Background to the diseaseGout is the most common cause of inflammatory arthritis worldwide. In UK general practice, the overall prevalence has increased from 1.4% in 1999 to 2.49% in 2012 1 , despite the availability of effective and potentially 'curative' urate-lowering drugs for more than 50 years and evidence-based British and European management guidelines for nearly a decade 2;3 . Clinical manifestations of gout resulting from monosodium urate (MSU) crystal deposition, include tophi, chronic arthritis, urolithiasis and renal disease as well as recurrent acute arthritis, bursitis and cellulitis. Gouty arthritis and tophi are associated with chronic disability, impairment of health-related quality of life (HRQOL) [4][5][6][7] , increased use of healthcare resources, and reduced productivity 8 . Gout is also frequently associated with co-morbidities such as obesity, dyslipidaemia, diabetes mellitus, chronic renal insufficiency, hypertension, cardiovascular disease, hypothyroidism, anaemia, psoriasis, chronic pulmonary diseases, depression and osteoarthritis 1 as well as with an increase in all-cause mortality (adjusted hazard ratio 1.13, 95% CI 1.08 to 1.18) and urogenital malignancy 1;9 . Sustained hyperuricaemia is the single most important risk factor for the development of gout. Hyperuricaemia occurs secondary to reduced fractional clearance of uric acid in more than 90% of patients with gout 10 . Age, male gender, menopausal status in females, impairment of renal function, hypertension and the co-morbidities that comprise the metabolic syndrome are all risk factors for incident Recently published guidelines include the 2012 American College of Rheumatology Guidelines for the Management of Gout 34,35 and the 2013 evidence-based recommendations for the diagnosis and management of gout by a multinational panel of rheumatologists participating in the 3e initiative 36 . Other National and Regional guidelines include the US Government 2014 Agency for Healthcare Research and Quality (AHRQ) Guidelines for the Diagnosis and Management of Gout 37,38 , and the Australian and New Zealand 39 and Portuguese 40 recommendations for the diagnosis and management of gout which arose from the 3e initiative. 36 Updated EULAR recommendations for the management of gout will be published in 2016. ObjectiveThis guideline aims to offer revised and updated, concise, patient-focussed, evidence-based, expert recommendations for the management of gout in the UK.

A number of prospective randomized comparator studies have suggested that there is a reduction in post-operative nausea and vomiting following maintenance of anaesthesia with propofol compared with inhalational agents. We analysed these studies in more detail by examining the effects of induction agent, choice of inhalation agent, presence/absence of nitrous oxide, age of patient or use of opiate on the incidence of emesis. A search of the Zeneca database MEDLEY was undertaken and prospective randomized comparator studies identified. These were examined individually and independently by two of the authors and log-odds ratios, calculated from the incidence data of each individual trial, were determined and combined using a fixed-effects meta-analysis approach. Patients who received maintenance of anaesthesia with propofol had a significantly lower incidence of post-operative nausea and vomiting in comparison with inhalational agents regardless of induction agent, choice of inhalation agent, presence/absence of nitrous oxide, age of patient or use of opiate.

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An assessment centre model based on the rating of non-technical skills can produce a reliable and valid selection tool for recruitment to speciality training in anaesthesia. Early results on predictive validity are encouraging and justify further development and evaluation.