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Instructions to authors

This is a revised version of the Extended Guide to Contributors which appeared in the Journal in 1998. It is intended to advise all contributors on the preparation of manuscripts, particularly those who are preparing a manuscript for the first time.

Please note that the journal now encourages authors to complete their copyright licence to publish form online.


Manuscripts for the British Journal of Anaesthesia should be submitted online. Once you have prepared your manuscript according to the instructions below please visit the online submission web site. Instructions on submitting your manuscript online can be viewed here.

All editorial communications should be addressed to: Prof. Ravi P. Mahajan, Editor-in-Chief, British Journal of Anaesthesia, Academic Division of Anaesthesia and Intensive Care, C-Floor, East Block, Queen’s Medical Centre, Nottingham NG7 2UH, UK. Tel: +44 (0)115 8231007; Fax: +44 (0)115 9700739; E-mail


The British Journal of Anaesthesia publishes original work in all branches of anaesthesia, critical care and pain management including the application of basic sciences, clinical practice, equipment and training. In addition, the journal publishes review articles, case reports and special articles of general interest.


The Editors of British Journal of Anaesthesia reserve the right to use plagiarism detection software on any submitted material. For further details, please refer to the section on British Journal of Anaesthesia Policies.



For guidance, the requested size for articles is:

Clinical investigations: up to 3000 words and 30-40 references, 4-6 tables or figures.

Laboratory investigations: up to 3000 words and 30-40 references, 4-6 tables or figures.

Review Articles: up to 5000 words and 150 references.

Editorials: up to 2500 words and 25 references, 1 table or figure.

Case Reports: up to 1500 words and 15 references, 1 table or figure

Submissions which ignore this guidance on word count or number of figures/tables may be returned without being assessed. Authors wishing to submit manuscripts with figures/tables in excess of the recommended number should justify this in the submission letter.

For review articles and laboratory/clinical investigations it is possible to include supplementary data (such as additional references for a review, expanded tables of results or additional images for investigations) for on-line publication only. Authors should make clear in their submission letter which files are to be considered for on-line only publication.


The British Journal of Anaesthesia welcomes case reports that illustrate new approaches to established clinical problems or describing a new problem. However, the acceptance rate for case reports is considerably lower than that for clinical studies. To be of value appropriate for publication a case report must provide a significant learning point for other anaesthetists. As a simple rule, just because a case is clinically challenging does not mean that it is appropriate to publish as a case report. To give an example, a case with a difficult airway and congenital heart disease who is managed using a recognized technique for a difficult airway and a recognized approach to managing the congenital heart defect, while being a clinical challenge, does not contain any learning points. Authors are referred to the editorial (British Journal of Anaesthesia 2008; 100 (6): 744) for further background to this subject.

The British Journal of Anaesthesia requires that permission is obtained from the patient or patient’s relatives for submission of the case report for potential publication. This must be obtained before submission of the manuscript and the authors must state this in their submission letter. If photographs of the patient, in any form, are used a specific signed permission from the patient must be obtained and a copy of this submitted with the manuscript. Failure to comply with this will result in rejection of the manuscript.


The British Journal of Anaesthesia welcomes review articles on clinical and scientific subjects. Authors are advised to contact the editor-in-chief before preparing or submitting a review to ascertain the appropriateness of the subject for the journal and to prevent duplication of reviews which have been commissioned or published recently.
Reviews can be either narrative or systematic (see N. Webster; British Journal of Anaesthesia 2008; 100: 285-7).

Narrative reviews should cover all aspects of a subject and avoid being 'opinion' based. Narrative reviews should follow a logical structure but not in the Introduction, Methods, Results, Discussion format. The Summary should not be structured but should give a clear indication of the objectives and findings.

Systematic reviews can be presented in the Introduction, Methods, Results, Discussion format and with a structured Summary. The subject must be clearly defined. The objective of a systematic review should be to produce an evidence-based conclusion and if there are only few RCTs available (example only 3 small studies including a total of 120 patients) the value of the review will be very limited as the level of evidence is inadequate. The Methods should give a clear indication of the literature search strategy, data extraction, grading of evidence and analysis. (Example Evans, Lysakowski and Tramer British Journal of Anaesthesia 2008; 101: 610-7).

Co-publication of Cochrane reviews in the BJA

The BJA will publish reviews already published in the Cochrane Library if they meet the editorial standards. A condition for accepting co-publication of Cochrane reviews is that the publication has been accepted by the hosting Cochrane Review Group. The manuscript has to be rewritten to fit the BJA style and size limit of 5000 words. It is emphasized that results and conclusions of the review cannot be changed. The introduction must state that this is a co-publication of a Cochrane Review. The following should also be included:
1. The article title must end with the text 'a Cochrane Systematic Review'.
2. A footnote with the following text: '†This review is an abridged version of a Cochrane Review previously published in the Cochrane Database of Systematic Reviews xxxx, Issue xx, DOI: xxx ( for information). Cochrane Reviews are regularly updated as new evidence emerge sand in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review.'


The standard layout of a manuscript is:
• Title page
• Summary, including Keywords
• Introduction (not headed)
• Methods
• Results
• Discussion
• Details of authors contributions
• Acknowledgements
• Declaration of interests
• Funding
• List of references
• Tables (including legends to tables)
• Legends to illustrations
The pages should be numbered in the top right-hand corner, the title page being page one, etc. Start each section on a separate page.


A separate page which includes the title of the paper. Titles should provide a reasonable indication of the contents of the paper. This is important as some search engines use the title for searches. Therefore, it is best to avoid enigmatic or vague titles such as 'An unusual cause of hypotension'. Titles in the form of a question, such as 'Is propofol epileptogenic?' may be acceptable.

The title page should include the name(s) and address(es) of all author(s). It should be made clear which address refers to which author. Details of the authors’ qualifications and post (e.g., consultant, senior lecturer) are not required. An author's present address, if it differs from that at which the work was carried out, or special instructions concerning the address for correspondence, should be given as a footnote on the title page and referenced at the appropriate place in the author list by superscript numbers (1 2 3 etc.) If the address to which proofs should be sent is not that of the first author, clear instructions should be given in a covering note, not on the title page.

All authors should follow the criteria for ‘authorship’ as determined by International Committee of Medical Journal Editors. For details, please refer to section on British Journal of Anaesthesia Policies.

A short running title containing not more than 50 characters (including spaces) should be included.


The Summary (Abstract) will be printed at the beginning of the paper. It should be on a separate sheet, in structured format (Background; Methods; Results; and Conclusions) for all Clinical Investigations and Laboratory Investigations. For Reviews and Case Reports, the Abstract should not be structured.

The Abstract should give a succinct account of the study or contents, in up to 250 words. The Results section should contain data. It is important that the results and conclusion given in the Abstract are the same as in the whole article, as the Abstract may be used, as it stands, by abstracting journals. References are not included in this section.


Three to five keywords should be included on the summary page under the heading Keywords. They should be in alphabetical order and must be classified according to MESH keywords. These can be found here. Please note that UK English spelling will be used for these. Please do not simply list words you think are key. For example, propofol should be listed as: anaesthetics i.v., propofol;


For Clinical Trials (also see below), please include the trial registry number under a separate heading after Keywords.


The recommended structure for this section is;
• Background to the subject
• What is known / unknown about it
• What bit you are interested in / hypothesis
• Aim of your study
As a rule, the introduction to a paper should not require more than about 200 words and have a maximum of 1.5 pages double-spaced. The introduction should give a concise account of the background of the problem and the object of the investigation. It should state what is known of the problem to be studied at the time the study was started. Previous work should be quoted here but only if it has direct bearing on the present problem. For example, a description and evaluation of an analgesic infusion as part of an intravenous anaesthesia regimen need not include an exhaustive account of the previous literature addressing the problems of intravenous anaesthesia and the many studies of different analgesics, etc.
The final paragraph should clearly state the primary and, if applicable, secondary aims of the study.
If a preliminary account of the results has been given in a published abstract, it is customary to refer to this.


The Methods section should give a clear but concise description of the process of the study. Subjects covered in this should include:
• Ethics approval / licence
• Patient population
• Inclusion / exclusion criteria
• Conduct of the study
• Data handling
• Statistics
• (CTA)

Ethics approval / licence
Regardless of the country of origin, all clinical investigators describing human research must abide by the Ethical Principles for Medical Research Involving Human Subjects outlined in the Declaration of Helsinki, and adopted in October 2000 by the World Medical Association. This document can be found at Investigators are encouraged to read and follow the Declaration of Helsinki. Clinical studies that do not meet the Declaration of Helsinki criteria will be denied peer review. If published research is subsequently found to be non-compliant it will be withdrawn or retracted.

On the basis of the Declaration of Helsinki, the British Journal of Anaesthesia requires that all manuscripts reporting clinical research state in the first paragraph of the Methods section that:
• The study was approved by the appropriate Ethics authority.
• Written informed consent was obtained from all subjects, a legal surrogate, or the parents or legal guardians for minor subjects, or that the requirement for written informed consent was waived by the ethics committee.

Human subjects should not be identifiable. Do not disclose patients’ names, initials, hospital numbers, dates of birth, or other protected healthcare information. Keep copies of ethics approval and written informed consents. In unusual circumstances the editors may request blinded copies of these documents to address questions about ethics approval and study conduct.

This section must include the Clinical Trials Authorization as all studies must be registered, as per the EU directive on clinical trials which came into force on 1st May 2004. There are a number of trial registration sites including EudraCT ( ) From January 2009 studies published in the British Journal of Anaesthesia must include the trial registration number in the Methods.
Example; The study was approved by the X regional research ethics committee (Ref: 07/A123/456) and registered with EudraCT (ref: 2007:123456:AA).
For more details about Clinical Trials, please see section below.

The title of this section should be 'Methods'. 'Materials and methods' or 'Patients and methods' should not be used. While brevity is essential, the methods must be described in sufficient detail to allow the experiment to be interpreted, and repeated if necessary, by the reader. Previously documented standard methods need not be recounted in detail, but appropriate reference to the original should be cited. Where the programme of research is complex such as might occur in a cardiovascular study in animals, it may be preferable to provide a table or figure to illustrate the plan of the experiment, thus avoiding a lengthy explanation.

Sometimes detailed laboratory techniques may be filed separately in a recognized library and a note to this effect given in the manuscript. Where measurements are made, an indication of the error of the method in the hands of the author should be given. The name of the manufacturer of instruments used for measurement should be given with an appropriate catalogue number or instrument identification (e.g. Radiometer PHM 7). The manufacturer's town and country must be provided. In the case of solutions for laboratory use, the methods of preparation and precise concentration should be stated.


When a drug is first mentioned, it should be given by the international non-proprietary name, followed by the chemical formula in parentheses if the structure is not well known, and (if relevant) by the proprietary name (with an initial capital letter). A figure giving the molecular configuration of the drug is necessary only in the case of the earliest reports of a new drug. The author should indicate in an accompanying note to the editor the source from which he has obtained the molecular configuration; it is an important requirement that the author should check the accuracy of the configuration in every detail. Drug dosages are normally given by the name of the drug followed by the dose (e.g. propofol 2.5 mg kg-1). Do not confuse drug dose with concentration.


In the interest of minimizing the risk to human and animal subjects, as well as promoting efficient use of scarce research funds, investigators will sometimes pose several questions and make multiple measurements in a single study, with the intent of publishing multiple manuscripts. This may be a laudable practice, or it may be an inappropriate attempt to slice a single study into 'minimum publishable units'. Division of data from a single research study into multiple manuscripts is acceptable, provided three requirements are met:

1. The cover letter for every paper derived from the study explains the need for dividing the study into multiple manuscripts. This applies even if only one of the submissions is to the British Journal of Anaesthesia. It is essential that the cover letter states that other parts of the study are currently under consideration or in press with another journal. The Journal will consider the appropriateness of the division as part of the review process.

2. In all manuscripts after the first, the investigator must disclose that the subjects reported in the study have been previously reported, with appropriate citation to the first manuscript. This practice is essential for scientific continuity. For example, should a question arise about the conduct of the study in one manuscript, readers should be able to identify all manuscripts based on the same experimental data.

3. Measurements must not interfere with each other. Such interference may happen in ways that are not evident at the time of the study. For example, measurements of pain thresholds may make it impossible to measure sedative effects. The potential for interfering measurements may not be evident if the pain thresholds and sedation effects are reported in separate manuscripts that are not appropriately cross-referenced.


Data on the mean age (range), weight, sex, height, criteria for selection, etc. (patient characteristics, not demographics) should be presented, with an indication of the general state of health and type of operation being undertaken. Animal data on sex, strain and weight should be included. Although it is usually possible to make such a statement in a short paragraph, more complex information may be preferable as a table. However, tables and figures are expensive to produce and should not be used unnecessarily. Where it has been necessary to seek permission from the patients for the type of study being undertaken, this should be indicated.


In accordance with the Clinical Trial Registration Statement from the International Committee of Medical Journal Editors (see here), all clinical trials in British Journal of Anaesthesia must be registered in a public trials registry at or before the onset of participant enrollment. This requirement applies to all clinical trials that begin enrollment after 1 January 2009. For trials that began enrollment before 1 January 2009, registration is strongly recommended and if the trial reported was not registered, please comment on this matter in the covering letter.

Research is considered to be a clinical trial if it involves prospective assignment of human subjects to an intervention or comparison group to study the relation between a health-related intervention and a health outcome. Further details of which clinical trials are covered by this policy are in the updated ICMJE guidelines available here.

The registry must be accessible to the public at no charge, searchable, open to all prospective registrants, and managed by a not-for-profit organization. The registry must include the following information: a unique identifying number, a statement of the intervention(s), study hypothesis, definition of primary and secondary outcome measurements, eligibility criteria, target number of subjects, funding source, contact information for the principal investigator, and key dates (registration date, start date, and completion date). The following registries are recommended by ICMJE: Clinical Trials, ISRCTN Register, UMIN Clinical Trials Registry, Australia New Zealand Clinical Trials Registry, Nederlands Trial Register.

In accordance with the ICMJE’s recommendation, British Journal of Anaesthesia will also accept registration of clinical trials in any of the primary registers that participate in the World Health Organization’s International Clinical Trial Registry Platform (see here). Primary registers are WHO selected registers managed by not-for-profit entities that will accept registrations for any interventional trials, delete duplicate entries from their own register, and provide data directly to the WHO. Please note that registration in any WHO partner register is insufficient.

Authors are requested to provide the exact URL and unique identification number for the trial registration at the time of submission. This information will be published in the article and we ask that you include the URL and identification number on the title page of your manuscript.

Clinical trial reports should also comply with the Consolidated Standards of Reporting Trials (CONSORT) and include a flow diagram presenting the enrollment, intervention allocation, follow-up, and data analysis with number of subjects for each (see here). Please also refer specifically to the CONSORT Checklist of items to include when reporting a randomized clinical trial.

Results posted in the same clinical trials registry in which the primary registration resides will not be considered prior publication if they are presented in the form of a brief abstract (500 words or less) or a table.


Institutional approval

Studies that involve the use of animals must clearly indicate that Institutional approval was obtained and state the UK Home Office Licence number or local equivalent that the studies were performed under. It is recognized that animal welfare legislation can vary between countries and so the BJA uses the UK standards as a baseline and reserves the right to reject manuscripts judged not to meet these standards, even when local approval has been granted.


The methods of anaesthesia and analgesia for research studies involving animals should be the best available to ensure the welfare of the animals involved. Reducing the potential for pain and distress is a significant refinement and provision of safe and effective anaesthesia that does not interfere with specific research objectives also reduces the numbers of animals used. Authors must also state how they assessed and monitored the adequacy of anaesthesia.
Some anaesthetics may have interactions that are important to certain areas of research. For example medetomidine and xylazine both cause hyperglycaemia, osmotic diuresis, and effects on the cardiovascular system. When used in conjunction with ketamine, these agents both produce surgical anaesthesia in rodents, suitable for a range of different operative procedures. However the side-effects may make them unsuitable for certain types of research. The safe dose of intra-peritoneal pentobarbital in rats has a narrow range and unpredictable duration; indeed a larger dose is often used for killing an animal at the end of a procedure. Whichever agent is used, an appropriate plane of anaesthesia for the intervention must be assessed and achieved. This is particularly important when neuromuscular blocking agents are used.

Information on potentially suitable anaesthetic regimens can be obtained from a variety of sources, including the veterinary advisor at your research institution, specialist laboratory animal anaesthesia and general veterinary anaesthesia textbooks. Obtaining information on potential interactions with research procedures is less easy to obtain and frequently requires a careful literature search. The agents available and the techniques for their administration are evolving so selecting the method used in other scientific publications will not guarantee the most appropriate method. The choice of anaesthetic and route of administration should:
• Provide the required depth and duration of anaesthesia for the procedure
• Be simple to administer, without distress to the animal
• Should be free from undesirable side effects and allow uncomplicated recovery
• Should cause the minimum of interference with the purpose of the research procedure


When animals are used in biomedical research, every effort should be made to minimise any pain or distress. Not only is this important for ethical reasons, but also because pain is a source of stress that can cause undesirable effects on the outcome of research projects. Considerable progress has been made over the last 10-15 years in preventing or alleviating pain. In particular, there is now considerable opportunity to minimise or eliminate pain following surgical procedures. A wide range of analgesics are available, and it is a simple process to administer one of these agents to prevent or alleviate postoperative pain. It is also important to:
• Administer an appropriate analgesic that provides the required intensity of pain relief
• Administer the analgesic at an appropriate dose
• Continue its administration at appropriate time intervals
• Stop administering the analgesic at an appropriate time after surgery

Provision of effective pain relief requires that all of these points are addressed, but this can only be done by assessing the degree of pain experienced by the animal involved. Animal pain assessment is difficult and time-consuming to implement effectively, so that it is tempting to simply give all animals a "standard dose" of analgesic. In man, the use of such fixed dose regimens has been identified as one of the factors contributing to inadequate pain management, so this approach should be avoided when dealing with laboratory animals.

In humans, analgesic dose rates are based on clinical trials, using well-established methods of assessing pain. In animals, we are unable to assess the severity of many types of pain accurately. Often, all that is possible is to use dose rates that have been established to be safe and effective in some of the tests used in rodents during early drug development. Provided these limitations are appreciated, there are some strategies for pain management which make best use of our existing knowledge:
• If methods of pain assessment have been developed for the species used, then these should be adapted to the requirements of the particular research procedure being undertaken
• If methods of pain assessment are not available, consider devoting resources to developing some form of scoring system
• If pain scoring is not possible, determine the analgesic protocol based on clinical experience with other surgical procedures in that species
• If possible, use dose rates that have been established using studies that have employed pain scoring systems
• Use pre-emptive analgesia and consider using several analgesic agents
• Attempt to evaluate the efficacy of the analgesic regimen selected using clinical assessment (your veterinary advisor will be able to help you to recognise pain in laboratory animals)
• Prepare a rescue analgesia protocol and an immediate euthanasia protocol for animals which appear to be in severe pain

The use of animal models of pain to investigate analgesia techniques is a particular minefield for journals in the field of anaesthesia. Such studies must be conducted with extremely careful regard to animal welfare. Rarely will this journal publish studies where an analgesic agent has been compared to a placebo in an animal model of severe pain.
The book ‘Laboratory animal anaesthesia’ by Professor Paul Flecknell (3rd Edition, 2009, Academic Press) provides a very helpful introduction for research workers for safe, effective and appropriate anaesthesia and analgesia in animals used in research studies.


Euthanasia is defined as a pain-free or stress-free death and animals used for research are usually euthanized at the end of a study for the purpose of sample collection or post-mortem examination. Animals may also be killed because they are experiencing severe pain or distress. The method of killing the animal after the experiment is completed should be chosen carefully and must be detailed in manuscripts. The method used should be appropriate to the species and the method used should not confound any objective of the research - veterinary advice should be sought. The conduct of euthanasia for those working with laboratory animals in the UK is quite straightforward. Either the Code of Practice for the Humane Killing of Animals under Schedule 1 to the Animals (Scientific Procedures) Act 1986 is followed or a project and personal licence authorisation is obtained to use a technique not covered by this Code. An updated code of practice for schedule 1 killing has been published by the Animal Procedures Committee and is available online at:

The use of carbon dioxide for killing is a subject of much debate and is not suitable for rabbits. For rodents, the use of carbon dioxide is still permitted but other methods are preferable. When carbon dioxide is used, do not pre-fill the cage or chamber with carbon dioxide and use slow filling rates to minimise discomfort. The flow rate can be increased when the animal is unconscious.

ARRIVE guidelines

The contribution of animal research in enabling better health for man and animals is incontrovertible and the BJA is committed to the publication of research studies which use animal models, but demands the same rigorous attention to detail as in clinical trials. Failure to describe research methods and to report results appropriately has scientific and ethical implications for the entire research process and the reputation of those involved in it.

Experiments involving animals should be appropriately designed, correctly analysed and then transparently reported, to both increase the validity of the results, and maximise the scientific gain. A minimum amount of relevant information must be included in manuscripts published in this journal to ensure that the methods and results of a study can be reviewed, analysed and repeated. The BJA will therefore refer to the ARRIVE (Animals in Research: Reporting In Vivo Experiments) guidelines as the basis for the process of reviewing manuscripts of research involving animals.

These guidelines were generated by The National Centre for the Replacement, Refinement and Reduction of Animals in Research, which is an independent scientific organisation, established by the UK Government, in consultation with scientists, statisticians, journal editors and research funders.


Descriptions of methods of anaesthesia are often unnecessarily cumbersome. The following model is presented as an example of economy of words: The patients did not receive premedication. Anaesthesia was induced with propofol 2 mg kg-1 and fentanyl 1.5 μg kg-1. Vecuronium 0.1 mg kg-1 was given to facilitate orotracheal intubation with a cuffed tube. Anaesthesia was maintained with sevoflurane 1.5-2.0% and nitrous oxide 60% in oxygen, with positive pressure ventilation in a circle system. A similar description should be used for animal anaesthesia.


Statistical methods must be described with enough detail to enable a knowledgeable reader with access to the original data to verify the report and results. Where possible, findings should be quantified and presented with appropriate indicators of measurement error or uncertainty (such as confidence intervals). Confidence intervals provide a more informative way to deal with a significance test than a simple P value. A power analysis should be performed before starting the study to determine the number of subjects which need to be studied in each group to detect a given change. Please note that a power analysis based on the primary end-point will not necessarily be applicable to any secondary measures.

It is recommended that authors seek appropriate statistical advice before starting their study, to ensure that the structure and planned recruitment is adequate to answer the question set.


Guidance for this section includes;
• Must be factual
• Relate to aims
• Logical order
• State significances
• Negative findings

From January 2009, all randomized control trials (RCTs) must adhere to the Consort guidelines and present a flow diagram which details the conduct of the study (

Description of experimental results should be concise. They should be presented in a factual manner and related to the aim of the study. It is often useful to present the results in the order described in the Methods section. Data should not be repeated unnecessarily in text, tables and figures (see below), and unwarranted numbers of digits should be avoided (Example: the mean dose of propofol was 2.1 mg kg-1 rather than 2.0897 mg kg-1 ). It may not be necessary to provide all the data from a complex study: only those values which are essential to the communication should be given. However, results should be presented in a manner so that the reader can check the statistical inferences. If the data are so numerous that this is not possible, the editor must be sent a full set with the submission of the original manuscript and the readers should be informed as to where they can obtain a similar full set of results. Where appropriate, for example in a pharmacokinetic study, more extensive sets of data can be included as an appendix with the on-line version of the article. If authors wish to make use of this facility, they should state this in the submission letter and upload the data as a separate file. The editor has the right to request the original data collected. In the results section there should be no attempt at a discussion of the findings.


Figures and Tables are often useful to present either complex or extensive data in a more easily understandable form. However, authors are cautioned against unnecessary use of tables and figures. A useful approach is to prepare the raw data in the form of tables and then decide which data are to be presented in the article. The author should then decide whether the essential data be presented succinctly in the text. If not, the essential tables/ figures should be prepared. To illustrate this with examples: a study outcome which compares two measurements in two groups can easily be presented as text, a comparison of arterial pressure and heart rate changes at five timepoints in two groups would be appropriate as a table and the same measurements in comparing three groups may be better as a figure.

Tables and figures are important communications and should be accompanied by a legend which makes it self-explanatory. However, the legend must not contain experimental details, which should be given in the methods section.

The use of a figure should be considered only where a figure will present the data more clearly than is possible in a table or when an important trend or comparison has to be made for which a graphic presentation is clearly superior to a table or text.

The authors should decide which form they wish to present data in. Please note the limitation given above on the number of figures/tables permissible for each article type. Duplication of data by including it as a table and as a figure is unnecessary and wasteful.

Authors are advised to note the limitation on the number of figures/tables given above (4-6 tables or figures, in total) for clinical and laboratory investigations and 1 figure or table for a case report or editorial. The use of multiple small figures submitted as one figure (for example Figure 1 a-f) is discouraged as when reduced to printed size these may not be clear. Authors are strongly advised to be selective in their use of figures and tables.

For further guidance on the format of tables and figures, see below. It is recommended that the author refers to previous issues of the journal regarding appropriate style.


This is an important part of the manuscript but it should not be too long, perhaps one third of the total length of the paper. This requires discipline by the author for two reasons: first, they may feel that the task is nearly completed and that they are subject to fewer constraints; second, many authors seem to wish to read into their data more than is actually there.
It is suggested that the discussion should normally follow the pattern below:

• State main findings
• How do they fit in with previous studies
• Why are they different / same
• What it adds to knowledge of subject
• Weaknesses in study
• Future studies
• Conclusions

State main findings
This does not mean a repetition of all the results with their statistics. It should provide a concise overview of the study. For example, 'Drug X produced a greater haemodynamic change on induction of anaesthesia than occurred with drug Y, resulting in a greater fall in arterial pressure and a higher incidence of tachycardia'.

How do they fit in with previous studies
This section should relate directly to the statements made in the Introduction and qualify you finding in relation to the previous studies of the subject. For example, mention any important uncertainties in the methods of measurement. In laboratory studies, try to relate the concentrations used to those encountered clinically.

Why are they different / same
Deductions which may explain important differences between the data of the present study, and the data of previous studies. The author should avoid excessive speculation in this section. It is quite reasonable to suggest possible explanations for your findings and any differences from previous studies but the 'missing parts' of such reasoning must be acknowledged.

What it adds to knowledge of subject
This can summarise the previous sections by pulling together the implications of your main findings, studies by other workers and their combined contribution to our knowledge of the subject. This should not be just another repetition of the results and preceding discussion but more of an expanded conclusion.

Weaknesses in study
It is appropriate to briefly acknowledge any limitations of your study at this point. Examples here could include the patient population, limitations of analytical tests, patients lost to follow-up. Authors are advised to be honest but succinct in this section.

Future studies
A logical follow on to the two previous sections is to identify future studies that would address some of the potential explanations and limitations discussed earlier. This should again be concise. An extensive list of future studies undermines you own study: i.e. has it answered anything if there are still so many questions?

Conclusions from the present study. The original contribution to knowledge from the present study is stated. A common fault here is to overstate the findings from a study. For example, if you have studied the effect of a new drug in an animal model you cannot draw any conclusions at all about its effect in humans and likewise if you studied ASA 1 and 2 patients you cannot comment on its use in critically ill patients.
It may be appropriate to give the implications of the conclusions for anaesthetic practice and the indications for further enquiry in this area of interest.
Authors should remember at all times, but especially in writing the discussion, that they will spoil their manuscript by excessive length. A discussion of more than three pages is often too long.


It is essential to acknowledge all sources of financial assistance, and any potential material benefit expected from publication of the work. Also, please describe the role of the study sponsor, if any, in study design; collection, analysis and interpretation of data; writing the report; and the decision to submit the report for publication.

Each manuscript must contain a declaration of interests from ALL authors. This should include all possible interests in the past five years. This is obviously most common in studies involving new equipment or drugs, but other areas such as advisory bodies are also relevant.

For example: 'Dr A has received an honorarium from Company X. Dr B has received a travel grant from Company Y. Prof C is a member of the national advisory committee on Z.'

You are required to declare all authors' interests at the time of submitting your manuscript by completing and uploading a conflict of interest form. Please upload it as a separate file labelled “conflict of interest form” along with your manuscript. Please make sure that all authors have signed before uploading, even if there are no interests to be declared.


Details of all funding sources for the work in question should be given in a separate section entitled 'Funding'. This should appear before the 'Acknowledgements' section.

The following rules should be followed:

  • The sentence should begin: ‘This work was supported by …’
  • The full official funding agency name should be given (one of the 27 subinstitutions), i.e. ‘National Institute for Academic Anaesthesia’, not ‘NIAA’ or 'NCI at NIH’ (full RIN-approved list of UK funding agencies)
  • Grant numbers should be complete and accurate and provided in brackets as follows: ‘[grant number ABX CDXXXXXX]’
  • Multiple grant numbers should be separated by a comma as follows: ‘[grant numbers ABX CDXXXXXX, EFX GHXXXXXX]’
  • Agencies should be separated by a semi-colon (plus ‘and’ before the last funding agency)
  • Where individuals need to be specified for certain sources of funding the following text should be added after the relevant agency or grant number 'to [author initials]'.

An example is given here: 'This study was funded by a small project grant from The Royal College of Anaesthetists (07/123) (AB). Equipment was provided by a project grant from British Journal of Anaesthesia/RCoA (06/321) (CD).'

Oxford Journals will deposit all NIH-funded articles in PubMed Central. See for details. Authors must ensure that manuscripts are clearly indicated as NIH-funded using the guidelines above.


All manuscripts submitted to BJA must inform the readers of individual contribution which each author made to the research and/or manuscript.

Please give initials of the names of each of the authors (i.e. R.D., I.K.M.) , and against their initials list the contributions which they individually made to the work (i.e. R.D. : Study design and data analysis; I.K.M.: Patient recruitment, data collection and writing up of the first draft of the paper).

Each author must take responsibility for at least one component of the work, should be able to identify who is responsible for each other component, and should ideally be confident in their co-authors’ ability and integrity.

The British Journal of Anaesthesia follows recommendations of International Committee of Medical Journal Editors (ICMJE). To comply with ICMJE recommendations, all the authors must meet all of the following four conditions:

• substantial contribution to conception and design, acquisition of data, or analysis and interpretation of data;
• drafting the article or revising it critically for important intellectual content;
• final approval of the version to be published; and
• agreement to be accountable for all aspects of the work thereby ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

For large, multicentre studies, the group of investigators should identify individuals who accept direct responsibility for the manuscript. These individuals should fully meet the criteria for authorship.

If the author list includes a group name all members of the group must meet the full criteria and requirements for authorship as described above. If all members of a group do not meet all authorship criteria, a group must designate one or more individuals as authors or members of a writing group who meet full authorship criteria and requirements. Other group members who are not authors may be listed as Collaborators (sometimes called non-author contributors) in an Appendix. PubMed will list the names of individual group members who are authors or collaborators. There should be a note associated with the byline clearly stating that the individual names are elsewhere in the paper and whether those names are authors or collaborators. Collaborator names are searchable on PubMed in the same way as authors. PubMed rules for this can be found here.


The contributors, who do not meet the criteria for authorship, as determined by International Committee of Medical Journal Editors and given in the section on BJA Policies, should be listed in acknowledgements section. You may acknowledge the contributors, who do not justify authorship, under headings such as 'clinical investigators', 'participating investigators', 'served as scientific advisors', 'critically reviewed the proposal', 'collected data', or 'provided care for study patients'.


Except for review articles, long lists of references are usually inappropriate. Restrict references to those that have direct bearing on the work described and cite only references to books and articles published in Index Medicus and Index Veterinarius journals.

  • Please avoid inappropriate and/or excessive self-citations. Appropriate self-citations are welcome.
  • References must be numbered consecutively in the order in which they are first mentioned in the text.
  • References in text, tables and legend should be identified by Arabic numbers appearing in the text in superscript, for example 5 or 5-7 or 5[space]16 for unrelated references. When a table or figure is first mentioned, its reference must continue the sequence.
  • Papers which carry a different system of reference will be returned to the authors for re-typing. The scope for major printer's errors in attempting to rectify inappropriate schemes is considerable.
  • References in the text. In general, it is not necessary to cite names of the authors of a study in the text (in addition to the identifying number) as it may disrupt the flow of the text. If it is felt to be essential, up to three names should be cited (A; B and C; D, E and F). In the case of four or more authors, 'G and colleagues', 'G and co-workers', 'G and others' are acceptable. The expression 'et al.' should not be used in the text.
  • An informal reference to previous work (Z's study or Y's study) is permissible only in a paragraph which contains the reference cited formally.
  • Abstracts that are more than two years old should not be used as references.
  • Text references to 'unpublished observations' or 'personal communications' should not be included in the final list of references. Personal communications should be cited in the text as (Brown AB, personal communication, year). Authors are responsible for verifying that the wording of references to unpublished work is approved by the persons concerned. This should be provided in writing with the first submission of the manuscript.
  • Papers which have been submitted and accepted for publication should be included in the list, with the phrase 'in press' replacing volume and page number. Authors should be prepared to give the volume and page number at the time of proof correction. Abstracts should also be sent with the original submission.
  • Information from manuscripts submitted but not yet accepted should be cited in the text as unpublished observations.
  • There should be a table of references at the conclusion of the paper, commencing on a new sheet. It should be prepared as follows. The names and initials of more than six authors and/or editors should be abbreviated to three names followed by et al. A maximum of 30 references is allowed for an original article.
  • Journals. Names and initials of six authors (if more than six, list three followed by et al.), title of paper, abbreviated title of journal, year of publication, volume number, first and any change in last page numbers:

    Myles PS, Chan MTV, Leslie K, Peyton P, Paesch M, Forbes A. Effect of nitrous oxide on plasma homocysteine and folate in patients undergoing major surgery. Br J Anaesth 2008; 100: 780-6
  • Chapter in a book. The reference for an article forming part of a book should take the form:

    Wildsmith JAW. Local anaesthetic agents. In: Aitkenhead AR, Smith G, Rowbotham DJ, eds. Textbook of Anaesthesia. Edinburgh: Churchill Livingstone Elsevier, 2007; 52-63

    Electronic source (web site/web page):

    Department of Health. Monthly Creutzfeldt-Jakob disease statistics 2002/0341 2002. Available from (accessed 30 March 2010)

    Online journal article:

    Lander JA, Weltman BJ, So SS. EMLA and amethocaine for reduction of children’s pain associated with needle insertion. Cochrane Database Syst Rev 2006; 3: CD004236


    O’Rourke K. Mixed means and medians: a unified approach to deal with disparate outcome summaries. Proceedings of the Symposium on Systematic Reviews: Pushing the Boundaries. Oxford: 2002; 49


    Royal College of Anaesthetists and Royal College of Radiologists. Sedation and Anaesthesia in Radiology. Report of a joint working party, London, 1992

    Advance access article:

    Qiao D, Chen W, Stratagoules E, Martinez J. Bile acid-induced activation of activator protein-1 requires both extracellular signal-regulated kinase and protein kinase C signaling. J Biol Chem Advance Access published on May 19, 2000, doi:10.1074/jbc.M908890199

It is a serious error to include in the list of references items which are not accurate. It is essential, therefore, that authors check the accuracy of all references which have been listed. It is important also to check that the references listed do indeed appear in the text and vice versa.


Tables must be supplied in an editable format (e.g. in Word or Excel) not as images, as they need to be edited to journal style. Failure to supply tables in editable format will delay publication.

All tables should be on separate sheets and accompanied by legends. Legends should be informative but brief and not contain information which is more appropriate to Methods. It is preferable to present the data in table format, in either Word or Excel, but not as images that cannot be accessed for editing. The tables should be numbered consecutively using Arabic numerals. Units in which results are expressed should be given in parentheses at the top of each column and not repeated in each line of the table. Ditto signs are not used. Avoid overcrowding the tables and the excessive use of words. The format of tables should be in keeping with that normally used by the journal; in particular, vertical lines should not be drawn. Please be certain that the data given in tables are correct, as changes at the proof stage are particularly expensive.


As the journal is now printed in full colour, there is no charge to authors for colour reproduction. It can help avoid delays in publication if line drawings are supplied using the journal's agreed colour palette:

Colour 1 (blue): c100 m57 y0 k2
Colour 2 (green): c71 m26 y100 k25
Colour 3 (Pink): c10 m70 y0 k0
Colour 4 (gold): c0 m50 y100 k0
Colour 5 (light blue): c80 m0 y0 k0
Colour 6 (orange): c0 m80 y100 k0

It should be borne in mind that reduction of figures results in an accompanying reduction of boldness (thickness) of all parts of the figure. It is thus inappropriate to use a variety of boldness of axes, graph lines and lettering in one figure, or to present a figure drawn to a large scale in fine lines and with small, fine lettering. The problem of computer-produced diagrams may be obviated by programming the computer to produce a diagram of the same size as that of the final published diagram or, alternatively, to produce lines and lettering of large thickness so that photoreduction results in the appropriate size. Photographs and micrographs should be annotated.

Care should be taken that the labelling of axes does not extend the dimensions of the figure substantially. Avoid suppression of the zero point (the axes may be broken(/ /) if required). (See also Units, symbols and abbreviations below). It should be emphasized that the dimensions of a figure prepared for a slide are often unsuitable for reproduction on the printed page. Symbols which are to appear in the figure (and not in the legend) should be chosen from the examples shown below:

● ○ ■  ▼ ▲ ♦ ◊ V X +

Symbols should be explained in boxed key included in the figure.

Accuracy in the preparation of figures is essential as is the appropriate use of symbols and abbreviations (see below).

Line drawings should be of a resolution of at least 600 dpi and half-tones at least 300 dpi.

Full instructions for the preparation of figures are available in the Online submission instructions page.

Third-Party Content in Open Access papers

If you will be publishing your paper under an Open Access licence but it contains material for which you do not have Open Access re-use permissions, please state this clearly by supplying the following credit line alongside the material:

Title of content
Author, Original publication, year of original publication, by permission of [rights holder]

This image/content is not covered by the terms of the Creative Commons licence of this publication. For permission to reuse, please contact the rights holder.


Videos can now be published in the online article with a still image of the video appearing in the print version. Authors should submit videos in MP4 format according to our video submission guidelines. Still images to be used in the article need to be provided and should represent as best as possible the main subject of the video. Video files should be clearly named as video 1, video 2 etc, and still images should be named ‘video 1 still image’. Any supplementary videos that should not be published in the article should be uploaded as supplementary data.

All videos should have an accompanying legend.


The British Journal of Anaesthesia uses the SI system of units with a few notable exceptions (pH and intravascular and ventilatory pressure measurements, which should be given in units of calibration, e.g. mm Hg, cm H2O). Blood-gas tensions and the partial pressures in the gas phase should be given in the appropriate SI unit (kPa for kilopascal). It is not intended to give a detailed account of the SI system, the notation of units, symbols and abbreviations in this document. Readers are referred to Units, Symbols and Abbreviations. A Guide for Biological and Medical Editors and Authors, 4th Edn. Baron DN, ed. (1988), published by and available from the Royal Society of Medicine, 1 Wimpole Street, London W1M 8AE.

Particular problems have arisen in relation to the notation of units which was introduced at the same time as the change to the SI system. Avoid the use of the solidus (/) in favour of various units of the expression set on one line. In the case of expressions 'below the line' superscript -1, -2, etc. as appropriate is given. Thus for drug dosage use mg kg-1 not mg/kg.


Standard Oxford UK English should be used. Examples: anaesthesia, haemorrhage, organization.


Each issue of the journal will contain correspondence (Letters to the Editor). We attempt to publish correspondence arising from papers in a recent issue with the minimum of delay, and for this reason such correspondence will be given priority. The Editor may change, delete or modify in any way all items of correspondence.

Correspondence relating to a recently published article
Correspondence relating to a recently published article should be submitted electronically through our 'eletters' facility. This can be accessed through the BJA website. Correspondents should access the relevant article on this site and use the 'submit an eletter about this article' button. This is the only route for submission of correspondence relating to published articles. Readers submitting a letter by post or email to the editor relating to a published article will be directed to submit them electronically.

The advantage of the eletter facility is that letters from readers are put on-line within a few days of submission. When an eletter is put on-line the author of the original article automatically receives notification that a comment has been submitted and is invited to respond promptly. The eletters are checked regularly and selected eletters are published subsequently in the Journal.

Correspondence not related to a published article
Correspondence which does not relate to a published article may be submitted either as an eletter using the 'out of the blue' system on the BJA website or as an email attachment to the Editor-in-chief. This includes studies that have had a 'submit as a letter' decision, case descriptions or topics of general interest. Correspondence may also be submitted by mail on a disk directly to the Editor-in-Chief. All authors must sign the accompanying submission letter. Authors should provide a contact E-mail and fax number. The eletters are checked regularly and selected eletters are published subsequently in the Journal.


These should be downloaded from the online proofing system, corrected and returned to the publisher by uploading them to the online site within 3 working days of receipt.


On publication, the corresponding author will be sent the URL for online access to their article. Offprints and single issues can be ordered using the Oxford Journals Author Services site. Orders from the UK will be subject to the current UK VAT charge. For orders from elsewhere in the EU you or your institution should account for VAT by way of a reverse charge.  Please provide us with your or your institution’s VAT number.


For information about this journal's policy, please visit our Author self-archiving policy


Upon receipt of accepted manuscripts at Oxford Journals authors will be invited to complete an online copyright licence to publish form.

Please note that by submitting an article for publication you confirm that you are the corresponding/submitting author and that Oxford University Press ('OUP') may retain your email address for the purpose of communicating with you about the article. Please notify OUP immediately if your details change. If your article is accepted for publication OUP will contact you using the email address you have used in the registration process. Please note that OUP does not retain copies of rejected articles.


British Journal of Anaesthesia authors have the option to publish their paper under the Oxford Open initiative; whereby, for a charge, their paper will be made freely available online immediately upon publication. After your manuscript is accepted the corresponding author will be required to accept a mandatory licence to publish agreement. As part of the licensing process you will be asked to indicate whether or not you wish to pay for open access. If you do not select the open access option, your paper will be published with standard subscription-based access and you will not be charged.

Oxford Open articles are published under Creative Commons licences.

RCUK/Wellcome Trust funded authors publishing in the British Journal of Anaesthesia can use the Creative Common Attribution licence (CC BY) for their articles.

All other authors can use the following Creative Commons licence:
• Creative Commons Attribution Non-Commercial licence (CC BY-NC)

Please click here for more information about the Creative Commons licences.


You can pay Open Access charges using our Author Services site. This will enable you to pay online with a credit/debit card, or request an invoice by email or post. The open access charges are as follows.

• Regular charge: £2000/ $3200 / €2600
• Reduced Rate Developing country charge*: £1000/ $1600 / €1300
• Free Developing country charge*: £0 /$0 / €0

*Visit our developing countries page (click here for a list of qualifying countries).

Please note that these charges are in addition to any colour charges that may apply.


This section articulates the policies which are followed by the journal in its editorial process. The policies are based on the recommendations by International Committee of Medical Journal Editors.


The editorial decisions of British Journal of Anaesthesia are taken separately from, and not influenced by, advertising or any related revenue. The journal makes all possible efforts to refuse advertisements which are misleading. The publication of an article about a product, alongside an advertisement of the product, if it occurs, is purely co-incidental.


The authors who may have a complaint against any of the aspects of their interaction with British Journal of Anaesthesia should, in the first instance, write/e-mail to the Editor responsible for handling the manuscript. In case it does not resolve the issue, the complaint should be forwarded to the Editor-in-Chief. The Editors and Editor-in-Chief aim to acknowledge the complaint within 7 days after receiving it. In addition, they should explain to the author the procedure which they will be undertaking to resolve the matter.


If the errors are noted in an article published in an issue, and these require publication of a correction, the corrections will appear on a numbered page and be listed in the Table of Contents.


The manuscripts which are authored by Editors, or members of Editorial Board, are treated no differently to any other manuscript submitted to British Journal of Anaesthesia. All possible measures are undertaken to avoid any potential conflict of interest in handling of such manuscripts at all the stages including allocation of handling editor, selection of reviewers, decision making and, if required, processing for publication.


Authors should not release stories related to their work prior to publication of their paper in the journal. If authors, and/or editors, consider particular work suitable for media release, they should discuss it among themselves, and agree on a planned media release and publication. In case of agreed media release, the editors will plan with the authors the way in which they can help the media in preparing accurate reports by providing news releases, answering questions, or referring reporters to relevant experts. This assistance will be contingent on the media’s cooperation in timing the release of a story to coincide with publication of the article.


All the manuscripts submitted to British Journal of Anaesthesia undergo plagiarism check using commercial software. Based on the findings of the check, editors may ask authors to address any minor duplication, or similarity, which the contents of their manuscript may have to any previously published work (even though it may be author’s own previously published work). However, severe cases of plagiarism amount to ‘misconduct’, and these cases will be dealt with as such.

The reviewers and the editors initially assume that authors are reporting work based on honest observations. However, if substantial doubt arises about the honesty or integrity of work, either submitted or published, the editor will inform the authors of the concern, seek clarification, and pursue the issue with the author’s sponsoring body and/or employing authority. Consequently, if the sponsoring body and/or employers find a published paper to be fraudulent, the journal will print a retraction. If, however, this method of investigation does not result in a satisfactory conclusion, the editor may choose to conduct his or her own investigation, and may choose to publish an expression of concern about the aspects of the conduct or integrity of the work. The validity of previous work by the author of a fraudulent paper cannot be assumed. Editors may ask the author’s institution to assure them of the validity of earlier work published in their journal or to retract it. If this is not done, editors may choose to publish an announcement expressing concern that the validity of previously published work is uncertain.


In order to meet your funding requirements authors are required to name their funding sources, or state if there are none, during the submission process. For further information on this process or to find out more about the CHORUS initiative please click here.