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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]

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]

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]

A structured literature review was carried out to assess recent trends in the administration of analgesics and anaesthetics to laboratory rats and mice undergoing surgical procedures. The ScienceDirect database was used to systematically identify studies published in peer-reviewed journals over two periods (2000-2001 and 2005-2006), 86 studies from each time period were included in the review. The total number of animals that underwent surgery, species used, type of procedure, anaesthetic regimen and analgesic administration were noted for each study. There was an increase in the reported administration of systemic analgesics from 10% in 2000-2001 to 20% in 2005-2006. Buprenorphine was the most commonly reported analgesic in both periods (2000-2001: 78%, 2005-2006: 35%) and reporting the use of non-steroidal anti-inflammatory drugs increased from 11% to 53%. There was also a change in reported anaesthetic practices, notably a decrease in the use of pentobarbital and an increase in the use of isoflurane and ketamine/xylazine. Although reported administration of analgesics has increased and there has been some refinement in the selection of anaesthetic agents used, the findings of this review suggest that there is still significant scope for improvement with respect to the perioperative care of laboratory rodents. [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 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]

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]

Introduction: Nasoendotracheal (NET) tubes are exposed to various external forces, handling, slippage, and accidental extubation, with the potential for fatal complications. In the modern era, several techniques have been developed to reduce the complication rate of Nasoendotracheal Intubation (NTI). NET tubes can be secured using twill or cotton tape, adhesive tape, gauze, or a manufactured device, either individually or in combination. In present study, a transcolumellar stitch and transeptal stitch were designed with 2-0 silk suture material and utilised by many anaesthetists and surgeons to secure the NET, providing good stability but sometimes leading to columellar ischaemia and cutting through. Aim: To compare the intraoperative stability of Nasoendotracheal Tubes (NETT) secured by a transept flower stitch with those secured using a simple surgical knot in patients undergoing NET Intubation (NETI) for open reduction and internal fixation of maxillofacial trauma. Materials and Methods: This cross-sectional study was conducted in the Department of Oral and Maxillofacial Surgery at Sharad Pawar Dental College and Hospital and Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India, over a period of six months from March 2023 to August 2023. The study involved 30 patients with maxillofacial fractures who were divided into two groups. Preoperative assessments included case history, physical examinations, and maxillofacial evaluations. Patients were divided into two groups: Group A underwent simple surgical knot using 2-0 silk suture (odd-numbered patients), while patients in Group B underwent transseptal flower stitch using 2-0 silk suture (even-numbered patients). All parameters were recorded by the same surgeon at the beginning and end of the procedure. The data was collected, tabulated, and statistically analysed using Statistical Package for the Social Sciences (SPSS) statistical software version 23.0. Results: Out of the total 30 patients enrolled in the study, 24 (80%) were male and 6 (20%) were female. The comparison between the two groups regarding the duration of surgery showed no statistically significant difference. Three parameters, namely the amount of NETT displacement, nasal tip laceration, and tip ischaemia, were evaluated and recorded both preoperatively and immediately after extubation. The amount of NETT displacement (p-value=0.031) and nasal tip laceration, haemorrhage, or necrosis (p-value=0.049) were shown to differ statistically significantly between the groups. Conclusion: The present study highlighted that the flower stitch method is an extremely beneficial approach. It offers advantages in terms of better stability and is associated with fewer complications and lower morbidity when compared to the simple surgical knot group. [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 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]

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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]

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]

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]

The purpose of the study is to establish the efficacy of different concentrations of clove oil and the time needed for induction and recovery from anesthesia of European catfish (Silurus glanis L.) fry. The experiment was carried out in laboratory conditions with 50 specimens with body weight 1.11±0.25g and body length 5.45±0.60cm. For the aim of this paper the following five concentrations of clove oil are used: 0.01 ml.l-1, 0.02 ml.l-1, 0.03 ml.l-1, 0.04 ml.l-1 and 0.05 ml.l-1. At the lowest concentration (0.01ml.l-1) the effect is sedative and the fry do not reach the phase of complete immobilization. The application of 0.02 ml.l-1 concentration of clove oil is not beneficial for practical usage, with only 30% of the fish reaching phase 4 of anesthesia. At the highest concentrations (0.04 ml.l-1 and 0.05 ml.l-1) all of the fry were anesthetized for a short time, but the process of recovery was not successful for all of the fry. All of the fry reach phase of anesthesia and recovery without loses at 0.03 ml.l-1. This concentration is advisable for anesthesia of European catfish fry during different manipulations. [ABSTRACT FROM AUTHOR]

In spite of a growing corpus of studies concerned with the body and its relationships to organizing and organization, there is a distinct lack of empirical work to take seriously the nature of `embodiment' in the workplace. This paper presents a video-based study of teamwork in preoperative anaesthesia in order to propose an approach to analysing the body that focuses on organizational members' practical orientations to the body, and in particular dynamic bodies, in the workplace. To demonstrate the value of this approach, the paper considers coordination work among anaesthetic teams and highlights the importance of intercorporeal knowing in the real-time coordination of a team's work. The analytic orientation is drawn from ethnomethodology and conversation analysis. [ABSTRACT FROM AUTHOR]

John Francis Nunn (1925–2022) was an anaesthetist and clinical scientist who used his incomprehension of the science of anaesthesia in his early career to guide an extensive lifetime of innovative research. His interests outside of medicine led to him developing renowned expertise in such diverse areas as Egyptian hieroglyphs and the origins of the Earth's atmosphere. He was an outstanding communicator, writing four books alongside an impressive number of papers covering diverse topics from cell biology to history. His greatest contribution is in the understanding of respiratory physiology during anaesthesia which continues to underpin current routine anaesthetic practice and patient safety. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate whether and to what extent perioperative hypnosis and relaxation techniques are used in German anaesthesia departments, what they are, where any difficulties in their application lie and how great the interest in this type of therapy is. Another research question was to find out whether there are specialist areas in which these methods are used more frequently than in other specialist areas. Methods: A descriptive survey was conducted by means of a questionnaire in all hospitals with anaesthesia departments in Germany. 1124 questionnaires were sent out by post. The survey period was five months from 27/02/2023 to 31/07/2023. The clinic directors of all anaesthesiology departments in German hospitals were surveyed. Results: 476 departments (42%) responded by pre-paid envelope. Of these, only 39 (8%) use hypnosis and relaxation techniques perioperatively. These are mostly progressive muscle relaxation, hypnotic trance according to Erickson, calming words and suggestions or the use of virtual reality (e.g. using VR-glasses). Conclusions: Hypnosis techniques have been shown in many studies to be effective in increasing patient comfort (less anxiety and stress) and reducing both the need for medication and perioperative pain. The therapy is rarely used in Germany, although once established it can be easily integrated into perioperative procedures. Many departments have shown great interest in the topic. In the interests of patients, a structural change should be considered to promote the use of hypnotic procedures. [ABSTRACT FROM AUTHOR]

Background: Palatal dysfunction (PD), which encompasses palatal instability (PI) and intermittent dorsal displacement of the soft palate, is the most common performance‐limiting upper respiratory tract obstruction in young Thoroughbred racehorses. Soft palate thermocautery (SPT) performed under general anaesthesia is a routinely performed procedure for PD in some countries, but the procedure for and outcome of SPT performed under standing sedation has not been published. Objectives: (1) To describe a technique for SPT performed under standing sedation; and (2) to assess post‐operative performance in horses compared to controls using the Racing Post rating (RPR), British Horseracing Authority official rating (OR), Performance Index and Earnings. Study design: Retrospective case series. Methods: Medical records were reviewed for all horses that had SPT performed under standing sedation following topical and local infusion of lidocaine hydrochloride into the rostral soft palate, and that were identified to have PI by overground endoscopy. Two matched controls were identified for each case. The median RPR, OR, Performance Index and Earnings for the three pre‐operative and three post‐operative races were compared. Results: No significant differences were identified between the SPT (n = 23) and Control groups (n = 46) for baseline characteristics or outcomes. Main limitations: Retrospective study design, small sample size. Conclusions: No significant differences in racing performance were identified between horses that had SPT performed under standing sedation and controls. [ABSTRACT FROM AUTHOR]

The identification of temporal patterns plays an important role in many medical diagnostic applications. Template systems that identify events and landmark points directly from time-series information have been shown to work well in various applications and in various forms. However, few such systems directly account for the uncertainty and vagueness often associated with medical decision-making. This paper describes a template system that uses fuzzy set theory to provide a consistent mechanism of accounting for uncertainty in the existence of events, as well as vagueness in their starting times and durations. Fuzzy set theory allows the creation of fuzzy templates from linguistic rules. The fuzzy template system that is introduced in this paper can accommodate multiple time signals, relative or absolute trends, and obviates the need to also design a regression formula for pattern matching (a requirement in non-fuzzy template systems)—the system automatically generates a normalised 'goodness of fit’ score. Our target application for the fuzzy template system is anaesthesia monitoring. Initial testing using both simulated and recorded patient data has been encouraging. Results are presented showing the diagnosis using various temporal relationships of a number of problems. [ABSTRACT FROM AUTHOR]

PICO question In horses undergoing volatile anaesthesia, is recovery quality superior with the use of sevoflurane compared to isoflurane during the maintenance phase? Clinical bottom line The category of research question Treatment Number and type of study designs reviewed Seven papers were available for critical appraisal. Of the seven papers, six were prospective, randomised trials and four of these were of crossover design. Of the same seven papers, three were experimental and four were clinical. Strength of evidence Moderate Outcomes reported Five out of seven critically appraised articles found that there was no clinically significant improvement in recovery quality following volatile anaesthesia with sevoflurane compared to isoflurane. Two of the seven articles did find improvement in recovery quality following the use of sevoflurane over isoflurane, but both studies were of crossover design, one of these studies used non-blinded evaluators and the second study used both unblinded and blinded evaluators and a recovery quality scoring scale that did not show interobserver reliability. Conclusion In healthy horses presented for elective surgical and diagnostic imaging procedures in a clinical setting, there is no significant difference in recovery quality following the use of sevoflurane or isoflurane for the maintenance phase. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Aims and method COVID-19 has had a heavy impact on healthcare provision worldwide, including delivery of electroconvulsive therapy (ECT). A survey was completed in the UK and Republic of Ireland in April and July 2020 by 95 and 89 ECT clinics respectively. Results In April 2020, 53% of the clinics provided only emergency treatment and 24% had closed. Reasons included unavailability of anaesthetists, infection control measures and staff sickness. Restrictions persisted in July, with disruption to an estimated 437 individuals' treatment and poor outcomes, including clinical deterioration and readmission. Clinical implications Risk stratification, longer clinic sessions, improvements in ventilation, regular virus testing, pragmatic staff rostering and availability of personal protective equipment will protect against service disruption in subsequent waves of the pandemic. [ABSTRACT FROM AUTHOR]

Background: Anaphylaxis during anaesthesia is a serious complication for patients and anaesthetists.Methods: The Sixth National Audit Project (NAP6) of the Royal College of Anaesthetists examined the incidence, predisposing factors, management, and impact of life-threatening perioperative anaphylaxis in the UK. NAP6 included: a national survey of anaesthetists' experiences and perceptions; a national survey of allergy clinics; a registry collecting detailed reports of all Grade 3-5 perioperative anaphylaxis cases for 1 yr; and a national survey of anaesthetic workload and perioperative allergen exposure. NHS and independent sector (IS) hospitals were approached to participate. Cases were reviewed by a multi-disciplinary expert panel (anaesthetists, intensivists, allergists, immunologists, patient representatives, and stakeholders) using a structured process designed to minimise bias. Clinical management and investigation were compared with published guidelines. This paper describes detailed study methods and reports on project engagement by NHS and IS hospitals. The methodology includes a new classification of perioperative anaphylaxis and a new structured method for classifying suspected anaphylactic events including the degree of certainty with which a causal trigger agent can be attributed.Results: NHS engagement was complete (100% of hospitals). Independent sector engagement was limited (13% of approached hospitals). We received >500 reports of Grade 3-5 perioperative anaphylaxis, with 266 suitable for analysis. We identified 199 definite or probable culprit agents in 192 cases.Conclusions: The methods of NAP6 were robust in identifying causative agents of anaphylaxis, and support the accompanying analytical papers. [ABSTRACT FROM AUTHOR]

Background: Inhaled anaesthetic agents like sevoflurane contribute for approximately 5% to healthcare's carbon footprint. Previous studies suggested that the use of these agents should be minimized. Although multiple trauma surgeries can be performed under regional anaesthesia, most are performed under general anaesthesia. This study aims to evaluate the environmental benefits of using regional anaesthesia over general anaesthesia and to compare the associated complication rates. Methods: This retrospective study included all trauma patients (≥ 18 years) who underwent surgical intervention for hand, wrist, hip, or ankle fractures from 2017 to 2021. The hypothetical environmental gain was calculated based on the assumption that all surgeries were performed under regional anaesthesia. Complication rates were compared between regional and general anaesthesia. Results: Of the 2,714 surgeries, 15% were hand, 26% wrist, 36% hip, and 23% ankle fractures. General anaesthesia was used in 95%, regional in 5%. Switching this 95% to regional anaesthesia would reduce the sevoflurane use by 92 k, comparable to driving 406,553 km by car. The complication rate was higher with general anaesthesia compared to regional (7.7% vs 6.9%, p = 0.75). Conclusion: The potential gain of the reduction of sevoflurane in trauma surgeries which can be performed under regional anaesthesia can be significant. [ABSTRACT FROM AUTHOR]

Background: Using anaesthetics is an important application in aquaculture especially where the fish transportation, vaccination, grading, sorting activities and many other handling operations have been conducted during the different stages of production periods in the farms or hatcheries. Objectives: This study aimed to evaluate the efficacy of oregano essential oil (OO) as an anaesthetic for Nile tilapia and to determine the optimal concentration and post‐application stress effects compared to clove oil (CO). Methods: Nile tilapia juveniles were exposed to different concentrations of OO (20–40–60–80–100 mg L−1) and CO (50 mg L−1) for different time periods to determine the optimal concentration and exposure time. After the effective concentration of OO was determined, in the second experiment, stress parameters (glucose, plasma cortisol) were analysed after 0, 2, 6, 12 and 24 h of application. The results compared to the control group and CO results. Results: The study found that OO which has carvacrol compound higher than 78% was an efficient anaesthetic for Nile tilapia, and the effective concentration was found to be 60 mg L−1. No significant differences were found between opercular beats in any concentration of OO and CO. Basal glucose level in blood without anaesthesia application and recorded at 39.33 mg dL−1 and significantly lower than OO and CO at first two sampling points, 0 and 2 h (p < 0.05). According to plasma cortisol level results, although CO experimental group showed secondary stress response at 12 h (17.91 ± 4.21 ng mL−1), OO and CO group cortisol levels decreased at 24 h after anaesthesia application 7.13 ± 0.14and 7.01 ± 0.54 ng mL−1, respectively, below the control group cortisol concentration (12.28 ± 1.81 ng mL−1). Conclusions: These findings have important implications for the aquaculture industry as the use of OO as an anaesthetic could reduce the stress and mortality associated with traditional anaesthetics. Further research is needed to evaluate the efficacy of OO as an anaesthetic agent for other fish species and to determine the optimal concentration and exposure time for different species. [ABSTRACT FROM AUTHOR]

The quality of training is a major contributor to workforce proficiency in healthcare, and there is a definite need to achieve a uniform level of knowledge and skill in medical education programmes. There is a paucity of literature comparing postgraduate anaesthesia medical education training structure and requirements across the globe. In a zeal to achieve uniform competencies and technical skills, the strengths and scope of training programmes need to be identified. In this article, we describe the core elements of postgraduate training in various countries while proposing an amalgamation of strengths of each programme and providing a roadmap to evolve further the competency-based comprehensive curriculum proposed by the National Medical Commission of India. [ABSTRACT FROM AUTHOR]

Background: Handwritten documentation process has drawbacks. Therefore, anaesthesia electronic record (AER) is becoming commonplace in operating theatres to help clinicians improve perioperative quality. This study aims to evaluate the efficiency of AER are compared to handwritten records in terms of completeness of information, time and cost, and assessing user satisfaction. Methods: A hospital-based cohort study was conducted, which was an Ambi-directional study that included a phase 1 part of the study that was retrospective (using a checklist) and phase 2 that was prospective (using a questionnaire at King Faisal Specialist Hospital and Research Center, Riyadh (KFSHRC), Saudi Arabia. For phase 1, data were collected for 165 handwritten records during 2016 - 2017 and 77 AERs during 2018 - 2019, both from the operating room at KFSHRC. For phase 2 survey was conducted on 47 anaesthetists. Results: The AER shows significantly higher completion of information than the handwritten records (AER: 62.3% versus handwritten: 48%; P = 0.02). In terms of time, the meantime for the handwritten report was 45.9 min compared to 53.9 min for AER, therefore, showing the handwritten method's efficiency compared to AER. The satisfaction survey found that 53% of the respondents recognise the growing role of AER in streamlining workflow and improving the quality of services. Conclusion: The study demonstrates that AER has better completion of information, which supports the enhancement of documentation quality. On the contrary, lesser time is taken for filling handwritten records than AER, therefore, handwritten records are cost-efficient. This also shows how the time spent impacts the cost in operating theatre. We recommend a user-friendly environment for AER with adequate training for its users. [ABSTRACT FROM AUTHOR]

This review paper examines (using systematic methodology) the evidence for the use of inhalation sedation (IHS) instead of dental general anaesthesia (DGA) for dental treatment. It finds that this is an area of healthcare lacking high-quality clinical evidence (i.e. derived from randomized controlled trials). However, evidence from seven case series studies (level of evidence 3) of variable quality and design is examined. Those studies suggest that IHS is effective for a large proportion (83–97 per cent) of selected subgroups of children who would have otherwise required DGA. This may represent 45–64 per cent of all children who are referred for DGA. There is a remarkable degree of consistency between all studies in the reported treatment effectiveness of IHS, despite differences in design and populations treated. IHS is particularly suitable for orthodontic treatment, for older children, and for children requiring no more than four extractions. Morbidity associated with IHS is minor and infrequent, and user satisfaction is high, or higher compared with DGA. Comparing with DGA, IHS requires significantly longer time per episode and more treatment sessions per patient. In teaching dental hospitals, staffing costs for IHS are estimated to be cheaper by about a third compared with outpatient DGA. Indications for further areas of research are made. [ABSTRACT FROM PUBLISHER]

Abstract 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.

Ischemic heart disease is one of the leading causes of deaths worldwide. A major hindrance to resolving this challenge lies in the mammalian hearts inability to regenerate after injury. In contrast, zebrafish retain a regenerative capacity of the heart throughout their lifetimes. Apex resection (AR) is a popular zebrafish model for studying heart regeneration, and entails resecting 10–20% of the heart in the apex region, whereafter the regeneration process is monitored until the heart is fully regenerated within 60 days. Despite this popularity, video tutorials describing this technique in detail are lacking. In this paper we visualize and describe the entire AR procedure including anaesthesia, surgery, and recovery. In addition, we show that the concentration and duration of anaesthesia are important parameters to consider, to balance sufficient levels of sedation and minimizing mortality. Moreover, we provide examples of how zebrafish heart regeneration can be assessed both in 2D (immunohistochemistry of heart sections) and 3D (analyses of whole, tissue cleared hearts using multiphoton imaging). In summary, this paper aims to aid beginners in establishing and conducting the AR model in their laboratory, but also to spur further interest in improving the model and its evaluation. [ABSTRACT FROM AUTHOR]