Anaesthesia reports最新文献

{"title":"Spinal anaesthesia using chloroprocaine 1% for caesarean birth.","authors":"N A Ratanshi, S Sodha","doi":"10.1002/anr3.70063","DOIUrl":"10.1002/anr3.70063","url":null,"abstract":"<p><p>Spinal anaesthesia with hyperbaric bupivacaine is the standard technique for caesarean birth. However, when amide local anaesthetics are contraindicated, alternative strategies are required. We report the management of a patient undergoing emergency caesarean birth for pre-eclampsia in whom a history suggestive of allergy to amide local anaesthetics precluded the use of bupivacaine. A spinal anaesthetic was performed using intrathecal chloroprocaine 1%, an ester local anaesthetic, in combination with diamorphine. An adequate sensory block to the T4 dermatome was achieved promptly. The density and duration of the block were sufficient for surgery, which proceeded uneventfully. Motor and sensory function returned after approximately 70 minutes, and the patient reported a high level of satisfaction with the anaesthetic technique.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":"e70063"},"PeriodicalIF":0.8,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13086618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracolumbar labour epidural analgesia in a parturient with permanent gluteal silicone-like biopolymer infiltration","authors":"T. Foggi Viligiardi,&nbsp;C. Matteoni,&nbsp;U. Bitossi,&nbsp;M. Micaglio","doi":"10.1002/anr3.70060","DOIUrl":"10.1002/anr3.70060","url":null,"abstract":"<p>Gluteal augmentation procedures with permanent soft tissue fillers, including liquid silicone and silicone-like biopolymers, are widely used. These procedures may be undertaken in settings without strict regulatory oversight. Unlike resorbable materials, permanent fillers can migrate along fascial planes and induce chronic inflammatory reactions, fibrosis and granulomatous reactions, potentially altering normal anatomical structures years after injection. Cranial migration into paraspinal soft tissues has been reported, causing concern regarding neuraxial access, although the implications for neuraxial anaesthesia are unclear. The presence of foreign material in the lumbar region is regarded as a relative or absolute contraindication to epidural or spinal techniques, even in the absence of radiological evidence of epidural space involvement. The key learning points in our case lie in the presence of extensive permanent silicone infiltration within the gluteal and lower lumbar soft tissues and in the anatomical assessment and clinical decision-making informed by radiology investigations. We report a case of a parturient with documented permanent gluteal silicone infiltration who had previously been considered unsuitable for neuraxial labour analgesia. Radiological re-assessment enabled the identification of a safe thoracolumbar approach to labour epidural analgesia.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous ARterial monitoring in Elderly and Frail patients for hip fractUre surgery to prevent Low blood pressure – the CAREFUL Study Protocol","authors":"A. D. Kane,&nbsp;L. Kottam,&nbsp;J. Adamson,&nbsp;S. Davies,&nbsp;A. Mitchell,&nbsp;R. Sheridan,&nbsp;J. Dorey,&nbsp;S. Liggett,&nbsp;N. L. Clark,&nbsp;A. Lakhani,&nbsp;A. Rangan,&nbsp;G. Danjoux","doi":"10.1002/anr3.70059","DOIUrl":"10.1002/anr3.70059","url":null,"abstract":"<p>Intra-operative hypotension is common and associated with postoperative organ injury and mortality, particularly in older patients living with frailty. Continuous invasive arterial blood pressure monitoring provides real-time measurements and may allow earlier detection and management of hypotension and improve outcomes. Contemporary UK data show that this intervention is rarely used in elderly patients living with frailty who are undergoing urgent hip fracture surgery. The CAREFUL Study (<b>C</b>ontinuous <b>AR</b>terial monitoring in <b>E</b>lderly and <b>F</b>rail patients for hip fract<b>U</b>re surgery to prevent <b>L</b>ow blood pressure) will synthesise evidence to determine the feasibility of a definitive randomised controlled trial evaluating continuous versus intermittent arterial blood pressure monitoring in this population. The study comprises three integrated workstreams: a systematic review and meta-analysis to evaluate existing evidence on continuous arterial blood pressure monitoring and peri-operative outcomes; mixed-methods qualitative analysis to explore clinician attitudes, barriers and facilitators to implementation; a multi-centre external feasibility randomised controlled trial with embedded qualitative research. The feasibility study will randomise 100 patients aged ≥ 65 years with a Clinical Frailty Scale score of ≥ 5 undergoing proximal femoral fracture surgery to either continuous invasive arterial blood pressure monitoring or non-invasive 3- to 5-minute cycle blood pressure monitoring. Data will include recruitment, retention and intervention compliance, exposure to intra-operative hypotension, postoperative complications and quality of life. Findings will inform the design of a definitive effectiveness trial. Results will be shared through peer-reviewed open-access publications, stakeholder events and collaboration with professional bodies and patient partners to guide future peri-operative care for older, frail surgical patients.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative polyuria after hepatectomy associated with prolonged sodium-glucose co-transporter-2 inhibitor effect","authors":"D. Tominaga,&nbsp;T. Okada,&nbsp;Y. Hosokawa,&nbsp;C. Tsuboi,&nbsp;H. Fukuoka,&nbsp;N. Obata","doi":"10.1002/anr3.70062","DOIUrl":"https://doi.org/10.1002/anr3.70062","url":null,"abstract":"<p>Sodium-glucose co-transporter-2 inhibitors are routinely withheld before surgery to reduce the risk of peri-operative metabolic complications. However, their pharmacodynamic effects may persist beyond the recommended discontinuation period. We report a 67-year-old man with type 2 diabetes who developed severe postoperative polyuria (6–7 l.day⁻¹) with persistent glycosuria after partial hepatectomy despite discontinuation of canagliflozin 3 days before surgery. Marked transient hepatic dysfunction occurred immediately after surgery, while serum sodium remained within the normal range. Glycosuria and mild ketonuria were observed without overt ketoacidosis. Polyuria gradually resolved with supportive management including glucose-containing fluids and insulin infusion. This case suggests that postoperative hepatic dysfunction may prolong the pharmacological effects of sodium-glucose co-transporter-2 inhibitors and lead to clinically significant disturbances in fluid balance. Careful peri-operative monitoring is warranted in patients undergoing major hepatic surgery after treatment with these agents.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147707995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of pharmacological and non-pharmacological interventions for pre-operative anxiety: a systematic review with network meta-analysis of randomised clinical trials","authors":"G. M. Pinto,&nbsp;E. E. T. Belfort,&nbsp;A. V. M. de Sousa,&nbsp;L. A. A. C. Silva,&nbsp;C. C. de Carvalho","doi":"10.1002/anr3.70058","DOIUrl":"https://doi.org/10.1002/anr3.70058","url":null,"abstract":"<p>Pre-operative anxiety is distressing for patients and is associated with peri-operative complications, yet the relative effectiveness of available pharmacological and non-pharmacological interventions remains unclear. We conducted a systematic review with network meta-analysis to compare anxiolytic strategies in the pre-operative setting. We searched six databases for randomised controlled trials in patients aged ≥ 16 years undergoing surgery, evaluating pharmacological or non-pharmacological anxiolytic interventions. Study selection, data extraction and risk-of-bias assessment were performed in duplicate. We performed pairwise and network meta-analysis for pre-operative anxiety and secondary outcomes (postoperative pain, patient satisfaction, pre-operative sedation and minor or major complications) and used the Grading of Recommendations Assessment, Development and Evaluation to rate certainty of evidence. A total of 350 studies were included. Data from 309 studies (27,218 patients) were analysed for the primary outcome (pre-operative anxiety). Fifteen interventions reduced pre-operative anxiety compared with placebo or sham or no intervention and usual care, including spiritual training standardised mean difference (95% CrI) −6.07 (−9.33 to −2.84), mirtazapine −3.37 (−5.55 to −1.17), binaural beats −2.99 (−5.00 to −0.97), benzodiazepines −1.27 (−1.67 to −0.86), gabapentinoids −1.13 (−1.78 to −0.48) and melatonin −0.90 (−1.65 to −0.16). Other interventions associated with lower anxiety included relaxation techniques, herbal medicines, massage, hydroxyzine, acupoint stimulation, audiovisual distraction, aromatherapy, clonidine and educational strategies. Five interventions improved peri-operative patient satisfaction compared with placebo: parecoxib, acupoint stimulation, psychological intervention, audiovisual distraction and education. No significant differences were identified between interventions for postoperative pain, pre-operative sedation or minor and major complications. Multiple pharmacological and non-pharmacological interventions reduce pre-operative anxiety and may improve peri-operative patient satisfaction. No single intervention appears clearly superior and comparative safety differences remain uncertain.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147708372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closing the monitoring gap: validation of a novel micro-electromechanical systems (MEMS) humidity-sensing device for continuous respiratory monitoring during patient transfer","authors":"D. Rowe,&nbsp;M. Rowe,&nbsp;P. Melksham","doi":"10.1002/anr3.70057","DOIUrl":"https://doi.org/10.1002/anr3.70057","url":null,"abstract":"<p>Transfer from the operating theatre to the post-anaesthesia care unit is a high-risk period with reduced respiratory monitoring, as conventional technologies are often impractical during patient movement. We evaluated a novel, low-cost respiratory monitor using a micro-electromechanical systems humidity sensor to detect breath-by-breath ventilation in spontaneously breathing adults. In this pilot validation study, 50 healthy volunteers wore a prototype humidity sensor mounted on a standard oxygen face mask delivering 4 l.min⁻¹ supplemental oxygen, with the device generating a visual light signal for each detected breath. Respiratory rates measured over 60 s were compared with capnography, and agreement was assessed using Bland–Altman analysis and Pearson correlation. The prototype achieved a breath detection accuracy of 98.8%, with a mean bias of 0.16 breaths.min⁻¹ and 95% limits of agreement from −1.17 to +1.49 breaths.min⁻¹. Strong correlation with capnography was observed (r = 0.98, p &lt; 0.001), and complete agreement occurred in 47 participants (94%), with discrepancies in three cases attributed to poor mask fit. This device provides an accurate, portable and inexpensive method for respiratory monitoring, offering continuous visual assurance when conventional capnography is unavailable or impractical during patient transfer.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.70057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147567119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The paediatric fluid fasting conundrum: a quality improvement initiative in Te Tai Tokerau (Northland, New Zealand)*","authors":"N. Y. E. Wong,&nbsp;C. Gunn,&nbsp;X. C. E. Vrijdag,&nbsp;H. van Waart","doi":"10.1002/anr3.70056","DOIUrl":"https://doi.org/10.1002/anr3.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Fasting is necessary to minimise the risk of aspiration; however, prolonged paediatric fluid fasting is associated with negative peri-operative effects. We evaluated the effect of a collaboratively designed ice block intervention to improve paediatric fluid consumption in the pre-operative room. This project took place in Te Tai Tokerau (Northland, New Zealand). The intervention involved offering children an ice block on arrival in the pre-operative room. Audits were performed pre-intervention, 6 weeks and 18 months post-intervention. The primary outcome was the proportion of children consuming clear fluid in the pre-operative room. Secondary outcomes included fluid fasting times and children's pre-operative experiences. Datasets were analysed using ANOVA and the chi-squared test. Post-intervention, more children consumed clear fluid in the pre-operative room (13% versus 83% versus 95%; p = 0.002) due to more nurses offering (51% versus 87% versus 98%; p &lt; 0.001) and fewer children declining clear fluid (56% versus 2% versus 3%; p = 0.007). The mean fluid fasting time decreased (10 h versus 3 h versus 2 h; p &lt; 0.001), fewer children reported feeling hungry or thirsty (51% versus 15% versus 15%; p &lt; 0.001) and more children reported feeling good or happy (2% versus 43% versus 30%; p &lt; 0.001). This intervention increased clear fluid consumption in the pre-operative room, reduced fluid fasting time and optimised children's pre-operative experience, with sustained effect over 18 months. Future initiatives should focus on prehospital interventions to improve fluid consumption before leaving home on the day of surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147564749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ciprofol–lidocaine combination for sedation in gastrointestinal endoscopy: a systematic review and meta-analysis protocol","authors":"P. Rinaldi,&nbsp;M. L. Garo","doi":"10.1002/anr3.70055","DOIUrl":"10.1002/anr3.70055","url":null,"abstract":"<div>\u0000 \u0000 <p>Ciprofol is a recently introduced intravenous hypnotic agent with sedative efficacy comparable to that of propofol while conferring superior haemodynamic stability and a lower incidence of adverse events. Intravenous lidocaine, widely employed as an adjuvant to propofol-based sedation, has been shown to reduce hypnotic requirements and may facilitate recovery. Nevertheless, no systematic synthesis has yet appraised the combined use of these two agents in the context of gastrointestinal endoscopy. The present protocol delineates the methodology for a systematic review and meta-analysis designed to determine whether the addition of intravenous lidocaine as an adjuvant to ciprofol-based sedation confers improvements in procedural efficacy and safety relative to ciprofol alone. The review will adhere to PRISMA guidelines and has been prospectively registered with PROSPERO (CRD420251166027). Inclusion will be restricted to randomised controlled trials comparing the ciprofol–lidocaine combination with ciprofol alone in adult patients undergoing gastrointestinal endoscopy. The primary outcome will be the total cumulative ciprofol dose administered during the endoscopic procedure, expressed in mg.patient⁻¹, from the induction of sedation through to procedural completion. Data will be synthesised using fixed or random effects models as dictated by the degree of heterogeneity, with risk of bias appraised using the RoB 2.0 tool and certainty of evidence graded according to the GRADE framework. This review will be the first comprehensive synthesis of the evidence pertaining to the efficacy and safety of intravenous lidocaine as an adjunct to ciprofol-based sedation, thereby informing future multimodal sedation strategies and clinical practice.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staff experiences of percutaneous tracheostomy in intensive care: challenges, complications and potential solutions","authors":"M. Moran,&nbsp;A. Goryanyy,&nbsp;A. Haron,&nbsp;C. Jay,&nbsp;A. Weightman,&nbsp;B. McGrath,&nbsp;C. Shelton","doi":"10.1002/anr3.70039","DOIUrl":"10.1002/anr3.70039","url":null,"abstract":"<p>Tracheostomies are performed in 10–13% of UK intensive care admissions. While the percutaneous technique is well established, accurate needle insertion can be difficult in patients with obesity or neck swelling. These challenges increase the risk of bleeding, airway loss and injury to neck structures. In anatomically complex cases, patients are referred for surgical tracheostomy, causing delays and additional healthcare costs. Semi-structured interviews and focus groups were conducted with 32 staff across three intensive care units. Participants included consultants, resident doctors, nurses, advanced practitioners and auxiliary staff. Interviews were recorded, transcribed and analysed using inductive thematic analysis. Six themes were identified. Tracheostomy was seen as a skilled, high-risk procedure best learned through supervised practice. Teamwork, equipment and the environment were considered vital to safety. Staff reported varied approaches to planning and performing the procedure, alongside strategies to prevent and manage complications. Participants reflected on how a guidance device might improve accuracy, drawing on experiences of the benefits and challenges of introducing new technologies into complex clinical settings. This study provides insights into tracheostomy practices, safety strategies and the potential role of guidance devices. Our study also presents a comprehensive end-user co-development model for future medical device design.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12930101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147291978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A low-cost ultrasound phantom for teaching fascial plane blocks, with integrated electrical and haptic feedback","authors":"J. R. Paulin,&nbsp;J. Chin","doi":"10.1002/anr3.70054","DOIUrl":"10.1002/anr3.70054","url":null,"abstract":"<div>\u0000 \u0000 <p>Ultrasound-guided fascial plane blocks are increasingly used as part of multimodal peri-operative analgesia, yet opportunities for structured training in deliberate targeting of fascial planes remain limited. We describe a low-cost ultrasound phantom designed to teach core technical skills required for fascial plane blocks, including ultrasound recognition of tissue layers, tactile feedback on plane entry and accurate needle-tip positioning. The phantom combines readily available soft tissue analogues with a compliant film layer to simulate fascial resistance and a simple electrical circuit that provides objective confirmation of needle contact with defined anatomical boundaries. The design is material-agnostic, reproducible and adaptable to simulate techniques with or without bony end points. This ultrasound phantom provides an accessible educational tool which integrates sonographic, haptic and objective feedback for training in ultrasound-guided fascial plane blocks across a range of teaching environments.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}