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:

1. Still a ‘boys’ club': a qualitative analysis of how gender affects a career in anaesthesia in Australia and Aotearoa New Zealand
2. Successful return to work in anaesthesia after maternity leave: a qualitative study
3. Impact of postoperative cardiovascular complications on 30-day mortality after major abdominal surgery: an international prospective cohort study
4. 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
5. Glucagon-like peptide-1 receptor agonists: a narrative review of clinical pharmacology and implications for peri-operative practice
6. 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!

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

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, 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.

Surgical decision-making after SARS-CoV-2 infection is influenced by the presence of comorbidity, infection severity and whether the surgical problem is time-sensitive.

This new paper utilised the OpenSAFELY database to look at practices and outcomes in England, and suggests that some patients can be safely operated within 2 weeks from infection. This podcast goes deeper into the associated issues and implications for clinicians, patients and hospitals. 

Detailed contemporary knowledge of the characteristics of the surgical population, national anaesthetic workload, anaesthetic techniques and behaviours are essential to monitor productivity, inform policy and direct research themes. Every 3–4 years, the Royal College of Anaesthetists, as part of its National Audit Projects (NAP), performs a snapshot activity survey in all UK hospitals delivering anaesthesia, collecting patient-level encounter data from all cases under the care of an anaesthetist.

For this podcast, Tanya Selak speaks with the authors about their work and explores some of the trends from these new data. 

Arguably the most important paper of 2023 so far and essential reading/listening for all!

This new paper from the AERATOR group examines the science around aerosol generation and awake tracheal intubation (ATI). Their study was performed on a single day during an ATI course on 12 anaesthetic trainees. They show that ATI without sedation generates high concentrations of respiratory aerosol. Professor Ross Hofmeyr talks to the authors about their study, its clinical implications and what the future holds for research in this area. 

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.

We caught up with Dr Fiona Kelly, lead author of a new guideline from the Association of Anaesthetists and the Difficult Airway Society on human factors in anaesthesia. The guideline and narrative review were published and launched live at the Winter Scientific Meeting in London today and there are several actions that we can all take today to impact patient care. 

Time to place less reliance on individual and team excellence to deliver high-quality patient care? We think so. Both papers are free to access and worth reading in full for all.

Pre-operative anaemia is common in patients undergoing non-cardiac surgery and associated with an increased risk of blood transfusion, hospital length of stay and postoperative complications.

This podcast is all about a new secondary analysis of the PREVENTT study. We are delighted to be joined in Australia by three of the papers authors, Professor Toby Richards, Dr Anastazia Keegan and Professor Lachlan Miles.

The aim of their analysis was to determine whether specific iron deficiency phenotypes derived clinical benefits from intravenous iron before major abdominal surgery compared with placebo.

Today, we were joined by three authors (Dr Alopi Patel, Dr Michelle Kars and Prof Ed Mariano) of a new paper which is all about how to use social media to get published. This forms part of a new series of articles called Reviewer Recommendations, which is very much a ‘how to’ guide for authors and readers. Enjoy!

Today we will be discussing this new paper which describes and validates a new anaesthetic complexity score, which is is a clinician-designed, real-world tested model of case complexity in anaesthetics. It is inclusive of, but distinct from, patient and surgical risk. 

The paper is of interest because of the methods used and also the potential implications for increasing efficiency and productivity in theatre. Joining us today we have authors Dr Elliott Ridgeon, Dr Katy Wilson and Dr Ahmed Elrefaey.

The Editors of Anaesthesia acknowledge the EDI problems we face in anaesthesia and medicine as a whole. Without taking action to address these problems, these issues will persist.

This newly published position statement is from the Editors of Anaesthesia, including the Editor-in-Chief.

For this podcast, the principal authors join Association of Anaesthetists CEO Nicky de Beer to discuss why and how the statement was written as well as its implications for the present and future.

Climate change is a real and accelerating existential danger. Urgent action is required to halt its progression, and everyone can contribute. Pollution mitigation represents an important opportunity for much needed leadership from the health community, addressing a threat that will directly and seriously impact the health and well-being of current and future generations.

Inhalational anaesthetics are a significant contributor to healthcare-related greenhouse gas emissions and minimising their climate impact represents a meaningful and achievable intervention. A challenge exists in translating well-established knowledge about inhalational anaesthetic pollution into practical action.

This new guideline is designed to provide a platform that engages health professionals as an active learning community, and invites sharing of success stories and evolving solutions across varied global practice settings.

For this podcast, @GongGasGirl interviews @jessahegedus about how they did it and why it is important. 

There is very limited evidence about the relative effectiveness of emergency surgery vs. non-emergency surgery strategies for patients with common acute conditions. This lack of evidence means that there is likely to be considerable practice variation in the NHS in England.

The ESORT study, which was published last night, aimed to compare the effectiveness of emergency surgery or not for five acute abdominal conditions.

Joining us this morning we have three authors of this excellent new paper, Professors Moonsinghe, Hinchliffe and Grieve.

This new guideline provides an update to the previously published consensus statement on SARS-CoV-2 infection, COVID-19 and timing of elective surgery to assist policymakers, administrative staff, clinicians and patients. It focuses on the omicron variant, which is now strongly dominant in many countries. However, the principles may also be of relevance to future variants.

To set the paper in its context, Rose Kearsley speaks with authors Scarlett McNally, Tim Cook and Kariem El-Boghdadly. Five thousand watched the broadcast, catch up with the audio recording here!

Joining us today we have the authors of a new paper reporting the effect of a text message intervention on burnout in trainee anaesthetists.

First we have Emily Larson who is a Senior Advisor at The Behavioural Insights Team. Emily has worked on reducing burnout and increasing wellbeing with physicians, educators and children. We also have Dr Alix Brazier who is also a Senior Advisor at The Behavioural Insights Team and currently leads BIT’s work applying behavioural insights to improve healthcare. Alix is also a PhD student at Imperial College, London, who also supported this research.

Finally, we have Dr Yihan Xu who is a research advisor at The Behavioural Insights Team and she designs and runs rapid online or field trials to inform and improve the delivery of government services in public health and education, for clients like the Department of Health and Social Care, the NHS, the Education Endowment Foundation, and the Ministry of Defence.

There were more applications for higher specialty training posts in anaesthesia in the UK starting in August 2021 than in previous years, with approximately two-thirds being unsuccessful.

This new national survey is all about recruitment to higher specialty training in anaesthesia in the UK during the COVID-19 pandemic. Joining Dr C Hughes was Dr C Holt, Dr J Subramaniam, Dr N Durrant and Dr S Edwardson. Their results suggest that junior anaesthetic doctors in the UK negatively perceived postgraduate training structures and changes to the postgraduate curriculum and experienced difficulties in securing higher training. This is a ‘must listen’ for all trainees and all those involved with training. Enjoy!

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.

What better way to see in any new year than with a brand-new Anaesthesia Special Supplement! This year, it is all about the peri-operative and critical care management of the brain, which has been guest edited by Dr Jugdeep Dhesi and Professor Alana Flexman. Joining us also were journal Editors Professor Iain Moppett and Dr Matt Wiles. Topics include:

• Chronic SDH
• Peri-operative neurocognitive disorders
• COVID-19-associated delirium
• Mode of anaesthesia for mechanical thrombectomy
• Status epilepticus
• Cerebral oximetry 

30 minutes of high quality CPD for all. Enjoy!

A recent coroner’s report in the UK concluded that a healthy patient died as a result of unrecognised oesophageal intubation. This did not seem to be the result of misinterpretation of a flat end-tidal carbon dioxide trace, but an apparent omission to check the capnograph after intubation and to perform clinical checks of tracheal tube position.

This podcast accompanies a new editorial from Pandit, Young and Davies which highlights the main lessons that can be learned from this tragic event.

Joining Professor Pandit we are delighted to have with us Professors Laura Duggan and Andrew Smith. The tread from Tanya Selak to accompany the podcast can also be found here.

Parachute (or ‘helicopter’) research is the practice of conducting primary research within a host country and subsequently publishing findings with inadequate recognition of local researchers, staff and/or supporting infrastructure.

The aim is that these recommendations will be broadly applicable within academic publishing; of use to international researchers at the point of study or partnership conceptualisation; and increase awareness of this issue among the general readership of academic journals.

Joining our Associate Editor Sheila Myatra was Seye Abimbola, Refiloe Masekela, Angela Obasi and Ben Morton who are authors of the paper.

In the UK, the Getting It Right First Time (GIRFT) programme was established by the Department of Health and Social Care as an initiative to investigate variation in healthcare delivery and patient outcomes between hospital Trusts in England. Variation between Trusts is unwarranted unless justified by patient case-mix, patient preference, equivocal evidence of effectiveness of a particular patient management approach or intractable resource constraints.

This new paper used the Hospital Episodes Statistics (HES) database to investigate variation in the rates Trusts discharged children the same day after tonsillectomy and associations with adverse postoperative outcomes. They found evidence that outcomes for day-case and overnight stay tonsillectomy are similar and conclude the majority of specialist and non-specialist Trusts should increase day-case surgery rates.

Joining the authors today was our chair Tanya Selak who is an Associate Editor as well as Ruth Tyrrell from GIRFT.

Robust evidence is needed to enable clinicians and policymakers to minimise VTE risk in patients with SARS-CoV-2 infection. Ideally, such evidence would stratify the risk of VTE against both the duration of time between infection and surgery and presence or absence of symptoms. This study aimed to determine the VTE rate in patients with SARS-CoV-2 infection, stratified by current or prior infection.

The authors found that SARS-CoV-2 infection was independently associated with an increased incidence of postoperative VTE in patients with peri-operative and recent SARS-CoV-2 infection. In patients with pre-operative SARS-CoV-2, ongoing symptoms were associated with an increased rate of postoperative VTE, irrespective of how long before surgery the diagnosis was made.

For this live podcast, Anaesthesia Editor Ed Mariano was joined by Elizabeth Li, Joana Simoes and Francesco Pata from the authorship group. They discuss the main findings, strengths, limitations, clinical applications and much more! Enjoy!

This international prospective cohort study analysed data on > 96k patients from > 1500 hospitals in > 100 countries. They found that the overall postoperative pulmonary complication rate for all patients was 2.0%, which alone is useful to know. Perhaps more strikingly, and following adjustment for various measured confounders, patients who isolated had a 20% increased risk of postoperative pulmonary complications. The risk climbed to 31% more in those isolating ≥ 8 days, which is still shorter than current periods recommended in England for certain patient groups.

The question is, can these new data be used to update guidelines and clinical practice, resulting in at once improved safety, outcomes, efficiency and patient experience?

Joining us today we have Joana Simoes, Elizabeth Li and Aneel Bhangu from the authorship group.

The WHO has developed a list of aerosol-generating procedures that healthcare organisations throughout the world have used as a framework for development of their guidelines. Supraglottic airways are used in the majority of the approximately 2.7 million general anaesthetics performed in the UK each year. In a UK survey in October 2020, 40% of responding hospitals reported that supraglottic airway removal, even in low COVID-19 risk pathways, is restricted exclusively to the operating theatre (rather than being performed in a recovery area), indicating the presence of policies that assume it is an aerosol-generating procedure. However, uncertainty remains as to whether insertion or removal of a supraglottic airway generates aerosols.

Given the uncertain balance of potential risks and benefits associated with the protective strategies put in place to limit airborne viral transmission, this new paper from Shrimpton et al. aimed to directly assess airborne particle emission during insertion and removal of supraglottic airways. They used real-time measures of aerosol generation with an optical particle sizer in a working operating theatre environment and compared the measured levels with reference to those generated by a volitional cough and the patient’s own breathing.

Joining two of the authors was our fellow, Craig Lyons as well as Laura Duggan who is an Editor of Anaesthesia.

Intra-operative hypotension frequently complicates anaesthesia and has been extensively associated with myocardial injury, acute kidney injury, stroke and death. The iHypE study aimed to describe the incidence of intra-operative hypotension in older patients and define both the intended blood pressure treatment threshold, and the clinically applied treatment threshold for intra-operative hypotension in UK anaesthetic practice.

The main finding was that intra-operative hypotension is documented in the majority of patients aged ≥ 65 y undergoing surgery in the UK using any of the applied definitions. Prolonged intra-operative hypotension was also prevalent in most patients.

This podcast discusses the how the study was done as well as its key clinical implications. It is essential listening for anyone interested in conducting a trainee network research project and the story of how such a study was coordinated and run is fascinating.

Tonight’s discussion is all about a new Association of Anaesthetists guideline on regional analgesia for lower leg trauma and the risk of acute compartment syndrome.

Pain resulting from lower leg injuries and consequent surgery can be severe. There is a range of opinion on the use of regional analgesia and its capacity to obscure the symptoms and signs of acute compartment syndrome. There is, however, very little high quality evidence to inform practice. These guidelines were developed, therefore, to provide pragmatic guidance to enable optimal analgesia and to highlight the need for careful observation for acute compartment syndrome in any patient at risk.

With us today to discuss this new paper we have one of the authors, Dr Matt Wiles from Sheffield, who is also an Editor of Anaesthesia. With us also we have Mr Simon Fleming who is a trainee Trauma and Orthopaedic surgeon who has developed a national, and growing international reputation, for his campaigning work to drive cultural change in the NHS and other healthcare organisations. Last but by no means least we have Dr Sally El-Ghazali who is a London based anaesthetist and intensive care doctor, and the immediate past chair of the Association of Anaesthetists Trainee committee

During the COVID-19 pandemic, there has been considerable focus on the escalation of critical care capacity, capability and delivery. Early in the first wave, NAP7 was postponed and, as part of assessing when anaesthetic and peri-operative services might have returned to a stable baseline and thus be ready for starting NAP7, the authors of this new paper undertook a series of national surveys in order to track activity during the second wave of the pandemic.

Their work describes and quantifies the huge pressures on the anaesthesia and critical care workforce during the winter wave of the pandemic, and the devastating drop in surgical activity.

Joining us today we have Dr Emira Kursumovic and Professor Tim Cook. Their work was published just last week, is highly relevant to hospitals, healthcare staff and patients alike, and was featured in the mainstream media.

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.

This guideline updates and replaces the 5th edition of the Standards of Monitoring published in 2015. The aim of this document is to provide guidance on the minimum standards for monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the UK and Ireland, but it is recognised that these guidelines may also be of use in other areas of the world.

For this podcast, Tanya Selak joined us from Australia with authors Andrew Klein, Tim Meek and Tei Sheraton. This one is not to be missed! Enjoy!

Welcome to this Anaesthesia Journal Podcast which is all about the the 7th UK National Audit Project (NAP7), and more specifically, the challenges of defining, studying and learning from peri‐operative cardiac arrest.

With the discovery of general anaesthesia came the issue of cardiac arrest during anaesthesia. It is thought to occur rarely, ranging from 2-13 per 10,000 anaesthetics and there is much that remains incompletely understood. As such, peri-operative cardiac arrest has been chosen as the topic for the 7th National Audit Project of the Royal College of Anaesthetists.

With us today we have the NAP7 clinical lead, Dr Jasmeet Soar, as well as NAP7 fellows Dr Andrew Kane and Dr Emira Kursumovic.

Welcome to the first ever Anaesthesia Reports live broadcast – what will hopefully be the first of many - where we chat with the authors of their reports about the interesting scenarios they have encountered in their own clinical practice. This session was chaired by Dr Maryann Turner, who is an editor of Anaesthesia Reports and a paediatric anaesthetist based in Sydney.

Dealing with a predicted difficult airway is a common challenge in anaesthesia. There are several different devices on the market that are designed to facilitate tracheal intubation in these patients and traditionally, a bronchoscope or a video laryngoscope would be used. But today, we are going to discuss the use of the ProVu™ video stylet as an alternative device for use in these patients.

We were joined by Dr Imran Ahmad and Dr Siew-Ling Harrison, who are the authors the paper. Imran is a consultant anaesthetist at Guy’s and St Thomas’ and the director of the Guy’s Airway Management Course, as well as the honorary secretary of the Difficult Airway Society. Siew-ling is a senior trainee in the south east of London who is the outgoing airway fellow under Imran and the current thoracic fellow at Guys Hospital.

There is much debate over the role of respiratory particles in guidelines for preventing transmission of COVID-19. Larger particles are traditionally called ‘droplets’ and are deemed to travel only 1-2 metres from an infected patient before falling to the ground. Aerosols are smaller particles and stay floating in the air for prolonged periods, spread further, may accumulate in poorly ventilated spaces, can be inhaled deep into the lungs and bypass looser fitting facemasks. Much current guidance is designed to protect from droplets and infection spread by aerosols is only considered a risk when caused by medical therapies. In this new study, the volunteers produced up to 100 times more aerosol particles with activities such as coughing than they did during treatment with oxygen therapies.

This challenges the current guidelines which state healthcare staff looking after patients with COVID-19 who are coughing and have breathing difficulty only need PPE that protects against the larger droplets. ‘Droplet protection’ includes surgical masks but does not prevent  aerosol particles passing around the edges of the masks and being inhaled. N95/FFP3 respirators which are tightfitting and filter better, block more aerosols but guidelines currently recommend these only for staff looking after patients receiving the advanced oxygen therapies.

This new study from Wilson et al. challenges the guidance that special aerosol precautions are only needed when using oxygen therapies for COVID-19 patients, and raises concerns about safety of staff and patients on hospital wards, if they are not protected from infectious aerosols. We were joined by authors Dr Nick Wilson and Professor Tim Cook, as well as expert Professor Tony Pickering and Editor Laura Duggan. The broadcast has already been viewed over 10k times!