Anesthesia Crisis Research Articles

Enhance the management of perioperative crisis events, improve the safety and quality of pediatric anesthesia

Perioperative crisis events refer to unexpected seriously life-threatening when the patient is during or after surgery, and require rapid identification, evaluation, and management by clinical teams to minimize harm. The pediatric anesthesia management during perioperative period is special and challenging for anesthesiologists, requiring professional technical and non-technical skills. The article mainly elaborates on the incidence and risk factors of pediatric anesthesia crisis events during perioperative period and introduces the concept of anesthesia crisis resource management and strategies. The anesthesiologist team needs to adopt a crisis resource management strategy, taking a typical crisis event of malignant hyperthermia as an example, including identification of crisis signs immediately, termination of trigger drugs rapidly, intravenous injection of the special drug dantrolene, physical cooling, and symptomatic support treatment, seeking assistance from other teams actively, recording and feeding back. This study aims to improve the cognitive decision-making ability and teamwork ability of anesthesiologists and their teams, effectively preventing and responding to potential crisis events effectively, and ensuring the safety of pediatric patients during perioperative period.

A prospective randomized comparative study of effectiveness of simulation-based training in improving the performance of non-technical skill among postgraduate students during anaesthesia crisis resource management

Background Non-technical skills are pivotal in ensuring patient safety during anaesthesia crisis resource management. Simulation-based training has emerged as a promising educational approach for enhancing these skills. This study protocol outlines a prospective randomised comparative study aimed at assessing the impact of simulation-based training on the performance of anaesthesia residents during anaesthesia crisis resource management, with a focus on task management, teamwork, situational awareness, and decision-making skills, using the Assessment of Non-Technical Skills (ANTS) scoring system. Methods Anesthesia residents in postgraduate years 1 and 2 from the Department of Anesthesia at Acharya Vinoba Bhave Rural Hospital will be included as study participants. Informed consent will be obtained, and no exclusion criteria will be applied. Participants will undergo an orientation session covering essential crisis management and simulation knowledge. The study will employ advanced simulation equipment, including a Human Patient Simulator (HPS) mannequin, an anaesthesia machine, and a simulated operating room. Faculty members have selected six distinct perioperative emergency scenarios for simulation sessions. Participants will be grouped in pairs and exposed to three scenarios during each session. Debriefing and feedback will follow each scenario, reinforcing non-technical skills. Experienced staff anesthesiologists, trained in the Assessment of Non-Technical Skills (ANTS) scoring system, will serve as assessors to evaluate participant performance. Expected outcomes Data collected will include ANTS scores, debriefing feedback, and post-test results. Statistical analysis will be employed to assess the effectiveness of simulation-based training in enhancing non-technical skills among anaesthesia residents during anaesthesia crisis resource management.

Regional anesthesia and sickle cell crisis in pediatric patients: An educational-focused review.

Sickle cell disease (SCD) is the most common inherited hemoglobinopathy, affecting approximately 100 000 patients in United States and millions worldwide. Although the mainstay of pain management for VOC remains systemic opioids, given the potential for adverse effects including respiratory depression and hypoxemia, there remains interest in the use of regional anesthetic techniques (neuraxial or peripheral nerve blockade). A systematic search of pubMed, Scopus, and Google Scholar was conducted using the terms sickle cell disease, sickle cell crisis, pain crisis, vaso-occlusive crisis, regional anesthesia, peripheral nerve blockade, and neuraxial anesthesia. We identified 7 publications, all of which were retrospective case series or single case reports, outlining the use of neuraxial anesthesia in a total of 26 patients with SCD. Additionally, we identified 4 publications, including one retrospective case series and 3 single case reports, entailing the use of peripheral blockade in patients with VOC and SCD. The available literature, albeit all retrospective or anecdotal, suggests the potential utility of regional anesthesia to treat pain in patients with SCD. Additional benefits have included avoidance of the potential deleterious physiologic effects of systemic opioids and in one case series, an improvement in respiratory function as judged by pulse oximetry. The anecdotal and retrospective nature of the available reports with an absence of prospective trials limits the evidence based medicine available from which to develop to guidlines for the optimal local anesthetic agent to use, its concentration, the rate of infusion, and the choice of adjunctive agents.

Using Simulation for Anesthesia Crisis Management in The Undergraduate Curriculum: Systematic Literature Review

This literature review aims to shed light on the present status of simulation-based training for anesthesia crisis management in undergraduate medical education and suggest prospective areas for further study and improvement. This research study will implement a PICO formula to facilitate the search strategy's organized documentation. The study selection was performed using the EBSCOhost, and ScienceDirect to find studies that investigated the use of simulation in anesthesiology. The search strategy involved combining the keywords using the Boolean operator "AND" to refine the search and ensure the retrieval of relevant articles. After the inclusion and exclusion criteria, 15 studies were included. In this systematic review. The search was limited from 2018 to 2023 in both databases. Finally, Using simulation for anesthesia crisis management in undergraduate curricula effectively improves the performance of non-technical skills, such as situational awareness, decision-making, communication, and teamwork. The long-term effects of simulation-based training on clinical results and patient safety also need further investigation.

Clinical triggers and vital signs influencing crisis acknowledgment and calls for help by anesthesiologists: A simulation-based observational study

Study objectiveIn a perioperative emergency, anesthesiologists must acknowledge the unfolding crisis promptly, call for timely assistance, and avert patient harm. We aimed to identify vital signs and qualitative factors prompting crisis acknowledgment and to compare responses between observers and participants in simulation. DesignProspective, simulation-based, observational study. SettingAn anesthesia crisis resource management course at a freestanding simulation center. SubjectsSixty attending anesthesiologists from a variety of practice settings. InterventionsIn each case, a primary anesthesiologist in charge (PAIC) managed a simulated patient undergoing a uniformly scripted sequence of perioperative anaphylaxis and called for help from another anesthesiologist when a crisis began. Anesthesiologist observers (AOs) viewed the case separately and recorded times of crisis onset. MeasurementsSimulation footage was reviewed by investigators for patient vital signs and participant behaviors at times of crisis acknowledgment, with the call for help as an explicit proxy for PAIC crisis acknowledgment. These factors were categorized, and group-level data were compared. ResultsNineteen PAICs and 41 AOs were included. Clinicians acknowledged crises around a mean arterial pressure (MAP) of 65 mmHg and oxygen saturation of 94% as anaphylactic shock progressed. PAICs acknowledged crises at a higher respiratory rate than AOs (20 vs. 18 breaths/min, p = 0.038). Other vitals and timing of crisis acknowledgment did not differ between PAICs and AOs. Nearly half of all participants (45%) identified crises at MAP <65 mmHg. Timing of crisis acknowledgment varied widely (range: 421 s). ConclusionsDespite overall heterogeneity in clinical performance, anesthesiologists acknowledged crises per standard definitions of hypotension. Thresholds for crisis acknowledgment did not significantly differ between PAICs and AOs, suggesting minimal effect from active care responsibility. Many indicated crises at MAP <65 mmHg or after significant deterioration, risking failure-to-rescue events. We suggest that crisis management instruction should address triggers for requesting help.

Editorial introductions.

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Editors of the journal and the Section Editors for this issue. EDITORS Peter KrankePeter KrankePeter Kranke is Consultant Anaesthesiologist and Professor of Anaesthesia at the Department of Anaesthesia and Critical Care, University Hospitals of Würzburg, Germany and the Würzburg Medical School. He is Head of Clinical Research and since 2007 Section Head for Obstetrics and Gynaecology within the Department of Anaesthesia at the University of Würzburg. He holds a Medical degree from the University of Heidelberg and earned an MBA and a PhD from the University of Würzburg. Prof. Kranke was appointed a Fellow of the European Society of Anaesthesiology and Intensive Care (FESAIC) at Euroanaesthesia 2022. He has been editor of the European Journal of Anaesthesiology and other national and international journals. As a member of the committee on Regional Anaesthesia and Obstetric Anaesthesia within the German Society of Anaesthesiology and member of the European Society of Anaesthesiology and Intensive Care (ESAIC) he contributes to various guidelines and consensus statements in the field of obstetric anaesthesia perioperative medicine on a national, European as well as international level. Currently, he is chairman of the guideline committee of the ESAIC. He is co-author of the international consensus guidelines on the management of post-operative nausea & vomiting (PONV) under the auspice of the Society of Ambulatory Anesthesia and ASER. Besides PONV, his current interests include healthcare economics, patient blood management, evidence-based medicine and clinical research in the perioperative setting, ambulatory anaesthesia, fast-track recovery, simulation and safety in medicine and outcomes research in perioperative medicine. Leopold EberhartLeopold EberhartLeopold Eberhart is a Professor of Anesthesiology and Intensive Care at the Philipps-University of Marburg and also works in a newly-opened Clinic for Day-Surgery as the head of Anesthesiology and Perioperative Care. He studied medicine at the University of Ulm, where he graduated in 1995 and also trained to be a specialist for Anesthesiology until 1999. In 2001, he transferred to the Philipps-University of Marburg and became a senior physician for Anesthesiology. Prof. Eberhart habilitated in 2003. In the early 2000 s he earned additional qualifications for Emergency Medicine, Intensive Care Medicine and Pain Medicine. He also studied the management of health and social care organisations at the Universities of Kaiserslautern and Witten-Herdecke and earned the title “Master of Arts” in 2007. Prof. Eberhart's main scientific topics are the improvement of the patients’ perioperative well-being by reducing common postoperative side-effects, like nausea, vomiting, shivering and pain. He also developed the PPP33-questionnaire for assessing quality of life in the perioperative period, which was awarded with the Lilly Quality of Life-Award in 2004. In total, he published over 200 scientific papers in peer-reviewed journals since 1994. Prof. Eberhart is a member of national and international anesthesia communities and a founding member of the Cochrane Anesthesia-Review Group. Daniel ArnalDaniel ArnalDr Daniel Arnal is anaesthesiologist, Head of the Surgical Process, at the Hospital Universitario Fundacion Alcorcon, Spain, and is the European Society of Anaesthesiology and Intensive Care (ESAIC) Patient Safety and Quality Committee Chair. Dr Arnal is cofounder and immediate past president of the Spanish Anaesthesia Incident Reporting System (SENSAR), and Latin America and Vice-president of the Quality, Patient Safety and Ethics of the Spanish Society of Anaesthesiology and Reanimation (SEDAR). His publications and scientific interests focus on Patient Safety and is Co-editor of the Spanish Anaesthesia and Critical Patient Crisis Manual. As clinical simulator instructor participates as faculty in IDEhA Simulation Centre (Alcorcon), SENSAR and ESAIC patient safety continuous education programs.

Factors influencing anesthesiologistsperceived usefulness of ACRM (Anaesthesia Crisis Resources Management) key points after a combined ACLS (AHA)-ACRM similation training

Background: The factors that may contribute to learners’ perception about the usefulness of Anaesthesia Crisis Resource Management (ACRM) key points are little known. Objectives: We investigated the link between demographic factors and the effect of an ACRM simulation training on anaesthesiologists’ perceived value of ACRM key points. Design: A prospective pre- and post-test survey from December 2017 to December 2019 of 111 anaesthesiologists involved into a combined ACRM-ACLS course in a simulation centre. Methods: Before and after the course participants were asked to indicate which were, in their opinion, the 5 ACRM key points most relevant for managing an anaesthetic emergency. No taxonomy tool of the 15 ACRM key points was used for teaching purposes. Main outcome measures: Pre-/post-course differences in participants’ subjective choices were connected by logistic regression analysis with demographic factors which included age, gender, years of work as anaesthesiologist, the amount of updating exposure, and familiarity with ACRM. Results: In median participants (47 M/64 F) had an age of 42 years (IQR 34-55 years), and 10 years working experience as anaesthesiologists (IQR 4-20 years). Around 20% of them had never heard of ACRM prior to this course. Communication was selected by up to 75% of participants without pre-/post-course differences. Although the other 4 ACRM points remained heterogeneously selected even after the course, we observed post-course vs pre-course increase in the selection rate of the ACRM points that address leadership, correct distribution of workload and utilization of all available resources. Among participants’ characteristics, the lack of familiarity with ACRM was the only significant predictor of the number of pre- to post-course changes in ACRM key points selection (OR=3.03, CI 95% 1.04 -9.09; p=0.0418). Conclusions: The familiarity with ACRM should be considered when planning ACRM training, especially in cases where the ACRM training is not yet part of a formal education in anaesthesia.

HISTORICAL SELECTION: Rosenberg MB. Simulation technology in anesthesiology. Anesth Prog. 2000;47(1):8-11.

HISTORICAL SELECTION: Rosenberg MB. Simulation technology in anesthesiology. Anesth Prog. 2000;47(1):8-11.

Simulation Technology in Anesthesiology.

Simulation Technology in Anesthesiology.

Avatar-based patient monitoring in critical anaesthesia events: a randomised high-fidelity simulation study

BackgroundFailures in situation awareness cause two-thirds of anaesthesia complications. Avatar-based patient monitoring may promote situation awareness in critical situations. MethodsWe conducted a prospective, randomised, high-fidelity simulation study powered for non-inferiority. We used video analysis to grade anaesthesia teams managing three 10 min emergency scenarios using three randomly assigned monitoring modalities: only conventional, only avatar, and split-screen showing both modalities side by side. The primary outcome was time to performance of critical tasks. Secondary outcomes were time to verbalisation of vital sign deviations and the correct cause of the emergency, perceived workload, and usability. We used mixed Cox and linear regression models adjusted for various potential confounders. The non-inferiority margin was 10%, or hazard ratio (HR) 0.9. ResultsWe analysed 52 teams performing 154 simulations. For performance of critical tasks during a scenario, split-screen was non-inferior to conventional (HR=1.13; 95% confidence interval [CI], 0.96–1.33; not significant in test for superiority); the result for avatar was inconclusive (HR=0.98; 95% CI, 0.83–1.15). Avatar was associated with a higher probability for verbalisation of the cause of the emergency (HR=1.78; 95% CI, 1.13–2.81; P=0.012). We found no evidence for a monitor effect on perceived workload. Perceived usability was lower for avatar (coefficient=–23.0; 95% CI, –27.2 to –18.8; P<0.0001) and split-screen (–6.7; 95% CI, –10.9 to –2.4; P=0.002) compared with conventional. ConclusionsThis study showed non-inferiority of split-screen compared with conventional monitoring for performance of critical tasks during anaesthesia crisis situations. The patient avatar improved verbalisation of the correct cause of the emergency. These results should be interpreted considering participants' minimal avatar but extensive conventional monitoring experience.

The Anesthesia Crisis Scenario Builder for Authoring Anesthesia Crisis-Based Simulations

In this article, we present the anesthesia crisis scenario builder (ACSB) framework prototype that allows for the development of (or modification of existing) anesthesia crisis resource management-based virtual simulations. The ACSB framework was developed specifically to allow medical educators, who may have a limited (if any) programming/software development background, to replicate and edit anesthesia scenarios based on preprogrammed steps from the anesthetic crisis manual. The scenarios can be developed simply and intuitively using a graphical user interface. Results of a preliminary study examining the usability of the ACSB framework indicate the ease of creating a crisis scenario with limited, if any, programming knowledge.

Correlation of Medical Knowledge and Non-Technical Skills Assessment in Anesthesia Residents

Objective: Non-technical skills training and assessment has been implemented in anesthesia residency training program to improve quality of patient care but have not been properly assessed. We hypothesized that trainees with good knowledge correlated with good cognitive parts of non-technical skills.Methods: Seventy anesthesia residents (24 PGY-1, 24 PGY-2 and 22 PGY-3) were assessed for their knowledge by 180-item MCQs, 5 key-feature essay questions, and 18-station OSCE’s. Subsequently, a perioperative anesthesia crisis situation was set up in the simulation lab for all residents and was video recorded. Non-technical skills were assessed by 2 independent trained raters using Anesthetists’ Non-Technical Skills (ANTS) behavioral markers. The residents’ scores were calculated to find the correlation within the ANTS rating scale.Results: The mean scores of knowledge tests were 164.3 ±18.4 out of 300 [165.5 ±18.0, 154.7 ±16.3 and 173.6 ±16.4 for PGY-1, PGY-2 and PGY-3 respectively]. The mean scores of ANTS was divided into 4 categories (rating scale 1 to 4): task management 2.9 (±0.6), teamworking 3.0 (±0.5), situation awareness 2.9 (±0.8) and decision making 2.8 (±0.7). The knowledge test results moderately correlated with ANTS score in task management, situation awareness and decision making [r=0.382 (p&lt;0.01), r=0.433 (p&lt;0.001) and r=0.350 (p&lt;0.01) respectively] and weakly correlated with the teamworking category (r=0.166, p=0.16).Conclusion: Resident’s scores showed moderate correlation with non-technical skills assessment results in cognitive skills. Non-technical skills are required to be trained and assessed together with knowledge to enhance the patient’s safety and outcome.

Improving Anesthesia Safety in Low-resource Settings

(Anesth Analg. 2018;126(4):1312–1320) Over the last century, anesthesia safety has improved significantly in high-income countries (HICs) of the world but has not done the same in low-income countries (LICs), due to characteristics like poor infrastructure and shortages of anesthesia providers, essential drugs, equipment and supplies. In the present article, the authors argued that further disregard of this global anesthesia crisis could result in failure to achieve the full potential of LIC populations. In order to address this issue, the authors provided a high-level overview of some of the relevant challenges and discussed current and potential initiatives at global, regional, national, and local levels. The authors believe that understanding how such systems work is essential to achieving sustainable, widespread improvement globally for safety in anesthesia.

Profile of malignant hyperthermia susceptibility reports confirmed with muscular contracture test in Brazil

Background and objectivesMalignant hyperthermia is an autosomal dominant hypermetabolic pharmacogenetic syndrome, with a mortality rate of 10%–20%, which is triggered by the use of halogenated inhaled anesthetics or muscle relaxant succinylcholine. The gold standard for suspected susceptibility to malignant hyperthermia is the in vitro muscle contracture test in response to halothane and caffeine. The determination of susceptibility in suspected families allows the planning of safe anesthesia without triggering agents for patients with known susceptibility to malignant hyperthermia by positive in vitro muscle contracture test. Moreover, the patient whose suspicion of malignant hyperthermia was excluded by the in vitro negative muscle contracture test may undergo standard anesthesia. Susceptibility to malignant hyperthermia has a variable manifestation ranging from an asymptomatic subject presenting a crisis of malignant hyperthermia during anesthesia with triggering agents to a patient with atrophy and muscle weakness due to central core myopathy. The aim of this study is to analyze the profile of reports of susceptibility to malignant hyperthermia confirmed with in vitro muscle contracture test. MethodAnalysis of the medical records of patients with personal/family suspicion of malignant hyperthermia investigated with in vitro muscle contracture test, after given written informed consent, between 1997 and 2010. ResultsOf the 50 events that motivated the suspicion of malignant hyperthermia and family investigation (sample aged 27±18 years, 52% men, 76% white), 64% were investigated for an anesthetic malignant hyperthermia crisis, with mortality rate of 25%. The most common signs of a malignant hyperthermia crisis were hyperthermia, tachycardia, and muscle stiffness. Susceptibility to malignant hyperthermia was confirmed in 79.4% of the 92 relatives investigated with the in vitro muscle contracture test. ConclusionThe crises of malignant hyperthermia resembled those described in other countries, but with frequency lower than that estimated in the country.

Analysis of anesthesia chief resident competencies in anesthesia crisis management simulation.

BackgroundAnesthesia crisis management (ACM) simulation would expose anesthesiology residents and trainees to dynamic emergencies that need quick yet effective responses to gain their core strength and capabilities as anesthesiologists. Our department had already employed ACM simulation into modules and practiced in examinations. The aim is to enhance professional working ethics and human responsibility in residents, which would be accomplished in semi-realistic simulation. This would be a useful tool for lecturers to evaluate current teaching methods and measure protégés in daily emergencies, which should be done better in continuous pattern.MethodsWe analyzed the ACM simulation scores from resident examination using Strata SE programs. The examination consisted of four topics in which points counted for each topic ranged from 0 to 15 and then would be counted into percentage for passing grade. The required minimum passing grade for each topic was 75%, in which the average score for one topic was 11.25.DiscussionOverall average score for all subjects was 12.07, which already achieved the 75% passing grade with a cutoff point of 11.25. Postsurgical bleeding and cannot intubate–cannot oxygenate topics were the two bottom topics that could not achieve the 75% passing grade. Preoperative evaluation and decision making were two lowest non-technical skill scores in the examination.ConclusionWeakest core competencies were found in preoperative evaluation and decision making even though all subjects had already passed the minimum requirements of 75% passing grade. Postsurgical bleeding and cannot intubate–cannot oxygenate were also topics with lowest scores in core competencies. These findings would suggest for innovation and reevaluation of current teaching.

Perfil dos relatos de suscetibilidade à hipertermia maligna confirmados com teste de contratura muscular no Brasil

Background and objectivesMalignant hyperthermia is an autosomal dominant hypermetabolic pharmacogenetic syndrome, with a mortality rate of 10%‐20%, which is triggered by the use of halogenated inhaled anesthetics or muscle relaxant succinylcholine. The gold standard for suspected susceptibility to malignant hyperthermia is the in vitro muscle contracture test in response to halothane and caffeine. The determination of susceptibility in suspected families allows the planning of safe anesthesia without triggering agents for patients with known susceptibility to malignant hyperthermia by positive in vitro muscle contracture test. Moreover, the patient whose suspicion of malignant hyperthermia was excluded by the in vitro negative muscle contracture test may undergo standard anesthesia. Susceptibility to malignant hyperthermia has a variable manifestation ranging from an asymptomatic subject presenting a crisis of malignant hyperthermia during anesthesia with triggering agents to a patient with atrophy and muscle weakness due to central core myopathy. The aim of this study is to analyze the profile of reports of susceptibility to malignant hyperthermia confirmed with in vitro muscle contracture test. MethodAnalysis of the medical records of patients with personal/family suspicion of malignant hyperthermia investigated with in vitro muscle contracture test, after given written informed consent, between 1997 and 2010. ResultsOf the 50 events that motivated the suspicion of malignant hyperthermia and family investigation (sample aged 27±18 years, 52% men, 76% white), 64% were investigated for an anesthetic malignant hyperthermia crisis, with mortality rate of 25%. The most common signs of a malignant hyperthermia crisis were hyperthermia, tachycardia, and muscle stiffness. Susceptibility to malignant hyperthermia was confirmed in 79.4% of the 92 relatives investigated with the in vitro muscle contracture test. ConclusionThe crises of malignant hyperthermia resembled those described in other countries, but with frequency lower than that estimated in the country.

"How do i perform" in cardiac anesthesia crisis situations?

"How do i perform" in cardiac anesthesia crisis situations?

"How do i perform" in cardiac anesthesia crisis situations?

"How do i perform" in cardiac anesthesia crisis situations?

Effect of sleep deprivation after a night shift duty on simulated crisis management by residents in anaesthesia. A randomised crossover study

BackgroundSleep deprivation has been associated with an increased incidence of medical errors and can jeopardise patients’ safety during medical crisis management. The aim of the study was to assess the effect of sleep deprivation on the management of simulated anaesthesia crisis by residents in anaesthesiology. MethodsA randomised, comparative, monocentric crossover study involving 48 residents in anaesthesia was performed on a high fidelity patient simulator. Each resident was evaluated in a sleep-deprived state (deprived group, after a night shift duty) and control state (control group, after a night of sleep). Performance was assessed through points obtained during crisis scenario 1 (oesophageal intubation followed by anaphylactic shock) and scenario 2 (anaesthesia-related bronchospasm followed by ventricular tachycardia). Sleep periods were recorded by actigraphy. Two independent observers assessed the performances. The primary endpoint of the study was the score obtained for each scenario. ResultsResident's crisis management performance is associated with sleep deprivation (scenario 1: control=39 [33–42] points vs. deprived=26 [19–40] points, P=0.02; scenario 2: control=21 [17–24] vs. deprived=14 [12–19], P=0.01). The main errors observed were: error in drug administration and dose, delay in identification of hypotension, and missing communication with the surgical team about situation. ConclusionsThe present study showed that sleep deprivation is associated with impairment of performance to manage crisis situations by residents in anaesthesia.

Validity evidence of non-technical skills assessment instruments in simulated anaesthesia crisis management.

We sought to evaluate the validity of two non-technical skills evaluation instruments, the Anaesthetists' Non-Technical Skills (ANTS) behavioural marker system and the Ottawa Global Rating Scale (GRS), to apply them to anaesthesia training. The content validity, response process, internal structure, relations with other variables and consequences were described for validity evidence. Simulated crisis management sessions were initiated during which two trained raters evaluated the performance of postgraduate first-, second- and third-year (PGY-1, PGY-2 and PGY-3) anaesthesia residents. The study included 70 participants, composed of 24 PGY-1, 24 PGY-2 and 22 PGY-3 residents. Both instruments differentiated the non-technical skills of PGY-1 from PGY-3 residents (P <0.05). Inter-rater agreement was measured using the intraclass correlation coefficient (ICC). For the ANTS instrument, the intraclass correlation coefficients for task management, team-working, situation awareness and decision-making were 0.79, 0.34, 0.81 and 0.70, respectively. For the Ottawa GRS, the intraclass correlation coefficients for overall performance, leadership, problem-solving, situation awareness, resource utilisation and communication skills were 0.86, 0.83, 0.84, 0.87, 0.80 and 0.86, respectively. The Cronbach's alpha for internal consistency of the ANTS instrument was 0.93, and was 0.96 for the Ottawa GRS. There was a high correlation between the ANTS and Ottawa GRS. The raters reported the ease of use of the Ottawa GRS compared to the ANTS. We found sufficient evidence of validity in the ANTS instrument and the Ottawa GRS for the evaluation of non-technical skills in a simulated anaesthesia setting, but the Ottawa GRS was more practical and had higher reliability.