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There is no perfect way to rank the most impactful papers in anaesthesia history, but collating according to a citation count is a rough approximation.

For this exercise I’ve gathered the most-cited papers per year, since 2010, for the top 10 anaesthesia journals according to CiteScore rank. In addition I’ve trawled Google Scholar results for any highly cited ‘outliers’ – articles relevant to anaesthesia published in lesser-read anaesthesia journals or non-anaesthesia journals. 

This collection has then been ranked according to citation count/year in an effort to reduce the ‘time published’ bias.

This is not a foolproof method by any means, but approximates the top papers at this point in history in a close-enough manner to make for interesting reading!


Airway management
  • Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists task force on management of the Difficult Airway – 2013, Anesthesiology
  • Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults – 2015, British Journal of Anaesthesia
  • Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia – 2011, British Journal of Anaesthesia
  • Guidelines for the management of tracheal intubation in critically ill adults – 2018, British Journal of Anaesthesia
  • Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways – 2015, Anaesthesia
  • Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments – 2011, British Journal of Anaesthesia
  • Difficult Airway Society Guidelines for the management of tracheal extubation – 2012, Anaesthesia
  • Strategies for the prevention of airway complications – a narrative review – 2018, Anaesthesia
Anaesthetic procedures
  • Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on Central Venous Access – 2012, Anesthesiology
Crisis management, resuscitation & fluid management
  • Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology (- 2013, European Journal of Anaesthesiology
  • Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016 – 2017, European Journal of Anaesthesiology
  • Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac Surgery: Toward an empirical definition of hypotension – 2013, Anesthesiology
  • A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients – 2011, Anesthesia & Analgesia
  • Point-of-Care Testing: A Prospective, Randomized Clinical Trial of Efficacy in Coagulopathic Cardiac Surgery Patients – 2012, Anesthesiology
  • Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy – 2012, British Journal of Anaesthesia
  • Perioperative fluid management strategies in major surgery: a stratified meta-analysis – 2012, Anesthesia & Analgesia
  • Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6) – 2018, British Journal of Anaesthesia
  • Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery – 2011, Anesthesiology
  • Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery – 2015, Anesthesiology
  • Oxidative stress and mitochondrial dysfunction in sepsis – 2011, British Journal of Anaesthesia
  • First-line therapy with coagulation factor concentrates combined with point-of-care coagulation testing Is associated with decreased allogeneic blood transfusion in cardiovascular surgery: a retrospective, single-center cohort study – 2011, Anesthesiology
  • Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a “Gray Zone” approach – 2011, Anesthesiology
  • Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions – 2013, British Journal of Anaesthesia
General anaesthesia & sedation
  • Consensus guidelines for the management of postoperative nausea and vomiting – 2014, Anesthesia & Analgesia
  • General anesthesia, sleep, and coma – 2010, New England Journal of Medicine
  • BIS-guided anesthesia decreases postoperative delirium and cognitive decline – 2013, Anesthesiology
  • Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function – 2013, Anesthesiology
  • 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors – 2014, British Journal of Anaesthesia
  • Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction – 2013, British Journal of Anaesthesia
  • Clinical electroencephalography for anesthesiologists: part I: background and basic signatures – 2015, Anesthesiology
  • Evidence-based analysis of risk factors for postoperative nausea and vomiting – 2012, British Journal of Anaesthesia
  • Dexmedetomidine versus propofol sedation reduces delirium after cardiac surgery: a randomized controlled trial – 2016, Anesthesiology
  • Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block – 2010, Anesthesia & Analgesia
  • American Society of Anaesthesiologists physical status classification – 2011, Indian Journal of Anaesthesia
  • Protection by remote ischemic preconditioning during coronary artery bypass graft surgery with isoflurane but not propofol – a clinical trial – 2012, Acta Anaesthesiologica Scandinavica
  • High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial – 2014, The Lancet
  • Protective versus Conventional Ventilation for Surgery: A Systematic Review and Individual Patient Data Meta-analysis – 2015, Anesthesiology
  • Hospital stay and mortality are increased in patients having a “triple low” of low blood pressure, low bispectral index, and low minimum alveolar concentration of volatile anesthesia – 2012, Anesthesiology
  • Postoperative cognitive dysfunction is independent of type of surgery and anesthetic – 2011, Anesthesia & Analgesia
  • Long-term survival for patients undergoing volatile versus IV anesthesia for cancer surgery: a retrospective analysis – 2016, Anesthesiology
  • Dexmedetomidine: new insights – 2011, European Journal of Anaesthesiology
  • Lasting impact of general anaesthesia on the brain: mechanisms and relevance – 2016, Nature Reviews Neuroscience
Pain management
  • Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council – 2016, The Journal of Pain
  • Pain Intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures – 2013, Anesthesiology
  • Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management – 2012, Anesthesiology
  • Sex differences in pain: a brief review of clinical and experimental findings – 2013, British Journal of Anaesthesia
  • Novel 10-kHz high-frequency therapy (hf10 therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: The SENZA-RCT Randomized Controlled Trial – 2015, Anesthesiology
  • Molecular mechanisms of opioid receptor-dependent signaling and behavior – 2011, Anesthesiology
  • Perioperative single dose systemic dexamethasone for postoperative Pain: A meta-analysis of randomized controlled trials – 2011, Anesthesiology
  • Effect of perioperative systemic α2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials – 2012, Anesthesiology
  • Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis – 2012, British Journal of Anaesthesia
  • Combining paracetamol (acetaminophen) with nonsteroidal anti-inflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain – 2010, Anesthesia & Analgesia
  • Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis – 2014, British Journal of Anaesthesia
  • Chronic pain epidemiology and its clinical relevance – 2013, British Journal of Anaesthesia
  • Mechanisms of acupuncture – electroacupuncture on persistent pain – 2014, Anesthesiology
  • Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants – 2011, Pain
  • The prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis – 2012, Anesthesia & Analgesia
  • Topical capsaicin for pain management: therapeutic potential and mechanisms of action of the new high-concentration capsaicin 8% patch – 2011, British Journal of Anaesthesia
  • Conditioned pain modulation (the diffuse noxious inhibitory control-like effect): its relevance for acute and chronic pain states – 2010, Current Opinion in Anesthesiology
  • Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: a systematic review – 2011, British Journal of Anaesthesia
  • Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial – 2010, Anesthesia & Analgesia
  • The neuropathic component in persistent postsurgical pain: a systematic literature review – 2013, Pain
  • Safeguards to prevent neurologic complications after epidural steroid injections: consensus opinions from a multidisciplinary working group and national organizations – 2015, Anesthesiology
  • Trends and predictors of opioid use following total knee and total hip arthroplasty – 2016, Pain
Regional anaesthesia
  • Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine evidence-based guidelines (Fourth Edition) – 2018, Regional Anesthesia and Pain Medicine
  • The analgesic efficacy of pre‐operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair – 2017, Anaesthesia
  • Serratus plane block: a novel ultrasound‐guided thoracic wall nerve block – 2013, Anaesthesia
  • Regional anaesthesia and antithrombotic agents: recommendations of the European Society of Anaesthesiology – 2010, European Journal of Anaesthesiology
  • Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain – 2015, Regional Anesthesia and pain medicine
  • Adductor canal block versus femoral nerve block for total knee arthroplastya prospective, randomized, controlled trial – 2014, Anesthesiology
  • The third American Society of Regional Anesthesia and Pain Medicine practice advisory on local anesthetic systemic toxicity: executive summary 2017 – 2018, Regional Anesthesia & Pain
  • Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery – 2015, Regional anesthesia and pain medicine
Safety & quality
  • What does one minute of operating room time cost? – 2010, Journal of clinical anesthesia
  • Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology – 2011, European Journal of Anaesthesiology
  • Correlation coefficients: appropriate use and interpretation – 2018, Anesthesia & Analgesia
  • Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures – 2011, Anesthesiology
  • Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland – 2016, Anaesthesia
Perioperative medicine
  • 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) – 2014, European Heart Journal
  • International consensus statement on the peri‐operative management of anaemia and iron deficiency – 2017, Anaesthesia
  • European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium – 2017, European Journal of Anaesthesiology
  • High STOP-Bang score indicates a high probability of obstructive sleep apnoea – 2012, British Journal of Anaesthesia
  • Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes – 2014, Anesthesiology
  • Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice – 2016, Acta Anaesthesiologica Scandinavica
  • Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines – 2011, British Journal of Anaesthesia
  • Effect of anaesthetic technique and other perioperative factors on cancer recurrence – 2010, British Journal of Anaesthesia
  • Overview of the coagulation system – 2014, Indian Journal of Anaesthesia
  • Society of anesthesia and sleep medicine guidelines on preoperative screening and assessment of adult patients with obstructive sleep apnea – 2016, Anesthesia and analgesia
  • Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol – 2014, Anesthesia & Analgesia
  • Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures – 2015, European Journal of Anaesthesiology
  • The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries – 2010, Anesthesia & Analgesia
  • International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia – 2018, Obstetric Anesthesia Digest
  • Regional versus general anaesthesia for caesarean section – 2012, Cochrane database of systematic reviews
  • Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial – 2016, The Lancet
  • Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood – 2016, JAMA
  • Anesthesia and developing brains – implications of the FDA warning – 2017, New England Journal of Medicine
  • Cognitive and behavioral outcomes after early exposure to anesthesia and surgery – 2011, Pediatrics
  • Long-term differences in language and cognitive function after childhood exposure to anesthesia – 2012, Pediatrics
  • One-year survival of extremely preterm infants after active perinatal care in Sweden – 2010, Obstetric Anesthesia
  • Association of anesthesia and surgery during childhood with long-term academic performance – 2017, JAMA
  • Early childhood exposure to anesthesia and risk of developmental and behavioral disorders in a sibling birth cohort – 2011, Anesthesia & Analgesia
  • Attention-deficit/hyperactivity disorder after early exposure to procedures requiring general anesthesia – 2012, Mayo Clinic Proceedings
  • Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy – 2015, Cochrane database of systematic reviews
Neurosurgery, neuroradiology
  • General anesthesia versus conscious sedation for endovascular treatment of acute ischemic stroke: the AnStroke trial (anesthesia during stroke) – 2017, Stroke
  • Effect of conscious sedation vs general anesthesia on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy: a randomized clinical trial – 2016, JAMA
  • Conscious sedation versus general anesthesia during endovascular acute ischemic stroke treatment: a systematic review and meta-analysis – 2015, American Journal of Neuroradiology

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