BJA: British Journal of Anaesthesia

NAP5 and the recent controversial guidance from NICE are putting commercial depth of anaesthesia monitors under intense scrutiny. How do they work? Does their use correlate with a reduced incidence of awareness? What is the neurobiological basis for

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

Whilst the vast majority of big number patient research focuses on physiological outcomes, few studies have attempted to investigate the factors that patients perceive to be indicative of quality anaesthesia. A group from Sir Charles Gairdner Hospita

Whilst medical cancer therapies are increasing in their utility and efficacy, the physiological effects of intensive combined treatment regimes on patients' reserves are becoming a greater concern. It is now routine practice to combine medical and su

As the the debate over perioperative neuraxial blockade rages on, more fuel is added to the fire in the form of a controversial secondary analysis carved from the original POISE data set. The authors have used propensity score matching to manipulate

Functional MRI is an exciting but complex imaging modality that is being used with increasing frequency in anaesthesia and pain research. Understanding and interpreting studies requires some knowledge of the fundamentals of fMRI, together with the nu

Checklists, checklists everywhere! Love them or hate them, since the introduction of the WHO surgical safety checklist there has been a tsunami of checklists affecting clinical areas of a hospital near you.

Imagine you are sitting on the runway, waiting to take off to your holiday destination.

Children requiring urgent but simple surgery is a common place phenomenon that can sometimes wreak havoc on the best planned emergency list. Operating on children in an urgent capacity can be logistically difficult outside tertiary centres and is not

There has been an increasing realisation that the majority of complications from high risk surgeries are not due to technical failings in either the operating theatre or anaesthetic room, but from medical complications occurring out on the wards. 'Fa

Probably one of the most talked about changes in the 2015 DAS guidelines will be Plan D. Whilst on a very basic level the recommendations have not altered, the emphasis on how to practically manage a 'can't intubate, can't oxygenate' scenario are qui

Dr Chris Frerk, chair of the airway guideline group talk about the updated 2015 DAS guidelines. 11 years after the publication of the original, the new guidelines reflect technical advances in airway management over the last decade as well recognisin

Accidental awareness under general anaesthesia (AAGA) is the stuff of nightmares for patients and anaesthetists alike. Data from NAP5 has demonstrated a relatively low incidence incidence of AAGA but recommendations from the project include the use o

Traumatic brain injury carries a devastating burden of disease for both the individual patient and the population as a whole. Many patients are young and those who survive are commonly left with a significant disability. Sadly, treatment options for

Patient blood management (PBM) is a multifaceted approach to reducing allogenic blood transfusion (ABT) in the surgical population. In this podcast Professor Manuel Munoz, a haematologist from Malaga in Spain, talks to us about the way in which a PBM

Assessment, calculation and composition of replacement fluid is a fundamental tenet of anaesthetic practice. Mounting evidence from the colorectal and enhanced recovery literature shows that attention to detail throughout the perioperative period res

As with many anticonvulsants, pregabalin is enjoying an ever increasing spectrum of use. Originally licensed for the treatment of epilepsy, diabetic neuropathic pain and post-herpetic neuralgia; pregabalin has become a staple of the chronic pain arma

Millions of operations take place in the UK each year; the majority occurring without undue patient morbidity. However, dependant on the nature of the procedure, post-operative morbidity is not uncommon and we will all recall patients who have suffer

Achieving adequate gas exchange whilst minimising ventilator induced lung inury is a major challenge in intensive care. The world of ICU ventilation is rich with novel proprietary modes but so far, none have proven an outcome benefit in ARDS. Whilst

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 pe

Successful kidney transplants have been shown to improve quality of life for the recipients and dramatically reduce the cost of caring for patients with end stage renal failure. However, there is still a significant shortfall in the number of donor o

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 dem

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. Howe

Widely regarded as champions of patient safety, it was anaesthetists who first pioneered incident reporting systems within hospital medicine. Signed in 2010, the Helsinki declaration for patient safety in anaesthesiology requires members to contribut

Opinions remain divided on the best form of post-operative analgesia following lower abdominal surgery, with an even split between those favouring epidural anaesthesia versus patient-controlled intravenous infusion. Many variations and combinations h

As a speciality, anaesthesia has long been a champion of simulation training. But whilst ever increasing numbers of simulation based courses are available, what evidence exists for the proposed advantages of this learning modality? For this podcast D

Despite being defined as a syndrome over 4 decades ago, current studies estimate that over half of patients diagnosed with acute respiratory distress syndrome do not in fact have the disease. In this podcast, Dr Stephen Frohlich explains the difficul

With the exponential expansion of the evidence base and increasing frequency of meta-analysis, clinical guidelines have become increasingly ubiquitous in all fields of medicine. Dr Georgina Imberger joins Dr Thomas to talk through the process of guid

Opinions on the use of propofol by non-anaesthetists remain controversial and divided. In this podcast Dr Gavin Lloyd, an emergency physician from The Royal Devon and Exeter NHS Foundation Trust, gives his point of view and describes his experience d

Anaphylaxis under anaesthesia is a dramatic and feared phenomenon. Whilst recognition and treatment has improved largely through awareness and training, the widely quoted mortality still lies between 3 and 9%. An unusual combination of legal obligati

This month the BJA features a volunteer study investigating the effects of low dose neuraxial clonidine from Stanford University. One of the authors of this paper, Dr Yehuda Ginosar, talks about the challenges surrounding the design and interpretatio

Anaesthetic neurotoxicity is currently one of the hottest research topics in anaesthesia. In June 2012 the BJA sponsored a seminar in Salzburg Austria which saw experts from all over the world come together to discuss the current state of the evidenc

Dr Sibtain Anwar interviews Professor Roger Fillingim on his work examining the differences in pain experienced between the sexes. Whilst a large body of quite disparate work has demonstrated a significant increase in pain reported by women, the scie

Guest editor Dr Lesley Colvin introduces this special post-graduate issue of the BJA focusing on recent advances and new research in the field of pain medicine. Dr Colvin talks about the the importance and relevance of basic science in this rapidly a

Dr Ellen O'Sullivan talks about the adoption of the BJA as the official journal of The College of Anaesthetists of Ireland. Together with Rik Thomas, Dr O'Sullivan celebrates some of Ireland's notable academic anaesthetists past, present and future,

Definitely one for the tricky vein society; Dr Franklin Chiao talks us through his experience and research evaluating near-infrared devices for perpiheral venous cannulation. Dr Chiao explains the physics behind this new technology plus its potential

Whether you relish the prospect of being on call from home or fear losing your job to a more consistently performing robot; automated anaesthesia delivery systems are increasing in their use and sophistication. In this podcast, Rik Thomas talks to Pr

The majority of morbidity and mortality due to anaesthesia is unfortunately caused by human error. In this podcast, Professors Alan Merry and Jennifer Weller gives us an introduction to human factors in anaesthesia, the types of errors that occur and

In this podcast, Dr Tanja Manser talks about the recent explosion of research into non-technical skills, crew resource management and team processes. Dr Manser describes some of the core principles behind CRM, explains the complexities of performing

The RCoA national audit projects have enjoyed incredible success, both at home in the UK and internationally. Professor Tim Cook takes us through the national audit project process; from inception, through to execution and recommendation. Professor C

Professor Jaideep Pandit, head of the Royal College's National Audit Project on accidental awareness under general anaesthesia, give us his views on the recent NICE guidelines on depth of anaesthesia monitoring. In the interview we explore the ration

Dr Rupert Pearce talks about the ideas and concepts behind the rapidly evolving speciality of peri-operative medicine. Dr Pearce and Dr Thomas discuss why a speciality service is required and what it may look like, how it will benefit patients and mo

Professor Albert Dahan, head of the Anesthesia and Pain Research Unit at Leiden University Medical Centre, talks about why this common and dangerous phenomenon is under-reported in the literature and as a result, why he has taken this unusual investi

Dr Rik Thomas talks with Dr Manuel Wenk (lead author) about the inspiration and background behind this unusual randomised controlled trial. Dr Wenk summarises what we already know about the effects of opioids on sleep, and why remifentanil may differ

This BJA podcast sees the Journal interview Dr J. P. van Besouw, President of the Royal College of Anaesthetists, UK for his thoughts on why more research is necessary in the field of anaesthesia.

Professor M. Mythen, University College, London shares his perspective on training in academic anaesthesia in the UK.

Dr A. Quinn, from Leeds General Infirmary in the UK, lead author of a recent BJA paper on failed tracheal intubation in obstetric anaesthesia talks us through this important UK national prospective survey. Using the UK Obstetric Surveillance System