Rapid Sequence

NAP7 – The incidence of potentially serious complications during anaesthetic practice

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.

NAP7 – Baseline Survey

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.

December 2023 with Dr Paul Bramley

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

November 2023 with Prof Ed Mariano

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

October 2023 with @GongGasGirl

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!

Pre-operative gastric ultrasound in patients at risk of pulmonary aspiration

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?

 

Impact of modified-release opioid use on clinical outcomes following total hip and knee arthroplasty

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.

High-volume patient-controlled epidural vs. programmed intermittent epidural bolus for labour analgesia: a randomised controlled study

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.

Timing of elective surgery and risk assessment after SARS-CoV-2 infection: 2023 update

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.

Clinical tests for confirming tracheal intubation or excluding oesophageal intubation

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.