Anaesthesia reports最新文献

{"title":"Consequences of spine imaging associated with guideline non-adherence in a pregnant patient with hereditary haemorrhagic telangiectasia","authors":"V. Pinkert,&nbsp;A. Molitor,&nbsp;P. K. Rao,&nbsp;B. M. Togioka","doi":"10.1002/anr3.70052","DOIUrl":"10.1002/anr3.70052","url":null,"abstract":"<p>A pregnant woman with hereditary haemorrhagic telangiectasia was referred to the obstetric anaesthetic team to determine the safety of neuraxial labour analgesia. International guidelines state that the risk of complications from spinal vascular malformations during neuraxial procedures is theoretical and recommend against routine imaging of the epidural space in asymptomatic patients. Despite this, magnetic resonance imaging was obtained to provide patient reassurance. Supine imaging was interpreted as showing an epidural arteriovenous malformation. A repeat scan in the lateral position demonstrated resolution of the apparent lesion, consistent with dynamic pregnancy-related engorgement of the epidural venous plexus due to inferior vena cava compression rather than true malformation. The initial interpretation led to the patient being incorrectly informed that neuraxial analgesia or anaesthesia were contraindicated, resulting in delayed epidural placement, inadequate labour analgesia and considerable anxiety. She ultimately received combined spinal-epidural analgesia, underwent urgent caesarean birth and recovered fully after transient postpartum femoral neuropathy; a third magnetic resonance imaging scan confirmed the absence of epidural haematoma. This case illustrates that non-adherence to guidelines and unnecessary imaging can create diagnostic confusion, delay effective treatment and expose patients to avoidable distress and additional investigations.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12917851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273191","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":"Anaesthetic considerations for a patient with Emery–Dreifuss muscular dystrophy undergoing cardiac resynchronisation therapy with pacemaker implantation","authors":"B. S. M. Ng,&nbsp;E. Lim,&nbsp;K. Valchanov","doi":"10.1002/anr3.70053","DOIUrl":"10.1002/anr3.70053","url":null,"abstract":"<div>\u0000 \u0000 <p>Emery–Dreifuss muscular dystrophy is a rare inherited neuromuscular disorder characterised by early joint contractures, slowly progressive humero-peroneal weakness and cardiac conduction defects or cardiomyopathy. Although contractures and weakness usually begin in childhood, cardiac complications, such as atrioventricular block, arrhythmias and dilated cardiomyopathy, typically emerge in early adulthood and may cause sudden cardiac death, if unrecognised. Anaesthetic management is challenging due to potential airway complications from cervical contractures, restrictive respiratory physiology and cardiac instability. Pre-operative cardiac and pulmonary assessment is essential. Depolarising neuromuscular blocking agents and volatile anaesthetics are not absolutely contraindicated but are preferably avoided due to the risk of rhabdomyolysis or malignant hyperthermia-like reactions. Total intravenous anaesthesia is preferred to minimise these risks. We report a 27-year-old man with genetically confirmed Emery–Dreifuss muscular dystrophy and severe multisystem involvement who underwent cardiac resynchronisation therapy pacemaker implantation under total intravenous anaesthetic technique with rocuronium and reversal with sugammadex. Anaesthetic management focused on malignant hyperthermia precautions, airway preparation for limited cervical mobility and minimising arrhythmia risk with readiness for external cardiac pacing. The procedure and recovery were uneventful, demonstrating that the total intravenous anaesthetic technique can be an effective technique for patients with Emery–Dreifuss muscular dystrophy undergoing device implantation.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146230091","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":"Improving decision-to-delivery interval for category 1 emergency caesarean births in a tertiary hospital","authors":"V. W. L. Ang,&nbsp;D. Y. Chee,&nbsp;S. H. Yap,&nbsp;W. J. Liew,&nbsp;W. K. Lau","doi":"10.1002/anr3.70051","DOIUrl":"10.1002/anr3.70051","url":null,"abstract":"<div>\u0000 \u0000 <p>Timely emergency caesarean birth is critical to maternal and neonatal outcomes. International guidance recommends a decision-to-delivery interval of within 30 min for category 1 cases, yet achieving this target is challenging in hospitals without dedicated obstetric theatres. At our institution, where emergency obstetric cases share operating theatres with other surgical specialities, local audit demonstrated inconsistent compliance with the 30-min standard. A multidisciplinary quality improvement project was undertaken using sequential plan-do-study-act cycles. Interventions focused on reinforcing appropriate categorisation, improving anaesthetists' awareness of decision-to-delivery interval expectations and introducing standardised workflow posters to support activation and escalation during emergencies. The primary outcome was the proportion of category 1 emergency caesarean births with a decision-to-delivery interval within 30 min, assessed using run-chart methodology. Following implementation, performance improved and was sustained above the institutional target of over 90% compliance with the decision-to-delivery interval within 30 min for category 1 caesarean births over a 12-month period. No maternal or neonatal adverse events or unintended theatre workflow disruptions were observed. This project demonstrates that low-cost, system-focused interventions can improve emergency obstetric timeliness in shared theatre environments and may be transferable to similar settings.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203907","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":"Ultralow concentration levobupivacaine 0.0625% for continuous wound infusion after open abdominal surgery: a prospective observational study","authors":"D. Zamudio,&nbsp;L. Gisbert,&nbsp;G. Egea,&nbsp;V. Heras,&nbsp;R. Real","doi":"10.1002/anr3.70050","DOIUrl":"10.1002/anr3.70050","url":null,"abstract":"<div>\u0000 \u0000 <p>Continuous wound infusion with local anaesthetics after open abdominal surgery may provide opioid-sparing analgesia, but evidence on very low-concentration regimens is limited. We conducted a prospective observational study including 50 patients receiving continuous infusion of levobupivacaine 0.0625% via pre-peritoneal or subfascial catheters at a flow rate of 12 ml.h⁻¹ per catheter. Six patients (12%) required intravenous morphine rescue in the first 48 h, with a median dose of 3 mg. Median pain scores remained consistently low and 14 patients (28%) received additional local anaesthetic boluses with effective relief. No major catheter-related complications or systemic local anaesthetic toxicity were observed. Continuous wound infusion with levobupivacaine 0.0625% after open abdominal surgery was feasible and associated with minimal opioid use. These findings provide preliminary evidence supporting the feasibility of an ultralow concentration regimen.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047518","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":"Recto-intercostal fascial plane block for postoperative analgesia in laparoscopic cholecystectomy","authors":"R. S. Theja,&nbsp;M. S. Sahi,&nbsp;R. Kain,&nbsp;V. Bhardwaj,&nbsp;A. Gupta,&nbsp;J. Malhotra,&nbsp;V. Krishna","doi":"10.1002/anr3.70049","DOIUrl":"10.1002/anr3.70049","url":null,"abstract":"<div>\u0000 \u0000 <p>The recto-intercostal fascial plane block is a novel regional anaesthetic technique proposed for cardiac and upper abdominal surgery, with limited evidence for its use in laparoscopic cholecystectomy. We report a series of seven patients undergoing elective laparoscopic cholecystectomy under general anaesthesia, one of whom required a xipho-umbilical incision for common bile duct exploration. All patients received a recto-intercostal fascial plane block prior to surgical incision. Postoperative analgesia included paracetamol 1000 mg for all patients, with one patient additionally receiving diclofenac 75 mg. At 1, 3, 6, 12 and 24 h postoperatively, pain scores remained low (numerical rating scale 0–2 at rest and 2–3 on movement), no rescue opioids were required and all patients had an uncomplicated recovery with early discharge. These cases illustrate the feasibility of incorporating recto-intercostal fascial plane block into multimodal analgesia after laparoscopic cholecystectomy.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031765","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":"Association between pre-operative adherence to positive airway pressure therapy and postoperative opioid use after lower limb arthroplasty in patients with obstructive sleep apnoea","authors":"J. K. Wong,&nbsp;A. Kou,&nbsp;S. G. Memtsoudis,&nbsp;O. Hunter,&nbsp;C. A. Kushida,&nbsp;E. R. Mariano","doi":"10.1002/anr3.70047","DOIUrl":"10.1002/anr3.70047","url":null,"abstract":"<div>\u0000 \u0000 <p>Poor sleep is known to have a negative impact on pain perception, and obstructive sleep apnoea is the most prevalent sleep disorder in adults. Current evidence is conflicting with respect to the benefits of positive airway pressure treatment on pain in patients with obstructive sleep apnoea, which leaves the question of obstructive sleep apnoea as a modifiable factor in pain syndromes unanswered. We conducted a retrospective cohort study of United States of America veterans with obstructive sleep apnoea who underwent total knee or hip arthroplasty to compare positive airway pressure treatment adherence to postoperative opioid use. We reviewed the records for patients with a diagnosis of obstructive sleep apnoea who underwent elective total knee or hip arthroplasty at a single Veterans Affairs hospital. For patients who reported nocturnal positive airway pressure use, we reviewed data downloaded from positive airway pressure devices to determine adherence to therapy based on Medicare criteria. Patient characteristics, peri-operative opioid prescriptions and postoperative outcomes were collected from the electronic medical record. The cohort consisted of 401 patients between April 2014 and May 2019: 104 patients were adherent to positive airway pressure therapy at the time of surgery and 297 were non-adherent. Patients adherent to positive airway pressure therapy were significantly less likely to be prescribed an opioid prior to surgery compared to untreated patients (22% vs 39%, respectively, p = 0.010). Positive airway pressure adherence was not an independent predictor of postoperative opioid requirements in the first three postoperative days. Independent predictors of postoperative opioid requirements included pre-operative opioid prescription, age, history of cocaine abuse and congestive heart failure. In patients with obstructive sleep apnoea who undergo lower limb arthroplasty, adherence to positive airway pressure therapy was not associated with opioid consumption in the immediate postoperative period.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031753","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":"Awake mastectomy in a patient with severe cardio-respiratory disease","authors":"R. Harling,&nbsp;G. Williams,&nbsp;Z. P. Spilsbury","doi":"10.1002/anr3.70048","DOIUrl":"https://doi.org/10.1002/anr3.70048","url":null,"abstract":"<div>\u0000 \u0000 <p>Regional anaesthesia to facilitate awake mastectomy is increasingly recognised as a viable alternative for patients in whom general anaesthesia presents significant risk. This case report describes a successful total mastectomy in a patient with secondary angiosarcoma and multiple complex comorbidities. The planned regional anaesthetic technique included multilevel transverse paravertebral blocks, pecto-intercostal fascial plane blocks and a supraclavicular brachial plexus block. The intricate sensory innervation of the breast, anterior chest wall and axilla present considerable challenges to achieving adequate anaesthesia; these are explored in detail, with emphasis on the necessity of an individualised approach which accounts for both patient-specific and surgical factors. Sedation is commonly employed to enhance patient comfort during awake procedures; however, pharmacological selection and administration may be complicated in patients with pulmonary hypertension, as illustrated in this case. The patient experienced optimal conditions for surgical resection and reported a positive peri-operative journey, from pre-assessment to hospital discharge. A reflective account of the patient's experience is included. This case, in conjunction with existing literature, supports the broader implementation of awake mastectomy as a feasible and patient-centred option in appropriately selected individuals.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146007744","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":"Anaesthetic management of the first caesarean birth following uterus transplantation in the United Kingdom","authors":"K. Murrell,&nbsp;B. A. S. Jones,&nbsp;B. P. Jones,&nbsp;A. L'Heveder,&nbsp;C. Frise,&nbsp;I. Quiroga,&nbsp;J. R. Smith,&nbsp;J. P. Campbell","doi":"10.1002/anr3.70042","DOIUrl":"https://doi.org/10.1002/anr3.70042","url":null,"abstract":"<div>\u0000 \u0000 <p>We describe the anaesthetic management of the first caesarean birth following uterus transplantation in the United Kingdom. This remains a novel procedure globally, and there are important considerations for the anaesthetist. A 36-year-old female with a background of Mayer–Rokitansky–Küster–Hauser syndrome presented for caesarean birth at 34⁺² weeks' gestation following uterus transplantation and in vitro fertilisation. The principal challenges for the anaesthetist are the ongoing requirement for immunosuppression, a different surgical technique compared with that required for caesarean birth in the native uterus and increased risk of haemorrhage requiring careful management of uterotonics and blood products. We used a combined spinal–epidural technique to provide anaesthesia in preparation for a potentially prolonged procedure. We prepared for the possibility of major haemorrhage, including the use of cell salvage. A multidisciplinary team involving transplant physicians and surgeons, obstetric physicians, obstetricians, midwives and anaesthetists guided the care of the patient throughout. We expect that this procedure will become increasingly common in the United Kingdom as uterus transplantation becomes more established as a treatment for uterine factor infertility.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002470","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":"Improving the assessment of acute pain in adult inpatients: a quality improvement project*","authors":"C. Adcock,&nbsp;R. McMahon,&nbsp;K. Duffy,&nbsp;L. Peters,&nbsp;N. Drury,&nbsp;C. Thomas,&nbsp;Adult Acute Pain Team at Leeds Teaching Hospitals NHS Trust","doi":"10.1002/anr3.70041","DOIUrl":"10.1002/anr3.70041","url":null,"abstract":"<div>\u0000 \u0000 <p>Acute pain remains a significant issue for inpatients, for example, 20–40% of surgical inpatients report severe pain in the first 24 postoperative hours. Simple pain rating scales are widely used but have limitations. National guidelines recommend incorporating functional assessment to guide individualised pain management, though how best to do this remains unclear. This quality improvement project aimed to enhance the assessment of acute pain in adult inpatients at Leeds Teaching Hospitals by introducing functional assessment alongside standard pain scoring. Applying the Model for Improvement and Plan–Do–Study–Act cycles, we prototyped a Leeds Functional Activity Score and evaluated its usability across three cycles. Once the methodology of assessing functional pain was prototyped (cycle one), 79 adult inpatients' pain was assessed using both Leeds Functional Activity Score and the Numeric Rating Scale (cycle two). We found pain intensity patterns did not always predict functional impact. Functional assessment enabled conversations with patients about the need to manage function rather than targeting a pain score. Cycle three involved evaluation by 37 ward staff, with 73% rating it as ‘easy’ or ‘very easy’ to use. This cycle helped us to identify training needs. This report demonstrates that implementing functional assessment alongside traditional pain scoring is feasible, well received by staff and provides clinically meaningful context to guide analgesia. The Leeds Functional Activity Score has now been integrated into the hospital's electronic systems, alongside supporting training videos and communications.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"13 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806327","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":"Management of induction of labour and subsequent emergency caesarean birth in a parturient with catecholaminergic polymorphic ventricular tachycardia","authors":"R. Foglia III,&nbsp;S. K. W. Mankowitz","doi":"10.1002/anr3.70044","DOIUrl":"10.1002/anr3.70044","url":null,"abstract":"<div>\u0000 \u0000 <p>We describe the anaesthetic management of a parturient with catecholaminergic polymorphic ventricular tachycardia and an implantable cardioverter-defibrillator during induction of labour and subsequent emergency caesarean birth. Catecholaminergic polymorphic ventricular tachycardia is characterised by genetic mutations leading to increased sympathetic activity, potentially causing ventricular arrhythmias and cardiac arrest. There are limited data discussing the anaesthetic management of parturients with catecholaminergic polymorphic ventricular tachycardia. We describe our approach to anaesthetic management, focusing on minimising sympathetic stimulation through early combined spinal-epidural placement, the use of epidural adjuvants, such as α2-agonists, and the avoidance of catecholaminergic medications.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"13 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806417","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}