within Australian ICUs. What does this paper add?: One of the main emerging areas of ESoP and/or ASoP in the cardiorespiratory field is the use of bronchoscopy by physiotherapists. This paper describes the framework, implementation, limitations and barriers of developing a physiotherapy-led bronchoscopy service from a regional hospital perspective. What are the implications for practitioners?: This paper allows the potential for our credentialing and practice framework model to be transferred in other public hospitals commencing or considering implementing physiotherapy-led bronchoscopy services within their ICU. [ABSTRACT FROM AUTHOR]

Objective This discussion paper explores the use of parental presence during induction of anaesthesia as a method of decreasing paediatric and parental perioperative anxiety. Setting A perioperative department in an Australian public hospital. Subjects Paediatric patients and parents/guardians. Primary argument There is evidence to support the importance of parental presence in the anaesthetic setting; however, this varies between different health care facilities. This paper will argue that the presence of the parent during induction of anaesthesia will decrease the anxiety of the child. However, there has been little discussion about the pivotal role parents can play when participating in the anaesthetic process. Parents need to be given a clear orientation and specific instruction regarding their role during induction of anaesthesia to ensure that the child's anaesthesia is safe. Conclusion Parental presence during induction of anaesthetic of a child may be a controversial practice in some hospitals; however, evidence states that it can reduce anxiety for the child. The presence of the parent working alongside the anaesthetic team combined with insight and understanding provided by a preoperative visit can assist in reducing anxiety for the child and parent. [ABSTRACT FROM AUTHOR]

The h-index has become a criterion for progress and advancement in the career of an academic surgeon and it is especially important for the surgical community to understand the importance of calculating the h-index of a manuscript post publication in a surgical journal. It is not only becoming a criterion for promotion in the faculty in a medical institution, but also becoming an important index to decide about the suitability of editorial board members in a medical journal. Even though there are few loopholes, the h-index remains the gold standard criterion to access the quality of the author to be designated as an academic surgeon. [ABSTRACT FROM AUTHOR]

Prolapse of the gland of the third eyelid (cherry eye) is one of the most common canine-related ophthalmic conditions presented to veterinary clinics and hospitals. In most poor resource settings, veterinarians embark on excision of the gland due to possible lack of skill, necessary ophthalmic tools and a misconception of the postoperative complications associated with excision of the gland. Currently, repositioning of the prolapsed gland is the gold standard for management. The Morgan’s Pocket Technique (MPT) is one of the preferred methods for repositioning the gland. This paper presents some modifications of the MPT, which involved making two elliptical incisions above and below the point of rent or laxity on the gland’s conjunctival tissue following proper visualisation of the gland using a magnifying loop and creating a pocket for proper situation of the gland. The anaesthetic protocol adopted for the procedures as well as vital instruments and gadgets have also been highlighted. The medical records of 31 dogs (44 eyes) managed for cherry eye at the Veterinary Teaching Hospital, University of Ibadan, Nigeria from May 2013 to April 2021 were reviewed. Cherry eye was most prevalent in brachycephalic dogs with Boerboel having the highest presentation of 45.2% among others. Seventeen out of the 31 dogs were male, representing 54.8% while the rest were female. Majority of the dogs (93.5%) were below 2 years. The condition was unilateral in 18 dogs (58.1%), while 13 (41.9%) were bilateral. Before modification of the MPT in July 2018, surgery was repeated for 5 out of 23 eyes (21.7%). Following modification, no recurrences were recorded. The authors therefore recommend the modification of the MPT as well as paying attention to suture size, pattern and placement to prevent recurrence and complications. [ABSTRACT FROM AUTHOR]