Quick Journal Club - ESRA

ESRA Updates

February 2021 | Issue 04

Quick Journal Club

Nuala Lucas (Co-Editor of ESRA Updates, Norwick Park Hospital, Harrow, UK) @noolslucas
Kris Vermeylen (Co-Editor of ESRA Updates, AZ Turnhout, Belgium) @KVermeylen
Sari Casaer (GZA Antwerpen, Belgium) @SCasaer

Anesthetic literature is one of the reasons people alter their clinical practice. The number of published articles in numerous journals is immense. But how can one differ clinically relevant or interesting articles from articles of less clinical importance? For those scientific active it all seems logic who to follow and what to read. But lots of colleagues depend for this info on cited literature in presentations (e.g. during meetings) or face-to-face discussions during networking sessions.
Since the start of the COVID pandemic however real time meetings could not or hardly be organized and networking sessions are banned.

We would therefor like to introduce a new section in our ESRA Updates. Every edition of the ESRA Updates we will ask a colleague to select one (or more) article(s) which for him/her were/are important, interesting or changed their clinical practice. This choice can be a general big randomized study but can also be very personal. Each of these collaborators will explain their choice.

We would like to invite all readers if they come across an article they find worthwhile sharing for what reason at all to contact one of the members of the editorial team.

For this edition Dr Sari Casaer (GzA hospitals, Antwerp, Belgium – board member BARA) selected her most recent top 3 of interesting articles.

“When I think about the publications that caught my interest, or kept running through my mind in 2020, my first choice is the Editorial of White and Shelton published in Anaesthesia[1], calling out to the community of anesthetists to abandon inhalational anaesthesia. It describes the non-negligible impact on the climate of one of our most common daily interventions and predicts, or begs for, a possible major shift in our daily practice during this century. The subsequent correspondence[2, 3] seems to temper the drastic change needed, but anyway all the recited arguments are also in favor of the importance of regional anesthesia. Shifting the opinion away from general anesthesia as the ever available first line option. Regional anesthesia is promoted as the main tool for perioperative management whenever possible, not only as a ‘fun technical alternative’ for the ones motivated and interested to broaden their practice and aiming to spare opioids. The same remarks are made by Kuvadia [4], launching the beautiful name ‘green-gional’ anesthesia, a technique with global benefit.

Another remarkable publication is the editorial by Leng and Mariano on marginal gains in enhanced recovery [5]. Reading this one feels even great names as Ed Mariano acknowledge the difficulties encountered during implementation of clinical pathways. The need of ‘big differences’ by changing one thing to the high-level medicine we are already practicing is tempered. A little better is also better, an important thought I will always keep in mind and applicable while reading many different research results. Anesthesia as an Olympic discipline, with a comparison to the efforts and reasoning made by the British Cycling team.

At last I chose to mention the daring discourse on anesthesia for joint arthroplasty by Schwenk and Johnson [6]. It gives a short and clear overview of the ongoing discussion on spinal versus general anesthesia in a written pro/con debate. Even when in doubt if outpatient TJA is really a necessary target to pursue, this discussion is applicable to all inpatients as well. Many of the same arguments can be found in the nice overview on hip fracture repair, again by Shelton and White [7] (apparently we share the same interests). And it all comes down to the most essential conclusion: the importance of preoperative preparation, patient selection, risk stratification and tailored anesthesia.”




  1. White, S.M. and C.L. Shelton, Abandoning inhalational anaesthesia. Anaesthesia, 2020. 75(4): p. 451-454.
  2. Tapley, P., M. Patel, and M. Slingo, Abandoning inhalational anaesthesia. Anaesthesia, 2020. 75(9): p. 1257-1258.
  3. White, S.M. and C.L. Shelton, Abandoning inhalational anaesthesia: a reply. Anaesthesia, 2020. 75(9): p. 1258-1259.
  4. Kuvadia, M., et al., ‘Green-gional’ anesthesia: the non-polluting benefits of regional anesthesia to decrease greenhouse gases and attenuate climate change. Regional Anesthesia & Pain Medicine, 2020. 45(9): p. 744-745.
  5. Leng, J.C. and E.R. Mariano, A little better is still better: using marginal gains to enhance ‘enhanced recovery’ after surgery. Regional Anesthesia & Pain Medicine, 2020. 45(3): p. 173-175.
  6. Schwenk, E.S. and R.L. Johnson, Spinal versus general anesthesia for outpatient joint arthroplasty: can the evidence keep up with the patients? Regional Anesthesia & Pain Medicine, 2020. 45(11): p. 934-936.
  7. White, S.M. and C.L. Shelton, Anesthesia for hip fracture repair. BJA Education. 20(5): p. 142-149.
Topics: Regional Anaesthesia , Recovery , Journal club , Top articles , Inhalation anaesthesia , Hip fracture repair

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