British Journal of Anaesthesia 117 (1): (2016) doi:10.1093/bja/aew181
IN THIS ISSUE
In the June BJA . . . In this issue of the BJA, among the published articles, airway devices and antibiotic therapy emerge as the themes.
Airway devices Recently, many airway management devices have been introduced into clinical practice with little or no evidence of their clinical efficacy and safety. Van Zundert and colleagues, in an editorial ( pages 12–6) show how, by careful analysis of the design and structure of the device, a range of specific hypotheses can be generated that are amenable to clinical testing. In another editorial, Timmermann and colleagues ( pages 5–7) highlight the importance of considering human factors that may come into play during emergency front-of-neck airway access. They point out that a scalpel technique may be associated with increased psychological barriers for anaesthetists who, in general, are more likely to be familiar with using needle/cannula in their everyday practice. They recommend training in both techniques, and the option to use either scalpel or cannula technique for emergency cricothyroidotomy. DeMaria Jr and colleagues ( pages 103–8) have examined whether or not performance differs between residents working alone or with a resident partner during simulated airway management scenarios. They conclude that training programmes should be designed so that airway management is practiced using a team-based approach. In another study, Balogh and colleagues compared side-stream capnography with mainstream capnography in patients on mechanical ventilation ( pages 109–17); they concluded that side-stream capnography provides adequate quantitative bedside information about uneven alveolar emptying and ventilation–perfusion mismatch, but mainstream capnography is required for a reliable measurement of volumetric parameters. In a study to predict difficult laryngoscopy with either GlideScope® or C-MAC® with D-blade in patients for whom difficult direct laryngoscopy was anticipated, Aziz and colleagues ( pages 118–23) concluded that differences in the position of the head and neck, type of surgery, type of person who attempted to intubate, and the degree of mouth opening may affect the ease of tracheal intubation. Teoh and Kristensen ( pages 1–3), commenting on a previously published BJA article, suggested that in addition to evaluating the potential ease or difficulty of noninvasive methods of securing the airway, we must evaluate feasibility of tracheostomy and/or cricothyroidotomy.
Antibiotic therapy Guilbart and colleagues ( pages 66–72) have concluded that non-compliance with an antimicrobial protocol, in a single centre study, was associated with worse clinical outcomes. In another study, Himebauch and colleagues ( pages 87–94) have shown that, for children with adolescent idiopathic scoliosis undergoing posterior spinal fusion, the cefazolin dosing strategy used in the study resulted in skeletal muscle concentrations that were likely not to be effective for intraoperative prophylaxis against Gram-negative pathogens. Jutte and colleagues, in an accompanying editorial ( pages 3–5) point out that for future research, not only the right timing of giving antibiotics (i.e. 30–60 min before the surgical incision) needs to be studied, but also that required concentrations of antibiotics may differ, in line with the operation undertaken, taking into account the duration of the procedure, the likely infecting organisms and the target tissue. The implication being that only local concentrations measured at the operation site and during the operation can confirm adequacy of applied doses and the need for additional doses to increase antibiotic concentrations.
Cover image The cover image, as backdrop to studies on modern airway devices, is a historical artwork of an early electrical lamp being used to examine a patient’s mouth and throat. The wire (far left) provides power for the lamp, which uses an incandescent sealed bulb with a helical platinum filament. A headband holds the lamp in place on the doctor’s forehead. The doctor is using a tongue depressor, as well as a cloth to absorb the patient’s saliva. The principle of the electric light bulb was demonstrated by Humphrey Davy in 1801. The first endoscopic device that used an electric lamp was built in 1869 by the French inventor Gustave Trouve (1838–1902). Artwork from A Travers l’Electricite (G. Dary, Paris, 1900). Credit: SHEILA TERRY/SCIENCE PHOTO LIBRARY
Podcasts The podcasts with the authors of the selected articles are available at http://bja.oxfordjournals.org.
© The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected]
IN THIS ISSUE
In the June BJA . . . In this issue of the BJA, among the published articles, airway devices and antibiotic therapy emerge as the themes.
Airway devices Recently, many airway management devices have been introduced into clinical practice with little or no evidence of their clinical efficacy and safety. Van Zundert and colleagues, in an editorial ( pages 12–6) show how, by careful analysis of the design and structure of the device, a range of specific hypotheses can be generated that are amenable to clinical testing. In another editorial, Timmermann and colleagues ( pages 5–7) highlight the importance of considering human factors that may come into play during emergency front-of-neck airway access. They point out that a scalpel technique may be associated with increased psychological barriers for anaesthetists who, in general, are more likely to be familiar with using needle/cannula in their everyday practice. They recommend training in both techniques, and the option to use either scalpel or cannula technique for emergency cricothyroidotomy. DeMaria Jr and colleagues ( pages 103–8) have examined whether or not performance differs between residents working alone or with a resident partner during simulated airway management scenarios. They conclude that training programmes should be designed so that airway management is practiced using a team-based approach. In another study, Balogh and colleagues compared side-stream capnography with mainstream capnography in patients on mechanical ventilation ( pages 109–17); they concluded that side-stream capnography provides adequate quantitative bedside information about uneven alveolar emptying and ventilation–perfusion mismatch, but mainstream capnography is required for a reliable measurement of volumetric parameters. In a study to predict difficult laryngoscopy with either GlideScope® or C-MAC® with D-blade in patients for whom difficult direct laryngoscopy was anticipated, Aziz and colleagues ( pages 118–23) concluded that differences in the position of the head and neck, type of surgery, type of person who attempted to intubate, and the degree of mouth opening may affect the ease of tracheal intubation. Teoh and Kristensen ( pages 1–3), commenting on a previously published BJA article, suggested that in addition to evaluating the potential ease or difficulty of noninvasive methods of securing the airway, we must evaluate feasibility of tracheostomy and/or cricothyroidotomy.
Antibiotic therapy Guilbart and colleagues ( pages 66–72) have concluded that non-compliance with an antimicrobial protocol, in a single centre study, was associated with worse clinical outcomes. In another study, Himebauch and colleagues ( pages 87–94) have shown that, for children with adolescent idiopathic scoliosis undergoing posterior spinal fusion, the cefazolin dosing strategy used in the study resulted in skeletal muscle concentrations that were likely not to be effective for intraoperative prophylaxis against Gram-negative pathogens. Jutte and colleagues, in an accompanying editorial ( pages 3–5) point out that for future research, not only the right timing of giving antibiotics (i.e. 30–60 min before the surgical incision) needs to be studied, but also that required concentrations of antibiotics may differ, in line with the operation undertaken, taking into account the duration of the procedure, the likely infecting organisms and the target tissue. The implication being that only local concentrations measured at the operation site and during the operation can confirm adequacy of applied doses and the need for additional doses to increase antibiotic concentrations.
Cover image The cover image, as backdrop to studies on modern airway devices, is a historical artwork of an early electrical lamp being used to examine a patient’s mouth and throat. The wire (far left) provides power for the lamp, which uses an incandescent sealed bulb with a helical platinum filament. A headband holds the lamp in place on the doctor’s forehead. The doctor is using a tongue depressor, as well as a cloth to absorb the patient’s saliva. The principle of the electric light bulb was demonstrated by Humphrey Davy in 1801. The first endoscopic device that used an electric lamp was built in 1869 by the French inventor Gustave Trouve (1838–1902). Artwork from A Travers l’Electricite (G. Dary, Paris, 1900). Credit: SHEILA TERRY/SCIENCE PHOTO LIBRARY
Podcasts The podcasts with the authors of the selected articles are available at http://bja.oxfordjournals.org.
© The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected]
