The International Standards for a Safe Practice of Anesthesia were developed on behalf of the World Federation of Societies of Anaesthesiologists (WFSA), a nonprofit organization representing anesthesiologists in 150 countries, and the World Health Organization (WHO). The recommendations have been approved by WHO and the membership of WFSA. These Standards are applicable to all anesthesia providers throughout the world. They are intended to provide guidance and assistance to anesthesia providers, their professional organizations, hospital and facility administrators, and governments for maintaining and improving the quality and safety of anesthesia care. The Standards cover professional aspects; facilities and equipment; medications and intravenous fluids; monitoring; and the conduct of anesthesia. HIGHLY RECOMMENDED standards, the functional equivalent of mandatory standards, include (amongst other things): the continuous presence of a trained and vigilant anesthesia provider; continuous monitoring of tissue oxygenation and perfusion by clinical observation and a pulse oximeter; intermittent monitoring of blood pressure; confirmation of correct placement of an endotracheal tube (if used) by auscultation and carbon dioxide detection; the use of the WHO Safe Surgery Checklist; and a system for transfer of care at the end of an anesthetic. The International Standards represent minimum standards and the goal should always be to practice to the highest possible standards, preferably exceeding the standards outlined in this document.

Key Points Question What percentage of the Virginia population had been exposed to severe acute respiratory syndrome coronavirus 2 after the first wave of coronavirus disease 2019 (COVID-19) infections in the US? Findings In this cross-sectional study of 4675 adult outpatients presenting for non–COVID-19–associated health care in Virginia, a seroprevalence of approximately 2% was found, with an estimated 66% of seropositive results associated with asymptomatic infections. Hispanic ethnicity, residence in a multifamily unit, and contact with an individual with confirmed COVID-19 infection were risk factors significantly associated with exposure. Meaning This study found that, as of August 2020, the population of Virginia remained largely immunologically naive to the virus.

Perioperative cardiac arrests were higher in patients with poor physical status, in those under 1 year of age, and in female patients. Anesthesia-related cardiac arrests were mainly due to medication- or airway-related causes. The majority of arrests were avoidable indicating the importance of prevention strategies.

Background and Objective:Sepsis remains a leading cause of death across the world, carrying a mortality rate of 20–50%. Women have been reported to be less likely to suffer from sepsis and to have a lower risk of mortality from sepsis compared to men. The objective of this study was to determine the relationship between gender and mortality in sepsis, and compare cytokine profiles of male and female patients.Methods:This was a prospective case series on 97 patients admitted with sepsis. Clinical and microbiological data was gathered, blood samples were collected for cytokine (IL-10, IL-6 and TNFα) levels and patients were followed up for clinical outcome.Results:There were 54% males and 46% females, with no significant difference of age or comorbids between genders. Respiratory tract infection was the commonest source of sepsis, and was more common in females (60%) compared to males (39%) (p=0.034). Males had a higher mortality (p=0.048, RR 1.73) and plasma IL-6 level(p=0.040) compared to females. Mean IL-6 plasma level was significantly (p<0.01) higher in patients who died vs. who recovered.Conclusion:Our study shows that males with sepsis have a 70% greater mortality rate, and mortality is associated with a higher IL-6 plasma level.

SummarySixty gynaecological day-case patients were anaesthetised with either desflurane or sevoflurane in oxygen/nitrous oxide, following intravenous induction. Mean end-tidal desflurane was 4.5% at 5 and 10 min post induction, whereas mean end-tidal sevoflurane was 1.7%. There were five untoward airway events (coughing, hiccoughs) in the desflurane group and three in the sevoflurane group, including one laryngospasm. Time to eye opening and orientation following anaesthesia were significantly faster in the desflurane group (2.8 min/4.8 min) than in the sevoflurane group (7.0 min/9.8 min; p , 0.0001). Time to being ready for discharge home was also significantly earlier in the desflurane group (3 h compared with 3.5 h). Telephone interview on the first postoperative day showed that in the desflurane group 29 of 31 were fully returned to normal activity compared with only 15 out of 29 in the sevoflurane group (p , 0.01).Keywords Anaesthetics, volatile: desflurane; sevoflurane. Surgery: day-case; gynaecology. The use of low-solubility inhalation agents can be of benefit to day-case anaesthesia as it allows more rapid emergence and recovery [1±3] and should hasten return to street fitness, although there are comparatively few studies to support this. The inhalation agents sevoflurane and desflurane have lower blood-gas solubility, which should result in rapid induction but, more importantly, rapid awakening [4]. However, there have been few direct comparisons of the two agents. A study on ventilated gynaecological laparosocopy patients showed a faster early recovery with desflurane than with sevoflurane [5], and another on day-case orthopaedic arthroscopy patients found faster recovery, but no faster discharge [6].However, although it possesses lower blood-gas solubility than sevoflurane, desflurane can be irritant to airways [7]. Therefore, sevoflurane is generally considered to be the agent of choice for day-case anaesthesia with spontaneous respiration for short cases, despite possibly faster recovery with desflurane. We wished to compare the efficacy of desflurane and sevoflurane for short daycase procedures in gynaecological day-case surgery. MethodsFollowing local research committee approval, 63 patients scheduled for minor day-case gynaecological surgery (D & C, hysteroscopy and suction termination of pregnancy) were randomly allocated to one of two groups. All patients were aged between 16 and 75 years, ASA 1 and 2, could speak English and would be contactable by telephone the next day. No patient was distressed by the forthcoming procedure and all had satisfactory domestic arrangements following the planned day-case discharge. They all had the nature of the study explained on the day of admission and gave written informed consent. No premedication was given.On arrival in the anaesthetic room, all patients had a venous cannula inserted and were given metoclopamide q 2001 Blackwell Science Ltd 171 10 mg, fentanyl 50 mg and propofol 2 mg.kg 21 . Patients were randomly allocated by sealed envelope to receive e...