25th Annual Meeting of Chinese Society of Anesthesiology
Zhengzhou China, September 7-10, 2017  (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - November 16, 2017 Category: Anesthesiology Source Type: research

Author's reply to Thomas et al.
Editor —We are pleased that Thomas and colleagues1 agree with many of the conclusions in our Editorial and audit23 of suboptimal laryngeal mask airway (LMA) placement. We agree with several points they make in their letter. If initial attempts fail, Magill forceps can be used to guide the flexible LMA beyond the epiglottis, or the cuff can be deflated even further, or more jaw thrust can be applied. All of these are included in our proposals. It is self-evident that there should be adequate levels of anaesthesia, but it would have been unnecessary to repeat such a fundamental point, as that necessity has been emphasized ...
Source: British Journal of Anaesthesia - November 16, 2017 Category: Anesthesiology Source Type: research

Response to: ‘Failed supraglottic airway’: an algorithm for suboptimally placed supraglottic airway devices based on videolaryngoscopy
Editor —We read with interest the editorial by van Zundert and colleagues1 in the recent issue ofBritish Journal of Anaesthesia. We strongly commend the authors for highlighting the problem of suboptimal laryngeal mask airway (LMA) placement. As a single specialty ear, nose, and throat hospital, we are perhaps in a unique position in that the majority of our caseload is shared airway using first-generation flexible LMAs. Since the flexible LMA was introduced at our hospital in 1990, we estimate that we have performed>135  000 ENT operations, with 80–85% performed with flexible LMAs. This includes a large number of ...
Source: British Journal of Anaesthesia - November 16, 2017 Category: Anesthesiology Source Type: research

New nomenclature: Clarion call or siren song. Reply to: perioperative cognitive disorders
Editor —We thank Evered and Eckenhoff1 for their great interest in our editorial.2 We agree entirely with their perspective that much previous research into postoperative cognitive decline (POCD) is tainted, and that methodological weaknesses have led to incorrect conclusions. For example, the most reliable evidence (e.g. from randomized controlled trials) suggests that persistent POCD (both mild and major neurocognitive disorders [postoperative]) is likely to be apost hoc ergo propter hoc (after this therefore because of this) misattribution fallacy.3 We hope, as they do, that future research into this topic will be mor...
Source: British Journal of Anaesthesia - November 16, 2017 Category: Anesthesiology Source Type: research

Perioperative cognitive disorders. Response to: Postoperative delirium portends descent to dementia
Editor —We read with great interest the recent editorial by Aranake-Chrisinger& Avidan.1 We were pleased to see that this editorial contains terminology developed over several yr by the multi-disciplinary International Perioperative Cognition Nomenclature Working Group. At the same time, we were surprised and disappointed that the terminology is presented before the official release (in theBritish Journal of Anaesthesia as well as Anesthesia& Analgesia, Canadian Journal of Anesthesiology, Acta Anaesthesiologica Scandinavica, Journal of Alzheimers Disease and Anesthesiology),2 without the necessary definitions or ...
Source: British Journal of Anaesthesia - November 16, 2017 Category: Anesthesiology Source Type: research

Don ’t crush the sensitive snout. Reply to: Sensitivity is not enough
Editor —We entirely agree with Wilson’s comments on our paper1 that sensitivity and positive predictive value (PPV) cannot be equated,2 and appreciate the opportunity to clarify this point. Indeed, it is important to highlight that a sensitive test often has a low PPV (Table 1).3 In the editorial, we did not in fact liken sensitivity to PPV, but rather related sensitivity to negative predictive value (NPV), using the acronym SNOUT (a negative result in a sensitive test rules out the disease). Table 1NPV, negative predictive value. PPV, positive predictive value. This table illustrates that a sensitive test (e.g. ≥90%...
Source: British Journal of Anaesthesia - November 16, 2017 Category: Anesthesiology Source Type: research

Sensitivity is not enough. Response to: Postoperative delirium portends descent to dementia
Editor —I welcome the thoughtful discussion by Aranake-Chrisinger& Avidan about testing for postoperative cognitive decline.1 However, the penultimate paragraph is potentially misleading because it makes two common statistical errors. Firstly, there is confusion about the meaning and importance of test sensitivity. In addition to sensitivity, a test ’s utility needs to be evaluated in the context of its specificity and the disease prevalence. A test with 99% sensitivity can be clinically useless if it has poor specificity, or is used in a low prevalence population.23 Their equating of a 50% sensitivity with a 50% p...
Source: British Journal of Anaesthesia - November 16, 2017 Category: Anesthesiology Source Type: research

Reply to: Pulse oximeter perfusion index for assessment of brachial plexus block: a holy grail or a design fail?
Editor —We thank Daoud for his interest in our study1 and are pleased to address the two concerns raised in his letter.2 (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - November 16, 2017 Category: Anesthesiology Source Type: research

Pulse oximeter perfusion index for assessment of brachial plexus block: a holy grail or a design fail?
Editor —I read with interest the recently published article by Abdelnasser and colleagues1 regarding prediction of successful supraclavicular brachial plexus block using the pulse oximeter perfusion index (PI). The article represents an addition to other articles evaluating the usefulness of the pulse oximeter perfusion index in objective assessment of brachial plexus blocks.2 –4 (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - November 16, 2017 Category: Anesthesiology Source Type: research

Limitations of clinical studies evaluating tertiary hyperalgesia
Editor —Shin and colleagues1 suggested that magnesium sulphate attenuates increased pain intensity at sites remote from the surgical site (tertiary hyperalgesia), based on the observation of reduced pain in a magnesium-administered groupvs controls after a second total knee arthroplasty (TKA) during staged bilateral total knee arthroplasty. This may serve as a basis for further studies of tertiary hyperalgesia, a topic that has not been studied extensively to date. Potential confounding factors or possible misinterpretations associated with this study should be discussed to enhance its influence on future studies. (Sourc...
Source: British Journal of Anaesthesia - November 16, 2017 Category: Anesthesiology Source Type: research

Reply to: Does intraoperative magnesium lessen pain after knee replacement surgery?
Editor —We greatly thank. Buswell& Fregene1 for their interest in our article.2 We are pleased to respond to their comments below. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - November 16, 2017 Category: Anesthesiology Source Type: research

Does intraoperative magnesium lessen pain after knee replacement surgery?
Editor —I write in response to the paper by Shin and colleagues1 regarding the use of magnesium sulphate as an analgesic in staged knee arthroplasty. Whilst the study appears well-planned and presents some convincing results, my colleagues and I were left with a few questions. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - November 16, 2017 Category: Anesthesiology Source Type: research

The role of propofol for remote ischaemic preconditioning in the setting of cardiac surgery – a Cochrane systematic review †
Editor —The concept of remote ischaemic preconditioning (RIPC) is an easy, readily available and inexpensive strategy to increase resistance to myocardial ischaemia/reperfusion injury. Within the past decade, RIPC has been translated from experimental studies with promising results to proof-of-principle randomized controlled trials (RCTs) in the setting of cardiac surgery. Despite some beneficial effects in terms of reduced myocardial injury as expressed by blood markers,1 most RCTs failed to show a benefit of RIPC on short or long-term clinical outcome in patients undergoing cardiac surgery.23 In this context, use of th...
Source: British Journal of Anaesthesia - November 16, 2017 Category: Anesthesiology Source Type: research

Formulation of a National Surgical Plan in Rwanda: a model for integration of physician and non-physician anaesthetists
Editor—Many low-income countries that have relied upon non-physician anaesthetists are now developing their own anaesthesia training programs for physician anaesthetists. Rwanda ’s experience of integrating and educating NPAs and PAs might serve as a model to other countries. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - November 16, 2017 Category: Anesthesiology Source Type: research

Why has NHS England introduced an innovation and technology tariff to improve safer arterial systems in England?
Editor —Arterial transducer infusion sets are associated with complications such as bacterial contamination and accidental arterial injection, potentially leading to bacteraemia, tissue necrosis and limb loss.1 In recognition of reported complications, the NHS England National Patient Safety Agency (NPSA)2 has issued warnings on the risks associated with accidental arterial injection, and the Joint Commission and the World Health Organization (WHO) have stated that injection ports on arterial catheters should be avoided.3 In England, after the 2008 National Awareness Alert, the NPSA required NHS hospitals to take immedia...
Source: British Journal of Anaesthesia - November 16, 2017 Category: Anesthesiology Source Type: research