We often hear calls for the use of PROMs and PREMs in research, and a range of studies report their use in the September issue. O’Carroll et al. report the largest multicentre dataset of day 1 and 30 postpartum recovery metrics using PROMs in patients from the UK. They provide data from 1631 patients in 107 centres and find that complications occur in 1 in 5 postpartum patients following hospital discharge, with 5% of these requiring readmission (Fig. 1). In the associated editorial, Bamber outlines why anaesthetists should care about postnatal care. Perhaps any quality improvement s ..read more

The PUMA guidelines for preventing unrecognised oesophageal intubation were published nearly a year ago, and the paper was arguably one of the most important of 2022. This new editorial from Qureshi et al. builds on this guidance by considering capnography during cardiopulmonary resuscitation, and there has been much discussion from this on social media and in our correspondence pages. There was also much debate on Twitter about the utility of clinical tests for confirming tracheal intubation, which include: tube misting; lung auscultation; 5-point auscultation; and the use of an oes ..read more

The association between ethnicity and outcomes in obstetrics is well known, but there has been little published about its relationship with obstetric anaesthetic care. This new national cohort study of women who gave birth between 2011–2021 from Bamber et al. finds differences between ethnic groups in rates of general anaesthesia received by women who had caesarean births and in rates of neuraxial anaesthesia received by women who had vaginal births (Fig. 1). In the associated editorial, Lee and Palanisamy examine parallels and paradoxes with care in the USA. Although this is th ..read more

The effect of COVID-19 infection on peri-operative mortality was characterised by the first CovidSurg study, which found an increased postoperative mortality across an international cohort if surgery was undertaken within the first 7 weeks following infection. In this issue, a service evaluation examined perioperative mortality in an English cohort (via OpenSAFELY) of over 3.5 million patients comparing pre-pandemic, pre-vaccination, and post-vaccination groups. It found that the same pattern of increased postoperative mortality following infection was present in both vaccinated and ..read more

This month, we are delighted to publish a narrative review and guideline on human factors in anaesthesia. The guideline recently received > 11k downloads after being shared widely by Martin Bromiley and holds an Altmetric score of > 200, having been tweeted by 250 users and reported by two news outlets. Publishing a review and guideline together in this way seems to work well, as the review can synthesise and comment on the relevant scientific evidence whilst the guideline builds on this with expert analysis, opinion and consensus. The authors should be congratulated ..read more

We are delighted to announce that our 2024 special supplement will focus on sustainable healthcare and the role of the anaesthetist. This month’s issue shows how important this theme is also in 2023. First, Waspe and Orr review regulatory guidelines for environmental risk assessment of propofol in wastewater. They outline the two phases of an environmental risk assessment for medicinal products and remind us that other drugs such as: erythromycin; clarithromycin; ibuprofen; diclofenac; ethinylestrodiol; metformin; and propranolol have the highest ecotoxicological risk to the surface water ..read more

This new guideline is without doubt one of the most important papers from 2022 and essential reading for all. Oesophageal intubation during attempted tracheal intubation could happen to any one of us, yet traditional teachings and practice might lead to misdiagnosis. The case of Glenda Logsdail demonstrates the very real consequences when things go wrong. The key elements of the paper are the 11 core recommendations, the criteria for ‘sustained exhaled carbon dioxide’ and an algorithm for what should happen when these criteria are not met. Because many will not be skilled with airway ultrasoun ..read more

Increasing numbers of NHS consultants are voluntarily reducing their time spent delivering contracted direct clinical care. The result is concerning, with experienced clinicians working less hours and retiring early. This new guidance aims to highlight contributory issues and list clear, implementable solutions. One theme is that ‘age’ in anaesthesia should not be perceived negatively and should instead be celebrated. Experienced clinicians have much to offer departments, hospitals and patients, and younger clinicians should think carefully now about how to ‘pace’ careers and continue to ..read more

This month, we are delighted to publish our new special selection of review articles on emergencies in anaesthesia. Some of these reviews appear in the October issue and the others on Early View and in future issues. All are free to access for all, forever!  First, Matt Wiles lists the evidence for airway management strategies in patients with suspected or confirmed traumatic spinal cord injury. He discusses: airway manoeuvres; manual in-line stabilisation; cricoid force; direct and indirect laryngoscopy; flexible bronchoscopy; and the associated risks of tracheal intubation. Overall ..read more

It is not clear yet why facemask ventilation becomes easier following neuromuscular blockade. This new prospective observational study from Lee et al. evaluates changes in tidal volume after administration of neuromuscular blockade and assesses the correlation of this with changes in the vocal cord angle. They found that tidal volume and vocal cord angle during induction of anaesthesia increased after neuromuscular blockade in patients with normal airways. In addition, both insufficiency of ventilation before neuromuscular blockade and improvement after neuromuscular blockade were correla ..read more