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Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia
© 2015 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland. Guidelines are presented for the organisational and clinical peri-operative management of anaesthesia and surgery for patients who are obese, along with a summary of the problems that obesity may cause peri-operatively. The advice presented is based on previously published advice, clinical studies and expert opinion.
Cricoid pressure: The case in favour
© 2015 Elsevier Ltd. Cricoid pressure (CP) was introduced into anaesthetic practice in the 1960s and has become the standard of care for patients at risk of aspiration during induction. However, the evidence supporting the widespread use of CP to prevent aspiration remains unconvincing. Equally, there is no robust evidence to suggest that CP causes harm, and as such, CP has become an established technique because of a mixture of anecdotal evidence and expert opinion. The future of CP lies in the answer to the question as to whether it is actually effective in preventing regurgitation or whether it is an unnecessary hazard.
Who operates when, where and on whom? A survey of anaesthetic-surgical activity in Ireland as denominator of NAP5
The second phase of the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland, concerning accidental awareness during general anaesthesia, consisted of a survey of anaesthetic activity in Ireland. A network of consultant anaesthetists co-ordinated data collection from the anaesthetic departments of 46 public and 20 independent hospitals over seven days. Data on patients' characteristics, anaesthetic techniques, staffing, and admission and discharge arrangements were collected on all cases for which anaesthetic care (general, regional or local anaesthesia, sedation or monitored anaesthesia care) was provided. A total of 8049 cases were reported during the survey, giving an annual estimate of 426 600 cases for which anaesthetic care is provided. General anaesthesia constituted 5621 (70%), regional anaesthesia 1404 (17%), local anaesthesia 290 (4%), sedation 618 (8%) and monitored anaesthesia care 116 (1%) of the total number of cases. This survey provides unique data regarding anaesthesia services in public and independent hospitals in Ireland. © 2014 The Association of Anaesthetists of Great Britain and Ireland.
A national survey (NAP5-Ireland baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in Ireland
As part of the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland concerning accidental awareness during general anaesthesia, we issued a questionnaire to every consultant anaesthetist in each of 46 public hospitals in Ireland, represented by 41 local co-ordinators. The survey ascertained the number of new cases of accidental awareness becoming known to them for patients under their care or supervision for a calendar year, as well as their career experience. Consultants from all hospitals responded, with an individual response rate of 87% (299 anaesthetists). There were eight new cases of accidental awareness that became known to consultants in 2011; an estimated incidence of 1:23 366. Two out of the eight cases (25%) occurred at or after induction of anaesthesia, but before surgery; four cases (50%) occurred during surgery; and two cases (25%) occurred after surgery was complete, but before full emergence. Four cases were associated with pain or distress (50%), one after an experience at induction and three after experiences during surgery. There were no formal complaints or legal actions that arose in 2011 related to awareness. Depth of anaesthesia monitoring was reported to be available in 33 (80%) departments, and was used by 184 consultants (62%), 18 (6%) routinely. None of the 46 hospitals had a policy to prevent or manage awareness. Similar to the results of a larger survey in the UK, the disparity between the incidence of awareness as known to anaesthetists and that reported in trials warrants explanation. Compared with UK practice, there appears to be greater use of depth of anaesthesia monitoring in Ireland, although this is still infrequent. © 2014 The Association of Anaesthetists of Great Britain and Ireland.