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Summary: It is now apparent that severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) and coronavirus disease 2019 (COVID‐19) will remain endemic for some time. Improved therapeutics and a vaccine may shorten this period, but both are far from certain. Plans must be put in place on the assumption that the virus and its disease will continue to affect the care of patients and the safety of staff. This will impact particularly on airway management due to the inherent risk to staff during such procedures. Research is needed to clarify the nature and risk of respiratory aerosol‐generating procedures. Improved knowledge of the dynamics of SARS‐CoV‐2 infection and immunity is also required. In the meantime, we describe the current status of airway management during the endemic phase of the COVID‐19 pandemic. Some controversies remain unresolved, but the safety of patients and staff remains paramount. Current evidence does not support or necessitate dramatic changes to choices for anaesthetic airway management. Theatre efficiency and training issues are a challenge that must be addressed, and new information may enable this. [ABSTRACT FROM AUTHOR]

Opening operating theatre doors after aerosol-generating procedures is not a high-risk action Throughout the COVID-19 pandemic, airway management procedures designated as being "aerosol generating" have been undertaken in a number of locations, including operating theatres. Even with the doors closed, operating theatres are not sealed, and a significant volume of air continuously leaks out into the adjacent lower pressure areas. [Extracted from the article]

Editorial. Comments on the continuous usage of regional anesthesia and analgesia. History of regional anesthesia and analgesia; Assessment on the safety of regional anesthesia; Limitation on the use of peripheral nerve blocks for prolonged surgical procedures.

Background and Objectives: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia., Methods: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement., Results: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29., Conclusion: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2022. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.)

There is no universally agreed set of anatomical structures that must be identified on ultrasound for the performance of ultrasound-guided regional anesthesia (UGRA) techniques. This study aimed to produce standardized recommendations for core (minimum) structures to identify during seven basic blocks. An international consensus was sought through a modified Delphi process. A long-list of anatomical structures was refined through serial review by key opinion leaders in UGRA. All rounds were conducted remotely and anonymously to facilitate equal contribution of each participant. Blocks were considered twice in each round: for "orientation scanning" (the dynamic process of acquiring the final view) and for the "block view" (which visualizes the block site and is maintained for needle insertion/injection). Strong recommendations for inclusion were made if ≥75% of participants rated a structure as "definitely include" in any round. Weak recommendations were made if >50% of participants rated a structure as "definitely include" or "probably include" for all rounds (but the criterion for "strong recommendation" was never met). Thirty-six participants (94.7%) completed all rounds. 128 structures were reviewed; a "strong recommendation" is made for 35 structures on orientation scanning and 28 for the block view. A "weak recommendation" is made for 36 and 20 structures, respectively. This study provides recommendations on the core (minimum) set of anatomical structures to identify during ultrasound scanning for seven basic blocks in UGRA. They are intended to support consistent practice, empower non-experts using basic UGRA techniques, and standardize teaching and research., Competing Interests: Competing interests: AD, CL, EM, LFV-V, TV, and MW are members of the Executive Board of the European Society of Regional Anaesthesia & Pain Therapy (ESRA). NE, SK, SM, SN, and MAR are members of the Board of Directors of the American Society of Regional Anesthesia & Pain Medicine (ASRA). AG, NH, DFJ, RJK, AJRM, AP, MPS, AT, LT, SW, JW are members of the Board of Regional Anaesthesia UK (RAUK). WH-G is the Vice-President of the Royal College of Anaesthetists. JSB, DBSL, AJRM, DP & AT declare honoraria and/or research funding from Intelligent Ultrasound. JAN is a Senior Scientific Advisor for Intelligent Ultrasound Limited. AP declares consultancy fees for B Braun Medical UK and honoraria from GE Healthcare, Butterfly Net Inc, Sintetica UK Ltd, and Pacira., (© American Society of Regional Anesthesia & Pain Medicine 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To establish whether pre-operative investigations are able to predict cerebral tolerance to carotid cross clamping during carotid endarterectomy (CEA)., Methods: A search of the MEDLINE database from 1950 to 2015 was made in combination with manual cross-referencing using the search strategy: ("carotid" [all fields] AND "endarterectomy" [all fields]) AND "preoperative" [all fields]) AND "clamping" [all fields]) AND ("MRA" [all fields] OR "MRI" [all fields] OR "CT" [all fields] OR "CTA" [all fields] OR "EEG" [all fields] OR "Doppler" [all fields] OR "angiography" [all fields]). A total of 20 studies were identified as eligible for inclusion., Results: 3D Time of Flight MRA and acetazolomide stress SPECT imaging have been reported to have a negative predictive value of 96% and 94% respectively for the need for intraoperative shunting during carotid endarterectomy., Conclusions: There is some evidence to suggest that pre-operative imaging investigations can reliably identify which patients undergoing CEA will not require carotid shunting for neurological protection. However, this evidence is limited and there is a need for more rigorous studies to be conducted., (Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.)