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 Zealand Successful return to work in anaesthesia after maternity leave: a qualitative study Impact of postoperative cardiovascular complications on 30-day mortality after major abdominal surgery: an international prospective cohort study Association of peri-operative prescription of non-steroidal anti-inflammatory drugs with continued prescription of opioids after total knee arthroplasty: a retrospective claims-based cohort study Glucagon-like peptide-1 receptor agonists: a narrative review of clinical pharmacology and implications for peri-operative practice Remifentanil for tracheal intubation without neuromuscular blocking drugs in adult patients: a systematic review and meta-analysis All 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.

There have been few large-scale, prospective cohort studies focusing on postoperative cardiovascular complications and their impact on postoperative mortality. This international prospective cohort study aimed to define the incidence and timing of these complications and to investigate their impact on 30-day all-cause mortality. The authors performed a prospective, international cohort study between January 2022 and May 2022. Data were collected on consecutive patients undergoing major abdominal surgery in 446 hospitals from 28 countries across Europe. The results are of clinical relevance to all who care for patients in the peri-operative period.

Our new 2024 special supplement is now online! We have put together a collection of articles that are at the cutting edge of peri-operative science. Joining @GongGasGirl is Dame Julia Slingo, Miss Virginia Ledda and Ms Alifia Chakera.  Their articles cover climate science, carbon literacy and The Nitrous Oxide Project. This podcast was viewed by more than 10k on X, and now you can listen to the discussion here in full.

This month, we spoke with Anaesthesia Reports Editor Dr Susannah Patey from Manchester. She chose three great papers from the Anaesthesia February 2024 issue covering burnout, aerosols during CPR and prefilled syringes.  Get all your CPD for the month right here, on #TheAnaesthesiaPodcast!

Welcome to this month’s Anaesthesia Journal Podcast! We are delighted to be joined by Dr Criag Lyons, who is an Editor of Anaesthesia Reports. This month, we are going to be talking about three new papers from the January 2024 issue covering regional anaesthesia, videolaryngoscopy and statistics. Three core topics for all anaesthetists. Enjoy!

The third instalment of our NAP7 podcast series discusses the main results papers from the project. The first paper reports on epidemiology and clinical features of peri-operative cardiac arrests and the second on management and outcomes. 

Complications and critical incidents arising during anaesthesia due to patient, surgical or anaesthetic factors, may cause harm themselves or progress to more severe events, including cardiac arrest or death. As part of the 7th National Audit Project of the Royal College of Anaesthetists, the authors studied a prospective national cohort of unselected patients. Anaesthetists recorded anonymous details of all cases undertaken over 4 days at their site through an online survey. This new podcast discusses the results and their implications.

There are two papers we are discussing today and they are the first in a series of results from probably the most important piece of peri-operative research from 2023 – NAP7! The first paper reports results from the local coordinator baseline survey. The second paper then looks at preparedness for and experiences of peri-operative cardiac arrest. The papers are rich with data and this interview aims to pick out key findings and discuss some of the associated clinical implications.

Today we are going to be talking about the December 2023 issue, which is online today! This issue is really exciting because it is the first to contain papers reporting results from NAP7. This will all be dealt with separately, so instead we are going to focus on other papers in the issue. And there is a lot to choose from: prehabilitation; pain assessment; dexmedetomidine; and dexamethasone. Joining us today all the way from Sheffield is one of our Journal Fellows Dr Paul Bramley. Here are the papers: Potential for using simulated altitude as a means of prehabilitation: a physiology study Effect of nociception level index-guided intra-operative analgesia on early postoperative pain and opioid consumption: a systematic review and meta-analysis

This month, we discuss three important papers from the November 2023 issue with Professor Ed Mariano. A great way to get all your CPD for the month in just half an hour! 1. Is the future of nitrous oxide as volatile as the gas itself? https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.16086 2. PROSPECT methodology for developing procedure-specific pain management recommendations: an update https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.16135 3. Beyond high-risk: analysis of the outcomes of extreme-risk patients in the National Emergency Laparotomy Audit https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.16130

This month, we spoke with @GongGasGirl about her time at Annual Congress 2023, conferencing, whether or not desflurane should be banned, changes in trends on social media and MR opioids. The October issue is available now and contains lots of great papers with clinically relevant content. Enjoy!

Point-of-care gastric sonography offers an objective approach to assessing individual pulmonary aspiration risk before induction of general anaesthesia. This new paper aimed to evaluate the potential impact of routine pre-operative gastric ultrasound on peri-operative management in a cohort of adult patients undergoing elective or emergency surgery at a single centre. For this new podcast, Dr Eimear Keane speaks with the authors about how they did it, and the resultant key messages for clinical practice. Should we all be doing gastric POCUS more?  

Despite concerns and recommendations, modified-release opioids are still commonly used for the management of acute pain following total hip and knee arthroplasty. There is a need to compare modified-release and immediate-release opioid use following these procedures, and to determine whether the use of modified-release opioids is safe or harmful. The primary objective of this study was to examine the impact of modified-release opioid use on the incidence of opioid-related adverse drug events compared with immediate-release opioid use among adult hospital inpatients following primary total hip or knee arthroplasty. In this multicentre propensity score matched cohort study, modified-release opioid use in the acute postoperative period is associated with an increased risk of experiencing opioid-related adverse events after total hip or knee arthroplasty compared with those given immediate-release opioids only. Further, patients given modified-release opioids experienced a higher incidence of constipation and in-hospital falls, as well as a longer length of hospital stay compared with patients given immediate-release opioids only. Join our Editor Dr Helen Laycock as she discusses the study and its implications with the authors.

Neuraxial labour analgesia is a safe and effective method of pain relief. Following initiation of analgesia with epidural or combined spinal-epidural, this can be maintained with continuous epidural infusion, manual intermittent boluses, patient-controlled epidural analgesia (PCEA), programmed intermittent epidural bolus (PIEB) or a combination of these. This new RCT finds that a PCEA high-volume bolus without a background infusion is not inferior to PIEB for maintenance of epidural labour analgesia and superior regarding local anaesthetic consumption. The results of the study support the use of high-volume bolus techniques, whether as part of PIEB or PCEA, for the maintenance of epidural labour analgesia. The PIEB techniques provide more consistent pain control (less variability), whereas PCEA-only may give women more control over their analgesia. For this podcast, Dr Louise Savic discussed the methods and resultant implications with the authors.

Guidance for the timing of surgery following SARS-CoV-2 infection needed reassessment given widespread vaccination, less virulent variants, contemporary evidence and a need to increase access to safe surgery. This is the third iteration of consensus guidance around timing of surgery and risk assessment. Find out here why the update was required and what is new for 2023.

This new meta-analysis from Hansel et al. is a must read for all. Join Associate Editor Susannah Patey as she speaks with the authors about the key findings and clinical conclusions. 

The two most commonly used airway management techniques during general anaesthesia are supraglottic airway devices and tracheal tubes. This new study compares their use for elderly patients undergoing low risk surgery with a composite of postoperative pulmonary complications as the primary outcome.  It is a fascinating trial for many reasons and we expect there will be much discussion amongst anaesthetists. Join Prof Mike Irwin and the authors to find out why they did it and a summary of the key clinical messages.