Anaesthesia最新文献

{"title":"Analgesia for elective midline laparotomy","authors":"Rhona C. F. Sinclair, Victoria Peacock, Joyce Yeung, Caroline Thomas","doi":"10.1111/anae.16640","DOIUrl":"10.1111/anae.16640","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 7","pages":"865-866"},"PeriodicalIF":7.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16640","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143933115","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":"Functional capacity, frailty and the future of peri-operative risk stratification.","authors":"Elnè Noppè,Aoife Lavelle","doi":"10.1111/anae.16639","DOIUrl":"https://doi.org/10.1111/anae.16639","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"30 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932774","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":"Qualitative exploration of stressors in anaesthesia training in the UK and mechanisms to improve resident wellbeing","authors":"Nicola S. Crowther, Francesca Millinchamp","doi":"10.1111/anae.16641","DOIUrl":"https://doi.org/10.1111/anae.16641","url":null,"abstract":"<p>We commend Gale et al. on their investigation into resident doctor stressors and wellbeing in years 2–5 of training [<span>1</span>]. This work complements a recent survey undertaken by the Severn Deanery Training Program Director and ST4+ resident representatives exploring anaesthesia resident doctors' welfare and burnout risk, alongside seeking feedback on how to improve the training experience. Our survey received a 96% response rate from stage 2 and 3 resident doctors (89/93). The 2017 Royal College of Anaesthetists' survey of trainee morale and welfare found that, nationally, 85% of anaesthetic resident doctors were at a high risk of burnout [<span>2</span>]. Our findings identified this risk as 67% (60/89), with a comprehensive picture of issues experienced locally. We aim to address these concerns and want to compare our findings with those of Gale et al. to highlight resident doctors' wellbeing.</p>\u0000<p>Our results largely reflect the national picture, with most resident doctors feeling satisfied overall in their job (72/89, 81%). Common stressors were related to training and career progression, including exam preparation; consultant applications; work–life balance; financial wellbeing; and incorrect pay. The desire for a single lead employer was the most cited suggestion to improve wellbeing. Although there is national guidance to support a lead employer model, there appear to be many barriers to implementation, and we hope the drive to achieve this is not neglected with the abolition of NHS England. Lack of support (including peer support) and rota problems were cited rarely as stressors but, interestingly, were common themes in suggestions on how to improve training experiences. Particularly prevalent was the theme of improving the sense of the resident community, echoing the importance of social spaces recognised in the work by Gale et al.</p>\u0000<p>These two pieces of work illustrate how stressors can evolve throughout training. In the survey, clinical stressors such as intensive care medicine and obstetrics were mentioned rarely. This may indicate the higher clinical confidence of the senior resident doctors who participated. The burden of participating in ‘tick box’ projects was also not mentioned, possibly because our survey participants were more senior than the cohort in the study by Gale et al. and, therefore, more likely to be assigned projects aligning with their interests. Conversely, concerns around consultant job applications were more frequent, as well as the pressure to improve portfolios and inter-trainee competition. Meeting wellbeing needs will require tailored approaches for each stage of training; a universal solution is unrealistic.</p>\u0000<p>Resident doctors had varied levels of confidence in discussing their mental health with supervisors and their knowledge of workplace mental health resources. Despite this, mental health support was listed rarely as a suggestion for ways to improve the quality of training. We feel ","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"2 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143933067","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":"Flexible-tip bougie vs. stylet for tracheal intubation with a hyperangulated videolaryngoscope in critical care","authors":"Timothy Makar, Andrew Downey, Jon M. Graham","doi":"10.1111/anae.16642","DOIUrl":"10.1111/anae.16642","url":null,"abstract":"<p>We read with interest the article by Taboada et al. examining the differences between flexible-tip bougie and stylet on first-pass success rate with hyperangulated videolaryngoscopy [<span>1</span>]. Their study describes a higher first-pass tracheal intubation success rate with a flexible-tip bougie; however, we were surprised by the low first-pass tracheal intubation success rate in the patients allocated to the stylet group, which may reflect a heterogeneity in terms of training or experience with hyperangulated videolaryngoscopy.</p><p>Driver et al. describe a similar tracheal intubation success rate in a critical care patient population where direct laryngoscopy was used in 25% of cases, only 2% were performed by consultants with a median of 60 previous tracheal intubations and only 2% came from an anaesthesia background [<span>2</span>]. In contrast, Ruetzler et al. showed a 98% first-pass tracheal intubation success rate with hyperangulated videolaryngoscopy and stylet in patients undergoing cardiothoracic and vascular surgery [<span>3</span>]. Further, Köhl et al. showed a 97% first-pass tracheal intubation success rate in patients with anticipated difficult airways [<span>4</span>]. While these are different patient populations, both studies described the training programme as well as the use of a preformed stylet designed for hyperangulated videolaryngoscopy. It is of concern in the study by Taboada et al. [<span>1</span>] that an experienced group of anaesthetists, more than a quarter of whom were consultants, achieved a similar first-pass tracheal intubation rate as that reported by Driver et al. [<span>2</span>].</p><p>Our local practice is to reverse load a tracheal tube on to a preformed Gliderite Rigid Stylet (Verathon Medical Inc., Bothell, WA, USA) or a stylet bent as closely as possible to the shape of the hyperangulated blade (Fig. 1). The blade is placed midline over the tongue, a full view of the entire larynx is modified to a partial view of the vocal cords (dropping the larynx posteriorly to align the primary and secondary curves), and the styleted tracheal tube is inserted in the mouth sideways to avoid obscuring the view on the screen. If the styleted tracheal tube needs to point more anteriorly to enter the glottis, the tracheal tube is elevated rather than angled in order to avoid the tip abutting the anterior tracheal wall [<span>5</span>]. Once inside the trachea, gradual withdrawal of the stylet and generous rotation of the tracheal tube enables advancement of the tracheal tube down the tracheal lumen, avoiding impingement on the anterior tracheal wall.</p><p>While we congratulate Taboada et al. on elucidating the high first-pass tracheal intubation success rate of flexible-tip bougies, we implore future authors of studies using a stylet with hyperangulated videolaryngoscopy to ensure they specify an appropriate technique and that their users are trained adequately in the technique so generalisable comparisons ca","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 7","pages":"875-876"},"PeriodicalIF":7.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16642","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932776","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":"An analysis of publication trends in Science Letters published in Anaesthesia","authors":"Navniel Kaur, Michael G. Irwin, Ben Morton","doi":"10.1111/anae.16638","DOIUrl":"10.1111/anae.16638","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 7","pages":"859-860"},"PeriodicalIF":7.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16638","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932775","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":"Issue Information – Editorial Board","authors":"","doi":"10.1111/anae.16338","DOIUrl":"https://doi.org/10.1111/anae.16338","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 6","pages":"605"},"PeriodicalIF":7.5,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16338","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939069","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":"Impact of honey on post-tonsillectomy pain in children (BEE PAIN FREE Trial): a multicentre, double-blind, randomised controlled trial*","authors":"David Sommerfield,&nbsp;Aine Sommerfield,&nbsp;Daisy Evans,&nbsp;Neil Hauser,&nbsp;Shyan Vijayasekaran,&nbsp;Paul Bumbak,&nbsp;Hayley Herbert,&nbsp;Cornelia Locher,&nbsp;Lee Yong Lim,&nbsp;R. Nazim Khan,&nbsp;Britta S. von Ungern-Sternberg","doi":"10.1111/anae.16619","DOIUrl":"10.1111/anae.16619","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Tonsillectomy, 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Two 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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 8","pages":"946-958"},"PeriodicalIF":7.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16619","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":"OA","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,&nbsp;Johnathan J. Choi,&nbsp;Dario von Wedel,&nbsp;Maximilian S. Schaefer,&nbsp;Denys Shay","doi":"10.1111/anae.16630","DOIUrl":"10.1111/anae.16630","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 7","pages":"861-864"},"PeriodicalIF":7.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16630","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":"OA","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":"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><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><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><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":"80 7","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16627","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of intrathecal diamorphine: replies","authors":"Eric Albrecht,&nbsp;Sina Grape,&nbsp;Kariem El-Boghdadly","doi":"10.1111/anae.16623","DOIUrl":"10.1111/anae.16623","url":null,"abstract":"<p>We thank Drs Xu and Rong [<span>1</span>] and Drs Leslie and Stranix [<span>2</span>] for their comments regarding our systematic review and meta-analysis exploring the efficacy and safety of intrathecal diamorphine [<span>3</span>].</p><p>Drs Xu and Rong correctly highlighted that the figure we initially presented regarding the risk of bias assessment of the included trials was not derived from the Cochrane Collaboration's Risk of Bias tool 2 (RoB2) [<span>1</span>], but rather RoB1. Whilst this was an oversight, and represents an educational opportunity for many readers, we fully agree with their observation and are pleased to now present the appropriate figure (Fig. 1) for included studies (online Supporting Information Appendix S1).</p><p>Drs. Leslie and Stranix share their experience with intrathecal diamorphine, reporting doses ranging from 0.4 to 1.0 mg with good efficacy and a 10% incidence of postoperative nausea and vomiting [<span>2</span>]. While they acknowledge the need for further trials, they also note the challenge of convincing colleagues to adjust their practices, even in the context of prospective trial results. However, clinical practice should be guided by robust evidence rather than personal experience. We, therefore, encourage Drs. Leslie and Stranix to collect prospective data and publish their results for the benefit of patients across the UK where diamorphine is used commonly. Indeed, as a drug that is used commonly in the UK, it is disappointing that only 12 trials have been published over the past 35 years. We encourage clinicians and researchers to conduct dose–response studies urgently to better define the efficacy and safety profiles of intrathecal diamorphine.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 6","pages":"724-725"},"PeriodicalIF":7.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16623","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}