Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

Septicemia caused by Neisseria meningitidis is characterized by increasing levels of meningococcal lipopolysaccharide (Nm-LPS) and cytokine production in the blood. We have used an in vitro human whole-blood model of meningococcal septicemia to investigate the potential of CyP, a selective Toll-like receptor 4 (TLR4)-MD-2 antagonist derived from the cyanobacterium Oscillatoria planktothrix FP1, for reducing LPS-mediated cytokine production. CyP (>1 g/ml) inhibited the secretion of the proinflammatory cytokines tumor necrosis factor alpha, interleukin-1␤ (IL-1␤), and IL-6 (by >90%) and chemokines IL-8 and monocyte chemoattractant protein 1 (by ϳ50%) induced by the treatment of blood with pure Nm-LPS, by isolated outer membranes, and after infection with live meningococci of different serogroups. In vitro studies with human dendritic cells and TLR4-transfected Jurkat cells demonstrated that CyP competitively inhibited Nm-LPS interactions with TLR4 and subsequent NF-B activation. These data demonstrate that CyP is a potent antagonist of meningococcal LPS and could be considered a new adjunctive therapy for treating septicemia.

Sickle cell disease and other hemoglobin disorders are becoming increasingly prevalent across the whole of Europe and hence within our anesthetic practice. Despite this, there still appears to be a largely varied consensus on when preoperative sickle cell testing is necessary in the pediatric population. In this article, we describe one approach adopted in a district hospital within London to simplify this problem.