British journal of anaesthesia
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Retrospective observational studies have reported a significant association between intraoperative hypotension and postoperative morbidity. However, association does not imply causation, and whether preventing intraoperative hypotension can improve patient outcome remains to be demonstrated. ⋯ In contrast, they reported a statistically significant (but not clinically relevant) reduction in postoperative cardiac arrhythmia and hospital length of stay when targeting mean arterial pressure ≤60 mm Hg. These findings suggest that during most surgical cases, intraoperative hypotension is a marker of the severity, frailty, or both rather than a mediator of postoperative complications.
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In the UK more women than men are practicing medicine, and for the first time in the history of the Royal College of Anaesthetists (RCoA), the president of the RCoA, Dean of the Faculty of Pain Medicine, and Dean of the Faculty of Intensive Care Medicine are all women. However, within the subspecialty of pain medicine, there are significantly more men practicing than women, with the most recent UK estimates identifying that only 26.7% of current pain physicians are women. ⋯ We discuss current trends in pain medicine recruitment within the UK, where most pain physicians are recruited from anaesthesia training programs, including the barriers to women's representation and reasons women enter the subspecialty. We advocate for speaker gender quotas at conferences, diversity considerate workforce planning, peer support groups, adjustments to training programs, and further research to help narrow the gender gap.
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Prophylactic administration of tranexamic acid is associated with a reduction of blood loss after Caesarean delivery, but cost-effectiveness for this indication has not been assessed. ⋯ NCT03431805.
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Airway-related articles have featured heavily in the British Journal of Anaesthesia since it was founded in 1923. In the 100 years thereafter, 1102 airway-related articles have been published in the journal, written by 2955 unique authors from 55 different countries. In this editorial, we highlight some of the major publications in airway management and their impact on the specialty. Summaries of the most cited articles are contained within online supplementary material as well as links to all airway-related articles for readers who wish to delve deeper into this body of work.
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As anaesthesiologists face increasing clinical demands and a limited and competitive funding environment for academic work, the sustainability of academic anaesthesiologists has never been more tenuous. Yet, the speciality needs academic anaesthesiologists in many roles, extending beyond routine clinical duties. Anaesthesiologist educators, researchers, and administrators are required not only to train future generations but also to lead innovation and expansion of anaesthesiology and related specialities, all to improve patient care. ⋯ Although multiple routes to success exist, one common thread is the need for consistent support of strong mentors and sponsors. Moreover, to address inequitable opportunities, we emphasise the need for diversity and inclusivity through global collaboration and exchange that aims to improve access to research training and participation. We are optimistic that by focusing on these fundamental principles, we can help build a more resilient and sustainable future for academic anaesthesiologists around the world.