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Publisher: Oxford University Press   (Total: 370 journals)

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Showing 1 - 200 of 370 Journals sorted alphabetically
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 6, SJR: 0.881, h-index: 38)
Adaptation     Hybrid Journal   (Followers: 8, SJR: 0.111, h-index: 4)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.538, h-index: 35)
African Affairs     Hybrid Journal   (Followers: 57, SJR: 1.512, h-index: 46)
Age and Ageing     Hybrid Journal   (Followers: 82, SJR: 1.611, h-index: 107)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 15, SJR: 0.935, h-index: 80)
American Entomologist     Full-text available via subscription   (Followers: 6)
American Historical Review     Hybrid Journal   (Followers: 129, SJR: 0.652, h-index: 43)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 41, SJR: 1.441, h-index: 77)
American J. of Epidemiology     Hybrid Journal   (Followers: 157, SJR: 3.047, h-index: 201)
American J. of Hypertension     Hybrid Journal   (Followers: 18, SJR: 1.397, h-index: 111)
American J. of Jurisprudence     Hybrid Journal   (Followers: 15)
American J. of Legal History     Full-text available via subscription   (Followers: 4, SJR: 0.151, h-index: 7)
American Law and Economics Review     Hybrid Journal   (Followers: 26, SJR: 0.824, h-index: 23)
American Literary History     Hybrid Journal   (Followers: 12, SJR: 0.185, h-index: 22)
Analysis     Hybrid Journal   (Followers: 24)
Annals of Botany     Hybrid Journal   (Followers: 35, SJR: 1.912, h-index: 124)
Annals of Occupational Hygiene     Hybrid Journal   (Followers: 26, SJR: 0.837, h-index: 57)
Annals of Oncology     Hybrid Journal   (Followers: 47, SJR: 4.362, h-index: 173)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 8, SJR: 0.642, h-index: 53)
Annals of Work Exposures and Health     Hybrid Journal  
AoB Plants     Open Access   (Followers: 4, SJR: 0.78, h-index: 10)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 19, SJR: 0.884, h-index: 31)
Applied Linguistics     Hybrid Journal   (Followers: 51, SJR: 1.749, h-index: 63)
Applied Mathematics Research eXpress     Hybrid Journal   (Followers: 1, SJR: 0.779, h-index: 11)
Arbitration Intl.     Full-text available via subscription   (Followers: 21)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 12)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 27, SJR: 0.96, h-index: 71)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 20)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 47, SJR: 0.144, h-index: 15)
Behavioral Ecology     Hybrid Journal   (Followers: 47, SJR: 1.698, h-index: 92)
Bioinformatics     Hybrid Journal   (Followers: 236, SJR: 4.643, h-index: 271)
Biology Methods and Protocols     Hybrid Journal  
Biology of Reproduction     Full-text available via subscription   (Followers: 9, SJR: 1.646, h-index: 149)
Biometrika     Hybrid Journal   (Followers: 19, SJR: 2.801, h-index: 90)
BioScience     Hybrid Journal   (Followers: 28, SJR: 2.374, h-index: 154)
Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 1, SJR: 0.213, h-index: 9)
Biostatistics     Hybrid Journal   (Followers: 16, SJR: 1.955, h-index: 55)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 141, SJR: 2.314, h-index: 133)
BJA Education     Hybrid Journal   (Followers: 66, SJR: 0.272, h-index: 20)
Brain     Hybrid Journal   (Followers: 61, SJR: 6.097, h-index: 264)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 45, SJR: 4.086, h-index: 73)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 50)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 33, SJR: 1.267, h-index: 38)
British J. of Aesthetics     Hybrid Journal   (Followers: 25, SJR: 0.217, h-index: 18)
British J. of Criminology     Hybrid Journal   (Followers: 510, SJR: 1.373, h-index: 62)
British J. of Social Work     Hybrid Journal   (Followers: 79, SJR: 0.771, h-index: 53)
British Medical Bulletin     Hybrid Journal   (Followers: 7, SJR: 1.391, h-index: 84)
British Yearbook of Intl. Law     Hybrid Journal   (Followers: 27)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 3, SJR: 1.474, h-index: 31)
Cambridge J. of Economics     Hybrid Journal   (Followers: 56, SJR: 0.957, h-index: 59)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 9, SJR: 1.067, h-index: 22)
Cambridge Quarterly     Hybrid Journal   (Followers: 10, SJR: 0.1, h-index: 7)
Capital Markets Law J.     Hybrid Journal  
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.439, h-index: 167)
Cardiovascular Research     Hybrid Journal   (Followers: 11, SJR: 2.897, h-index: 175)
Cerebral Cortex     Hybrid Journal   (Followers: 39, SJR: 4.827, h-index: 192)
CESifo Economic Studies     Hybrid Journal   (Followers: 16, SJR: 0.501, h-index: 19)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.436, h-index: 76)
Children and Schools     Hybrid Journal   (Followers: 6, SJR: 0.211, h-index: 18)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 3)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 21, SJR: 0.737, h-index: 11)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 8, SJR: 1.238, h-index: 15)
Christian Bioethics: Non-Ecumenical Studies in Medical Morality     Hybrid Journal   (Followers: 11, SJR: 0.191, h-index: 8)
Classical Receptions J.     Hybrid Journal   (Followers: 17, SJR: 0.1, h-index: 3)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 58, SJR: 4.742, h-index: 261)
Clinical Kidney J.     Open Access   (Followers: 4, SJR: 0.338, h-index: 19)
Community Development J.     Hybrid Journal   (Followers: 24, SJR: 0.47, h-index: 28)
Computer J.     Hybrid Journal   (Followers: 7, SJR: 0.371, h-index: 47)
Conservation Physiology     Open Access   (Followers: 2)
Contemporary Women's Writing     Hybrid Journal   (Followers: 11, SJR: 0.111, h-index: 3)
Contributions to Political Economy     Hybrid Journal   (Followers: 6, SJR: 0.313, h-index: 10)
Critical Values     Full-text available via subscription  
Current Legal Problems     Hybrid Journal   (Followers: 25)
Current Zoology     Full-text available via subscription   (SJR: 0.999, h-index: 20)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 11, SJR: 1.068, h-index: 24)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 12)
Diplomatic History     Hybrid Journal   (Followers: 18, SJR: 0.296, h-index: 22)
DNA Research     Open Access   (Followers: 4, SJR: 2.42, h-index: 77)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 3)
Early Music     Hybrid Journal   (Followers: 14, SJR: 0.124, h-index: 11)
Economic Policy     Hybrid Journal   (Followers: 54, SJR: 2.052, h-index: 52)
ELT J.     Hybrid Journal   (Followers: 25, SJR: 1.26, h-index: 23)
English Historical Review     Hybrid Journal   (Followers: 46, SJR: 0.311, h-index: 10)
English: J. of the English Association     Hybrid Journal   (Followers: 13, SJR: 0.144, h-index: 3)
Environmental Entomology     Full-text available via subscription   (Followers: 11, SJR: 0.791, h-index: 66)
Environmental Epigenetics     Open Access   (Followers: 1)
Environmental History     Hybrid Journal   (Followers: 25, SJR: 0.197, h-index: 25)
EP-Europace     Hybrid Journal   (Followers: 2, SJR: 2.201, h-index: 71)
Epidemiologic Reviews     Hybrid Journal   (Followers: 10, SJR: 3.917, h-index: 81)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 15, SJR: 0.1, h-index: 6)
European Heart J.     Hybrid Journal   (Followers: 47, SJR: 6.997, h-index: 227)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 9, SJR: 2.044, h-index: 58)
European Heart J. - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 1)
European Heart J. - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart J. Supplements     Hybrid Journal   (Followers: 8, SJR: 0.152, h-index: 31)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 8, SJR: 1.568, h-index: 104)
European J. of Intl. Law     Hybrid Journal   (Followers: 149, SJR: 0.722, h-index: 38)
European J. of Orthodontics     Hybrid Journal   (Followers: 4, SJR: 1.09, h-index: 60)
European J. of Public Health     Hybrid Journal   (Followers: 22, SJR: 1.284, h-index: 64)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 12, SJR: 1.549, h-index: 42)
European Review of Economic History     Hybrid Journal   (Followers: 27, SJR: 0.628, h-index: 24)
European Sociological Review     Hybrid Journal   (Followers: 39, SJR: 2.061, h-index: 53)
Evolution, Medicine, and Public Health     Open Access   (Followers: 11)
Family Practice     Hybrid Journal   (Followers: 12, SJR: 1.048, h-index: 77)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 8, SJR: 1.687, h-index: 115)
Fems Microbiology Letters     Hybrid Journal   (Followers: 20, SJR: 1.126, h-index: 118)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 25, SJR: 7.587, h-index: 150)
Fems Yeast Research     Hybrid Journal   (Followers: 13, SJR: 1.213, h-index: 66)
Foreign Policy Analysis     Hybrid Journal   (Followers: 21, SJR: 0.859, h-index: 10)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 16, SJR: 0.903, h-index: 44)
Forum for Modern Language Studies     Hybrid Journal   (Followers: 6, SJR: 0.108, h-index: 6)
French History     Hybrid Journal   (Followers: 30, SJR: 0.123, h-index: 10)
French Studies     Hybrid Journal   (Followers: 19, SJR: 0.119, h-index: 7)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.102, h-index: 3)
Gastroenterology Report     Open Access   (Followers: 2)
Genome Biology and Evolution     Open Access   (Followers: 10, SJR: 3.22, h-index: 39)
Geophysical J. Intl.     Hybrid Journal   (Followers: 31, SJR: 1.839, h-index: 119)
German History     Hybrid Journal   (Followers: 25, SJR: 0.437, h-index: 13)
GigaScience     Open Access   (Followers: 3)
Global Summitry     Hybrid Journal  
Glycobiology     Hybrid Journal   (Followers: 14, SJR: 1.692, h-index: 101)
Health and Social Work     Hybrid Journal   (Followers: 46, SJR: 0.505, h-index: 40)
Health Education Research     Hybrid Journal   (Followers: 12, SJR: 0.814, h-index: 80)
Health Policy and Planning     Hybrid Journal   (Followers: 21, SJR: 1.628, h-index: 66)
Health Promotion Intl.     Hybrid Journal   (Followers: 20, SJR: 0.664, h-index: 60)
History Workshop J.     Hybrid Journal   (Followers: 27, SJR: 0.313, h-index: 20)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 23, SJR: 0.115, h-index: 13)
Human Molecular Genetics     Hybrid Journal   (Followers: 9, SJR: 4.288, h-index: 233)
Human Reproduction     Hybrid Journal   (Followers: 79, SJR: 2.271, h-index: 179)
Human Reproduction Update     Hybrid Journal   (Followers: 19, SJR: 4.678, h-index: 128)
Human Rights Law Review     Hybrid Journal   (Followers: 58, SJR: 0.7, h-index: 21)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 54, SJR: 1.233, h-index: 88)
ICSID Review     Hybrid Journal   (Followers: 9)
ILAR J.     Hybrid Journal   (Followers: 1, SJR: 1.099, h-index: 51)
IMA J. of Applied Mathematics     Hybrid Journal   (SJR: 0.329, h-index: 26)
IMA J. of Management Mathematics     Hybrid Journal   (Followers: 2, SJR: 0.351, h-index: 20)
IMA J. of Mathematical Control and Information     Hybrid Journal   (Followers: 2, SJR: 0.661, h-index: 28)
IMA J. of Numerical Analysis - advance access     Hybrid Journal   (SJR: 2.032, h-index: 44)
Industrial and Corporate Change     Hybrid Journal   (Followers: 8, SJR: 1.37, h-index: 81)
Industrial Law J.     Hybrid Journal   (Followers: 29, SJR: 0.184, h-index: 15)
Information and Inference     Free  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 8, SJR: 1.911, h-index: 90)
Interacting with Computers     Hybrid Journal   (Followers: 10, SJR: 0.529, h-index: 59)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 4, SJR: 0.743, h-index: 35)
Intl. Affairs     Hybrid Journal   (Followers: 51, SJR: 1.264, h-index: 53)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 27)
Intl. Health     Hybrid Journal   (Followers: 4, SJR: 0.835, h-index: 15)
Intl. Immunology     Hybrid Journal   (Followers: 3, SJR: 1.613, h-index: 111)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 32, SJR: 1.593, h-index: 69)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 59, SJR: 0.613, h-index: 19)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 126, SJR: 4.381, h-index: 145)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 3, SJR: 0.247, h-index: 8)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 28, SJR: 0.307, h-index: 15)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 8, SJR: 0.404, h-index: 18)
Intl. J. of Low-Carbon Technologies     Open Access   (Followers: 1, SJR: 0.457, h-index: 12)
Intl. J. of Neuropsychopharmacology     Open Access   (Followers: 3, SJR: 1.69, h-index: 79)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 8, SJR: 0.906, h-index: 33)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 32, SJR: 0.231, h-index: 21)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 13, SJR: 0.833, h-index: 12)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.052, h-index: 42)
Intl. Political Sociology     Hybrid Journal   (Followers: 30, SJR: 1.339, h-index: 19)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 17, SJR: 0.539, h-index: 17)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 7, SJR: 0.998, h-index: 28)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 36, SJR: 2.184, h-index: 68)
Intl. Studies Review     Hybrid Journal   (Followers: 17, SJR: 0.783, h-index: 38)
ISLE: Interdisciplinary Studies in Literature and Environment     Hybrid Journal   (Followers: 1, SJR: 0.155, h-index: 4)
ITNOW     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 4)
J. of African Economies     Hybrid Journal   (Followers: 15, SJR: 0.647, h-index: 30)
J. of American History     Hybrid Journal   (Followers: 39, SJR: 0.286, h-index: 34)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 13, SJR: 1.038, h-index: 60)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 17, SJR: 2.157, h-index: 149)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 3, SJR: 0.563, h-index: 43)
J. of Biochemistry     Hybrid Journal   (Followers: 43, SJR: 1.341, h-index: 96)
J. of Chromatographic Science     Hybrid Journal   (Followers: 16, SJR: 0.448, h-index: 42)
J. of Church and State     Hybrid Journal   (Followers: 11, SJR: 0.167, h-index: 11)
J. of Competition Law and Economics     Hybrid Journal   (Followers: 34, SJR: 0.442, h-index: 16)
J. of Complex Networks     Hybrid Journal   (Followers: 1, SJR: 1.165, h-index: 5)
J. of Conflict and Security Law     Hybrid Journal   (Followers: 12, SJR: 0.196, h-index: 15)
J. of Consumer Research     Full-text available via subscription   (Followers: 41, SJR: 4.896, h-index: 121)
J. of Crohn's and Colitis     Hybrid Journal   (Followers: 9, SJR: 1.543, h-index: 37)
J. of Cybersecurity     Hybrid Journal   (Followers: 3)
J. of Deaf Studies and Deaf Education     Hybrid Journal   (Followers: 8, SJR: 0.69, h-index: 36)
J. of Design History     Hybrid Journal   (Followers: 15, SJR: 0.166, h-index: 14)
J. of Economic Entomology     Full-text available via subscription   (Followers: 6, SJR: 0.894, h-index: 76)
J. of Economic Geography     Hybrid Journal   (Followers: 34, SJR: 2.909, h-index: 69)
J. of Environmental Law     Hybrid Journal   (Followers: 23, SJR: 0.457, h-index: 20)
J. of European Competition Law & Practice     Hybrid Journal   (Followers: 19)
J. of Experimental Botany     Hybrid Journal   (Followers: 14, SJR: 2.798, h-index: 163)
J. of Financial Econometrics     Hybrid Journal   (Followers: 21, SJR: 1.314, h-index: 27)
J. of Global Security Studies     Hybrid Journal   (Followers: 2)
J. of Heredity     Hybrid Journal   (Followers: 3, SJR: 1.024, h-index: 76)
J. of Hindu Studies     Hybrid Journal   (Followers: 7, SJR: 0.186, h-index: 3)
J. of Hip Preservation Surgery     Open Access  
J. of Human Rights Practice     Hybrid Journal   (Followers: 20, SJR: 0.399, h-index: 10)
J. of Infectious Diseases     Hybrid Journal   (Followers: 40, SJR: 4, h-index: 209)
J. of Insect Science     Open Access   (Followers: 9, SJR: 0.388, h-index: 31)

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Journal Cover BJA : British Journal of Anaesthesia
  [SJR: 2.314]   [H-I: 133]   [141 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0007-0912 - ISSN (Online) 1471-6771
   Published by Oxford University Press Homepage  [370 journals]
  • In This Issue
    • PubDate: 2017-06-02
      DOI: 10.1093/bja/aex169
  • Emergency front-of-neck access: scalpel or cannula—and the parable of
           Buridan’s ass †
    • Authors: Greenland KB; Bradley WL, Chapman GA, et al.
      First page: 811
      Abstract: Maintaining oxygenation is the principal purpose of airway management. Oxygen delivery in airway crises is aimed at preventing cardiac arrest and limiting hypoxic consequences before quickly moving on to secure the airway or wake the patient up if appropriate. Currently, there is debate12 concerning the most appropriate method to facilitate oxygenation during a ‘can’t intubate, can’t oxygenate’ (CICO) scenario while a definitive airway is secured. Emergency front-of-neck access (FONA) courses include a critical analysis of cannula cricothyroidotomy as part of their curricula. This has been driven by widespread acceptance and teaching of Heard’s algorithm.3 However, concerns124–6 have been raised over the high failure rate of cannula cricothyroidotomy in CICO management when compared with surgical access, and its future omission has been advocated. The Canadian Airway Focus Group7 excludes cannula cricothyroidotomy from their recommendations unless the clinician is very experienced with jet ventilation. They state that options should be limited to either the percutaneous needle-guided wide-bore cannula or an open surgical technique.
      PubDate: 2017-05-16
      DOI: 10.1093/bja/aex101
  • Bank blood shortage, transfusion containment and viscoelastic
           point-of-care coagulation testing in cardiac surgery
    • Authors: Ranucci MM.
      First page: 814
      Abstract: In January 2017, many Italian hospitals (including my own institution) were forced to reduce the number of major surgical operations because of a severe shortage of packed red blood cells (RBCs). Blood banks warned that donors with blood group O (both O+ and O–) were scarce, and imposed that units of RBCs of this group were to be reserved for non-postponable major surgeries. Subsequently, other blood groups were affected by the shortage. On January 12, 2017 the National Blood Center warned that about 2600 RBC units were lacking in nine Italian regions. This emergency, resulting from the combination of Christmas holidays and an outbreak of influenza, came to an end by the end of January.
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aex143
  • More or less? The Goldilocks Principle as it applies to red cell
    • Authors: Shander AA; Ferraris VA.
      First page: 816
      Abstract: The quest for the optimal haemoglobin threshold (previously referred to as ‘trigger’) for red blood cell transfusion seems a never-ending journey. As if we are chasing a mirage, the closer we seem to think we get to the ‘just right’ haemoglobin level, the further it seems to move away. Applying the ‘Goldilocks Principle’ to transfusion of red cells, regardless of the population queried, appears to yield results that satisfy some investigators but leave many practitioners still wondering what is best for the patient.
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aex135
  • The great fluid debate: time for Flexit?
    • Authors: Wilson RJ; Minto GG.
      First page: 819
      Abstract: ‘Insanity is doing the same thing over and over again and expecting different results’—attributed to A. Einstein
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aex076
  • Routine use of viscoelastic blood tests for diagnosis and treatment of
           coagulopathic bleeding in cardiac surgery: updated systematic review and
    • Authors: Serraino GF; Murphy GJ.
      First page: 823
      Abstract: Viscoelastic point-of-care tests are commonly used to provide prompt diagnosis of coagulopathy and allow targeted treatments in bleeding patients. We updated existing meta-analyses that have evaluated the clinical effectiveness of viscoelastic point-of-care tests vs the current standard of care for the management of cardiac surgery patients at risk of coagulopathic bleeding. Randomized controlled trials comparing viscoelastic point-of-care diagnostic testing with standard care in cardiac surgery patients were sought. All-cause mortality, blood loss, reoperation, blood transfusion, major morbidity, and intensive care unit and hospital length of stay were analysed using random-effects modelling. Fifteen trials that randomized a total of 8737 participants were included for the analysis. None of the trials was classified as low risk of bias. The use of thromboelastography- (TEG®) or thromboelastometry (ROTEM®)-guided algorithms did not reduce mortality [risk ratio (RR) 0.55, 95% confidence interval (CI) 0.28–1.10] without heterogeneity (I2=1%), reoperation for bleeding, stroke, ventilation time, or hospital length of stay compared with standard care. Use of TEG® or ROTEM® resulted in reductions in the frequency of red blood cell (Risk Ratio 0.88, 95% Confidence Interval 0.79-0.97; I2=43%) and platelet transfusion (Risk Ratio 0.78, 95% Confidence Interval 0.66-0.93; I2=0%). Group Reading Assessment and Diagnostic Evaluation (GRADE) assessment demonstrated that the quality of the evidence was low or very low for all estimated outcomes. Routine use of viscoelastic point-of-care tests did not improve important clinical outcomes beyond transfusion in adults undergoing cardiac surgery.
      PubDate: 2017-05-14
      DOI: 10.1093/bja/aex100
  • Deep neuromuscular block to optimize surgical space conditions during
           laparoscopic surgery: a systematic review and meta-analysis
    • Authors: Bruintjes MH; van Helden EV, Braat AE, et al.
      First page: 834
      Abstract: Neuromuscular block (NMB) is frequently used in abdominal surgery to improve surgical conditions by relaxation of the abdominal wall and prevention of sudden muscle contractions. The evidence supporting routine use of deep NMB is still under debate. We aimed to provide evidence for the superiority of routine use of deep NMB during laparoscopic surgery. We performed a systematic review and meta-analysis of studies comparing the influence of deep vs moderate NMB during laparoscopic procedures on surgical space conditions and clinical outcomes. Trials were identified from Medline, Embase, and Central databases from inception to December 2016. We included randomized trials, crossover studies, and cohort studies. Our search yielded 12 studies on the effect of deep NMB on the surgical space conditions. Deep NMB during laparoscopic surgeries improves the surgical space conditions when compared with moderate NMB, with a mean difference of 0.65 (95% confidence interval (CI): 0.47–0.83) on a scale of 1–5, and it facilitates the use of low-pressure pneumoperitoneum. Furthermore, deep NMB reduces postoperative pain scores in the postanaesthesia care unit, with a mean difference of − 0.52 (95% CI: −0.71 to − 0.32). Deep NMB improves surgical space conditions during laparoscopic surgery and reduces postoperative pain scores in the postanaesthesia care unit. Whether this leads to fewer intraoperative complications, an improved quality of recovery, or both after laparoscopic surgery should be pursued in future studies. The review methodology was specified in advance and registered at Prospero on July 27, 2016, registration number CRD42016042144.
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aex116
  • Influence of anaemia and red blood cell transfusion on mortality in high
           cardiac risk patients undergoing major non-cardiac surgery: a
           retrospective cohort study
    • Authors: Feng SS; Machina MM, Beattie WS.
      First page: 843
      Abstract: Background. Perioperative anaemia is common. Physicians believe that patients at increased cardiac risk do not tolerate anaemia and, consequently, these patients receive transfusions earlier and more often. This practice runs counter to a growing body of evidence that perioperative red blood cell (RBC) transfusion is harmful. The aims of this study were as follows: (i) to assess the effects of transfusion at moderate to severely low ranges of postoperative haemoglobin concentrations; and (ii) to assess whether transfusion was beneficial in patients at high cardiac risk within these haemoglobin ranges.Methods. A single-centre retrospective cohort study enrolled 75 719 consecutive major, non-cardiac surgery patients. Multivariable logistic regressions with 98.4% confidence intervals looking at specific nadir postoperative haemoglobin groups were compared to examine the effects of anaemia, RBC transfusion, and cardiac risk on postoperative 30 day in-hospital mortality.Results. Patients at moderate to high cardiac risk had a two-fold greater prevalence of preoperative anaemia. In unadjusted analysis, RBC transfusion was associated with increased mortality at all transfusion thresholds in all patients. After adjustment, RBC transfusion in patients with high cardiac risk was associated with decreased mortality when the postoperative haemoglobin concentration was <80 g litre−1 [odds ratio 0.37 (98.4% confidence interval 0.17–0.77)].Conclusions. High cardiac risk was associated with increased incidence of anaemia, transfusion, and mortality. Red blood cell transfusion is associated with reduced mortality only in high cardiac risk patients with nadir postoperative haemoglobin concentration <80 g litre−1. Transfusion, the main treatment for postoperative anaemia, does not appear to be associated with reduced postoperative mortality at higher nadir haemoglobin ranges.
      PubDate: 2017-05-07
      DOI: 10.1093/bja/aex090
  • Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic
           surgery - a single centre randomized parallel-arm trial
    • Authors: Kaufmann KB; Stein LL, Bogatyreva LL, et al.
      First page: 852
      Abstract: Background: Postoperative pulmonary and renal complications are frequent in patients undergoing lung surgery. Hyper- and hypovolaemia may contribute to these complications. We hypothesized that goal-directed haemodynamic management based on oesophageal Doppler monitoring would reduce postoperative pulmonary complications in a randomized clinical parallel-arm trial.Methods: One hundred patients scheduled for thoracic surgery were randomly assigned to either standard haemodynamic management (control group) or goal-directed therapy (GDT group) guided by an oesophageal Doppler monitoring-based algorithm. The primary endpoint was postoperative pulmonary complications, including spirometry. Secondary endpoints included haemodynamic variables, renal, cardiac, and neurological complications, and length of hospital stay. The investigator assessing outcomes was blinded to group assignment.Results: Forty-eight subjects of each group were analysed. Compared to the control group, fewer subjects in the GDT group developed postoperative pulmonary complications (6 vs. 15 patients; P = 0.047), while spirometry did not differ between groups. Compared to the control group, patients of the GDT group showed higher cardiac index (2.9 vs. 2.1 [l min−1 m − 2]; P < 0.001) and stroke volume index (43 vs. 34 [ml m2]; P < 0.001) during surgery. Renal, cardiac and neurological complications did not differ between groups. Length of hospital stay was shorter in the GDT compared to the control group (9 vs. 11 days; P = 0.005).Conclusions: Compared to standard haemodynamic management, oesophageal Doppler monitor-guided GDT was associated with fewer postoperative pulmonary complications and a shorter hospital stay.Clinical trial registration. The study was registered in the German Clinical Trials Register (DRKS 00006961).
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aew447
  • Financial and environmental costs of reusable and single-use anaesthetic
    • Authors: McGain FF; Story DD, Lim TT, et al.
      First page: 862
      Abstract: Background. An innovative approach to choosing hospital equipment is to consider the environmental costs in addition to other costs and benefits.Methods. We used life cycle assessment to model the environmental and financial costs of different scenarios of replacing reusable anaesthetic equipment with single-use variants. The primary environmental costs were CO2 emissions (in CO2 equivalents) and water use (in litres). We compared energy source mixes between Australia, the UK/Europe, and the USA.Results. For an Australian hospital with six operating rooms, the annual financial cost of converting from single-use equipment to reusable anaesthetic equipment would be an AUD$32 033 (£19 220), 46% decrease. In Australia, converting from single-use to reusable equipment would result in an increase of CO2 emissions from 5095 (95% CI: 4614–5658) to 5575 kg CO2 eq (95% CI: 5542–5608), a 480 kg CO2 eq (9%) increase. Using the UK/European power mix, converting from single-use (5575 kg CO2 eq) to reusable anaesthetic equipment (802 kg CO2 eq) would result in an 84% reduction (4873 kg CO2 eq) in CO2 emissions, whilst in the USA converting to reusables would have led to a 2427 kg CO2 eq (48%) reduction. In Australia, converting from single-use to reusable equipment would more than double water use from 34.4 to 90.6 kilolitres.Conclusions. For an Australian hospital with six operating rooms, converting from single-use to reusable anaesthetic equipment saved more than AUD$30 000 (£18 000) per annum, but increased the CO2 emissions by almost 10%. The CO2 offset is highly dependent on the power source mix, while water consumption is greater for reusable equipment.
      PubDate: 2017-05-15
      DOI: 10.1093/bja/aex098
  • Use of an anaesthesia workstation barrier device to decrease contamination
           in a simulated operating room
    • Authors: Hunter SS; Katz DD, Goldberg AA, et al.
      First page: 870
      Abstract: Background. Strategies to achieve reductions in perioperative infections have focused on hand hygiene among anaesthestists but have been of limited efficacy. We performed a study in a simulated operating room to determine whether a barrier covering the anaesthesia workstation during induction and intubation might reduce the risk of contamination of the area and possibly, by extension, the patient.Methods. Forty-two attending and resident anaesthetists unaware of the study design were enrolled in individual simulation sessions in which they were asked to induce and intubate a human simulator that had been prepared with fluorescent marker in its oropharynx as a marker of potentially pathogenic bacteria. Twenty-one participants were assigned to a control group, whereas the other 21 performed the simulation with a barrier device covering the anaesthesia workstation. After the simulation, an investigator examined 14 target sites with an ultraviolet light to assess spread of the fluorescent marker of contamination to those sites.Results. The difference in rates of contamination between the control group and the barrier group was highly significant, with 44.8% (2.5%) of sites contaminated in the control group vs 19.4% (2.6%) of sites in the barrier group (P<0.001). Several key clinical sites showed significant differences in addition to this overall decrement.Conclusions. The results of this study suggest that application of a barrier device to the anaesthesia workstation during induction and intubation might reduce contamination of the intraoperative environment.
      PubDate: 2017-05-16
      DOI: 10.1093/bja/aex097
  • Comparative total and unbound pharmacokinetics of cefazolin administered
           by bolus versus continuous infusion in patients undergoing major surgery:
           a randomized controlled trial
    • Authors: Naik BI; Roger CC, Ikeda KK, et al.
      First page: 876
      Abstract: Background. Perioperative administration of cefazolin reduces the incidence of perioperative infections. Intraoperative re-dosing of cefazolin is commonly given between 2 and 5 h after the initial dose. This study was undertaken to determine whether intraoperative continuous infusions of cefazolin achieve better probability of target attainment (PTA) and fractional target attainment (FTA) than intermittent dosing.Methods. Patients undergoing major surgery received cefazolin 2 g before surgical incision. They were subsequently randomized to receive either an intermittent bolus (2 g every 4 h) or continuous infusion (500 mg h−1) of cefazolin until skin closure. Blood samples were analysed for total and unbound cefazolin concentrations using a validated chromatographic method. Population pharmacokinetic modelling was performed using Pmetrics® software. Calculations of PTA and FTA were performed for common pathogens.Results. Ten patients were enrolled in each arm. A two-compartment linear model best described the time course of the total plasma cefazolin concentrations. The covariates that improved the model were body weight and creatinine clearance. Protein binding varied with time [mean (range) 69 (44–80)%] with a fixed 21% unbound value of cefazolin used for the simulations (120 min post-initial dosing). Mean (sd) central volume of distribution was 5.73 (2.42) litres, and total cefazolin clearance was 4.72 (1.1) litres h−1. Continuous infusions of cefazolin consistently achieved better drug exposures and FTA for different weight and creatinine clearances, particularly for less susceptible pathogens.Conclusions. Our study demonstrates that intraoperative continuous infusions of cefazolin increase the achievement of target plasma concentrations, even with lower infusion doses. Renal function and body weight are important when considering the need for alternative dosing regimens.Clinical trial registration. NCT02058979.
      PubDate: 2017-05-15
      DOI: 10.1093/bja/aex026
  • Predictive performance of the modified Marsh and Schnider models for
           propofol in underweight patients undergoing general anaesthesia using
           target-controlled infusion
    • Authors: Lee YH; Choi GH, Jung KW, et al.
      First page: 883
      Abstract: Background: In our preliminary study, the modified Marsh (M-Marsh) model caused an inadvertent underdosing of propofol in underweight patients. However, the predictive performance of the M-Marsh and Schnider models incorporated in commercially available target-controlled infusion (TCI) pumps was not evaluated in underweight patients.Methods: Thirty underweight patients undergoing elective surgery were randomly allocated to receive propofol via TCI using the M-Marsh or Schnider models. The target effect-site concentrations (Ces) of propofol were, in order, 2.5, 3, 4, 5, 6 and 2 μg ml−1. Arterial blood samples were obtained at least 7 min after achieving each pseudo-steady-state.Results: A total of 172 plasma samples were used to determine the predictive performance of both models. The pooled median (95% confidence interval) biases and inaccuracies at a target Ce ≤ 3 μg ml−1 were −22.6 (−28.8 to −12.6) and 31.9 (24.8–36.8) for the M-Marsh model and 9.0 (1.7–16.4) and 28.5 (21.7–32.8) for the Schnider model, respectively. These values at Ce ≥ 4 μg ml−1 were −9.6 (−16.0 to −6.0) and 24.7 (21.1–27.9) for the M-Marsh model and 19.8 (12.9–25.7) and 36.2 (31.4–39.7) for the Schnider model, respectively.Conclusions: The pooled biases and inaccuracies of both models were clinically acceptable. However, the M-Marsh and Schnider models consistently produced negatively and positively biased predictions, respectively, in underweight patients. In particular, the M-Marsh model showed greater inaccuracy at target Ce ≤ 3 μg ml−1 and the Schnider model showed greater inaccuracy at target Ce ≥ 4 μg ml−1. Therefore, it is necessary to develop a new pharmacokinetic model for propofol in underweight patients.Clinical trial registration: KCT0001502.
      PubDate: 2017-05-24
      DOI: 10.1093/bja/aex102
  • Effect of isotonic versus hypotonic maintenance fluid therapy on urine
           output, fluid balance, and electrolyte homeostasis: a crossover study in
           fasting adult volunteers
    • Authors: Van Regenmortel NN; De Weerdt TT, Van Craenenbroeck AH, et al.
      First page: 892
      Abstract: Background. Daily and globally, millions of adult hospitalized patients are exposed to maintenance i.v. fluid solutions supported by limited scientific evidence. In particular, it remains unclear whether fluid tonicity contributes to the recently established detrimental effects of fluid, sodium, and chloride overload.Methods. This crossover study consisted of two 48 h study periods, during which 12 fasting healthy adults were treated with a frequently prescribed solution (NaCl 0.9% in glucose 5% supplemented by 40 mmol litre−1 of potassium chloride) and a premixed hypotonic fluid (NaCl 0.32% in glucose 5% containing 26 mmol litre−1 of potassium) at a daily rate of 25 ml kg−1 of body weight. The primary end point was cumulative urine volume; fluid balance was thus calculated. We also explored the physiological mechanisms behind our findings and assessed electrolyte concentrations.Results. After 48 h, 595 ml (95% CI: 454–735) less urine was voided with isotonic fluids than hypotonic fluids (P<0.001), or 803 ml (95% CI: 692–915) after excluding an outlier with ‘exaggerated natriuresis of hypertension’. The isotonic treatment was characterized by a significant decrease in aldosterone (P<0.001). Sodium concentrations were higher in the isotonic arm (P<0.001), but all measurements remained within the normal range. Potassium concentrations did not differ between the two solutions (P=0.45). Chloride concentrations were higher with the isotonic treatment (P<0.001), even causing hyperchloraemia.Conclusions. Even at maintenance rate, isotonic solutions caused lower urine output, characterized by decreased aldosterone concentrations indicating (unintentional) volume expansion, than hypotonic solutions and were associated with hyperchloraemia. Despite their lower sodium and potassium content, hypotonic fluids were not associated with hyponatraemia or hypokalaemia.Clinical trial registration. (NCT02822898) and EudraCT (2016-001846-24).
      PubDate: 2017-05-16
      DOI: 10.1093/bja/aex118
  • Pharmacokinetics and pharmacodynamics of propofol: changes in patients
           with frontal brain tumours
    • Authors: Sahinovic MM; Eleveld DJ, Miyabe-Nishiwaki TT, et al.
      First page: 901
      Abstract: Background: Models of propofol pharmacokinetics and pharmacodynamics developed in patients without brain pathology are widely used for target-controlled infusion (TCI) during brain tumour excision operations. The goal of this study was to determine if the presence of a frontal brain tumour influences propofol pharmacokinetics and pharmacodynamics and existing PK-PD model performance.Methods: Twenty patients with a frontal brain tumour and 20 control patients received a propofol infusion to achieve an induction–emergence–induction anaesthetic sequence. Propofol plasma concentration was measured every 4 min and at each transition of the conscious state. Bispectral index (BIS) values were continuously recorded. We used non-linear mixed-effects modelling to analyse the effects of the presence of a brain tumour on the pharmacokinetics and pharmacodynamics of propofol. Subsequently we calculated the predictive performance of Marsh, Schnider, and Eleveld models in terms of median prediction error (MdPE) and median absolute prediction error (MdAPE).Results: Patients with brain tumours showed 40% higher propofol clearance than control patients. Performance of the Schnider model (MdPEpk −20.0%, MdAPEpk 23.4%) and Eleveld volunteer model (MdPEpk −8.58%, MdAPEpk 21.6%) were good. The Marsh model performed less well (MdPEpk −14.3%, MdAPEpk 41.4%), as did the Eleveld patient model (MdPEpk −30.8%, MdAPEpk 32.1%).The first-order rate constant (ke0; 0.108 min−1), the concentration in the effects compartment associated with 50% of the maximum effect (Ce50; 2.77 ml litre−1) and γ (1.49) did not significantly differ between groups. Lower baseline BIS values were found in patients with brain tumours (90 vs 95).Conclusions: Brain tumours might alter the pharmacokinetics of propofol. Caution should be exerted when using propofol TCI in patients with frontal brain tumours due to higher clearance.Trial registry number: NCT01060631.
      PubDate: 2017-05-26
      DOI: 10.1093/bja/aex134
  • Validation of a simple tool for anxiety trait screening in children
           presenting for surgery
    • Authors: Bellon MM; Taillardat EE, Hörlin AL, et al.
      First page: 910
      Abstract: Background. Screening for preoperative anxiety is an important challenge during the preoperative period. The aim of our study was to validate the faces scale used to detect anxiety trait in children.Methods. Children aged 8–18 yr were asked to quantify their anxiety trait using the readily available faces scale and to respond to the trait component of the State-Trait Anxiety Inventory (STAI) for children (C) or adults (A) before the anaesthesia consultation. Using receiver operating characteristics analysis, we determined the faces scale optimal value on a construct cohort. A validation cohort was recruited to assess the accuracy of the results.Results. The construction cohort comprised 207 patients and the validation cohort 91 patients. The receiver operating characteristics analysis found an area under the curve of 0.75 [95% confidence interval (CI) 0.67, 0.83]. The optimal value for faces scale score was 4, with a sensitivity of 0.61 [95% CI 0.59, 0.62] and a specificity of 0.82 [95% CI 0.81, 0.83]. When this threshold was applied to the construction and validation cohorts, 61.3 and 44.4% of positives were true positives in the construction and validation cohorts, respectively; and 82.1 and 81.3% of negatives were true negatives, respectively.Conclusions. Our study determined the performance of a simple faces scale to measure the preoperative anxiety trait in children aged 8–18 yr. This tool is potentially helpful for clinicians aiming to identify patients at risk of preoperative anxiety and to assign them to targeted management.
      PubDate: 2017-05-16
      DOI: 10.1093/bja/aex120
  • Addition of droperidol to prophylactic ondansetron and dexamethasone in
           children at high risk for postoperative vomiting. A randomized,
           controlled, double-blind study
    • Authors: Bourdaud NN; François CC, Jacqmarcq OO, et al.
      First page: 918
      Abstract: Background: The combination of dexamethasone (DEX), ondansetron (OND) and droperidol (DRO) is efficacious in preventing postoperative nausea and vomiting in adults, but has not been well assessed in children.Methods: Children undergoing elective surgery under general anaesthesia and considered at high risk for postoperative vomiting (POV) were randomly assigned to receive a combination of DEX, OND and placebo (Group A) or a combination of DEX, OND and DRO (Group B). The primary outcome was the incidence of POV during the first 24 hours after surgery. We hypothesized that the addition of DRO to the standard antiemetic prophylaxis would provide a further 15% reduction in the residual risk for POV. The secondary outcome considered was any adverse event occurring during the study.Results: One hundred and fifty-three children, aged three to 16 years, were randomized to Group A and 162 to Group B. The overall incidence of POV did not differ significantly between the two groups, with 16 patients in Group A (10.5%) and 18 in Group B (11.1%) presenting with one or more episodes of POV, P=0.86. Fewer patients presented with adverse events in Group A (2%) compared with Group B (8%), P=0.01. Drowsiness and headache were the principal adverse events reported.Conclusions: The addition of DRO to a combination of OND and DEX did not decrease POV frequency below that obtained with the two-drug combination in children at high risk of POV, but increased the risk of drowsiness. The combination of DEX and OND should be recommended in children with a high risk of POV.Clinical trial registration. NCT01739985.
      PubDate: 2017-05-15
      DOI: 10.1093/bja/aex099
  • Characterization of peripheral and central sensitization after dorsal root
           ganglion intervention in patients with unilateral lumbosacral radicular
           pain: a prospective pilot study
    • Authors: Mehta VV; Snidvongs SS, Ghai BB, et al.
      First page: 924
      Abstract: Background. Quantitative sensory testing (QST) has been used to predict the outcome of epidural steroid injections in lumbosacral radicular pain and has the potential to be an important tool in the selection of appropriate treatment (such as epidural steroid injections vs surgery) for patients with chronic radicular pain. In addition, QST assists in identification of the pain pathways of peripheral and central sensitization in selected groups of patients.Methods. Twenty-three patients were given dorsal root ganglion (DRG) infiltration with local anaesthesia and steroid (‘DRG block’), and those who demonstrated at least 50% pain relief were offered pulsed radiofrequency (PRF) to the DRG. Questionnaires and QST scores were measured before the DRG blocks and at 1 week and 3 months after their procedure. Those who received PRF also answered questionnaires and underwent QST measurements at 1 week and 3 months after their procedure.Results. There was a significant increase in pressure pain threshold scores after DRG blocks. A reduced conditioned pain modulation response was seen before DRG, which increased after the procedure. Ten out of 23 patients underwent PRF to the DRG, and an increase in pressure pain threshold scores after PRF was observed. The conditioned pain modulation response was maintained in this group and increased after PRF.Conclusions. The study demonstrates that patients with unilateral radicular low back pain who receive dorsal root ganglion interventions show changes in pressure pain thresholds and conditioned pain modulation that are consistent with a ‘normalization’ of peripheral and central sensitization.
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aex089
  • Randomized equivalence trial of the King Vision aBlade videolaryngoscope
           with the Miller direct laryngoscope for routine tracheal intubation in
           children <2 yr of age
    • Authors: Jagannathan NN; Hajduk JJ, Sohn LL, et al.
      First page: 932
      Abstract: Background. We conducted a randomized equivalence trial to compare direct laryngoscopy using a Miller blade (DL) with the King Vision videolaryngoscope (KVL) for routine tracheal intubation. We hypothesized that tracheal intubation times with DL would be equivalent to the KVL in children <2 yr of age.Methods. Two hundred children were randomly assigned to tracheal intubation using DL or KVL. The primary outcome was the median difference in the total time for successful tracheal intubation. Secondary outcomes assessed were tracheal intubation attempts, time to best glottic view, time for tracheal tube entry, percentage of glottic opening score, airway manoeuvres needed, and complications.Results. The median difference between the groups was 5.7 s, with an upper 95% confidence interval of 7.5 s, which was less than our defined equivalence time difference of 10 s. There were no differences in the number of tracheal intubation attempts and the time to best glottic view [DL median 5.3 (4.1–7.6) s vs KVL 5.0 (4.0–6.3) s; P=0.19]. The percentage of glottic opening score was better when using the KVL [median 100 (100–100) vs DL median 100 (90–100); P<0.0001]. Use of DL was associated with greater need for airway manoeuvres during tracheal intubation (33 vs 7%; P<0.001). Complications did not differ between devices.Conclusions. In children <2 yr of age, the KVL was associated with equivalent times for routine tracheal intubation when compared with the Miller blade.Clinical trial registration NCT02590237.
      PubDate: 2017-05-26
      DOI: 10.1093/bja/aex073
  • Effects of arterial load variations on dynamic arterial elastance: an
           experimental study
    • Authors: Monge García MI; Guijo González PP, Gracia Romero MM, et al.
      First page: 938
      Abstract: Background. Dynamic arterial elastance (Eadyn), the relationship between pulse pressure variation (PPV) and stroke volume variation (SVV), has been suggested as a functional assessment of arterial load. The aim of this study was to evaluate the impact of arterial load changes during acute pharmacological changes, fluid administration, and haemorrhage on Eadyn.Methods. Eighteen anaesthetized, mechanically ventilated New Zealand rabbits were studied. Arterial load changes were induced by phenylephrine (n=9) or nitroprusside (n=9). Thereafter, animals received a fluid bolus (10 ml kg−1), followed by stepwise bleeding (blood loss: 15 ml kg−1). The influence of arterial load and cardiac variables on PPV, SVV, and Eadyn was analysed using a linear mixed-effects model analysis.Results. After phenylephrine infusion, mean (sd) Eadyn decreased from 0.89 (0.14) to 0.49 (0.12), P<0.001; whereas after administration of nitroprusside, Eadyn increased from 0.80 (0.23) to 1.28 (0.21), P<0.0001. Overall, the fluid bolus decreased Eadyn [from 0.89 (0.44) to 0.73 (0.35); P<0.01], and haemorrhage increased it [from 0.78 (0.23) to 0.95 (0.26), P=0.03]. Both PPV and SVV were associated with similar arterial factors (effective arterial elastance, arterial compliance, and resistance) and heart rate. Furthermore, PPV was also related to the acceleration and peak velocity of aortic blood flow. Both arterial and cardiac factors contributed to the evolution of Eadyn throughout the experiment.Conclusions. Acute modifications of arterial load induced significant changes on Eadyn; vasodilatation increased Eadyn, whereas vasoconstriction decreased it. The Eadyn was associated with both arterial load and cardiac factors, suggesting that Eadyn should be more properly considered as a ventriculo-arterial coupling index.
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aex070
  • Perioperative use of beta-blockers in vascular and endovascular surgery
    • Authors: Bolsin SC; Conroy MM.
      First page: 947
      Abstract: Editor—We were disappointed to read the content of the recent article by Hajibandeh and colleagues1 in the British Journal of Anaesthesia. Since the early, implausible reports of long-term benefit attributable to short-term perioperative beta-blockade, there has been increasing scepticism of this treatment among both anaesthetists and cardiologists.2–8 Following the early criticisms of publications by Mangano and colleagues and Poldermans’ group, the specialty of anaesthesia has discovered that the conclusions of these workers were baseless.9 This is because of a flawed analysis on the basis of ‘intention to treat’ with respect to the study by Mangano and colleagues and a seriously discredited first author in the case of the Poldermans’ study.283
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aex144
  • Perioperative use of beta-blockers in vascular and endovascular surgery
    • Authors: Myles PS.
      First page: 948
      Abstract: Editor—I thank Drs Bolsin and Conroy1 for raising their concerns regarding a recent publication by Hajibandeh and colleagues2 in the British Journal of Anaesthesia. There is no doubt that the role of perioperative beta-blockade has come under close scrutiny since the 1990s,34 but it is misleading to describe the conclusions of the trial by Mangano and colleagues5 as ‘baseless’ despite there being some legitimate criticisms of its design and interpretation. The Mangano data have been used by others in other systematic reviews.67 We agree that data derived from the DECREASE trials are unreliable.
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aex145
  • Perioperative use of beta-blockers in vascular and endovascular surgery
    • Authors: Hajibandeh SS; Hajibandeh SS, Antoniou SA, et al.
      First page: 949
      Abstract: Editor—Thank you for the opportunity to respond to the letter from Bolsin and Conroy1 in reference to our systematic review and meta-analysis of randomized clinical trials and observational studies investigating the effect of perioperative use of beta-blockers in vascular and endovascular surgery.2 They express their concerns regarding the inclusion of two observational studies34 and a randomized clinical trial,5 and suggest that these studies should be excluded from the meta-analysis because of allegations of scientific misconduct of the senior (or first) author, D. Poldermans, of these studies. Of note, the randomized trial5 (related to the DECREASE-1 study) has already been excluded from our analysis in light of the expression of concern published by the editors of the European Heart Journal.6
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aex146
  • 25-Hydroxyvitamin D deficiency among anaesthesiologists and
           anaesthesiology residents in Chile
    • Authors: Aguilera GG; Barberán MM, Vargas JJ, et al.
      First page: 951
      Abstract: Editor—Approximately one billion people worldwide have 25-hydroxyvitamin D (25OHD) deficiency.1–3 The Endocrine Society considers plasma levels equal or lower than 20 ng mL−1 as a deficiency and levels higher than 30 ng mL−1 as optimal levels.4 Low sunlight exposure is the determining factor for 25OHD deficiency. Such factor relies on the season and the latitude of residence, among others.56 Indoor work is associated with a low sunlight exposure. Therefore, anaesthesiologists may be at risk of developing deficient levels of 25OHD. The prevalence of 25OHD deficiency in this population remains unknown.
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aex147
  • Prediction of postoperative mortality in elderly patients with hip
           fracture: are specific and geriatric scores better than general scores?
    • Authors: Boddaert JJ; Na NN, Le Manach YY, et al.
      First page: 952
      Abstract: Editor—Elderly patients with hip fracture are at high risk of mortality. An accurate prediction of postoperative mortality is important for communicating information, in guiding decision-making, and management. Among preoperative scores, the ASA physical status score does not consider the surgery, makes no adjustment for age, and is subjective.1 The PreOperative Score to predict PostOperative Mortality (POSPOM) is more accurate but has not been validated specifically in elderly patients.2 Many geriatric scores focusing on multimorbidity, such as the Cumulative Illness Rating Scale (CIRS)3 and Charlson comorbidity index,4 have been proposed but not validated for postoperative prediction, and specific scores, such as the Nottingham Hip Fracture Score (NHFS), have also been proposed.5 We tested the hypothesis that specific or geriatric scores predict postoperative mortality better than general scores in this frail population.
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aex148
  • Maintaining oxygenation with high-flow nasal cannula during emergent awake
           surgical tracheostomy
    • Authors: ffrench-O’Carroll RR; Fitzpatrick KK, Jonker WR, et al.
      First page: 954
      Abstract: Editor—Patients presenting with acute upper airway obstruction are at significant risk of morbidity and continue to be managed poorly.1 Although several approaches can be taken, surgical tracheostomy placement under local anaesthesia is recommended because it ensures patients are kept awake, maintaining airway patency.2 This poses several challenges for the anaesthetist, including limited access to the surgical field and risk of complete airway obstruction in a patient with potentially limited reserve.
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aex149
  • Raw EEG characteristics, bispectral index, and suppression ratio
           variations during generalized seizure in electroconvulsive therapy
    • Authors: Ntahe AA; Fournis GG, Gohier BB, et al.
      First page: 955
      Abstract: Editor—We wish to report our findings of an observational prospective study of raw EEG characteristics, bispectral index (BIS) and suppression ratio (SR) variations during a generalized tonic–clonic seizure induced by electroconvulsive therapy (ECT). After obtaining the approval of the Ethics Committee for biomedical research, 20 patients were included for a total of 39 sessions. The BIS sensor (BIS Quatro, Medtronic-minneapolis USA) was connected to the BIS-VISTA® (Medtronic-minneapolis USA) monitor (smoothing rate, 10 s). The BIS and SR values were retained for analysis if their corresponding signal quality index were ≥50 and EMG ≤50. To overcome electromagnetic interference, we excluded from analysis all BIS and SR values obtained from the end of the electrical impulse to 15 s later. Sedation was induced with a bolus of propofol [(median dose 0.86 (interquartile range 0.68–1) mg kg−1] after 3 min of preoxygenation. Suxamethonium [median dose 1.1 (range 1–1.2) mg kg−1] was injected 30 s after loss of the ciliary reflex. Electroconvulsive therapy began at least 30 s after the end of fasciculation and after the stabilization of BIS. The lungs were ventilated until ECT began, in order to avoid hypercapnia. Differences between BIS and SR values were analysed with the Friedman test, and when a significant difference was encountered the trend over time was analysed by a Mann–Kendall test. Statistical significance was assumed at P<0.05.
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aex150
  • Hydrogen peroxide: more harm than good?
    • Authors: Akuji MA; Chambers DJ.
      First page: 958
      Abstract: Editor—Hydrogen peroxide remains a frequently used agent in operating theatres despite its marginal benefits and potential for serious complications. We are writing to remind anaesthetists of the risks of hydrogen peroxide use and pose the question: does hydrogen peroxide cause more harm than good?
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aex151
  • Ventilation through an extraglottic tracheal tube: a technique for deep
           extubation and airway control
    • Authors: Cattano DD; Rane MM.
      First page: 959
      Abstract: Editor—Tracheal extubation after general anesthesia is a critical event of an anaesthetic, probably more important than induction and intubation of the airway; minor complications can result in significant morbidity and even mortality.12 Both the Fourth National Audit Project and the ASA closed claims analysis reported complications from extubation.34 The Difficult Airway Society developed a systematic approach to anticipated easy extubations and to those deemed difficult. Asleep extubation (commonly referred to as deep extubation), as opposed to awake extubation, is in a different arm of the Difficult Airway Society algorithm from the easy airway extubation.5
      PubDate: 2017-06-02
      DOI: 10.1093/bja/aex152
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