Anaesthesia最新文献

{"title":"Factors affecting UK anaesthetic trainees' wellbeing and stress: a scoping review","authors":"Sophie Winter, Nicola Brennan, Thomas Gale","doi":"10.1111/anae.16410","DOIUrl":"https://doi.org/10.1111/anae.16410","url":null,"abstract":"Poor wellbeing and stress in UK anaesthetic trainees impacts significantly on clinical performance, workforce retention and patient care. This study aimed to provide an overview of the evidence in this field and to explore the factors affecting wellbeing and stress in UK anaesthetic trainees.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"41 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142166238","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":"Incidence and relative risk of delirium after major surgery for patients with pre-operative depression: a systematic review and meta-analysis","authors":"Calvin Diep,&nbsp;Krisha Patel,&nbsp;Jessica Petricca,&nbsp;Julian F. Daza,&nbsp;Sandra Lee,&nbsp;Yuanxin Xue,&nbsp;Luka Kremic,&nbsp;Maggie Z. X. Xiao,&nbsp;Bianca Pivetta,&nbsp;Simone N. Vigod,&nbsp;Duminda N. Wijeysundera,&nbsp;Karim S. Ladha","doi":"10.1111/anae.16398","DOIUrl":"10.1111/anae.16398","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Delirium is a common and potentially serious complication after major surgery. A previous history of depression is a known risk factor for experiencing delirium in patients admitted to the hospital, but the generalised risk has not been estimated in surgical patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review and meta-analysis of studies reporting the incidence or relative risk (or relative odds) of delirium in the immediate postoperative period for adults with pre-operative depression. We included studies that defined depression as either a formal pre-existing diagnosis or having clinically important depressive symptoms measured using a patient-reported instrument before surgery. Multilevel random effects meta-analyses were used to estimate the pooled incidences and pooled relative risks. We also conducted subgroup analyses by various study-level characteristics to identify important moderators of pooled estimates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-two studies (n = 4,664,051) from five continents were included. The pooled incidence of postoperative delirium for patients with pre-operative depression was 29% (95%CI 17–43%, I² = 99.0%), compared with 15% (95%CI 6–28%, I² = 99.8%) in patients without pre-operative depression and 21% (95% CI 11–33%, I² = 99.8%) in the cohorts overall. For patients with pre-operative depression, the risk of delirium was 1.91 times greater (95%CI 1.68–2.17, I² = 42.0%) compared with patients without pre-operative depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with a previous diagnosis of depression or clinically important depressive symptoms before surgery have substantially greater risk of experiencing delirium after surgery. Clinicians and patients should be informed of these increased risks. Robust screening and other risk mitigation strategies for postoperative delirium are warranted, especially for patients with pre-operative depression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"79 11","pages":"1237-1249"},"PeriodicalIF":7.5,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16398","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124583","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":"Time to treat the bleeding obstetric patient like the trauma patient and lower the dose of opioid","authors":"Georgina Margiotta, Felicity Plaat","doi":"10.1111/anae.16425","DOIUrl":"https://doi.org/10.1111/anae.16425","url":null,"abstract":"<p>The 7th National Audit Project (NAP7) confirmed haemorrhage as a leading cause of maternal cardiac arrest[<span>1</span>]. In this audit of cardiac arrest in patients under the care of an anaesthetist, nearly half of the obstetric cases involved a general anaesthetic, and anaesthetic care was judged to be a key factor in 68% of cases. The specific drugs used for induction of anaesthesia were not recorded [<span>1</span>]. We speculate that over-generous use of opioids may be implicated. In the hypovolaemic obstetric patient, it is important to minimise the haemodynamic effects of induction. Most anaesthetists are familiar with techniques that achieve smooth induction for patients with cardiac disease. During and after training, anaesthetists come across more opportunities to care for such patients compared with managing major trauma. This may explain why, anecdotally at least, they tend to opt for a ‘cardiac anaesthetic induction’ comprising high-dose opioids with a reduced dose of induction drug when providing anaesthesia to patients who are haemodynamically unstable [<span>2</span>].</p>\u0000<p>Liberal use of opioids in a hypovolaemic patient may, however, worsen haemodynamic status. Due to a reduced volume of distribution and clearance, plasma concentrations of fentanyl during haemorrhage can double. Activation of the sympathetic nervous system maintains cardiac output in the face of hypovolaemia through an increase in heart rate and systemic vascular resistance [<span>3</span>]. Fentanyl, through its sympatholytic action, can obtund these mechanisms, exacerbating haemodynamic instability, especially at high doses. It is for this reason that rapid sequence induction in a patient with shock is undertaken using limited doses of opioids, e.g. 1 μg.kg^-1 of fentanyl [<span>4</span>]. Once effective volume resuscitation has been established and blood pressure has increased, fentanyl can be titrated in aliquots to dilate the microcirculation and restore tissue perfusion, as evidenced by a reduction in serum lactate and base deficit [<span>5</span>].</p>\u0000<p>To promote haemodynamic stability, we suggest that the anaesthetic management of an obstetric patient with haemorrhage should be more akin to that of a patient with trauma and shock by judicious use of opioids and induction with drugs such as ketamine. A ‘cardiac anaesthetic’ should instead be reserved for those with cardiac pathology.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"20 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142131001","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":"Depression and delirium: association, prediction, causation, and care","authors":"Hyundeok Joo,&nbsp;Elizabeth L. Whitlock","doi":"10.1111/anae.16399","DOIUrl":"10.1111/anae.16399","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"79 11","pages":"1153-1156"},"PeriodicalIF":7.5,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124582","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":"Sterile gowns for spinal anaesthesia – environmental cost without clinical gain?","authors":"Stephen Waite,&nbsp;Charlotte Collison,&nbsp;Ronan Mukherjee","doi":"10.1111/anae.16423","DOIUrl":"10.1111/anae.16423","url":null,"abstract":"&lt;p&gt;We read with interest the article by Ledda et al. [&lt;span&gt;1&lt;/span&gt;], which highlights a drive to change from single-use to reusable gowns to be more environmentally sustainable. While laudable, we feel that it does not consider wider changes to our practice which could have an impact of greater magnitude.&lt;/p&gt;&lt;p&gt;Standard practice in many UK centres is to wear a sterile gown for spinal anaesthesia to reduce the incidence of infective complications. This practice is mandated in the 2014 Association of Anaesthetists guidance [&lt;span&gt;2&lt;/span&gt;]. However, this practice is not standard globally. In the UK, practice varies for other neuraxial procedures, e.g. many doctors from medical specialities do not wear a sterile gown for lumbar punctures.&lt;/p&gt;&lt;p&gt;Most anaesthetists are cognisant of the risk of infective complications. However, the incidence of infection following single-shot spinal anaesthesia is very low. The 3rd UK National Audit Project (NAP3) reported only two cases of vertebral canal abscess and one of infective meningitis associated with approximately 325,000 spinal anaesthetics [&lt;span&gt;3&lt;/span&gt;]. It noted failings of asepsis and specifically referenced the importance of sterile drapes and use of facemasks, but did not specifically mention sterile gowns. Beyond NAP3 there is very little evidence for the use of sterile gowns. Only a single randomised controlled trial has been identified [&lt;span&gt;4&lt;/span&gt;], which investigated gowning on the incidence of catheter tip colonisation in lumbar epidural for labour analgesia. Siddiqui et al. concluded that the use of gowns did not affect catheter colonisation.&lt;/p&gt;&lt;p&gt;The volume of waste generated using sterile gowns for spinal anaesthesia is significant. In NHS Tayside, a health board with a patient population of 416,090 (2017 Census), we undertook 2877 spinal anaesthetics in 2022. Gowns generated nearly half a metric tonne of carbon dioxide equivalent (CO&lt;sub&gt;2&lt;/sub&gt;e) from disposal in clinical waste. These gowns are manufactured in China, and it is challenging to estimate the (likely extensive) additional environmental cost of production and shipping to the UK. As stated, NAP3 estimated that there were approximately 325,000 spinal anaesthetics undertaken in the UK in 2009 [&lt;span&gt;3&lt;/span&gt;]. Using a sterile gown for every spinal anaesthetic generates vast amounts of CO&lt;sub&gt;2&lt;/sub&gt;e.&lt;/p&gt;&lt;p&gt;Many anaesthetists seem to be receptive to a change of practice in this area. Tuohey et al. raised similar concerns in 2023 and called for a change in practice in the UK and Australasia [&lt;span&gt;5&lt;/span&gt;]. When we surveyed 51 anaesthetists in NHS Tayside, 89.9% of respondents were receptive to changing their practice if supported by a change in guidance. While changing to reusable alternatives may help environmentally and financially, it seems that high quality asepsis for single-shot spinal anaesthesia can still be achieved without the use of a sterile gown, and that individual clinicians should be encouraged to choose wha","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"79 12","pages":"1381"},"PeriodicalIF":7.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118767","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":"Comparison between adjusted Montreal Cognitive Assessment and neuropsychological assessment for diagnosing postoperative neurocognitive disorders","authors":"Annerixt Gribnau,&nbsp;Gert J. Geurtsen,&nbsp;Hanna C. Willems,&nbsp;Jeroen Hermanides,&nbsp;Mark L. van Zuylen","doi":"10.1111/anae.16424","DOIUrl":"10.1111/anae.16424","url":null,"abstract":"&lt;p&gt;The current gold standard neuropsychological assessment for detecting postoperative neurocognitive disorders is too time-consuming, costly and burdensome to use in clinical practice. Brief screening instruments, such as the Montreal Cognitive Assessment (MoCA), are used frequently instead. However, previous research by our team suggested that the original MoCA is not suitable to detect postoperative neurocognitive disorders in older adult surgical patients [&lt;span&gt;1&lt;/span&gt;]. To improve the accuracy of the MoCA, Kessels et al. presented norms controlling for age, sex and educational level [&lt;span&gt;2&lt;/span&gt;]. Accordingly, our study aimed to compare the performance of the adjusted MoCA score in diagnosing postoperative neurocognitive disorder.&lt;/p&gt;&lt;p&gt;We prospectively enrolled patients aged ≥ 65 y scheduled for elective surgery, involving any type of anaesthesia or surgical procedure, from September 2019 to January 2021, after approval by our local research ethics committee. Patients who were not fluent in Dutch, had pre-operative cognitive impairment, severe hearing impairment or needed several procedures under anaesthesia were not studied. The original study is described in full elsewhere [&lt;span&gt;1&lt;/span&gt;]. Simultaneous administration of neuropsychological assessment and MoCA occurred pre-operatively and 30–60 days postoperatively, using alternate versions to minimise practice effect. Performance on neuropsychological assessment was reported as T-scores after comparison to a Dutch norm group (https://andi.nl). For neuropsychological assessment, a decline of 1–2 SD on ≥ 1 cognitive domain score indicated mild postoperative cognitive disorder, and ≥ 2 SD decline indicated major postoperative neurocognitive disorder [&lt;span&gt;3&lt;/span&gt;]. In the post hoc analysis, we transformed the original, education-uncorrected, MoCA scores to percentiles according to Kessels et al. [&lt;span&gt;2&lt;/span&gt;]. Mild postoperative neurocognitive disorder was defined as a reliable change index decrease of 1–2 SD [&lt;span&gt;4&lt;/span&gt;] and ≥ 2 SD decline indicated major postoperative neurocognitive disorder. Test–retest reliability was measured by intraclass correlation coefficient. Data were missing completely at random and were imputed.&lt;/p&gt;&lt;p&gt;Sensitivity, specificity and area under the receiver operating characteristic curve of the adjusted MoCA were calculated. We examined pre-operative, postoperative and pre- to postoperative correlations of MoCA and total neuropsychological assessment and domain scores. We transformed the outcome to z-scores to assess agreement between MoCA and neuropsychological assessment by Bland–Altman plots. Ordinary or regression limits of agreement were chosen based on the presence or absence of proportional bias [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;A total of 73 patients completed neuropsychological assessment and MoCA. Baseline characteristics are detailed in online Supporting Information Appendix S1. Neuropsychological assessment identified 14 (19%) cases of postoperative ","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"79 11","pages":"1250-1252"},"PeriodicalIF":7.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16424","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118766","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":"Breathing system terminology","authors":"D. M. Lowe, S. W. M. Feaver","doi":"10.1111/j.1365-2044.1997.tb00104.x","DOIUrl":"https://doi.org/10.1111/j.1365-2044.1997.tb00104.x","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"147 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142084777","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":"My anaesthetic machine's on fire","authors":"S. Rogers, M. W Davies","doi":"10.1111/j.1365-2044.1997.tb00099.x","DOIUrl":"https://doi.org/10.1111/j.1365-2044.1997.tb00099.x","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"19 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142085452","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":"Mortality predicted by APACHE II. The effect of changes in physiological values on predicted hospital mortality","authors":"R. D. Tunnell, A. W. Miller, G. B. Smith","doi":"10.1111/j.1365-2044.1997.tb00097.x","DOIUrl":"https://doi.org/10.1111/j.1365-2044.1997.tb00097.x","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"1 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142084769","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":"NAP7 – what's the point?","authors":"Jasmeet Soar,&nbsp;Tim M. Cook,&nbsp;Richard A. Armstrong,&nbsp;Emira Kursumovic,&nbsp;Fiona C. Oglesby,&nbsp;Andrew D. Kane","doi":"10.1111/anae.16422","DOIUrl":"10.1111/anae.16422","url":null,"abstract":"&lt;p&gt;Ward and Illif ask whether there have been too many papers on the 7th UK National Audit Project (NAP7) and whether the “&lt;i&gt;primary purpose&lt;/i&gt;” of the project has been lost [&lt;span&gt;1&lt;/span&gt;]. NAP7 was a massive project during a pandemic. It is unsurprising that peri-operative cardiac arrest and its contributing factors have generated a large amount of information given this is the final common pathway for serious complications of anaesthesia and surgery [&lt;span&gt;2&lt;/span&gt;]. These include those studied in previous NAPs (e.g. airway complications, anaphylaxis) [&lt;span&gt;2&lt;/span&gt;]. Of note, NAP7 reported on more cases than NAPs 3–6 combined [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We have a duty to share our findings as widely as possible; for our patients, their families, our stakeholders and the thousands of anaesthetists in the UK and Ireland who contributed data to NAP7. In addition to providing new information about complications and for different patients or subspecialties (e.g. children [&lt;span&gt;4&lt;/span&gt;], obstetrics [&lt;span&gt;5&lt;/span&gt;]), secondary outputs have been driven by our stakeholders. NAP7 has provided novel and up-to-date information in several areas that are important or contentious for anaesthetists and our patients (e.g. impact of COVID-19 [&lt;span&gt;6&lt;/span&gt;], use of monitoring [&lt;span&gt;7&lt;/span&gt;], the independent sector [&lt;span&gt;8&lt;/span&gt;], anaesthesia associates [&lt;span&gt;9&lt;/span&gt;] and wellbeing [&lt;span&gt;3&lt;/span&gt;]).&lt;/p&gt;&lt;p&gt;At all stages, we made efforts to minimise the number of chapters and the length of these to improve accessibility. An illustration of this is the NAP7 ‘airway and breathing’ chapter and paper [&lt;span&gt;10&lt;/span&gt;] that reports on 113 cases and runs to 12 pages compared with NAP4 which included 133 anaesthesia airway cases and runs to 216 pages. The division of the report into discrete short chapters specifically enables and encourages readers to focus on areas most relevant to their areas of practice.&lt;/p&gt;&lt;p&gt;Many of the report chapters have been subsequently published as papers in &lt;i&gt;Anaesthesia&lt;/i&gt;, often with additional data and discussion. No project is complete until it is disseminated, and it was, therefore, an intentional strategy to improve visibility of the project by publishing key topic chapters as papers, after full peer review. This further enabled dissemination through podcasts and social media. We judge this a success and thank &lt;i&gt;Anaesthesia&lt;/i&gt; and its editors.&lt;/p&gt;&lt;p&gt;The prime purpose of the NAPs is “&lt;i&gt;through national effort to provide detailed numerical and case&lt;/i&gt;-&lt;i&gt;based analysis of risk and complications of anaesthesia and surgery, to make these data available to patients and clinicians and in so doing so facilitate better communication and decision making and drive changes that improve safety&lt;/i&gt;”. We believe all the findings and recommendations of NAP7 will help make anaesthesia safer and are important for anaesthetists and their patients – we have no regrets about sharing them as widely as possible.&lt;/p&gt;&lt;p&gt;Finally, we thank War","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"79 11","pages":"1262-1263"},"PeriodicalIF":7.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142071835","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}