Anaesthesia最新文献

{"title":"Intra-operative cardiac arrest – we need to do better","authors":"James Penketh, Jerry P. Nolan","doi":"10.1111/anae.16487","DOIUrl":"10.1111/anae.16487","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 1","pages":"3-8"},"PeriodicalIF":7.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666908","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":"Gastric ultrasound performance time and difficulty: a prospective observational study","authors":"Mark G. Filipovic,&nbsp;Sascha J. Baettig,&nbsp;Monika Hebeisen,&nbsp;Roman Meierhans,&nbsp;Michael T. Ganter","doi":"10.1111/anae.16472","DOIUrl":"10.1111/anae.16472","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Point-of-care gastric ultrasound is an emerging tool in peri-operative practice. However, data on the technical challenges of gastric ultrasound, which are essential for optimised training, remain scarce. We analysed gastric ultrasound examinations performed after basic training to identify factors associated with difficulty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was an analysis of data from a prospective observational study evaluating the potential impact of routine pre-operative gastric ultrasound on peri-operative management in adult patients undergoing elective or emergency surgery at a single centre. Before initiation, physicians received extensive structured training with at least 30 supervised gastric sonograms before independent practice. We then used regression models to identify factors associated with deviation from a predefined sonography algorithm, performance time and scan difficulty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-three trained physicians performed 2003 ultrasound scans. Median (IQR [range]) performance time was 5 (4–6 [1–20]) min, which was achieved after 20–27 scans following structured training. Patient characteristics associated with more difficult and longer duration scans were: increase in BMI per 5 kg.m^-2 (odds ratio (95%CI) 1.57 (1.35–1.83), p &lt; 0.001 for difficulty and percentage change coefficient (95%CI) 1.03 (1.02–1.05), p &lt; 0.001 for duration); and male sex (odds ratio (95%CI) 3.31 (2.28–4.88), p &lt; 0.001 for difficulty and percentage change coefficient (95%CI) 1.08 (1.04–1.12), p &lt; 0.001, for duration). Trauma surgery (odds ratio (95%CI) 3.26 (1.88–5.68), p &lt; 0.001), ASA physical status of 3 or 4 (odds ratio (95%CI) 1.86 (1.21–2.88), p = 0.0049) and emergency surgery (odds ratio (95%CI) 1.86 (1.20–2.89), p = 0.006) were associated with deviation from the predefined sonography algorithm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Approximately 50 scans are required to achieve a baseline performance of 5 min per gastric ultrasound. Future training programmes should focus on patients with obesity, male sex, higher ASA physical status and trauma.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 2","pages":"161-169"},"PeriodicalIF":7.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612016","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":"Viscoelastic haemostatic assays to guide therapy in elective surgery: an updated systematic review and meta-analysis","authors":"Joao D. Dias,&nbsp;Jerrold H. Levy,&nbsp;Kenichi A. Tanaka,&nbsp;Kai Zacharowski,&nbsp;Jan Hartmann","doi":"10.1111/anae.16463","DOIUrl":"10.1111/anae.16463","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients undergoing major surgery frequently experience major uncontrolled bleeding. The aim of this systematic review and meta-analysis was to evaluate the clinical efficacy of using viscoelastic haemostatic assays to manage peri-operative bleeding in elective surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched PubMed/MEDLINE and Embase databases for randomised controlled trials according to pre-determined criteria. The primary outcomes were blood product requirements; duration of stay in the operating theatre or ICU; and surgical reintervention rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 20 randomised controlled trials. The overall risk of bias was low to moderate. Twelve studies used thromboelastography-based transfusion algorithms, while eight used thromboelastometry. Viscoelastic haemostatic assay-guided therapy was associated with a statistically significant reduction in transfusion of red blood cells (standardised mean difference (95%CI) 0.16 (-0.29 to 0.02)), platelets (standardised mean difference (95%CI) -0.33 (-0.56 to -0.10)) and fresh frozen plasma (standardised mean difference (95%CI) -0.64 (-1.01 to -0.28)). There was no evidence of an effect of viscoelastic haemostatic assay-guided therapy on surgical reintervention (relative risk (95%CI) 1.09 (0.70–1.69)). Viscoelastic haemostatic assay-guided therapy was associated with lower blood loss and shorter ICU duration of stay. There was no evidence of any effect on total duration of stay and all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Viscoelastic haemostatic assay-guided therapy may reduce peri-operative blood product transfusion requirements and blood loss during major elective surgery, with no discernible effect on patient-centred outcomes. The overall quality of evidence was modest.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 1","pages":"95-103"},"PeriodicalIF":7.5,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612023","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":"Anaesthetists should adopt a patient-centric approach to labour analgesia and embrace the combined spinal-epidural","authors":"Ronald B. George,&nbsp;Ruth Landau","doi":"10.1111/anae.16465","DOIUrl":"10.1111/anae.16465","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 1","pages":"9-12"},"PeriodicalIF":7.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16465","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142597021","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":"Assessing the impact of additional clinical variables on SOFA score predictive accuracy: a retrospective cohort study","authors":"Shunsuke Yawata,&nbsp;Seiya Nishiyama,&nbsp;Shohei Ono,&nbsp;Shinshu Katayama,&nbsp;Junji Shiotsuka","doi":"10.1111/anae.16470","DOIUrl":"10.1111/anae.16470","url":null,"abstract":"&lt;p&gt;The Sequential Organ Failure Assessment (SOFA) score was developed to describe the morbidity of patients who are critically ill [&lt;span&gt;1&lt;/span&gt;] and is still used widely. However, some of the original score constituents no longer align with contemporary critical care clinical practice. Proposals to update the score including the addition and/or update of SOFA score constituents are yet to be evaluated [&lt;span&gt;2&lt;/span&gt;]. The aim of our study was to evaluate the impact of potential updates on the predictive accuracy of a modified SOFA (mSOFA) score.&lt;/p&gt;&lt;p&gt;This single-centre retrospective cohort study was conducted at Jichi Medical University Saitama Medical Center. This study was approved by the institutional review board. Patients aged ≥ 18 y who were admitted to the ICU and stayed for ≥ 24 h between August 2017 and July 2023 were included. Data on patient characteristics, clinical data to inform mSOFA calculations and survival outcomes were extracted from electronic medical records.&lt;/p&gt;&lt;p&gt;The additional mSOFA score constituents included: the use of high-flow nasal oxygenation (HFNO), non-invasive ventilation (NIV) and veno-venous extracorporeal membrane oxygenation (VV-ECMO) to the respiratory component; platelet transfusion to the coagulation component; vasopressin and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to the cardiovascular component; renal replacement therapy (RRT) to the renal component; and lactate levels to a new, seventh, component.&lt;/p&gt;&lt;p&gt;The scoring for the new items was as follows: VV-ECMO, 4 points; NIV, minimum of 3 points assigned with 4 points if the ratio of partial pressure of oxygen in arterial blood to the fraction of inspiratory oxygen concentration (P/F) during use was &lt; 100; HFNC, minimum of 2 points assigned, with 3 points if the P/F ratio was &lt; 200 and 4 points if it was &lt; 100; platelet transfusion, 4 points; vasopressin use, 4 points; VA-ECMO, 4 points; and RRT (in patients not on maintenance dialysis), 4 points. Lactate levels were scored as: &lt; 2 mmol.l&lt;sup&gt;-1&lt;/sup&gt;, 0 points; 2–4 mmol.l&lt;sup&gt;-1&lt;/sup&gt;, 1 points; 4–6 mmol.l&lt;sup&gt;-1&lt;/sup&gt;, 2 points; 6–8 mmol.l&lt;sup&gt;-1&lt;/sup&gt;, 3 points; and ≥ 8 mmol.l&lt;sup&gt;-1&lt;/sup&gt;, 4 points. Scores were assigned to the new items based on their mortality rates and compared with the mortality rates of the original SOFA score items. The outcome was the area under the receiver operating characteristic curve (AUROC) for hospital mortality. The highest scores within 24 h of admission were defined as ‘admission SOFA’, and the highest scores during the ICU stay were defined as ‘max SOFA’ [&lt;span&gt;3&lt;/span&gt;]. Analysis was performed using R (version 4.3.3, R Foundation, Vienna, Austria), and the DeLong test was used to compare the AUROCs. A two-sided test with a significance level of 5% was used.&lt;/p&gt;&lt;p&gt;Of the 9629 patients admitted, 6167 were included in the analysis (online Supporting Information Figure S1). Patient demographics are shown in Table 1. The distribution an","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 1","pages":"112-114"},"PeriodicalIF":7.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16470","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142597022","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":"Combined spinal-epidural vs. dural puncture epidural techniques for labour analgesia: a randomised controlled trial*","authors":"Hannah Zang,&nbsp;Andrew Padilla,&nbsp;Trung Pham,&nbsp;Samantha M. Rubright,&nbsp;Matthew Fuller,&nbsp;Amanda Craig,&nbsp;Ashraf S. Habib","doi":"10.1111/anae.16433","DOIUrl":"10.1111/anae.16433","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The dural puncture epidural technique is a modification of the combined spinal-epidural technique. Data comparing the two techniques are limited. We performed this randomised study to compare the quality of labour analgesia following initiation of analgesia with the dural puncture epidural vs. the combined spinal-epidural technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Term parturients requesting labour epidural analgesia were allocated randomly to receive either dural puncture epidural or combined spinal-epidural. Analgesia was initiated with 2 mg intrathecal bupivacaine and 10 μg fentanyl in parturients allocated to the combined spinal-epidural group and with 20 ml ropivacaine 0.1% with 2 μg.ml^-1 fentanyl in parturients allocated to the dural puncture epidural group. Analgesia was maintained using patient-controlled epidural analgesia with programmed intermittent epidural boluses. The primary outcome of the study was the quality of labour analgesia, which was defined by a composite of five components: asymmetric block after 30 min of initiation (difference in sensory level of more than two dermatomes); epidural top-up interventions; catheter adjustment; catheter replacement; and failed conversion to neuraxial anaesthesia for caesarean delivery, requiring general anaesthesia or replacement of the neuraxial block.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred parturients were included in the analysis (48 combined spinal-epidural, 52 dural puncture epidural). There were no significant differences between the two groups in the primary composite outcome of quality of analgesia (33% in the combined spinal-epidural group vs. 25% in the dural puncture epidural group), risk ratio (95%CI) 0.75 (0.40–1.39); p = 0.486. Median (IQR [range]) pain scores at 15 min were significantly lower in patients allocated to the combined spinal-epidural group compared with the dural puncture epidural group (0 (0–1[0–8]) vs. 1 (0–4 [0–10]); p = 0.018).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There were no significant differences in the quality of labour analgesia following initiation of a combined spinal-epidural compared with a dural puncture epidural technique.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 1","pages":"29-37"},"PeriodicalIF":7.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142597293","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":"The peri-operative implications of sodium-glucose co-transporter 2 inhibitors: a narrative review","authors":"Paul A. Stewart,&nbsp;Claire C. Nestor,&nbsp;Cillian Clancy,&nbsp;Michael G. Irwin","doi":"10.1111/anae.16461","DOIUrl":"10.1111/anae.16461","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Sodium-glucose co-transporter 2 inhibitors are a novel class of antihyperglycaemic drugs used in the management of type 2 diabetes, that improve glycaemic control, cardiovascular outcomes and promote weight loss. They are also approved for the treatment of heart failure and chronic kidney disease in patients with or without diabetes. This narrative review discusses the peri-operative effects and implications of sodium-glucose co-transporter 2 inhibitors and gives an overview of current evidence and existing peri-operative guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a literature review to identify peer-reviewed English language articles published since 2000, with further articles identified by reviewing the references of key papers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Peri-operative sodium-glucose cotransporter 2 inhibitor use carries a risk of euglycaemic ketoacidosis. Although clinically significant diabetic ketoacidosis remains a rare event, sodium-glucose co-transporter 2 inhibitors inhibitor-associated diabetic ketoacidosis has been observed across almost all surgical specialities. Ketoacidosis may present with any blood glucose level. Existing guidelines are inconsistent and may be a source of clinical confusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Based on the half-life of sodium-glucose cotransporter 2 inhibitors, we recommend withholding treatment for 72 h before elective surgery (5 half-lives), with additional multidisciplinary input for specific procedures with dietary alterations and in patients with poorly controlled diabetes of cardiac/renal disease. In the event of emergency surgery or any surgery within 72 h of sodium-glucose cotransporter 2 inhibitor administration, we recommend pre-, intra- and postoperative blood ketone monitoring (6 hourly for 24 h post-surgery and until full oral diet is resumed). Sodium-glucose cotransporter 2 inhibitor treatment should only be resumed after resumption of full oral diet in the absence of ketosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 1","pages":"85-94"},"PeriodicalIF":7.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589974","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.16469","DOIUrl":"10.1111/anae.16469","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"79 12","pages":"1267"},"PeriodicalIF":7.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16469","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142597224","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":"Sterile gowns for spinal anaesthesia - environmental cost without clinical gain: a reply.","authors":"Claire Abeysekera, Matthew Peacock","doi":"10.1111/anae.16468","DOIUrl":"https://doi.org/10.1111/anae.16468","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581812","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":"Erector spinae plane block vs. rectus sheath block","authors":"Guanyu Yang","doi":"10.1111/anae.16466","DOIUrl":"10.1111/anae.16466","url":null,"abstract":"<p>We congratulate Urmale Kusse et al. [<span>1</span>] on their recent study that found that the analgesic effect following erector spinae plane block was superior to that of the rectus sheath block in midline abdominal surgeries. However, there are three points that I would like to discuss further with the authors.</p><p>First, three primary endpoints were established but it was not clearly stated whether their conclusion that erector spinae plane block is superior to the rectus sheath block requires the fulfilment of all three endpoints or just one of them. If only one endpoint is sufficient, the issue of inflated type 1 errors must be considered. Furthermore, the sample size calculation should have been conducted separately for the three endpoints, selecting the largest sample size for the study. This approach would reduce the incidence of type 1 and type 2 errors, thereby yielding more reliable results.</p><p>Second, the study did not evaluate standardised endpoints such as the time of first activity, gastrointestinal recovery, duration of hospital stay and patient satisfaction [<span>2</span>]. In this context, it is difficult for readers to determine whether the improvement in early postoperative pain control associated with the erector spinae plane block is clinically significant.</p><p>Third, the authors suggest broad applicability of their findings to middle- and low-income countries. However, as a single-centre trial with a small sample size, the generalisability of this study is limited, making the conclusion potentially overstated.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 2","pages":"216"},"PeriodicalIF":7.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16466","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567765","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}