Category Archives: Articles

Interesting journal articles

Early Anesthesia Exposure Linked to Minimal Academic Gap Later

Observational study;

Results  Among 33 514 exposed children (22 484 male and 11 030 female) and 159 619 unexposed children (105 812 male and 53 807 female) in the primary study cohort, 1 exposure before age 4 years was associated with a mean difference of 0.41% (95% CI, 0.12%-0.70%) lower school grades and 0.97% (95% CI, 0.15%-1.78%) lower IQ test scores. The magnitude of the difference was the same after multiple exposures. There was no difference in school grades with 1 exposure before ages 6 months, 7 to 12 months, 13 to 24 months, or 25 to 36 months. The overall difference was markedly less than the differences associated with sex, maternal educational level, or month of birth during the same year.

Conclusions and Relevance  Exposure to anesthesia and surgery before age 4 years has a small association with later academic performance or cognitive performance in adolescence on a population level. While more vulnerable subgroups of children may exist, the low overall difference in academic performance after childhood exposure to surgery is reassuring. These findings should be interpreted in light of potential adverse effects of postponing surgery.

I wonder how much is due to disease e.g. middle ear infection vs the anaesthesiapoi160080

Airway Articles

Hugh Stephens has graciously supplied the following articles on airway management;

  • Airway risk assessment –  a review of current evidence to aid clinical decision-making Download
  • Airway management roundtable – six international airway experts offer their opinions on various airway matters Download
  • Submental tracheal intubation for a patient with multiple facial fractures – let me know if you plan to do one of these and I’ll come and watch Download

If you come across any interesting articles that you think are worth sharing, please contact me and I’ll post details on GCAPE.

Updated Guidelines


Updated Consensus Guidelines for PONV were published in Anesthesia and Analgesia in January. You can download the article below.

Download PONV Guidelines

Also hot off the press are the 2014 ACC/AHA Guidelines on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. You can download the 100+ pages of the full article and the executive summary below.

Download ACC AHA Guidelines

Download ACC AHA Summary

ANZCA Safety Alerts

ANZCA publishes safety alerts on their website at

Starch solutions

NZ review of safety, basically existing restrictions are appropriate. More info…

Here is the Anesthesia and Analgesia article by Van der LInden evaluating its safety in surgery.

Safety of Starches pdf

Propofol contamination

Restrictions have been lifted, more info…