Anaesthesia最新文献

{"title":"Impact of honey on post‐tonsillectomy pain in children (BEE PAIN FREE Trial): a multicentre, double‐blind, randomised controlled trial*","authors":"David Sommerfield, Aine Sommerfield, Daisy Evans, Neil Hauser, Shyan Vijayasekaran, Paul Bumbak, Hayley Herbert, Cornelia Locher, Lee Yong Lim, R. Nazim Khan, Britta S. von Ungern‐Sternberg","doi":"10.1111/anae.16619","DOIUrl":"https://doi.org/10.1111/anae.16619","url":null,"abstract":"SummaryIntroductionTonsillectomy, a common childhood surgery, is associated with difficult postoperative recovery. Previous reviews provided low‐grade evidence that honey may improve recovery. The BEE PAIN FREE study investigated whether honey alongside multimodal analgesia improved the recovery trajectory in children following tonsillectomy.MethodsA prospective randomised controlled trial was conducted across three centres in Western Australia. Children undergoing extracapsular tonsillectomy by coblation were allocated randomly to one of four postoperative treatment groups: standard treatment alone; Marri honey (from Western Australia); Manuka honey (from Western Australia); or placebo. The intervention groups took 5 ml of honey or placebo, six times a day, for at least 7 days, in addition to usual discharge analgesia (standard treatment). Data for daily pain scores, Parents' Postoperative Pain Measure scores, medications and unplanned re‐presentations were collected.ResultsA total of 400 children were recruited; 20% were lost to follow‐up or withdrew. The mean number of honey doses taken varied between 2 and 3 doses per day over 7 days. Treatment with honey at this frequency did not impact postoperative pain scores significantly, with all groups showing similar trajectories. These findings did not alter with as‐treated analysis or using imputed models for missing data. Most children experienced significant pain until around postoperative day 8. Children allocated to the honey and placebo groups showed some improved oral tolerance around day 6 but had increased vomiting during earlier days. There were no clinically significant differences in medical re‐presentations, simple analgesia or oxycodone usage between groups.DiscussionTwo to three doses daily of oral honey/placebo in children post‐extracapsular tonsillectomy for 7 days, in addition to regular paracetamol, ibuprofen and as required oxycodone did not result in a clinical improvement in pain or recovery over a 14‐day follow‐up period.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"58 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143905720","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":"Private equity consolidation in anaesthesiology: trends and sector‐specific investment patterns from 2006 to 2024","authors":"Ravi Dhawan, Johnathan J. Choi, Dario von Wedel, Maximilian S. Schaefer, Denys Shay","doi":"10.1111/anae.16630","DOIUrl":"https://doi.org/10.1111/anae.16630","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"82 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884704","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":"Patient positioning and dural puncture epidural","authors":"Reginald Edward","doi":"10.1111/anae.16627","DOIUrl":"https://doi.org/10.1111/anae.16627","url":null,"abstract":"<p>I commend Drs Bamber and Lucas for their insightful commentary on the universal adoption of combined spinal–epidural techniques in labour analgesia [<span>1</span>]. Their points regarding patient-centric care and the balance between analgesia quality, onset time and complication risks, particularly postdural puncture headache, are pertinent [<span>2</span>].</p>\u0000<p>Recent evidence and physiological insights into the dural puncture epidural technique provide additional clarity. The faster onset of analgesia associated with dural puncture epidural appears attributable primarily not just to diffusion but also to pressure-driven bulk flow of local anaesthetic into the intrathecal space. This is facilitated by transient elevations in epidural pressures during bolus administration [<span>3, 4</span>].</p>\u0000<p>The supine position is associated with higher epidural pressures due to posterior epidural venous engorgement and tissue compression compared with lateral or sitting positions [<span>5, 6</span>]. Consequently, it is plausible that administering the initial epidural bolus in the supine position following dural puncture may enhance the pressure gradient, potentially accelerating intrathecal drug migration and analgesia onset. This mechanism, however, does not diminish the significance of postdural puncture headache risk, which remains a vital consideration in patient-centred care [<span>2</span>]. Instead, it highlights a nuanced opportunity to optimise analgesic efficacy through strategic positioning and careful bolus administration. Vigilant clinical management and incremental dosing may help balance the benefits of enhanced analgesia with potential complication risks, without necessitating universal adoption of the combined spinal–epidural approach.</p>\u0000<p>Future research exploring the relationship between patient positioning, epidural pressures and analgesic outcomes in the context of dural puncture epidural would provide valuable insights to further refine labour analgesia practices.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"11 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885078","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":"Efficacy and safety of intrathecal diamorphine: replies","authors":"Eric Albrecht, Sina Grape, Kariem El‐Boghdadly","doi":"10.1111/anae.16623","DOIUrl":"https://doi.org/10.1111/anae.16623","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"8 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884702","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":"Rescuing the stylet: how technique can close the gap in hyperangulated videolaryngoscopy","authors":"Chiung-Fang Hsu, Shu-Yueh Cheng, Ming-Hui Hung","doi":"10.1111/anae.16626","DOIUrl":"https://doi.org/10.1111/anae.16626","url":null,"abstract":"&lt;p&gt;The trial by Taboada et al. [&lt;span&gt;1&lt;/span&gt;] showed superior first-attempt tracheal intubation success with a flexible-tip bougie compared with a stylet when using a hyperangulated videolaryngoscope in patients who were critically ill. While the manoeuvrability of the bougie offers advantages, we believe that the results also highlight how adjustments in technique could improve stylet performance substantially, rescuing it from perceived inferiority.&lt;/p&gt;\u0000&lt;p&gt;Taboada et al. shaped the stylet with a 30–40° angulation in the distal 5 cm of the tracheal tube (‘hockey stick’ shape) [&lt;span&gt;2&lt;/span&gt;]. This shape is used commonly for direct laryngoscopy or Macintosh videolaryngoscopy but may not replicate the curvature of hyperangulated blades such as the C-MAC® D-Blade (Karl Storz Endoscopy-America, Inc., El Segundo, CA, USA) used in the study. In contrast, Köhl et al. used the same videolaryngoscope with the manufacturer-designed hyperangulated stylet (C-MAC Guide™), achieving a 99% first-attempt success rate in patients with anticipated difficult airways [&lt;span&gt;3&lt;/span&gt;]. This suggests that mismatched blade-stylet geometry, rather than intrinsic limitations of the stylet, may have contributed to the lower success observed in the stylet group in the study by Taboada et al.&lt;/p&gt;\u0000&lt;p&gt;Notably, both groups achieved excellent glottic visualisation (modified Cormack and Lehane grade 1 view in 96% of the bougie group and 90% in the stylet group). Despite this, the stylet group had a lower first-attempt tracheal intubation success rate (83% vs. 99%) and a higher rate of laryngeal manipulation (31% vs. 10%). These findings support previous observations that overexposure of the glottis may hinder tube delivery by increasing the angle between the tracheal tube and tracheal inlet [&lt;span&gt;2, 4&lt;/span&gt;]. A full glottic view is not always favourable; deliberate limitation of blade insertion to achieve a grade 2a or 2b view may, paradoxically, make tracheal intubation easier, especially when using a stylet. Gu et al. showed that limiting glottic exposure improved tracheal intubation speed and ease, despite similar overall success rates [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;While flexible-tip bougies are useful adjuncts, they are not available in many clinical environments. In such settings, technique becomes paramount. A practical alternative involves shaping a standard malleable stylet to match the blade's curvature, limiting blade insertion depth to avoid excessive angulation and withdrawing the stylet as the tracheal tube passes the vocal cords. These pragmatic, evidence-based refinements [&lt;span&gt;2-4&lt;/span&gt;] may help close the performance gap between bougie and stylet, particularly in environments where specialised equipment is unavailable.&lt;/p&gt;\u0000&lt;p&gt;In summary, the work of Taboada et al. provides valuable insight into how performance differences between adjuncts may reflect not only device characteristics but also how those devices are used. Emphasising these pragmatic refinements c","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"8 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884995","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":"Culture of excellence or culture of control?","authors":"Reginald Edward","doi":"10.1111/anae.16629","DOIUrl":"https://doi.org/10.1111/anae.16629","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"11 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884703","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":"Improving tracheal intubation outcomes requires deeper analysis of the three axes of tracheal tube orientation","authors":"Erich B. Schulz","doi":"10.1111/anae.16625","DOIUrl":"https://doi.org/10.1111/anae.16625","url":null,"abstract":"&lt;p&gt;I read with interest the network meta-analysis examining the relative performance of modern videolaryngoscopes by de Carvalho et al. [&lt;span&gt;1&lt;/span&gt;]. The authors' call to action includes identifying strategies to translate better glottic visualisation into improved tracheal intubation efficacy. This call is most compelling in emergency tracheal intubations by relatively inexperienced non-anaesthetists in out-of-hospital or emergency department contexts [&lt;span&gt;2&lt;/span&gt;]. Maximising the value of limited opportunities for first responders to practise tracheal intubation in controlled environments is crucial for improving field outcomes.&lt;/p&gt;\u0000&lt;p&gt;Peyton's teaching approach has been shown to speed learning and aid retention, particularly in small group or individual teaching environments [&lt;span&gt;3&lt;/span&gt;]. This requires deconstructing and describing each step in a procedure precisely, followed by allowing the trainee to test their understanding by describing back the steps before completing the task themselves. We need to deconstruct the step of positioning and orienting the tracheal tube in order to pass it through the glottis, as a startling number of tracheal intubation attempts fail despite a full view of the cords. The complexity of this step appears to have gone unrecognised. Positioning and orienting an object in a three-dimensional space requires a total of six different numbers, each with a specific zero reference. While clinical language covers the three dimensions of position (left/right; anterior/posterior; and superior/inferior) the three axes of rotation of a free-floating object like a tracheal tube are not. The terms pitch, roll and yaw, originally from sailing but popularised by aviation, describe the three distinct rotations.&lt;/p&gt;\u0000&lt;p&gt;Some studies have investigated the rotation of hands during tracheal intubation [&lt;span&gt;4&lt;/span&gt;], but there is limited research on the orientation of the tracheal tube itself. There is no published analysis of the interactions between each of the three rotations of a curved tracheal tube with a curved laryngoscope blade and maxillary dental arch during tracheal intubation. The orientation of the tracheal tube and the pressure at the tube-blade contact point significantly influence the anteroposterior position of the tracheal tube tip at the level of the glottis [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Overall, there seems to be an underlying assumption that correct tracheal tube three-dimensional orientation either develops with experience, as an unteachable competence, or can be circumvented by equipment modifications. Numerous studies show that relying on trainees to gain proficiency after 50–100 tracheal intubations leaves non-anaesthetists under-prepared for emergency tracheal intubations.&lt;/p&gt;\u0000&lt;p&gt;In my experience, the most common observable orientation error with a standard Macintosh blade is bending the proximal tracheal tube cephalad over the upper teeth. Despite this leading to a predictable posterior deflection ","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"39 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885077","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":"Postoperative intravenous iron: haemoglobin gains are clear, but do they translate to clinical benefit?","authors":"Reginald Edward","doi":"10.1111/anae.16628","DOIUrl":"https://doi.org/10.1111/anae.16628","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"18 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884700","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":"Assessing healthcare simulation facilitation using a competency-based tool derived from practice in low-resource settings","authors":"Adam I. Mossenson, Janie A. Brown, Eugene Tuyishime, Rodrigo Rubio Martinez, Karima Khalid, Patricia Livingston","doi":"10.1111/anae.16621","DOIUrl":"https://doi.org/10.1111/anae.16621","url":null,"abstract":"The worldwide expansion in healthcare simulation training includes accelerated uptake in low-resource settings. Until recently, no framework has specifically delineated the competencies underpinning effective facilitation practice in low-resource settings. We describe the development of the Facilitation Behavioural Assessment Tool for simulation facilitation training and report reliability in scoring facilitation performance. This tool was informed by healthcare simulation facilitation practice in low-resource settings.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"36 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885079","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":"Temporal characteristics of remimazolam-induced sedation in paediatric anaesthesia: a reply","authors":"Yu-Bo Fang, Hua-Cheng Liu","doi":"10.1111/anae.16615","DOIUrl":"https://doi.org/10.1111/anae.16615","url":null,"abstract":"<p>We appreciate the insightful commentary from Li et al. [<span>1</span>]. In our multicentre trial, the median time to loss of consciousness during induction of anaesthesia was 45 s and 25 s, for children aged 3–6 y receiving 0.3 mg.kg^-1 remimazolam vs. 2.5 mg.kg^-1 propofol, respectively [<span>2</span>]. Although the pharmacokinetic simulation from Li et al. suggests increased drug efficacy, our findings regarding time to loss of consciousness were consistent with previous paediatric research [<span>3</span>]. The use of remimazolam monotherapy for anaesthetic induction did indeed necessitate higher doses [<span>4</span>]. Notably, opioid co-administration can reduce the dose of sedative drugs, and our protocol for anaesthesia induction included intravenous administration of 3 μg.kg^-1 fentanyl 3 min before injection of the study drugs. Consequently, we observed a Modified Observer's Assessment of Alertness/Sedation score of 3 or 2 in some patients before injection of the study drugs. This sequential approach was designed specifically to synchronise tracheal intubation with the peak opioid analgesic effect, accounting for known pharmacokinetic variability in paediatric populations.</p>\u0000<p>Regarding the methods, our protocol mandated randomised administration of initial bolus doses; an injection duration &lt; 60 s; and a standardised assessment of loss of consciousness with no response to gentle shoulder shaking. Consequently, establishing robust temporal pharmacokinetic-pharmacodynamic models between sedative drug administration and loss of consciousness through covariate-adjusted analyses (e.g. age, sex and BMI) using both linear and logistic regression approaches is crucial in optimising safe and effective anaesthetic induction in paediatric anaesthesia.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"1 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857830","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}