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182 results on '"Kariem El-Boghdadly"'

1. European anesthesiologists’ experiences with gender-based mistreatment in the workplace: a secondary multilevel regression analysis

Author: Joana Berger-Estilita, Luana Fritsche, Kariem El-Boghdadly, Claudia Camila Dias, and Marko Zdravkovic
Subjects: anesthesiology, gender bias, gender equity, occupational stress, perceived discrimination, sexism, working conditions, workplace violence, Anesthesiology, RD78.3-87.3
Abstract: Background Workplace gender-based mistreatment (GBM) refers to negative or harmful behaviors directed towards employees. In healthcare settings, this can lead to job dissatisfaction and underperformance and potentially compromise patient outcomes. The aim of this study was to examine workplace GBM among European anesthesiologists and produce the first European GBM Rank in Anesthesiology. Methods We conducted a secondary analysis from a worldwide cross-sectional survey database consisting of a 46-item questionnaire exploring, among other outcomes, gender bias attributable to workplace attitudes. The survey completion rate was 80.8%. All respondents were selected from European countries. Associations between mistreatment and the remaining variables were analyzed using univariate and multivariable logistic regression analyses. A generalized linear mixed model was then used to quantify the impact of mistreatment in each European country. Statistical significance was set at P < 0.05. Results This study included 5,795 respondents from 43 European countries. The independent predictors of GBM were as follows: female gender, younger age, perceiving gender as a disadvantage for leadership, and perceiving gender as a disadvantage for research. The full model was statistically significant, indicating an ability to distinguish between those who experienced GBM and those who did not (P < 0.001). Thus, 26 European countries were ranked based on the prevalence of mistreatment, with Italy showing the best performance (lowest prevalence). Conclusions The aim of our study was to provide preliminary insight into GBM in anesthesiology in Europe, function as a key benchmark for gender equity, and chart the evolution of disparities over time.
Published: 2024
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2. Anaesthesia Choice for Creation of Arteriovenous Fistula (ACCess) study protocol : a randomised controlled trial comparing primary unassisted patency at 1 year of primary arteriovenous fistulae created under regional compared to local anaesthesia

Author: Philip Bennett, Karen Stevenson, Marc Clancy, Mark Wright, Catherine Jardine, Sanjay Sinha, Cecilia Vindrola-Padros, Andrew Jackson, Regin Lagaac, Rajesh Sivaprakasam, Reza Motallebzadeh, Gavin Pettigrew, Rani Badhan, Ramani Moonesinghe, Kariem El-Boghdadly, Liz Brown, James Gilbert, Cecilia Vindrola, Nikki Dewhirst, Rosemary Hogg, Darren Morrow, Thalakunte Muniraju, Alex Vesey, Alan Macfarlane, David Kingsmore, Sheera Sutherland, Scott Oliver, Alan JR Macfarlane, Rachel J Kearns, Marc James Clancy, Patrick Mark, Margaret Aitken, Lucian Gaianu, Nikolaos Karydis, Rita Singh, Stuart Suttie, Kirsty Wetherall, Iain Thomson, Vishal Nangalia, Emma Aitken, Rosie Hogg, Andrew Dalton, Rose Ross, David McNair, Linda Stiff, Mohammed Tariq Dosani, Jennifer Sainsbury, Kiran Sran, Nadia Castrillo, Sarah Crosbie, Madita Gavrila, Sandra Montgomery, Tina McLennan, Nina Tarkowska, Shelley McLachlan, Jonathan de Siqueira, Max Troxler, Chetan Srinath, Vashist Deelchand, Gareth Ackland TimEgan, Matt Wikner, Rachel Kearns, Alex MacConnachie, and Ramani Moonsinghe
Subjects: Medicine
Abstract: Introduction Arteriovenous fistulae (AVF) are the ‘gold standard’ vascular access for haemodialysis. Universal usage is limited, however, by a high early failure rate. Several small, single-centre studies have demonstrated better early patency rates for AVF created under regional anaesthesia (RA) compared with local anaesthesia (LA). The mechanistic hypothesis is that the sympathetic blockade associated with RA causes vasodilatation and increased blood flow through the new AVF. Despite this, considerable variation in practice exists in the UK. A high-quality, adequately powered, multicentre randomised controlled trial (RCT) is required to definitively inform practice.Methods and analysis The Anaesthesia Choice for Creation of Arteriovenous Fistula (ACCess) study is a multicentre, observer-blinded RCT comparing primary radiocephalic/brachiocephalic AVF created under regional versus LA. The primary outcome is primary unassisted AVF patency at 1 year. Access-specific (eg, stenosis/thrombosis), patient-specific (including health-related quality of life) and safety secondary outcomes will be evaluated. Health economic analysis will also be undertaken.Ethics and dissemination The ACCess study has been approved by the West of Scotland Research and ethics committee number 3 (20/WS/0178). Results will be published in open-access peer-reviewed journals within 12 months of completion of the trial. We will also present our findings at key national and international renal and anaesthetic meetings, and support dissemination of trial outcomes via renal patient groups.Trial registration number ISRCTN14153938.Sponsor NHS Greater Glasgow and Clyde GN19RE456, Protocol V.1.3 (8 May 2021), REC/IRAS ID: 290482.
Published: 2021
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3. Prospective observational study of gender and ethnicity biases in respiratory protective equipment for healthcare workers in the COVID-19 pandemic

Author: Paul Robert Greig, Jan Schumacher, Kariem El-Boghdadly, Danny J N Wong, and Clarissa Y M Carvalho
Subjects: Medicine
Abstract: Objective To describe success rates of respiratory protective equipment (RPE) fit testing and factors associated with achieving suitable fit.Design Prospective observational study of RPE fit testing according to health and safety, and occupational health requirements.Setting A large tertiary referral UK healthcare facility.Population 1443 healthcare workers undergoing quantitative fit testing.Main outcome measures Quantitative fit test success (pass/fail) and the count of tests each participant required before successful fit.Results Healthcare workers were fit tested a median (IQR) 2 (1–3) times before successful fit was obtained. Males were tested a median 1 (1–2) times, while females were tested a median 2 (1–2) times before a successful fit was found. This difference was statistically significant (p
Published: 2021
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4. healthcareCOVID: a national cross-sectional observational study identifying risk factors for developing suspected or confirmed COVID-19 in UK healthcare workers

Author: Justin Kua, Reshma Patel, Eveliina Nurmi, Sarah Tian, Harpreet Gill, Danny J.N. Wong, Calvin Moorley, Dmitri Nepogodiev, Imran Ahmad, and Kariem El-Boghdadly
Subjects: Coronavirus, COVID-19, SARS-CoV-2, Healthcare workers, Medical workers, Medicine, Biology (General), QH301-705.5
Abstract: Objective To establish the prevalence, risk factors and implications of suspected or confirmed coronavirus disease 2019 (COVID-19) infection among healthcare workers in the United Kingdom (UK). Design Cross-sectional observational study. Setting UK-based primary and secondary care. Participants Healthcare workers aged ≥18 years working between 1 February and 25 May 2020. Main outcome measures A composite endpoint of laboratory-confirmed diagnosis of SARS-CoV-2, or self-isolation or hospitalisation due to suspected or confirmed COVID-19. Results Of 6,152 eligible responses, the composite endpoint was present in 1,806 (29.4%) healthcare workers, of whom 49 (0.8%) were hospitalised, 459 (7.5%) tested positive for SARS-CoV-2, and 1,776 (28.9%) reported self-isolation. Overall, between 11,870 and 21,158 days of self-isolation were required by the cohort, equalling approximately 71 to 127 working days lost per 1,000 working days. The strongest risk factor associated with the presence of the primary composite endpoint was increasing frequency of contact with suspected or confirmed COVID-19 cases without adequate personal protective equipment (PPE): ‘Never’ (reference), ‘Rarely’ (adjusted odds ratio 1.06, (95% confidence interval: [0.87–1.29])), ‘Sometimes’ (1.7 [1.37–2.10]), ‘Often’ (1.84 [1.28–2.63]), ‘Always’ (2.93, [1.75–5.06]). Additionally, several comorbidities (cancer, respiratory disease, and obesity); working in a ‘doctors’ role; using public transportation for work; regular contact with suspected or confirmed COVID-19 patients; and lack of PPE were also associated with the presence of the primary endpoint. A total of 1,382 (22.5%) healthcare workers reported lacking access to PPE items while having clinical contact with suspected or confirmed COVID-19 cases. Conclusions Suspected or confirmed COVID-19 was more common in healthcare workers than in the general population and is associated with significant workforce implications. Risk factors included inadequate PPE, which was reported by nearly a quarter of healthcare workers. Governments and policymakers must ensure adequate PPE is available as well as developing strategies to mitigate risk for high-risk healthcare workers during future COVID-19 waves.
Published: 2021
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5. COVID-19 risk tools should incorporate assessment of working environment risk and its mitigation

Author: Tim M. Cook and Kariem El-Boghdadly
Subjects: Medicine (General), R5-920
Published: 2020
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6. Transmuscular quadratus lumborum versus lumbar plexus block for total hip arthroplasty: A retrospective propensity score matched cohort study

Author: Sanjib D Adhikary, Anthony J Short, Kariem El-Boghdadly, Mena J Abdelmalak, and Ki Jinn Chin
Subjects: Analgesia, nerve block, postoperative pain, total hip replacement, ultrasound, Anesthesiology, RD78.3-87.3, Pharmacy and materia medica, RS1-441
Abstract: Background and Aims: Cadaveric studies have shown that injectate from transmuscular quadratus lumborum block (QLB) can spread to the lumbar plexus. Our aim was to compare analgesic efficacy of transmuscular QLB with lumbar plexus block (LPB) for patients undergoing total hip arthroplasty (THA). Material and Methods: Thirty patients receiving transmuscular QLB were propensity score matched with 30 patients receiving LPB for age, sex, ASA score, BMI, operative time, preoperative oxycodone, and intraoperative opioid use. The primary outcome was postoperative opioid consumption during the first 24 postoperative hours. Secondary outcomes included static pain scores at 0–12, 12–24, and 24–48 h intervals, opioid consumption at 0–12, 12–24, and 24–48 h intervals and the length of hospital stay. The incidence of severe adverse events was also compared. Results: Opioid consumption (median [IQR]) in the first 24 h was similar between the transmuscular QLB and LPB patient groups—33.6 mg (22.9–48.5) versus 32.8 mg (24.8–58.3) intravenous morphine equivalents. There was no difference between groups in static pain scores or opioid consumption during any time interval up to 48 h postoperatively. Length of hospital stay (median [IQR]) was similar between the transmuscular QLB and LPB groups—55.6 h (53.7–60.3) versus 57.9 h (54.3–79.1). Conclusions: This study suggests that transmuscular QLB provides similar analgesia to LPB following THA. Prospective studies are needed to confirm this.
Published: 2018
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7. Reliability and safety of anaesthetic equipment around an high-field 7-Tesla MRI scanner

Author: Philippa Bridgen, Shaihan Malik, Thomas Wilkinson, John N. Cronin, Tahzeeb Bhagat, Nicholas Hart, Stuart Mc Corkell, Joanne Perkins, Shane Tibby, Sara Hanna, Richard Kirwan, Thomas Pauly, Arthur Weeks, Geoff Charles-Edwards, Francesco Padormo, David Stell, Kariem El-Boghdadly, Sebastien Ourselin, Sharon L. Giles, Anthony D. Edwards, Joseph V. Hajnal, and Benjamin J. Blaise
Subjects: Anesthesiology and Pain Medicine
Published: 2023
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8. Recommendations for anatomical structures to identify on ultrasound for the performance of intermediate and advanced blocks in ultrasound-guided regional anesthesia

Author: Toby Ashken, James Bowness, Alan James Robert Macfarlane, Lloyd Turbitt, Boyne Bellew, Nigel Bedforth, David Burckett-St Laurent, Alain Delbos, Kariem El-Boghdadly, Nabil M Elkassabany, Jenny Ferry, Ben Fox, James L H French, Calum Grant, Ashwani Gupta, Rajnish K Gupta, Yavuz Gürkan, Nat Haslam, Helen Higham, Rosemary M G Hogg, David F Johnston, Rachel Joyce Kearns, Clara Lobo, Sonya McKinlay, Edward R Mariano, Stavros Memtsoudis, Peter Merjavy, Madan Narayanan, J Alison Noble, David Phillips, Meg Rosenblatt, Amy Sadler, Maria Paz Sebastian, Eric S Schwenk, Alasdair Taylor, Athmaja Thottungal, Luis Fernando Valdés-Vilches, Thomas Volk, Simeon West, Morné Wolmarans, Jonathan Womack, and Amit Pawa
Subjects: Anesthesiology and Pain Medicine, pain management, lower extremity (regional anesthesia), Anesthesia, Conduction, Humans, ultrasonography, Peripheral Nerves, General Medicine, regional anesthesia, upper extremity (regional anesthesia), Ultrasonography, Interventional, Ultrasonography
Abstract: Recent recommendations describe a set of core anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia (UGRA). This project aimed to generate consensus recommendations for core structures to identify during the performance of intermediate and advanced blocks. An initial longlist of structures was refined by an international panel of key opinion leaders in UGRA over a three-round Delphi process. All rounds were conducted virtually and anonymously. Blocks were considered twice in each round: for “orientation scanning” (the dynamic process of acquiring the final view) and for “block view” (which visualizes the block site and is maintained for needle insertion/injection). A “strong recommendation” was made if ≥75% of participants rated any structure as “definitely include” in any round. A “weak recommendation” was made if >50% of participants rated it as “definitely include” or “probably include” for all rounds, but the criterion for strong recommendation was never met. Structures which did not meet either criterion were excluded. Forty-one participants were invited and 40 accepted; 38 completed all three rounds. Participants considered the ultrasound scanning for 19 peripheral nerve blocks across all three rounds. Two hundred and seventy-four structures were reviewed for both orientation scanning and block view; a “strong recommendation” was made for 60 structures on orientation scanning and 44 on the block view. A “weak recommendation” was made for 107 and 62 structures, respectively. These recommendations are intended to help standardize teaching and research in UGRA and support widespread and consistent practice.
Published: 2022
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9. High-intensity theatre (HIT) lists to tackle the elective surgery backlog

Author: Marc A. Furrer, Imran Ahmad, Jonathan Noel, Kariem El-Boghdadly, and Ben Challacombe
Subjects: Urology, 610 Medicine & health
Published: 2023
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10. Core outcome set for peripheral regional anesthesia research: a systematic review and Delphi study

Author: Jeremy Hill, Toby Ashken, Simeon West, Alan James Robert Macfarlane, Kariem El-Boghdadly, Eric Albrecht, Ki Jinn Chin, Ben Fox, Ashwani Gupta, Stephen Haskins, Nat Haslam, Rosemary MG Hogg, Anil Hormis, David F Johnston, Edward R Mariano, Peter Merjavy, Timothy Moll, James Parry, Amit Pawa, Kim Russon, Maria Paz Sebastian, Lloyd Turbitt, Jonathan Womack, and Maria Chazapis
Subjects: Anesthesiology and Pain Medicine, General Medicine
Abstract: Background/importanceThere is heterogeneity among the outcomes used in regional anesthesia research.ObjectiveWe aimed to produce a core outcome set for regional anesthesia research.MethodsWe conducted a systematic review and Delphi study to develop this core outcome set. A systematic review of the literature from January 2015 to December 2019 was undertaken to generate a long list of potential outcomes to be included in the core outcome set. For each outcome found, the parameters such as the measurement scale, timing and definitions, were compiled. Regional anesthesia experts were then recruited to participate in a three-round electronic modified Delphi process with incremental thresholds to generate a core outcome set. Once the core outcomes were decided, a final Delphi survey and video conference vote was used to reach a consensus on the outcome parameters.ResultsTwo hundred and six papers were generated following the systematic review, producing a long list of 224 unique outcomes. Twenty-one international regional anesthesia experts participated in the study. Ten core outcomes were selected after three Delphi survey rounds with 13 outcome parameters reaching consensus after a final Delphi survey and video conference.ConclusionsWe present the first core outcome set for regional anesthesia derived by international expert consensus. These are proposed not to limit the outcomes examined in future studies, but rather to serve as a minimum core set. If adopted, this may increase the relevance of outcomes being studied, reduce selective reporting bias and increase the availability and suitability of data for meta-analysis in this area.
Published: 2022
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11. Management of adverse effects of intrathecal opioids in acute pain

Author: Sina Grape, Kariem El-Boghdadly, and Eric Albrecht
Subjects: Anesthesiology and Pain Medicine
Published: 2023
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12. The ‘haves’ and ‘have-nots’ of personal protective equipment during the COVID-19 pandemic: the ethics of emerging inequalities amongst healthcare workers

Author: Clifford Shelton, Kariem El-Boghdadly, and John B Appleby
Subjects: Issues, ethics and legal aspects, Health (social science), Arts and Humanities (miscellaneous), Health Policy
Abstract: The COVID-19 pandemic has exacerbated inequalities, including among the healthcare workforce. Based on recent literature and drawing on our experiences of working in operating theatres and critical care in the UK’s National Health Service during the pandemic, we review the role of personal protective equipment and consider the ethical implications of its design, availability and provision at a time of unprecedented demand. Several important inequalities have emerged, driven by factors such as individuals purchasing their own personal protective equipment (either out of choice or to address a lack of provision), inconsistencies between guidelines issued by different agencies and organisations, and the standardised design and procurement of equipment required to protect a diverse healthcare workforce. These, we suggest, have resulted largely because of a lack of appropriate pandemic planning and coordination, as well as insufficient appreciation of the significance of equipment design for the healthcare setting. As with many aspects of the pandemic, personal protective equipment has created and revealed inequalities driven by economics, gender, ethnicity and professional influence, creating a division between the ‘haves’ and ‘have-nots’ of personal protective equipment. As the healthcare workforce continues to cope with ongoing waves of COVID-19, and with the prospect of more pandemics in the future, it is vital that these inequalities are urgently addressed, both through academic analysis and practical action.
Published: 2021
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13. Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

Author: Dmitri Nepogodiev, Joana Ff Simoes, Elizabeth Li, Maria Picciochi, James C Glasbey, Glauco Baiocchi, Ruth Blanco-Colino, Daoud Chaudhry, Ehab AlAmeer, Kariem El-Boghdadly, Funmilola Wuraola, Dhruva Ghosh, Rohan R Gujjuri, Ewen M Harrison, Herman Lule, Haytham Kaafarani, Mohammad Khosravi, Irmgard Kronberger, Sezai Leventoğlu, Harvinder Mann, Kenneth A Mclean, Mengistu Gebreyohanes Mengesha, Maria Marta Modolo, Faustin Ntirenganya, Lisa Norman, Oumaima Outani, Riinu Pius, Peter Pockney, Ahmad Uzair Qureshi, April Camilla Roslani, Sohei Satoi, Catherine Shaw, Aneel Bhangu, Omar M Omar, Waheed-Ul-Rahman Ahmed, Leah Argus, Alasdair Ball, Edward P Bywater, Amanpreet Brar, Brett E Dawson, Irani Duran, Muhammed Elhadi, Conor S Jones, Sivesh K Kamarajah, James M Keatley, Samuel Lawday, Ella J Marson, Riinu Ots, Irène Santos, Elliott H Taylor, Isobel M Trout, Chris Varghese, Mary L Venn, William Xu, Irida Dajti, Arben Gjata, Salah Eddine Oussama Kacimi, Luis Boccalatte, Daniel Cox, Philip Townend, Felix Aigner, Irmgard Elisabeth Kronberger, Elgun Samadov, Amer Alderazi, Kamral Hossain, Greg Padmore, Gabrielle van Ramshorst, Ismaïl Lawani, Anis Cerovac, Samir Delibegovic, Gustavo Mendonça Ataíde Gomes, Igor Lima Buarque, Muhammad Gohar, Mihail Slavchev, Chukwuemeka Nwegbu, Arnav Agarwal, Janet Martin, Joshua Ng-Kamstra, Maricarmen Olivos, Wenhui Lou, Dong-Lin Ren, Jose Andres Calvache, Carlos J Perez Rivera, Ana Danic Hadzibegovic, Tomislav Kopjar, Jakov Mihanovic, Pablo Mijahil Avilés Jiménez, Nikolaos Gouvas, Jaroslav Klat, René Novysedlák, Nicolas Amisi, Peter Christensen, Alaa El-Hussuna, Sylvia Batista, Eddy Lincango-Naranjo, Sameh Emile, Danilo Alfonso Arévalo Sandoval, Hailu Dhufera, Samuel Hailu, Mengistu G Mengesha, Joonas H Kauppila, Alexis P Arnaud, Zaza Demetrashvili, Markus Albertsmeier, Hans Lederhuber, Markus W Löffler, Daniel Kwesi Acquah, Bernard Ofori, Stephen Tabiri, Symeon Metallidis, Georgios Tsoulfas, Maria-Lorena Aguilera-Arevalo, Gustavo Recinos, Tamás Mersich, Dániel Wettstein, Gabriele Kembuan, Peiman Brouki Milan, Mohammad Hossein Khosravi, Masoud Mozafari, Ahmed Hilmi, Helen Mohan, Oded Zmora, Gaetano Gallo, Francesco Pata, Gianluca Pellino, Yuki Fujimoto, Naoto Kuroda, Mohamad K Abou Chaar, Faris Ayasra, Ildar Fakhradiyev, Intisar Hisham Said Hamdun, Jang Jin-Young, Mohammad Jamal, Lina Karout, Aiste Gulla, Fanjandrainy Rasoaherinomenjanahary, Luc Hervé Samison, Iran Irani Durán Sánchez, Diana Samantha Gonzalez, Laura Martinez, María José Martínez, Alejandra Nayen, Antonio Ramos-De la Medina, Jade Nunez, Pueya Rashid Nashidengo, Rakesh Shah, Ashish Lal Shrestha, Pascal Jonker, Schelto Kruijff, Milou Noltes, Pieter Steinkamp, Deborah Wright, Lukman Abdur-Rahman, Adesoji Ademuyiwa, Adewale Adisa, Babatunde Osinaike, Justina Seyi-Olajide, Omolara Williams, Emmanuel Williams, Sofija Pejkova, Zainab Al Balushi, Raza Sayyed, Mustafa Abo Mohsen, Sadi A Abukhalaf, Moises Cukier, Hugo Gomez-Fernandez, Sebastian Shu Yip, Ximena Paola Vasquez Ojeda, Marie Dione Sacdalan, Piotr Major, José Azevedo, Miguel F Cunha, Ahmad Zarour, Eduard-Alexandru Bonci, Ionut Negoi, Sergey Efetov, Viktor Kochetkov, Andrey Litvin, Jc Allen Ingabire, Georges Bucyibaruta, Ntirenganya Faustin, Sosthene Habumuremyi, Alphonsine Imanishimwe, Haragirimana Jean de Dieu, Emmanuel Munyaneza, Isaie Ncogoza, Ehab Alameer, Abdourahmane Ndong, Dejan Radenkovic, Min Hoe Chew, Frederick Koh, James Ngu, Arpád Panyko, Uros Bele, Jurij Aleš Košir, Hassan Daoud, Ana Maria Minaya Bravo, Umesh Jayarajah, Dakshitha Wickramasinghe, Mohammed Elmujtba Adam Essa Adam, Martin Rutegård, Malin Sund, Michel Adamina, Eleftherios Gialamas, Karoline Horisberger, Muhammad Alshaar, Abel Huang, Varut Lohsiriwat, Shane Charles, Haithem Jlassi, Arda Isik, Hervé Monka Lekuya, Slava Kopetskyi, Hayder Alsaadi, Sattar Alshryda, Osaid Alser, Brittany Bankhead-Kendall, Kerry Breen, Hassan Mashbari, Fernando Bonilla Cal, Hamza Al-Naggar, Mayaba Maimbo, Dennis Mazingi, Tom Abbott, Melika Akhbari, Ruth Benson, Shivam Bhanderi, Bruce Biccard, Edward Caruana, Sohini Chakrabortee, Reema Chapatwala, Ainhoa Costas-Chavarri, Andreas K Demetriades, Anant Desai, Salomone Di Saverio, Thomas Drake, John Edwards, Jonathan Evans, Marco Fiore, Samuel Ford, Christina Fotopoulou, Alexander Fowler, Kaori Futaba, Ian Ganly, Harelimana Grace James, Ewen Griffiths, Alessandro Gronchi, Peter Hutchinson, Gabriella Yael Hyman, Joseph Incorvia, Ritu Jain, Michael Jenkinson, Tabassum Khan, Stephen Richard Knight, Angelos Kolias, Søren Kudsk-Iversen, Tsun Yu Kwan, Elaine Leung, Julio Mayol, Siobhan McKay, John G Meara, Emily Mills, Susan Moug, Akshay Patel, Roberto Perinotti, Henry E Rice, Keith Roberts, Andrew Schache, Richard Shaw, Neil Smart, Matthew Stephens, Grant D Stewart, Ella Teasdale, Peter Vaughan-Shaw, Raghavan Vidya, Naomi Wright, Natalie Zimmelman, Ervis Agastra, Dariel Thereska, Sergio Martin Lucchini, Veronica Laudani, Carina Chwat, Ivana Ines Pedraza Salazar, Diana Alejandra Pantoja Pachajoa, Agustin Duro, José Alfredo Calderón Arancibia, Giuliana D'Aulerio, Nagendra Dudi-Venkata, Natasha Egoroff, Shebani Farik, Natalie Lott, Jana-Lee Moss, Sarah Rennie, Lorwai Tan, Uyen Giao Vo, David Watson, David Watters, Tim Bright, Paul Hollington, Xuanyu Zhou, Hidde M Kroon, Anthony Farfus, John Barker, Eleanor Watson, Sean Stevens, Haider Latif, Amanda Caroline Dawson, Alwin Chuan, Vijayaragavan Muralidharan, Enoch Wong, Travis Ackermann, Maurizio Pacilli, Russell Hodgson, Alexander Heriot, Peter Choong, Wendy Brown, Surjit Lidder, Justin Yeung, Luke Traeger, Guillermo Regalo, Ralph Gourlay, Sarit Badiani, Cherry Koh, Soni Putnis, Fayza Haider, Ashrarur Rahman Mitul, Niels Komen, Bert Dhondt, Serge Cappeliez, Manon Pigeolet, Martijn Schoneveld, Jasper Stijns, Wouter Oosterlinck, Nicolas Flamey, Cyrille Kpangon, Mouhamed Agbadebo, S Mèvo Romaric Tobome, Aldo Vieira Barros, Samuel Aguiar Júnior, Heloisa Galvão do Amaral Campos, Jefferson Gross, Felipe José Fernandez Coimbra, Luiz Paulo Kowalski, Fabiana Makdissi, Suely Nakagawa, Joao Pedreira Duprat Neto, Jose Guilherme Vartanian, Guilherme Yazbek, Stenio C Zequi, Ronald Flumignan, Natalia Jaworska, Angela Dell, Harsha Shanthanna, Abdollah Behzadi, Carolyn Nessim, Michelle Mozel, Pascal St-Germain, Crispin Russell, Gary Groot, Najib Safieddine, Duminda Wijeysundera, Antoine Eskander, Sami Chadi, Shawn MacKenzie, Alana Flexman, Fernando Heredia, Julio Villanueva, Sofia Waissbluth, Roberto Macchiavello, Mario I Escudero, Tyare Fuentes, Ximena Mimica, Dinimo Bolivar Saenz, Lina Caicedo, Juan Pablo Alzate, Joaquin Luna, Nestor Fabian Pedraza Alonso, Camilo Ortiz Silva, Juliana Rodriguez, Liliana Silva-Igua, Martha Luz Torres, Lina María Trujillo, Albaro José Nieto Calvache, Julián Balanta-Melo, Rafael Figueroa-Casanova, Oscar-Julián García-Montoya, Carlos Andres Marulanda Toro, Marcela Velez Botero, Maria Clara Mendoza Arango, Eneida Diaz Martinez, Valentina Gutiérrez Perdomo, Emileth Montenegro, Julia Rodriguez-Abreu, Dolores Mejía, Galal Abouelnagah, Sameh Shehata, Ahmed Hossam Eldin Fouad Rida, Ramy A Hassan, Mahmoud M Saad, Mohamed Reda Loaloa, Badr Mostafa, Mohamed Qassem, Mohamed Fahmy, Hesham Abozied, Ahmed Y Azzam, Sherief Ghozy, Asser Sallam, Ahmed Shehta, Mohamed Abdelkhalek, Rehab Samaka, Amr Morsy, Ahmed Elshawadfy Sherif, Abraham Negussie, Tigist Fisseha, Kibruyisfaw Shumbash, Metasebia Abebe, Seid Mohammed Yasin, Yemisirach Bizuneh Akililu, Abebe Megersa, Teshome Tefera, Melatework Assefa, Bahru Atnafu, Bereket Tsegaye, Yoseph Solomon Bezabih, Silamlak Sisay, Kebebe Bekele, Moa Jira, Habtamu Derilo, Eyueal Degefa, Anteneh Tadesse, Melkamu Nidaw, Elise Sarjanoja, Sylvie Testelin, Sophie Boucher, Lionel Jouffret, Zaher Lakkis, Alban Zarzavadjian Le Bian, Luke Harper, Marc Danguy des Déserts, Benoît André, Karem Slim, Romain Verhaeghe, Andrea Police, Edouard Girard, Alexandre Chebaro, Armande Subayi Nkembi, Laurent Arnalsteen, Quentin Ballouhey, Diane Mege, Clement Jeandel, Emilie Duchalais, Pierre-Alban Bouche, Gilles Manceau, Célia Crétolle, Erik Hervieux, Noémie Girard, Agathe Seguin-Givelet, Sebastien Gaujoux, Belinda De Simone, Matthieu Boisson, Damien Bergeat, Fabien Fredon, Francesco Nappi, Radwan Kassir, Aurélien Scalabre, Federico Migliorelli, Anne-Cecile Ezanno, Barbara Seeliger, Charlotte Vaysse, Helene Charbonneau, Vincent Misrai, Olivier Abbo, Martina Aida Angeles, Laurent Brunaud, Ali Modabber, Sebastian Wolf, Carsten Kamphues, Philipp Höhn, Tim R Glowka, Alexander Christopher Rokohl, Ulrich Bork, Georg Fluegen, Raymund E Horch, Andrea Schmedding, Andreas Schnitzbauer, Helge Eberbach, Daniel Schlager, Fritz Spelsberg, Lena Keppler, Andreas Hecker, Susanne Wolfer, Ulrich Ronellenfitsch, Christine Nitschke, Christian Peiper, Ibrahim Hakami, Stefan Welter, Karine Nikolaieva, Andreas Roth, Judith Lindert, Konstantinos Gousias, Anke Rissmann, Valerie Catherine Linz, Nuh Rahbari, Marie-Claire Rassweiler-Seyfried, Anna Eleonora Gut, Jens Gempt, Daniel Reim, Arthur Wagner, Alexander M Keppler, Mircea Gabriel Stoleriu, Tim Saier, Josef Stadler, Julia Christina Kaiser, Stefan M Brunner, Karin Pfister, Jonas Herzberg, Kai Nowak, Tobias Reinhard, Gregor A Stavrou, Alfred Königsrainer, Christian Konrads, Markus Quante, Simon Laban, Silke von Pusch, Markus Hirschburger, Johannes Doerner, Armin Wiegering, Ekaterini Christina Tampaki, Alitza Gutiérrez Ruiz, Alejandra Rodas, Ana Lucía Portilla, Jacqueline Carrera, Amalia Barrios Duarte, Megan Lowey, Sabrina Barillas, Atul Suroy, Dhaivat Vaishnav, Raghunandan Gorantlu Chowdappa, Irappa Madabhavi, Dhananjaya Bhat, Sunil Kumar Venkatappa, Sumit Thakar, Kavitha Jain, Aruna Kumar, Manoj Nagar, Tushar Mishra, Arunkumar Sekar, Anand Gupta, Lileswar Kaman, Madhivanan Karthigeyan, Manjul Tripathi, Ashwin Rammohan, Sudheer Othiyil Vayoth, Anupama Rajanbabu, Anbukkani Subbian, Rahul Gupta, Monish Raut, Nissi Evelyn, R Lavanya Kannaiyan, Anil Matai, Sanjeev Misra, Vishal 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Mohamed Reda Loaloa, Badr Mostafa, Mohamed Qassem, Mohamed Fahmy, Hesham Abozied, Ahmed Y Azzam, Sherief Ghozy, Asser Sallam, Ahmed Shehta, Sameh Emile, Mohamed Abdelkhalek, Rehab Samaka, Amr Morsy, Ahmed Elshawadfy Sherif, Danilo Alfonso Arévalo Sandoval, Abraham Negussie, Tigist Fisseha, Kibruyisfaw Shumbash, Metasebia Abebe, Samuel Hailu, Seid Mohammed Yasin, Yemisirach Bizuneh Akililu, Abebe Megersa, Teshome Tefera, Melatework Assefa, Bahru Atnafu, Bereket Tsegaye, Yoseph Solomon Bezabih, Silamlak Sisay, Kebebe Bekele, Moa Jira, Mengistu G Mengesha, Habtamu Derilo, Eyueal Degefa, Anteneh Tadesse, Melkamu Nidaw, Elise Sarjanoja, Joonas H Kauppila, Sylvie Testelin, Sophie Boucher, Lionel Jouffret, Zaher Lakkis, Alban Zarzavadjian Le Bian, Luke Harper, Marc Danguy des Déserts, Benoît André, Karem Slim, Romain Verhaeghe, Andrea Police, Edouard Girard, Alexandre Chebaro, Armande Subayi Nkembi, Laurent Arnalsteen, Quentin Ballouhey, Diane Mege, Clement Jeandel, Emilie Duchalais, Pierre-Alban Bouche, Gilles Manceau, Célia Crétolle, Erik Hervieux, Noémie Girard, Agathe Seguin-Givelet, Sebastien Gaujoux, Belinda De Simone, Matthieu Boisson, Damien Bergeat, Alexis P Arnaud, Fabien Fredon, Francesco Nappi, Radwan Kassir, Aurélien Scalabre, Federico Migliorelli, Romain Verhaeghe, Anne-Cecile Ezanno, Barbara Seeliger, Charlotte Vaysse, Helene Charbonneau, Vincent Misrai, Olivier Abbo, Martina Aida Angeles, Laurent Brunaud, Zaza Demetrashvili, Ali Modabber, Sebastian Wolf, Carsten Kamphues, Philipp Höhn, Tim R Glowka, Alexander Christopher Rokohl, Ulrich Bork, Georg Fluegen, Raymund E Horch, Andrea Schmedding, Andreas Schnitzbauer, Helge Eberbach, Daniel Schlager, Fritz Spelsberg, Lena Keppler, Andreas Hecker, Susanne Wolfer, Ulrich Ronellenfitsch, Christine Nitschke, Christian Peiper, Ibrahim Hakami, Stefan Welter, Karine Nikolaieva, Andreas Roth, Judith Lindert, Konstantinos Gousias, Anke Rissmann, Valerie Catherine Linz, Nuh Rahbari, Marie-Claire Rassweiler-Seyfried, Anna Eleonora Gut, Jens Gempt, Daniel Reim, Arthur Wagner, Markus Albertsmeier, Alexander M Keppler, Mircea Gabriel Stoleriu, Tim Saier, Josef Stadler, Julia Christina Kaiser, Stefan M Brunner, Karin Pfister, Jonas Herzberg, Kai Nowak, Tobias Reinhard, Gregor A Stavrou, Alfred Königsrainer, Christian Konrads, Markus Quante, Simon Laban, Silke von Pusch, Markus Hirschburger, Johannes Doerner, Armin Wiegering, Ekaterini Christina Tampaki, Alitza Gutiérrez Ruiz, Alejandra Rodas, Ana Lucía Portilla, Gustavo Recinos, Maria-Lorena Aguilera-Arevalo, Jacqueline Carrera, Amalia Barrios Duarte, Megan Lowey, Sabrina Barillas, Atul Suroy, Dhaivat Vaishnav, Raghunandan Gorantlu Chowdappa, Irappa Madabhavi, Dhananjaya Bhat, Sunil Kumar Venkatappa, Sumit Thakar, Kavitha Jain, Aruna Kumar, Manoj Nagar, Tushar Mishra, Arunkumar Sekar, Anand Gupta, Lileswar Kaman, Madhivanan Karthigeyan, Manjul Tripathi, Ashwin Rammohan, Sudheer Othiyil Vayoth, Anupama Rajanbabu, Anbukkani Subbian, Rahul Gupta, Monish Raut, Nissi Evelyn, R Lavanya Kannaiyan, Anil Matai, Sanjeev Misra, Vishal Bhende, Sathish Muthu, Indranil Ghosh, Abhishek Sharma, Ankur Bajaj, Shiv Rajan, Gaurav Agarwal, Pranay Pawar, Philip Alexander, M Vijayakumar Vijayakumar, Zeeshan Hameed, L Badareesh, Navneet Kumar Chaudhry, Lipika Baliarsing, Satish Dharap, Amruta Kulkarni, Yuvaraja Thyavihally, Rahul Deo Sharma, C S Pramesh, Rajesh Soni, Surya Kumar Dube, Shilpa Sharma, Harvinder Singh, Lovenish Bains, Rahul Ghodke, Ashwani Kumar, Vivek Sodhai, Suvendu Maji, Somprakas Basu, Chandrashekhar Mahakalkar, Ravi Kannan, Asif Mehraj, N Ranganath, Ashish Phadnis, I Yadev, Alfie Kavalakat, Rohin Mittal, Karthik Chandra Vallam, Hamed Akhavizadegan, Esmaeil Rezghi Maleki, Naser Yousefzadeh Kandevani, Hilary Ikele, Catherine McNestry, Christina Fleming, Stephen O'Brien, Sami Abd Elwahab, Niall Davis, Mohsen Javadpour, Brendan McDonnell, Clare O Connor, Jarlath Bolger, Cillian Clancy, Stefanie M Croghan, Noel Donlon, 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Alkaseek, Ghozlan Yagoub, Anass Ben Amer, Marwa Salem, Ayman Almugaddami, Dania Burgan, Mohammed Abdelkabir, Khayriyah Alshareef, Rayet Al Islam Ben Jouira, Ayman Meelad, Ahmad Bouhuwaish, Sumayya Essayah Dwaga, Houda Khalifa, Bushray Almiqlash, Taha Suliaman, Mohammed Alawami, Fras Elhajdawe, Hajir Aboazamazem, Ibrahim Ellojli, Ahmed Msherghi, Ismail Ali Saleh, Mohammed Alayan, April Camilla Roslani, Marcel Didier Ndayishyigikiye, Akutu Munyika, Philipp Plarre, David W Borowski, Pueya Rashid Nashidengo, Milou Noltes, Pieter Steinkamp, Cameron Wells, Rebecca Teague, Brodie Elliott, David Kieser, Omar Mohyieldin, Chris Varghese, Nick McIntosh, Cheyaanthan Haran, Sarah Rennie, Jasmin King, Jeong Ha, Matthew James McGuinness, Opeoluwa Adesanya, Julius Olaogun, Akinola Akinmade, Kefas Bwala, Peter Agbonrofo, Akinwale Afolabi, Usang Usang, Sebastian Ekenze, Samson Olori, Taiwo Akeem Lawal, Justina Seyi-Olajide, Abiodun Okunlola, Omolara Williams, Adewale Adisa, Lukman Abdur-Rahman, Stephen Kache, Danjuma Sale, Lofty-John Anyanwu, Chukwuma Okereke, Musliu Adetola Tolani, Venko Filipce, Lazar Todorovic, Sofija Pejkova, Sotir Stavridis, John George Massoud, Sareyah Alsibai, Rizwan Sultan, Humera Naz Altaf, Abu Bakar Hafeez Bhatti, Shahzad Hussain Waqar, Aliya Aziz, Asad Ali Kerawala, Lajpat Rai, Mariyah Anwer, Aiman Tariq, Bushra Ayub, Sami Ullah Niazi, Muhammad Yasir Naseem, Muhammad Zeeshan Sarwar, Muhammad Imran Khokhar, Imdad Ahmad Zahid, Haroon Javaid Majid, Nabila Talat, Muhammad Asif, Muhammad Hamid Chaudhary, Umer Farooq, Siddique Ahmad, Waleed Mabood, Syed Imran Bukhari, Muhammad Tariq, Eesha Yaqoob, Saad Javed, Saad Javed, Muhammad Usman Malik, Hassan Nawaz Yaqoob, Moises Cukier, Glenda Marina Falcon Pacheco, Robinson Mas Melendez, Arazzelly Del Pilar Paucar Urbina, Jose Rios Chiuyari, Carlos Eduardo Otiniano Alvarado, Lorena Fuentes Rivera Lau, Giuliano Borda-Luque, Milagros Niquen-Jimenez, Claudia Arias, Sergio Zegarra, Jenner Betalleluz Pallardel, Regina Amparo Ugarte Oscco, Gian Mendiola, Yahaira Tatiana Carpio Colmenares, Carlos Shiraishi Zapata, Maria Rosa Ortiz, Marie Dione Sacdalan, Piotr Major, Filipe Castro Borges, Octavio Viveiros, Pedro Serralheiro, Paulo Santos-Costa, Filipa Mendes, Miguel Rocha Melo, Paulo Cardoso, Ana Soares, José Azevedo, Rita Gonçalves Pereira, Nelson Silva, André Caiado, Maria Luís Sacras, Pedro Azevedo, Rui Almeida-Reis, Miguel F Cunha, João Oliveira, Jorge Nogueiro, Mafalda Sampaio-Alves, Luciana Cidade Costa, Catarina Baía, Ana Cláudia Deus, Rita Branquinho, André Marçal, André Tojal, Ahmad Zarour, Ahmad Zarour, Silviu Tiberiu Makkai-Popa, Aurel Mironescu, Florin Grama, Elena Adelina Toma, Ionut Negoi, Daniela Filipescu, Nicolae Bacalbasa, Natalia Motas, Sebastian Ionescu, Octav Ginghina, Radu Costea, Narcis Octavian Zarnescu, Radu Drasovean, Eduard-Alexandru Bonci, Mihail-Gabriel Dimofte, Vlad Porumb, Mikhail Kirov, Yegor Molitvin, Andrey Litvin, Vadim Pykhteev, Marianna Raevskaya, Sergey Efetov, Aleksandr Butyrskii, Mushabab Alshahrani, Azah Althumairi, Nasser Alzerwi, Ahmed Al Ameer, Ahmed Al Ameer, Tariq Madkhali, Abddulrahman Saleh Almulhim, Salman Ghazwani, Abdu Ayoub, Othman Iskander, Mohammed Ghunaim, Mohammed Alharthi, Turki M Alzaidi, Azah Althumairi, Mohammad Alyami, Abdulrahman Al Amri, Azah Althumairi, Abdullah AlFakhri, Amal Alhefdhi, Sharfuddin Chowdhury, Thamer Nouh, Ameen Alshehri, Abdulrahman Alzahrani, Yousef Alalawi, Selmy Awad, Ibrahima Konate, Abdourahmane Ndong, Jacques Tendeng, Nan Zun Teo, Frederick Koh, Jurij Aleš Košir, Uros Bele, Sabra Aqil, Cristina Barrena López, Ana Sánchez Mozo, Antonio Rodriguez Infante, Patricia Caja Vivancos, Mikel Prieto, Igor Alberdi San Roman, Laura Gomez Fernandez, Josep Maria Muñoz Vives, Anna Carreras-Castañer, Berta Díaz-Feijoo, Ramon Sieira-Gil, Victor Turrado-Rodriguez, Anna Sánchez López, Santiago Sánchez-Cabús, Marta Jimenez Toscano, MªPilar Canals Sin, Saura García Laura, Oriol Martin Sole, Pedro Palazon Bellver, Sonia Pérez-Bertólez, Jordi Prat-Ortells, Mireia Riba Martínez, Josep Rubio-Palau, Xavier Tarrado, Jorge Nuñez, Veronica Alonso Mendoza, Coro Bescós, Eloy Espin-Basany, Martin Espinosa-Bravo, Daniel Gil-Sala, Susana González-Suárez, Nuria Montferrer Estruch, Jorge Nuñez, Lucia Porteiro Mariño, Ana Rodríguez-Tesouro, Fabian Rojas Portilla, M Pilar Tormos Pérez, Inmaculada Vives, Unai Garcia De Cortazar, Kiara Tudela, Aitor Landaluce-Olavarria, Mercedes Estaire Gómez, Jorge Almoguera, Bakarne Ugarte-Sierra, Virginia Jimenez, Marta Bertrand, Laura Cárdenas Puiggrós, Olga Delisau-Puig, Jorge Garcia-Adamez, David Julià Bergkvist, Eloy Maldonado-Marcos, Lucia Diego García, Marta Roldón Golet, Iván Soto-Darias, Aida Cristina Rahy-Martín, Diego Enjuto, Adolfo Ramos-Luengo, Juan Delgado Fernandez, Carolina Lugo Duarte, Cristina Ojeda Thies, Lucila Marquez, Diana Crego Vita, Jana Dziakova, Ana Maria Minaya Bravo, Jorge Caño Velasco, Olga Mateo-Sierra, Begoña Quintana-Villamandos, Cristina Rey Valcarcel, Javier Rio, Laura Román García de León, Marcello Di Martino, Jorge Prada, Javier Serrano González, Manuel Losada, Jose Tomas Castell Gomez, Ramon Corripio-Sanchez, Alexander Forero-Torres, José Manuel Morales-Puebla, Hanna Perez-Chrzanowska, Santiago Valderrabano Gonzalez, Alvaro Yebes, Ignacio Zapardiel, Manuel Diez Alonso, Nelson Morales Palacios, Alberto Cabañero Sánchez, Fátima Sánchez Fernández, Alfredo Abad Gurumeta, Ane Abad-Motos, Fernando Corella, Javier Ripollés-Melchor, Rosa Sanz-Gonzalez, Marta Alcaraz Fuentes, Maria Teresa Fernández Martín, Pablo Calvo Espino, Milagros Carrasco Prats, Antonio-José Fernández-López, Damián García Escudero, Vanesa Garcia Soria, Jesús Aarón Martínez Alonso, Miguel Ruiz-Marín, Beatriz Gómez Pérez, Joaquin Moya-Angeler, Daniel Fernández Martínez, Heura Llaquet Bayo, Enrique Colás-Ruiz, Susana Bella Romera, M Teresa Gavaldà Pellicé, Misericòrdia Jordà Solé, Enrique Jose Ruiz Velasquez, Bernardo Núñez, Raul Jimenez, Jon Zabaleta, Maria Jose González-Gimeno, Irene Ortega Vázquez, Antonio Perez Ferrer, Rubén Martín-Láez, Marcelo Moreno Suarez, Miguel Angel Freiria Eiras, Irene Ramallo-Solís, Juan-Carlos Gomez-Rosado, Jose Ramon Oliver Guillen, Mar Achalandabaso Boira, Juan Carlos Catalá Bauset, Julio Domenech, Rafael Badenes, Juan Carlos Bernal-Sprekelsen, Jorge Sancho-Muriel, Beatriz De Andrés-Asenjo, Francisco J Tejero-Pintor, Marc Vallve-Bernal, Alba Vazquez Melero, Laura Sánchez Blasco, Jorge Escartin, Victoria Duque Mallén, Selvaratnam Srishankar, Umesh Jayarajah, Charitha Sooriyabandara, Oshan Basnayake, Nalaka Gunawansa, Dakshitha Wickramasinghe, Prabuth Dulanjan Weeraddana, Thanusan Vimalakanthan, Shanthamoorthy Gishanthan, Pramodh Chandrasinghe, Eleftherios Gialamas, Marc-Olivier Sauvain, Ahmad Ghazal, Yusra Al-Sabbagh, Turki Alhassoun, Sara Maa Albared, Antoine Naem, Hareth Alnahr, Ghassan Jisry, Ali Hammed, Arda Isik, Okedi Francis Xaviour, Gaston Turinawe, Isaac Mubezi, Franck K Sikakulya, Andrew Kakeeto, Wilberforce M Kabweru, Hervé Monka Lekuya, Ronald Kiweewa, Herman Lule, Paul Matovu, Otolia Isaac, Mohamed Mashhour, Amin El Helw, Sattar Alshryda, Safeena Kherani, Awadelkarim Mohamed, Ferial Mohamed Ali Abbas, Diary Mohammed, Ehab Aldlyami, Rakesh Kundra, Mohamed Mashhour, Mohamed Mashhour, Antony Louis Rex Michael, Hayder Alsaadi, Kareem S Khalil, Rachel Dbeis, Shafaque Shaikh, Jenny Ferry, Aiman Jamal, Haleema Siddique, Rishi Das, Nikhil Ponugoti, Sivesh K Kamarajah, Pornjittra Rattanasirivilai, Asma Sultana, Frances Mosley, Matthew Chan, Antony Bateman, Gareth Davies-Jones, Fanourios Georgiades, Grant D Stewart, Navid Ahmadi, Aman Coonar, Mariam Baig, Chetan Khatri, Arthika Surendran, Julian Sonksen, Robert Sinnerton, Caitlin Brennan, Gemma Faulkner, Michael Greenhalgh, Hannah Emerson, Kiran Singisetti, Joshua Totty, Michael Wilson, Terence Lo, Harriet Corbett, Ijeoma Okonkwo, Gill Arbane, Kariem El-Boghdadly, Cyrus Kerawala, Chetan Parmar, Tom Abbott, Michael Bath, Funlayo 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Larrañaga, Juan Liyo, Lionel Llano, Pablo Lobos, Emilia Luzzi, Gustavo Mastroianni, Santiago Miguel Mata-Suarez, Horacio F Mayer, Santiago Mc Loughlin, Efrain Mendoza, Ricardo Esteban Mentz, Pedro Mercado, Pablo Moyano, Florencia Noll, Diego Odetto, Agustina Rene Oliva, Rafael Perez Vidal, Catalina Poggi, Eduardo Jorge Premoli, María Lourdes Ramos, Patricio Rosas, Luciano Rossi, Gustavo Rossi, Jose Saadi, Jordán Scherñuk, Pablo Slullitel, María Verona Stang, María Victoria Taboada, Sebastian Tirapegui, Constanza Uffelmann, Carlos Vaccaro, Roberto Vagni, Ana Clara Valerio, Celeste Soledad Zarratea, Carina Chwat, Silvina Montal, Brian Morris, Pedro Valdez, Fernando Diaz-Couselo,Ricci C, Casadei R, Fruscio, R, Ornaghi, S, Felice Pecoraro, Emanuele Cammarata, Sofia Campanella, Daniela Canzonieri, Adriana Cordova, Federico De Michele, Ettore Dinoto, Mara Franza, Leo Licari, Daniele Matta, Domenico Mirabella, Roberto Pirrello, Pierfrancesco Pugliese, Fernando Rosatti, Giuseppe Salamone, Francesca Toia, Massimiliano Tripoli, Vito Chiantera, Mariano Catello Di Donna, Collaborative, Covidsurg, Collaborative, Globalsurg, Palmisano, Silvia, de Manzini, Nicolo', Simoes, J, Rosati, R, on behalf of COVIDSurg Collaborative, GlobalSurg Collaborative, Aldrighetti, L, Mortini, P, Olmi, S, Medical Oncology, Assoc Surg Training ASiT, European Soc Coloproctology ESCP, EuroSurg, G4 Alliance, GlobalPaedSurg, GICS, ItSURG, ISRC, Italian Soc Colorectal Surg SICCR, PTSurg, S-ECCO, South African Soc, and SpainSurg
Subjects: Lung Diseases, Male, Internationality, SARS-Cov-2, COVID-19, surgery, pathways, pre-operative isolation, Settore MED/18 - CHIRURGIA GENERALE, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Lung Disease, ESTUDOS PROSPECTIVOS, Cohort Studies, Patient Isolation, Postoperative Complications, 80 and over, Prospective Studies, Prospective cohort study, 610 Medicine & health, Aged, 80 and over, Incidence (epidemiology), Treatment Outcome, Elective Surgical Procedures, Female, Elective Surgical Procedure, Cohort study, Human, medicine.medical_specialty, Isolation (health care), Preoperative care, NO, Anesthesiology, Preoperative Care, medicine, Humans, Elective surgery, LS7_4, Aged, business.industry, pathway, Surgery, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Prospective Studie, Anesthesiology and Pain Medicine, Human medicine, Postoperative Complication, Cohort Studie, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p=0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3days, with an OR (95%CI) at 4–7days or ≥8days of 1.25 (1.04–1.48), p=0.015 and 1.31 (1.11–1.55), p=0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p=0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3days, with an OR (95%CI) at 4–7days or ≥8days of 1.25 (1.04–1.48), p=0.015 and 1.31 (1.11–1.55), p=0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.
Published: 2021
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14. Facemask or high‐flow nasal oxygenation: time to switch?

Author: Anil Kumar Patel and Kariem El-Boghdadly
Subjects: Anesthesiology and Pain Medicine, business.industry, Anesthesia, medicine.medical_treatment, Masks, Respiratory Physiological Phenomena, Humans, Medicine, Insufflation, Airway management, Oxygenation, business, High flow
Published: 2021
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15. Efficacy and safety of intrathecal morphine for analgesia after lower joint arthroplasty: a systematic review and meta‐analysis with meta‐regression and trial sequential analysis

Author: S. Grape, Kariem El-Boghdadly, E Gonvers, and Eric Albrecht
Subjects: Pain, Postoperative, Morphine, business.industry, medicine.medical_treatment, Arthroplasty, Intrathecal morphine, Analgesics, Opioid, Anesthesiology and Pain Medicine, Relative risk, Meta-analysis, Anesthesia, Postoperative Nausea and Vomiting, medicine, Humans, Meta-regression, Respiratory system, medicine.symptom, Arthroplasty, Replacement, Knee, Respiratory Insufficiency, business, Injections, Spinal, Postoperative nausea and vomiting, Depression (differential diagnoses)
Abstract: Widespread adoption of intrathecal morphine into clinical practice is hampered by concerns about its potential side-effects. We undertook a systematic review, meta-analysis and trial sequential analysis with the primary objective of determining the efficacy and safety of intrathecal morphine. Our secondary objective was to determine the dose associated with greatest efficacy and safety. We also assessed the impact of intrathecal morphine on respiratory depression. We systematically searched the literature for trials comparing intrathecal morphine with a control group in patients undergoing hip or knee arthroplasty under spinal anaesthesia. Our primary efficacy outcome was rest pain score (0-10) at 8-12 hours; our primary safety outcome was the rate of postoperative nausea and vomiting within 24 hours. Twenty-nine trials including 1814 patients were identified. Rest pain score at 8-12 hours was significantly reduced in the intrathecal morphine group, with a mean difference (95%CI) of -1.7 (-2.0 to -1.3), p < 0.0001 (19 trials; 1420 patients; high-quality evidence), without sub-group differences between doses (p = 0.35). Intrathecal morphine increased postoperative nausea and vomiting, with a risk ratio (95%CI) of 1.4 (1.3-1.6), p < 0.0001 (24 trials; 1603 patients; high-quality evidence). However, a sub-group analysis by dose revealed that rates of postoperative nausea and vomiting within 24 hours were similar between groups at a dose of 100 µg, while the risk significantly increased with larger doses (p value for sub-group difference = 0.02). Patients receiving intrathecal morphine were no more likely to have respiratory depression, the risk ratio (95%CI) being 0.9 (0.5-1.7), p = 0.78 (16 trials; 1173 patients; high-quality evidence). In conclusion, there is good evidence that intrathecal morphine provides effective analgesia after lower limb arthroplasty, without an increased risk of respiratory depression, but at the expense of an increased rate of postoperative nausea and vomiting. A dose of 100 µg is a 'ceiling' dose for analgesia and a threshold dose for increased rate of postoperative nausea and vomiting.
Published: 2021
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16. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature

Author: Alexander S. McLawhorn, Sang Jo Kim, Jacques T. YaDeau, Christopher L. Wu, Rosemary Hogg, George Go, Ellen M. Soffin, Janis Bekeris, Carlos B. Mantilla, Sandra L. Kopp, Paul Kessler, Peter Gerner, Rebecca L. Johnson, Jiabin Liu, Douglas S Wetmore, Jashvant Poeran, Philip Peng, Rie Goto, Eriphili Argyra, Mary J. Hargett, Pamela Wendel, Nigel E. Sharrock, Crispiana Cozowicz, Patricia Lavand'homme, Lila Baaklini, Effrossyni Gina Votta-Velis, Lazaros Poultsides, Eric C. Sun, Javad Parvizi, Eric S. Schwenk, Lukas Pichler, Michael John Barrington, Catherine H. MacLean, Alain Borgeat, Jose De Andres, Alejandro Gonzalez Della Valle, Stavros G. Memtsoudis, Kariem El-Boghdadly, Nabil M. Elkassabany, Eugene R. Viscusi, Ottokar Stundner, Henrik Kehlet, Philippe Gautier, Bradley H. Lee, Genewoo Hong, Michael L. Parks, Enrique A. Goytizolo, Brian D. Sites, Dan McIsaac, Dace Bekere, Vassilis Athanassoglou, Edward R. Mariano, Joseph M. Neal, Zhenggang Guo, Alan J. R. Macfarlane, Bridget Jivanelli, and Mark Brouillette
Subjects: medicine.medical_specialty, Consensus, Arthroplasty, Replacement, Hip, medicine.medical_treatment, MEDLINE, Cochrane Library, law.invention, Randomized controlled trial, Anesthesia, Conduction, law, Anesthesiology, medicine, Humans, Peripheral Nerves, Arthroplasty, Replacement, Knee, Pain, Postoperative, business.industry, General Medicine, Arthroplasty, Surgery, Anesthesiology and Pain Medicine, Systematic review, Meta-analysis, Observational study, Analgesia, business
Abstract: BackgroundEvidence-based international expert consensus regarding the impact of peripheral nerve block (PNB) use in total hip/knee arthroplasty surgery.MethodsA systematic review and meta-analysis: randomized controlled and observational studies investigating the impact of PNB utilization on major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, thromboembolic, neurologic, infectious, and bleeding complications.Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, were queried from 1946 to August 4, 2020.The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess evidence quality and for the development of recommendations.ResultsAnalysis of 122 studies revealed that PNB use (compared with no use) was associated with lower ORs for (OR with 95% CIs) for numerous complications (total hip and knee arthroplasties (THA/TKA), respectively): cognitive dysfunction (OR 0.30, 95% CI 0.17 to 0.53/OR 0.52, 95% CI 0.34 to 0.80), respiratory failure (OR 0.36, 95% CI 0.17 to 0.74/OR 0.37, 95% CI 0.18 to 0.75), cardiac complications (OR 0.84, 95% CI 0.76 to 0.93/OR 0.83, 95% CI 0.79 to 0.86), surgical site infections (OR 0.55 95% CI 0.47 to 0.64/OR 0.86 95% CI 0.80 to 0.91), thromboembolism (OR 0.74, 95% CI 0.58 to 0.96/OR 0.90, 95% CI 0.84 to 0.96) and blood transfusion (OR 0.84, 95% CI 0.83 to 0.86/OR 0.91, 95% CI 0.90 to 0.92).ConclusionsBased on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes.Recommendation: PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured. Evidence level: moderate; recommendation: strong.
Published: 2021
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17. Staff: our most valuable asset

Author: Danny J.N. Wong, Kariem El-Boghdadly, and C. R. Bailey
Subjects: Finance, 2019-20 coronavirus outbreak, Anesthesiology and Pain Medicine, Coronavirus disease 2019 (COVID-19), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pandemic, Staffing, Medicine, Asset (economics), business
Published: 2021
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18. Preoperative assessment and optimisation: the key to good outcomes after the pandemic

Author: S Ramani Moonesinghe, Scarlett McNally, Justin Kua, and Kariem El-Boghdadly
Subjects: medicine.medical_specialty, business.industry, Decision Making, Psychological intervention, General Medicine, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Pandemic, medicine, Key (cryptography), Humans, 030212 general & internal medicine, Patient Participation, Intensive care medicine, business, Decision Making, Shared, Pandemics
Abstract: Complications following surgery are common, predictable and often preventable. New preoperative assessment and optimisation guidance recommends clear pathways with triggers for interventions, patient involvement, shared decision making and team education, to help both patients and service efficiency.
Published: 2021
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19. Emergency Airway Management in Patients with COVID-19: A Prospective International Multicenter Cohort Study

Author: Faisal Shamim, Kathleen Quintero, Mark Coburn, Ruth Owen, Bruce M Biccard, Kariem El-Boghdadly, Imran Ahmad, Guillermo Navarro, Paul S. Myles, Sheila Nainan Myatra, Mark D. Neuman, Danny J.N. Wong, Malin Jonsson Fagerlund, Nabil Shallik, Ming Hua Cheng, E.P. O’Sullivan, Clara A Lobo, Laura Pasin, Gregory L. Bryson, Paul A. Baker, Eugenio Martinez-Hurtado, Matthew T. V. Chan, C. Johnstone, Paweł Andruszkiewicz, Wilton A. van Klei, and Ki Jinn Chin
Subjects: Mechanical ventilation, medicine.medical_specialty, business.industry, medicine.medical_treatment, Tracheal intubation, Odds ratio, Rapid sequence induction, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, Emergency medicine, medicine, Intubation, Airway management, 030212 general & internal medicine, business, Prospective cohort study, Cohort study
Abstract: Background Tracheal intubation for patients with COVID-19 is required for invasive mechanical ventilation. The authors sought to describe practice for emergency intubation, estimate success rates and complications, and determine variation in practice and outcomes between high-income and low- and middle-income countries. The authors hypothesized that successful emergency airway management in patients with COVID-19 is associated with geographical and procedural factors. Methods The authors performed a prospective observational cohort study between March 23, 2020, and October 24, 2020, which included 4,476 episodes of emergency tracheal intubation performed by 1,722 clinicians from 607 institutions across 32 countries in patients with suspected or confirmed COVID-19 requiring mechanical ventilation. The authors investigated associations between intubation and operator characteristics, and the primary outcome of first-attempt success. Results Successful first-attempt tracheal intubation was achieved in 4,017/4,476 (89.7%) episodes, while 23 of 4,476 (0.5%) episodes required four or more attempts. Ten emergency surgical airways were reported—an approximate incidence of 1 in 450 (10 of 4,476). Failed intubation (defined as emergency surgical airway, four or more attempts, or a supraglottic airway as the final device) occurred in approximately 1 of 120 episodes (36 of 4,476). Successful first attempt was more likely during rapid sequence induction versus non–rapid sequence induction (adjusted odds ratio, 1.89 [95% CI, 1.49 to 2.39]; P < 0.001), when operators used powered air-purifying respirators versus nonpowered respirators (adjusted odds ratio, 1.60 [95% CI, 1.16 to 2.20]; P = 0.006), and when performed by operators with more COVID-19 intubations recorded (adjusted odds ratio, 1.03 for each additional previous intubation [95% CI, 1.01 to 1.06]; P = 0.015). Intubations performed in low- or middle-income countries were less likely to be successful at first attempt than in high-income countries (adjusted odds ratio, 0.57 [95% CI, 0.41 to 0.79]; P = 0.001). Conclusions The authors report rates of failed tracheal intubation and emergency surgical airway in patients with COVID-19 requiring emergency airway management, and identified factors associated with increased success. Risks of tracheal intubation failure and success should be considered when managing COVID-19. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
Published: 2021
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20. SARS‐CoV‐2 infection, COVID‐19 and timing of elective surgery

Author: S. Denmark, N. Mercer, Lindsay Blake, S. McNally, D. J. Summerton, T. Goodacre, J. Kua, Tim Cook, Kariem El-Boghdadly, and Suneetha Ramani Moonesinghe
Subjects: medicine.medical_specialty, business.industry, Prehabilitation, Disease, Perioperative, Asymptomatic, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, Pandemic, medicine, 030212 general & internal medicine, Elective surgery, medicine.symptom, Elective Surgical Procedure, Intensive care medicine, business, Surgical Specialty
Abstract: The scale of the COVID-19 pandemic means that a significant number of patients who have previously been infected with SARS-CoV-2 will require surgery. Given the potential for multisystem involvement, timing of surgery needs to be carefully considered to plan for safe surgery. This consensus statement uses evidence from a systematic review and expert opinion to highlight key principles in the timing of surgery. Shared decision-making regarding timing of surgery after SARS-CoV-2 infection must account for severity of the initial infection; ongoing symptoms of COVID-19; comorbid and functional status; clinical priority and risk of disease progression; and complexity of surgery. For the protection of staff, other patients and the public, planned surgery should not be considered during the period that a patient may be infectious. Precautions should be undertaken to prevent pre- and peri-operative infection, especially in higher risk patients. Elective surgery should not be scheduled within 7 weeks of a diagnosis of SARS-CoV-2 infection unless the risks of deferring surgery outweigh the risk of postoperative morbidity or mortality associated with COVID-19. SARS-CoV-2 causes either transient or asymptomatic disease for most patients, who require no additional precautions beyond a 7-week delay, but those who have persistent symptoms or have been hospitalised require special attention. Patients with persistent symptoms of COVID-19 are at increased risk of postoperative morbidity and mortality even after 7 weeks. The time before surgery should be used for functional assessment, prehabilitation and multidisciplinary optimisation. Vaccination several weeks before surgery will reduce risk to patients and might lessen the risk of nosocomial SARS-CoV-2 infection of other patients and staff. National vaccine committees should consider whether such patients can be prioritised for vaccination. As further data emerge, these recommendations may need to be revised, but the principles presented should be considered to ensure safety of patients, the public and staff.
Published: 2021
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21. Using ultrasound for nerve blocks and neuraxial anaesthesia

Author: Philipp Lirk and Kariem El-Boghdadly
Subjects: medicine.medical_specialty, Critical Care, business.industry, medicine.medical_treatment, Ultrasound, MEDLINE, Nerve Block, Anesthesiology and Pain Medicine, Text mining, Anesthesiology, Anesthesia, medicine, Nerve block, Humans, Peripheral Nerves, Ultrasonography, business
Published: 2021
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22. American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians—part I: clinical indications

Author: Vincent W. S. Chan, Antoun Nader, Joshua M. Zimmerman, William Clark Manson, Melissa Byrne, Richelle Kruisselbrink, Anahi Perlas, Jemiel A Nejim, Hari Kalagara, Jan Boublik, Kariem El-Boghdadly, Stephen C. Haskins, Yuriy S. Bronshteyn, Dmitri Souza, Nadia Hernandez, Marcos Silva, Davinder Ramsingh, Rosemary Hogg, Hariharan Shankar, Samer Narouze, Jonathan Wilkinson, and Karen Boretsky
Subjects: Point-of-Care Systems, Pain medicine, Pain, Routine practice, 03 medical and health sciences, 0302 clinical medicine, Anesthesia, Conduction, 030202 anesthesiology, medicine, Humans, Child, Ultrasonography, Perioperative management, business.industry, Point of care ultrasound, Chronic pain, 030208 emergency & critical care medicine, General Medicine, Perioperative, medicine.disease, Anesthesiologists, Anesthesiology and Pain Medicine, Regional anesthesia, Narrative review, Medical emergency, business
Abstract: Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain physicians to help diagnose relevant complications related to routine practice and guide perioperative management. In an effort to inform the regional anesthesia and pain community as well as address a need for structured education and training, the American Society of Regional Anesthesia and Pain Medicine (ASRA) commissioned this narrative review to provide recommendations for POCUS. The guidelines were written by content and educational experts and approved by the Guidelines Committee and the Board of Directors of the ASRA. In part I of this two-part series, clinical indications for POCUS in the perioperative and chronic pain setting are described. The clinical review addresses airway ultrasound, lung ultrasound, gastric ultrasound, the focus assessment with sonography for trauma examination and focused cardiac ultrasound for the regional anesthesiologist and pain physician. It also provides foundational knowledge regarding ultrasound physics, discusses the impact of handheld devices and finally, offers insight into the role of POCUS in the pediatric population.
Published: 2021
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23. A crossover trial investigating the atmospheric content of improvised respirators

Author: Jan Schumacher, Clarissa Carvalho, Kariem El-Boghdadly, Suniel Ramessur, and Paul Greig
Subjects: business.product_category, Coronavirus disease 2019 (COVID-19), business.industry, Medicine, Medical emergency, Respirator, Critical Care and Intensive Care Medicine, Critical Care Nursing, business, medicine.disease, Brief Communications, Personal protective equipment, Crossover study
Abstract: Introduction This study was designed to determine the respiratory safety of improvised respirators based on modified full-face snorkel masks, making comparisons with a purpose-designed mask Methods This is a prospective crossover study conducted on ten recruits. Volunteers wore snorkel masks mated to an anaesthetic heat and moisture exchange filter. The system was worn at rest then during exercise. Gases were sampled from the mask at 5-min intervals. Results The modified snorkel was satisfactory in seven participants. For three carbon dioxide concentrations were >1%. Two participants exposed to excessive CO2 also experienced oxygen concentrations Conclusions Modifying snorkel masks changes the way that gases circulate through the system. These modifications increase the risk of rebreathing in some users, which may yield an unsafe gas mixture. These improvised masks cannot be recommended as a substitute for purpose-designed equipment.
Published: 2022

24. The Anaesthesia Case Report (ACRE) checklist: a tool to promote high‐quality reporting of cases in peri‐operative practice

Author: C. R. Bailey, Andrew A. Klein, Kariem El-Boghdadly, and Clifford Shelton
Subjects: Publishing, Research Report, Research design, business.industry, media_common.quotation_subject, Psychological intervention, Perioperative, Perioperative Care, Checklist, Rigour, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, Anesthesia, Humans, Medicine, Quality (business), 030212 general & internal medicine, Acre, Medical diagnosis, business, media_common
Abstract: Case reports have fulfilled an important role in the development of anaesthesia and continue to be highly relevant to modern practice. Despite this, they are sometimes criticised for being insufficiently rigorous to meaningfully inform clinical practice or research design. Reporting checklists are a useful tool to improve rigour in research and, although case report checklists have previously been developed, no existing checklist focuses on the peri-operative setting. In order to address the need for a case reports checklist that better accommodates peri-operative care, we used an established tool as the basis for developing the 12-item Anaesthesia Case Report checklist. This was refined using an iterative approach through feedback from journal editors with experience of handling case reports, patient and public involvement, and trialling its use on Anaesthesia Reports submissions. The Anaesthesia Case Report checklist differs from existing checklists by aligning with peri-operative practice; it places less emphasis on making diagnoses and focuses on the way in which clinical challenges, for example, related to the patient's comorbidities or operative interventions, are addressed. Adopting a standardised approach to the content of case reports presents clear benefits to authors, editors and peer reviewers through streamlining the processes involved in writing and publication. The Anaesthesia Case Report checklist provides a pragmatic framework for comprehensive and transparent reporting. We hope it will facilitate the authorship of high-quality case reports with the potential to further improve the quality and safety of peri-operative care.
Published: 2021
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25. Mechanisms of action of the erector spinae plane (ESP) block: a narrative review

Author: Ki Jinn Chin and Kariem El-Boghdadly
Subjects: medicine.medical_specialty, Local anesthetic, medicine.drug_class, business.industry, Thoracolumbar fascia, General Medicine, Epidural space, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Action (philosophy), Anesthesiology, Anesthesia, Anesthetic, medicine, Erector spinae muscles, Narrative review, business, medicine.drug
Abstract: The erector spinae plane (ESP) block is an emerging regional anesthetic technique with significant potential for clinical benefit. Nevertheless, its exact mechanism(s) of action has been much debated. We reviewed the available literature to explore the possible mechanisms of analgesia for the ESP block. These include neural blockade and central inhibition from direct spread of local anesthetic to the paravertebral or epidural space; analgesia mediated by elevated local anesthetic plasma concentrations due to systemic absorption; immunomodulatory effects of local anesthetics; and an effect mediated through the mechanosensory properties of thoracolumbar fascia. Based on evidence from clinical, human cadaveric, animal, and mechanistic laboratory studies, the most probable primary mechanism is a direct effect of local anesthetic via physical spread and diffusion to neural structures in the fascial plane deep to the erector spinae muscles and adjacent tissue compartments. Biological plausibility of this primary mechanism is confirmed by injectate spread to the ventral rami of spinal nerves (though quite variable) in most studies. There is consistent involvement of dorsal rami; epidural spread is a less commonly observed phenomenon. A systemic effect of local anesthetic is also plausible, but unlikely to be a major contributor to clinical analgesic efficacy. The evidence for significant analgesia due to other proposed mechanisms, such as fascia-mediated analgesia or lymphatic spread, are currently limited and thus remain speculative. Understanding the mechanisms of action could assist clinicians in further investigating and refining ESP block performance, with the ultimate goal of optimizing analgesic efficacy and improving postoperative patient outcomes.
Published: 2021
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26. Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks

Author: Margaretha B. Breebaart, Anahi Perlas, Sandra L. Kopp, Edward R. Mariano, Clara Lobo, Rafael Blanco, Lloyd Turbitt, Rebecca L. Johnson, Mette Dam, Hesham Elsharkawy, Ellen M. Soffin, Amit Pawa, Manoj K. Karmakar, Teresa Parras, Angela D Stengel, Maria Fernanda Rojas Gomez, Karen Boretsky, Nabil M. Elkassabany, Mario Fajardo, Athmaja Thottungal, Kwesi Kwofie, Jeff L Xu, Eml Moran, Jeff Gadsden, Paul Kessler, Peter Merjavy, Andrea Saporito, P. Hebbard, Nadia Hernandez, Sandra Coppens, David Burckett-St Laurent, Serkan Tulgar, Başak Altıparmak, Jens Børglum, Admir Hadzic, Philippe Gautier, Michael J. Barrington, Kariem El-Boghdadly, Ki Jinn Chin, Alwin Chuan, Sanjay K. Sinha, John G. McDonnell, Thomas Volk, Graeme McLeod, Xavier Capdevila, Danielle Ludwin, Brendan Carvalho, C. Egeler, Rosemary Hogg, Vishal Uppal, I. Costache, Ban C. H. Tsui, Xavier Sala-Blanch, Geert J. van Geffen, Morné Wolmarans, Brian D O'Donnell, Eric Albrecht, Margaret Holtz, Sanjib Das Adhikary, Stuart A Grant, S Bloc, Alan J. R. Macfarlane, MÜ, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü, and Altıparmak, Başak
Subjects: medicine.medical_specialty, Consensus, Standardization, Delphi Technique, Delphi method, Regional anesthesia, Harmonization, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], Abdominal wall, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Block (programming), Anesthesia, Conduction, medicine, Humans, Medical physics, 030212 general & internal medicine, Thoracic Wall, Nomenclature, computer.programming_language, business.industry, Abdominal Wall, General Medicine, Anesthesiology and Pain Medicine, medicine.anatomical_structure, ASRA-ESRA, Human medicine, business, computer, Delphi
Abstract: BackgroundThere is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques.MethodsWe conducted an international consensus study involving experts using a three-round Delphi method to produce a list of names and corresponding descriptions of anatomical targets. After long-list formulation by a Steering Committee, the first and second rounds involved anonymous electronic voting and commenting, with the third round involving a virtual round table discussion aiming to achieve consensus on items that had yet to achieve it. Novel names were presented where required for anatomical clarity and harmonization. Strong consensus was defined as ≥75% agreement and weak consensus as 50% to 74% agreement.ResultsSixty expert Collaborators participated in this study. After three rounds and clarification, harmonization, and introduction of novel nomenclature, strong consensus was achieved for the names of 16 block names and weak consensus for four names. For anatomical descriptions, strong consensus was achieved for 19 blocks and weak consensus was achieved for one approach. Several areas requiring further research were identified.ConclusionsHarmonization and standardization of nomenclature may improve education, research, and ultimately patient care. We present the first international consensus on nomenclature and anatomical descriptions of blocks of the abdominal wall, chest wall, and paraspinal blocks. We recommend using the consensus results in academic and clinical practice.
Published: 2021

27. Advancing towards the next frontier in regional anaesthesia

Author: Edward R. Mariano, Ki Jinn Chin, and Kariem El-Boghdadly
Subjects: medicine.medical_specialty, 2019-20 coronavirus outbreak, business.industry, medicine.medical_treatment, Pain medicine, MEDLINE, Historical Article, History, 19th Century, Nerve Block, Regional anaesthesia, History, 20th Century, History, 21st Century, Frontier, Anesthesiology and Pain Medicine, Anesthesia, Conduction, medicine, Nerve block, Humans, Intensive care medicine, business, Introductory Journal Article
Published: 2021
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28. Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

Author: Guy L. Weinberg, Alan J. R. Macfarlane, M Gitman, K J Bornstein, and Kariem El-Boghdadly
Subjects: medicine.medical_specialty, Local anaesthetic, business.industry, Nerve Block, Context (language use), Appropriate use, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, Systemic toxicity, Anesthesia, Conduction, 030202 anesthesiology, Humans, Medicine, Narrative review, In patient, Patient Safety, 030212 general & internal medicine, Anesthetics, Local, Intraoperative Complications, business, Intensive care medicine, Risk management, Patient factors
Abstract: Despite advances in clinical practice, local anaesthetic systemic toxicity continues to occur with the therapeutic use of local anaesthesia. Patterns of presentation have evolved over recent years due in part to the increasing use of ultrasound which has been demonstrated to reduce risk. Onset of toxicity is increasingly delayed, a greater proportion of clinical reports are secondary to fascial plane blocks, and cases are increasing where non-anaesthetist providers are involved. The evolving clinical context presents a challenge for diagnosis and requires education of all physicians, nurses and allied health professionals about these changing patterns and risks. This review discusses: mechanisms; prevention; diagnosis; and treatment of local anaesthetic systemic toxicity. The local anaesthetic and dose used, site of injection and block conduct and technique are all important determinants of local anaesthetic systemic toxicity, as are various patient factors. Risk mitigation is discussed including the care of at-risk groups, such as: those at the extremes of age; patients with cardiac, hepatic and specific metabolic diseases; and those who are pregnant. Advances in the changing clinical landscape with novel applications and settings for the use of local anaesthesia are also described. Finally, we signpost future directions to potentially improve the management of local anaesthetic systemic toxicity. The utility of local anaesthetics remains unquestionable in clinical practice, and thus maximising the safe and appropriate use of these drugs should translate to improvements in patient care.
Published: 2021
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29. Moving on from AAA: the 3Ps and 3Rs protocol for remote management of dental patients

Author: Tarik Shembesh, Kariem El-Boghdadly, Wala Belhaj, Samy Darwish, and Maysoon Abdelmajeed
Subjects: Protocol (science), Coronavirus disease 2019 (COVID-19), business.industry, 030206 dentistry, Limiting, medicine.disease, Dental patients, 03 medical and health sciences, 0302 clinical medicine, Pandemic, Medicine, Medical emergency, business, Teledentistry, General Dentistry, 030217 neurology & neurosurgery, Remote management
Abstract: With the coronavirus disease 2019 (COVID-19) pandemic limiting movement, and dental services being somewhat reduced, there is a need for remotely managing patients through teledentistry. The ‘advice, analgesics, antibiotics’ (AAA) protocol has become common practice but concerns have become apparent on its application, as some patients' needs are not met, sometimes with potentially serious consequences. Throughout different phases of the pandemic, there may, at times, continue to be a need to minimize direct clinical contact with a patient, while safely managing their care. We suggest an alternative protocol for the remote management of the dental patient: the 3Ps and 3Rs, namely phone, photo, prescription and record, refer, review. This modified protocol has the potential to improve safe patient care throughout the current crisis and beyond, by providing an enhanced structure to the remote management of the dental patient. CPD/Clinical Relevance: The current widely practised ‘AAA’ clinical protocol may be appropriate for some patients, but also has scope for much improvement. An alternative acronym is suggested, presenting an improved structure for how a dental patient could be managed remotely.
Published: 2020
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30. An analysis of the academic capacity of anaesthesia in the UK by publication trends and academic units

Author: Jaideep J. Pandit, G. Ratnayake, and Kariem El-Boghdadly
Subjects: Publishing, Bibliometric analysis, Databases, Factual, business.industry, Academies and Institutes, Staffing, Bibliometrics, Authorship, United Kingdom, Anesthesiology and Pain Medicine, Anesthesiology, Secondary analysis, Anesthesia, Medicine, Observational study, Search filter, business, Primary research
Abstract: Over a decade ago, bibliometric analysis predicted the disappearance of UK publishing in anaesthesia by 2020. We repeated this analysis to assess if this had turned out to be the case, searching PubMed for papers associated with UK consultant anaesthetists for 2017-2019 across 15 journals. Although the rate of decline has flattened using the same search filter, including a wider range of publication types shows that outputs still remain at half 1990s levels (381 papers for all 3 years combined), authored by 769 anaesthetists, 274 of whom are associated with an academic centre. There are now 11 identifiable academic units, and a further 15 places where anaesthetists have affiliations with academic centres as individuals. The majority of papers (71%) are in secondary analysis (observational, database and association studies, surveys and meta-analyses), rather than in primary research (clinical trials or laboratory studies). These data reflect the current academic capacity in terms of publications, academic units and staffing. We discuss how this information can be used to inform a new strategy for UK academic anaesthesia.
Published: 2020
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31. A prospective, observational, cohort study of airway management of patients with COVID-19 by specialist tracheal intubation teams

Author: Imran Ahmad, Jeyanjali Jeyarajah, Kariem El-Boghdadly, Danny J.N. Wong, Sophie Ragbourne, Ganeshkrishna Nair, and Benjamin Vowles
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Tracheal intubation, COVID-19, tracheostomy, General Medicine, Intensive care unit, Reports of Original Investigations, intubation, law.invention, Anesthesiology and Pain Medicine, Interquartile range, law, Anesthesia, Anesthesiology, Cohort, Emergency medicine, medicine, Intubation, Airway management, business, Cohort study
Abstract: Purpose Because of the anticipated surge in cases requiring intensive care unit admission, the high aerosol-generating risk of tracheal intubation, and the specific requirements in coronavirus disease (COVID-19) patients, a dedicated Mobile Endotracheal Rapid Intubation Team (MERIT) was formed to ensure that a highly skilled team would be deployed to manage the airways of this cohort of patients. Here, we report our intubation team experience and activity as well as patient outcomes during the COVID-19 pandemic. Methods The MERIT members followed a protocolized early tracheal intubation model. Over a seven-week period during the peak of the pandemic, prospective data were collected on MERIT activity, COVID-19 symptoms or diagnosis in the team members, and demographic, procedural, and clinical outcomes of patients. Results We analyzed data from 150 primary tracheal intubation episodes, with 101 (67.3%) of those occurring in men, and with a mean (standard deviation) age of 55.7 (13.8) yr. Black, Asian, and minority ethnic groups accounted for 55.7% of patients. 91.3% of tracheal intubations were performed with videolaryngoscopy, and the first pass success rate was 88.0%. The 30-day survival was 69.2%, and the median [interquartile range] length of critical care stay was 11 [6–20] days and of hospital stay was 12 [7–22] days. Seven (11.1%) MERIT healthcare professionals self-isolated because of COVID-19 symptoms, with a total 41 days of clinical work lost. There was one reported incident of a breach of personal protective equipment and multiple anecdotal reports of doffing breaches. Conclusion We have shown that a highly skilled designated intubation team, following a protocolized, early tracheal intubation model may be beneficial in improving patient and staff safety, and could be considered by other institutions in future pandemic surges. Electronic supplementary material The online version of this article (10.1007/s12630-020-01804-3) contains supplementary material, which is available to authorized users.
Published: 2020
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32. Quadratus lumborum block vs. transversus abdominis plane block for caesarean delivery: a systematic review and network meta‐analysis *

Author: Brendan Carvalho, Kariem El-Boghdadly, Lindsay Blake, Peter M. Odor, Stephen H. Halpern, Pervez Sultan, Neel Desai, and Sohail Bampoe
Subjects: Sedation, Network Meta-Analysis, Caesarean delivery, Block (permutation group theory), Intrathecal morphine, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, 030202 anesthesiology, Transversus Abdominis Plane Block, medicine, Humans, 030212 general & internal medicine, Transversus abdominis, Abdominal Muscles, Pain, Postoperative, Cesarean Section, business.industry, Nerve Block, Anesthesiology and Pain Medicine, Meta-analysis, Anesthesia, Analgesia, Obstetrical, Female, medicine.symptom, business, Postoperative nausea and vomiting
Abstract: Caesarean delivery is the most commonly performed inpatient surgical procedure globally. Pain after caesarean delivery is moderate to severe if not adequately treated, and is a primary anaesthetic concern for patients. Transversus abdominis plane and quadratus lumborum blocks are fascial plane blocks that have the potential to improve analgesia following caesarean delivery. Although proponents of the quadratus lumborum block suggest that this technique may provide better analgesia compared with transversus abdominis plane block, there are limited data directly comparing these two techniques. We, therefore, performed a systematic review and network meta-analysis to compare transversus abdominis plane and quadratus lumborum block approaches, seeking randomised controlled trials comparing both techniques to each other, or to control, with or without intrathecal morphine. In all, 31 trials with 2188 patients were included and our primary outcome, the cumulative intravenous morphine equivalent consumption at 24 h, was reported in 12 trials. In the absence of intrathecal morphine, transversus abdominis plane and quadratus lumborum blocks were equivalent, and both were superior to control (moderate-quality evidence). In the presence of intrathecal morphine, no differences were found between control, transversus abdominis plane and quadratus lumborum blocks (moderate-quality evidence). Similar results were found for resting and active pain scores at 4-6 h, 8-12 h, 24 h and 36 h, although quadratus lumborum block was associated with lower pain scores at 36 h when compared with transversus abdominis plane block (very low-quality evidence). However, transversus abdominis plane block was associated with a reduced incidence of postoperative nausea and vomiting (moderate-quality evidence) and sedation when compared with inactive control following intrathecal morphine administration (low-quality evidence). There are insufficient data to draw definitive conclusions, but transversus abdominis plane and quadratus lumborum block appear to be superior to control in the absence of intrathecal morphine, but provide limited additional benefit over inactive control when intrathecal morphine is also used.
Published: 2020
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33. Protocol for direct reporting of awareness in maternity patients (DREAMY): a prospective, multicentre cohort study of accidental awareness during general anaesthesia

Author: P.M. Odor, S. Bampoe, D.N. Lucas, S.R. Moonesinghe, J. Andrade, J.J. Pandit, Alicja A'Court, Dina Abdel-Gadir, Ayman Abdu, Caroline Abisogun, Zainab Aboud, Judith Abrams, Andrea Ackerman, Christine Adamso, Rachel Addison, Adedayo Adeyeye, Rachel Adler, Maame Aduse-Poku, Siddharth Adyanthaya, Najmiah Ahmad, Dabeeruddeen Ahmed, Atif Ahmed, Bucky Akindele, Olubukola Akindele, Sonia Akrimi, Samar Al-Rawi, Yousif Ali, Jo Allam, Alisha Allana, Kellie Allen, Orlanda Allen, Natasha Amaradasa, Lareina Amarasekara, Freda Amoakwa-adu, Padmanabhan Anandageetha, Suresh Anandakrishnan, Rathai Anandanadesan, Michelle Anderson, Simon Apps, Audrey Aquilina, Gill Arbane, Alice Arch, Sarah Armstrong, Rita Arya, Gloria Ashiru, Keri Ashpole, Claire Atkinson, Francesca Atkinson, Elizabeth Auer, Ben Avery, Maite Babio-Galan, Hareth Bader, George Badham, Subha Bagchi, Sarah Bailey, Yolanda Baird, Cristina Balaka, Melissa Baldwin, Paul Balfour, Shreya Bali, Samantha Banks, Philip Barclay, Lucy Barnes, Thomas Barnes, Niraj Barot, Stephen Barrett, Venetia Barrett, Kate Barrett, Louise Bates, Katherine Batte, Beki Baytug, Mona Behravesh, Suzanne Bell, Raul Benloch, Richard Bentley, Jennifer Berg, Charlotte Berwick, Richard Berwick, Rashmi Bhadange, Sanjoy Bhattacharyya, Egidija Bielskute, Sian Birch, Scott Bird, Ruth Bird, William Birts, Becky Black, Tatyana Blagova, Holly Blake, Oliver Blightman, Susara Blunden, Richard Bolton, Caroline Borkett-Jones, John Boselli, Manuella Bowen, Ruth Bowen, James Bowye, Henry Boyle, Zameen Brar, Jo Bray, Samantha Brayshaw, Catherine Bressington, Alison Brewer, Naomi Brice, Laura Bridge, James Briscoe, Sonia Brocklesby, Harry Brown, Sarah Brown, Derek Brunnen, Keshavareddy Burijintichenna, Sara Burnard, Agnieszka Burtt, Victoria Buswell, Hannah Bykar, Matthew Cairney, Clare Calvert, Laura Camarasa, Natasha Campbell, Frederick Campbell-Jones, Jane Cantliffe, William Carrol, Joanna Carvalho, Catherine Cashell, Sarah Cassie, Kadu Cassim, Marika Chandler, Rachel Chapman, Robert Charles, Ping Chen, Deanne Cheyne, Kiran Chima, Floju Chin, Radu Chirvasuta, Martin Shao Chong, Sadia Choudhury, Priyakam Chowdhury, Tracey Christmas, Shilpa Chughwani, Sarah Ciechanowicz, Emma Clarey, Rob Coe, Jolyon Cohen, Nicholas Coker, Karen Collins, Lauren Collis, Jasna Comar, Marianne Conroy, Kathy Constantin, Jeremy Corfe, Elaine Coulborn, Vanessa Cowie, Rachel Crone, James Cronin, Jennifer Crooks, Nicola Crowther, Elizabeth Crowther, Carina Cruz, Alexa Curtis, Sarah Curtis, Sam Curtis, Adrian Dabrowicz, Nick Daines, Viral Dalal, Peter Dannatt, Dinesh Das, Jennifer Dash, Katherine Davidson, Sarah Davies, Yvette Davis, James Dawson, Jonathan Dean, Caroline Dean, Jane Denman, Neel Desai, Preeti Dewan, Sarah Dimont, Clare Donovan, Mano Doraiswami, Kate Doughty, Jamie Douglass, Michelle Dower, Samantha Downing, Wendy Duberry, Emily Duckham, Lucy Dudgeon, Stephanie Dukes, Leigh Dunn, Venkat Duraiswamy, Anthony O' Dwyer, Kristyn Dyer, Suresh Eapen, Mark Earl, Sally Eason, Kylie-Ellen Edwards, Zara Edwards, Osinachi Egole, John Ekpa, Olivia El-Amin, Kariem El-Boghdadly, Okba Elbasir, James Eldridge, Laura Elgie, Matt Ellington, Katharine Elliott, Justine Elliott, Mohamed Elmi, Ramy Elnoumeir, Eunice Emeakaraoha, Matt Evans, Mary Everett, Philippa Fabb, Hadia Farooq, Rohan Farrimond, Fiona Faulds, Erik Fawcett, Andrew Feneley, Dinushi Fernando, Janis Ferns, Claire Finlay, Simon Fitzgerald, Doireann O'Flaherty, Mark Fleet, Lydia Fletcher, Vanessa Fludder, Terri Follet, Jane Forbes, Mark Forth, Greg Foster, John Francis, Kate Fraser, Lauren Friedman, Luca Fruggeri, Laura Fulton, Sam Funnell, Amit Gadre, Ajay Gandhi, Harriet Gardiner, Zoe Garner, Gráinne Garvey, Tom Gately, Richard George, Siobhan Gillespie, Stephanie Glover, Jennifer Goddard, Ben Goodman, Tarikere Gopal, George Graham, David Green, Denise Griffin, Jessica Griffith, Stephanie Grigsby, Julie Grindey, Huw Griffiths, Jonathan Groome, Christine Grother, Gabrielle Grounds, Alice Groves, Abhik Guha, Amila Gunawardhana, Aman Gupta, Rekha Gupta, James Gutsell, Richard Haddon, Dina Hadi, Nicola Hadjipavlou, Henry Hammerbeck, Laura Hammon, Sarah Hammond, Hampesh Hampanna, Holly Hancock, Hemantha Handapangoda, Yumna Haroon-Mowahed, Dawn Harpham, Grant Harris, Abigail Harrison, Divya Harshan, Andrew Hartopp, Eoin Harty, Nick Haslam, Gemma Hawkins, Edith Hawkins, Sarah Hawksey, Carole Hays, Tracy Hazelton, Andrew Heavyside, Chibuzo Hemeson, Katrina Henderson, Oliver Henry, Lara Herbert, Nikki Higgins, James Hilton, Claire Hindmoor, Rachael Hitchcock, Laura Hobbs, Michele Homsy, Cassandra Honeywell, Nazima Hoque, Kirsty House, Ryan Howle, Amanda Tiller, Matthew Huniak, Jeremy Hunte, Tauqeer Husain, Coralie Huson, Catriona Hussain, Tawhida Hussain, Zainab Hussein, Jeremy Hyams, Eleanor Hyde, Marina Iaverdino, Alex Ignacka, Erin Innes, Stefanos Ioannidis, Rehana Iqbal, Fahja Ismail, Jenny Jackson, Michael Jackson, Guy Jackson, Robyn Jacobs, Poonam Jadhav, Aisha Jalaly, Lorraine James, Monica James, Surekha Jani, Chandran Jeganathan, Claire Joannides, Robert Johnson, Thosa Johnson, Carolyn Johnston, Reeanne Jones, Tom Jones, Miran Kadr, Rasmeet Kainth, Jenna Kane, Rafiq Kanji, Sunil Kannanparambil, Girish Kar, Theanalli Kasianandan, Husam Kaskos, Lisa Kavanagh, Richard Kaye, Leith Kelliher, Serena Kelliot, Jemma Kelly, Jenna Kelly, Carol Kenyon, Laura Kessack, Samuel Kestner, Mohammed Khaku, Sophia Khaleeq, Pervaz Khan, Sabeen Khan, Usamah Kidwai, Christopher King, Helen King, Elizabeth Kingston, Waisun Kok, Rebekka Konig, Zheyna Konstantinova, Priya Krishnan, Justin Kua, Kavitha Kuntumalla, Emira Kursumovic, Krzysztof Kurzatkowski, Hariprasad Kuttambakam, Katherine Lane, Sophie Lane, Andrew Langton, Hamad Latif, Norlan Lau, Shyam Laxman, Helen Laycock, Rachel Lee, Silvia Leonardi, Karen Light, Heidi Lightfoot, Shuang Liu, Sanduni Liyanage, Jessica Lowe, Nuala Lucas, Miyoba Lungu, Marianne Lunn, Heather Lynes, Kishore Machavarapu, Matthew Mackenzie, Jonathan Major, Victoria Male, Zain Malik, Katarina Manso, Myrna Maquinana, Katarzyna Marciniak, Lizzie Maronge, Chris Marsh, Carmela Martella, Nicki Martin, Nicole Martins, Jaspreet Marway, Louisa Mason, Lucy Mason, Nadia Masood, James Masters, Matthew Maton-Howarth, Francesca Mazzola, Tamsin McAllister, Rachel McCarthy, Claire McCormick, Sharon McCready, Steffan McDougall, Lorna Mcewan, Jon McGarry, Helen McKevitt, Stephanie Mckinley, Anna Mckskeane, Eloise McMaster, Martina McMonagle, Helen McNamara, Hannah McPhee, Laura McRae, Dee Mead, Emma Meadows, Madhur Mehta, Joanne Meikle, Yavor Metodiev, Chloe Michael, Victoria Millar, Sarah Miller, Gregg Miller, Sezanne Milne, Kostas Miltsios, Lucia Misquita, Simone Misquita, Manasi Mittal, Mohamed Mohamed, Katherine Powell Monaghan, Joanna Monk, Alexandra Monkhouse, David Monks, Laura Montague, Angela Moon, Jennifer Moran, Annette Moreton, Endaf Morgan, Oliver Morgan, Danny Morland, Monica Morosan, Kimberley Morris, Andrea Morris, Clare Moser, Manulella Mount, Carol Muir, McDonald Mupudzi, Mayur Murali, Iona Murdoch, Heather Murray, Theresa Murray, Karen Murrell, Girish Narasimha Murthy, Diana Neeley, Hannah Nei, Kerry Neil, Tara Nejim, Mark Nel, Anne Nicholson, Angela Nicklin, Catherine Nolan, Tracey Nolan, Eveliina Nurmi, Bridie O'Neill, Christie Oakes, Neil Oakes, Maria Ochoa-Ferraro, Nike Odeleye, Katy Oliver, Mark Oliver, Julie Onslow, Desire Onwochei, Thomas Oommen, Tim Orr, Osato Osagie, Hannah Osborn, Jennie Overend, Hazel Owston, Emma Pack, Pulak Padhi, Prabvathy Palani, Rajesh Pandey, Dhruti Pandya, Navjot Panesar, Con Papageorgiou, Georgios Papanastasiou, Costas Papoutsos, Suji Pararajasingham, James Parry, Hasita Patel, Jaishel Patel, Jiten Patel, Kaumudi Patel, Kiran Patel, Mitul Patel, Reshma Patel, Ruchira Patel, Nimisha Patel, Sangeeta Pathak, Fiona Pearson, Viktorija Peciulene, Beth Peers, Benjamin Peirce, Stacey Pepper, Jasmina Perinpanayagam, Hollie Perry, Nadya Petrova, Trudie Phillips, Sioned Phillips, Leonidas Phylactides, Felicity Pilkington, James Plumb, Evangelia Poimenidi, Anna Sau Kuk Poon, Thomas Potter, Una Poultney, Lucy Powell, Andrew Prenter, Katie Preston, Anna Price, Naomi Pritchard, Jenny Pullen, Manishi Purohit, Charlotte Quamina, Jibran Qureshi, Zahra Rajput, Stephen Ramage, Tamilselvi Ramanathan, Upeka Ranasinghe, Kalum Ranatunga, Abby Rand, Seema Randive, Desikan Rangarajan, Chandana Rao, Sambasiva Rao Pelluri, Antony Ratnasingham, Jamil Razzaque, Anuvidya Reddy, Katie Redington, Emma Reel, Peter Remeta, Francesca Ricco, Anna Riccoboni, Polly Rice, Mel Rich, Nicole Richards, Joanne Riches, Simon Ripoll, Fleur Roberts, Kitty Roberts, Kay Robins, Susie Robinson, Samantha Roche, Maria Rojo, Milena Carmela Romano, Hilary Rosser, Lindsay Roughley, Catriona Routley, Christine Rowley, Pallab Rudra, Robin Russell, Christine Ryan, Chloe Saad, Abtin Sadeghi, Armorel Salberg, Matt Samuel, Rebecca Samuels, Suresh Sanapala, Seliat Sanusi, Sarbpreet Sarao, Sathyabhama Sathyabhama, Zoe Saunders, Bernadetta Sawarzynska-ryszka, Panagiota Sceales, Penny Sceales, Natasha Schumacher, Nuala Schwartz, Claudia Sellers, Heather Sellers, Jessica Sellick, Soumen Sen, Dhaneesha Senaratne, Sarah Senbeto, Dineth Seneviratna, Thunga Setty, Raj Shah, Sonia Shah, James Shambly, Saju Sharafudeen. Imran Sharieff, Laurence Sharifi, Lisa Sharpe, Michael Shaw, Ian Sheldrake, Priya Shinde, Adam Shonfeld. Jonathon Short, Julian Siah, Sheena Sibug. Omar Siddique, Sara Siew, Matthew Simpson, Georgina Singleton, Kathryn Sinha, Aneeta Sinha, Matthew Sinnott, Harry Sivadhas, Sivanth Sivakumar, Boopathi Sivarajan, Sinduja Sivarajan, Chris Skeoch, Samuel Slade, Paul Slater, Camilla Smith, Carys Smith, Christopher Smith, James Smith, Lorraine Smith, Annika Smith, Edward Smith, Ruth Smith, Sue Smith, Tim Smith, Helen Smithers, Sue Smolen, Claire Smyth, Toni Snel, Carol Snipe, Sam Soltanifar, Nilesh Sonawane, Andal Soundararaja, Emily Spence, Mark Spiliopoulos, Chhavi Srivastava, Karen Stacey, Helena Stafford, Nikki Staines, Richard Stead, Emma Stevens, Alex Stilwell, Gary Stocks, Aaron Stokes, Christopher Stone, Ben Straughan, Vanitha Subbarathnam, Srinath Sudunagunta, Pervez Sultan, Puvan Suppiah, Priyanka Surve, Angus Sutherland, Rob Swanton, Claire Swarbrick, Amy Swinson, Eleni Syrrakou, Shahrzad Tadbiri, Preetam Tamhane, Perumal Tamilselvan, Andrew Tan, Shamil Tanna, Hayley Tarft, Laura Tarry, Ian Taylor, Suzanne Taylor, Julie Tebbot, Svetlana Theron, Megan Thomas, Sarah Todd, Hermione Tolliday, Charlotte Topham, Nicholas Tovell, Martyn Traves, Dawn Trodd, Aseem Tufchi, Katie Turley, Marc Turnbull, Chris Turnbull, Oliver Turner, William Turner, Sharon Turney, Eleanor Tyagi, David Uncles, Vanessa Unsworth, Pradnya Vadnere, Rama Varadan, Vik Vasishta, Andrew Veal, Lalitha Vedham, Jessica Venkaya, Miriam Verghese, Icel Veronica, Dinesh Vidanagamage, Rachel Vincent, Vinodhan Vyapury, Harris Wain, Fiona Walbridge, Elaine Walker, Pete Walsh, Eleanor Walshe, Michelle Walters, Yize Wan, Cherry Wang, Kavita Wankhade, Gareth Waters, Christopher Watts, Alex Webber, Tom Wedgwood, Michael Wee, Susan Wellstead, Alison White, Michael Whitear, Lucy Whitefield, Sarah Wilkinson, Lauren Williams, Rhys Williams, Dawn Wilson, Samantha Wilson, Katie Wimble, Elaine Winkley, Luke Winslow, Paul Winwright, Karolina Wloch, Gideon Wong, Hannah Wong, Jan Man Wong, Tim Wood, Sarah Wray, Ian Wrench, James Wu, Kynn Wynn, Yeng Yap, Chia Kuan Yeow, Emily Young, Alex Yusaf, Saeed Uz Zafar, Darius Zeinali, Sheldon Zhang, Sarvesh Zope, Liana Zucco, Sibtain Anwar, Nadia Blunt, John Cronin, Vimal Grover, Kate Grailey, Martin Grey, David Highton, Phil Hopkins, Harriet Kemp, Queenie Lo, Daniel Martin, Clare Morkane, James O'Carroll, Charles Oliver, Benjamin Post, Anil Visram, and Alex Wickham
Subjects: Adult, One year follow up, Trial protocol, Guidelines as Topic, Anesthesia, General, Intraoperative Awareness, Cohort Studies, Interviews as Topic, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Anesthesia, Obstetrical, Humans, Medicine, General anaesthesia, Prospective Studies, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics and Gynecology, medicine.disease, United Kingdom, Anesthesiology and Pain Medicine, Accidental, Cohort, Structured interview, Female, Medical emergency, business, Surgical patients, Cohort study
Abstract: Background Accidental awareness during general anaesthesia (AAGA) is a complex and rare outcome to investigate in surgical patient populations, particularly obstetric patients. We report the protocol of the Direct Reporting of Awareness in Maternity patients (DREAMY) study, illustrating how the research was designed to address practical and methodological challenges for investigating AAGA in an obstetric cohort. Methods This is the trial protocol of a prospective, multicentre cohort study of patients undergoing obstetric surgery under general anaesthesia. Accidental awareness during general anaesthesia will be detected using three repetitions of standardised direct questioning over 30 days, with responses indicating memories during general anaesthesia verified using structured interviews. Reports will be adjudicated, then classified, in accordance with pre-defined and pre-validated structures, including the Michigan Awareness Classification tool. Quantitative data will be collected on general anaesthesia conduct for all participants. This descriptive study is being conducted in England and aims to recruit a minimum of 2015 patients. Results The DREAMY study was prospectively registered (ClinicalTrials.gov Identifier: NCT03100396) and ethical approval granted. Participant recruitment began in May 2017 and one year follow up concluded in August 2019. Publication of the results is anticipated in 2020. Conclusions The DREAMY study will provide data on incidence, experience and implications of AAGA for obstetric patients, using a robust methodology that will reliably detect and translate subjective AAGA reports into objective outcomes. In addition, the study is expected to improve vigilance for AAGA in participating hospitals and encourage adoption of recommendations for support of patients experiencing AAGA.
Published: 2020
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34. Apnoeic oxygenation and ventilation: go with the flow

Author: Anil Kumar Patel and Kariem El-Boghdadly
Subjects: business.industry, medicine.medical_treatment, Insufflation, Oxygenation, Respiration, Artificial, law.invention, Anesthesiology and Pain Medicine, law, Anesthesia, Ventilation (architecture), medicine, Airway management, Prospective Studies, business, Apnoeic oxygenation
Published: 2020
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35. Consensus guidelines for managing the airway in patients with <scp>COVID</scp> ‐19

Author: A.F. McNarry, Kariem El-Boghdadly, B. McGuire, A. Higgs, Tim Cook, and Anil Kumar Patel
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Tracheal intubation, respiratory system, Airway obstruction, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, Intensive care, Health care, medicine, Emergency medical services, Intubation, Airway management, 030212 general & internal medicine, Airway, business, Intensive care medicine
Abstract: Severe acute respiratory syndrome-corona virus-2, which causes coronavirus disease 2019 (COVID-19), is highly contagious. Airway management of patients with COVID-19 is high risk to staff and patients. We aimed to develop principles for airway management of patients with COVID-19 to encourage safe, accurate and swift performance. This consensus statement has been brought together at short notice to advise on airway management for patients with COVID-19, drawing on published literature and immediately available information from clinicians and experts. Recommendations on the prevention of contamination of healthcare workers, the choice of staff involved in airway management, the training required and the selection of equipment are discussed. The fundamental principles of airway management in these settings are described for: emergency tracheal intubation; predicted or unexpected difficult tracheal intubation; cardiac arrest; anaesthetic care; and tracheal extubation. We provide figures to support clinicians in safe airway management of patients with COVID-19. The advice in this document is designed to be adapted in line with local workplace policies.
Published: 2020
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36. CArdiovaSCulAr outcomes after major abDominal surgEry: study protocol for a multicentre, observational, prospective, international audit of postoperative cardiac complications after major abdominal surgery

Author: Omar Kouli, Daoud Chaudhry, Shiraz Q. Shafi, Aya M. Riad, Aneel Bhangu, Bruce Biccard, Ruth Blanco-Colino, Annemarie B. Docherty, Kariem El-Boghdadly, James C. Glasbey, Ewen M. Harrison, Janet Martin, Kenneth A. McLean, Emily C. Mills, Susan J. Moug, Ronelle Mouton, Mandeep Phull, Thomas Pinkney, Toby Richards, Alessandro Sgrò, Neil Smart, David R. Thickett, Sivesh K. Kamarajah, Niall Brindl, Sam Brown, William A. Cambridge, Kassandra Gressmann, Rohan R. Gujjuri, Amie Hilder, Alisha Jaffer, Ieva Jakaityte, Michal Kawka, Esther Matey, Aleksandra ergo, Victoria Murray, Setthasorn Z.Y. Ooi, Irène S. Pereira, Isobel Trout, Adam Turňa, Chris Varghese, and William Xu
Subjects: Observational Studies as Topic, Anesthesiology and Pain Medicine, Postoperative Complications, Heart Diseases, Abdomen, Humans, Multicenter Studies as Topic, Prospective Studies, Abdominal Muscles
Published: 2022

37. Standardizing nomenclature for fascial plane blocks: the destination not the journey

Author: Kariem El-Boghdadly, Morné Wolmarans, Sandra Kopp, Edward R Mariano, Eric Albrecht, and Nabil M Elkassabany
Subjects: Anesthesiology and Pain Medicine, Humans, Nerve Block, General Medicine, Analgesia
Published: 2021

38. Projecting COVID-19 disruption to elective surgery

Author: Dmitri Nepogodiev, Tom EF Abbott, Adesoji O Ademuyiwa, Ehab AlAmeer, Brittany K Bankhead-Kendall, Bruce M Biccard, Sohini Chakrabortee, Daoud Chaudhry, John G Edwards, Kariem El-Boghdadly, Dhruv Ghosh, James C Glasbey, Rohan R Gujjuri, Ewen M Harrison, Conor S Jones, Haytham MA Kaafarani, Sivesh K Kamarajah, Angelos G Kolias, Ismail Lawani, Elizabeth Li, Harvinder Mann, Ella Marson, Janet Martin, Kenneth A Mclean, Ana Minaya-Bravo, Rachel Moore, Faustin Ntirenganya, Omar M Omar, Peter Pockney, Antonio Ramos-De la Medina, Richard Shaw, Joana FF Simões, Neil J Smart, Sudha Sundar, Stephen Tabiri, Elliott H Taylor, Mary L Venn, and Aneel Bhangu
Subjects: Hospitalization, England, Elective Surgical Procedures, Correspondence, Communicable Disease Control, COVID-19, Humans, General Medicine, Health Services Accessibility, State Medicine, Forecasting
Published: 2021

39. Six tips for successful virtual anesthesiology interviews in the COVID-19 era and beyond

Author: Jody C. Leng, Edward R. Mariano, and Kariem El-Boghdadly
Subjects: 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, Pain medicine, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), General Medicine, medicine.disease, Anesthesiology and Pain Medicine, Anesthesia, Anesthesiology, Correspondence, Medicine, Medical emergency, business
Published: 2021

40. Role of regional anesthesia and analgesia in enhanced recovery after colorectal surgery: a systematic review of randomized controlled trials

Author: Kariem El-Boghdadly, James M Jack, Aine Heaney, Nick D Black, Marina F Englesakis, Henrik Kehlet, and Vincent W S Chan
Subjects: Analgesia, Epidural, Anesthesiology and Pain Medicine, Anesthesia, Conduction, Humans, General Medicine, Length of Stay, Colorectal Surgery, Anesthetics, Randomized Controlled Trials as Topic
Abstract: BackgroundEffective analgesia is an important element of enhanced recovery after surgery (ERAS), but the clinical impact of regional anesthesia and analgesia for colorectal surgery remains unclear.ObjectiveWe aimed to determine the impact of regional anesthesia following colorectal surgery in the setting of ERAS.Evidence reviewWe performed a systematic review of nine databases up to June 2020, seeking randomized controlled trials comparing regional anesthesia versus control in an ERAS pathway for colorectal surgery. We analyzed the studies with successful ERAS implementation, defined as ERAS protocols with a hospital length of stay of ≤5 days. Data were qualitatively synthesized. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.FindingsOf the 29 studies reporting ERAS pathways, only 13 comprising 1170 patients were included, with modest methodological quality and poor reporting of adherence to ERAS pathways. Epidural analgesia had limited evidence of outcome benefits in open surgery, while spinal analgesia with intrathecal opioids may potentially be associated with improved outcomes with no impact on length of stay in laparoscopic surgery, though dosing must be further investigated. There was limited evidence for fascial plane blocks or other regional anesthetic techniques.ConclusionsAlthough there was variable methodological quality and reporting of ERAS, we found little evidence demonstrating the clinical benefits of regional anesthetic techniques in the setting of successful ERAS implementation, and future studies must report adherence to ERAS in order for their interventions to be generalizable to modern clinical practice.PROSPERO registration numberCRD42020161200.
Published: 2021

41. 39 Efficacy and safety of intrathecal morphine for analgesia after lower joint arthroplasty: a systematic review and meta-analysis with meta-regression and trial sequential analysis

Author: Kariem El-Boghdadly, Erin Gonvers, Eric Albrecht, and S Grape
Subjects: Pain score, Joint arthroplasty, Threshold dose, business.industry, Anesthesia, Meta-analysis, medicine.medical_treatment, medicine, Meta-regression, In patient, business, Arthroplasty, Intrathecal morphine
Abstract: Background and Aims Widespread adoption of intrathecal morphine into clinical practice is hampered by concerns of its potential side-effects. We undertook a systematic review, meta-analysis and trial sequential analysis with the primary objective of determining the efficacy and safety of intrathecal morphine. Our secondary objective was to determine the dose associated with greatest efficacy and safety. Methods We systematically searched the literature for any trials comparing intrathecal morphine with a control group in patients undergoing hip, knee arthroplasty under spinal anaesthesia. Our primary efficacy outcome was rest pain score (0–10) at 8–12h; our primary safety outcome was the rate of PONV within 24h. Results Twenty-nine trials including 1814 patients were identified. Rest pain score at 8–12h was significantly reduced in the intrathecal morphine group with a mean difference (95%CI) of -1.7(-2.0,-1.3),I2=71%,p Conclusions There is high level evidence that intrathecal morphine provides effective analgesia after lower limb arthroplasty but at the expense of an increased profile of side-effects. However, a dose of 100µg represents a ceiling dose for analgesia and a threshold dose for increased rate of PONV.
Published: 2021
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42. Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery

Author: T S Tatla, V Lan-Pak-Kee, Kariem El-Boghdadly, H A Iliff, J O'Connor, S Khan, L Powell, J.R. Davis, G Rees, A Harris, and Imran Ahmad
Subjects: medicine.medical_specialty, Hematoma, Hyperbaric Oxygenation, business.industry, medicine.medical_treatment, Thyroid, Tracheal intubation, Delphi method, Thyroid Gland, Airway obstruction, medicine.disease, Surgery, Airway Obstruction, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Cognition, Otorhinolaryngology, Multidisciplinary approach, Elective Surgical Procedures, medicine, Intubation, Intratracheal, Endocrine system, Humans, Airway, business
Abstract: Haematoma after thyroid surgery can lead to airway obstruction and death. We therefore developed guidelines to improve the safety of peri-operative care of patients undergoing thyroid surgery. We conducted a systematic review to inform recommendations, with expert consensus used in the absence of high-quality evidence, and a Delphi study was used to ratify recommendations. We highlight the importance of multidisciplinary team management and make recommendations in key areas including: monitoring; recognition; post-thyroid surgery emergency box; management of suspected haematoma following thyroid surgery; cognitive aids; post-haematoma evacuation care; day-case thyroid surgery; training; consent and pre-operative communication; postoperative communication; and institutional policies. The guidelines support a multidisciplinary approach to the management of suspected haematoma following thyroid surgery through oxygenation and evaluation; haematoma evacuation; and tracheal intubation. They have been produced with materials to support implementation. While these guidelines are specific to thyroid surgery, the principles may apply to other forms of neck surgery. These guidelines and recommendations provided are the first in this area and it is hoped they will support multidisciplinary team working, improving care and outcomes for patients having thyroid surgery.
Published: 2021

43. Predicting Hospital Resource Use During COVID-19 Surges: A Simple but Flexible Discretely Integrated Condition Event Simulation of Individual Patient-Hospital Trajectories

Author: Alistair McGuire, Jörgen Möller, Vatshalan Santhirapala, Kariem El-Boghdadly, Jessica Johnston, Paul Kelly, Ramai Santhirapala, Harpreet Gill, and J. Jaime Caro
Subjects: Themed Section, DICE, Occupancy, Computer science, Resource Allocation, hospital resources, 03 medical and health sciences, 0302 clinical medicine, Resource (project management), Peak demand, Humans, Computer Simulation, Operations management, 030212 general & internal medicine, Duration (project management), 030304 developmental biology, Face validity, Event (probability theory), 0303 health sciences, Health Policy, capacity, Surge Capacity, Public Health, Environmental and Occupational Health, COVID-19, Emergency department, Bed Occupancy, individual simulation, patient trajectories
Abstract: Objectives To assist with planning hospital resources, including critical care (CC) beds, for managing patients with COVID-19. Methods An individual simulation was implemented in Microsoft Excel using a discretely integrated condition event simulation. Expected daily cases presented to the emergency department were modeled in terms of transitions to and from ward and CC and to discharge or death. The duration of stay in each location was selected from trajectory-specific distributions. Daily ward and CC bed occupancy and the number of discharges according to care needs were forecast for the period of interest. Face validity was ascertained by local experts and, for the case study, by comparing forecasts with actual data. Results To illustrate the use of the model, a case study was developed for Guy’s and St Thomas’ Trust. They provided inputs for January 2020 to early April 2020, and local observed case numbers were fit to provide estimates of emergency department arrivals. A peak demand of 467 ward and 135 CC beds was forecast, with diminishing numbers through July. The model tended to predict higher occupancy in Level 1 than what was eventually observed, but the timing of peaks was quite close, especially for CC, where the model predicted at least 120 beds would be occupied from April 9, 2020, to April 17, 2020, compared with April 7, 2020, to April 19, 2020, in reality. The care needs on discharge varied greatly from day to day. Conclusions The DICE simulation of hospital trajectories of patients with COVID-19 provides forecasts of resources needed with only a few local inputs. This should help planners understand their expected resource needs.
Published: 2021

44. Fasten your seatbelts: innovation in regional anaesthesia is a bumpy ride

Author: Edward R. Mariano and Kariem El-Boghdadly
Subjects: Anesthesiology and Pain Medicine, Double-Blind Method, Anesthesia, Conduction, business.industry, Anesthesia, Medicine, Regional anaesthesia, business, Brachial Plexus Block, Diaphragm (structural system), Phrenic nerve, Interscalene block
Published: 2020
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45. Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults

Author: E.P. O’Sullivan, F. Mir, Kariem El-Boghdadly, M. S. Stacey, A.F. McNarry, D. J. A. Vaughan, Anil Kumar Patel, Iljaz Hodzovic, R Bhagrath, and Imran Ahmad
Subjects: Adult, medicine.medical_specialty, medicine.medical_treatment, Sedation, Laryngoscopy, Tracheal tube, 03 medical and health sciences, 0302 clinical medicine, Bronchoscopy, 030202 anesthesiology, Intubation, Intratracheal, medicine, Humans, Intubation, 030212 general & internal medicine, Wakefulness, Intensive care medicine, Societies, Medical, medicine.diagnostic_test, business.industry, Tracheal intubation, respiratory system, Anesthesiology and Pain Medicine, Airway management, medicine.symptom, Airway, business
Abstract: Awake tracheal intubation has a high success rate and a favourable safety profile but is underused in cases of anticipated difficult airway management. These guidelines are a comprehensive document to support decision making, preparation and practical performance of awake tracheal intubation. We performed a systematic review of the literature seeking all of the available evidence for each element of awake tracheal intubation in order to make recommendations. In the absence of high-quality evidence, expert consensus and a Delphi study were used to formulate recommendations. We highlight key areas of awake tracheal intubation in which specific recommendations were made, which included: indications; procedural setup; checklists; oxygenation; airway topicalisation; sedation; verification of tracheal tube position; complications; management of unsuccessful awake tracheal intubation; post-tracheal intubation management; consent; and training. We recognise that there are a range of techniques and regimens that may be effective and one such example technique is included. Breaking down the key practical elements of awake tracheal intubation into sedation, topicalisation, oxygenation and performance might help practitioners to plan, perform and address complications. These guidelines aim to support clinical practice and help lower the threshold for performing awake tracheal intubation when indicated.
Published: 2019
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46. A systematic review and cost effectiveness analysis of reusable vs. single‐use flexible bronchoscopes

Author: Julia Kovaleva, Lars Holger Ehlers, Jakob Munk Mouritsen, Kariem El-Boghdadly, and Imran Ahmad
Subjects: Cost effectiveness, Total cost, Cost-Benefit Analysis, Review Article, intubation, bronchoscope, Bronchoscopy, Equipment Reuse, Medicine, Humans, Operations management, Disposable Equipment, Flexible bronchoscopy, Review Articles, health care economics and organizations, Single use, airway management, business.industry, Cost-effectiveness analysis, Equipment Design, economics, Flexible bronchoscopes, infection, Anesthesiology and Pain Medicine, Bronchoscopes, business
Abstract: Summary The cost effectiveness of reusable vs. single‐use flexible bronchoscopy in the peri‐operative setting has yet to be determined. We therefore aimed to determine this and hypothesised that single‐use flexible bronchoscopes are cost effective compared with reusable flexible bronchoscopes. We conducted a systematic review of the literature, seeking all reports of cross‐contamination or infection following reusable bronchoscope use in any clinical setting. We calculated the incidence of these outcomes and then determined the cost per patient of treating clinical consequences of bronchoscope‐induced infection. We also performed a micro‐costing analysis to quantify the economics of reusable flexible bronchoscopes in the peri‐operative setting from a high‐throughput tertiary centre. This produced an accurate estimate of the cost per use of reusable flexible bronchoscopes. We then performed a cost effectiveness analysis, combining the data obtained from the systematic review and micro‐costing analysis. We included 16 studies, with a reported incidence of cross‐contamination or infection of 2.8%. In the micro‐costing analysis, the total cost per use of a reusable flexible bronchoscope was calculated to be £249 sterling. The cost per use of a single‐use flexible bronchoscope was £220 sterling. The cost effectiveness analysis demonstrated that reusable flexible bronchoscopes have a cost per patient use of £511 sterling due to the costs of treatment of infection. The findings from this study suggest benefits from the use of single‐use flexible bronchoscopes in terms of cost effectiveness, cross‐contamination and resource utilisation.
Published: 2019
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47. Difficult airway management for the anaesthetist

Author: I Ahmad, Kariem El-Boghdadly, and J Hews
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Treatment outcome, Anesthesia, General, Risk Assessment, 03 medical and health sciences, Patient safety, 0302 clinical medicine, 030202 anesthesiology, Intubation, Intratracheal, medicine, Humans, 030212 general & internal medicine, Airway Management, Intensive care medicine, Difficult airway, Unanticipated difficult airway, business.industry, General Medicine, respiratory system, Treatment Outcome, Anesthetists, Female, Airway management, Patient Safety, Respiratory System Abnormalities, business, Algorithms
Abstract: This article reviews the key considerations when managing a patient with a difficult airway. The difficult airway may be anticipated from preassessment allowing time for investigations and preparation. Alternatively, the unanticipated difficult airway can present in an emergency situation, or unexpectedly during a routine anaesthetic. The main airway management techniques are discussed with a description of their advantages and limitations. Current guidelines are included that demonstrate how the techniques are incorporated into an overall strategy with a plan A–D when failure occurs. It is critical to progress through such an algorithm in a timely manner to prevent the onset of hypoxia.
Published: 2019
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48. A randomised controlled trial of the pectoral nerves‐2 (PECS‐2) block for radical mastectomy

Author: M. Robertson, Kariem El-Boghdadly, A. Al Ja'bari, and Eric Albrecht
Subjects: medicine.medical_treatment, Breast Neoplasms, Sufentanil, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Radical mastectomy, Dexamethasone, Aged, Pain Measurement, Pain, Postoperative, Thoracic Nerves, Morphine, business.industry, Pruritus, Chronic pain, Nerve Block, Middle Aged, Ibuprofen, medicine.disease, 3. Good health, Analgesics, Opioid, Treatment Outcome, Anesthesiology and Pain Medicine, Anesthesia, Postoperative Nausea and Vomiting, Vomiting, Female, medicine.symptom, Mastectomy, Radical, business, Droperidol, Mastectomy, medicine.drug
Abstract: We randomly allocated 50 women scheduled for radical mastectomy to pectoral nerves-2 (PECS-2) block (n = 25) or no block (n = 25), 20 and 22 of whom we analysed for the primary outcome of a cumulative 24-h postoperative morphine dose. We gave intra-operative sufentanil, magnesium, dexamethasone and droperidol. Participants received regular postoperative paracetamol, ibuprofen and patient-controlled intravenous morphine. Pectoral nerves-2 block reduced mean (SD) cumulative 24 h postoperative morphine dose from 9.7 (8.9) mg to 5.0 (5.4) mg and 48 h morphine dose from 12.8 (12.5) mg to 6.0 (6.5) mg, p = 0.04 for both. The mean (SD) pain scores 24 h and 48 h after surgery were similar with or without block: 0.8 (1.4) vs. 1.2 (1.9), p = 0.39; and 0.2 (0.4) vs. 0.9 (1.8), p = 0.09, respectively. Rates of postoperative nausea, vomiting and pruritus were unaffected. Rates of chronic pain at six postoperative months were 2/19 and 2/18 after block and no block, respectively, p = 0.95.
Published: 2019
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49. Future directions in regional anaesthesia: not just for the cognoscenti

Author: Edward R. Mariano, Kariem El-Boghdadly, and L. R. Turbitt
Subjects: business.industry, medicine.medical_treatment, MEDLINE, Nerve Block, Regional anaesthesia, Anesthesiology and Pain Medicine, Anesthesia, Conduction, Anesthesiology, Anesthesia, Nerve block, medicine, Humans, Pain Management, Ultrasonography, business, Ultrasonography, Interventional
Published: 2019
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50. Perioperative point-of-care gastric ultrasound

Author: A. Perlas, T. Wojcikiewicz, and Kariem El-Boghdadly
Subjects: medicine.medical_specialty, Anesthesiology and Pain Medicine, Text mining, business.industry, Ultrasound, medicine, MEDLINE, Perioperative, Intensive care medicine, business, Article, Point of care
Published: 2019
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