Rapid Sequence

Association between multimorbidity and postoperative mortality in patients undergoing major surgery

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.

June 2024 with Professor Kariem El-Boghdadly

This month, Dr Maryann Turner is joined by Professor Kariem El-Boghdadly to discuss three papers from the June 2024 issue.

1. Comparison of the success rate of tracheal intubation between stylet and bougie with a hyperangulated videolaryngoscope: a randomised controlled trial.
2. The effect of a bundle intervention for ambulatory otorhinolaryngology procedures on same-day case cancellation rate and associated costs.
3. Principles for management of hip fracture for older adults taking direct oral anticoagulants: an international consensus statement.

Patterns of opioid use after surgical discharge

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.

Airway management in patients with suspected or confirmed cervical spine injury

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.

Association of peri-operative prescription of non-steroidal anti-inflammatory drugs with continued prescription of opioids after total knee arthroplasty

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.

Still a ‘boys’ club': a qualitative analysis of how gender affects a career in anaesthesia

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.

May 2024 with Dr Maryann Turner and Dr Mike Charlesworth

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!

April 2024 with Dr Nicolai Bang Foss

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. 

March 2024 with Dr Ben Gibbison

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.

Impact of postoperative cardiovascular complications on 30-day mortality after major abdominal surgery: an international prospective cohort study

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.