EA21 Newsletter: Hot topics in general anaesthesiology - top publications from the last 12 months (or slightly more!)

Friday December 17, 16:30 – 17:15   –  Channel 2

This review of important papers in general anaesthesiology will be given by Professor Anthony Absalom, University Medical Center Groningen, Groningen University, Netherlands.

He says: “We look back wistfully on another tumultuous year during which anesthesiologists around the world have been at the forefront caring for the most unwell patients (with and without COVID-19) in challenging circumstances. Despite the challenges of the COVID-19 pandemic, anesthesiologists around the world have remained scientifically active. This article highlights some of the eye-catching publications relevant to general anaesthesiology from the past year.”

A feature of the pandemic has been the eagerness of healthcare professionals to share their knowledge and experience of the care of patients with COVID-19. At the same time journals have worked hard to publish clinically useful material with minimal delay. Many of the most highly cited publications have had little or no direct relevance to anaesthesia. The guidelines for airway management in patients with COVID-19, published in June 2020 by Cook and colleagues, were certainly relevant to all anaesthesiologists, and were rapidly incorporated into the protocols of many hospitals around the world. This article has been highly cited (393 citations to date [Web of Science]) and attracted a large amount of social media interest (altmetric score 548). It was just one of the very many articles related to COVID-19 published by Prof. Cook in the past two years, who was recently honoured by Queen Elizabeth II for services to anaesthesia.

It is just over a year since the untimely passing of Prof. Andreas Hoeft. His passing and the pandemic remind us that life is precious, and highlight the value of health and well-being. Prof. Hoeft was a co-author of three articles published in 2021. One of them, on the hot topics in anaesthesiology during 2019/2020, highlights behaviour in the operating theatre, and the adverse effect that impoliteness can have on patient care. [2] This is a timely reminder. Articles about the mental health and wellbeing of anesthesiologists seldom attract much attention, but still, this remains an important issue. Occupational factors that harm wellbeing, and lead to stress and burnout include age, fatigue and bullying,[3] with the latter being highlighted in policy statements by progressive organizations such as the Faculty of Anaesthetists of New Zealand and Australia. [4]

Post-operative nausea and vomiting (PONV) are among the most feared complications of anaesthesia. Updated consensus guidelines for the management of PONV were published in August 2020. [5] They were widely cited (91 citations) and attracted considerable social media attention (altmetric score 150). Dexamethasone has become a routine element of PONV prophylaxis protocols but has a theoretical risk of promoting surgical site infections, an issue addressed by the PADDI (Perioperative Administration of Dexamethasone and Infection). Almost 9000 patients undergoing non-cardiac, non-urgent surgery, were included and randomized to receive either dexamethasone or placebo. No significant difference in the incidence of surgical site infection was found (risk difference adjusted for diabetes status was −0.9%; 95.6% CI −2.1 to 0.3; P<0.001). The results were published in May 2021 [6] (citations to date 9; altmetric score 241).

Over recent years, increasing attention has focused on the influence of anaesthetic choices on patient outcomes. Many anesthesiologists consider spinal anaesthesia to be a safer option for elderly patients undergoing hip replacement surgery. Neuman et al conducted a pragmatic superiority trial involving 1600 patients (age > 50 years) who were randomly assigned to receive either spinal anaesthesia or general anaesthesia. [7] The primary outcome was a composite of death or inability to walk 3m independently at 60 days. It occurred in 18.5% of patients in the spinal anaesthesia group and 18.0% of patients in the general anaesthesia group (relative risk, 1.03; 95% CI: 0.84 to 1.27). Among the secondary outcomes, there was no difference in the incidence of delirium (20.5% in the spinal anaesthesia group and 19.7% in the general anaesthesia group (relative risk, 1.04; 95% CI, 0.84 to 1.30). The article, published in November 2021, has attracted a considerable amount of social media attention (altmetric 502), including comments and videos on Youtube.

There are many other hot topics at present, such as the environmental effects of anaesthesia, long term consequences of anaesthetic exposure, new drugs, and diverse aspects of perioperative anaesthetic management such as fluid and haemodynamic management. Our speciality faces many future challenges, among which is the challenge of improving diversity, equality and inclusion. It is well known that not only does diversity within organizations improve staff morale and wellbeing, it also promotes creativity, flexibility, efficiency and progress. Following on from an issue of The Lancet devoted to this issue,[8] the British Journal of Anaesthesia published a special issue on women in anaesthesia.[9]

For some of the papers referred to by Prof Absalom, see links below

For Cook paper, click here

For Corcoran paper, click here

For Gan paper, click here

For Neuman paper, click here

For Wong paper, click here

References

1. Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19 Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia 2020; 75(6): 785-799. DOI10.1111/anae.15054
2. Thudium M, Hoeft A, Coburn M. “Hot topics” in der Anästhesiologie 2019/2020. Anaesthesist 2021; 70(1):73-77
3. White SM. Mental health, moral injury – and mandatory psychological assessment? Anaesthesia 2021; 76(7):879-882. DOI: 10.1111/anae.15447
4. anzca-policy-on-bullying-discrimination-and-harass.pdf (accessed 8 December 2021)
5. Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg. 2020 Aug;131(2):411-448. doi: 10.1213/ANE.0000000000004833
6. Corcoran TB, Myles PS, Forbes AB, Cheng AC, Bach LA, O’Loughlin E, et al. Dexamethasone and Surgical-Site Infection. N Engl J Med 2021; 384(18):1731-1741. DOI: 10.1056/NEJMoa2028982
7. Neuman MD, Feng R, Carson JL, et al. Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. N Engl J Med 2021; DOI: 10.1056/NEJMoa2113514
8. Advancing women in science, medicine, and global health 2019. Lancet 2019; 393(10171),p493-610, e6-e28
9. Women in anaesthesia special issue. Br J Anaesth 2020; 124(3):e40-e189

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