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Celebrating World Anaesthesia Day 2014

World Anaesthesia Day commemorates the first successful demonstration of ether anaesthesia at the Massachusetts General Hospital on 16 October 1846. This was one of the most significant events in medical history, enabling patients to undergo surgical treatments without the associated pain of an operation. To celebrate this important day, we are highlighting a selection of British Journal of Anaesthesia podcasts so you can learn more about anaesthesia practices today.

Fifth National Audit Project on Accidental Awareness during General Anaesthesia

Accidental awareness during general anaesthesia (AAGA) is a rare but feared complication of anaesthesia. Studying such rare occurrences is technically challenging but following in the tradition of previous national audit projects, the results of the fifth national audit project have now been published receiving attention from both the academic and national press. In this BJA podcast Professor Jaideep Pandit (NAP5 Lead) summarises the results and main findings from another impressive and potentially practice changing national anaesthetic audit. Professor Pandit highlights areas of AAGA risk in anaesthetic practice, discusses some of the factors (both technical and human) that lead to accidental awareness, and describes the review panels findings and recommendations to minimise the chances of AAGA.
October 2014 || Volume 113 – Issue 4 || 36 Minutes

 

Pre-hospital Anaesthesia

Emergency airway management in trauma patients is a complex and somewhat contentious issue, with opinions varying on both the timing and delivery of interventions. London’s Air Ambulance is a service specialising in the care of the severely injured trauma patient at the scene of an accident, and has produced one of the largest data sets focusing on pre-hospital rapid sequence induction. Professor David Lockey, a consultant with London’s Air Ambulance, talks to the BJA about LAA’s approach to advanced airway management, which patients benefit from pre-hospital anaesthesia and the evolution of RSI algorithms. Professor Lockey goes on to discuss induction agents, describes how to achieve a 100% success rate for surgical airways and why too much choice can be a bad thing, as he gives us an insight into the exciting world of pre-hospital emergency care.
August 2014 || Volume 113 – Issue 2 || 35 Minutes

 

Fluid responsiveness: an evolution in our understanding

Fluid therapy is a central tenet of both anaesthetic and intensive care practice, and has been a solid performer in the medical armamentarium for over 150 years. However, mounting evidence from both surgical and medical populations is starting to demonstrate that we may be doing more harm than good by infusing solutions of varying tonicity and pH into the arms of our patients. As anaesthetists we arguably monitor our patient’s response to fluid-based interventions more closely than most, but in emergency departments and on intensive care units this monitoring me be unavailable or misleading. For this podcast Dr Paul Marik, Professor and Division Chief of Pulmonary Critical Care at Eastern Virginia Medical Center delivers a masterclass on the physiology of fluid optimisation, tells us which monitors to believe and importantly under which circumstances, and reviews some of the current literature and thinking on fluid responsiveness.
April 2014 || Volume 112 – Issue 4 || 43 Minutes

 

Post-operative Cognitive Decline

Post-operative cognitive decline (POCD) has been detected in some studies in up to 50% patients undergoing major surgery. With an ageing population and an increasing number of elective surgeries, POCD may represent a major public health problem. However POCD research is complex and difficult to perform, and the current literature may not tell the full story. Dr Rob Sanders from the Wellcome Department of Imaging Neuroscience at UCL talks to us about the methodological limitations of previous studies and the important concept of a cognitive trajectory. In addition, Dr Sanders discusses the risk factors and role of inflammation in causing brain injury, and reveals the possibility that certain patients may in fact undergo post-operative cognitive improvement (POCI).
March 2014 || Volume 112 – Issue 3 || 20 Minutes

 

Needle Phobia – A Psychological Perspective

For anaesthetists, intravenous cannulation is the gateway procedure to an increasingly complex and risky array of manoeuvres, and as such becomes more a reflex arc than a planned motor act. For some patients however, that initial feeling of needle penetrating epidermis, dermis and then vessel wall is a dreaded event, and the cause of more anxiety than the surgery itself. Needle phobia can be a deeply debilitating disease causing patients not to seek help even under the most dire circumstances. Dr Kate Jenkins, a hospital clinical psychologist describes both the psychology and physiology of needle phobia, what we as anaesthetists need to be aware of, and how we can better serve out patients for whom ‘just a small scratch’ may be their biggest fear.
July 2014 || Volume 113 – Issue 1 || 32 Minutes

 

For more information, visit the dedicated BJA World Anaesthesia Day webpage for a selection of free articles.

Headline image credit: Anaesthesia dreams, by Tc Morgan. CC-BY-SA-2.0 via Flickr.

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