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In the March BJA …
British Journal of Anaesthesia 114 (3): (2015) doi:10.1093/bja/aev041
IN THIS ISSUE
In the March BJA . . . Tracheostomy In this issue of the BJA, there are two papers that address the issues related to airway access using tracheostomy, or a related procedure. In an editorial related to a previously published study, Kristensen and colleagues (pages 357 –61) have provided insights into the requirements and technique of gaining emergency airway access in situations such as ‘can’t ventilate, can’t intubate’. They have emphasised the importance of prior airway assessment and palpation of cricothyroid membrane. In addition, they have highlighted the importance of simulation in aiding training of every anaesthetist in gaining emergency airway access using tracheostomy-like procedures. In a meta-analysis, Szakmany and colleagues (pages 396– 405) synthesised results from earlier studies related to the role of early tracheostomy in ventilator dependent ICU patients in improving their outcomes. This meta-analysis could not find evidence that early (,10 days) tracheostomy reduced mortality, ICU length of stay, or duration of mechanical ventilation. The only perceived advantage was a shorter duration of sedation, but at the cost of an increased procedure rate.
Pain management In a systematic review and meta-analysis, Martinez and colleagues (pages 384–95) could not find any definite advantage of combining tramadol and morphine for pain relief in adult surgical patients. Lambert and colleagues (pages 364–6) have provided pharmacological profiles and some new information on newer agents which are currently under investigation in the area of pain management. In another editorial, Colvin and Dougherty (pages 361–3) have provided insights into linkage between the presentation, mechanisms and causation of neuropathic pain.
Outcomes There has been a trend of an increasing number of studies aiming to address either the effects of various interventions on, or prediction of, perioperative outcomes. Moppett and colleagues (pages 444 –59) could not show any advantage of goal-directed fluid therapy in improving outcomes of patients undergoing surgery for hip fracture under spinal anaesthesia. Grant and colleagues (pages 430 –6) have provided preliminary evidence that some of the variables measured during pre-operative exercise test may indicate the risk of poor outcome. In a large ICU study, Nisula and colleagues (pages 460 –8) could not find any linkage between urinary interleukins and the risk of acute kidney injury. Methylnaltrexone bromide was shown to have no effect on the incidence of pruritis after intrathecal morphine in patients undergoing Caesarean section (Paech and colleagues; pages 469–76). Kong and colleagues (pages 437 –43) have shown that pre-operative assessment of coronary calcium score using coronary CT can predict adverse postoperative myocardial events in patients undergoing liver transplant surgery.
Cover image The cover image (MEDICAL RF.COM/SCIENCE PHOTO LIBRARY) shows a lateral view (left side) of the head and neck of a patient on which a tracheostomy has been performed. The skin is semi-transparent, showing larynx and the trachea beneath it. This image was selected as a backdrop to the one of the themes in this issue of the BJA.
Podcasts The podcasts with the authors of the selected articles are available at http://bja.oxfordjournals.org.
& The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected]
IN THIS ISSUE
In the March BJA . . . Tracheostomy In this issue of the BJA, there are two papers that address the issues related to airway access using tracheostomy, or a related procedure. In an editorial related to a previously published study, Kristensen and colleagues (pages 357 –61) have provided insights into the requirements and technique of gaining emergency airway access in situations such as ‘can’t ventilate, can’t intubate’. They have emphasised the importance of prior airway assessment and palpation of cricothyroid membrane. In addition, they have highlighted the importance of simulation in aiding training of every anaesthetist in gaining emergency airway access using tracheostomy-like procedures. In a meta-analysis, Szakmany and colleagues (pages 396– 405) synthesised results from earlier studies related to the role of early tracheostomy in ventilator dependent ICU patients in improving their outcomes. This meta-analysis could not find evidence that early (,10 days) tracheostomy reduced mortality, ICU length of stay, or duration of mechanical ventilation. The only perceived advantage was a shorter duration of sedation, but at the cost of an increased procedure rate.
Pain management In a systematic review and meta-analysis, Martinez and colleagues (pages 384–95) could not find any definite advantage of combining tramadol and morphine for pain relief in adult surgical patients. Lambert and colleagues (pages 364–6) have provided pharmacological profiles and some new information on newer agents which are currently under investigation in the area of pain management. In another editorial, Colvin and Dougherty (pages 361–3) have provided insights into linkage between the presentation, mechanisms and causation of neuropathic pain.
Outcomes There has been a trend of an increasing number of studies aiming to address either the effects of various interventions on, or prediction of, perioperative outcomes. Moppett and colleagues (pages 444 –59) could not show any advantage of goal-directed fluid therapy in improving outcomes of patients undergoing surgery for hip fracture under spinal anaesthesia. Grant and colleagues (pages 430 –6) have provided preliminary evidence that some of the variables measured during pre-operative exercise test may indicate the risk of poor outcome. In a large ICU study, Nisula and colleagues (pages 460 –8) could not find any linkage between urinary interleukins and the risk of acute kidney injury. Methylnaltrexone bromide was shown to have no effect on the incidence of pruritis after intrathecal morphine in patients undergoing Caesarean section (Paech and colleagues; pages 469–76). Kong and colleagues (pages 437 –43) have shown that pre-operative assessment of coronary calcium score using coronary CT can predict adverse postoperative myocardial events in patients undergoing liver transplant surgery.
Cover image The cover image (MEDICAL RF.COM/SCIENCE PHOTO LIBRARY) shows a lateral view (left side) of the head and neck of a patient on which a tracheostomy has been performed. The skin is semi-transparent, showing larynx and the trachea beneath it. This image was selected as a backdrop to the one of the themes in this issue of the BJA.
Podcasts The podcasts with the authors of the selected articles are available at http://bja.oxfordjournals.org.
& The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected]