Anaesthesia最新文献

{"title":"Mental health and disordered eating in childhood and adolescence: increasing core business in anaesthesia.","authors":"Zoë A Burton,Lee D Hudson","doi":"10.1111/anae.16729","DOIUrl":"https://doi.org/10.1111/anae.16729","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"5 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819824","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":"Delirium identification, prevention and management in intensive care units in England, Wales and Northern Ireland: a survey of practice.","authors":"Ben Gibbison,Amelia Francis Johnson,Kathryn M Rowan,Roxanne Parslow,Andrew J Moore,Sarah C Smith,James Long,Molly Potter,Maria Pufulete, ","doi":"10.1111/anae.16728","DOIUrl":"https://doi.org/10.1111/anae.16728","url":null,"abstract":"INTRODUCTIONDelirium is the most common sign of acute brain dysfunction and is prevalent in ICUs. This work is part of a UK National Institute of Health and Social Care Research-funded Programme Development Grant to identify optimal approaches to prevent, identify and manage ICU delirium in the UK. This survey aimed to provide a baseline for contemporary practice.METHODSA structured online survey was designed and sent to all ICUs in England, Wales and Northern Ireland, identified through the Intensive Care National Audit and Research Centre Case Mix Programme. Participants were asked to provide a response that reflected ICU-level care.RESULTSThe ICU participant response rate was 249/268 (93%). Of these, 222/249 (89%) ICUs screened for ICU delirium routinely and 208/222 (94%) used the CAM-ICU tool. Delirium care packages were applied by 125/249 (50%) ICUs, but 81/125 (68%) conveyed that this was not consistent for all patients. Both antipsychotics and benzodiazepines are used commonly to manage delirium. All respondents stated that early mobilisation; early removal of invasive catheters; maintenance of hearing aids/glasses; regular mealtimes; and daytime activity were used as non-pharmaceutical delirium management strategies. Enhanced follow-up was reported by 195/249 (79%) respondents, either routinely or for selected cases.DISCUSSIONOnly half of UK ICUs use a standardised care package to prevent and manage ICU delirium, with inconsistent implementation. Future work should focus on the development and evaluation of an evidence-based and sustainable care package.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"169 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819823","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 dexmedetomidine nasal spray and emergence agitation in adults undergoing ear, nose and throat surgery: a randomised controlled trial.","authors":"Dan Wang,Wei Dou,Jing-Hui Hu,Lei Huang,Hong Liu,Fu-Hai Ji,Ke Peng","doi":"10.1111/anae.16726","DOIUrl":"https://doi.org/10.1111/anae.16726","url":null,"abstract":"INTRODUCTIONEmergence agitation is common after ear, nose and throat surgery, causing patient discomfort and increased risk of complications. We hypothesised that pre-operative dexmedetomidine nasal spray would reduce the incidence of emergence agitation in adult patients undergoing these procedures.METHODSWe conducted a randomised double-blind controlled trial in adults scheduled for ear, nose and throat surgery. Patients were allocated (1:1) to receive nasal spray with dexmedetomidine (75-100 μg based on age and weight) or 0.9% saline, 30 min before induction. Sevoflurane anaesthesia was titrated to bispectral index 40-60. The primary outcome was the incidence of emergence agitation (Riker sedation agitation scale score ≥ 5 from sevoflurane discontinuation to 5 min post-tracheal extubation).RESULTSWe recruited 159 patients (median (IQR [range]) age 50 (36-60 [18-77]) y; 62% male). The incidence of emergence agitation in patients allocated to the dexmedetomidine group was 25% (20/80) compared with 47% (37/79) in those allocated to the 0.9% saline group (RR 0.53, 95%CI 0.34-0.82, p = 0.004), with a number needed to treat of 4.6. Secondary and exploratory outcomes showed that dexmedetomidine nasal spray was associated with: less venepuncture pain; reduced rate of sleep disturbance on the first night after surgery; and higher patient satisfaction, without increasing adverse events.DISCUSSIONPre-operative dexmedetomidine nasal spray reduced emergence agitation in adult patients undergoing ear, nose and throat surgery, and could enhance peri-operative care for these procedures.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"736 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144797090","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":"Regional anaesthesia for hip fracture: are we measuring what matters?","authors":"Liam Barrett,David Metcalfe","doi":"10.1111/anae.16734","DOIUrl":"https://doi.org/10.1111/anae.16734","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"70 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144797050","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":"Trends in greenhouse gas emissions from volatile anaesthetics in 41 countries: 2013-2023.","authors":"Marta Caviglia,Andrealuna Ucciero,Andrea Conti,Aurora Di Filippo,Francesco Trotta,Luca Ragazzoni,Francesco Della Corte,Francesco Barone-Adesi","doi":"10.1111/anae.16709","DOIUrl":"https://doi.org/10.1111/anae.16709","url":null,"abstract":"INTRODUCTIONInhalational anaesthetics contribute to greenhouse gas emissions, leading to regulatory restrictions in some countries. This study analysed time trends of greenhouse gas emissions directly attributable to the use of volatile anaesthetic agents in 41 countries.METHODSSales data were obtained using data from IQVIA MIDAS® and national medicines agencies. We calculated the kilograms of carbon dioxide equivalents (based on global warming potential) per capita and percentage change in greenhouse gas emissions, from the emission of volatile anaesthetics from 2018 to 2023.RESULTSData were obtained for 41 countries, representing approximately 35% of the global population. Greenhouse gas emissions associated with volatile anaesthetic agents decreased in the 27 European Union nations and other 'western' countries included in the study (Australia, Canada, New Zealand, UK and USA), achieving in some cases below 0.5 kg of carbon dioxide equivalents per inhabitant. In contrast, several Asian countries showed a substantial increase in emissions, with South Korea and Japan reporting the highest values globally (approximately 2.5 kg of carbon dioxide equivalents per inhabitant). A secondary analysis restricted to European countries showed a 17-fold difference in per-capita carbon-equivalent emissions between the highest and lowest emitters, suggesting that recommendations on the use of volatile anaesthetic agents are implemented inconsistently.DISCUSSIONOur study highlighted large differences in the management of greenhouse gas emissions attributable to volatile anaesthetic use. While results show a decreasing trend in western countries, albeit with substantial variation, rising trends observed in many Asian countries may constitute a source of concern. The experience of nations that have phased out the highest impacting volatile anaesthetic agents show that reducing emissions below 0.5 kg of carbon dioxide equivalents per inhabitant is attainable. This should serve as a model for other systems, prompting implementation of educational initiatives and specific policies.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"55 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787429","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":"Translating regional anaesthesia training into clinical impacts: is good instructional design good enough?","authors":"Alia Mahmood,Christopher Tennuci,Ganesh Hanumanthu","doi":"10.1111/anae.16730","DOIUrl":"https://doi.org/10.1111/anae.16730","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"58 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777829","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":"Development of an assessment tool for ultrasound-guided regional anaesthesia image interpretation.","authors":"Sam J Haddad,Mayur Murali,Shun W S Ko,Madan Narayanan,James S Bowness,Peter Merjavy,Lloyd Turbitt,Alan J R Macfarlane,Amit Pawa,Boyne Bellew, ","doi":"10.1111/anae.16724","DOIUrl":"https://doi.org/10.1111/anae.16724","url":null,"abstract":"INTRODUCTIONThe success of ultrasound-guided regional anaesthesia depends on the acquisition and interpretation of optimal ultrasound images. This study aimed to develop an assessment tool to evaluate proficiency in interpreting ultrasound images for regional anaesthesia.METHODSThis study involved domain and item generation; preliminary testing; and content validity evaluation by an expert panel review. Questions were generated by the study group and pilot testing was conducted with UK-based anaesthesia consultants and resident doctors. Face validity was tested by thematic analysis of participant feedback questionnaires, discriminative ability using Rasch modelling of item response and internal reliability using Cronbach's α method.RESULTSA 57-item pilot test was completed by 43 participants across clinical experiences from stage 1 training to consultant. Median (IQR [range]) completion time was 55 (41-64 [29-94]) min and fatigue point was question 49 of 57 (37-57 [15-57]). Rasch analysis led to the exclusion of seven items and content validity evaluation resulted in the removal of a further six items, resulting in a 44-item question set. The test showed good face validity, with a Cronbach's α of 0.92, indicating high internal reliability.DISCUSSIONThis study produced a 44-item assessment tool to assess the proficiency of ultrasound image interpretation in regional anaesthesia for a range of upper limb, lower limb and truncal blocks, with proven face validity, internal reliability and content validity. Further testing with a larger sample is planned to verify reliability and validity, with the hope that this may be an asset for regional anaesthesia training and assessment.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"9 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144747700","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":"Views of people who have given birth on the environmental and occupational exposure risks of nitrous oxide for labour analgesia: an interview-based qualitative study.","authors":"Laura Elgie,Tom Salih,S Ramani Moonesinghe","doi":"10.1111/anae.16687","DOIUrl":"https://doi.org/10.1111/anae.16687","url":null,"abstract":"INTRODUCTIONA 50:50 nitrous oxide/oxygen mix is commonly used for labour analgesia in the UK; however, nitrous oxide is associated with comparatively high environmental impact and potential exposure risks to staff if appropriate measures are not taken. Reduction of the impact of nitrous oxide in line with net zero emissions targets would require widespread changes in the way nitrous oxide is administered or in the availability of alternative options for labour analgesia. The aims of this qualitative study were to understand nitrous oxide use from the perspective of the parturient in the context of concerns regarding the environment and occupational exposure, and to provide evidence to guide the development of patient-centred nitrous oxide mitigation strategies.METHODSWe conducted semi-structured interviews with participants who had used nitrous oxide for labour analgesia. Participants were recruited purposively. Data were analysed using reflexive thematic analysis.RESULTSWe conducted 12 interviews and identified three themes: nitrous oxide is the default for labour analgesia in the UK; mitigating nitrous oxide harm depends on personal priorities; and institutions have a responsibility to mitigate nitrous oxide harm. Participants viewed nitrous oxide as a safe option, readily available in the context of limited choices for labour analgesia. They would be interested to know about the environmental risk of nitrous oxide, though this would not necessarily influence their choice to use it. They were less interested in its occupational risks and considered institutions, rather than individuals in labour, to have a responsibility to mitigate these. Though they felt that investment in reducing NHS emissions is important, participants also felt there may be other more pressing financial priorities.DISCUSSIONThis study provides evidence to support the development of strategies to reduce nitrous oxide emissions, which consider the views of people who have used nitrous oxide for labour analgesia.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"18 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720011","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":"Age, ASA physical status and surgical outcomes: insights from a nationwide cohort study.","authors":"Naima Kilhamn,Jesper Eriksson,Erik von Oelreich,Malin Jonsson Fagerlund,Anders Oldner,Emma Larsson","doi":"10.1111/anae.16723","DOIUrl":"https://doi.org/10.1111/anae.16723","url":null,"abstract":"INTRODUCTIONWith over 300 million surgical procedures performed worldwide annually and an ageing population with increasing comorbidities, peri-operative risk assessment is more important than ever. Whilst the ASA physical status is used widely to assess surgical risk, its association with age remains underexplored in contemporary, broad surgical populations. This study examines the relationship between ASA physical status, age and postoperative mortality in an adult surgical cohort.METHODSThis nationwide cohort study analysed data from the Swedish Perioperative Register on patients aged ≥ 18 y undergoing major non-cardiac surgery from January 2019 to March 2023. Data on comorbidities, socioeconomic factors and mortality were retrieved from national health registries. The primary outcome was 30-day mortality. Secondary outcomes were 365-day mortality and days at home alive at 30 days.RESULTSA total of 262,938 elective and 197,108 acute procedures were analysed, with median ages of 66 and 68 y, respectively. Crude mortality rates in elective surgery were 1369 (0.5%) at 30 days and 10,437 (4.0%) at 365 days. For acute surgery, mortality was 10,602 (5.4%) at 30 days and 27,912 (14.2%) at 365 days. Adjusted odds ratios (OR) for 30-day mortality indicated a 14-fold increased risk for ASA physical status 3 compared with ASA physical status 1 in both elective (OR 13.7, 95%CI 7.5-25.0) and acute (OR 14.0, 95%CI 10.2-19.3) surgeries. Correspondingly, ASA physical status ≥ 4 was associated with odds ratios of 62.2 (95%CI 33.5-115.5) for elective and 51.1 (95%CI 37.1-70.3) for acute surgery.DISCUSSIONAs populations age and surgical demand increases, continuous evaluation of risk assessment tools like the ASA physical status is essential. This study shows a strong association between ASA physical status and mortality across all ages in a contemporary adult surgical cohort. These findings could enhance our understanding of peri-operative risk stratification in the context of shifting demographic trends.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"21 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719948","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":"Comparing the pericapsular nerve group block and fascia iliaca block for acute pain management in patients with hip fracture: a randomised clinical trial.","authors":"Santi Di Pietro,Riccardo Maffeis,Eugenio Jannelli,Benedetta Mascia,Flavia Resta,Annalisa De Silvestri,Valeria Musella,Clarissa Elisabeth Centurioni,Elena Regeni,Federico Alberto Grassi,Alessandro Locatelli,Stefano Perlini, ","doi":"10.1111/anae.16695","DOIUrl":"https://doi.org/10.1111/anae.16695","url":null,"abstract":"INTRODUCTIONThe fascia iliaca block (FIB) is currently recommended as a component of multimodal acute pain management for patients with hip fracture. The pericapsular nerve group (PENG) block is a newer technique that may provide superior analgesia. We therefore designed this study in an academic emergency department to compare the acute analgesic effect of these two approaches in patients with a hip fracture.METHODSAdult patients with an acute hip fracture who reported at least moderate pain were eligible for inclusion. Patients were allocated randomly to receive either a PENG block with 20 ml 0.375% levobupivacaine plus 4 mg dexamethasone or infra-inguinal FIB with 30 ml 0.25% levobupivacaine plus 4 mg dexamethasone. Primary outcome was the percentage of summed pain intensity difference (%SPID) calculated from visual analogue pain scores measured during the first hour post-block. Secondary outcomes included: number of patients reaching 33% and 50% SPID; dose of rescue opioid administered in morphine milligram equivalents; and incidence of adverse events.RESULTSIn total, 92 patients were screened for eligibility and 64 were enrolled (32 in each group). Patients allocated to the PENG block group showed a greater %SPID when compared with those allocated to the FIB group (62.7% (95%CI 52.9-72.4%) vs. 38.0% (95%CI 30.7-45.4%), respectively; difference: -24.7% (95%CI -36.6 to -12.7%), p < 0.001). In the PENG group, 24/32 patients achieved 50% SPID compared with 7/32 in the FIB group (p < 0.001). Similarly, in the PENG group, 28/32 patients achieved 33% SPID compared with 19/32 in the FIB group (p = 0.022). There was no significant difference in the rescue opioid dose administered or in the incidence of adverse events.DISCUSSIONThe PENG block provides superior analgesia for the first hour after intervention when compared with the infra-inguinal FIB and represents a promising modality for acute pain management in emergency departments.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"5 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720012","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}