Anaesthesia最新文献

{"title":"Racial and ethnic disparity in obstetric anaesthesia: a systematic review and meta-analysis","authors":"Robert Craig, Shaima El Nour, Lauren Borg Xuereb, Alexander Gibbs, Sureka Suriyakumar, Lindsay Blake, Anna L. David, Allison Lee, Diane Nzelu, S. Ramani Moonesinghe, Sohail Bampoe, Brendan Carvalho, Justin Kua, James E. O'Carroll","doi":"10.1111/anae.16581","DOIUrl":"https://doi.org/10.1111/anae.16581","url":null,"abstract":"Racial and ethnic disparities in obstetrics persist globally despite improvements in maternal mortality rates and are related to access, experience and outcomes. We aimed to elucidate the racial and ethnic disparity in obstetric analgesia and anaesthesia.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"17 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Issue Information – Editorial Board","authors":"","doi":"10.1111/anae.16334","DOIUrl":"https://doi.org/10.1111/anae.16334","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 4","pages":"347"},"PeriodicalIF":7.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16334","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143564895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in anaesthesia: shaping the future of workforce and wellbeing","authors":"Cian J. Hurley","doi":"10.1111/anae.16585","DOIUrl":"https://doi.org/10.1111/anae.16585","url":null,"abstract":"<p>Burnout is a syndrome characterised by emotional exhaustion leading to frustration, fatigue and a lack of professional efficacy [<span>1</span>]. Healthcare professionals are particularly susceptible [<span>2</span>], resulting from disruption of the delicate balance between workload and factors that contribute to career fulfilment. Factors that influence trainee burnout are well established [<span>3</span>]. Anaesthesia residents can rotate hospitals every 6 months and poorly designed, rigid rotas that lack transparency have been highlighted as a key contributor to burnout [<span>4</span>].</p>\u0000<p>Artificial intelligence (AI) has the power to revolutionise efficiency in many areas across healthcare, but its role in well-being has yet to be considered. This study examines the application of AI in designing a rota for 27 residents in an anaesthesia department. It was hypothesised that AI can assist with the delivery of complete 6-month rotas, equal share of on-call commitments and facilitate flexibility with leave requests. A rota template was constructed using Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) with commands built from ChatGPT (OpenAI, Inc., San Francisco, CA, USA). The programme was tailored for the requirements of an anaesthetic department. The process then began by assigning leave ensuring minimum daily staffing requirements were met and all residents received their leave entitlements. The on-call rota was then assembled across three tiers: operating theatres; obstetrics; and critical care. A weekly rota was designed to auto-populate, accounting for the on-call, post call and leave schedules. The study investigates the performance of the AI-derived rota for two 6-month cycles (July 2024 to January 2025 and January–July 2025).</p>\u0000<p>Residents received a complete 6-month rota before commencing the post. There was an equal spread of on-call commitments accounting for planned changes between call tiers due to training progression. During the first 6 months, the mean number of on-calls for operating theatres, obstetrics and critical care was 23.8 (95%CI 20.3–27.3); 42.5 (95%CI 41.3–43.7); and 37.7 (95%CI 32.2–43.2), respectively. The on-call frequency during the second cycle was 31.5 (95%CI 30.4–32.6); 33.1 (95%IC 32.5–33.7); and 27.4 (95%CI 23.2–31.6), respectively.</p>\u0000<p>Artificial intelligence-assisted decision-making resulted in a turnaround time of 1 day for the final approval of all leave requests. A call frequency tracker was published to ensure rostering transparency. Table 1 highlights the results of the AI-derived rota for the two 6-month rota cycles. The performance of the programme improved following minor adjustments after the first 6-month cycle. Sixty-four (89%) of first preference annual leave requests were approved which increased to 68 (100%) during the second cycle. All residents sitting exams (n = 20) received a minimum 10 days of leave and all attended college training days (n = 25).</p>\u0000<div>\u0000<heade","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"67 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143561176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"It's not (all) about the bike: making pre-operative risk stratification equitable","authors":"Donna Shrestha, Cliff Shelton, Mike Charlesworth","doi":"10.1111/anae.16582","DOIUrl":"https://doi.org/10.1111/anae.16582","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"1 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Pain as regional anaesthesia wears off’ or ‘rebound pain’: what's in a name?","authors":"Priyanka Singla, Ying Ye, Nabil M. Elkassabany, Edward R. Mariano","doi":"10.1111/anae.16583","DOIUrl":"https://doi.org/10.1111/anae.16583","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"29 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity may present challenges but does not preclude gastric ultrasound","authors":"Rafael S. F. Nersessian, Leopoldo M. da Silva, Glenio B. Mizubuti","doi":"10.1111/anae.16587","DOIUrl":"https://doi.org/10.1111/anae.16587","url":null,"abstract":"<p>We thank Yarımoglu et al. [<span>1</span>] for their valuable comments regarding our recently published work [<span>2</span>]. As noted in our methods, we had initially not included patients with BMI > 40 kg.m<sup>-2</sup> and ASA physical status score ≥ 3 [<span>2</span>]. However, and as rightfully pointed out by Yarımoglu et al. [<span>1</span>], the data in table 1 indicate that the upper range limit of BMI was 46.4 kg.m<sup>-2</sup> in the semaglutide group and 40.1 kg.m<sup>-2</sup> in the non-semaglutide group [<span>2</span>]. Upon reviewing our data, we identified four patients with morbid obesity (BMI 40.7, 42.4, 45.1 and 46.4 kg.m<sup>-2</sup>) in the semaglutide group and one (BMI 40.1 kg.m<sup>-2</sup>) in the non-semaglutide group [<span>2</span>]. While we apologise for this oversight, on further review of our data, neither of these patients had increased residual gastric content upon point-of-care gastric ultrasound assessment.</p>\u0000<p>As per our institutional protocol, all patients (regardless of BMI) who had used semaglutide within 10 days of their elective surgical procedure underwent pre-operative bedside gastric ultrasound to mitigate the risk of bronchoaspiration which explains the inclusion of patients with morbid obesity in our dataset. In the non-semaglutide group, patients were recruited from a convenience sample of those presenting for elective procedures under anaesthesia, according to the institutional elective surgical scheduling. Given logistical constraints, it was impractical to perform gastric ultrasound in all patients during the data collection period.</p>\u0000<p>Importantly, despite our unintentional inclusion (in both groups) of five patients with BMI > 40 kg.m<sup>-2</sup>, the conclusions of our study remain unchanged [<span>2</span>]. Even with the original analysis using propensity score, no statistical difference in residual gastric content was observed related to obesity, which aligns with existing published data [<span>3</span>]. Our findings suggest that semaglutide use and patient age (but not BMI) were the key determinants of increased residual gastric content in our studied population. It is important to note that our studied groups were not initially matched for age, weight, BMI or sex, as the convenience sampling of non-semaglutide users remains a recognised limitation [<span>2</span>].</p>\u0000<p>Finally, our primary reason for excluding patients with BMI > 40 kg.m<sup>-2</sup> was the potential technical challenges in performing gastric ultrasound in this patient population, which could lead to inconclusive results. Nevertheless, several studies have shown the feasibility and validity of point-of-care gastric ultrasound to assess residual gastric content in patients with BMI > 40 kg.m<sup>-2</sup> [<span>4, 5</span>]. It is important to note that all bedside gastric ultrasound assessments in our study were performed by trained/experienced professionals, thereby significantly reducing, alb","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"49 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suture choice when securing central lines: an update in the light of NICE surgical guidance","authors":"Thomas Lightburn, William Beswick, Usmahn Yasin, David Mayhew","doi":"10.1111/anae.16588","DOIUrl":"https://doi.org/10.1111/anae.16588","url":null,"abstract":"<p>Despite substantial advances in care packages to reduce central venous catheter-related blood stream infections, silk sutures are used widely to secure lines. This may be due to the opening on to sets or as part of pre-arranged procurement processes, likely originating from the very easy handling characteristics of a braided silk stitch, and its ability to grip a tube such as a line or drain when tied circumferentially. Surgical practice guidelines, however, suggest that antimicrobial-coated monofilament sutures should be used due to lower surface area and direct antimicrobial effects that lead to lower rates of infection.</p>\u0000<p>Due to the braided construction, the large surface area of silk sutures predisposes to colonisation and biofilm formation, and the antigenic properties of (animal-derived) silk protein lead to local inflammation [<span>1</span>]. This sloughy tissue can be difficult to discern from early infective changes. These are of limited consequence when securing a drain or vascular access device for a period of hours to a couple of days.</p>\u0000<p>In surgical wound closure, monofilament antimicrobial-coated sutures have been available for many years. Whilst they are slightly harder to handle, and do not grip well to a structure like a drain, they work perfectly well for securing lines fitted with a collar and suture holes. They require an increased number of throws to guarantee security and must be locked with an appropriate locking knot. Since 2021, National Institute for Health and Care Excellence surgical guidance has been that antimicrobial-coated sutures should be used for all wound closures due to an overall reduction in wound infection rates [<span>2</span>]. We suggest that an antibiotic-coated monofilament should be used instead of a silk stitch to secure vascular access devices anticipated to remain in situ for &gt; 48 h. There are a wide selection of sizes and needle styles available. When tying the knot, such sutures benefit from additional throws beyond the three needed for silk; typically, six for a monofilament. Whilst monofilament is absorbable, it absorbs over several months which does not preclude its use for securing lines. The only additional requirement is training in correct suture tying technique, as the sutures are broadly equivocal in price.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"54 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143518009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-operative pain: an unaddressed confounder in anaesthesia-related cognitive outcomes.","authors":"Qi-Hao Yang, Chuan-Bang Chen","doi":"10.1111/anae.16586","DOIUrl":"https://doi.org/10.1111/anae.16586","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative exploration of stressors in anaesthesia training in the UK and mechanisms to improve resident wellbeing","authors":"Thomas Gale, Sophie Winter, Harriet Daykin, John Tredinick-Rowe, Lyndsey Withers, Marie Bryce","doi":"10.1111/anae.16575","DOIUrl":"https://doi.org/10.1111/anae.16575","url":null,"abstract":"High levels of stress and burnout have been identified among resident anaesthetists in UK training programmes. Factors involving clinical roles, workplace culture and training are known stressors, but in-depth research investigating how to improve wellbeing is limited.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"22 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arterial trauma due to central venous catheter insertion: an analysis of incidents reported to the National Reporting and Learning System for England and Wales 2013–2023","authors":"Peter W. Hart, Penelope Beddoes, David Burtle, Michelle L. Bradshaw","doi":"10.1111/anae.16570","DOIUrl":"https://doi.org/10.1111/anae.16570","url":null,"abstract":"Arterial trauma is a rare, but potentially life-threatening complication of central venous catheter insertion, with limited evidence to guide its prevention and management. We aimed to identify incidents from two national databases of incident reports to better characterise this complication and its consequences.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"127 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143462991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}