Anaesthesia reports最新文献

{"title":"Airway management and one-lung ventilation strategies during hepatic histotripsy: a retrospective service evaluation from a single institution in Hong Kong","authors":"M. H. M. Chu,&nbsp;C. Y. T. Hui,&nbsp;H. M. K. Wong","doi":"10.1002/anr3.70092","DOIUrl":"10.1002/anr3.70092","url":null,"abstract":"<p>This retrospective single-centre service evaluation describes double-lumen tube one-lung ventilation as a respiratory motion-control strategy for hepatic histotripsy in 26 adults in Hong Kong. Histotripsy is a non-invasive, non-thermal focused ultrasound technique requiring precise targeting, challenged by respiratory-induced liver motion. High-frequency jet ventilation has been used to minimise motion but carries practical and physiological limitations. All procedures were performed under general anaesthesia with intended double-lumen tube one-lung ventilation. Successful double-lumen tube placement without modification was achieved in 81% of cases; overall, 92% of patients received one-lung ventilation using either double-lumen tube or bronchial blockers. Transient intra-operative desaturation occurred in 29% of one-lung ventilation cases but was managed with standard ventilatory adjustments. Technical success was achieved in 92% of cases. No major airway or respiratory complications or unplanned critical care admissions occurred and all patients were discharged within 2 days postoperatively. These findings suggest that double-lumen tube one-lung ventilation is a feasible and safe alternative to high-frequency jet ventilation for respiratory motion control during hepatic histotripsy, using widely available thoracic anaesthesia techniques. The retrospective design, small sample size and absence of comparator group highlight the need for future prospective trials to evaluate efficacy, safety and cost-effectiveness relative to high-frequency jet ventilation.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551571","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":"Airway obstruction due to a reinforced tracheal tube obstruction during submental intubation","authors":"B. Etienne Lopes,&nbsp;T. Saucy","doi":"10.1002/anr3.70091","DOIUrl":"10.1002/anr3.70091","url":null,"abstract":"<div>\u0000 \u0000 <p>Submental intubation is an alternative to nasotracheal intubation or tracheostomy in maxillofacial surgery when unobstructed access to the oral cavity is required. Reinforced tracheal tubes are considered the standard for this technique to avoid kinking during the procedure. Removal of the fixed standard 15 mm connector is required to perform the original Altemir's technique, which is the most used technique of submental intubation. Disconnecting the glued connector is a modification developed by clinicians, not endorsed by manufacturers and may expose patients to unforeseen risks. We report the management of a patient undergoing surgical repair of complex facial fractures with planned submental intubation. After repeated disconnections during tube repositioning, mechanical ventilation became difficult due to an intraluminal obstruction. Obstruction was caused by a polyvinyl chloride flap originating from the reinforced tracheal tube at the level of the forcibly removed connector. Removal of the flap restored normal ventilation and the remainder of the procedure was uneventful. To our knowledge, this is the first report of such a complication during submental intubation. It highlights material-related risk and underscores the importance of careful handling and inspection of the tracheal tube after removing the connector. Preventive strategies and alternative airway devices should be considered to enhance airway safety during submental intubation.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551546","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":"Comment on ‘Staff experiences of percutaneous tracheostomy in intensive care: challenges, complications and potential solutions’","authors":"J. Gibson,&nbsp;U. Watson,&nbsp;N. Botting,&nbsp;T. Leckie,&nbsp;L. Hodgson","doi":"10.1002/anr3.70093","DOIUrl":"https://doi.org/10.1002/anr3.70093","url":null,"abstract":"","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467550","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":"Comment on ‘Local anaesthetic documentation: from maximum dose to cumulative dose reconciliation’","authors":"Eanna O'Sullivan,&nbsp;Ranil Soysa","doi":"10.1002/anr3.70089","DOIUrl":"10.1002/anr3.70089","url":null,"abstract":"","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450913","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 equity in prehabilitation before cancer surgery: consensus-based considerations for leaders and practitioners: a nominal group technique study*","authors":"X. Zhang,&nbsp;L. Ashmore,&nbsp;C. Hadley,&nbsp;C. Kullikowski,&nbsp;S. Stanley,&nbsp;H. Stewart,&nbsp;L. Wareing,&nbsp;C. Gaffney,&nbsp;A. Partridge,&nbsp;A. Smith,&nbsp;J. Rycroft Malone,&nbsp;C. Shelton","doi":"10.1002/anr3.70085","DOIUrl":"10.1002/anr3.70085","url":null,"abstract":"<p>Prehabilitation aims to improve physical, nutritional and psychological health before surgery. Despite its potential benefits, inequitable access remains a concern. The wider PARITY study aimed to identify and help address inequalities in prehabilitation before cancer surgery using a mixed-methods approach. This report describes the end-of-study prioritisation workshop, which brought together professional, public and patient participants to prioritise considerations to promote equity in prehabilitation services using a nominal group technique. Before the workshop, 42 considerations identified from preceding work, including co-design, Delphi, service mapping and case studies, were shared with participants for review. Participants (n = 15) discussed and prioritised these considerations according to perceived impact and feasibility of implementation. Considerations were ranked by perceived priority and categorised by level of implementation. Forty-two considerations were prioritised and categorised as system level (n = 15), service level (n = 22) and practitioner level (n = 5). The six highest-priority considerations relate to: understanding how prehabilitation and surgery may affect each patient's life; adapting delivery to individual needs; making services available at a system-wide level; contacting patients who are not engaging; providing interpreters where needed; and training care teams in equality and diversity issues. These findings provide consensus-based considerations to support more equitable prehabilitation before cancer surgery, at a time when prehabilitation is increasingly prominent in national guidance.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457799","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":"Considerations for an awake craniotomy in a paediatric patient","authors":"S. M. Z. Naqvi,&nbsp;A. Akram,&nbsp;A. Iqbal,&nbsp;F. A. Hashmi,&nbsp;Q. A. Tariq,&nbsp;J. Hussain,&nbsp;H. Saleem","doi":"10.1002/anr3.70082","DOIUrl":"10.1002/anr3.70082","url":null,"abstract":"<div>\u0000 \u0000 <p>Awake craniotomy facilitates real-time assessment of neurological function and maximises the extent of tumour resection, reducing the risk of postoperative deficits. Awake craniotomy is uncommonly performed in young children. To our knowledge, we report the youngest case of awake craniotomy in medical literature, involving a 6-year-old child. He had a right frontoparietal tumour and a 4-year history of drug-resistant epilepsy. As the tumour was located in an eloquent brain area, an awake craniotomy was planned. Pre-operative preparation included psychological assessment, theatre environment simulation and interpreter-assisted counselling. An asleep-awake-asleep technique was employed. Maximum safe resection was achieved without haemodynamic instability. The patient remained neurologically intact postoperatively, with no speech or motor deficits. Postoperative magnetic resonance imaging demonstrated satisfactory resection. Psychological follow-up confirmed no distress or significant recall of the surgery. He was discharged seizure-free and without any deficit on postoperative day 4. This case shows that with thorough preparation and multidisciplinary teamwork, awake craniotomy is feasible and well tolerated even in very young paediatric patients.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450900","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":"Quantifying the volume of nitrous oxide mix wasted through stock rotation in a manifold supply system","authors":"J. Waller,&nbsp;J. Russell,&nbsp;E. Harman,&nbsp;C. Mitchell,&nbsp;C. El Zerbi,&nbsp;C. Hadley,&nbsp;C. Shelton","doi":"10.1002/anr3.70086","DOIUrl":"10.1002/anr3.70086","url":null,"abstract":"<p>Nitrous oxide accounts for more healthcare-associated carbon-equivalent emissions than all other anaesthetic gases combined. Prior research has demonstrated significant waste of pure nitrous oxide. However, waste from nitrous oxide mix (‘gas and air’) remains poorly characterised. We conducted a single-site service evaluation of waste due to returns of unused nitrous oxide mix. A manifold-based system of eight G-size cylinders was assessed across four exchanges in two non-consecutive weeks. Cylinders were weighed following removal from the manifold. The residual mass of gas was calculated by subtracting the tare weight from the total mass. Results were analysed using descriptive statistics. Carbon-equivalent greenhouse gas emissions were estimated using 100-year global warming potential (273). The mean residual mass per cylinder was 1.25 kg (SD 0.53; range 0–2.1), representing 14.8% of original contents. Across four exchanges, 38.9 kg of nitrous oxide mix was returned unused, equivalent to 6.17 tonnes CO₂. Waste is embedded in the routine practice of maintaining an uninterrupted supply of nitrous oxide mix. There is substantial variance, both between and within cylinder bank changes, which may be due to leaks or gas handling practices. Multi-site evaluations are needed to develop a broader understanding of waste, and why it occurs.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13348591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426886","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 and intensive care management of refractory hypotension in a high-risk patient with chronic cocaine use*","authors":"Gülgün E. Aksoy,&nbsp;Gamze Küçükosman,&nbsp;Esra Kongur","doi":"10.1002/anr3.70087","DOIUrl":"10.1002/anr3.70087","url":null,"abstract":"<div>\u0000 \u0000 <p>Chronic cocaine use is associated with complex cardiovascular changes, including catecholamine depletion and dilated cardiomyopathy, predisposing patients to peri-operative haemodynamic instability. We report a 41-year-old man with chronic cocaine use, severe left ventricular dysfunction (left ventricular ejection fraction 20%), type 2 diabetes mellitus and recent myocardial infarction who underwent emergency surgery for perforated appendicitis. After induction of anaesthesia, he developed profound hypotension refractory to fluids and ephedrine, requiring a noradrenaline infusion. The postoperative course was complicated by septic shock and acute kidney injury requiring continuous renal replacement therapy, followed by gradual stabilisation in intensive care. This case highlights that peri-operative hypotension in patients with chronic cocaine use and advanced cardiac dysfunction may reflect catecholamine depletion rather than acute intoxication. Early use of direct acting vasopressors with planned postoperative intensive care monitoring may be crucial in reducing morbidity and mortality.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426851","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":"Lipid emulsion infusion and its effect on anaesthetic drugs","authors":"D. Coffey,&nbsp;A. Mangalam Lonappan,&nbsp;D. Dillon","doi":"10.1002/anr3.70080","DOIUrl":"10.1002/anr3.70080","url":null,"abstract":"<div>\u0000 \u0000 <p>Lipid emulsion has several established clinical uses, including parenteral nutrition, treatment of local anaesthetic systemic toxicity and as an energy source in metabolic crises, such as maple syrup urine disease. In toxicological settings, it acts via a ‘lipid sink’ mechanism, sequestering lipophilic drugs and reducing their bioavailability. This raises the possibility that the pharmacokinetics of commonly used anaesthetic agents may be affected in patients with a high intravascular lipid load. We report the peri-operative management of a 14-year-old child with maple syrup urine disease receiving a high-dose lipid emulsion infusion during a metabolic crisis, who required general anaesthesia and intubation to facilitate transfer to a specialist paediatric centre. During induction of anaesthesia, fentanyl appeared to have a minimal sedating effect. Ketamine was avoided due to concerns regarding unpredictable efficacy in the setting of lipid loading. The patient also developed significant hypotension during maintenance with sevoflurane at one minimum alveolar concentration, raising the possibility of altered anaesthetic potency. A review of the literature revealed a lack of evidence examining the pharmacodynamics of anaesthetic drugs in lipid-loaded patients. As the use of lipid emulsion increases, further research is required to guide safe and effective anaesthetic practice in this setting.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426843","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":"Study protocol for the SECURE (RAFT-5) study: Service Evaluation of in-hospital Cross-speciality UK adult Rapid sequence intubation Events","authors":"T.E. Baumer,&nbsp;S. Gupta,&nbsp;T.W. Davies,&nbsp;S. Tomassini,&nbsp;S.R. Harrogate,&nbsp;A.V. Ramesh,&nbsp;T.E. Cloke,&nbsp;C. Taylor,&nbsp;C. Lim,&nbsp;J.D. Barnes,&nbsp;I. Grossi,&nbsp;S. Sudan,&nbsp;T.M. Cook,&nbsp;SECURE (RAFT-5) Investigation Group (STAR, RAFT, TRIC, TERN and EMAR)","doi":"10.1002/anr3.70071","DOIUrl":"10.1002/anr3.70071","url":null,"abstract":"<p>Rapid sequence intubation has evolved substantially since its inception over 50 years ago. Contemporary in-hospital rapid sequence intubation practice includes a combination of variably employed components, many of which lack robust supporting evidence. Real-world practice and the beliefs underpinning it are poorly characterised. We present the protocol for SECURE (Service Evaluation of Cross-speciality United Kingdom Rapid Sequence Intubation Events), a prospective service evaluation which aims to characterise adult in-hospital rapid sequence intubation practice across the United Kingdom. SECURE will comprise three electronic surveys (with data collection windows): (1) a Site Survey (six weeks) assessing local resources and governance; (2) a Vignette-based Survey (seven weeks) exploring drivers of variation in self-reported rapid sequence intubation practice; and (3) an Activity Survey (14 days per site) capturing user-defined rapid sequence intubation events and immediate complications. Survey development followed the Consensus-Based Checklist for Reporting of Survey Studies and was reviewed by expert advisers. Data will be stored securely at the Sponsor site and analysed in collaboration with a statistician. SECURE will provide a national overview of in-hospital rapid sequence intubation practice, including variation in resources and decision-making and describe the incidence of immediate complications. Formally recognised as a service evaluation, the study will be registered with information governance departments and represents the fifth project of the Research and Audit Federation of Anaesthetists in Training, overseen by the SECURE Investigation Group. Findings will inform future recommendations, investment and research in rapid sequence intubation practice.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"14 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426866","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}