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  1. Article ; Online: Promoting practice change towards environmentally sustainable health care: more than meets the eye.

    Ip, Vivian H Y / Shelton, Clifford L / Zimmermann, Gabrielle L

    Canadian journal of anaesthesia = Journal canadien d'anesthesie

    2023  Volume 70, Issue 3, Page(s) 295–300

    Title translation Promouvoir un changement de pratique vers des soins de santé durables sur le plan environnemental: plus que des apparences.
    MeSH term(s) Humans ; Conservation of Natural Resources ; Delivery of Health Care
    Language English
    Publishing date 2023-02-10
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 91002-8
    ISSN 1496-8975 ; 0832-610X
    ISSN (online) 1496-8975
    ISSN 0832-610X
    DOI 10.1007/s12630-022-02391-1
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  2. Article ; Online: There is (probably) no (meaningful) difference in (most) outcomes between 'spinal' and 'general' anaesthesia for hip fracture surgery: time to move forward.

    White, Stuart M / Tedore, Tiffany / Shelton, Clifford L

    British journal of anaesthesia

    2023  Volume 130, Issue 4, Page(s) 385–389

    Abstract: A meta-analysis influenced by two recent large randomised controlled trials (REGAIN and RAGA) concluded that little, if any, difference in commonly measured outcomes exists between patients administered spinal or general anaesthesia for their hip ... ...

    Abstract A meta-analysis influenced by two recent large randomised controlled trials (REGAIN and RAGA) concluded that little, if any, difference in commonly measured outcomes exists between patients administered spinal or general anaesthesia for their hip fracture surgery. We explore whether there is genuinely no difference, or what the methodological problems in research might be that prevent any real difference from being observed. We also discuss the need for greater nuance in future research to determine how anaesthetists might deliver perioperative care towards improving postoperative recovery trajectories in patients following hip fracture.
    MeSH term(s) Humans ; Postoperative Complications/prevention & control ; Hip Fractures/surgery ; Anesthesia, General ; Perioperative Care ; Anesthesia, Spinal
    Language English
    Publishing date 2023-02-16
    Publishing country England
    Document type Meta-Analysis ; Editorial ; Comment
    ZDB-ID 80074-0
    ISSN 1471-6771 ; 0007-0912
    ISSN (online) 1471-6771
    ISSN 0007-0912
    DOI 10.1016/j.bja.2023.01.013
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  3. Article ; Online: Pentafluoropropane with tetrafluoroethane: a hidden greenhouse gas in regional anaesthesia.

    Sparke, Rachael E / Song, Andrew / Shelton, Clifford L / Patey, Susannah J

    British journal of anaesthesia

    2023  

    Language English
    Publishing date 2023-11-27
    Publishing country England
    Document type Letter
    ZDB-ID 80074-0
    ISSN 1471-6771 ; 0007-0912
    ISSN (online) 1471-6771
    ISSN 0007-0912
    DOI 10.1016/j.bja.2023.10.028
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  4. Article ; Online: Maternal body weight and estimated circulating blood volume: a review and practical nonlinear approach.

    Kennedy, Helen / Haynes, Sarah L / Shelton, Clifford L

    British journal of anaesthesia

    2022  Volume 129, Issue 5, Page(s) 716–725

    Abstract: Postpartum haemorrhage continues to be a leading cause of morbidity and mortality in the obstetric population worldwide, especially in patients at extremes of body weight. Quantification of blood loss has been considered extensively in the literature. ... ...

    Abstract Postpartum haemorrhage continues to be a leading cause of morbidity and mortality in the obstetric population worldwide, especially in patients at extremes of body weight. Quantification of blood loss has been considered extensively in the literature. However, these volumes must be contextualised to appreciate the consequences of blood loss for individual parturients. Knowledge of a patient's peripartum circulating blood volume is essential to allow accurate interpretation of the significance of haemorrhage and appropriate resuscitation. Greater body weight in obesity can lead to overestimation of blood volume, resulting in inappropriately high thresholds for blood product transfusion and delays in treatment. The most recent Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) surveillance report demonstrated the risk to this population, with more than half of all maternal mortality recorded in parturients who were either overweight or obese. Current linear calculations used to estimate circulating blood volumes based on patients' weights could be contributing to this phenomenon, as blood volume increases at a disproportional rate to body composition. In this review, we summarise the relevant physiology and explore the existing literature on the estimation of circulating blood volume, both during pregnancy and in obesity. Building on key works and principal findings, we present a practical, nonlinear approach to the adjustment of estimated blood volume with increasing body mass. This clinical tool aims to reduce the clinical bias influencing the management of obstetric haemorrhage in a population already at increased risk of morbidity and mortality. Discussion of the limitations of this approach and the call for further research within this field completes this review.
    MeSH term(s) Pregnancy ; Female ; Humans ; Postpartum Hemorrhage/therapy ; Body Weight ; Obesity/complications ; Obesity/therapy ; Blood Transfusion ; Blood Volume
    Language English
    Publishing date 2022-09-24
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 80074-0
    ISSN 1471-6771 ; 0007-0912
    ISSN (online) 1471-6771
    ISSN 0007-0912
    DOI 10.1016/j.bja.2022.08.011
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  5. Article ; Online: Effects of the COVID-19 pandemic on environmental sustainability in anaesthesia. Comment on Br J Anaesth 2020; 125: 680-92.

    White, Stuart M / Shelton, Clifford L

    British journal of anaesthesia

    2020  Volume 126, Issue 3, Page(s) e118–e119

    MeSH term(s) Anesthesia ; COVID-19 ; Critical Care ; Humans ; Pandemics ; SARS-CoV-2
    Language English
    Publishing date 2020-12-05
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 80074-0
    ISSN 1471-6771 ; 0007-0912
    ISSN (online) 1471-6771
    ISSN 0007-0912
    DOI 10.1016/j.bja.2020.12.003
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  6. Article ; Online: Towards zero carbon healthcare: anaesthesia.

    Shelton, Clifford L / Knagg, Rebecca / Sondekoppam, Rakesh V / McGain, Forbes

    BMJ (Clinical research ed.)

    2022  Volume 379, Page(s) e069030

    MeSH term(s) Anesthesia, Conduction ; Anesthesiology ; Carbon ; Carbon Dioxide ; Delivery of Health Care ; Humans
    Chemical Substances Carbon Dioxide (142M471B3J) ; Carbon (7440-44-0)
    Language English
    Publishing date 2022-10-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj-2021-069030
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  7. Article ; Online: The carbon footprint of different modes of birth in the UK and the Netherlands: An exploratory study using life cycle assessment.

    Spil, Nienke A / van Nieuwenhuizen, Kim E / Rowe, Rachel / Thornton, Jim G / Murphy, Elizabeth / Verheijen, Evelyn / Shelton, Clifford L / Heazell, Alexander E P

    BJOG : an international journal of obstetrics and gynaecology

    2024  Volume 131, Issue 5, Page(s) 568–578

    Abstract: Objective: To compare the carbon footprint of caesarean and vaginal birth.: Design: Life cycle assessment (LCA).: Setting: Tertiary maternity units and home births in the UK and the Netherlands.: Population: Birthing women.: Methods: A ... ...

    Abstract Objective: To compare the carbon footprint of caesarean and vaginal birth.
    Design: Life cycle assessment (LCA).
    Setting: Tertiary maternity units and home births in the UK and the Netherlands.
    Population: Birthing women.
    Methods: A cradle-to-grave LCA using openLCA software to model the carbon footprint of different modes of delivery in the UK and the Netherlands.
    Main outcome measures: 'Carbon footprint' (in kgCO
    Results: Excluding analgesia, the carbon footprint of a caesarean birth in the UK was 31.21 kgCO
    Conclusion: The carbon footprint of a caesarean is higher than for a vaginal birth if analgesia is excluded, but this is very sensitive to the analgesia used; use of nitrous oxide with oxygen multiplies the carbon footprint of vaginal birth 25-fold. Alternative methods of pain relief or nitrous oxide destruction systems would lead to a substantial improvement in carbon footprint. Although clinical need and maternal choice are paramount, protocols should consider the environmental impact of different choices.
    MeSH term(s) Pregnancy ; Female ; Humans ; Animals ; Carbon Footprint ; Netherlands/epidemiology ; Nitrous Oxide ; Pain ; Oxygen ; United Kingdom/epidemiology ; Life Cycle Stages
    Chemical Substances Nitrous Oxide (K50XQU1029) ; Oxygen (S88TT14065)
    Language English
    Publishing date 2024-01-25
    Publishing country England
    Document type Journal Article
    ZDB-ID 2000931-8
    ISSN 1471-0528 ; 0306-5456 ; 1470-0328
    ISSN (online) 1471-0528
    ISSN 0306-5456 ; 1470-0328
    DOI 10.1111/1471-0528.17771
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  8. Article ; Online: Desflurane in modern anaesthetic practice: walking on thin ice(caps)?

    Shelton, Clifford L / Sutton, Rebecca / White, Stuart M

    British journal of anaesthesia

    2020  Volume 125, Issue 6, Page(s) 852–856

    MeSH term(s) Anesthetics, Inhalation ; Desflurane ; Perfusion Index ; Sevoflurane ; Walking
    Chemical Substances Anesthetics, Inhalation ; Sevoflurane (38LVP0K73A) ; Desflurane (CRS35BZ94Q)
    Language English
    Publishing date 2020-10-07
    Publishing country England
    Document type Editorial ; Comment
    ZDB-ID 80074-0
    ISSN 1471-6771 ; 0007-0912
    ISSN (online) 1471-6771
    ISSN 0007-0912
    DOI 10.1016/j.bja.2020.09.013
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  9. Article ; Online: Erroneous neuraxial administration of neuromuscular blocking drugs: Case reports and 'the absence of evidence'.

    Elsayed, Eslam / Al-Kamil, Abdulla / England, Emma Louise / Shelton, Clifford L

    European journal of anaesthesiology

    2021  Volume 38, Issue 12, Page(s) 1303–1304

    MeSH term(s) Humans ; Neuromuscular Blockade/adverse effects ; Neuromuscular Blocking Agents/adverse effects ; Pharmaceutical Preparations
    Chemical Substances Neuromuscular Blocking Agents ; Pharmaceutical Preparations
    Language English
    Publishing date 2021-11-04
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 605770-6
    ISSN 1365-2346 ; 0265-0215
    ISSN (online) 1365-2346
    ISSN 0265-0215
    DOI 10.1097/EJA.0000000000001460
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  10. Article ; Online: Bubble-PAPR: a phase 1 clinical evaluation of the comfort and perception of a prototype powered air-purifying respirator for use by healthcare workers in an acute hospital setting.

    McGrath, Brendan A / Shelton, Clifford L / Gardner, Angela / Coleman, Ruth / Lynch, James / Alexander, Peter G / Cooper, Glen

    BMJ open

    2023  Volume 13, Issue 5, Page(s) e066524

    Abstract: Objectives: We aimed to design and produce a low-cost, ergonomic, hood-integrated powered air-purifying respirator (Bubble-PAPR) for pandemic healthcare use, offering optimal and equitable protection to all staff. We hypothesised that participants would ...

    Abstract Objectives: We aimed to design and produce a low-cost, ergonomic, hood-integrated powered air-purifying respirator (Bubble-PAPR) for pandemic healthcare use, offering optimal and equitable protection to all staff. We hypothesised that participants would rate Bubble-PAPR more highly than current filtering face piece (FFP3) face mask respiratory protective equipment (RPE) in the domains of comfort, perceived safety and communication.
    Design: Rapid design and evaluation cycles occurred based on the identified user needs. We conducted diary card and focus group exercises to identify relevant tasks requiring RPE. Lab-based safety standards established against British Standard BS-EN-12941 and EU2016/425 covering materials; inward particulate leakage; breathing resistance; clean air filtration and supply; carbon dioxide elimination; exhalation means and electrical safety. Questionnaire-based usability data from participating front-line healthcare staff before (usual RPE) and after using Bubble-PAPR.
    Setting: Overseen by a trial safety committee, evaluation progressed sequentially through laboratory, simulated, low-risk, then high-risk clinical environments of a single tertiary National Health Service hospital.
    Participants: 15 staff completed diary cards and focus groups. 91 staff from a range of clinical and non-clinical roles completed the study, wearing Bubble-PAPR for a median of 45 min (IQR 30-80 (15-120)). Participants self-reported a range of heights (mean 1.7 m (SD 0.1, range 1.5-2.0)), weights (72.4 kg (16.0, 47-127)) and body mass indices (25.3 (4.7, 16.7-42.9)).
    Outcome measures: Preuse particulometer 'fit testing' and evaluation against standards by an independent biomedical engineer.Primary:Perceived comfort (Likert scale).Secondary: Perceived safety, communication.
    Results: Mean fit factor 16 961 (10 participants). Bubble-PAPR mean comfort score 5.64 (SD 1.55) vs usual FFP3 2.96 (1.44) (mean difference 2.68 (95% CI 2.23 to 3.14, p<0.001). Secondary outcomes, Bubble-PAPR mean (SD) versus FFP3 mean (SD), (mean difference (95% CI)) were: how safe do you feel? 6.2 (0.9) vs 5.4 (1.0), (0.73 (0.45 to 0.99)); speaking to other staff 7.5 (2.4) vs 5.1 (2.4), (2.38 (1.66 to 3.11)); heard by other staff 7.1 (2.3) vs 4.9 (2.3), (2.16 (1.45 to 2.88)); speaking to patients 7.8 (2.1) vs 4.8 (2.4), (2.99 (2.36 to 3.62)); heard by patients 7.4 (2.4) vs 4.7 (2.5), (2.7 (1.97 to 3.43)); all p<0.01.
    Conclusions: Bubble-PAPR achieved its primary purpose of keeping staff safe from airborne particulate material while improving comfort and the user experience when compared with usual FFP3 masks. The design and development of Bubble-PAPR were conducted using a careful evaluation strategy addressing key regulatory and safety steps.
    Trial registration number: NCT04681365.
    MeSH term(s) Humans ; State Medicine ; Respiratory Protective Devices ; Health Personnel ; Perception ; Hospitals
    Language English
    Publishing date 2023-05-08
    Publishing country England
    Document type Clinical Trial, Phase I ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2022-066524
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