The 7th National Audit Project (NAP7) of the RCoA examined peri-operative cardiac arrest and each of the three phases captured the involvement of anaesthesia associates in clinical practice. In view of current interest and controversy concerning the roles and scope of practice of anaesthesia associates, the authors aimed to share a full account of information collected during NAP7 to add to the limited available data in this area. This likely represents the only national dataset which incorporates anaesthetists and anaesthesia associates. This interview accompanies the paper and includes the authors Prof Tim Cook and Lee Varney, as well of the President of the Association of Anaesthesia Associates, Sarah Massey. They talk about the paper and the wider associated issues. Essential listening for all.

There are lots of excellent papers this month which have been highlighted by our dissemination editors Maryann and Mike! This month, they discuss:

1. Still a ‘boys’ club': a qualitative analysis of how gender affects a career in anaesthesia in Australia and Aotearoa New Zealand
2. Successful return to work in anaesthesia after maternity leave: a qualitative study
3. Impact of postoperative cardiovascular complications on 30-day mortality after major abdominal surgery: an international prospective cohort study
4. Association of peri-operative prescription of non-steroidal anti-inflammatory drugs with continued prescription of opioids after total knee arthroplasty: a retrospective claims-based cohort study
5. Glucagon-like peptide-1 receptor agonists: a narrative review of clinical pharmacology and implications for peri-operative practice
6. Remifentanil for tracheal intubation without neuromuscular blocking drugs in adult patients: a systematic review and meta-analysis

All your CPD for the month in one place, free to listen and clinically relevant for all. Enjoy!

Multimorbidity poses a global challenge to healthcare delivery. This study aimed to describe the prevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort of patients undergoing major abdominal surgery.

This month, Dr Maryann Turner is joined by Professor Kariem El-Boghdadly to discuss three papers from the June 2024 issue.

1. Comparison of the success rate of tracheal intubation between stylet and bougie with a hyperangulated videolaryngoscope: a randomised controlled trial.
2. The effect of a bundle intervention for ambulatory otorhinolaryngology procedures on same-day case cancellation rate and associated costs.
3. Principles for management of hip fracture for older adults taking direct oral anticoagulants: an international consensus statement.

The Opioid PrEscRiptions and Usage After Surgery (OPERAS) study aimed to quantify the current global practice of opioid prescribing and consumption patterns in patients after discharge from common surgical procedures, and to identify factors associated with increased opioid consumption.

It found that double the quantity of opioids patients consume in the post-discharge period are prescribed at discharge, exposing them to risk of opioid-related harm. Individualised opioid prescribing at discharge remains important as excess prescriptions are driving increased consumption of opioids by patients. While patient pain levels and pre-discharge opioid consumption influence opioid consumption at discharge, the quantity of opioids prescribed remains a modifiable factor to curtailing excessive prescriptions of unused opioids.

Despite a lack of supporting evidence, airway management in patients with suspected or confirmed cervical spine injury is traditionally thought to increase the risk of worsening existing neurological deficits (secondary spinal cord injury) or risk of causing a new spinal cord injury (primary spinal cord injury). Although there has been evidence synthesis for specific elements of airway management in this setting, there has been little guidance to support clinical decision-making for airway management in this cohort of patients.

These guidelines focus on the impact of airway management on cervical spine-related safety outcomes rather than efficacy of different airway management techniques. Whilst these two are related, the primary aim is to support clinicians in performing airway management whilst minimising the risk of airway complications and cervical spine cord injury.

While effective for acute pain control, recent pre-clinical evidence has raised concerns regarding an association between NSAIDs and chronic pain and potential opioid use. The objective of this paper was to explore the association between peri-operative use of prescription NSAIDs and the need for continued opioid prescriptions lasting 90–180 days in previously opioid-naïve patients undergoing total knee arthroplasty. Join Prof Ed Mariano and the authors to find out what the key messages are for clinicians.

Gender inequity remains an issue in anaesthesia despite increasing numbers of women training and achieving fellowship in the speciality. Women are under-represented in all areas of anaesthetic research, academia and leadership. This podcast featuring Dr Seema Agarwal discusses two new qualitative papers on related topics. The first is an analysis of how gender affects a career in anaesthesia in Australia and Aotearoa New Zealand. The second examines successful return to work in anaesthesia after maternity leave.