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Article ; Online: Anaesthesia and the older brain: what should we do?

Dhesi, J K / Moppett, I K

2022 Volume 77 Suppl 1, Page(s) 8–10

MeSH term(s)	Aged, 80 and over ; Anesthesia/adverse effects ; Anesthesia/standards ; Brain/drug effects ; Brain/pathology ; Frail Elderly/psychology ; Geriatric Assessment ; Humans ; Patient Care Team/standards ; Risk Factors
Language	English
Publishing date	2022-01-09
Publishing country	England
Document type	Editorial
ZDB-ID	80033-8
ISSN	1365-2044 ; 0003-2409
ISSN (online)	1365-2044
ISSN	0003-2409
DOI	10.1111/anae.15636
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Article ; Online: Hypotension - what we say and what we do.

Lyons, C / Moppett, I K

Anaesthesia

2021 Volume 77, Issue 2, Page(s) 132–134

MeSH term(s)	Anesthesia/standards ; Blood Pressure/physiology ; Humans ; Hypotension/diagnosis ; Hypotension/prevention & control ; Intraoperative Complications/diagnosis ; Intraoperative Complications/prevention & control ; Monitoring, Intraoperative/methods ; Monitoring, Intraoperative/standards
Language	English
Publishing date	2021-09-20
Publishing country	England
Document type	Editorial
ZDB-ID	80033-8
ISSN	1365-2044 ; 0003-2409
ISSN (online)	1365-2044
ISSN	0003-2409
DOI	10.1111/anae.15584
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Article ; Online: Peri-operative cardiac arrest in the older frail patient as reported to the 7th National Audit Project of the Royal College of Anaesthetists.

Moppett, I K / Kane, A D / Armstrong, R A / Kursumovic, E / Soar, J / Cook, T M

Anaesthesia

2024

Abstract: Frailty increases peri-operative risk, but details of its burden, clinical features and the risk of, and outcomes following, peri-operative cardiac arrest are lacking. As a preplanned analysis of the 7th National Audit Project of the Royal College of ... ...

Abstract	Frailty increases peri-operative risk, but details of its burden, clinical features and the risk of, and outcomes following, peri-operative cardiac arrest are lacking. As a preplanned analysis of the 7th National Audit Project of the Royal College of Anaesthetists, we described the characteristics of older patients living with frailty undergoing anaesthesia and surgery, and those reported to the peri-operative cardiac arrest case registry. In the activity survey, 1676 (26%) of 6466 patients aged > 65 y were reported as frail (Clinical Frailty Scale score ≥ 5). Increasing age and frailty were both associated with increasing comorbidities and the proportion of surgery undertaken as an emergency. Except in patients who were terminally ill (Clinical Frailty Scale score 9), increasing frailty was associated with an increased proportion of complex or major surgery. The rate of use of invasive arterial blood pressure monitoring was associated with frailty only until Clinical Frailty Scale score 5, and then plateaued or fell. Of 881 cardiac arrests reported to the 7th National Audit Project, 156 (18%) were in patients aged > 65 y and living with frailty, with an estimated incidence of 1 in 1204 (95%CI 1 in 1027-1412) and a mortality rate of 1 in 2020 (95%CI 1 in 1642-2488), approximately 2.6-fold higher than in adults who were not frail. Hip fracture, emergency laparotomy, emergency vascular surgery and urological surgery were the most common surgical procedures in older patients living with frailty who had a cardiac arrest. We report a high burden of frailty within the surgical population, requiring complex, urgent surgery, and the extent of poorer outcomes of peri-operative cardiac arrest compared with patients of the same age not living with frailty.
Language	English
Publishing date	2024-03-31
Publishing country	England
Document type	Journal Article
ZDB-ID	80033-8
ISSN	1365-2044 ; 0003-2409
ISSN (online)	1365-2044
ISSN	0003-2409
DOI	10.1111/anae.16267
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Article ; Online: Errors in published papers are multifactorial.

Moppett, I K

Anaesthesia

2017 Volume 72, Issue 11, Page(s) 1415–1416

MeSH term(s)	Anesthetics ; Publishing
Chemical Substances	Anesthetics
Language	English
Publishing date	2017-10-18
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	80033-8
ISSN	1365-2044 ; 0003-2409
ISSN (online)	1365-2044
ISSN	0003-2409
DOI	10.1111/anae.14048
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Article ; Online: Reversal of direct oral anticoagulants in adult hip fracture patients. A systematic review and meta-analysis.

Alcock, H M F / Nayar, S K / Moppett, I K

Injury

2021 Volume 52, Issue 11, Page(s) 3206–3216

Abstract: ... either a vitamin-K antagonist or not receiving anticoagulation therapy. This allowed construction of a network ...

Abstract	Background: Increasing numbers of patients are taking Direct Oral Anticoagulants at the time of hip fracture. Evidence is limited on how and if the effects of DOAC's should be reversed before surgical fixation. Wide variations in practice exist. We conducted a systematic review to investigate outcomes for three reversal strategies. These were: "watch and wait" (also referred to as "time-reversal"), plasma product reversal and reversal with specific antidotes. Methods: A systematic search was conducted using multiple databases. Results were obtained for studies directly comparing different DOAC reversal strategies in hip fracture patients and for studies comparing DOAC-taking hip fracture patients (including patients "reversed" using any method and "non-reversed" patients) against matched controls taking either a vitamin-K antagonist or not receiving anticoagulation therapy. This allowed construction of a network meta-analysis to indirectly compare outcomes between "reversed" and "non-reversed" DOAC patients. With respect to "watch and wait"/"time-reversal", a cut-off time to surgery of 36 hours was used to distinguish between "time-reversed" and "non time-reversed" DOAC patients. The primary outcome was early/inpatient mortality, reported as Odds Ratios (OR). Results: No studies investigating plasma products or reversal agents specifically in hip fracture patients were obtained. Fourteen studies were suitable for analysis of "watch and wait"/"time- reversal". Two studies directly compared "time-reversed" and "non time-reversed" DOAC-taking hip fracture patients (58 "time-reversed", 62 "non time-reversed"). From 12 other studies we used indirect comparisons between "time-reversed" and "non time-reversed" DOAC patients (total, 357 "time-reversed", 282 "non time-reversed"). We found no statistically significant differences in mortality outcomes between "time-reversal" and "non time-reversal" (OR 1.48 [95%CI: 0.29-7.53]). We also did not find a statistically significant difference between "time reversal" and "non time-reversal" in terms of blood transfusion requirements (OR 1.16 [95% CI 0.42-3.23]). However, several authors described that surgical delay is associated with worse outcomes related to prolonged hospitalisation, and that operating within 36 hours is safe. Conclusions: We suggested against "watch and wait" to reverse the DOAC effect in hip fractures. Further work is required to assess the optimal timing for surgery as well as the use of plasma products or specific antidotes in DOAC-taking hip fracture patients.
MeSH term(s)	Adult ; Anticoagulants ; Blood Transfusion ; Hip Fractures/surgery ; Humans ; Randomized Controlled Trials as Topic
Chemical Substances	Anticoagulants
Language	English
Publishing date	2021-09-12
Publishing country	Netherlands
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2021.09.005
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Zs.A 778: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 10: Show issues

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Article ; Online: Surgical caseload and the risk of surgical Never Events in England.

Moppett, I K / Moppett, S H

Anaesthesia

2016 Volume 71, Issue 1, Page(s) 17–30

Abstract: Never Events are medical errors that are believed to be preventable with appropriate measures. We surveyed all English acute NHS trusts to determine the number of surgical Never Events and surgical caseload for 2011-2014. There were 742 surgically ... ...

Abstract	Never Events are medical errors that are believed to be preventable with appropriate measures. We surveyed all English acute NHS trusts to determine the number of surgical Never Events and surgical caseload for 2011-2014. There were 742 surgically related Never Events in three years, with no change in the number annually. The risk of a surgical Never Event was 1 in 16 423 operations (95% CI 1 in 15 283 to 1 in 17 648) or 1 Never Event per 12.9 operating theatres per year (95% CI 1 in 12.1 to 1 in 13.9). The risk of severe harm due to a Never Event was approximately 1 in 238 939 operations. There was no meaningful association between number of Never Events and other safety indicators. Surgical Never Events are undoubtedly important to individual patients, but they are not a useful metric to judge quality of care.
MeSH term(s)	England ; Humans ; Medical Errors/prevention & control ; Medical Errors/statistics & numerical data ; Patient Safety ; Risk ; Workload
Language	English
Publishing date	2016-01
Publishing country	England
Document type	Journal Article
ZDB-ID	80033-8
ISSN	1365-2044 ; 0003-2409
ISSN (online)	1365-2044
ISSN	0003-2409
DOI	10.1111/anae.13290
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Zs.A 388: Show issues

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Article ; Online: Interchangeability of AMT4 and AMTS in a hip fracture population.

Lindsay, W A / Moppett, I K

Anaesthesia

2019 Volume 74, Issue 11, Page(s) 1477–1478

MeSH term(s)	Aged ; Hip Fractures ; Humans ; Intelligence Tests
Language	English
Publishing date	2019-10-08
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	80033-8
ISSN	1365-2044 ; 0003-2409
ISSN (online)	1365-2044
ISSN	0003-2409
DOI	10.1111/anae.14803
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Article ; Online: Who is distracting whom?

Moppett, I K

Anaesthesia

2015 Volume 70, Issue 8, Page(s) 1006–1007

MeSH term(s)	Anesthesia, Obstetrical/methods ; Cesarean Section/methods ; Female ; Humans ; Pregnancy
Language	English
Publishing date	2015-08
Publishing country	England
Document type	Comment ; Letter
ZDB-ID	80033-8
ISSN	1365-2044 ; 0003-2409
ISSN (online)	1365-2044
ISSN	0003-2409
DOI	10.1111/anae.13162
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Zs.A 388: Show issues

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Article ; Online: Total intravenous anaesthesia with propofol and remifentanil is associated with reduction in operative time in surgery for glioblastoma when compared with inhalational anaesthesia with sevoflurane.

Kumaria, Ashwin / Hughes, Matthew / Fenner, Helen / Moppett, Iain K / Smith, Stuart J

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

2024 Volume 120, Page(s) 191–195

Abstract: Background: Total intravenous anaesthesia (TIVA) is emerging as a preferred neuroanaesthetic agent compared with inhalational anaesthetic (IA) agents. We asked if TIVA with propofol and remifentanil was associated with shorter operative times compared ... ...

Abstract	Background: Total intravenous anaesthesia (TIVA) is emerging as a preferred neuroanaesthetic agent compared with inhalational anaesthetic (IA) agents. We asked if TIVA with propofol and remifentanil was associated with shorter operative times compared to IA using sevoflurane in brain tumour surgery under GA. Methods: We performed a retrospective analysis of all patients undergoing surgery for glioblastoma (GBM). We assessed choice of GA agent (TIVA or IA) with total time patient was under GA (anaesthetic time), operative time and time taken to recover fully from GA (recovery time). Results: Over a two year period 263 patients underwent surgery under GA for their GBM including 188 craniotomy operations, 63 burr hole biopsy procedures and 12 open biopsy procedures. Of these, 79 operations took place under TIVA and 184 operations under IA. TIVA was associated with significantly reduced mean operative time including time taken to wake up in theatre (104 min with TIVA, 129 min with IA; p = 0.02). TIVA was also associated with trends toward shorter mean recovery time (118 min, versus 135 min with IA; p = 0.08) and shorter mean anaesthetic time (163 min, versus 181 min with IA; p = 0.07). There was no difference between TIVA and IA groups as regards duration of inpatient stay, readmission rates, complications or survival. Conclusions: TIVA with propofol and remifentanil may reduce anaesthetic, operative and recovery times in patients undergoing surgery for their GBM. These findings may be attributable to favourable effects on intracranial pressure and cerebral perfusion, as well as rapid recovery from GA. In addition to clinical advantages, there may be financial and logistical benefits.
MeSH term(s)	Humans ; Propofol ; Sevoflurane ; Remifentanil ; Operative Time ; Anesthesia, Intravenous/methods ; Glioblastoma/surgery ; Retrospective Studies ; Anesthetics, Inhalation ; Anesthetics, Intravenous
Chemical Substances	Propofol (YI7VU623SF) ; Sevoflurane (38LVP0K73A) ; Remifentanil (P10582JYYK) ; Anesthetics, Inhalation ; Anesthetics, Intravenous
Language	English
Publishing date	2024-01-24
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	1193674-5
ISSN	1532-2653 ; 0967-5868
ISSN (online)	1532-2653
ISSN	0967-5868
DOI	10.1016/j.jocn.2024.01.022
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Zs.A 3999: Show issues

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Article ; Online: Clinician perspectives on nonoperative management of hip fractures during COVID-19.

Xiang, Lucille / Singh, Mriganka / McNicoll, Lynn / Moppett, Iain K

Bone & joint open

2023 Volume 4, Issue 10, Page(s) 766–775

Abstract: Aims: To identify factors influencing clinicians' decisions to undertake a nonoperative hip fracture management approach among older people, and to determine whether there is global heterogeneity regarding these factors between clinicians from high- ... ...

Abstract	Aims: To identify factors influencing clinicians' decisions to undertake a nonoperative hip fracture management approach among older people, and to determine whether there is global heterogeneity regarding these factors between clinicians from high-income countries (HIC) and low- and middle-income countries (LMIC). Methods: A SurveyMonkey questionnaire was electronically distributed to clinicians around the world through the Fragility Fracture Network (FFN)'s Perioperative Special Interest Group and clinicians' personal networks between 24 May and 25 July 2021. Analyses were performed using Excel and STATA v16.0. Between-group differences were determined using independent-samples Results: A total of 406 respondents from 51 countries answered the questionnaire, of whom 225 came from HIC and 180 from LMIC. Clinicians from HIC reported a greater median and mean estimated proportion of admitted patients with hip fracture undergoing surgery (median 96% (interquartile range (IQR) 95% to 99%); mean 94% (SD 8%)) than those from LMIC (median 85% (IQR 75% to 95%); mean 81% (SD 16%); p < 0.001). Global heterogeneity seems to exist regarding factors such as anticipated life expectancy, insufficient resources, ability to pay, treatment costs, and perception of risk in hip fracture management decision-making. Conclusion: This study represents the first international sampling of clinician perspectives regarding nonoperative hip fracture management. Several factors seemed to influence the clinician decision-making process. Further research is needed to inform the development of best practice guidelines to improve decision-making and the quality of hip fracture care among older people.
Language	English
Publishing date	2023-10-13
Publishing country	England
Document type	Journal Article
ISSN	2633-1462
ISSN (online)	2633-1462
DOI	10.1302/2633-1462.410.BJO-2023-0069.R1
Database	MEDical Literature Analysis and Retrieval System OnLINE

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