BJA open最新文献

{"title":"Succinylcholine for electroconvulsive therapy after neuroleptic malignant syndrome: a case report supporting individualised risk assessment","authors":"Zhang Ming Isabella","doi":"10.1016/j.bjao.2026.100594","DOIUrl":"10.1016/j.bjao.2026.100594","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"19 ","pages":"Article 100594"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003948","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":"Using Perioperative Quality Improvement Programme data to evaluate and improve perioperative pain management in major colorectal surgery: are we following recommended protocols?","authors":"Surumi Makkatmukkil Sheikh, Sofia Peacock, Sadiq Parpia, Marta Blanco Cabana","doi":"10.1016/j.bjao.2026.100628","DOIUrl":"10.1016/j.bjao.2026.100628","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"19 ","pages":"Article 100628"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149004049","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":"International Medical Graduate handbook: aiding the transition to NHS anaesthesia","authors":"C. Dean, J. Cartwright-Gill, O. Zelenchuk","doi":"10.1016/j.bjao.2026.100638","DOIUrl":"10.1016/j.bjao.2026.100638","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"19 ","pages":"Article 100638"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149004188","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":"Correlation of intrathecal drug dosing, hemodynamic stability, and vasopressor documentation in caesarean sections under spinal anaesthesia: a re-audit and quality improvement initiative","authors":"A. Ahad, Z. Ahmad, M. Fareed, S. Miglani","doi":"10.1016/j.bjao.2026.100609","DOIUrl":"10.1016/j.bjao.2026.100609","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"19 ","pages":"Article 100609"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149004369","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":"Associate Editorial Board","authors":"","doi":"10.1016/j.bjao.2026.100872","DOIUrl":"10.1016/j.bjao.2026.100872","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"19 ","pages":"Article 100872"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149004469","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":"Pain catastrophising as a risk factor for hospitalisation and readmissions in fast-track hip and knee arthroplasty, an observational multicentre cohort study","authors":"Christoffer C. Jørgensen ,&nbsp;Simon Kornvig ,&nbsp;Henrik Kehlet ,&nbsp;Martin Lindberg-Larsen ,&nbsp;Kirill Gromov ,&nbsp;Manuel J. Bieder ,&nbsp;Mikkel R. Andersen ,&nbsp;Søren Overgaard ,&nbsp;Torben B. Hansen ,&nbsp;Thomas Jakobsen ,&nbsp;Claus Varnum","doi":"10.1016/j.bjao.2026.100564","DOIUrl":"10.1016/j.bjao.2026.100564","url":null,"abstract":"<div><h3>Background</h3><div>A preoperative pain catastrophising scale (PCS) of &gt;20 is associated with increased postoperative pain, development of chronic pain, and impaired function after hip and knee arthroplasty. However, whether PCS &gt;20 is associated with prolonged length of hospital stay (LOS), readmissions, and reduced likelihood of same-day discharge is unknown.The primary aim of this study was to investigate the association between a preoperative PCS of &gt;20 and a LOS &gt;2 days Secondary aims were to investigate the association of PCS &gt;20 with 90-day readmission rate and admission postoperatively.</div></div><div><h3>Methods</h3><div>This prospective cohort study is from eight Danish arthroplasty departments with similar fast-track protocols. Data on preoperative PCS, patient characteristics, and prescribed medications were collected. Postoperative follow-up was conducted through patient records and self-reported questionnaires. Binary multilevel logistic regression was used to investigate the association between PCS &gt;20 and hospital LOS of &gt;2 days, 90-day readmission rate due to pain or insufficient mobilisation, and immediate admission despite scheduled same-day surgery.</div></div><div><h3>Results</h3><div>The study period ran from September 2022 to June 2025. Of 15 965 procedures, 6728 (43%) were total hip arthroplasties (THA), 5992 (38%) were total knee arthroplasties (TKA), and 2974 (19%) were unicompartmental knee arthroplasties (UKA). Of these, 5225 (33%) reported a preoperative PCS &gt;20. Median hospital LOS was 1 day, 90-day readmission rate was 7.3%, and 5464 (35%) of patients were scheduled for same-day discharge. For the total cohort, PCS &gt; 20 was associated with LOS &gt;2 days (odds ratio [OR]: 1.54; 95% confidence interval [CI]: 1.29–1.83; <em>P</em>&lt;0.001), 90-day all-cause readmissions (OR: 1.18; CI:1.03–1.35; <em>P</em>=0.02), hospitalisation due to pain or insufficient mobilisation (OR: 1.38; CI: 1.11–1.72; <em>P</em>=0.004), and admission despite planned same-day discharge (OR: 1.25; CI: 1.06–1.40; <em>P</em>=0.005). However, procedure-specific analysis did not find associations with LOS after UKA (OR: 0.59; CI: 0.30–1.17; <em>P</em>=0.129), or readmission after TKA (OR: 1.02; CI: 0.82–1.26; <em>P</em>=0.890).</div></div><div><h3>Conclusions</h3><div>A preoperative pain catastrophising scale of &gt;20 was associated with increased hospital length of stay and increased 90 day readmission rate despite planned same-day discharge after fast-track total hip arthoplasty, total knee arthoplasty and unicompartmental knee arthroplasty surgery.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"18 ","pages":"Article 100564"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148178052","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":"Platform trials in anaesthesia and perioperative medicine: a scoping review","authors":"Pooveshni Govender ,&nbsp;Daniel R. Frei ,&nbsp;Hassan M. Ahmed ,&nbsp;Richard Beasley ,&nbsp;Elizabeth G. Ryan ,&nbsp;Paul S. Myles","doi":"10.1016/j.bjao.2026.100569","DOIUrl":"10.1016/j.bjao.2026.100569","url":null,"abstract":"<div><h3>Background</h3><div>Traditional randomized control trials underpin evidence generation in anaesthesia and perioperative medicine, but are often poorly suited to evaluating multiple, evolving clinical questions. Platform trials encorporate a trial design that evaluates multiple interventions within one or more domains, is governed centrally using a master or core protocol, and has the capacity to add new research questions through the addition of new treatments and/or subgroup. Platform trials offer a flexible alternative, enabling the concurrent and sequential evaluation of multiple interventions and more efficient identification of effective or harmful treatments.</div></div><div><h3>Methods</h3><div>We conducted a scoping review using the Joanna Briggs Institute methodology, reported in accordance with PRISMA-ScR. Searches of bibliographic databases, grey literature and clinical trial registries (Ovid MEDLINE, Ovid Embase, Scopus, CINAHL Complete, Web of Science and the Cochrane Library) were undertaken. Records meeting an a priori definition of platform trials in anaesthesia or perioperative medicine were included. Trial design and methodological features were extracted and synthesised descriptively.</div></div><div><h3>Results</h3><div>Among 32 062 records identified, nine platform trials met eligibility criteria. Most were registered (8/9) and university-sponsored, with nearly half in the planning phase. All trials were multicentre, predominantly conducted in high-income countries and 44% involved international collaboration. Adult surgical populations were most commonly studied, with surgical site infection prevention being the leading perioperative focus. Across the nine platform trials, 24 interventions were evaluated, predominantly surgical (58.3%), followed by anaesthetic (12.5%). Adaptive features were universal, and Bayesian statistical methods predominated.</div></div><div><h3>Conclusions</h3><div>Platform trials remain uncommon and methodologically diverse in anaesthesia and perioperative medicine, reflecting early-stage adoption within an evolving field. Greater consensus regarding nomenclature, governance, and methodological standards, alongside expansion into anaesthesia-specific domains, is needed to realise their efficiency and ethical advantages.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"18 ","pages":"Article 100569"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148178049","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":"Assessing ultraviolet-C light-emitting diode disinfection of disposable video laryngoscope blades: a sustainable approach through an integrated microbiological, environmental, economic, and regulatory evaluation","authors":"Hannah Siwe ,&nbsp;Bjorn Delbeecke ,&nbsp;Piet Cools ,&nbsp;Philip Meuleman ,&nbsp;Pascal Verdonck ,&nbsp;Alain F. Kalmar","doi":"10.1016/j.bjao.2026.100566","DOIUrl":"10.1016/j.bjao.2026.100566","url":null,"abstract":"<div><h3>Background</h3><div>The shift from reusable to single-use anaesthesia devices, such as laryngoscope blades, is increasingly questioned because of the financial and environmental costs of disposables. Validated disinfection methods enabling safe reuse could provide clinical, economic, and sustainability benefits.</div></div><div><h3>Methods</h3><div>In this laboratory-based experimental study, disposable McGRATH™ X-blade video laryngoscope blades were artificially contaminated with <em>Staphylococcus aureus</em> and subjected to automated ultraviolet-C (UV-C) light-emitting diode (LED) disinfection under different reprocessing conditions. An integrated assessment was performed, including microbiological efficacy, material integrity after repeated UV-C exposure, estimated economic and environmental impact, and regulatory considerations. Results were compared with single-use, steam autoclaving, and chlorine dioxide wipe-based disinfection.</div></div><div><h3>Results</h3><div>UV-C disinfection reduced <em>Staphylococcus aureus</em> contamination to undetectable levels across all experimental conditions; unpackaged cleaned, uncleaned blades, and packaged uncleaned blades (<em>n</em>=6, <em>n</em>=5, and <em>n</em>=5, respectively). No visible degradation, functional impairment, or deterioration in image quality was observed after repeated UV-C exposure. Per-cycle cost was less than €0.20, and greenhouse-gas emissions were reduced by 92–94% compared with single-use. In contrast, autoclaving or chemical disinfection compromised blade usability.</div></div><div><h3>Conclusions</h3><div>Automated UV-C LED treatment effectively disinfected McGRATH X-blades under controlled laboratory conditions, preserving material integrity and offering substantial environmental and economic advantages. This approach may support more sustainable anaesthetic practice where validated point-of-care reprocessing is implemented.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"18 ","pages":"Article 100566"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148178051","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":"How hyperoxia affects systemic redox state: insights from PULSE-Ox, a randomised double-blind mechanistic feasibility trial","authors":"Andrew F. Cumpstey ,&nbsp;Anna D. Clark ,&nbsp;Magdalena Minnion ,&nbsp;Siobhan F. Crosby ,&nbsp;Renato C. Nogueira ,&nbsp;Helen Moyses ,&nbsp;Daniel Martin ,&nbsp;José E. Tanus-Santos ,&nbsp;Alan A. Jackson ,&nbsp;Mark Edwards ,&nbsp;Michael P.W. Grocott ,&nbsp;Martin Feelisch","doi":"10.1016/j.bjao.2026.100563","DOIUrl":"10.1016/j.bjao.2026.100563","url":null,"abstract":"<div><h3>Background</h3><div>Oxygen therapy is ubiquitous in medical practise, but recommendations for administration during surgery are conflicting, and mechanisms of harm are ill-defined. The World Health Organization (WHO) recommends that all anaesthetised patients receive 80% oxygen intraoperatively to reduce surgical site infections. Whether such high oxygen concentrations cause oxidative stress remains uncertain.</div></div><div><h3>Methods</h3><div>Adults undergoing major cancer surgery were randomly allocated to conservative (FiO₂=0.3, <em>n</em>=8), typical (FiO₂=0.55, <em>n</em>=10) or recommended (FiO₂=0.8, <em>n</em>=10) oxygen throughout anaesthesia. The aims were to determine whether i) intraoperative oxygen at or below WHO-recommended levels affects whole-body redox state, and ii) redox profiling could distinguish between different oxygen concentrations. Peripheral oxygen saturation (SpO₂) and oxygen reserve index were monitored (co)oximetrically. Paired arterial/central venous blood samples/gases were collected 2-hourly. Lipid peroxides, protein carbonyls, free thiols, antioxidants and nitroso species were quantified using Liquid Chromatography-Tandem Mass Spectrometry, Enzyme-Linked Immunosorbent Assay (ELISA), colourimetry and gas-phase chemiluminescence.</div></div><div><h3>Results</h3><div>Double-blinded recruitment of 28 patients (median age 65.8 yr) to three different intraoperative oxygen concentrations was feasible and successful during the study period from September, 2018 to May 2021. While SpO₂ remained unchanged, systemic oxygen utilisation paradoxically decreased with higher oxygen concentrations (<em>P</em>=0.0006). While free thiol levels rose moderately, nitrosation increased significantly (<em>P</em>=0.039/0.002/0.039 for FiO₂=0.3/0.55/0.8). Administration of 80% oxygen was associated with diminished reductive power (<em>P</em>=0.012) and significant oxidative stress (<em>P</em>=0.004).</div></div><div><h3>Conclusions</h3><div>Cross-sectional redox profiling may allow early identification of patients at risk of postoperative complications, while longitudinal profiling may distinguish between oxygen intervention groups. High oxygen concentrations challenge the body’s ability to maintain redox balance, potentially increasing vulnerability to other stressors. Our results lay the foundation for large clinical effectiveness studies evaluating oxygen therapy targets and suggest that ‘redox scoring’ could guide individualised oxygen administration.</div></div><div><h3>Trial registration number</h3><div>NCT03552627 (<span><span>Clinicaltrials.gov</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"18 ","pages":"Article 100563"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148178050","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":"Effect of atropine on time to cardiac arrest in hypoxic bradycardia: a randomised cross-over study in a porcine apnoea model","authors":"Tomáš Pařízek ,&nbsp;Petr Waldauf ,&nbsp;Michal Kalina ,&nbsp;Zuzana Kurzová ,&nbsp;Irena Odstrčilová ,&nbsp;Jan Hunák ,&nbsp;Jakub Freml ,&nbsp;Radim Dvořák ,&nbsp;David Peřan ,&nbsp;Alena Vlková ,&nbsp;František Duška","doi":"10.1016/j.bjao.2026.100565","DOIUrl":"10.1016/j.bjao.2026.100565","url":null,"abstract":"<div><h3>Background</h3><div>In profound hypoxia, including ‘cannot intubate, cannot oxygenate’ (CICO) situations, bradycardia may represent an oxygen-conserving reflex rather than a correctable pathology. We hypothesised that atropine would, by increasing heart rate and myocardial oxygen demand, hasten cardiac arrest in apnoea-induced hypoxic bradycardia.</div></div><div><h3>Methods</h3><div>We performed a randomised, placebo-controlled, cross-over trial in intubated, anaesthetised pigs (<em>n</em>=8). Each animal underwent two episodes of apnoea-induced hypoxia separated by a 6–12-h stabilisation period. At the onset of hypoxia-induced bradycardia, 1 mg of atropine or placebo was administered in random order. Apnoea was maintained until 50 s after cardiac arrest, then mechanical ventilation was resumed, and standard cardiopulmonary resuscitation was initiated. The primary outcome was time from study-drug administration to cardiac arrest. Secondary outcomes included time to return of spontaneous circulation (ROSC), heart-rate response, oxygen-delivery indices, and brain tissue oxygen tension.</div></div><div><h3>Results</h3><div>No statistically significant difference in time to cardiac arrest was detected: 142 seconds (95% Confidence interval [CI] 84–199) after atropine <em>vs</em> 138 seconds (95% CI 80–195) after placebo; mean difference 4 seconds (95% CI −33 to 41), <em>P</em>=0.803. In four animals, atropine shortened the time to arrest, and in four it prolonged it. No significant between-condition differences were observed in systemic haemodynamic, brain oxygenation, lactate concentrations, or time to ROSC.</div></div><div><h3>Conclusions</h3><div>In this porcine model of apnoea-induced hypoxic bradycardia, atropine neither delayed cardiac arrest nor improved oxygenation, perfusion, or resuscitation outcomes.</div></div><div><h3>Trial registration number</h3><div>Open Science Framework (OSF), DOI: <span><span>https://doi.org/10.17605/OSF.IO/492NY</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"18 ","pages":"Article 100565"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148241063","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}