• Breathtaking obesity?

      Reynolds, Nick (2011-07)
    • What is the optimal type of fluid to be used for peri-operative fluid optimisation directed by oesophageal Doppler monitoring?

      Morris, C; Rogerson, D (2011-09)
      The objective of this review was to determine the optimal type or class of intravenous fluid to be used during peri-operative patient optimisation guided by oesophageal Doppler monitoring and to identify future directions for research. We undertook a literature review of patients undergoing major (general, colorectal, orthopaedic and urological) surgery, whose fluid therapy was managed using peri-operative oesophageal Doppler monitoring. We identified 10 studies that included 891 randomised patients. A variety of regimens and types of fluid were used in association with oesophageal Doppler monitoring, including crystalloid, gelatin and hydroxyethyl starch. A wide variety of hydroxyethyl starch preparations were used, including high molecular weight and highly substituted hetastarches, and lower molecular weight tetrastarches. Most studies were of high quality, associated with reduced hospital stay, but underpowered to evaluate other outcomes. In units with established enhanced recovery facilities, the benefits of colloid based on oesophageal Doppler monitoring were not reproduced. There is little evidence to support preferential use of any particular type of fluid during oesophageal Doppler guided optimisation; however, routine use of colloids is associated with significantly higher costs and may increase hospital stay. Furthermore, many of these fluids have not been evaluated in patient populations in whom optimisation is being applied or proposed, and the potential for harm cannot be excluded. Recommendations for future studies are provided, including adequate power for primary end points beyond hospital stay and adequate follow-up, and inclusion of a crystalloid comparison group.
    • An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting.

      Gold, Stuart; Elliott, Richard; Vater, Mair; Heinink, Thomas; Williams, John P (2014-11)
      BACKGROUND: POSSUM and P-POSSUM are used in the assessment of outcomes in surgical patients. Neither scoring systems' accuracy has been established where a level 1 critical care facility (level 1 care ward) is available for perioperative care. We compared POSSUM and P-POSSUM predicted with observed mortality on a level 1 care ward. METHODS: A prospective, observational study was performed between May 2000 and June 2008. POSSUM and P-POSSUM scores were calculated for all postoperative patients who were admitted to the level 1 care ward. Data for post-operative mortality were obtained from hospital records for 2552 episodes of patient care. Observed vs expected mortality was compared using receiver operating characteristic (ROC) curves and the goodness of fit assessed using the Hosmer-Lemeshow equation. RESULTS: ROC curves show good discriminative ability between survivors and non-survivors for POSSUM and P-POSSUM. Physiological score had far higher discrimination than operative score. Both models showed poor calibration and poor goodness of fit (Hosmer-Lemeshow). Observed to expected (O:E) mortality ratio for POSSUM and P-POSSUM indicated significantly fewer than expected deaths in all deciles of risk. CONCLUSIONS: Our data suggest a 30-60% reduction in O:E mortality. We suggest that the use of POSSUM models to predict mortality in patients admitted to level 1 care ward is inappropriate or that a recalibration of POSSUM is required to make it useful in a level 1 care ward setting.
    • The effect of anaesthetist grade and frequency of insertion on epidural failure: a service evaluation in a United Kingdom teaching hospital.

      Heinink, Thomas (2015-01)
      BACKGROUND: Despite being a commonly performed procedure, epidural catheter insertion has a significant failure rate. There is a lack of guidance as to how regularly the procedure should be performed in order to maintain competence. This study aimed to quantify whether increasing frequency of practice is associated with a reduction in failure rates. METHODS: Data were collected prospectively on all patients undergoing intra-abdominal or thoraco-abdominal surgery who received epidural analgesia as part of their post-operative analgesic regimen over a 36 month period. Records were examined to identify the reason for epidural catheter removal, classified according to standardised definitions, the seniority of the inserting anaesthetist, and whether or not they were a permanent member of the anaesthetic department. Data were analysed using independent t tests, Mann-Whitney tests and Fisher's test. RESULTS: 881 epidurals were inserted during the study period. 48 hour failure rate was 27.2%, whilst by 96 hours 33.9% of epidurals had failed. Increasing frequency of epidural insertion did not show a significant decrease in failure rate at either 48 (p = 0.36) or 96 hours (p = 0.28). However, long-term survival of epidurals at 96 hours was greater if inserted by permanent rather than temporary members of staff (non-permanent 60/141, 42.6% vs permanent 228/715, 31.9%, OR 1.58 (CI 1.09-2.29) p = 0.02). CONCLUSION: This study demonstrates that failure rates for postoperative epidural analgesia in major surgery are not dependent upon the frequency with which practitioners insert epidural catheters. However, failure rates are dependent on permanency of anaesthetic staff. These findings are significant when placed in the context of the General Medical Council's requirements for clinicians to maintain competence in their clinical practice, suggesting that institutional factors may have greater bearing on epidural success or failure than frequency of task performance.
    • Study investigating the role of skeletal muscle mass estimation in metastatic spinal cord compression

      Blackwell, James; Williams, John P (2015-10)
      BACKGROUND: Age-related loss of functional muscle mass is associated with reduced functional ability and life expectancy. In disseminated cancer, age-related muscle loss may be exacerbated by cachexia and poor nutritional intake, increasing functional decline, morbidity and accelerate death. Patients with spinal metastases frequently present for decompressive surgery with decision to operate based upon functional assessment. A subjective assessment of physical performance has, however, been shown to be a poor indicator of life expectancy in these patients. We aimed to develop an objective measure based upon lean muscle mass to aid decision making, in these individuals, by investigating the association between muscle mass and 1-year survival. METHODS: Muscle mass was calculated as total psoas area (TPA)/ vertebral body area (VBA), by two independent blinded doctors from CT images, acquired within 7 days of spinal metastases surgery, at the mid L3 vertebral level. Outcome at 1 year following surgery was recorded from a prospectively updated metastatic spinal cord compression database. RESULTS: 86 patients were followed for 1 year, with an overall mortality of 39.5%. Mortality rates at 1 year were significantly high among patients in the lowest quartile of muscle mass, compared with those in the highest quartile (57.1 vs 23.8%, p=0.02). CONCLUSION: Death within 1 year in individuals with spinal metastases is related to lean muscle mass at presentation. Assessment of lean muscle mass may inform decision to operate in patients with spinal metastases.
    • Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland.

      Morris, C; Verma, R (2016-01)
      This guideline updates and replaces the 4th edition of the AAGBI Standards of Monitoring published in 2007. The aim of this document is to provide guidance on the minimum standards for physiological monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the United Kingdom and Ireland. Minimum standards for monitoring patients during anaesthesia and in the recovery phase are included. There is also guidance on monitoring patients undergoing sedation and also during transfer of anaesthetised or sedated patients. There are new sections discussing the role of monitoring depth of anaesthesia, neuromuscular blockade and cardiac output. The indications for end-tidal carbon dioxide monitoring have been updated.
    • Agitation: This reflective account is based on NS786 Pritchard JC, Brighty A (2015) Caring for older people experiencing agitation.

      Salt, Clair (2016-03)
      As a staff nurse on a surgical step-down unit, I care for patients with surgical needs who require monitoring.
    • Audit of airway assessment and documentation for emergency patients at the Royal Derby Hospital

      Thirugnanam, Madan; Edmondson, E (2016-06)
      Various methods of airway assessment exist in order to enable prediction of the difficult airway, be it difficult direct laryngoscopy, difficult intubation or difficult mask ventilation [1]. It is recognised that one method of assessment is insufficient to predict a difficult airway and a combination of tests should be used [2, 3]. This audit reviewed documentation of airway assessment for patients undergoing emergency surgery at the Royal Derby Hospital (RDH). This is typically a list with a high turnover of patients and anaesthetists, of varying experience, warranting high standards of documentation. Methods We retrospectively reviewed 50 anaesthesia charts of patients undergoing emergency surgical procedures from 12-29 January 2015. Audit standards were derived from a seminal paper by Calder [1]. Criteria we included were: interdental distance, dental health, mandibular protrusion, neck movement, thyromental distance and Mallampati classification. The first three criteria were described as a minimum to constitute an appropriate airway assessment by Calder, but we accepted any three as the minimum standard. We also recorded which anaesthetist pre-operatively assessed the patient and whether the same practitioner went on to induce anaesthesia. Results Of the 50 anaesthesia charts, 25 documented interdental distance; two documented jaw protrusion and 37 documented dental health. Three charts documented all three nominated criteria. In total, 15 charts documented a minimum of three assessments of the six we were examining. As described in Table 1, eight charts showed no evidence of an airway assessment, and of these eight charts, five were completed by consultant anaesthetists, one by a specialist trainee and one by a core trainee. The assessor of the eighth chart was undetermined. Twenty six patients were assessed and anaesthetised by the same person. Discussion These data show that documentation of airway assessment at RDH is poor, with 50% of charts failing to demonstrate at least three assessments of the airway. The review by Calder describes how it would be indefensible to induce anaesthesia only to then discover the patient has an interdental distance of 2 cm, rendering insertion of a supraglottic airway rescue device extremely difficult. Following this audit we can make the following recommendations: (Table Presented) .
    • Ultrasound guided popliteal sciatic block combined with femoral nerve block for managing a high risk patient on apixaban for i&d of footabscess

      Gnanamuttu, Anush; Haldar, Manabendra (2017)
      Current guidance is to avoid peripheral nerve blocks in the presence of anticoagulation. However in certain situations, where the risks of alternative techniques are high, then it may be appropriate to perform these blocks in the presence of anticoagulation. Here we present our management of a high risk anticoagulated patient who presented for incision and drainage of abscess using peripheral nerve blocks alone. Methods:We were asked to pre-assess a 89 year old patient posted for i&d of an absess of the foot. He had been admitted to hospital following falls and increased confusion and known to have COPD, hypertension, atrial fibrillation for which hewas on apixaban and congestive cardiac failure. His exercise tolerance was only 10 yards and saturations were 87% on air. Results: Ultrasound guided popliteal sciatic nerve and saphenous nerve block at the level of knee was performed. After 25 minutes there was almost complete motor block and surgery performedwithout any complications. Therewere no complications to report. Conclusions: Peripheral nerve blocks in the presence of anticoagulation can be associated with complications.Most of these have been associated with deep blocks or with peripheral nerve catheters. If the risks for alternative techniques are high, then on a relative risk basis, there may be role for peripheral nerve blocks in the presence of anticoagulation. The use of ultrasound guidance, helps avoid injury to vascular structures, which might cause nerve injury through haematoma formation.
    • Designing and delivering non-technical skills simulation based education in regional anaesthesia

      Bhatti, Tajammal (2017)
      In the last decade there has been rising interest in non-technical skills (NTS) in anaesthetic practice. These set of skills are important to maintain the efficiency of a working team and deliver high quality service. Despite the importance of the NTS, its role has not been adequately emphasised in regional anaesthesia teaching curricula. In an attempt to introduce the anaesthetic trainee to NTS in regional anaesthesia, we designed a simulation based teaching session, using both actor and high fidelity mannequin simulation. Methods: The designed simulation consisted of 4 stations. They incorporated task management, teamworking, situation awareness and decision making to assess anaesthetists' NTS. Two involved an actor, which included consenting an anxious patient for regional block and interviewing a patient with suspected nerve injury. The mannequin based simulation involved preparation, communication and ergonomics while performing regional anaesthesia, followed by critical incident. Each session was led by a trainee and feedback on performance given afterwards. Results: Through formal survey, the trainees highly valued the teaching session and the use of different styles of simulation. They felt it touched on important aspect of their daily practice which is rarely covered in formal teaching. Conclusions: We believe there is a room for improvement. For example introducing remote video recording for better reflective learning and more stations to enrich the educational experience.
    • AAGBI: Safer pre-hospital anaesthesia 2017: Association of Anaesthetists of Great Britain and Ireland.

      Klein, Juergen (2017-01)
      St Mary's Major Trauma Centre, Imperial College, Military Pre-hospital Emergency Medicine, London, UK. Pre-hospital emergency anaesthesia with oral tracheal intubation is the technique of choice for trauma patients who cannot maintain their airway or achieve adequate ventilation. It should be carried out as soon as safely possible, and performed to the same standards as in-hospital emergency anaesthesia. It should only be conducted within organisations with comprehensive clinical governance arrangements. Techniques should be straightforward, reproducible, as simple as possible and supported by the use of checklists. Monitoring and equipment should meet in-hospital anaesthesia standards. Practitioners need to be competent in the provision of in-hospital emergency anaesthesia and have supervised pre-hospital experience before carrying out pre-hospital emergency anaesthesia. Training programmes allowing the safe delivery of pre-hospital emergency anaesthesia by non-physicians do not currently exist in the UK. Where pre-hospital emergency anaesthesia skills are not available, oxygenation and ventilation should be maintained with the use of second-generation supraglottic airways in patients without airway reflexes, or basic airway manoeuvres and basic airway adjuncts in patients with intact airway reflexes.
    • A randomised clinical trial comparing the 'sniffing' and neutral position using channelled (KingVision® ) and non-channelled (C-MAC® ) videolaryngoscopes

      Ungureanu, Narcis (2018-04)
      Head and neck position is one of the factors which can be associated with difficult videolaryngoscopy and tracheal intubation. This prospective randomised clinical trial compared 'sniffing' and neutral positions using a channelled (KingVision® ) and a non-channelled (C-MAC® D-blade) videolaryngoscope in 200 adult patients randomly allocated into four groups (KingVision 'sniffing', KingVision neutral, C-MAC 'sniffing' and C-MAC neutral). The primary outcome was the ease of tracheal intubation using the modified intubation difficulty scale (mIDS) score. Laryngoscopy time, intubation time, laryngoscopic view using the percentage of glottic opening (POGO) score and success rate of tracheal intubation were secondary outcomes. The median (IQR [range]) modified difficulty scale scores for the four groups, respectively, were 0 (0-1 [0-3]), 0 (0-1 [0-4]), 1 (0-1 [0-5]) and 0 (0-1 [0-3]; p = 0.384). There was no significant difference in laryngoscopy time (p = 0.020), intubation time (p = 0.272) and success rate (p = 0.968) between the groups. The percentage of glottic opening score was lower for C-MAC neutral group as compared with other three groups (p = 0.01). There was no significant difference in the ease of intubation between the 'sniffing' and the neutral position when using the KingVision and the C-MAC videolaryngoscopes. Therefore, either of the two positions could be used with these types of videolaryngoscopes, if deemed advantageous for the patient.
    • Femoral Nerve Block Intervention in Neck of Femur Fracture (FINOF): a randomised controlled trial.

      Walt, Gerrie Van De (2018-04)
      OBJECTIVE: Fractured neck of femur is a severely painful condition with significant mortality and morbidity. We investigated whether early and continuous use of femoral nerve block can improve pain on movement and mobility after surgery in older participants with fragility neck of femur fracture. DESIGN: Prospective single-centre, randomised controlled pragmatic trial. SETTING: Secondary care, acute National Health Service Trust, UK. PARTICIPANTS: Participants admitted with a history and examination suggesting fractured neck of femur. INTERVENTION: Immediate continuous femoral nerve block via catheter or standard analgesia. OUTCOME MEASURES: Primary outcome measures were Cumulative Dynamic Pain score and Cumulated Ambulation Score from surgery until day 3 postoperatively. Secondary outcome measures included pain scores at rest, cumulative side effects (nausea and constipation), quality of life (measured by EuroQOL 5 D instrument (EQ-5D) score) at day 3 and day 30, and rehabilitation outcome (measured by mobility score). RESULTS: 141 participants were recruited, with 23 excluded. No significant difference was detected between Cumulative Dynamic Pain Score (standard care (n=56) vs intervention (n=55) 20 (IQR 15-24) vs 20 (15-23), p=0.51) or Cumulated Ambulation Score (standard care vs intervention 6 (5-9) vs 7 (5-10), p=0.76). There were no statistically different differences in secondary outcomes except cumulative pain at rest: 5 (0.5-6.5) in the standard care group and 2 (0-5) in the intervention group (p=0.043). CONCLUSIONS: Early application of continuous femoral nerve block compared with standard systemic analgesia did not result in improved dynamic pain score or superior postoperative ambulation. This technique may provide superior pain relief at rest. Continuous femoral nerve block did not delay initial control of pain or mobilisation after surgery. TRIAL REGISTRATION NUMBER: ISRCTN92946117; Pre-results
    • A multicentre prospective cohort study of the accuracy of conventional landmark technique for cricoid localisation using ultrasound scanning.

      Lee, David; Elriedy, Mohamed; Nair, Ashok (2018-07)
      Cricoid pressure is employed during rapid sequence induction to reduce the risk of pulmonary aspiration. Correct application of cricoid pressure depends on knowledge of neck anatomy and precise identification of surface landmarks. Inaccurate localisation of the cricoid cartilage during rapid sequence induction risks incomplete oesophageal occlusion, with potential for pulmonary aspiration of gastric contents. It may also compromise the laryngeal view for the anaesthetist. Accurate localisation of the cricoid cartilage therefore has relevance for the safe conduct of rapid sequence induction. We conducted a multicentre, prospective cohort study to determine the accuracy of cricoid cartilage identification in 100 patients. The cranio-caudal midpoint of the cricoid cartilage was identified by a qualified anaesthetic assistant using the conventional landmark technique and marked. While maintaining the patient in the same position, a second mark was made by identifying the midpoint of the cricoid cartilage using ultrasound scanning. The mean (SD) distance between the two marks was 2.07 (8.49) mm. In 41% of patients the midpoint was incorrectly identified by a margin greater than 5 mm. This error was uniformly distributed both above and below the midpoint of the cricoid cartilage. The Pearson correlation coefficient of this error with respect to body mass index was 0.062 (p = 0.539) and with age was -0.020 (p = 0.843). There were also no significant differences in error between male and female patients. Identification of cricoid position using a landmark technique has a high degree of variability and has little correlation with age, sex or body mass index. These findings have significant implications for the safe application of cricoid pressure in the context of rapid sequence induction.
    • Beyond the fear of tetanus

      Lee, David; Van Staden, Bernhard; Webb, Carole (2018-07)
      While quoted as 'man's best friend', a commensal found commonly in the oral cavity of dogs can cause fulminant sepsis in humans. Although Clostridium tetani is prominent, few may know about Capnocytophaga carnimorsus. We attended a patient with multi-organ failure, purpuric rash and limb ischaemia resulting in above knee amputations. Description A previously well 62-year-old female presented to the ED shocked with significant metabolic acidosis (pH 6.9 and lactate 20). Of note was rapidly spreading purpura, leading initial suspicion to meningococcal septicaemia. She had crystalloid resuscitation, peripheral vasopressors and central access for noradrenaline. Following ketamine induction she was intubated and transferred to ITU for multi-organ support (included RRT, high inotropic requirements and management of DIC). Two days prior she sustained an apparently trivial dog bite to her finger while separating her dog fighting the pet rabbit. Discussion with haematologists raised the possibility of C. canimorsus. Knowing the organism is slow growing on standard agar but visible as phagocytised rods in neutrophils and macrophages, the haematologist reviewed the peripheral blood film, which confirmed this suspicion. Microbiology colleagues isolated and identified the organism. Fortuitously, she was on appropriate antibiotics from the outset, but had presented late to the ED. Despite improved physiological parameters, she developed widespread necrosis requiring bilateral above knee amputations. After a turbulent period on ITU, including cardiac arrests, she rehabilitated well and made good physical and cognitive recovery; however, she has rehomed the dog. Discussion C. canimorsus is a fastidious, capnophilic gram negative rod, described in 1976 [1]. While previously known to cause sepsis and endocarditis in humans, the overwhelming majority of patients were immunosuppressed, including asplenic and alcoholic patients. A quarter of UK households own a dog [2]. There are over 7000 dog bites per year in the UK and PCR samples show presence of C. canimorsus in up to 75% of dogs and 57% of cats [3]. Thus, exposure to C. canimorsus is potentially grossly underestimated. Although tetanus is commonly thought of in the context of dog bites, C. canimorsus should not be overlooked. Patients should be advised to have low thresholds seeking medical advice regardless of tetanus status. C. canimorsus should always be considered in the differential diagnosis of any septic patient with a recent animal bite.
    • Acute presentation of a partially obstructing laryngeal tumour: adjuvant agents to gaseous induction of anaesthesia.

      Walters, Matt (2018-07)
      We present the case of a 53-year-old man who attended our emergency department with stridor. He had recently undergone investigation for possible glottis cancer. We discuss the airway management of such a case. We believe this to be the first description of propofol target controlled infusion and clonidine to supplement a sevoflurane gas induction, in order to obtund response to intubation while maintaining spontaneous ventilation. We also consider how airway interventions may impact prognosis and need to be considered.
    • Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals.

      University Hospitals of Derby and Burton (2018-10)
      BACKGROUND: Cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS. METHODS: We conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity. RESULTS: We analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure; contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92; 95% confidence interval (CI), 2.12-4.02; P<0.001] and the presence of an emergency department in the treating hospital (OR=4.18; 95% CI, 2.22-7.89; P<0.001). Patients undergoing cancer surgery (OR=0.32; 95% CI, 0.22-0.46; P<0.001), obstetric procedures (OR=0.17; 95% CI, 0.08-0.32; P<0.001), and expedited surgery (OR=0.39; 95% CI, 0.27-0.56; P<0.001) were less likely to be cancelled. CONCLUSIONS: A significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations.
    • Guidelines for the safe practice of total intravenous anaesthesia (TIVA): Joint Guidelines from the Association of Anaesthetists and the Society for Intravenous Anaesthesia.

      Mulvey, David (2018-10)
      Guidelines are presented for safe practice in the use of intravenous drug infusions for general anaesthesia. When maintenance of general anaesthesia is by intravenous infusion, this is referred to as total intravenous anaesthesia. Although total intravenous anaesthesia has advantages for some patients, the commonest technique used for maintenance of anaesthesia in the UK and Ireland remains the administration of an inhaled volatile anaesthetic. However, the use of an inhalational technique is sometimes not possible, and in some situations, inhalational anaesthesia is contraindicated. Therefore, all anaesthetists should be able to deliver total intravenous anaesthesia competently and safely. For the purposes of simplicity, these guidelines will use the term total intravenous anaesthesia but also encompass techniques involving a combination of intravenous infusion and inhalational anaesthesia. This document is intended as a guideline for safe practice when total intravenous anaesthesia is being used, and not as a review of the pros and cons of total intravenous anaesthesia vs. inhalational anaesthesia in situations where both techniques are possible.
    • The efficacy of 'static' training interventions for improving indices of cardiorespiratory fitness in premenopausal females.

      Herrod, Philip; Blackwell, James; Moss, BF; Lund, Jonathan; Williams, John P; Phillips, Bethan (2019-03)
      PURPOSE: Cardiovascular disease (CVD) is the leading cause of death worldwide. Many risk factors for CVD can be modified pharmacologically; however, uptake of medications is low, especially in asymptomatic people. Exercise is also effective at reducing CVD risk, but adoption is poor with time-commitment and cost cited as key reasons for this. Repeated remote ischaemic preconditioning (RIPC) and isometric handgrip (IHG) training are both inexpensive, time-efficient interventions which have shown some promise in reducing blood pressure (BP) and improving markers of cardiovascular health and fitness. However, few studies have investigated the effectiveness of these interventions in premenopausal women. METHOD: Thirty healthy females were recruited to twelve supervised sessions of either RIPC or IHG over 4 weeks, or acted as non-intervention controls (CON). BP measurements, flow-mediated dilatation (FMD) and cardiopulmonary exercise tests (CPET) were performed at baseline and after the intervention period. RESULTS: IHG and RIPC were both well-tolerated with 100% adherence to all sessions. A statistically significant reduction in both systolic (- 7.2 mmHg) and diastolic (- 6 mmHg) BP was demonstrated following IHG, with no change following RIPC. No statistically significant improvements were observed in FMD or CPET parameters in any group. CONCLUSIONS: IHG is an inexpensive and well-tolerated intervention which may improve BP; a key risk factor for CVD. Conversely, our single arm RIPC protocol, despite being similarly well-tolerated, did not elicit improvements in any cardiorespiratory parameters in our chosen population.