BJA open最新文献

{"title":"Improving preoperative assessment investigations in elective surgery","authors":"R. Rodgers, M. Harty, S. Millen, J. McKenna, E. McQuillan, M.J. Duffy","doi":"10.1016/j.bjao.2025.100467","DOIUrl":"10.1016/j.bjao.2025.100467","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"15 ","pages":"Article 100467"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879925","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":"Innovative technologies in regional anaesthesia education: a scoping review.","authors":"Samuel Chequer","doi":"10.1016/j.bjao.2025.100473","DOIUrl":"10.1016/j.bjao.2025.100473","url":null,"abstract":"<p><strong>Background: </strong>Regional anaesthesia has experienced a global resurgence over recent decades alongside increasing demand for anaesthetists to be competent in its delivery. This was reflected in a recent UK anaesthetic curriculum update, which mandates a wide range of specific regional anaesthesia competencies. Despite this, regional anaesthesia education remains <i>ad hoc</i> and inconsistent. Innovative technologies (artificial intelligence, virtual reality, and augmented reality) are increasingly integrated within medical education, and have the potential to transform training practices. This scoping review aimed to explore the ways in which innovative technologies are currently used in regional anaesthesia, and to consider their role in education and training.</p><p><strong>Methods: </strong>This review was conducted using established frameworks for scoping reviews, and included searches of three major databases, alongside targeted citation searching. Data were analysed numerically, followed by reflexive thematic analysis.</p><p><strong>Results: </strong>In total, 855 citations were identified. After removal of duplicates and abstract eligibility screening, 106 full-text articles were assessed and 38 met the criteria for inclusion. The majority of studies were published in the last 2 yr and a lack of high-quality evidence, particularly focussing on educational outcomes, was noted. A wide range of applications for innovative technologies in regional anaesthesia education were described including roles in anatomy education, accelerated skill acquisition, simulation-based medical education, and assessment.</p><p><strong>Conclusions: </strong>Innovative technologies were associated with benefits such as provision of reliable learning experiences, reduced supervisory requirements, and enhanced educational outcomes. Future educators should consider their utility and provide structured evaluation. Significant heterogeneity was noted in the literature base and further research is recommended, specifically studying primary educational outcomes.</p>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"15 ","pages":"100473"},"PeriodicalIF":0.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12351347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877034","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":"Socioeconomic deprivation and postoperative mortality: a retrospective analysis of prospectively collected data","authors":"Ross Lilley ,&nbsp;Jason Woodier ,&nbsp;Jennifer Summers ,&nbsp;Patrice Forget","doi":"10.1016/j.bjao.2025.100479","DOIUrl":"10.1016/j.bjao.2025.100479","url":null,"abstract":"<div><h3>Background</h3><div>Deprivation and inequality are globally increasing. This study aims to explore the relationship between deprivation and postoperative mortality.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using prospectively collected data from all Aberdeen Royal Infirmary surgical patients from 2011 to 2019. Trends in Scottish Index of Multiple Deprivation (SIMD), sex, ethnicity, and speciality of care over the period were described. A Cox regression model was used to determine the effect of SIMD quintiles on 90-day postoperative mortality.</div></div><div><h3>Results</h3><div>No trends were observed in sex and SIMD, but proportions of certain specialities and ethnicities changed over time. A total of 2609 of 79 708 participants died within 90 days of their operation (crude mortality of 3.3%). There were significant differences in sex, age, ethnicity, and speciality across SIMD quintiles. Cox regression, adjusted for these variables, revealed that a greater level of deprivation was associated with greater mortality at 90 days (hazard ratio 1.594, 95% confidence interval 1.335–1.905 for SIMD 1 compared with SIMD 5 reference).</div></div><div><h3>Conclusions</h3><div>Deprivation is associated with 90-day postoperative mortality. The level of deprivation may be considered when planning perioperative care.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"15 ","pages":"Article 100479"},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721715","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":"Peripartum takotsubo cardiomyopathy after an emergency Caesarean delivery—diagnosis and specialist management","authors":"Cathriona Murphy ,&nbsp;Deirdre Edgeworth ,&nbsp;Gerard Giblin ,&nbsp;Rosemarie Kearsley","doi":"10.1016/j.bjao.2025.100478","DOIUrl":"10.1016/j.bjao.2025.100478","url":null,"abstract":"<div><div>We report the case of a 32-yr-old primiparous patient who underwent an emergency Caesarean delivery and subsequently developed peripartum takotsubo cardiomyopathy necessitating transfer to a tertiary referral critical care unit and the heart failure service. Takotsubo cardiomyopathy, also called stress cardiomyopathy, is a form of left ventricular dysfunction with distinct wall motion abnormalities in the absence of coronary artery disease. It is considered extremely rare in the peripartum period, most commonly presenting in postmenopausal women with increased myocardial sensitivity to excess circulating catecholamines as a potential role in the pathogenesis. In the peripartum period, the physiological cardiovascular adaptations of pregnancy superimposed on psychosocial stressors is the assumed pathogenesis. Unexplained dyspnoea in the peripartum period should prompt early transthoracic echocardiography and specialist critical care and heart failure team input, where appropriate. This case highlights the need to consider rare cardiac causes of acute dyspnoea and demonstrates the value of point-of-care transthoracic ultrasound for prompt bedside assessment, aiding diagnosis and management. Clinical, echocardiographic, and radiological features can aid differentiating takotsubo cardiomyopathy from other differential diagnoses. Specialist multidisciplinary teams comprised of obstetricians, anaesthetists, intensivists, cardiologists, and specialist services, such as lactation and psychology services, should be available to care for these patients and a holistic approach needs to be adopted to counsel and address the psychological sequelae after such a diagnosis and appropriately plan for future pregnancies.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"15 ","pages":"Article 100478"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702534","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":"Equity of participants in clinical trials in critical care and perioperative medicine research: a systematic review","authors":"Joanna Kae Ling Wong ,&nbsp;Caroline Thomas ,&nbsp;Hannah Gravett ,&nbsp;Kavi Thobhani ,&nbsp;Ayah Mekhaimar ,&nbsp;Jan Man Wong ,&nbsp;Yize Isalina Wan","doi":"10.1016/j.bjao.2025.100425","DOIUrl":"10.1016/j.bjao.2025.100425","url":null,"abstract":"<div><h3>Background</h3><div>Underrepresentation in critical care and perioperative randomised controlled trials (RCTs) limit generalisability and drive health inequity. This systematic review of large, high-quality RCTs analysed representation and reporting trends of equity data over 10 yr.</div></div><div><h3>Methods</h3><div>We searched MEDLINE, Embase, and Clinicaltrials.gov between 01 January 2013 and 11 May 2023 for RCTs recruiting adults (age ≥18 yr) receiving a critical care/perioperative intervention. We examined study characteristics, completeness of participant characteristic reporting, considerations accounting for participant characteristics, differential missing data rates, participant representativeness, and considerations to improve equitable recruitment. Participant characteristics were defined using the PROGRESS framework: Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital. We assessed risk of bias using the Cochrane Risk of Bias 2 tool.</div></div><div><h3>Results</h3><div>We included 60 trials (52 critical care, eight perioperative medicine) involving 155 036 participants. Mean (<span>sd</span>) age was 62.9 (4.1) yr. Gender/sex (<em>n</em>=59, 98.3%), race/ethnicity (<em>n</em>=10, 16.7%), place of residence (<em>n</em>=1, 1.7%), and social capital (<em>n</em>=1, 1.7%) were reported in trials. Statistical considerations were made for gender/sex in nine (15.0%) trials. Gender/sex data were missing in two trials with 5.0% and 0.3% missingness. Race/ethnicity data were missing in seven trials, with 7.39% (inter-quartile range 0.4–19.2%) missingness. Trials underrepresented female and non-White participants compared with baseline populations. No trial explicitly stated efforts to improve equitable recruitment.</div></div><div><h3>Conclusions</h3><div>Large, high-quality critical care and perioperative RCTs inconsistently collect and report equity data. Female and non-White participants are underrepresented. These findings potentially limit generalisability of research findings. Further work is required to promote equitable study designs.</div></div><div><h3>Systematic review protocol</h3><div>PROSPERO (CRD42023401126)</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"15 ","pages":"Article 100425"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694427","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":"Reply to Walker and Nott","authors":"Anton Utas ,&nbsp;Stefanie Seifert ,&nbsp;Knut Taxbro","doi":"10.1016/j.bjao.2025.100423","DOIUrl":"10.1016/j.bjao.2025.100423","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"15 ","pages":"Article 100423"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694428","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":"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}