British journal of anaesthesia
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Editorial Comment
Patient blood management programmes: keeping the ball rolling.
Patient blood management programmes have been endorsed by the World Health Organization and multiple medical societies. It seems important to review the progress and results of patient blood management programmes so necessary modifications or new initiatives can be added to achieve their major goals. In this issue of the British Journal of Anaesthesia, Meybohm and colleagues show that a nationwide patient blood management programme had an impact and was potentially cost-effective in centres that previously utilised large amounts of allogeneic blood transfusions. Before implementing a programme, each institution might need to identify the area(s) of deficiency with respect to established patient blood management methods, which will warrant specific focus in subsequent clinical practice reviews.
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Editorial Comment
Systems, safety, and anaesthesia outside the operating room.
An increasing number of patients are receiving sedation or anaesthesia in locations outside of the operating room. Compared with the operating room, anaesthesia providers working in a non-operating room anaesthesia (NORA) location report significantly lower perceived levels of safety, and higher levels of anxiety, stress, and workload. These results are likely to affect the well-being of staff in NORA locations and are clinically relevant in terms of patient safety.
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Editorial Comment
Phase-amplitude coupling during maintenance of general anaesthesia: towards a better understanding of anaesthetic-induced brain dynamics in children.
Electroencephalogram signatures associated with anaesthetic-induced loss of consciousness have been widely described in adult populations. A recent study helps verify our understanding of brain dynamics induced by anaesthetics in a paediatric population by describing a specific pattern in terms of an interaction of the phase of delta oscillations and the amplitude of alpha oscillations. This feature has potential translational implications for optimising future monitoring technologies.
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Preventing postoperative organ dysfunction is integral to the practice of anaesthesia. Although intraoperative hypotension is associated with postoperative end organ dysfunction, there remains ambiguity with regards to its definition, targets, thresholds for initiating treatment, and ideal treatment modalities.
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Editorial Comment
Videolaryngoscopy in critical care and emergency locations: moving from debating benefit to implementation.
The recently published INTUBE study subanalysis and DEVICE trial findings both demonstrate a clear benefit of videolaryngoscopy over direct laryngoscopy in facilitating tracheal intubation of patients in the emergency department and ICU. We consider the increasing evidence supporting the use of videolaryngoscopy, the possible reasons behind its relatively slow adoption into clinical practice, and the potential role of the hyperangulated videolaryngoscope blade. We discuss the significance of improved first-pass tracheal intubation success in reducing the overall risk of complications in critically ill patients. Additionally, we address the need for specific training in videolaryngoscopy in order to maximise patient benefit, and propose that adequate training and rehearsal opportunities in videolaryngoscopy can only be realised by widespread and regular use wherever the clinical setting.