Position statement from the Editors of Anaesthesia and Anaesthesia Reports on best practice in academic medical publishing

It is essential that academic publishing complies with the highest standards in terms of ethics, research conduct and manuscript preparation. This protects the rights and welfare of research participants, ensures the integrity of study results and aids the communication and dissemination of novel findings into clinical practice. This position statement outlines the current policies and practices of the Editors of Anaesthesia and Anaesthesia Reports in relation to academic medical publishing.

Principles of environmentally-sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists

The Earth's mean surface temperature is already approximately 1.1°C higher than pre-industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three-stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high-, middle- and low-income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists' education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re-evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references.

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

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.

Patients as partners in readiness for COVID-19: using 'live simulation' to implement infection prevention and control procedures in the maternity operating theatre

Insitu simulation can be used to improve care within a particular setting and has specific value in developing and testing guidelines and procedures. However, it can be challenging to undertake simulation when clinical work is ongoing. Responding to the need to develop infection prevention and control procedures for coronavirus disease 2019 in the obstetric operating theatre, we asked three patients who required operative intervention to consent to be managed according to preliminary standard operating procedures as if they were severe acute respiratory syndrome-coronavirus-2 positive. With this method, we were able to run scenarios in real-time without interrupting clinical work. As well as allowing us to develop and refine procedures, these 'live simulations' provided staff training and highlighted system problems that needed to be addressed as the first wave of the pandemic approached. In this case series, we describe our procedure for live simulation, report the learning points that this approach yielded, present the feedback from patient participants and reflect on the ethical implications of this technique.

Management of tracheostomy-related tracheomegaly in a patient with COVID-19 pneumonitis

Acquired tracheomegaly is a rare condition associated with pulmonary fibrosis, connective tissue disease and the use of cuffed tracheal tubes. We describe the urgent tracheal re-intubation and subsequent tracheal repair of a previously well 58-year-old man who developed tracheostomy-related tracheomegaly during prolonged mechanical ventilation for coronavirus disease 2019 pneumonitis. Urgent tracheal re-intubation was required due to a persistent cuff leak, pneumomediastinum and malposition of the tracheostomy tube. We describe the additional challenges and risks associated with airway management in patients with tracheomegaly, and discuss how even in urgent cases these can be mitigated through planning and teamwork. We present a stepwise approach to tracheal re-intubation past a large tracheal dilatation, including the use of an Aintree catheter inserted via the existing tracheal stoma for oxygenation or tracheal re-intubation if required. Computed tomography imaging was valuable in characterising the defect and developing a safe airway management strategy before starting the procedure. This report emphasises the role of planning, teamwork and the development of an appropriate airway strategy in the safe management of complex cases.

The safety of paediatric surgery between COVID-19 surges: an observational study

Despite the ongoing coronavirus disease 2019 (COVID‐19) pandemic, elective paediatric surgery must continue safely through the first, second and subsequent waves of disease. This study presents outcome data from a children's hospital in north‐west England, the region with the highest prevalence of COVID‐19 in England. Children and young people undergoing elective surgery isolated within their household for 14 days, then presented for real‐time reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus disease‐2 (SARS‐CoV‐2) within 72 h of their procedure (or rapid testing within 24 h in high‐risk cases), and completed a screening questionnaire on admission. Planned surgery resumed on 26 May 2020; in the four subsequent weeks, there were 197 patients for emergency and 501 for elective procedures. A total of 488 out of 501 (97.4%) elective admissions proceeded, representing a 2.6% COVID‐19‐related cancellation rate. There was no difference in the incidence of SARS‐CoV‐2 among children and young people who had or had not isolated for 14 days (p > 0.99). One out of 685 (0.1%) children who had surgery re‐presented to the hospital with symptoms potentially consistent with SARS‐CoV‐2 within 14 days of surgery. Outcomes were similar to those in the same time period in 2019 for length of stay (p = 1.0); unplanned critical care admissions (p = 0.59); and 14‐day hospital re‐admission (p = 0.17). However, the current cohort were younger (p = 0.037); of increased complexity (p < 0.001) and underwent more complex surgery (p < 0.001). The combined use of household self‐isolation, testing and screening questionnaires has allowed the re‐initiation of elective paediatric surgery at high volume while maintaining pre‐COVID‐19 outcomes in children and young people undergoing surgery. This may provide a model for addressing the ongoing challenges posed by COVID‐19, as well as future pandemics.

Can changes in clinical attire reduce likelihood of cross-infection without jeopardising the doctor-patient relationship?

Research has shown that healthcare workers' clothes can become contaminated with pathogens. This study aimed to determine whether hospital doctors can change their attire to reduce the possibility of cross-infection without jeopardising the doctor-patient relationship. In this experimental repeated-measures study, 55 male and 45 female inpatients (mean age: 52.89 years) were randomly selected. Participants were shown photographs of medical dresscodes and asked to rate their appropriateness on a 5-point Likert scale. They were then read a standardised statement regarding the significance of attire to cross-infection and the exercise was repeated. Pre statement, there was no significant difference between the majority of dress options, though casual dress (male and female) and short-sleeved top (female) were considered significantly less appropriate. Post statement, surgical 'scrubs' and short-sleeved top/shirt were deemed most appropriate (P<0.0001). There was no significant difference between short-sleeved shirt and scrubs for males. For females, scrubs were preferred (P=0.0005). Participants expressed no significant preference for medical attire, with the exception of a dislike of casual dress. However, once informed of the significance of attire to cross-infection, preference changes to favour dresscodes which may minimise infection risk.