The European anaesthesia workforce is facing increased demand and expansion of the labour market, which may likely exceed supply. This survey assesses the numbers and practice patterns of anaesthesiologists and studies migration and shortage of the anaesthesia workforce in Europe.

A questionnaire was sent to all national European anaesthesia societies. Countries were grouped according to their relationship with the European Union.

The number of anaesthesiologists per 100 000 population varies between 2.7 (Turkey) and 20.7 (Estonia). There seems to be no clear evidence for feminization of the anaesthesia workforce. Anaesthesia physician training lasts between 3 yr (Armenia, Belarus, Uzbekistan) and 7 yr (Ireland, UK), and seems to positively correlate with the number of trainees. Throughout Europe, anaesthesiologists typically work in public practice, and are involved in the entire care chain of surgical patients (anaesthesia, intensive care, chronic pain and pre-hospital emergency medicine). The differences between European salaries for anaesthesiologists are up to 50-fold. Most Western European countries are recipients of migrating anaesthesiologists who often originate from the new member states of the European Union. However, it seems that expectations about anaesthesia workforce shortages are not confined to Eastern Europe.

Each European country has its own unique workforce constellation and practice pattern. Westward migration of anaesthesiologists from those countries with access to the European Union labour market may be explained by substantial salary differences. There is a European-wide lack of systematic, comparable data about the anaesthesia workforce, which makes it difficult to accurately assess the supply of anaesthesiologists.

The case/problem-based learning discussion method was recently introduced into the theory-based training program for residents run by the Catalan Society of Anaesthesiology. This study was designed to assess and compare its effectiveness with that of the lecture-based approach for teaching pre-anaesthetic assessment, applying an objective tool for knowledge evaluation before and after teaching.

A prospective randomized study of two consecutive year groups of first year anaesthesiology residents was conducted. Twenty-nine residents attended a lecture, and 25, a case/problem-based learning discussion session. Their knowledge of pre-anaesthetic assessment was assessed before and after the teaching session with tests on four different clinical cases measuring six fields: (1) ‘recognizing clinical data with anaesthetic implications’; (2) ‘reasoning clinical data with anaesthetic implications’; (3) ‘ASA class’; (4) ‘Mallampati class’; (5) ‘choice of anaesthetic technique’; (6) ‘reasoning choice of anaesthetic technique’.

Before the teaching session, the lecture group scored significantly higher on field 1 (P = 0.006). Both teaching methods improved scores on fields 1, 2 and 4. The case/problem group also improved on fields 3 and 6. After the teaching session, the field 1 score was still significantly higher in the lecture group (P = 0.005), and the field 3 score was significantly higher in the case/problem group (P = 0.044).

The effectiveness of lecture and case/problem-based learning discussion differed little in terms of improving participants’ immediate knowledge of ‘pre-anaesthetic assessment’.

The purpose of this study was to determine whether brain oxyhaemoglobin–deoxyhaemoglobin coupling was altered by anaesthesia or intubation-induced stress.

This was a prospective observational study in the operating room. Thirteen patients (ASA I and II) undergoing spinal or peripheral nerve procedures were recruited. They were stabilized before surgery with mask ventilation of 100% oxygen. Anaesthesia was induced with 2 μg kg−1 fentanyl and 3 mg kg−1 thiopental. Laryngoscopy and intubation were performed 4 min later. After intubation, desflurane anaesthesia (FiO2=1.0) was adjusted to maintain response entropy of the electroencephalogram at 40–45 for 20 min. Prefrontal cortex oxyhaemoglobin and deoxyhaemoglobin were determined every 2 s using frequency domain near-infrared spectroscopy. Blood pressure, heart rate and response entropy were collected every 10 s.

Awake oxyhaemoglobin and deoxyhaemoglobin were 18.9 ± 2.3 μmol (mean ± SD) and 12.7 ± 0.8 μmol, respectively, and neither changed significantly during induction. Intubation increased oxyhaemoglobin by 37% (P < 0.05) and decreased deoxyhaemoglobin by 16% (P < 0.05), and both measures returned to baseline within 20 min of desflurane anaesthesia. Blood pressure, heart rate and electroencephalogram response entropy increased during intubation, and the increase in heart rate correlated with the increase in brain oxygen saturation (r = 0.48, P < 0.05).

Intubation-related stress increased oxyhaemoglobin related to electroencephalogram and autonomic activation. Stress-induced brain stimulation may be monitored during anaesthesia using frequency domain near-infrared spectroscopy.

Propofol is reported to have protective effects on cerebral ischaemia-induced neuronal death. The aim of this study was to explore whether propofol and halothane can protect hippocampal neuronal function from ischaemic injury during general anaesthesia in rats.

Rats were divided into 2-vessel occlusion (incomplete cerebral ischaemia) and 4-vessel occlusion (complete cerebral ischaemia) groups consisting of three subgroups each (sham-operated, propofol and halothane groups). One hour after starting propofol 1 mg kg−1 min−1 with 30% O2 and N2 or halothane 0.8% in 30% O2 and N2 rats with or without bilateral vertebral artery occlusion had bilateral common carotid arteries occluded by vessel clips for 10 min. Anaesthesia was maintained for another 1 h. Seven days after ischaemia–reperfusion, hippocampal long-term potentiation in the perforant path–dentate gyrus synapse was determined as an index of cerebral outcome.

In the propofol groups, the formation of long-term potentiation was significantly impaired in the 2-vessel and 4-vessel occlusion groups compared to the respective sham-operated groups (P < 0.01 and P < 0.05, respectively). Impaired formation of long-term potentiation in propofol groups was comparable to that in halothane groups. The formation of long-team potentiation in the propofol and halothane 2-vessel group was not significantly different from that in the awake 2-vessel group.

Propofol and halothane administered during ischaemia do not possess protective effects against hippocampal neuronal dysfunction induced by cerebral ischaemia–reperfusion as evaluated by our transient ischaemic rat models.

The aim of this study was to compare cardiac output measurements of the non-invasive cardiac output and the pulmonary artery catheter during repeat surgery for hip replacement.

In this prospective observational study, patients undergoing repeat hip surgery who needed a pulmonary artery catheter were included. A standard protocol was followed for induction, endotracheal intubation and maintenance of anaesthesia (sufentanil, etomidate, sevoflurane, cisatracurium). After endotracheal intubation, the non-invasive cardiac output was connected and a pulmonary artery catheter was inserted. Data were collected every 3 min until patients were extubated.

Ten patients were included and 2455 points of comparison recorded. Cardiac output from the pulmonary artery catheter varied from 1.7 to 8.9 L min−1 (mean 4.1 L min−1) and the non-invasive cardiac output (using averaging mode) from 1.7 to 8.0 L min−1 (mean 3.7 L min−1). There was a significant correlation between them (P < 0.01; bias 0.3 L min−1; limits of agreement +1.9 and –2.5 L min−1), although these differed between patients.

The perioperative bias was small and the non-invasive cardiac output slightly underestimated cardiac output intraoperatively compared to the pulmonary artery catheter. The bias was smaller when mean cardiac output was below 3 L min−1. Core temperature between 34.4°C and 37.6°C had no influence on the differences.

Preoperative evaluation is important in the detection of patients at risk for difficult airway management. It is still unclear whether true prediction is possible and which variables should be chosen for evaluation. The aim of this prospective, multi-centre study was to investigate the incidence of difficult intubation, the sensitivity and positive predictive values of clinical screening tests and whether combining two or more of these tests will improve the prediction of difficult intubation in Turkish patients.

Seven study sites from six regions in Turkey participated in this study. One thousand six hundred and seventy-four ASA physical status I–III patients, scheduled to undergo elective surgery under general anaesthesia, were included.

The incidence of difficult intubation was 4.8% and increased with age (P < 0.05). The incidence of difficult intubation was significantly higher in patients who had a Mallampati III or IV score, a decreased average thyromental and sternomental distance, decreased mouth opening, or decreased protrusion of the mandible (P < 0.05). Mouth opening and Mallampati III–IV were found to be the most sensitive criteria when used alone (43% and 35%, respectively). Combination of tests did not improve these results.

There is still no individual test or a combination of tests that predict difficult intubations accurately. Tests with higher specificity despite low positive predictive value are needed.

Medialization thyroplasty is a surgical technique for improving voice quality, cough effort and laryngeal competence in patients with unilateral vocal fold paralysis. Precision surgery is enabled by operating under total intravenous anaesthesia with controlled ventilation and by using a laryngoscopic video-assisted technique. The anaesthetic challenge is to manage the shared airway with the surgeon, provide a stable operative field and ensure patient safety throughout the procedure. The objective of this case series was to evaluate the use of a modified general anaesthetic technique using the laryngeal mask airway, total intravenous anaesthesia with controlled ventilation.

In all, 29 patients underwent medialization thyroplasty using a disposable laryngeal mask airway, total intravenous anaesthesia and controlled ventilation. Standard anaesthetic monitoring including capnography was used intraoperatively. Total intravenous anaesthesia was achieved using effect site target-controlled infusions of propofol and remifentanil.

The technique proved safe with stable haemodynamic observations and only two minor complications. It also provided the surgeon with stable view of the vocal folds in order to perform this precision surgery under an operating microscope.

Tracheal intubation may be more difficult in morbidly obese patients (body mass index >35 kg m−2) than in the non-obese. Recently, new video-assisted intubation devices have been developed. After some experience with videolaryngoscopy, we hypothesized that it could improve the laryngoscopic view in this specific population and therefore facilitate intubation. The aim of this study was to assess the benefit of a videolaryngoscope on the grade of laryngoscopy in morbid obesity.

We studied 80 morbidly obese patients undergoing bariatric surgery. They were randomly assigned to one of two groups. One group was intubated with the help of the videolaryngoscope and in the control group the screen of the videolaryngoscope was hidden to the intubating anaesthesiologist. The primary end-point of the study was to assess in both groups the Cormack and Lehane direct and indirect grades of laryngoscopy. The duration of intubation, the number of attempts needed as well as the minimal SPO2 reached during the intubation process were measured.

Grade of laryngoscopy was significantly lower with the videolaryngoscope compared with the direct vision (P < 0.001). When the grade of laryngoscopy was higher than one with the direct laryngoscopy (n = 30), it was lower in 28 cases with the videolaryngoscope and remained the same only in two cases (P < 0.001). The minimal SPO2 reached during the intubation was higher with the videolaryngoscope but it did not reach statistical significance.

In morbidly obese patients, the use of the videolaryngoscope significantly improves the visualization of the larynx and thereby facilitates intubation.

This study follows up an initial audit in 1992 indicating that anaesthetic machine checking practices were often incomplete. The aims were to ascertain if there has been any improvement during this period with special reference to the latest guidelines.

Following the Association of Anaesthetists of Great Britain and Ireland machine checking guidelines, a structured questionnaire, was used to interview 41 anaesthetists in the South West region on one particular day.

Despite 80% of subjects stating that they had read the latest guidelines recently, only one undertook a complete check and 39/41 (95%) performed partial checks (omitting one or more steps in the guidelines). Steps most commonly omitted were additional monitoring, ventilator function, availability of an alternative means of ventilation and function of ancillary equipment such as laryngoscopes. Only 5/41 subjects performed any check between cases. Several of these checks have been introduced in the 2004 guidelines.

Although there has been a significant increase in the proportion of anaesthetists undertaking machine checks since 1992 (P = 0.0007), we conclude that machine checking guidelines are still poorly followed, with checks specific to the latest guidelines most likely to be omitted.