This conference will run concurrently with the New Zealand Anaesthesia Annual Scientific Meeting. 

The theme for the conference is Trauma: making trauma less traumatic.  Organisers envisage the programme will stimulate attendees to think about and focus on;

• the skills and techniques required to ensure that patients under our care receive the best possible in both the elective and ‘extreme’ settings
• Hand’s on workshops will be running concurrently through the programme

To find out more about this event, go to:  http://conferenceteam.co.nz/nzats2015/

The programme will cover current concepts, controversies and cases relevant to the General Anaesthetist involved in the care of pregnant women.

To find out more, go to:  http://www.oasis-conference.org.nz/

To find out more, go to:  http://www.anzca.edu.au/fellows/special-interest-groups/anaesthetists-in-management/the-12th-annual-combined-communication-education.html

Conversations and debates will centre around professional directions, clinical conundrums, and specific challenges where networks are needed to improve the quality of the care delivered.

To find out more about this event, go to:  https://www.eiseverywhere.com//ehome/102795

Studies in this issue (attached below):

The theme for the 2015 ASM is Trauma: Personal, professional and patient perspectives. 

For further information about this event, go to:  http://www.anzcanzasm2015.com/

"Lack of manpower, poor communication and collaboration, resistance to change, and patient factors were cited by most as barriers. Discipline-specific issues were identified although most related to resistance to change. Overall, interviewees were supportive of implementation of a standardized ERAS program and agreed that a standardized guideline based on best evidence; standardized order sets; and education of the staff, patients, and families are essential". The authors discuss the implications of these findings.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1097/SLA.0000000000000604 or contact your DHB library, or organisational or local library for assistance.

Pearsall, E.A., et al. (2015). A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program. Annals of Surgery, 261(1), 92–96.

Studies in this issue (attached below):

With rising demand, patient waits increased. The average lead time for a patient (time from entering the department to leaving) was 79 minutes. 9.3% of patients attended within two weeks of their scheduled surgery date. 10% of patients were asked to return on a later day, as there was not sufficient capacity to undertake their assessment. There were nine routes of referral in to the department.

Patients moved between different clinic rooms and the waiting area several times. Work patterns were uneven, as many attendances were from out-patient clinics which meant peak attendance times were linked to clinic times. There were substantial differences in the approaches of different nurses, making the HCA role difficult. Patients reported dissatisfaction with waits.

Using a Lean quality improvement process with rapid PDSA cycles, the service changed to one in which patients were placed in a room, and remained there for the duration of their assessment. Standard work was developed for HCWs and nurses. Rooms were standardised using 5S processes, and set up improved to reduce time spent looking for supplies. A co-ordinator role was introduced using existing staff to monitor flow and to organise the required medical assessments and ECGs. Timing of booked appointments were altered to take account of clinic times. Routes in to the department were reduced from nine to one.

Ten months after the work began, the average lead time had reduced to 59 minutes. The proportion of people attending within two weeks of their surgery decreased from 9.3% to 5.3%. Referrals for an anaesthetic opinion decreased from 30% to 20%, and in the month reviewed no one had to return to be seen as a result of limited capacity.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1136/bmjquality.u201341.w1226

Start, C., et al. (2015). Improving patient flow in pre-operative assessment. BMJ Quality Improvement Reports, 4.

International, Australian and New Zealand invited speakers are Debra Schwinn from Iowa, BobbieJean Sweitzer from Chicago, Alicia Dennis from Melbourne, Kelly Byrne from Hamilton, Martin Smith from London, and John West, from San Diego.

For further information about this event, go to:  http://www.aomevents.com/asa2015

Three rounds of surveys were undertaken with 23 members of international clinical specialist groups with expertise in anaesthesia or postanaesthetic care.

Consensus (at least 75% agreement), "... was reached in regard to 24 criteria considered essential (e.g. respiratory rate 100%; pain 100%; heart rate 95%; temperature 91%). Consensus was also reached for 15 criteria not considered essential (e.g. appetite 96%; headache 76%). Consensus was not obtained for a further 10 criteria. Participants (95%) agreed that a discharge tool was important to ensure safe patient discharge". 

To read the full abstract, and for information on how to access the full text, go to:  http://onlinelibrary.wiley.com/doi/10.1111/jocn.12576/abstract or contact your DHB library, or organisational or local library for assistance.

Phillips, N. M., Street, M., Kent, B. and Cadeddu, M. (2014). Determining criteria to assess patient readiness for discharge from postanaesthetic care: an international Delphi study. Journal of Clinical Nursing, 23(23-24): 3345–3355.

Three of the University of Auckland’s top researchers were among 12 New Zealanders elected as Fellows of the Royal Society this week.

They are Professors Alan Merry and John Windsor from the Faculty of Medical and Health Science and Professor Peter Watts from the Faculty of Law.

Professor Watts has a high international standing in the general area of commercial law, more especially in agency law, company law, and the law of restitution. In agency law, which has connections to most branches of private law, he is one of the Commonwealth’s most distinguished researchers.

Professor Merry, from the Department of Anaesthesiology, has researched patient safety (particularly in anaesthetics) and the influence of the law on medical practice. His work on the conceptual basis of negligence and medical manslaughter has contributed to changes in clinical practice internationally and to legislative changes in New Zealand.

Professor Windsor, from the Department of Surgery, is a pre-eminent academic surgeon and research scientist and a pioneer in laparoscopic or keyhole surgery. He is acknowledged as a leading New Zealand specialist in pancreatic surgery and has developed innovative surgical skills training methods and centres.

Honorary Fellowships are aimed at encouraging liaison and collaboration between outstanding scientists and scholars of different nations with established and new initiatives in the New Zealand knowledge community.

Academy Chairperson Dr John Caradus FRSNZ says “Being elected as a Fellow is an honour given to our top researchers for showing exceptional distinction in research or in the advancement of science, technology or the humanities.

“These newly elected Fellows are leaders in fields as diverse as surgery, mathematics, psychology, law, climate science and biochemistry. They reflect the wide range of work being undertaken by researchers in science, the social sciences and humanities in New Zealand. It gives me great pleasure to announce their election today.”

The Royal Society of New Zealand promotes science, technology and humanities in schools, in industry and in society. 

The review is attached below.

Anaesthetists across New Zealand are urging smokers scheduled for surgery to “stop before the op” as part of National Anaesthesia Day on October 16, organised by the Australian and New Zealand College of Anaesthetists.

Hospitals and health services will be holding stalls, offering information to the public and spreading the word that it is never too late to quit.

Auckland City Hospital plans a major demonstration in its main foyer with anaesthetists using a mannequin to demonstrate how to give an anaesthetic and the public given the opportunity to participate in hands-on activities such as ventilating “patients” and using ultrasound. At an Auckland District Health Board Smoke-free booth they will be able to measure their carbon monoxide levels and compare how these differ between smokers and non-smokers, and a video clip will show the patient journey through an operation.

Smoking leads to more complications during and after an operation. It starves the body of oxygen, makes it more difficult to breathe during and after surgery and can lead to blood clots. Smokers also have more trouble recovering.

ANZCA’s newly released guidelines on smoking state “ANZCA ... recognises that the perioperative period represents a ‘teachable moment’ when many smokers quit or attempt to quit smoking, sometimes permanently” and that it is never too late to quit with every day making a difference.

After 24 hours, blood pressure improves and more oxygen reaches the heart. After one week, lungs are better at removing mucus, tar and dust. After three to four weeks, the body is better at fighting wound infections.

Tobacco use is the single greatest preventable cause of death and disease in New Zealand. At least half of all smokers will eventually die as a result of their smoking and 5000 deaths annually in New Zealand are attributable to tobacco.

Although the information in this document may be of benefit to the community as a whole, it is intended to apply to clinicians with a view to advocating cessation of smoking and ensuring optimal timing for cessation".

The guidelines are available to read at: http://www.anzca.edu.au/resources/professional-documents/pdfs/ps12-2013-guidelines-on-smoking-as-related-to-the-perioperative-period.pdf

A background paper is available at: http://www.anzca.edu.au/resources/professional-documents/pdfs/ps12-bp-2013-guidelines-on-smoking-as-related-to-the-perioperative-period-background-paper.pdf

Studies in this issue (attached below):

Intensive Care Medicine is the official journal of The European Society of Intensive Care Medicine and The European Society of Paediatric and Neonatal Intensive Care.

A new report reveals the latest information on death rates from surgery and anaesthesia in New Zealand.

The Perioperative Mortality Review Committee (POMRC) today released its third report to the Health Quality & Safety Commission.

The POMRC reviews deaths related to surgery and anaesthesia which occur within 30 days of an operation, and makes recommendations aimed at making surgery safer for patients. Its latest report covers deaths from 2007 to 2011 in five clinically important areas:

• cholecystectomy (surgical removal of the gallbladder) – death rate of 0.98 percent for emergency admissions and 0.15 percent for elective admissions within 30 days of surgery
• colorectal resection (surgical removal of part of the colon) – death rate of 8.46 percent for emergency admissions and 1.7 percent for elective admissions within 30 days of surgery (both figures for patients aged 45 or above)
• general anaesthesia – death rate of 0.13 percent within one day of surgery
• elective admissions for low-risk patients – death rate of 0.06 percent within 30 days of surgery
• pulmonary embolism (blood clot in the lung) - death rate of 0.06 percent for emergency admissions and 0.009 percent for elective patients who had surgery/anaesthesia and developed pulmonary embolism.

Within 30 days of surgery, there were 555 deaths from colorectal resection (for patients aged 45 and above), 118 deaths from cholecystectomy, and 249 deaths of low-risk patients having anaesthetic during elective surgery.

There were 276 deaths from pulmonary embolism within 30 days of surgery, and 136 deaths of people who had surgery/anaesthesia and developed pulmonary embolism.

Within a day of surgery, there were 1465 deaths from general anaesthesia. Heart disease was the most common underlying reason for dying from general anaesthesia, and the risks of dying significantly increased for patients who were aged over 65, in poor health, and admitted as emergency patients.

There have been no clinically significant changes in deaths related to surgery and anaesthesia over the past three years.

Dr Leona Wilson, chair of the POMRC, says collecting high-quality data on mortality rates can help measure the safety of health care and identify areas where improvements can be made.

“We want operations and anaesthesia to be as safe as possible for all New Zealanders,” she says.

The POMRC’s recommendations include ensuring all theatre staff are aware of each patient’s ASA score. Developed by the American Society of Anesthesiologists, ASA scores assess a patient’s physical status before surgery.

The committee also recommends that it keeps working with health care providers to develop ways to standardise mortality reporting, and that it continue exploring World Health Organization measures that aim to make it possible to more accurately compare mortality statistics between countries.

The full report can be downloaded at: http://www.hqsc.govt.nz/publications-and-resources/publication/1575/

Questions & Answers for the Third Report are available here (47 KB, doc).

Studies in this issue (attached below):

The Gluckman Medal is the faculty’s premier acknowledgement of research excellence.

To read the full story, go to:  http://www.hqsc.govt.nz/news-and-events/news/1367/

Studies in this issue (attached below):

The authors conclude that, based on currently available evidence, "... the design and implementation of an enhanced recovery programme [in the UK] based on this review in selected patients as a package of care may reduce morbidity and length of hospital stay, thus maximising utilisation of available resources".

This article is available to read in free full text at: http://onlinelibrary.wiley.com/doi/10.1111/anae.12067/full

Jones, N. L., Edmonds, L., Ghosh, S. and Klein, A. A. (2013), A review of enhanced recovery for thoracic anaesthesia and surgery. Anaesthesia, 68: 179–189. doi: 10.1111/anae.12067

Professor Merry was awarded an honorary membership of the American Society of Anaesthesiology last week. He is Head of the School of Medicine at the University of Auckland and practises anaesthesia and chronic pain management at Auckland City Hospital.

“This is a singularly high international honour which has been awarded to only 34 individuals in the world since 1935,” says the Dean of the Faculty of Medical and Health Sciences, Professor John Fraser. “Alan delivered the prestigious Ellison C. Pierce, Jr., MD Patient Safety Memorial Lecture in San Francisco this week.”

To read the full media release from the University of Auckland, go to: http://www.scoop.co.nz/stories/GE1310/S00123/international-recognition-for-patient-safety.htm

Studies in this issue (attached below):

The article by two consultant anaesthetists at Great Ormond Street Hospital in London highlights the importance of good preoperative assessment and also discusses strategies to minimise postoperative pain and nausea and vomiting.

To read the full abstract, and for information on how to access the full text, go to: http://www.anaesthesiajournal.co.uk/article/S1472-0299(13)00112-4/abstract or contact your DHB library, or organisational or local library for assistance.

Navaratnarajah, J. & Thomas, M. (2013). Day surgery for children. Anaesthesia & Intensive Care Medicine, 14(6), 232–236.

• Incidence of accidental awareness during general anaesthesia
• Penehyclidine and intraanaesthesia
• Penehyclidine and intra-operative awareness
• BIS-guided induction anaesthesia with propofol vs. etomidate
• Falls and major orthopaedic surgery with peripheral nerve block
• Perioperative anaesthetic technique in orthopaedics
• Caudal block by sacral hiatus injection under ultrasound guidance in children
• Epidural vs. continuous preperitoneal analgesia during open colorectal surgery
• Hypercapnic hyperpnoea hastens anaesthesia recovery
• Leukocyte DNA damage and wound infection after N2O
• Long-term effects of a perioperative safety checklist

To subscribe to this Research Review, go to: http://www.researchreview.co.nz

The survey was completed by 125 participants, and 19 (15.2%) stated their main place of employment had a pain management policy during immunisations (20  were not sure). Distraction strategies were frequently used for all age groups, while breastfeeding for infants younger than 6 months was used occasionally (44.6%), often (9.1%) or never (45.5%) and even less frequently for infants aged 6–12 months. Sucrose or other sweet solutions were almost never used for infants prior to, or during, immunisation. Lollies were frequently given to children after immunisations. 

The authors conclude that strategies, such as sweet solutions, breastfeeding or topical anaesthetics, where feasible, should be facilitated.

To view the full abstract and for information on how to access the full text, go to:
http://onlinelibrary.wiley.com/doi/10.1111/jpc.12161/abstract or contact your DHB library, or organisational or local library for assistance.

Harrison, D., Elia, S., Royle, J. & Manias, E. (2013), Pain management strategies used during early childhood immunisation in Victoria. Journal of Paediatrics and Child Health, 49(4), 313-318.

To view the full abstract and for information on how to access the full text, go to:
http://link.springer.com/article/10.1007/s12630-012-9852-z or contact your DHB library, or organisational or local library for assistance.

Eichhorn, J.H., et al. (2013). Review article: Practical current issues in perioperative patient safety. Canadian Journal of Anesthesia, 60(2), 111-118.

Patient misadventure (e.g. acute respiratory tract infections) were the major cause of anaesthetic cancellations, with non-adherence to fasting and medication guidelines the next major reason. The authors suggest that the overall cancellation rate could potentially be improved with relatively simple changes to the way clinics function.

To view the full abstract and for information on how to access the full text, go to:
http://www.aaic.net.au/document/?D=20120511 or contact your DHB library, or organisational or local library for assistance.

Emanuel, A. & MacPherson, R. (2013). The anaesthetic pre-admission clinic is effective in minimising surgical cancellation rates. Anaesthesia and Intensive Care, 41(1).

Anaesthesia and Intensive Care is published by the Australian Society of Anaesthetists and is the official journal of the Australian Society of Anaesthetists, Australian and New Zealand Intensive Care Society and the New Zealand Society of Anaesthetists.

Covert observations of anaesthetic practitioners were made while they were checking their designated anaesthetic machine, and structured interviews with staff who check the anaesthetic machine were carried out to determine the training they had received. The results indicated poor compliance with recommendations, and the authors make suggestions for increasing compliance.

To view the full abstract and for information on how to access the full text, go to: http://www.aaic.net.au/Document/?D=20120074 or contact your DHB library, or organisational or local library for assistance.

Sweeney, N., et al. (2012). An audit of level two and level three checks of anaesthesia delivery systems performed at three hospitals in South Australia. Anaesthesia and Intensive Care, 40(6).

• Intermediate-acting NMBs and postop respiratory complication risk
• Errors during preparation of drug infusions
• Distractions/interruptions in anaesthetic practice
• Cartoons reduce anxiety in children during anaesthesia induction
• Regional vs. general anaesthesia for hip fracture surgery
• Naloxone and posthysterectomy morphine consumption
• Impact of TTE in hip fracture surgery patients at risk of cardiac disease
• Two premed intranasal dexmedetomidine doses in children
• Systemic metoclopramide to prevent PONV
• Preventing IV bacterial injection from hands

To subscribe to this Research Review, go to: http://www.researchreview.co.nz

Health Minister Tony Ryall says faster recovery for patients is just one benefit of a new programme being used by public hospitals across the country.

The Enhanced Recovery After Surgery (ERAS) programme helps people recover more quickly and safely after their operation so they have fewer complications and get home to their families sooner.

“Bay of Plenty District Health Board (DHB), who recently adopted the programme, has reported significant improvements,” says Mr Ryall.

“Following major bowel surgery, patients are now able to eat and drink and are out of bed on the day of their surgery. And they start walking about the ward the following day.

“This is a great result. Prior to the ERAS programme, it would normally take patients several days before they could get out of bed after bowel surgery.

“The DHB is doing this by ensuring patients are in optimal condition for surgery. They are changing anaesthetic and surgery techniques, such as using laparoscopic surgery, avoiding the use of drains and having targeted rehabilitation after surgery. Patients feel better, quicker.

“This innovative programme which began in Counties-Manukau is now in six DHBs – Bay of Plenty, Capital & Coast, Counties-Manukau, Nelson Marlborough, Southern and Waitemata – and is being taken up by other regions.”

To view the full abstract and for information on how to access the full text, go to:
http://onlinelibrary.wiley.com/doi/10.1111/jan.12018/abstract or contact your DHB library, or organisational or local library for assistance.

Reynolds, H. Dulhunty, J. Tower, M. Taraporewalla, K. & Rickard, C. (2013) A snapshot of guideline compliance reveals room for improvement: A survey of peripheral arterial catheter practices in Australian operating theatres. Journal of Advanced Nursing, 69(7), 1584–1594.

The authors note that information from the the review could contribute to the design and implementation of quality improvement initiatives and the development of an instrument to measure patient satisfaction with general anesthesia care.

To view the full abstract and for information on how to access the full text, go to:
http://www.aornjournal.org/article/S0001-2092(12)00775-2/abstract or contact your DHB library, or organisational or local library for assistance.

Hawkins, R.J., et al. (2012). An integrative review of factors related to patient satisfaction with general anesthesia care. AORN Journal, 96(4), 368-376

To view the full abstract and for information on how to access the full text, go to:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60990-8/abstract or contact your DHB library, or organisational or local library for assistance.

Bainbridge, D., et al. (2012). Perioperative and anaesthetic-related mortality in developed and developing countries: A systematic review and meta-analysis. The Lancet, 380(9847), 1075-1081.

• High inspired O2 and postoperative hypoxaemia
• Sugammadex in laparoscopic bariatric surgery
• Tuohy needle dural puncture increases chronic headache
• Reducing sodium in local anaesthetics for peripheral nerve blocks
• Dexamethasone ±ondansetron for preventing postoperative vomiting in children
• Warmth is analgesic in healthy newborns
• Postoperative analgesic efficacy of caudal additives in children
• Vasopressors for hypotension after spinal anaesthesia for elective caesarean
• Rocuronium priming, magnesium pretreatment and both Radiation awareness among referrers
• PIH during emergency airway management

To subscribe to this Research Review, go to: http://www.researchreview.co.nz

281 service providers from the perioperative pathway of three Australian public hospitals completed the survey, including surgeons, nurses, anaesthetists, theatre technicians, patient service assistants and receptionists.

The authors found that there was dissatisfaction with communication from top management, with nurses less satisfied with channels of information than surgeons, and anaesthetists less satisfied with the timeliness of information than nurses.

To view the full abstract and for information on how to access the full text, go to:
http://dx.doi.org/10.1111/j.1365-2702.2012.04228.x or contact your DHB library, or organisational or local library for assistance.

Braaf, S., et al. (2012), Healthcare service provider perceptions of organisational communication across the perioperative pathway: a questionnaire survey. Journal of Clinical Nursing, 22(1-2), 180–191.

The authors find that these articles "... indicate that parental presence alone is the least effective means of decreasing a child's anxiety during the induction of anesthesia".

To view the full abstract and for information on how to access the full text, go to:
http://www.aornjournal.org/article/S0001-2092(12)00414-0/abstract or contact your DHB library, or organisational or local library for assistance.

Scully, S.M. (2012). Parental presence during pediatric anesthesia induction. AORN Journal, 96(1), 26-33.

 Studies in this issue (attached below):

• Economic impact of moderate weight loss in type 2 diabetes
• Multimorbidity in primary care and healthcare resources
• Resource usage/outcomes in a facilitated discharge service
• Hospital volume and outcomes after elective hip/knee arthroplasty
• Work environment and upper limb musculoskeletal disorders
• Using hi-tech to enforce low-tech safety measures
• A ‘swing room’ model for regional anaesthesia
• Critical anaesthetic equipment incidents
• Essential requirements for health managers
• Antecedents, consequences and contingencies of change readiness

Studies in this issue (attached below):

• 6MWD predicts anaerobic threshold
• Anxiety and pain predict anaesthetic requirement
• Fentanyl vs. tramadol during propofol-based sedation
• N2O reduces postoperative opioidinduced hyperalgesia
• Pain after paediatric tonsillectomy, orchidopexy or IHR
• Delaying lying down after spinal anaesthesia for Caesarean
• Air-sealing with tapered vs. cylindrical tube cuffs
• Dexamethasone augments treatment of PONV
• Information recall during postanaesthesia recovery
• Magnesium and intraoperative bleeding.

To subscribe to this Research Review, go to: http://www.researchreview.co.nz

• Multimodal system reduces errors with anaesthetics
• Temperature of oral fluids affects vomiting
• Intraoperative isotonic electrolyte solution in neonates
• Excessive preoperative fasting causes discomfort in children
• rSO2 desaturation during shoulder surgery
• ‘Fast-track’ discharge after total joint arthroplasty
• PICC malpositions common in head/neck surgery
• Trainees identify aortic stenosis on echocardiography
• PCA remifentanil vs. pethidine for labour analgesia
• Pudendal vs. dorsal penile nerve block for circumcision.

To subscribe to this Research Review, go to: http://www.researchreview.co.nz

• Volume for epidural blood patch in obstetrics
• Spinal anaesthesia failure after injection into CSF
• Preventing intraoperative awareness in high-risk patients
• Lean bodyweight scalar for propofol induction in morbidly obese patients
• Maternal deaths associated with anaesthesia/intensive care
• Effect of age on intraoperative cerebrovascular autoregulation
• One vs. two applications of chlorhexidine ⁄ethanol
• Foetal RBC contamination with autologous blood following Caesarean 
• Single-use vs. reusable LMAs for airway management in the prone position
• Topical capsaicin for pain management

To subscribe to this Research Review, go to: http://www.researchreview.co.nz

Anaesthesia is focused on maximising positive outcomes for the patient underpinned by astrong evidence base in science and advanced clinical skills. Anaesthetists are involved in patient care from initial pre-operative assessment of the patient through to post-operative care and pain management. They are involved in retrieval, trauma, emergency resuscitation work and intensive care.

This approach has informed the work of the Review Group, through a process of survey work and evaluation of a range of options looking to sustain the anaesthesia workforce into the 21st century and beyond.

The genesis of this review was the development of a Memorandum of Understanding (MOU) agreed between the NZ Society of Anaesthetists NZSA and HWNZ in July 2010, in recognition of the need to review and consider options for the future of a critical and potentially vulnerable workforce. Since that time, the Anaesthesia Resource Review Group (ARRG) has developed. The group incorporates representation from the New Zealand National Committee of the Australian and New Zealand College of Anaesthetists and from amongst the Vocational Trainees in Anaesthesia.

The review represents a major step forward as a profession led investigation and response to the issues facing the current workforce and those in training. 

The report, Anaesthesia 2020: A report on how to provide sufficient anaesthesia resources in New Zealand for the next decade and beyond (published by Health Workforce New Zealand in 2011), is available in summary form or full text at: http://www.healthworkforce.govt.nz/our-work/workforce-service-reviews/anaesthesia

• Remifentanil for foetal immobilisation/analgesia
• Continuous care and empathic attitudes: impact on anxiety/satisfaction
• Defining intraoperative hypotension: BP during sleep vs. general anaesthesia
• Maintaining tissue perfusion in high-risk surgical patients
• Femoral + popliteal catheter for analgesia after major ankle surgery
• Preoperative endoscopic airway examination and airway information
• Clinical meaningfulness of numeric pain ratings in children
• Smoking and perioperative outcomes
• Perioperative IV lidocaine infusion for postoperative pain control
• Calibration in acceleromyography to assess neuromuscular recovery

Minnick, A. F., Donaghey, B., Slagle, J. and Weinger, M. B. (2011), Operating room team Members' views of workload, case difficulty, and nonroutine events. Journal for Healthcare Quality, 33, no. doi: 10.1111/j.1945-1474.2011.00142.x

For the full abstract and information on how to access the full text, go to: http://onlinelibrary.wiley.com/doi/10.1111/j.1945-1474.2011.00142.x/abstract

The authors make recommendations for communication practice, including paying attention to the ‘non-informational’ aspects of communication, as these can be used to therapeutic advantage. They emphasise that effective communication at handover to recovery room staff plays a key part in ensuring the continuity, quality, and safety of patient care.

Smith, A. & Mishra, K. (2010). Interaction between anaesthetists, their patients, and the
anaesthesia team. British Journal of Anaesthesia, 105(1), 60-68.

The full-text version of the article can be found at http://bja.oxfordjournals.org/content/105/1/60.full.pdf+html