Rapid Sequence

Sepsis is a high burden syndrome associated with increased morbidity and mortality in both the acute and longer-term phases of illness. There remain multiple treatment uncertainties that require resolution through high quality research. This new study aimed to identify the top 10 research priorities for sepsis research in the UK.

Monthly Editor podcasts are back! This month, Dr Maryann Turner talks with Dr Mike Charlesworth, who was the previous Dissemination Editor for the journal. He talks about his time as Dissemination Editor, NAP7, Core Topics and his favourite part of being an Editor. Papers mentioned: 1. Rapid sequence induction: a modern-day example of Theseus' Paradox? 2. Regional anaesthesia for awake urgent upper limb surgery in children 3. Measurement and interpretation of central venous pressure: a narrative review 4. Anaesthesia support for transcatheter heart valve interventions: a narrative review

In the UK, approximately 70% of surgical procedures are undertaken as day-cases. Little information exists about recovery from day-case surgery, yet international data highlights patients are at risk of developing significant longer-term health problems including chronic post-surgical pain and persistent postoperative opioid use. This paper outlines the methods for the POPPY study, the largest UK multicentre prospective observational study considering short- and longer-term outcomes following day-case surgery. Join the authors and our Editor, Dr Helen Laycock, for a discussion about this excellent new methods paper.

Prehabilitation seeks to enhance functional capacity and preparedness before surgery with the aim of improving outcomes; it is generally based on exercise, diet and psychological interventions. While there is obvious appeal to this approach in terms of patient experience and resource use, the interventions are complex and the evidence base for prehabilitation before cancer surgery is heterogeneous. Prehabilitation requires patient understanding and motivation as well as commitment of resources. Programmes are challenging to design and implement, and can generate ‘intervention-based inequalities’ based on the capacity of patients to engage. Find out why prehabilitation must be implemented carefully to avoid widening inequalities with this new podcast hosted by Professor Cliff Shelton and his coauthors. Full paper here. 2025 Special Issue on Oncoanaesthesia here.

Until more evidence becomes available, this pragmatic, multidisciplinary consensus statement aims to support shared decision-making and improve safety for patients taking glucagon-like peptide-1 receptor agonists, dual glucose-dependent insulinotropic peptide receptor agonists and sodium-glucose cotransporter-2 inhibitors during the peri-operative period.

This podcast was recorded live at the Association of Anaesthetists Annual Congress 2024 in Harrogate. We spoke with keynote speaker Sir Julian Hartley (Chief Executive of NHS Providers) and Association of Anaesthetists President Dr Tim Meek about the role of the modern consultant in healthcare systems, HIT lists and whether or not the NHS is 'broken'.

This podcast was recorded live at the Association of Anaesthetists Annual Congress 2024 in Harrogate. We recently published a new multidisciplinary consensus statement from the Association of Anaesthetists and the British Pain Society. We were delighted to join authors Dr Helen Laycock and Prof Kariem El-Boghdadly to discuss the need for this new document, how it was written and the key clinical implications for practice.

This podcast was recorded live at the Association of Anaesthetists Annual Congress 2024 in Harrogate. We were delighted to be joined by Dr Sarah Marsden and Dr Stuart Edwardson to talk about a new scoping review from Winter et al. Dr Marsden is the Chair of the Association of Anaesthetists Trainee Committee having taken over the role from Dr Edwardson, who received the anniversary medal for his service to the Association.

This podcast was recorded following the airway session at the Association of Anaesthetists Annual Congress 2024 in Harrogate. Our dissemination Editor Dr Maryann Turner was joined by Prof Kariem El-Boghdadly, Dr Emilie Hoogenboom, Prof Ed Mariano and Dr Imran Ahmad. The discussion was around difficult airway management and how the choice between technique A vs. B vs. C vs. others never has an obvious 'correct' answer. For this session, even members of the expert panel chose different options, demonstrating the difficulties clinicians face in everyday practice.

The 7th National Audit Project (NAP7) of the RCoA examined peri-operative cardiac arrest and each of the three phases captured the involvement of anaesthesia associates in clinical practice. In view of current interest and controversy concerning the roles and scope of practice of anaesthesia associates, the authors aimed to share a full account of information collected during NAP7 to add to the limited available data in this area. This likely represents the only national dataset which incorporates anaesthetists and anaesthesia associates. This interview accompanies the paper and includes the authors Prof Tim Cook and Lee Varney, as well of the President of the Association of Anaesthesia Associates, Sarah Massey. They talk about the paper and the wider associated issues. Essential listening for all.

There are lots of excellent papers this month which have been highlighted by our dissemination editors Maryann and Mike! This month, they discuss: Still a ‘boys’ club': a qualitative analysis of how gender affects a career in anaesthesia in Australia and Aotearoa New ZealandSuccessful return to work in anaesthesia after maternity leave: a qualitative studyImpact of postoperative cardiovascular complications on 30-day mortality after major abdominal surgery: an international prospective cohort studyAssociation of peri-operative prescription of non-steroidal anti-inflammatory drugs with continued prescription of opioids after total knee arthroplasty: a retrospective claims-based cohort studyGlucagon-like peptide-1 receptor agonists: a narrative review of clinical pharmacology and implications for peri-operative practiceRemifentanil for tracheal intubation without neuromuscular blocking drugs in adult patients: a systematic review and meta-analysisAll your CPD for the month in one place, free to listen and clinically relevant for all. Enjoy!

Multimorbidity poses a global challenge to healthcare delivery. This study aimed to describe the prevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort of patients undergoing major abdominal surgery.

This month, Dr Maryann Turner is joined by Professor Kariem El-Boghdadly to discuss three papers from the June 2024 issue. Comparison of the success rate of tracheal intubation between stylet and bougie with a hyperangulated videolaryngoscope: a randomised controlled trial.The effect of a bundle intervention for ambulatory otorhinolaryngology procedures on same-day case cancellation rate and associated costs.Principles for management of hip fracture for older adults taking direct oral anticoagulants: an international consensus statement.

The Opioid PrEscRiptions and Usage After Surgery (OPERAS) study aimed to quantify the current global practice of opioid prescribing and consumption patterns in patients after discharge from common surgical procedures, and to identify factors associated with increased opioid consumption. It found that double the quantity of opioids patients consume in the post-discharge period are prescribed at discharge, exposing them to risk of opioid-related harm. Individualised opioid prescribing at discharge remains important as excess prescriptions are driving increased consumption of opioids by patients. While patient pain levels and pre-discharge opioid consumption influence opioid consumption at discharge, the quantity of opioids prescribed remains a modifiable factor to curtailing excessive prescriptions of unused opioids.

Despite a lack of supporting evidence, airway management in patients with suspected or confirmed cervical spine injury is traditionally thought to increase the risk of worsening existing neurological deficits (secondary spinal cord injury) or risk of causing a new spinal cord injury (primary spinal cord injury). Although there has been evidence synthesis for specific elements of airway management in this setting, there has been little guidance to support clinical decision-making for airway management in this cohort of patients. These guidelines focus on the impact of airway management on cervical spine-related safety outcomes rather than efficacy of different airway management techniques. Whilst these two are related, the primary aim is to support clinicians in performing airway management whilst minimising the risk of airway complications and cervical spine cord injury.

While effective for acute pain control, recent pre-clinical evidence has raised concerns regarding an association between NSAIDs and chronic pain and potential opioid use. The objective of this paper was to explore the association between peri-operative use of prescription NSAIDs and the need for continued opioid prescriptions lasting 90–180 days in previously opioid-naïve patients undergoing total knee arthroplasty. Join Prof Ed Mariano and the authors to find out what the key messages are for clinicians.

Gender inequity remains an issue in anaesthesia despite increasing numbers of women training and achieving fellowship in the speciality. Women are under-represented in all areas of anaesthetic research, academia and leadership. This podcast featuring Dr Seema Agarwal discusses two new qualitative papers on related topics. The first is an analysis of how gender affects a career in anaesthesia in Australia and Aotearoa New Zealand. The second examines successful return to work in anaesthesia after maternity leave.

This month, Dr Maryann Turner takes the helm to discuss three papers from the May issue with Dr Mike Charlesworth. The first is a national prospective observational cohort study of risk factors for complications after emergency surgery for paediatric appendicitis. The second is a new Resuscitation Council UK algorithm for the emergency treatment of peri-operative anaphylaxis. The final paper is a ‘Reviewer Recommendations’ article about how to conduct and report guidelines and position, best practice and consensus statements. These are three excellent papers from a jam-packed issue that contains something for everyone. Enjoy!

The April issue contains lots of excellent clinically-orientated papers and this month, Associate Editor Dr Nicolai Bang Foss has chosen three that caught his eye. The first is a comparison of a new intravenous agent remimazolam vs. propofol for TIVA and we talk about depth of anaesthesia, hypotension and everything inbeteeen. The second is a new PQIP study modelling postoperative complications and their prediction. Finally, we talk about a standalone editorial on neuromuscular blockade and the gap between what we known and what we do.

This month, all the main articles in the issue come from a special collection on sustainable healthcare, climate science and the anaesthetist. All papers are free to read, forever! Our Associate Editor, Dr Ben Gibbison, has chosen three of his favourite from the issue to discuss. These include an editorial on misconceptions about sustainable anaesthesia, a review of background science on global warming potentials and a comparison of the environmental impact of volatiles vs. TIVA in 50k patients.