Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia.

Guidelines are presented for the organisational and clinical peri-operative management of anaesthesia and surgery for patients who are obese, along with a summary of the problems that obesity may cause peri-operatively. The advice presented is based on previously published advice, clinical studies and expert opinion.

I-gel insertion by novices in manikins and patients.

The i-gel, a novel supraglottic airway, has been proposed for use during cardiopulmonary resuscitation. We evaluated the performance of this device in manikins and anaesthetised patients when used by novices: medical students, non-anaesthetist physicians and allied health professionals all unfamiliar with the i-gel. Fifty i-gels were placed in manikins.

Emergency treatment of anaphylactic reactions--guidelines for healthcare providers.

*The UK incidence of anaphylactic reactions is increasing. *Patients who have an anaphylactic reaction have life-threatening airway and, or breathing and, or circulation problems usually associated with skin or mucosal changes. *Patients having an anaphylactic reaction should be treated using the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach.

The Acute Care Undergraduate TEaching (ACUTE) Initiative: consensus development of core competencies in acute care for undergraduates in the United Kingdom.

Background: The care of the acutely ill patient in hospital is often sub-optimal. Poor recognition of critical illness combined with a lack of knowledge, failure to appreciate the clinical urgency of a situation, a lack of supervision, failure to seek advice and poor communication have been identified as contributory factors. At present the training of medical students in these important skills is fragmented.

Inconsistencies in cardiac arrest reporting.

Data relating to survival from in-hospital cardiac arrest are used to audit staff performance and to help to determine whether new resuscitation techniques are effective. Individual studies into outcome from cardiac arrest have defined inclusion and exclusion criteria, but no such national criteria have been published to enable constant auditing of cardiac arrests. The aim of this survey was to investigate the consistency with which in-hospital cardiac arrests are recorded throughout the United Kingdom.

Cardiopulmonary resuscitation standards for clinical practice and training in the UK.

The Royal College of Anaesthetists, the Royal College of Physicians, the Intensive Care Society and the Resuscitation Council (UK) have published new resuscitation standards. The document provides advice to UK healthcare organisations, resuscitation committees and resuscitation officers on all aspects of the resuscitation service. It includes sections on resuscitation training, resuscitation equipment, the cardiac arrest team, cardiac arrest prevention, patient transfer, post-resuscitation care, audit and research.

Cardiopulmonary resuscitation standards for clinical practice and training in the UK.

The Royal College of Anaesthetists, the Royal College of Physicians, the Intensive Care Society and the Resuscitation Council (UK) have published new resuscitation standards. The document provides advice to UK healthcare organisations, resuscitation committees and resuscitation officers on all aspects of the resuscitation service. It includes sections on resuscitation training, resuscitation equipment, the cardiac arrest team, cardiac arrest prevention, patient transfer, post resuscitation care, audit and research.

A comparison of two techniques for manual ventilation of the lungs by non-anaesthetists: the bag-valve-facemask and the cuffed oropharyngeal airway (COPA) apparatus.

In order to evaluate the possible role of the cuffed oropharyngeal airway during cardiopulmonary resuscitation, we compared its use by non-anaesthetists with the bag-valve-facemask technique of providing ventilation. A group of anaesthetic nurses and operating department practitioners were asked to manually ventilate the lungs of 40 patients undergoing elective surgery following the induction of general anaesthesia with neuromuscular blockade. Ventilation was first attempted using the bag-valve-facemask technique and then using the appropriate size cuffed oropharyngeal airway and self-inflating bag.

Communication between members of the cardiac arrest team--a postal survey.

Aims: Effective communication enhances team building and is perceived to improve the quality of team performance. A recent publication from the Resuscitation Council (UK) has highlighted this fact and recommended that cardiac arrest team members make contact daily. We wished to identify how often members of this team communicate prior to a cardiopulmonary arrest.

An evaluation of the Airway Management Device.

We have evaluated the Airway Management Device (AMD) in 105 anaesthetised patients. We were successful in establishing a clear airway on the first attempt on 69 occasions and unable to establish a patent airway at all in 10 patients. Airway obstruction requiring removal of the device occurred during maintenance of anaesthesia in a further two cases and during emergence in three.

The effect of single-handed cricoid pressure on cervical spine movement after applying manual in-line stabilisation -- a cadaver study.

Six adult cadavers had 40 N cricoid pressure applied using a cricoid 'yoke' whilst maintaining manual in-line stabilisation of the cervical spine. No other spinal supports were used. Lateral radiographs were taken before and after applying pressure to the cricoid cartilage and the degree of cervical spine movement accurately determined.

Use of the cuffed oropharyngeal airway for manual ventilation by nonanaesthetists.

We studied the use of the cuffed oropharyngeal airway in 100 ASA I and II anaesthetised patients. In the first 50 patients (group A), an experienced anaesthetist inserted the airway. The optimum sizes and cuff volumes for manual ventilation in adult males and females were found to be sizes 11 and 10 with up to 60 ml and 50 ml in each cuff, respectively.

Insertion of the Combitube airway with the cervical spine immobilised in a rigid cervical collar.

The Combitube is a twin lumen device designed to establish the airway after blind insertion. Under general anaesthesia a rigid cervical collar was used to immobilise the neck in 15 ASA 1 and 2 patients. Insertion of the Combitude airway was then attempted.

The influence of neck position on ventilation using the Combitube airway.

A Combitube airway was inserted into 40 patients undergoing general anaesthesia. A rigid cervical collar was then used to immobilise the neck of each patient. In all 40 subjects adequate ventilation of the lungs was possible in this position as assessed by chest movement and auscultation, measurement of expired tidal volume and maintenance of satisfactory arterial oxygen saturation.

The influence of timing of ketorolac administration on post-operative analgesic requirements following total abdominal hysterectomy.

One hundred and thirty-seven patients were studied to assess whether the timing of a dose of ketorolac affected cumulative morphine requirements during the first 12 post-operative hours. Pain, sedation and nausea scores, respiratory rate and degree of operative blood loss were also recorded. Thirty-six patients (group A) were given placebo injections pre- and intra-operatively.

The effect of single-handed cricoid pressure on neck movement after applying manual in-line stabilisation.

In 30 ASA 1 and 2 patients undergoing general anaesthesia and neuromuscular paralysis, manual in-line stabilisation of the neck in a neutral position was performed and single-handed cricoid pressure was applied. Vertical displacement was measured from the midpoint of the neck (directly below the cricoid cartilage). Measurements were also made at the tragus of the ear and the shoulder; both of which acted as fixed reference points.