BJA open最新文献

{"title":"Ethical decision making in airway management: a difficult Airway Society position statement on good practice","authors":"Barry McGuire ,&nbsp;Simon Crawley ,&nbsp;Nicki Dill ,&nbsp;Paul Greig ,&nbsp;Rehana Iqbal ,&nbsp;Mathew Patteril ,&nbsp;Kate Rivett ,&nbsp;Anika Sud ,&nbsp;Anne-Marie Slowther","doi":"10.1016/j.bjao.2025.100416","DOIUrl":"10.1016/j.bjao.2025.100416","url":null,"abstract":"<div><div>Practitioners involved in airway management must balance ethical issues in their practice. Ethical tensions exist because clinicians must maintain clinical standards while maximising skill development, exploring advances in airway practice, and incorporating new learning to benefit future patients. Balancing the benefits and risks to the patient and choosing the right techniques in the right situations and with the right level of patient understanding and respect for patient autonomy can be challenging.</div><div>These challenges are shared by airway practitioners from many professional backgrounds; however, this document has been developed specifically to support anaesthetists in their airway management decisions, and for simplicity, the term ‘anaesthetists’ will be used throughout the document. However, the ethical considerations will have relevance to all airway practitioners.</div><div>Practice combined with training is central to professional development. Most patients are aware that training is entwined with care and trust anaesthetists to deliver this safely. Trainers should use airway teaching methods appropriate to the trainee's needs and skills.</div><div>Informed consent is required for airway management, and the level of detail should be proportionate to the risks involved. Patients have individual preferences and appreciation of risks, so these conversations must be individualised.</div><div>Anaesthetists should support the development of new airway devices and techniques. New methods must be assessed within governance structures, and it may be appropriate to collect data or feedback as part of the introduction to practice.</div><div>Ethical practice requires doing what is best, doing it openly, honestly, and in patients' interests. The modern ethical and legal landscape has emphasised patient information, discussion, and documentation. We hope this position statement provides guidance, structure, and clarity for the benefit of our patients and our specialty.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"15 ","pages":"Article 100416"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322378","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":"PICCs versus PORTs, an Australian perspective. Comment on BJA Open 2025; 13: 100377","authors":"Stuart Walker,&nbsp;Louise Nott","doi":"10.1016/j.bjao.2025.100424","DOIUrl":"10.1016/j.bjao.2025.100424","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"15 ","pages":"Article 100424"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307979","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":"Patient preference for intraoperative opioid use and early recovery after noncardiac surgery: protocol for a randomised factorial design trial of opioid-free versus opioid-based anaesthesia (the PERFECT trial)","authors":"Yann Gricourt ,&nbsp;Nancy M. Boulos ,&nbsp;Amelie Delaporte ,&nbsp;Brenton Alexander ,&nbsp;Stephane Besada ,&nbsp;Ryan Bakhit ,&nbsp;Aline Toukhtarian ,&nbsp;Ido Neuman ,&nbsp;Daniel Pearce ,&nbsp;Meziar M. Nourian ,&nbsp;Arthur Chebishian ,&nbsp;Amy Zhou ,&nbsp;Janice Boktor ,&nbsp;Dylan Mayanja ,&nbsp;Tristan Grogan ,&nbsp;David Boldt ,&nbsp;Maxime Cannesson ,&nbsp;Patrice Forget ,&nbsp;Alexandre Joosten","doi":"10.1016/j.bjao.2025.100420","DOIUrl":"10.1016/j.bjao.2025.100420","url":null,"abstract":"<div><h3>Introduction</h3><div>Although opioids are commonly used to relieve pain associated with surgery, they are not consequence free. Moreover, the USA and many western countries are currently experiencing a significant health crisis because of opioid addiction and its related overdose potential. There have been no studies that have evaluated patient preference regarding opioid use and its potential impact on the quality of recovery. The aim of this study is to compare the effect of patient preference on intraoperative opioid use on early postoperative quality of recovery after moderate risk laparoscopic/robotic abdominal surgery.</div></div><div><h3>Methods</h3><div>This trial is an interventional, pragmatic, partially randomised factorial trial. Adults (<em>N</em>=240) scheduled for moderate-risk abdominal surgery under laparoscopic/robotic assistance (colorectal, urologic, and gynaecologic) will be allocated into four groups, according to their preference (choice of opioid-free <em>vs</em> opioid-based anaesthesia <em>vs</em> no choice and, if no choice, then the patient is randomised to opioid-based <em>vs</em> opioid-free anaesthesia). Anaesthesia providers and patients who choose their anaesthesia type will be unblinded of the allocation group. The primary endpoint will be the Quality of Recovery-15 score at postoperative day 1. Secondary endpoints will include patient satisfaction, postoperative nausea and vomiting, intraoperative bradycardia, postoperative opioid consumption, postoperative hypoxemia, and health-related quality of life using the EuroQoL 5-Dimension 5-Level (EQ-5D-5L).</div></div><div><h3>Conclusions</h3><div>This trial will provide evidence on whether patient preference on intraoperative opioid use can improve patient quality of recovery after moderate-risk abdominal surgery.</div></div><div><h3>Clinical trial registration</h3><div>NCT06855641.</div></div><div><h3>Protocol version number and date</h3><div>2.0, 24 February 2025.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"15 ","pages":"Article 100420"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307978","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":"Anxiety and induction of anaesthesia in children: the impact of big data and children's rights","authors":"Tom Giedsing Hansen ,&nbsp;Susan M. Goobie ,&nbsp;Thomas Engelhardt","doi":"10.1016/j.bjao.2025.100413","DOIUrl":"10.1016/j.bjao.2025.100413","url":null,"abstract":"<div><div>This editorial explores the role of big data in understanding paediatric anaesthesia anxiety, analysing a study of 155 000 cases. It highlights challenges such as parental presence, premedication, and methodological limitations. The authors advocate combining big data with more rigorous studies, including qualitative research, to improve patient-centred care.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100413"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255178","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":"A GAP analysis of the current state of Pain Management Services in the UK, 2024","authors":"Sue Copley ,&nbsp;Beatrice Bretherton ,&nbsp;Suzanne Carty ,&nbsp;Matthew Brown ,&nbsp;Sailesh Mishra ,&nbsp;Emmy Kato Clarke ,&nbsp;Ganesan Baranidharan ,&nbsp;Devjit Srivastava ,&nbsp;GAP Analysis Working Group","doi":"10.1016/j.bjao.2025.100414","DOIUrl":"10.1016/j.bjao.2025.100414","url":null,"abstract":"<div><h3>Background</h3><div>In the UK, multidisciplinary services for patients experiencing chronic pain are currently commissioned by the NHS as specialised services. Pain services across the UK were placed under significant strain during the COVID pandemic. The ‘GAP Analysis working group’ (GAP group) was commissioned by the Board of the Faculty of Pain Medicine (FPM) in November 2021 to evaluate the post-COVID state of pain services across the country.</div></div><div><h3>Methods</h3><div>The GAP group's remit was to establish any deficit in pain services when measured against the service ‘gold standard’ outlined in the published FPM document ‘Core Standards for Pain Management Services volume 2.0’ (CSPMS). A survey was developed using an iterative consensus process among the group and was distributed to all FPM members.</div></div><div><h3>Results</h3><div>The survey included questions pertaining to 21 standards. There were 164 respondents to this GAP analysis from 97 individual clinical sites delivering pain services in the UK. The majority of respondents worked in secondary care (74%), followed by tertiary care (23%) and finally primary care (3%). No single standard was met by all reporting sites. The degree of compliance with individual standards varied, ranging from only 30% of sites reporting full compliance (standard 9: research and development) to 79% of sites reporting full compliance (standard 21: interventional pain procedure).</div></div><div><h3>Conclusions</h3><div>The following aspects of chronic pain services need urgent redress: provision of paediatric pain services, provision of cancer pain services, outcome data management support, research and development, and increased support of psychological services and pain management programme access.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100414"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178038","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":"Systemic role of orexin A, substance P, bradykinin, and DABK in severe COVID-19 and 2.5-yr follow-ups: an observational study","authors":"Ulrike Heinicke ,&nbsp;Steven R. Talbot ,&nbsp;Filippos Thanasis ,&nbsp;Elisabeth H. Adam ,&nbsp;Andreas von Knethen ,&nbsp;Andrea U. Steinbicker ,&nbsp;Sebastian Zinn ,&nbsp;Kai Zacharowski ,&nbsp;Armin N. Flinspach","doi":"10.1016/j.bjao.2025.100415","DOIUrl":"10.1016/j.bjao.2025.100415","url":null,"abstract":"<div><h3>Background</h3><div>Orexin A regulates sleep–wake cycles, arousal, and energy homeostasis, linking it to the renin–angiotensin system and substance P. Dysfunction in these pathways occurs in acute and long-term COVID-19, including post-COVID syndrome.</div></div><div><h3>Methods</h3><div>This observational study analysed plasma orexin A, substance P, bradykinin, and des-Arg⁹-bradykinin (DABK) in 78 ICU COVID-19 patients, 14 survivors of severe COVID-19 (2.5-yr follow-ups), and 14 healthy controls.</div></div><div><h3>Results</h3><div>During acute COVID-19, bradykinin and substance P were significantly reduced, whereas DABK was elevated compared with healthy controls and 2.5-yr follow-ups. Orexin A concentration correlated with ICU survival (Cohen’s d=0.4), length of stay (LOS; r=–0.26, <em>P</em>=0.02), and sedation concentrations. Intriguingly, substance P plasma concentrations were elevated in 2.5-yr follow-ups. Plasma orexin A, substance P, and bradykinin increased with lower Richmond Agitation–Sedation Score (RASS): a combination of orexin A, substance P, and bradykinin concentrations at RASS –3 to –5 distinguished survivors from non-survivors of COVID-19 when categorised by age.</div></div><div><h3>Conclusions</h3><div>Changes in the bradykinin axis, affecting substance P and orexin A signalling, are associated with severe COVID-19, ICU LOS, and survival. Elevated substance P concentrations in the 2.5-yr follow-up cohort may be associated with physical, cognitive, and neuropsychological impairments commonly seen in post-ICU syndrome and post-COVID syndrome. The predictive values of orexin A, substance P, bradykinin, and DABK and the complex interplay between the renin–angiotensin system and the orexinergic system in severe, critical illnesses or viral diseases will be investigated in future studies.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100415"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220872","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":"Long-term outcomes of time-dependent phenotypes of perioperative myocardial injury☆","authors":"Mikael Fält ,&nbsp;Rasmus Åhman ,&nbsp;Fredrik Hammarskjöld ,&nbsp;Sara Lyckner ,&nbsp;Monir Jawad ,&nbsp;Ulrika Andersson ,&nbsp;Mats Fredrikson ,&nbsp;Jesper Sperber ,&nbsp;Louise Elander ,&nbsp;Lina De Geer ,&nbsp;Helén Didriksson ,&nbsp;Carina Jonsson ,&nbsp;Henrik Andersson ,&nbsp;Michelle S. Chew","doi":"10.1016/j.bjao.2025.100422","DOIUrl":"10.1016/j.bjao.2025.100422","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative myocardial injury (PMI) is associated with increased short-term major adverse cardio- and cerebrovascular events (MACCE) and mortality. We evaluated how different phenotypes of PMI based on timing of injury impact long-term MACCE and mortality among patients undergoing major noncardiac surgery (NCS).</div></div><div><h3>Methods</h3><div>A prospective, observational study was carried out in 1290 patients aged ≥50 yr undergoing major noncardiac surgery. High-sensitivity cardiac troponin T (hs-cTnT) was measured before surgery and up to 3 days after surgery. Patients were classified into four groups: (1) no hs-cTnT elevation, (2) isolated preoperative hs-cTnT increases, (3) normal preoperative hs-cTnT with perioperative elevation, and (4) increased preoperative hs-cTnT with perioperative elevation. The main outcomes were MACCE and mortality up to 3 yr after operation.</div></div><div><h3>Results</h3><div>At 3-yr follow-up, MACCE had occurred in 17.1%, 37.9%, 45.2%, and 50.7% and mortality was 21.4%, 30.3%, 30.1%, and 33.8% in groups 1–4, respectively. All PMI phenotypes were independently associated with MACCE. Patients with ‘normal preoperative hs-cTnT with perioperative elevation’ appeared to have the highest risk. In this phenotype, the risk was greatest at 30 days (adjusted odds ratio, 4.5; 95% confidence interval, 2.3–8.8) and persisted over 3 yr (adjusted odds ratio, 3.5; 95% confidence interval, 2.0–5.9). PMI was associated with increased mortality, but the relationship was not sustained after multivariable adjustment.</div></div><div><h3>Conclusions</h3><div>Increased hs-cTnT based on timing identifies prognostically important subgroups. Perioperative increases, regardless of preoperative levels, are associated with a high risk of MACCE that is sustained up to 3 yr after surgery. This supports the use of time-based PMI phenotypes for prognostic enrichment studies to mitigate the risk of MACCE.</div></div><div><h3>Clinical trial registration</h3><div>NCT03436238.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100422"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212813","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":"Investigating the effectiveness of an intraoperative decision support guided fluid therapy intervention on postoperative outcome of high-risk patients undergoing high-risk abdominal surgery: protocol for an international multicentre stepped-wedge cluster-randomised implementation trial","authors":"Sean Coeckelenbergh ,&nbsp;Amelie Delaporte ,&nbsp;Damien Rousseleau ,&nbsp;Jacques De Montblanc ,&nbsp;Stephanie Roullet ,&nbsp;Joanna Ramadan ,&nbsp;Bernard Cholley ,&nbsp;Alexandre Stibon ,&nbsp;Emmanuel Weiss ,&nbsp;Maria-Christina Kassab ,&nbsp;Sylvain Diop ,&nbsp;Elsa Manzi ,&nbsp;Marco Pustetto ,&nbsp;Guillaume Porta Bonette ,&nbsp;Pierre Gregoire Guinot ,&nbsp;Philippe Guerci ,&nbsp;Domien Vanhonacker ,&nbsp;Francois Martin Carrier ,&nbsp;Brenton Alexander ,&nbsp;Joseph Rinehart ,&nbsp;Alexandre Joosten","doi":"10.1016/j.bjao.2025.100421","DOIUrl":"10.1016/j.bjao.2025.100421","url":null,"abstract":"<div><h3>Background</h3><div>Inappropriate fluid administration can impact patient outcome. Intraoperative advanced haemodynamic monitoring coupled with a treatment protocol based on stroke volume optimisation can help determine the appropriate timing for fluid boluses. Although recommended by several anaesthesia societies, this strategy is rarely implemented because protocols are complex and compliance is often poor. The Acumen Assisted Fluid Management (AFM) software is a decision support system that uses machine learning to predict fluid responsiveness and individualise fluid therapy. AFM reportedly predicts fluid responsiveness better than clinicians, decreases preload-dependent states, and improves both macro- and microcirculatory variables. The goal of this international multicentre stepped-wedge cluster randomised trial is to test whether implementing AFM during high-risk surgery improves patient outcome.</div></div><div><h3>Methods</h3><div>The trial is ongoing in 16 academic hospitals in France, Belgium, Canada, and the USA. All centres (clusters) deliver routine care (control arm) at the start of the study and crossed over (one way) to AFM-guided fluid therapy (intervention arm). The time when different centres switch to AFM is randomised by an independent statistician. At the end of the trial, all centres will cross over to the intervention group. The primary outcome is a composite of major complications and death 30 days after surgery that will be analysed as intention-to-treat. A total of 2000 patients are required to detect a relative 20% differences in the primary outcome between groups.</div></div><div><h3>Conclusions</h3><div>This trial is powered to provide evidence on whether implementing AFM is effective in reducing postoperative complications in high-risk patients after high-risk abdominal surgery.</div></div><div><h3>Clinical trial registration</h3><div>NCT06011187.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100421"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220908","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":"Intraoperative methadone for postoperative pain in adult patients undergoing tonsillectomy—a randomised controlled trial","authors":"Michael Bøndergaard ,&nbsp;Peter Gaarsdal Uhrbrand ,&nbsp;Tutku Karaca ,&nbsp;Marianne Rhode ,&nbsp;Thomas Kjærgaard ,&nbsp;Rene Thunberg Svendsen ,&nbsp;Tejs Ehlers Klug ,&nbsp;Lone Nikolajsen ,&nbsp;Kristian Dahl Friesgaard","doi":"10.1016/j.bjao.2025.100418","DOIUrl":"10.1016/j.bjao.2025.100418","url":null,"abstract":"<div><h3>Background</h3><div>Tonsillectomy is a common procedure often associated with severe postoperative pain. This study hypothesised that methadone would provide superior postoperative pain relief and reduced opioid consumption compared with fentanyl.</div></div><div><h3>Methods</h3><div>A total of 120 adult patients undergoing elective bilateral tonsillectomy were randomly allocated to receive either methadone (0.2 mg kg⁻¹; <em>n</em>=62) or fentanyl (3 μg kg⁻¹; <em>n</em>=58) after anaesthesia induction. Joint primary outcomes were pain intensity (numeric rating scale, 0–10) at swallowing upon postanaesthesia care unit (PACU) arrival and cumulative opioid consumption (oral morphine equivalents) over 5 postoperative days. Secondary outcomes included pain at swallowing, PACU and hospital stay duration, sedation at 4 h, patient satisfaction at days 1 and 7, postoperative nausea/vomiting (PONV) on days 1–3, and PACU adverse events.</div></div><div><h3>Results</h3><div>Cumulative 5-day opioid consumption was lower in the methadone group (30 mg, inter-quartile range [IQR] 10–50 mg) <em>vs</em> the fentanyl group (49 mg, IQR 29–80 mg, <em>P</em>=0.002), driven by reduced use on day 1. Pain intensity was lower in the methadone group compared with the fentanyl group in the PACU (4, IQR 3–5 <em>vs</em> 5, IQR 4–7, <em>P</em>=0.0004), at 24 h (<em>P</em>=0.005) and 48 h (<em>P</em>=0.03). More patients in the methadone group experienced moderate to severe PONV at 24 h (45.0%, <em>vs</em> 14.1%, <em>P</em>=0.001), 48 h (43.3% <em>vs</em> 17.6%, <em>P</em>=0.005), and 72 h (33.9% <em>vs</em> 18.2%, <em>P</em>=0.03). Secondary outcomes, including patient satisfaction, sedation, and discharge times, did not differ significantly.</div></div><div><h3>Conclusion</h3><div>Methadone reduced opioid consumption and pain intensity but increased PONV. Identifying risk factors for both severe postoperative pain and PONV may help guide patient selection for methadone use.</div></div><div><h3>Clinical trial registration</h3><div>NCT05445856, EudraCT ID 2022-002496-11.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100418"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134374","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":"Glucose variability and mode of anaesthesia in major noncardiac surgery (GlucoVITAL): study protocol for a randomised controlled trial","authors":"Henrike Janssen ,&nbsp;Priyanthi Dias ,&nbsp;Louise Hiller ,&nbsp;Russell Hewson ,&nbsp;Rupert M. Pearse ,&nbsp;Nick S. Oliver ,&nbsp;Shaman Jhanji ,&nbsp;Gareth L. Ackland","doi":"10.1016/j.bjao.2025.100419","DOIUrl":"10.1016/j.bjao.2025.100419","url":null,"abstract":"<div><h3>Background</h3><div>Hyperglycaemia after noncardiac surgery occurs commonly and is associated with complications. The choice of maintenance anaesthesia may promote hyperglycaemia and increase glucose variability, both of which exacerbate inflammation and organ dysfunction. We hypothesise that total intravenous anaesthesia reduces glucose variability, particularly in individuals with insulin resistance or diabetes mellitus, and hence may reduce postoperative complications.</div></div><div><h3>Methods</h3><div>This multicentre, randomised controlled parallel group trial will recruit 450 participants ≥50 yr undergoing elective noncardiac surgery. Participants will be randomly allocated in a 1:1 ratio (with minimisation) to receive either total intravenous anaesthesia or inhalation agents (typically sevoflurane) for maintenance of anaesthesia. The primary outcome is blood glucose, measured at prespecified timepoints (before, immediately after, and the morning after surgery). Continuous glucose monitoring (CGM; Dexcom G7) will commence at induction of anaesthesia for up to 10 days after surgery (or hospital discharge) to establish the reliability and accuracy of CGM compared with blood glucose measurements. Secondary outcomes include days alive and out of hospital within 30 days of surgery and postoperative complications (Clavien–Dindo grade ≥2). Absolute glucose and CGM-derived measures of glucose variability will be compared between participants who sustain, or remain free of, myocardial injury within 24 h of surgery, infectious complications within 30 days of surgery, and vasopressor use persisting &gt;4 h after surgery.</div></div><div><h3>Conclusions</h3><div>GlucoVITAL will establish whether the mode of anaesthesia may alter glucose control in susceptible individuals and also explore the role of glucose variability in organ injury after noncardiac surgery using CGM.</div></div><div><h3>Clinical trial registration</h3><div>ISRCTN46862025.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100419"},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131256","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}