BJA open最新文献

{"title":"Development of a key performance indicator set for perioperative red blood cell transfusion","authors":"Akshay Shah ,&nbsp;Hayley G. Evans ,&nbsp;Antony J.R. Palmer ,&nbsp;Alan M. MacDonald ,&nbsp;Martha Belete ,&nbsp;Linda von Neree ,&nbsp;Michael M.F. Murphy ,&nbsp;Simon J. Stanworth ,&nbsp;Robbie Foy ,&nbsp;for the NIHR Blood and Transplant Research Unit in Data Driven Transfusion Practice","doi":"10.1016/j.bjao.2024.100372","DOIUrl":"10.1016/j.bjao.2024.100372","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative red blood cell (RBC) transfusion is a common intervention in patients undergoing surgery but there is marked variation in practice. Key performance indicators (KPIs) are central to identifying deviation from agreed standards and improving clinical outcomes. We aimed to identify KPIs which can potentially be measured from routinely collected electronic healthcare records.</div></div><div><h3>Methods</h3><div>We undertook a three-stage process. First, we completed a scoping review to identify potential KPIs from relevant literature and clinical guidelines. Next, we conducted a modified RAND consensus process with a multidisciplinary panel including medical professionals, patients and public involvement members. The consensus panel rated these KPIs according to importance and feasibility.</div></div><div><h3>Results</h3><div>We identified 28 candidate KPIs covering the entire perioperative RBC transfusion process. The majority of the KPIs focused on improving patient care around the time of decision to transfuse RBCs and transfusion safety. Clinical outcome KPIs included hospital length of stay, hospital acquired infection, mortality, and hospital readmission at 30 and 90 days. Five candidate KPIs were judged as unimportant whilst there were concerns around the feasibility of measurement using routine data for 14 candidate KPIs. The panel identified nine potential KPIs for future testing.</div></div><div><h3>Conclusions</h3><div>Using a systematic, stepwise, transparent approach, we have identified a set of 28 KPIs for assessment, monitoring, and improvement of perioperative RBC transfusion. Future research is needed to further validate this set for external use and benchmarking between hospitals and departments.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"13 ","pages":"Article 100372"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151222","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":"Effective utilisation of rapid infusion catheters in perioperative care: a narrative review","authors":"Adam Scorer ,&nbsp;Rani Chahal ,&nbsp;Louise Ellard ,&nbsp;Paul S. Myles ,&nbsp;William P.L. Bradley","doi":"10.1016/j.bjao.2024.100365","DOIUrl":"10.1016/j.bjao.2024.100365","url":null,"abstract":"<div><div>The Rapid Infusion Catheter (RIC) has transformed intravenous (i.v.) access, allowing for rapid fluid delivery peripherally. It may negate the need for a central vein sheath to be placed. This review explores the clinical utility of RICs while addressing technical considerations and potential risks.</div><div>The RIC is a large-bore i. v. sheath available in two sizes. Its maximal flow rate is 1200 ml min⁻¹, making it advantageous in significant blood loss scenarios such as trauma and major surgeries. Insertion involves the Seldinger technique.</div><div>Monitoring and maintaining the RIC is crucial to detect and address immediate complications such as occlusions, infiltration, phlebitis, and extravasation of infusate. Although the related complications share similarities with those of other peripheral i. v. cannulae, they have a lower risk of occlusion and accidental displacement. Catheter removal should be considered once the patient is stable or alternative access is available to avoid infectious complications. Removal of the RIC needs to be performed by those educated in RIC management.</div><div>Maximal flow rate is an essential factor in assessing the performance of i. v. cannulae, and studies have shown that RICs outperform other peripheral and central catheters in this regard.</div><div>In conclusion, RIC offers advantages over large-bore central venous access for large-volume rapid infusions, including ease of insertion and reduced severe complications. The RIC demonstrates lower thrombosis rates and a different complication profile than peripherally inserted central catheters.</div><div>Understanding the characteristics and applications of RICs can help healthcare professionals make informed decisions about their use in various medical scenarios.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"13 ","pages":"Article 100365"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143151224","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":"Evaluating the impact of an enhanced recovery programme on the Obstetric Quality-of-Recovery score (ObsQoR-10) after elective Caesarean section in a South African public hospital: a prospective before–after study","authors":"Jan A. van Niekerk ,&nbsp;Thomas Kleyenstuber ,&nbsp;Zainub Jooma","doi":"10.1016/j.bjao.2024.100373","DOIUrl":"10.1016/j.bjao.2024.100373","url":null,"abstract":"<div><h3>Background</h3><div>Caesarean section is a common surgical procedure, accounting for almost a third of all surgical procedures in low- middle-income countries. Enhanced recovery after Caesarean section (ERAC) programmes are rarely implemented in resource-limited settings. This study evaluated a tailored enhanced recovery programme's impact on quality of recovery after elective Caesarean section in a Johannesburg public hospital.</div></div><div><h3>Methods</h3><div>This was a prospective, observational, before–after cohort study. Fifty-two patients (aged ≥18 yr) undergoing elective Caesarean section were analysed, comprising a pre-ERAC cohort (<em>n</em>=25), analysed from 8 to 22 April 2024 and a post-ERAC cohort (<em>n</em>=27), analysed from 3 to13 June 2024. The primary outcome was postpartum recovery measured by the Obstetric Quality of Recovery-10 score.</div></div><div><h3>Results</h3><div>There was a significant improvement in Obstetric Quality of Recovery-10 scores post-ERAC, with a difference in medians of 9 between cohorts (95% confidence interval: 6–14; <em>P</em>&lt;0.001). There was also a significant reduction in opioid consumption with a median decrease of 10 mg oral morphine equivalent in the post-ERAC cohort in the first 24 h after operation (95% confidence interval: −26 to 6; <em>P</em>&lt;0.001). Time to urinary catheter removal, time to first oral intake, time to first mobilisation, and preoperative fasting for liquids all showed significant improvement in the post-ERAC cohort. There was no difference in length of stay and other secondary outcomes.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that ERAC implementation in a resource-limited setting is feasible and can enhance maternal recovery after elective Caesarean section. These findings highlight the potential for ERAC programs to significantly improve patient-centred outcomes in low-middle income countries.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"13 ","pages":"Article 100373"},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082500","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":"Maintenance of prehospital anaesthesia in trauma patients: inconsistencies and variability in practice","authors":"Brad Sheridan ,&nbsp;Zane Perkins","doi":"10.1016/j.bjao.2024.100366","DOIUrl":"10.1016/j.bjao.2024.100366","url":null,"abstract":"<div><h3>Background</h3><div>Literature on prehospital anaesthesia predominantly focuses on preparation and induction, while there is limited guidance on anaesthesia maintenance. The hypothesis of this study was that for prehospital trauma patients, protocols and practice for anaesthesia maintenance may vary considerably between services. Hence, we sought to describe the practice of prehospital anaesthesia maintenance for trauma patients in Australia, New Zealand, and the UK.</div></div><div><h3>Methods</h3><div>An online practice survey of prehospital and retrieval services in Australia, New Zealand, and the UK was conducted from May to September 2022. Branching logic of between five and 140 questions covered services' background information, protocols relating to anaesthesia maintenance, and perceived effectiveness and governance.</div></div><div><h3>Results</h3><div>Forty-two services were approached with an 81% response rate. While most services (88%) had some form of maintenance protocol, only 14% had one specific for trauma patients. Most services (61%) used a combination of intermittent boluses and continuous infusions. Ketamine and midazolam were the favoured hypnotics, and fentanyl the favoured opioid. However, there was considerable variation in drug selection and dosing, and in the detail contained within protocols. There was high self-reported confidence in effectiveness and governance of anaesthesia maintenance practices.</div></div><div><h3>Conclusions</h3><div>Protocols for anaesthesia maintenance in prehospital trauma patients show considerable variation in content and detail across the surveyed services. Further consideration of pharmacokinetics and the specific aims of anaesthesia maintenance is warranted. More research is needed to establish the optimal choice of drugs, dosing, delivery, and adjustment criteria for anaesthesia maintenance in prehospital trauma patients.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"13 ","pages":"Article 100366"},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048934","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":"Assessing UK patients' knowledge of anaesthetists and anaesthesia","authors":"Oliver J.H. Baker,&nbsp;Rama Varadan","doi":"10.1016/j.bjao.2024.100363","DOIUrl":"10.1016/j.bjao.2024.100363","url":null,"abstract":"<div><h3>Background</h3><div>Previous UK studies found that only 50–67% of patients are aware that anaesthetists are qualified doctors, and public knowledge of anaesthetists' roles was poor. This study aimed to assess patients' knowledge of anaesthetists and anaesthesia, to identify if there has been any improvement over the past two decades. A secondary aim was to determine if exposure to anaesthetists during day case surgery improved patient knowledge.</div></div><div><h3>Methods</h3><div>This UK-based, single-centre, cross-sectional study included 150 patients attending for day case surgery. Patients were given a questionnaire on their knowledge of anaesthetists and anaesthesia both before and after surgery. Patients were included if they had not yet been pre-assessed by an anaesthetist, if they were over 18 years old and if they were not healthcare professionals.</div></div><div><h3>Results</h3><div>All 150 patients completed both preoperative and postoperative questionnaires. 51.3% were female and the median age was 51.6 years (range 18–90 years). Before surgery, only 39.3% of patients knew that anaesthetists were doctors, despite 82.4% having had previous anaesthetics. After surgery, this reduced to 38%. There was no significant improvement in patients' knowledge of anaesthetists’ roles both inside and outside of operating theatres in postoperative questionnaires (p&gt;0.05). Patients most frequently recognised that anaesthetists work in operating theatres (80%), intensive care units (54%), medical emergency teams (52.7%), and on labour wards (50%). Furthermore, 76.6% of patients recalled seeing an anaesthetist before previous operations and 81.3% were aware that general anaesthesia involved volatile gases or intravenous drugs.</div></div><div><h3>Conclusions</h3><div>This study found that many patients are not aware that anaesthetists are medically qualified. Exposure to anaesthetists on the day of surgery did not improve patients' knowledge of the roles of anaesthetists or their knowledge of anaesthesia itself.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"13 ","pages":"Article 100363"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017229","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":"Environmental impact of commonly used anaesthetic agents: systematic literature review with narrative synthesis","authors":"Philippa Lloyd ,&nbsp;Alexander J. Fowler ,&nbsp;Anna Wozniak ,&nbsp;William Rattenberry ,&nbsp;Sara Scott ,&nbsp;Vikas Tripurneni ,&nbsp;Mark Earl ,&nbsp;Rupert M. Pearse ,&nbsp;Sarah-Louise Watson ,&nbsp;Tom.E.F. Abbott ,&nbsp;Sarah Hare","doi":"10.1016/j.bjao.2024.100362","DOIUrl":"10.1016/j.bjao.2024.100362","url":null,"abstract":"<div><h3>Background</h3><div>Increasing awareness of the potential environmental impact of volatile anaesthetic agents has stimulated increased use of total i.v. anaesthesia. However, consolidated comparative evidence of the environmental impact of anaesthetic agents across the whole life cycle is lacking.</div></div><div><h3>Methods</h3><div>We performed a systematic review and narrative evidence synthesis of the environmental impact of anaesthetic agents stratified by drug life cycle. We searched MEDLINE (PubMed), Excerpta Medica dataBASE (EMBASE), Cumulative index to nursing and allied health literature (CINAHL), and DrugBank, from inception until 05 March 2023, for studies describing the environmental impact of anaesthetic drugs on the WHO essential medicine list. Independent review and data extraction were performed by pairs of reviewers. Data on any aspect of cradle-to-grave life cycle analysis were reported, with narrative synthesis grouped according to life cycle domains.</div></div><div><h3>Results</h3><div>From 15 229 records, 42 unique reports met our inclusion criteria. The predominant environmental impact of inhalation anaesthetic agents is atmospheric release, contributing to global warming. This may be improved with the emergence of more efficacious scavenging and capture systems. Packaging and waste contributed most to the environmental impact of i.v. anaesthetic agents. There is increasing concern over the ecological impact of i.v. agents entering water sources, either by disposal of unused medication or through the excretion of drug post-administration.</div></div><div><h3>Conclusions</h3><div>There is increasing concern about the global warming impact of inhalation anaesthetic agents. However, there are insufficient ‘cradle-to-grave’ comparative analyses of the environmental impact of i.v. and inhalation anaesthesia to form evidence-based conclusions. Further research is urgently needed to guide clinical practice.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"13 ","pages":"Article 100362"},"PeriodicalIF":0.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985550","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":"Both the extended neck position and insertion of a supraglottic airway device increases the height of the cricothyroid membrane in females. A prospective observational study","authors":"Ankita Miglani ,&nbsp;Sandeep Miglani ,&nbsp;Hassan M. Tawfik ,&nbsp;Thomas Drew","doi":"10.1016/j.bjao.2024.100364","DOIUrl":"10.1016/j.bjao.2024.100364","url":null,"abstract":"<div><h3>Background</h3><div>Emergency Front of Neck access <strong>(</strong>eFONA) via cricothyroidotomy using a size 6 internal diameter tracheal tube is recommended by the Difficult Airway Society in the event of a ‘can't intubate, can't oxygenate’ (CICO) scenario in adults. There is a lack of clear guidance on whether to retain or remove a previously inserted supraglottic airway device (SAD) before eFONA. We aimed to study the effect of both neck extension and insertion of an SAD on sagittal cricothyroid membrane (CTM) height.</div></div><div><h3>Methods</h3><div>We recruited 40 adult female patients attending for minor gynaecological surgery under general anaesthesia and suitable for an SAD. Sagittal ultrasound images of the CTM were obtained in the neutral and extended neck position, both before and after insertion of the i-gel® (160 images). The CTM height was measured from the images by a blinded assessor and the data analysed to determine the magnitude of change in CTM height and its relevance for cricothyroidotomy.</div></div><div><h3>Results</h3><div>There was a significant difference in the height of the CTM between the groups (<em>P</em>&lt;0.001). The extended neck position accounted for 10% increase over the neutral position. Inserting an i-gel® and extending the neck increased the CTM height by 26% over neutral position, thereby lengthening it sufficiently to accommodate a size 6.0 tracheal tube in 100% of the patients.</div></div><div><h3>Conclusions</h3><div>Both neck extension and the insertion of an i-gel® increased the sagittal height of the CTM. This suggests there may be benefit to retaining or re-inserting an SAD during eFONA.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"13 ","pages":"Article 100364"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985542","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":"Noradrenergic suppression to reduce electroencephalographic arousal after intubation: a randomised, placebo-controlled trial","authors":"Kaitlin Kramer ,&nbsp;Thomas Payne ,&nbsp;Mitchell Brooks ,&nbsp;Jessica Barry ,&nbsp;Neha Mahajan ,&nbsp;Samantha Malcolm ,&nbsp;Hannah Braithwaite ,&nbsp;Alex Wang ,&nbsp;Chris Thompson ,&nbsp;Keith Liyanagama ,&nbsp;Robert D. Sanders","doi":"10.1016/j.bjao.2024.100359","DOIUrl":"10.1016/j.bjao.2024.100359","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative awareness, without explicit recall, occurs after induction of anaesthesia in approximately 10% of persons under 40 yr of age. Most anaesthetic agents minimally suppress the noradrenergic system. We hypothesised that addition of dexmedetomidine, which suppresses noradrenergic activity, may reduce encephalographic (EEG) arousal in response to tracheal intubation; such an effect would lay the foundation for future studies of dexmedetomidine in reducing intraoperative awareness.</div></div><div><h3>Methods</h3><div>A single-site randomised, placebo-controlled trial with sex-based stratification was conducted. Participants, aged 18–40 yr old, undergoing intubation for general anaesthesia were eligible for recruitment and randomly allocated to receive dexmedetomidine or placebo. Dexmedetomidine (0.5 μg kg⁻¹) was given as a 5-min loading dose before induction. Bispectral index (BIS) values were collected during the induction phase of anaesthesia and the isolated forearm technique was used to assess patients' responsiveness before and after tracheal intubation. The primary outcome was the effect of dexmedetomidine on changes in BIS from pre-to postintubation.</div></div><div><h3>Results</h3><div>A total of 51 patients were recruited and included in the primary analysis. We did not observe an effect of dexmedetomidine on changes in BIS after tracheal intubation (mean difference –1.13, 95% confidence interval [CI] –4.87 to 2.62; <em>p</em>=0.556). Dexmedetomidine reduced the estimated plasma propofol concentration at loss of responsiveness (difference [dexmedetomidine – placebo]: –1.06 μg ml⁻¹, 95% CI –1.66 to –0.46; <em>p</em>&lt;0.001) and before intubation (difference [dexmedetomidine – placebo]: –1.84 μg ml⁻¹, 95% CI –2.79 to –0.90; <em>p</em>&lt;0.001). There was one patient in the placebo group who gave positive responses in the isolated forearm test before and after tracheal intubation.</div></div><div><h3>Conclusions</h3><div>Dexmedetomidine demonstrated an anaesthetic-sparing effect at induction of anaesthesia but did not prevent EEG arousal after tracheal intubation, as defined by an increase in the BIS value.</div></div><div><h3>Clinical Trial Registration</h3><div>Australia and New Zealand Clinical Trials Registry (Trial ID: ACTRN12622000754741).</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"13 ","pages":"Article 100359"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973655","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 unseen animal behind medicine: exploring considerations of animal-derived medications and anaesthetics in today's landscape","authors":"Jennifer R. Wang,&nbsp;Eric Oh,&nbsp;Benjamin Aronow,&nbsp;Wendy K. Bernstein","doi":"10.1016/j.bjao.2024.100360","DOIUrl":"10.1016/j.bjao.2024.100360","url":null,"abstract":"<div><div>Requests for medical and anaesthetic care that is ‘vegan’ or free of animal-derived components are becoming increasingly common in the cultural landscape. Such requests are often rooted in religious beliefs and practices. There are currently no requirements for the disclosure of animal-derived components in medical items. However, both patients and medical professionals agree that greater transparency regarding such items is needed in obtaining informed consent. Although the ethical argument for disclosure has been established, there remain gaps in practical guidelines in recognising animal-derived components in medical items and understanding how to avoid them. This lack of comprehensive knowledge leads to challenges in initiating conversations about appropriate medication selection.</div><div>This manuscript will outline the common dietary restrictions of various religious groups and provide instruction on common animal-derived ingredients in medications. It will also introduce potential viable animal-free alternatives for some commonly used medications in the perioperative environment which has not been done previously in the literature. Moreover, we note the broader implications and reasoning behind considering dietary restrictions in medication choices.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"13 ","pages":"Article 100360"},"PeriodicalIF":0.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973658","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":"Xenon anaesthesia is associated with a reduction in frontal electroencephalogram peak alpha frequency","authors":"Steven McGuigan ,&nbsp;Andria Pelentritou ,&nbsp;David A. Scott ,&nbsp;Jamie Sleigh","doi":"10.1016/j.bjao.2024.100358","DOIUrl":"10.1016/j.bjao.2024.100358","url":null,"abstract":"<div><h3>Background</h3><div>Administration of conventional anaesthetic agents is associated with changes in electroencephalogram (EEG) oscillatory dynamics, including a reduction in the peak alpha frequency. Computational models of neurones can reproduce such phenomena and are valuable tools for investigating their underlying mechanisms. We hypothesised that EEG data acquired during xenon anaesthesia in humans would show similar changes in peak alpha frequency and that computational neuronal models of recognised cellular actions of xenon would be consistent with the observed changes.</div></div><div><h3>Methods</h3><div>EEG recordings were obtained for 11 participants from a randomised controlled trial of xenon anaesthesia and for 21 participants from a volunteer study of xenon administration. The frontal peak alpha frequency was calculated for both cohorts at awake baseline and during xenon administration. <em>In silico</em> simulations with two computational models of neurones were performed to investigate how xenon antagonism of hyperpolarisation-activated cyclic nucleotide-gated channel 2 (HCN2) and glutamatergic excitatory neurotransmission would influence peak alpha frequency.</div></div><div><h3>Results</h3><div>Compared with awake baseline, frontal peak alpha frequency was significantly lower during xenon administration in the randomised controlled trial cohort, median (inter-quartile range) frequency 7.73 Hz (7.27–8.08 Hz) <em>vs</em> 8.81 Hz (8.35–9.03 Hz), <em>P</em>=0.012, and the volunteer cohort, 8.69 Hz (8.34–8.98 Hz) <em>vs</em> 9.41 Hz (9.11–9.92 Hz), <em>P</em>=0.001. <em>In silico</em> simulations with both computational models suggest that antagonism of HCN2 and glutamatergic excitatory neurotransmission are associated with a reduction in peak alpha frequency.</div></div><div><h3>Conclusions</h3><div>Xenon administration is associated with a reduction of peak alpha frequency in the frontal EEG. <em>In silico</em> simulations utilising two computational models of neurones suggest that these changes are consistent with antagonism of HCN2 and glutamatergic excitatory neurotransmission.</div></div><div><h3>Clinical trial registration</h3><div>The Australian New Zealand Clinical Trials Registry: ANZCTR number 12618000916246.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"12 ","pages":"Article 100358"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757540","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}