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Introduction: Women continue to be underrepresented in academic anesthesiology. This study assessed guidelines in anesthesia journals over the past 5 years, evaluating differences in woman-led versus man-led guidelines in terms of author gender, quality, and changes over time. We hypothesized that anesthesia guidelines would be predominately man-led, and that there would be differences in quality between woman-led versus man-led guidelines., Methods: All clinical practice guidelines published in the top 10 anesthesia journals were identified as per Clarivate Analytics Impact Factor between 2016 and 2020. Fifty-one guidelines were included for author, gender, and quality analysis using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Each guideline was assessed across 6 domains and 23 items and given an overall score, overall quality score, and overall rating/recommendation. Stratified and trend analyses were performed for woman-led versus man-led guidelines., Results: Fifty out of 51 guidelines were included: 1 was excluded due to unidentifiable first-author gender. In total, 255 of 1052 (24%) authors were women, and woman-led guidelines (woman-first author) represented 12 of 50 (24%) overall guidelines. Eighteen percent (9 of 50) of guidelines had all-male authors, and a majority (26 of 50, 52%) had less than one-third of female authors. The overall number and percentage of woman-led guidelines did not change over time. There was a significantly higher percentage of female authors in woman-led versus man-led guidelines, median 39% vs 20% ( P = .012), as well as a significantly higher number of female coauthors in guidelines that were woman-led median 3.5 vs 1.0, P = .049. For quality, there was no significant difference in the overall rating or objective quality of woman- versus man-led guidelines. However, there was a significant increase in the overall rating of all the guidelines over time ( P = .010), driven by the increase in overall rating among man-led guidelines, P = .002. The overall score of guidelines did not increase over time; however, they increased in man-led but not woman-led guidelines. There was no significant correlation between the percentage of female authors per guideline and either overall score or overall rating., Conclusions: There is a substantial disparity in the number of women leading and contributing to guidelines which has not improved over time. Woman-led guidelines included more women and a higher percentage of women. There was no difference in quality of guidelines by first-author gender or percentage of female authors. Further systematic and quota-driven sponsorship is needed to promote gender equity, diversity, and inclusion in anesthesia guidelines., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 International Anesthesia Research Society.)

Sessile water droplet evaporation in varied gravity and electric fields has been experimentally studied. Specifically, the influences of gravity and electric fields are investigated in the context of the heat flux distribution beneath the droplets, as well as the droplet mechanics and resulting shapes. Experimental testing was carried out during a European Space Agency (ESA) Parabolic Flight Campaign (PFC 66). The droplets tested evaporated with a pinned contact line, a single wettability condition, and varied droplet volume and substrate heat flux. The peak heat transfer was located at the contact line for all cases. The peak heat flux, average heat flux, and droplet evaporation rate were shown to vary strongly with gravity, with higher values noted for hypergravity conditions and lower values in microgravity conditions. The droplet thermal inertia was shown to play a significant role, with larger droplets taking more time to reach thermal equilibrium during the parabolic testing period. No significant impact of the electric field on the droplet evaporation was noted for these test conditions., (© 2024. The Author(s).)

Background: Guidance documents are a valuable resource to clinicians to guide evidenced-based decision making. The quality of guidelines in anaesthesia and across other specialties has been demonstrated to be poor. COVID-19 presented an urgent need for immediate guidance for anaesthetists as frontline clinicians. The aim of this study was to evaluate the quality of COVID-19 guidance documents using the internationally validated Appraisal of Guidelines for Research & Evaluation (AGREE) II tool., Methods: A search was conducted in Ovid EMBASE and Ovid MEDLINE to identify all COVID-19 anaesthesia guidance documents from 2020-2021. Thirty-eight guidance documents were selected for analysis by 4 independent appraisers using the AGREE II instrument, across its 6 domains and 23 items. A scoring threshold for high quality was agreed by the working group via consensus., Results: Overall, the body of COVID-19 guidance documents achieved poor scores using AGREE II. Only 5% of documents met the high-quality criteria. Markers of quality included international and multi-institutional collaboration. Document title ('guideline' vs 'consensus statement'/ 'recommendations') did not yield any differences in domain scores and overall quality ratings. Compared with recent general anaesthesia guidelines, COVID-19 guidelines performed significantly worse., Conclusions: COVID-19 guidance documents published during the first two years of the pandemic lacked rigour and appropriate quality. This raises concern about their trustworthiness for use in clinical practice. Enhanced systems are required to ensure the integrity of rapidly formulated guidance., (Copyright © 2022 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Clinical practice guidelines are a valuable resource aiding medical decision-making based on scientific evidence. In anaesthesia, guidelines are increasing in both number and scope, influencing individual practice and shaping local departmental policy. The aim of this review is to assess the quality of clinical practice guidelines published in high impact anaesthesia journals over the past 5 yr using the internationally validated Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. A literature search was conducted in Scopus to identify all guidelines published in the top 10 anaesthesia journals as per Clarivate Analytics Impact Factor from 2016 and 2020. Fifty-one guidelines were included for analysis by five independent appraisers using AGREE II. Each guideline was assessed across six domains and 23 items. Individual domain scores were calculated with a threshold agreed via consensus to represent high-quality guidelines. There was a significant increase in overall score over time (P=0.041), driven by Domain 3 (Rigour of Development, P=0.046). The raw overall score for Domain 3, however, was low. The other domains performed as expected based on previous studies, with Domains 1, 4, and 6 achieving high scores and Domains 2 and 5 incurring poor ratings. Most guidelines studied involved international collaboration but emerged from a single professional society. Use of an appraisal tool was stated as high but poorly detailed. The improvement in the overall score of guidelines and rigour of development is promising; however, only seven guidelines met high-quality criteria, suggesting room for improvement for the overall integrity of guidelines in anaesthesia., (Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

We describe the case of a 61-year-old immunocompetent male who developed septic shock and multiorgan failure due to Capnocytophaga canimorsus (C. canimorsus) bloodstream infection, sustained from a dog bite. Unusually, this patient developed acute liver failure and splenic infarction in addition to many of the better-known clinical sequelae of C. canimorsus infection., Competing Interests: None declared

Purpose: The purpose of this study is to introduce peer teaching of communication skills to first-year anaesthesia trainees in Ireland and to evaluate their perception of this teaching modality., Methods: Seventy-nine first-year anaesthesia trainees participated in a novel peer-led communication skills programme over a 2-year period (Y1, Y2). A Likert scaling questionnaire was developed to explore trainee perception of the peer teaching programme., Results: Of the 79 respondents (36 in Y1 and 43 in Y2), 99% either agreed or strongly agreed that the peer teachers were successful in their role. Ninety-two percent requested formal peer teaching in other areas of training. The trainees regarded a peer teacher as an appropriate information provider (92%), role model (88%), planner (88%) and facilitator (94%), but less so as an assessor (70%). The most consistently stated strength of peer teaching was the relatability of peer teachers with their lack of experience cited as the main weakness. Eighty percent of participants preferred peer teaching to regular expert teaching., Conclusion: This study highlights the positive attitudes of first-year anaesthesia trainees towards a novel peer teaching programme in communication skills. This author recommends that peer teaching is further developed within postgraduate medical programmes to maximise learning for trainees in the student and teacher roles and to redistribute the teaching burden within clinical departments.

The liquid motion induced by surface tension variation, termed the thermocapillary or Marangoni effect, and its contribution to boiling heat transfer has long been a very controversial issue. In the past this convection was not the subject of much attention because, under terrestrial conditions, it is superimposed by the strong buoyancy convection, which makes it difficult to obtain quantitative experimental results. The scenario under consideration in this paper may be applicable to the analysis of boiling heat transfer, specifically the bubble waiting period and, possibly, the bubble growth period. To elucidate the influence of Marangoni convection on local heat transfer, this work numerically investigates the presence of a hemispherical bubble of constant radius, R(b)= 1.0 mm, situated on a heated wall immersed in a liquid silicone oil (Pr= 82.5) layer of constant depth H= 5.0 mm. A comprehensive description of the flow driven by surface tension gradients along the liquid-vapor interface required the solution of the nonlinear equations of free-surface hydrodynamics. For this problem, the procedure involved solution of the coupled equations of fluid mechanics and heat transfer using the finite-difference numerical technique. Simulations were carried out under zero-gravity conditions for temperatures of 50, 40, 30, 20, 10, and 1 K, corresponding to Marangoni numbers of 915, 732, 550, 366, 183, and 18.3, respectively. The predicted thermal and flow fields have been used to describe the enhancement of the heat transfer as a result of thermocapillary convection around a stationary bubble maintained on a heated surface. It was found that the heat transfer enhancement, as quantified by both the radius of enhancement and the ratio of Marangoni heat transfer to that of pure molecular diffusion, increases asymptotically with increasing Marangoni number. For the range of Marangoni numbers tested, a 1.18-fold improvement in the heat transfer was predicted within the region of R(b)< or = r< or = 7R(b).