Top 10 Papers

A recent survey of anaesthetists asked which papers were the most influential to their practice.

In no particular order, here are the top 10 most frequently mentioned papers


1. The UK National Audit Projects (NAPs).

NAP 3 – Major complications of central neuraxial block.

NAP 4 – Major Complication of airway management.

NAP 5 – Accidental awareness during general anaesthesia.

NAP 6 – Perioperative anaphylaxis (ongoing).

2. The Difficult Airway Society’s (DAS) guidelines for unexpected difficult intubation

3. Devereux’s review of Cardiac Complications in Patients Undergoing Major Non-Cardiac Surgery.

4. A Surgical Safer Checklist. Atul Gawande’s paper that showed that the implementation of a surgical checklist reduces mortality and complications

5. IMPROVE. Patients having major abdominal surgery had better outcomes if they were ventilated with 6-8ml/kg tidal volumes with PEEP compared to 10-12 ml/kg without PEEP

6. POISE. Peri-operative beta blockade increases mortality in patients with, or at risk of athero-sclerotic disease undergoing non-cardiac surgery. Lower rates of myocardial infarction were offset by higher rates of stroke and higher overall mortality.

7. The paper by Rivers et al. that showed that early goal-directed therapy improves outcomes in patients with sepsis and septic shock (see also the PROMISE, PROCESS and ARISE trials)

8. TRICC  Using a lower haemoglobin of 7 g/dl as a trigger for blood transfusion has the same mortality as a trigger of 10 g/dl and may be beneficial in some patient groups

9. ARDSNet. Patients with ARDS or Acute Lung Injury had lower mortality if they were ventilated on ICU with tidal volumes of 6ml/kg and a plateau pressure of <30cm water compared with those ventilated at 12ml/kg and a plateau pressure of <50cm water

10. The CRASH trials

CRASH I  – IV corticosteroids increase mortality in adults with severe traumatic head injury

CRASH II – Early IV tranexamic acid reduces mortality in bleeding trauma patients


In addition to this list, I would also add MBRRACE’s Confidential Enquiries into Maternal Deaths and the NCEPOD reports.

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