Publications
65 results found
Kemp H, Laycock H, Costello A, et al., 2019, Chronic pain in critical care survivors, BJA: British Journal of Anaesthesia, ISSN: 1471-6771
Chronic pain is an important problem following critical care admission. Estimates of prevalence of chronic pain in the year following discharge range from 14-77% depending on the type of cohort, the tool used to measure pain and the time point when pain was assessed. The majority of data available comefrom studies using health-related quality of life tools,although some have included pain-specific tools. Nociceptive, neuropathic and nociplastic pain can occur in critical caresurvivors butlimited information about aetiology, body site and temporal trajectory of pain is currently available. Older age, pre-existing pain andmedicalco-morbidity have been associated with pain after critical careadmission. No trials were identified of interventions to target chronic pain in survivors specifically. Larger studies, using pain-specific tools, over an extended follow up period are required to confirm prevalence, identify risk factors, explore anyassociation between acute and chronic pain in this setting, determine underlying pathological mechanisms and inform the development of future analgesic interventions.
Stamenkovic DM, Laycock H, Karanikolas M, et al., 2019, Chronic pain and chronic opioid use after intensive care discharge - Is it time to change practice?, Frontiers in Pharmacology, Vol: 10, ISSN: 1663-9812
Almost half of patients treated on intensive care unit (ICU) experience moderate to severe pain. Managing pain in the critically ill patient is challenging, as their pain is complex with multiple causes. Pharmacological treatment often focuses on opioids, and over a prolonged admission this can represent high cumulative doses which risk opioid dependence at discharge. Despite analgesia the incidence of chronic pain after treatment on ICU is high ranging from 33–73%. Measures need to be taken to prevent the transition from acute to chronic pain, whilst avoiding opioid overuse. This narrative review discusses preventive measures for the development of chronic pain in ICU patients. It considers a number of strategies that can be employed including non-opioid analgesics, regional analgesia, and non-pharmacological methods. We reason that individualized pain management plans should become the cornerstone for critically ill patients to facilitate physical and psychological well being after discharge from critical care and hospital.
Laycock H, Crawford V, Rice ASC, et al., 2019, Lessons learnt from establishing a high dose opioid review clinic for people living with HIV, Pain Management, Vol: 9, ISSN: 1758-1869
People living with HIV represent a unique aging population, living with a chronic condition associated with significant pain. A number take high dose, long-term opioids to manage moderate to severe chronic pain, presenting specific risks. This article highlights the size and impact of this problem and outlines the service objectives and set up of a specialist clinic to manage people living with HIV on high dose opioids, alongside its successes and learning points.
Watson X, Chereshneva M, Odor PM, et al., 2018, Adoption of lung protective ventilation IN patients undergoing emergency laparotomy: the ALPINE study. A prospective multicentre observational study, British Journal of Anaesthesia, Vol: 121, Pages: 909-917, ISSN: 0007-0912
BackgroundEmergency abdominal surgery is associated with a high risk of postoperative pulmonary complications (PPCs). The primary aim of this study was to determine whether patients undergoing emergency laparotomy are ventilated using a lung-protective ventilation strategy employing tidal volume ≤8 ml kg−1 ideal body weight−1, PEEP >5 cm H2O, and recruitment manoeuvres. The secondary aim was to investigate the association between ventilation factors (lung-protective ventilation strategy, intraoperative FiO2, and peak inspiratory pressure) and the occurrence of PPCs.MethodsData were collected prospectively in 28 hospitals across London as part of routine National Emergency Laparotomy Audit (NELA). Patients were followed for 7 days. Complications were defined according to the European Perioperative Clinical Outcome definition.ResultsData were collected from 568 patients. The median [inter-quartile range (IQR)] tidal volume observed was 500 ml (450–540 ml), corresponding to a median tidal volume of 8 ml kg−1 ideal body weight−1 (IQR: 7.2–9.1 ml). A lung-protective ventilation strategy was employed in 4.9% (28/568) of patients, and was not protective against the occurrence of PPCs in the multivariable analysis (hazard ratio=1.06; P=0.69). Peak inspiratory pressure of <30 cm H2O was protective against development of PPCs (hazard ratio=0.46; confidence interval: 0.30–0.72; P=0.001). Median FiO2 was 0.5 (IQR: 0.44–0.53), and an increase in FiO2 by 5% increased the risk of developing a PPC by 8% (2.6–14.1%; P=0.008).ConclusionsBoth intraoperative peak inspiratory pressure and FiO2 are independent factors significantly associated with development of a postoperative pulmonary complication in emergency laparotomy patients. Further studies are required to identify causality and to demonstrate if their manipulation could lead to better clinical outcomes.
Wong DJN, Harris SK, Moonesinghe SR, 2018, Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals, British Journal of Anaesthesia, Vol: 121, Pages: 730-738, ISSN: 0007-0912
Morkane CM, McKenna H, Cumpstey AF, et al., 2018, Intraoperative oxygenation in adult patients undergoing surgery (iOPS): a retrospective observational study across 29 UK hospitals, Perioperative Medicine, Vol: 7, ISSN: 2047-0525
BackgroundConsiderable controversy remains about how much oxygen patients should receive during surgery. The 2016 World Health Organization (WHO) guidelines recommend that intubated patients receive a fractional inspired oxygen concentration (FIO2) of 0.8 throughout abdominal surgery to reduce the risk of surgical site infection. However, this recommendation has been widely criticised by anaesthetists and evidence from other clinical contexts has suggested that giving a high concentration of oxygen might worsen patient outcomes. This retrospective multi-centre observational study aimed to ascertain intraoperative oxygen administration practice by anaesthetists across parts of the UK.MethodsPatients undergoing general anaesthesia with an arterial catheter in situ across hospitals affiliated with two anaesthetic trainee audit networks (PLAN, SPARC) were eligible for inclusion unless undergoing cardiopulmonary bypass. Demographic and intraoperative oxygenation data, haemoglobin saturation and positive end-expiratory pressure were retrieved from anaesthetic charts and arterial blood gases (ABGs) over five consecutive weekdays in April and May 2017.ResultsThree hundred seventy-eight patients from 29 hospitals were included. Median age was 66 years, 205 (54.2%) were male and median ASA grade was 3. One hundred eight (28.6%) were emergency cases. An anticipated difficult airway or raised BMI was documented preoperatively in 31 (8.2%) and 45 (11.9%) respectively. Respiratory or cardiac comorbidity was documented in 103 (27%) and 83 (22%) respectively. SpO2 < 96% was documented in 83 (22%) patients, with 7 (1.9%) patients desaturating < 88% at any point intraoperatively. The intraoperative FIO2 ranged from 0.25 to 1.0, and median PaO2/FIO2 ratios for the first four arterial blood gases taken in each case were 24.6/0.5, 23.4/0.49, 25.7/0.46 and 25.4/0.47 respectively.ConclusionsIntraoperative oxygenation currently varies widely. An intraoperative FIO2 of 0
Bantel C, Laycock HC, 2017, Between evidence and commerce - the case of sufentanil sublingual tablet systems, Anaesthesia, Vol: 73, Pages: 143-147, ISSN: 0003-2409
Kemp H, Bantel C, Gordon F, et al., 2017, Pain Assessment in INTensive care (PAINT): an observational study of physician-documented pain assessment in 45 intensive care units in the United Kingdom, Anaesthesia, Vol: 72, Pages: 737-748, ISSN: 1365-2044
Pain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environ-ment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTen-sive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect topublished guidelines. This observational service evaluation considered all pain and analgesia-related entries inpatients’records over a 24-h period, in 45 adult intensive care units (ICUs) in London and the South-East ofEngland. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two-thirds ofpatients (n=475, 64.5 95% CI 60.9–67.8%) received no physician-documented pain assessment during the 24-hstudy period. Just under one-third (n=215, 28.6 95% CI 25.5–32.0%) received no nursing-documented pain assess-ment, and over one-fifth (n=159, 21.2 95% CI 19.2–23.4)% received neither a doctor nor a nursing pain assessment.Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician painassessment was affected by the following factors: the number of nursing assessments performed; whether the patientwas admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU.Physician-documented pain assessments in the majority of participating ICUs were infrequent and did not utiliserecommended behavioural pain assessment tools. Further research to identify factors influencing physician painassessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed.
Laycock H, Bantel C, 2016, Objective Assessment of Acute Pain, Journal of Anaesthesia and Clinical Research, Vol: 7, ISSN: 2155-6148
Assessing acute pain in those unable to communicate is challenging yet essential. Objective assessment tools utilizing measures derived from autonomic changes alone or in combination appear to represent a potential solution to this difficult aspect of pain management.
Halford P, Laycock H, Bantel C, et al., 2016, Doctors' documentation of pain in the intensive care unit: 'not putting pen to paper', Meeting of the Difficult-Airway-Society, Publisher: Oxford University Press (OUP), Pages: E931-E932, ISSN: 1471-6771
Wickham A, Highton D, Martin D, et al., 2016, Care of elderly patients: a prospective audit of the prevalence of hypotension and the use of BIS intraoperatively in 25 hospitals in London, Perioperative Medicine, Vol: 5, ISSN: 2047-0525
Background: Anaesthesia is frequently complicated by intraoperative hypotension (IOH) in the elderly, and this isassociated with adverse outcome. The definition of IOH is controversial, and although management guidelines forIOH in the elderly exist, the frequency of IOH and typical clinically applied treatment thresholds are largelyunknown in the UK.Methods: We audited frequency of intraoperative blood pressure against national guidelines in elderly patientsundergoing surgery. Depth of anaesthesia (DOA) monitoring was also audited due to the association between lowDOA values and IOH with increased mortality (as part of “double” and “triple low” phenomena) and because it is asuggested management strategy to reduce IOH.Results: Twenty-five hospitals submitted data on 481 patients. Hypotension varied depending on the definition,but affected 400 patients (83.3 %) using the AAGBI standard. Furthermore, 2.9, 13.5, and 24.6 % had mean arterialblood pressures <50, <60, and <70 mmHg for 20 min, respectively, and 136 (28.4 %) had systolic blood pressuredecrease by 20 % for 20 min. DOA monitors were used for 45 (9.4 %) patients.Conclusions: IOH is common and use of DOA monitors is less than implied by guidelines. Improved managementof IOH may be a simple intervention with real potential to reduce morbidity in this vulnerable group.
Patel D, Laycock H, 2016, Should anaesthetic technique be modified for cancer surgery?, British Journal of Hospital Medicine, Vol: 77, ISSN: 1750-8460
Following surgical resection of cancer, morbidity often results from recurrence and metastatic disease. The neuroendocrine response to surgery and choice of surgical technique can influence metastatic spread, but perioperative factors may also be important. Should we modify anaesthetic technique during cancer surgery to reduce metastatic disease and recurrence?
Tatham KC, Laycock H, Wordsworth H, 2016, Pain Assessment In Cardiothoracic Intensive Care Units: A Snapshot Audit Of Practice In London Intensive Care Units, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Kemp H, Laycock HC, 2015, Pain in the intensive care unit, Key Topics in Management of the Critically Ill, Editors: Vizcaychipi, Corredor, Publisher: Springer, ISBN: 9783319223773
This book is designed to assist clinicians who are new to intensive care by providing information on a range of important and novel topics of relevance in the day-to-day management of critically ill patients.
Laycock H, Wordsworth H, Pan-London Peri-operative Research and Audit Network PLAN and South East Anaesthetic Research CHain SEARCH, 2015, Pain assessment in intensive care: who puts pen to paper?, Publisher: Springer Verlag, ISSN: 2197-425X
Laycock HC, Halford P, 2015, APPEAL beyond medical school, Publisher: BMJ Publishing Group: Open Access
Cowen R, Stasiowska M, Laycock HC, et al., 2015, Assessing pain objectively: The use of physiological markers, Anaesthesia, Vol: 70, Pages: 828-847, ISSN: 0003-2409
Pain diagnosis and management would benefit from the development of objective markers of nociception and pain. Current research addressing this issue has focused on five main strategies, each with its own advantages and disadvantages. These encompass: (i) monitoring changes in the autonomic nervous system; (ii) biopotentials; (iii) neuroimaging; (iv) biological (bio-) markers; and (v) composite algorithms. Although each strategy has shown areas of promise, there are currently no validated objective markers of nociception or pain that can be recommended for clinical use. This article introduces the most important developments in the field and highlights shortcomings, with the aim of allowing the reader to make informed decisions about what trends to watch in the future.
Laycock H, Wordsworth H, Casely E, et al., 2015, Do value judgements of analgesic drugs alter between the expert and junior doctor?, Winter Scientific Meeting of the Association-of-Anaesthetists-of-Great-Britain-and-Ireland (AAGBI), Publisher: Wiley, Pages: 38-38, ISSN: 0003-2409
Laycock H, Bakare S, Rubulotta F, et al., 2015, Documentation of pain in an intensive care unit by doctors, Winter Scientific Meeting of the Association of Anaesthetists of Great Britain and Ireland (AAGBI), Publisher: Wiley, Pages: 14-14, ISSN: 0003-2409
Laycock HC, Jaggar S, 2014, Acute Pain in the ICCU, The ESC Textbook of Intensive and Acute Cardiovascular Care, Publisher: Oxford University Press, USA, ISBN: 9780199687039
More recently, terminology has changed, with CCUs being regarded as cardiac care units or intensive cardiac care units ... The ESC textbook of intensive and acute cardiac care, second edition, follows the IACC training CC and is designed to ...
Laycock H, Kinsella SM, 2014, The case for invasive placebo - is the devil in the detail?, ANAESTHESIA, Vol: 69, Pages: 945-948, ISSN: 0003-2409
- Author Web Link
- Cite
- Citations: 3
Kemp H, Laycock HC, Yentis S, 2014, Costs incurred by anaesthetic trainees and students presenting posters at the 2014 AAGBI Winter Scientific Meeting, GAT AAGNI, Publisher: Wiley, ISSN: 0003-2409
Rivers A, Laycock HC, Yentis S, 2014, Trainee contributions to articles published in Anaesthesia: a UK trainee perspective., GAT AAGBI 2014, Publisher: Wiley, ISSN: 1365-2044
Rivers A, Laycock H, Yentis S, 2014, Trainee contributions to articles published in <i>Anaesthesia</i>: a UK trainee perspective, Annual Scientific Meeting of the Association-of-Anaesthetists-of-Great-Britain-and-Ireland (AAGBI) GAT, Publisher: WILEY, Pages: 108-108, ISSN: 0003-2409
Poynton M, Sawicki C, Laycock HC, et al., 2014, What does multimodal analgesia mean? – Results of a multi-centre survey., Annual Scientific Meeting British Pain Society, Publisher: SAGE Publications (UK and US), ISSN: 2049-4645
Wickham A, 2013, The quality of intraoperative cerebral protection in the elderly: an audit of London practice, AAGBI WSM 2014, Publisher: Wiley: 12 months, ISSN: 1365-2044
Laycock H, Valente J, Bantel C, et al., 2013, Peripheral mechanisms of burn injury-associated pain, EUROPEAN JOURNAL OF PHARMACOLOGY, Vol: 716, Pages: 169-178, ISSN: 0014-2999
- Author Web Link
- Cite
- Citations: 26
Laycock HC, Bantel C, 2013, The value of pupillary dilation in pre-emptive analgesia: is there more to this than meets the eye?, Critical Care, Vol: 17, Pages: 178-178
Wynn-Jones W, Casely E, Laycock H, et al., 2013, Codeine: the 'safe' analgesic?, BRITISH JOURNAL OF ANAESTHESIA, Vol: 110, Pages: 843-844, ISSN: 0007-0912
- Author Web Link
- Cite
- Citations: 3
Angco L, Cheema M, Bantel C, et al., 2013, Is confidence the key to accurate paediatric pain assessment or is there more we need to learn., ASM British Pain Society 2013, Publisher: SAGE Publications (UK and US), ISSN: 2049-4645
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.