Anaesthesia最新文献

{"title":"Hyperangulated videolaryngoscopy: styletiquette.","authors":"Jane L Orrock, Patrick A Ward","doi":"10.1111/anae.16408","DOIUrl":"https://doi.org/10.1111/anae.16408","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Have anaesthetists' concerns about anaesthesia associates finally been justified?","authors":"Andreas Sotiriou, Stuart Edwardson, Sarah Marsden","doi":"10.1111/anae.16402","DOIUrl":"10.1111/anae.16402","url":null,"abstract":"<p>We congratulate Cook et al. on the publication of their important article [<span>1</span>] produced with data from the 7th National Audit Project (NAP7) from the Royal College of Anaesthetists [<span>2</span>]. The topic of anaesthesia associates remains highly controversial in UK anaesthesia and has suffered from a relative lack of objective data to inform discussion. We feel this documented window into the clinical activity of anaesthesia associates reinforces our concerns on patient safety and parallels with training of anaesthetists.</p><p>It is now clear that anaesthesia associates are working outside the original 2016 scope of practice [<span>3</span>]. This includes the provision of anaesthetic care of patients undergoing paediatric, obstetric, neurosurgical and vascular surgeries [<span>1</span>]. Carrying this out under the auspices of ‘local governance’ is mentioned in the 2016 scope document [<span>3</span>]; however, a restriction to these extended roles is now reflected in position statements from the Royal College of Anaesthetists and the Association of Anaesthetists. Updated guidance is awaited but it seems that, if this practice is already embedded within some departments, it may be difficult to reverse.</p><p>Scope of practice supervision levels were also not consistently followed. Supervising consultants were not always immediately available and, in 63 cases, the anaesthesia associate was identified as the most senior anaesthetic provider [<span>1</span>]. This concern has been raised in a recent publication by Evans et al. [<span>4</span>]. If the standard of practice for anaesthetists in training and non-autonomous Specialty doctor and Associate Specialist was applied to this (via the use of the Cappuccini test [<span>5</span>]), the supervision of anaesthesia associates would frequently be inadequate.</p><p>The proposed expansion of anaesthesia associates risks negatively impacting the training of anaesthetists. The well-used argument against this has traditionally been that they only take part in the care of healthy patients in limited scenarios. The clinical activity data in this publication disproves this by showing activity across all acuity and comorbidity levels. The potential for the reduction of clinical experience in anaesthetic training is, therefore, significant.</p><p>Anaesthesia is a field of medicine still fraught with risk and remaining aware of one's unknowns guards against complacency. It is, therefore, concerning to read that anaesthesia associates felt they did not need more training in the management of peri-operative cardiac arrest and were confident in existing guidelines [<span>1</span>]. Peri-operative cardiac arrest must be viewed as a distinct entity, the management of which is not adequately covered as part of current Advanced Life Support courses.</p><p>Drawing firm conclusions from this article about the role anaesthesia associates play in UK anaesthesia is difficult, given that the authors hav","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16402","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NAP7 – something for everyone","authors":"Mike Charlesworth","doi":"10.1111/anae.16405","DOIUrl":"10.1111/anae.16405","url":null,"abstract":"<p>Ward and Iliff suggest there have been too many NAP7 papers [<span>1</span>], which makes it difficult to discern and retain key information [<span>2</span>]. All 12 papers went through our normal peer review processes and were judged by their own merit to have met or exceeded the standards required for publication. The series was spread over two years, with the reporting of the methods first (September 2022, 5200 downloads) followed by the activity survey (March 2023, 9200 downloads), the five main results papers (November 2023, 21,500 downloads) and several specialist papers focusing on topics such as obstetrics [<span>3</span>], anaphylaxis [<span>4</span>], airway management [<span>5</span>] and resuscitation decisions [<span>6</span>].</p><p>Peri-operative cardiac arrest is a broad topic encompassing all areas of clinical practice. This perhaps explains why so much data were collected and analysed. Dissemination was through a combination of gold open-access publishing; posts on social media platforms (&gt; 1 million cumulative impressions); author interviews (&gt; 67,000 viewers); and podcasts (&gt; 4200 listens). That said, the content of a paper is always superior to the means of dissemination, and there remains no substitute for reading a published paper in full, critiquing the methods used and contextualising the conclusions reported. Anyone who feels NAP7 has passed them by would benefit from reading the main results papers from November 2023 and any of those relating to their specialist area(s) of practice published thereafter. While supplementary materials such as infographics are sometimes helpful, readers will always benefit more from engaging with the primary published material and reflecting on key messages relevant to their area of practice.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between functional capacity and motivation to engage in physical activity before surgery","authors":"Kyle Tingling,&nbsp;David E. Conroy,&nbsp;Margaret K. Danilovich,&nbsp;Daniel S. Rubin","doi":"10.1111/anae.16406","DOIUrl":"10.1111/anae.16406","url":null,"abstract":"&lt;p&gt;Functional capacity assessment before surgery identifies older adults at increased risk of functional decline after major surgery [&lt;span&gt;1&lt;/span&gt;]. Increasing physical activity before surgery has shown efficacy to mitigate functional decline afterwards [&lt;span&gt;2&lt;/span&gt;]. A key component necessary to initiate physical activity is motivation, defined as the processes that energises, orients and sustains behaviour. The COM-B model proposes that there are three necessary components for any behaviour change to occur: capability; opportunity; and motivation. As physical activity interventions before surgery vary in the amount of supervision and social support provided (i.e. facility based vs. home-based), individual differences in self-determined motivation may impact participation and improvements in functional capacity. It is unclear whether motivation for physical activity varies between patients with high vs. low functional capacity before surgery. Links between these determinants would indicate the need for multifaceted strategies and our aim was to explore the association between motivation and functional capacity.&lt;/p&gt;&lt;p&gt;Older adults (aged ≥ 60 y) were screened prospectively from the Anaesthesia Peri-operative Medicine Clinic at the University of Chicago Medical Center. Patients were included if they were able to walk with or without an assistive device. We did not study those patients who were non-English speaking or scheduled for ophthalmic surgery. The University of Chicago institutional review board approved the study and written informed consent was obtained. Patient characteristics, medical history and structured questionnaires were assessed. We used the 19-item Behavioural Regulation in Exercise Questionnaire [&lt;span&gt;3&lt;/span&gt;]. Patients rated each item on a 5-point Likert scale (0–4, 0 = not true for me; 4 = very true for me) to assess five reasons for engaging in physical activity. Scale scores were weighted and combined to estimate the relative autonomy index score, a cumulative score of level of self-determined motivation. Lower, negative scores indicated more controlled regulation whereas higher, positive scores indicated larger relative autonomy. We used the Fried frailty phenotype to evaluate frailty status and the Duke Activity Status Index (DASI) to measure functional capacity [&lt;span&gt;4, 5&lt;/span&gt;]. A DASI score &lt; 34 identified patients with a poor functional capacity who may benefit from exercise before surgery [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We performed descriptive analyses for patient characteristics, comorbidities, frailty, outcome expectations and motivation to exercise. We used χ&lt;sup&gt;2&lt;/sup&gt; tests for categorical variables or t-tests for continuous variables for comparisons between patients with low and high functional capacity. To evaluate for differences in relative autonomy index and motivation subtypes we used the Mann–Whitney U test. All analyses were performed using STATA v16.1 (StataCorp LLC, College Station, TX, USA).&lt;/p&gt;&lt;","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16406","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective development and validation of a universal classification for paediatric videolaryngoscopic tracheal intubation: the PeDiAC score","authors":"Thorsten Dohrmann,&nbsp;Nelly Gutsche,&nbsp;Rilana Kramer,&nbsp;Eva M. Zeidler,&nbsp;Katharina Röher,&nbsp;Viktor A. Wünsch,&nbsp;André Dankert,&nbsp;Linda Krause,&nbsp;Christian Zöllner,&nbsp;Phillip B. Sasu,&nbsp;Martin Petzoldt","doi":"10.1111/anae.16394","DOIUrl":"10.1111/anae.16394","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The VIDIAC score, a prospectively developed universal classification for videolaryngoscopy, has shown excellent diagnostic performance in adults. However, there is no reliable classification system for videolaryngoscopic tracheal intubation in children. We aimed to develop and validate a multivariable logistic regression model and easy-to-use score to classify difficult videolaryngoscopic tracheal intubation in children and to compare it with the Cormack and Lehane classification. A secondary aim was to externally validate the VIDIAC score in children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a prospective observational study within a structured universal videolaryngoscopy implementation programme. We used C-MAC™ videolaryngoscopes in all children undergoing tracheal intubation for elective surgical procedures. We validated the VIDIAC score externally and assessed its performance. We then identified eligible co-variables for inclusion in the PeDiAC score, developed a multivariable logistic regression model and compared its performance against the Cormack and Lehane classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We studied 809 children undergoing 904 episodes of tracheal intubation. The VIDIAC score outperformed the Cormack and Lehane classification when classifying the difficulty of videolaryngoscopic tracheal intubation, with an area under the receiver operating characteristic curve of 0.80 (95%CI 0.73–0.87) vs. 0.69 (95%CI 0.62–0.76), respectively, p = 0.018. Eight eligible tracheal intubation-related factors, that were selected by 100-times repeated 10-fold cross-validated least absolute shrinkage selector operator regression, were used to develop the PeDiAC model. The PeDiAC model and score showed excellent diagnostic performance and model calibration. The PeDiAC score achieved significantly better diagnostic performance than the Cormack and Lehane classification, with an area under the receiver operating characteristic curve of 0.97 (95%CI 0.96–0.99) vs. 0.69 (95%CI 0.62–0.76), respectively, p &lt; 0.001.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We developed and validated a specifically tailored classification for paediatric videolaryngoscopic tracheal intubation with excellent diagnostic performance and calibration that outperformed the Cormack and Lehane classification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16394","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A trainee perspective on anaesthesia associates and their scope of practice – caution and clarity are needed","authors":"Wesley Channell","doi":"10.1111/anae.16403","DOIUrl":"10.1111/anae.16403","url":null,"abstract":"&lt;p&gt;I read with interest the article regarding the clinical activity of anaesthesia associates, as reported to the 7th National Audit Project [&lt;span&gt;1&lt;/span&gt;], which raises many questions about their current and future roles.&lt;/p&gt;&lt;p&gt;Anaesthesia associates have a nationally defined scope of practice on qualification, published by the Royal College of Anaesthetists (RCoA) in 2016 [&lt;span&gt;2&lt;/span&gt;]. This limits their supervision ratios to a maximum of 1:2, with the proviso that the patients must be American Society of Anesthesiologists physical status 1–2 undergoing minor to intermediate surgery in adjacent operating theatres. This scope of practice excludes anaesthesia associates from performing regional anaesthesia (both central neuraxial and peripheral techniques). The RCoA does not currently support local opt-outs of this scope of practice, sometimes termed as ‘enhanced’ roles. The work by Cook et al. shows that many anaesthesia associates are working outside of this scope of practice, as 24% of cases were major or complex surgery with an anaesthesia associate as the senior provider [&lt;span&gt;1&lt;/span&gt;]. In 21% and 25% of spinal and regional anaesthesia cases, respectively, an anaesthesia associate was the senior provider.&lt;/p&gt;&lt;p&gt;There is concern that these enhanced roles may lead to loss of training opportunities. Evans et al. reported that 35.5% of anaesthetists in training who had worked with anaesthesia associates felt they had a negative impact on their training [&lt;span&gt;3&lt;/span&gt;]. Their thematic analysis showed that ‘&lt;i&gt;loss of regional anaesthesia experience&lt;/i&gt;’ and ‘&lt;i&gt;trainees covering emergency work so that anaesthesia associates can do elective work&lt;/i&gt;’ were among trainees' chief concerns. Elective surgery lists with healthy patients undergoing low-complexity surgery are ideal for anaesthetic trainees to gain vital experience in independent practice conducted under consultant supervision. These lists, likely decreasing in number as the patient population becomes more complex, may not be available for anaesthetic trainees if there is an expansion in anaesthesia associate numbers.&lt;/p&gt;&lt;p&gt;Financial modelling by Hanmer et al. suggests that expansion of the anaesthesia associate workforce, as outlined in the NHS Long Term Workforce Plan, is not financially viable without a relaxation in supervision ratios beyond the 1:2 currently accepted by the RCoA, or other less plausible alternatives [&lt;span&gt;4&lt;/span&gt;]. This has led to concerns that supervision ratios may relax, and anaesthesia may begin to move from being physician-delivered to physician-supervised. These concerns, among others, resulted in an emergency general meeting of the RCoA in October 2023, where a motion to pause the expansion of anaesthesia associate numbers passed with 88.9% of a vote that totalled more than 5000 respondents overall [&lt;span&gt;5&lt;/span&gt;]. A subsequent survey by the RCoA showed that 78% of over 6000 anaesthetists, of all grades, held negative views about the expansion of the","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16403","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are we putting patients on steroid treatment at risk under anaesthesia?","authors":"Jeremy W. Tomlinson","doi":"10.1111/anae.16375","DOIUrl":"10.1111/anae.16375","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141892657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peri-operative Replacement of Exogenous Steroids (PREdS): a national audit of current peri-operative prescribing for patients taking therapeutic steroids","authors":"Oliver J. H. Barker,&nbsp;Aravind V. Ramesh,&nbsp;Inthu Kangesan,&nbsp;Jonathan Barnes,&nbsp;Suzanne Harrogate,&nbsp;Swati Gupta,&nbsp;Barnaby C. Reeves,&nbsp;Ben Gibbison,&nbsp;the PREdS Trainee Research Network Collaborators","doi":"10.1111/anae.16388","DOIUrl":"10.1111/anae.16388","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Approximately 1% of the UK population take oral corticosteroids for ≥ 28 days each year, for broadly two reasons: deficiency in corticosteroid requiring replacement; or therapeutic corticosteroid for inflammatory conditions. Acute deficiency can occur at times of physiological stress (e.g. surgery), potentially leading to major complications. The Association of Anaesthetists' 2020 consensus guideline provides detailed advice for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency. This national audit aimed to assess compliance with this guideline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were collected from 59 Trusts over 14 consecutive days for all eligible patients undergoing procedures under the care of an anaesthetist. Patients who were prescribed ≥ 5 mg oral prednisolone equivalents pre-operatively, in whom supplementary corticosteroid would be indicated, were compared with those prescribed &lt; 5 mg oral prednisolone equivalents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Operations for 21,731 patients were audited: 277 (1.3%) patients were taking therapeutic corticosteroids. Detailed peri-operative data were collected for all patients receiving therapeutic corticosteroids: 201/277 (73%) were ASA physical status ≥ 3; 184/277 (66%) underwent elective procedures; and 252/277 (91%) were prescribed prednisolone pre-operatively, of whom 219/277 (79%) were prescribed ≥ 5 mg oral prednisolone equivalents. In the patients who were prescribed ≥ 5 mg oral prednisolone equivalents, 186/219 (85%) received pre-operative glucocorticoid supplementation and 97/219 (42%) received it postoperatively; however, only 67/219 (31%) and 43/219 (20%) respectively received glucocorticoid supplementation according to the guidelines. Overall, peri-operative prescribing was compliant in 19/219 (9%) patients. A similar proportion, 30/219 (14%), received no supplementation. In the patients taking &lt; 5 mg oral prednisolone equivalents pre-operatively, 28/58 (48%) received inappropriate supplementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite 125/277 (45%) of anaesthetists reporting Association of Anaesthetists' guidelines use, compliance remained low, with adherence in only 27/125 (22%) patients. Further research is required to identify the correct peri-operative strategy for patients taking therapeutic corticosteroids.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141880069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usability comparison scoring of video and direct laryngoscopes","authors":"Stuart D. Marshall","doi":"10.1111/anae.16397","DOIUrl":"10.1111/anae.16397","url":null,"abstract":"&lt;p&gt;Lotlikar recently demonstrated that the perceived usability of Macintosh-shaped videolaryngoscopes was inferior to direct laryngoscopes of the same profile [&lt;span&gt;1&lt;/span&gt;]. While I fully agree that the design of tools used by our speciality is commonly overlooked and provides substantial opportunity to improve safety and efficiency, the comparison in this instance needs further context and is only a small part of the story.&lt;/p&gt;&lt;p&gt;The very nature of the two laryngoscopes compared are of different complexities with similar but not identical modes of use. A direct laryngoscope is a simple device with a handle, blade, batteries and light source. In comparison, a videolaryngoscope has complex electronics including a fibreoptic camera and image processor in addition to the familiar physical components of its ‘analogue’ partner.&lt;/p&gt;&lt;p&gt;Arguably, a similar comparison could be made, for example, between physically typed letters and emails – one requiring a typewriter and paper, the other a computer with an email user interface, internet connection, screens and a multitude of complicated components. In this case, both require similar physical steps of pressing keys to communicate an idea, but the broader task is potentially much more complex when the functioning of electronic devices is included.&lt;/p&gt;&lt;p&gt;The interpretation of the system usability scale should be undertaken cautiously [&lt;span&gt;2&lt;/span&gt;]. It was initially derived in the 1980s to aid comparison of similar computer hardware and software products and through the development cycle. However, it has since become ubiquitous and valuable as a ‘quick and dirty’, adaptable human factors assessment tool. Scores are graded on a sigmoid-shaped curve (Fig. 1) with nearly all scores being found in the 40–80 point range and little perceived improvement over the upper 20 points [&lt;span&gt;3&lt;/span&gt;]. Given the simplicity and duration of use of the direct laryngoscope (first introduced into practice in 1944), it is unsurprising that it scored exceptionally in the top 5% (A+ or Best imaginable), whereas the videolaryngoscope, despite an apparently high mark, scored barely in the top 50% (C+ or Good). Asking the question “&lt;i&gt;I found the system unnecessarily complex&lt;/i&gt;” when comparing a simple device with a complicated one that achieves the same outcome is perhaps unfair. Indeed, in a previous study, a comparison between desk and mobile (cellular) phones showed statistically significantly higher system usability scale scores with the analogue versions. This outlines the imbalance of such direct score comparisons with similar devices of different technological eras [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The introduction of videolaryngoscopes has been a leap forward in the safe management of airways and in the last few years there has been a frenzy of comparisons between direct- and videolaryngoscopes [&lt;span&gt;5, 6&lt;/span&gt;]. While we should always strive to improve the design, usability and safety of our tools, this simple comparison of","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16397","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot multicentre randomised clinical trial to determine the effect of a pharmacist-partnered opioid tapering intervention before total hip or knee arthroplasty","authors":"Shania Liu,&nbsp;Asad E. Patanwala,&nbsp;Jennifer Stevens,&nbsp;Jonathan Penm,&nbsp;Justine Naylor,&nbsp;the OpioidHALT Study Investigators and Coordinators","doi":"10.1111/anae.16390","DOIUrl":"10.1111/anae.16390","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Opioid analgesic use before total hip or knee arthroplasty has been associated with worse postoperative outcomes. This pilot study aimed to examine the feasibility of a telehealth-based pharmacist-partnered opioid tapering intervention before elective primary hip or knee arthroplasty and its potential effectiveness compared with usual care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was conducted at seven hospitals in New South Wales, Australia. Eligible patients were those aged ≥ 18 years, scheduled to undergo primary hip or knee arthroplasty for osteoarthritis and taking opioid analgesics pre-operatively. The intervention group participated in an opioid tapering telehealth service, a partnership between a pharmacist and general practitioner, for 3 months pre-operatively up to the day of surgery, while the control group received usual care. The primary outcomes of the study were to investigate the feasibility of the intervention (i.e. adherence to treatment) and potential effectiveness in decreasing baseline daily opioid dose by &gt; 50% before surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between December 2021 and June 2023, 70 patients were recruited and assigned randomly to the intervention group (n = 35) or control group (n = 35). Baseline characteristics were similar between groups. Thirty patients in each group completed their allocated treatment. All patients allocated to the intervention group completed at least one appointment with a pharmacist, with the median (IQR [range]) being 2 (1–4 [1–6]) appointments. The number of patients who successfully decreased their baseline daily opioid dose by ≥ 50% before surgery was 27/30 in the intervention group compared with 5/30 in the usual care group (p &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings of this pilot study support the feasibility of a telehealth-delivered, pharmacist-partnered opioid tapering service for patients scheduled for primary hip or knee arthroplasty. A broader multicentre study to examine the effectiveness of this intervention on clinical outcomes is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}