Anaesthesia最新文献

{"title":"Individualised vs. fixed positive end-expiratory pressure.","authors":"Wei Song, Shan Wu","doi":"10.1111/anae.70255","DOIUrl":"10.1111/anae.70255","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":"1313-1314"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13446854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148154874","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":"Real-time vs. pre-procedural ultrasound guidance for lower thoracic epidural puncture: a randomised controlled trial.","authors":"Shosaburo Jotaki, Naoki Maesako, Kenta Murotani, Moeto Uchimura, Teruyuki Hiraki","doi":"10.1111/anae.70361","DOIUrl":"https://doi.org/10.1111/anae.70361","url":null,"abstract":"<p><strong>Introduction: </strong>Ultrasound-guided neuraxial anaesthesia has gained increasing attention because it may improve procedural success and safety. Lower thoracic epidural anaesthesia provides effective postoperative analgesia and is used widely in patients undergoing abdominal surgery. However, studies evaluating lower thoracic epidural puncture remain limited, and whether real-time or pre-procedural ultrasound guidance provides superior technical performance remains unclear. Therefore, we aimed to compare real-time and pre-procedural ultrasound-guided techniques in achieving first-pass success in lower thoracic epidural puncture.</p><p><strong>Methods: </strong>We enrolled patients scheduled to undergo abdominal surgery requiring thoracic epidural anaesthesia. Patients were allocated randomly to real-time or pre-procedural ultrasound groups. In both groups, a preliminary scan was performed to identify and mark the target intervertebral level before needle insertion. In patients allocated to the real-time group, continuous in-plane ultrasound guidance was maintained throughout needle advancement. The primary outcome was first-pass success rate. Secondary outcomes included procedure time; number of passes; and number of punctures.</p><p><strong>Results: </strong>In total, 64 patients were included in the final analysis. Patients allocated to the pre-procedural ultrasound group had a significantly lower first-pass success rate compared with the real-time ultrasound group (15/32 (47%) vs. 26/32 (81%), p = 0.008). In addition, fewer passes and punctures were required in patients allocated to the real-time group. Procedure time did not differ significantly between groups.</p><p><strong>Discussion: </strong>Real-time ultrasound guidance significantly improved first-pass success compared with pre-procedural ultrasound guidance. These findings support the use of real-time ultrasound guidance to improve procedural success and technical performance during lower thoracic epidural puncture.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872661","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":"Post-intensive care syndrome after critical illness.","authors":"Yinuo Chen, Yining Yan","doi":"10.1111/anae.70254","DOIUrl":"10.1111/anae.70254","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":"1311-1312"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13446828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148148132","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":"Individualised vs. fixed positive end-expiratory pressure: a reply.","authors":"Wei Wang, Jingxiang Wu","doi":"10.1111/anae.70257","DOIUrl":"10.1111/anae.70257","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":"1314-1315"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13446832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148154952","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":"Calibrating artificial intelligence against human expertise using femoral nerve segmentation on ultrasound: a consensus framework.","authors":"Johan Berggreen, Anders Johansson, Sebastian Möller, Tomas Jansson, Annelie Augustinsson, Pether Jildenstål","doi":"10.1111/anae.70364","DOIUrl":"https://doi.org/10.1111/anae.70364","url":null,"abstract":"<p><strong>Introduction: </strong>Meaningful validation of artificial intelligence for medical image interpretation requires comparison against human expert performance, yet multi-rater frameworks establishing such comparisons remain uncommon.</p><p><strong>Methods: </strong>We developed and applied a consensus framework using nine clinicians who independently segmented the femoral nerve on 100 ultrasound images, yielding 900 annotations and a combined consensus standard established by majority voting. We then evaluated an academic deep learning model against this consensus and individual human performance.</p><p><strong>Results: </strong>The artificial intelligence model achieved a median (IQR [range]) Dice coefficient of 0.72 (0.56-0.84 [0.00-0.91]) against combined consensus. Sensitivity was 0.94 (0.88-0.97 [0.33-1.00]) and precision 0.60 (0.44-0.76 [0.00-0.89]). Individual human Dice scores ranged from 0.32 to 0.73 (median 0.60). The artificial intelligence model matched median human performance and outperformed five of nine annotators (31%-125% relative improvement), with the greatest benefit for the lowest-performing practitioners. Leave-one-annotator-out analysis confirmed consensus stability (median (IQR [range]) artificial intelligence Dice 0.749 (0.745-0.752 [0.742-0.769])). Inter-rater reliability was moderate overall (Fleiss's κ 0.54, p < 0.001).</p><p><strong>Discussion: </strong>The sensitivity and precision profile of the artificial intelligence model indicated reliable nerve detection with over-segmentation that remained clinically interpretable. The moderate inter-rater reliability is consistent with the inherent subjectivity of nerve delineation on ultrasound. The circularity inherent in evaluating annotators against a consensus they helped define limits direct comparison of artificial intelligence and human scores. A Dice score of 0.72 represents the upper range of human expert performance rather than moderate accuracy. The framework methodology is independent of the specific artificial intelligence system evaluated and offers a transferable approach for calibrating artificial intelligence performance in clinical imaging where no single correct interpretation exists.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872640","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":"Project for Universal Management of Airways: guidelines for providing a foundation for airway management.","authors":"Nicholas C Chrimes, Andy Higgs, Robert Greif, Paul A Baker, Richard M Cooper, Carin A Hagberg, George Kovacs, J Adam Law, Sheila N Myatra, Ellen P O'Sullivan, William H Rosenblatt, Christopher H Ross, John C Sakles, Massimiliano Sorbello, Stuart D Marshall","doi":"10.1111/anae.70366","DOIUrl":"https://doi.org/10.1111/anae.70366","url":null,"abstract":"<p><strong>Introduction: </strong>Before commencing airway management in any individual patient, a foundation should be provided that establishes the capability of organisations, departments and practitioners to undertake all episodes of airway care safely and effectively. Components of this foundation include the environment; equipment; education; culture; and processes within an organisation. It is important to consider how the interaction between these elements and airway practitioners working in the system impacts individual and team performance.</p><p><strong>Methods: </strong>An international, multidisciplinary working group reviewed existing airway guidelines and published literature. A structured process for generating expert consensus statements was undertaken, including consultation with an international advisory group comprising airway operators and assistants, as well as human factors experts. Discrepancies between the results of these two processes were analysed and reconciled. Guidelines were generated, and recommendations were categorised according to the American Heart Association classification system.</p><p><strong>Results: </strong>These guidelines make recommendations to assist in providing an adequate foundation for airway management that are applicable independent of geography, practitioner background or the context for airway care. Key components of an adequate foundation for airway management include design of systems and clinical environments; availability of suitable and functional equipment and monitoring; training of airway practitioners in both the behavioural and procedural skills necessary for safe and effective performance; and promoting a patient-centred, fair and just, no-blame culture. Consultation with human factors experts is required to optimise the impact that interaction between these elements and airway practitioners has on individual and team performance.</p><p><strong>Discussion: </strong>Providing an adequate foundation for airway management is fundamental to enabling all episodes of airway care to be undertaken safely and effectively. The principles outlined in this guideline are applicable across geographical boundaries, patient populations and clinical contexts in which airway management occurs.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838705","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":"Classification of videolaryngoscopy: a systematic review.","authors":"Catharina Grün, André Dankert, Viktor A Wünsch, Yasmin Engels, Aljoscha Ewert, Hans-Heinrich Sieg, Lili Plümer, Christian Zöllner, Martin Petzoldt","doi":"10.1111/anae.70358","DOIUrl":"https://doi.org/10.1111/anae.70358","url":null,"abstract":"<p><strong>Introduction: </strong>Structured classification and consistent documentation of videolaryngoscopy findings are essential for future airway planning. Although numerous classification tools for communication have been proposed, their accuracy and effectiveness remain uncertain. We aimed to synthesise the evidence on the accuracy, performance and inter-rater reliability of existing tools used to classify videolaryngoscopic tracheal intubation.</p><p><strong>Methods: </strong>Databases were searched for original articles framed by the Participants - Index test - Target conditions criteria. We extracted accuracy, performance, concordance and reliability to evaluate the generalisability and clinical utility of each classification. We applied the QUADAS-2 tool for quality assessment.</p><p><strong>Results: </strong>We identified 13 eligible studies evaluating characteristics of seven distinct classification tools in adults and children, including the Cormack-Lehane classification; percentage of glottic opening score; intubation difficulty scale; Fremantle score; video classification of intubation score; videolaryngoscopic intubation and difficult airway classification (VIDIAC) score; and paediatric difficult airway classification (PeDiAC) score. Eight publications reported clinical studies in patients. Since many studies reported only inter-rater reliability or concordance, the accuracy, performance, generalisability and clinical utility of the respective classification tools remained uncertain. Accuracy or performance metrics were reported for three classification tools - the Cormack-Lehane classification, VIDIAC and PeDiAC scores - with the first showing only limited performance. Empirically-derived thresholds were not reported for most classification tools. Overall risk of bias was high among the reviewed studies, particularly regarding the reference standard, flow and timing, accompanied by substantial applicability concerns.</p><p><strong>Discussion: </strong>Despite widespread dissemination of various proposed classification tools, current evidence remains limited. Accuracy, performance and thresholds have been evaluated for only three classification tools, while remaining largely unknown for the other four tools. Further high-quality research is needed.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817277","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":"Project for Universal Management of Airways: guidelines for tracheal extubation.","authors":"Louise Ellard, Andy Higgs, Richard M Cooper, Carin A Hagberg, Paul A Baker, Robert Greif, George Kovacs, J Adam Law, Sheila N Myatra, Ellen P O'Sullivan, William H Rosenblatt, Christopher H Ross, John C Sakles, Massimiliano Sorbello, Nicholas C Chrimes","doi":"10.1111/anae.70365","DOIUrl":"https://doi.org/10.1111/anae.70365","url":null,"abstract":"<p><strong>Introduction: </strong>Risk evaluation, strategy formulation and preparation are important to decreasing the incidence of adverse events associated with tracheal extubation. The focus of this guideline is tracheal extubation, but many of the principles outlined are relevant to all forms of discontinuation of airway management (tracheal extubation; removal of a supraglottic airway; cessation of facemask support; and tracheostomy removal) and conversion between upper airway lifelines (facemask; supraglottic airway; and tracheal tube) or a neck airway.</p><p><strong>Methods: </strong>An international, multidisciplinary working group reviewed existing airway guidelines and published literature. A structured process for generating expert consensus statements was undertaken, which included consultation with an international advisory group comprising both airway operators and assistants, as well as human factors experts. Discrepancies between the results of these two processes were analysed and reconciled. Guidelines were generated and recommendations were categorised according to the American Heart Association classification system.</p><p><strong>Results: </strong>Risk evaluation for tracheal extubation includes assessing the risk of hypoxaemia, pulmonary aspiration and harm from airway stimulation. The patient's baseline risk as well as any potential changes since tracheal intubation should be considered. In addition to patient risks, team and situation risk factors should be considered when formulating the extubation strategy. Planned extubation is always elective, maximising ability to control the timing, environment and resources available. Deferring extubation is recommended if this will significantly decrease risk. When substituting one lifeline for another, 'conversion procedures', characterised by the presence of a continuous guide to maintain or facilitate rapid restoration of alveolar ventilation, are safer and preferred over airway 'replacement procedures', particularly when airway management is regarded as 'at risk'.</p><p><strong>Discussion: </strong>These guidelines assist airway practitioners from any discipline to evaluate whether tracheal extubation is 'at risk' and link this to formulating a safe and effective strategy that addresses the specific challenges identified.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817289","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 breast surgery: a narrative review","authors":"Oliver Tolson, Andreas Sotiriou, Amit Pawa","doi":"10.1111/anae.70341","DOIUrl":"https://doi.org/10.1111/anae.70341","url":null,"abstract":"Summary Introduction Regional anaesthesia for breast surgery has evolved rapidly in recent decades. Breast cancer surgery is associated with significant postoperative pain. This narrative review explores the relevant anatomy, regional anaesthetic strategies and their efficacy for breast surgery based on the most recent evidence available. Methods We performed a focused literature review to identify articles published within the last 3 years evaluating the efficacy of regional anaesthetic techniques in breast surgery. Identified abstracts underwent screening and full‐text review before inclusion. Results The initial search identified 558 papers, 182 of which were published in the last 3 years. After screening, 63 were included in the narrative synthesis. Breast and axillary innervation arises from several neural territories. Newer paraspinal blocks, including the erector spinae plane block, have shown analgesic efficacy, but the thoracic paravertebral remains the most reliable technique. Anterolateral chest wall blocks, including the serratus anterior plane and pectoserratus, cover the lateral cutaneous branches of the intercostal nerves but may also provide axillary coverage. The interpectoral block is the sole chest wall approach that covers the medial and lateral pectoral nerves supplying the pectoral muscles. Techniques such as the superficial parasternal intercostal plane block cover the medial breast and can be combined with anterolateral chest wall blocks for mastectomy. All blocks are superior to local anaesthetic infiltration. Discussion Regional anaesthesia provides superior analgesic outcomes for patients undergoing breast surgery compared with local infiltration. Despite the multitude of recent studies, heterogeneity in surgical procedures and outcome measures limits direct comparison between blocks. Regional anaesthesia should be tailored to the surgical procedure based on an understanding of breast innervation, with an individualised approach formulated in partnership with patients and surgeons. Future research should prioritise comparing nerve blocks with similar anatomical or neural targets for specific surgical procedures, using patient‐centred outcomes.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"12 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148767507","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":"Rethinking postoperative analgesia for day‐case surgery: a reply","authors":"Anna Ratcliffe, Mark Rockett","doi":"10.1111/anae.70331","DOIUrl":"https://doi.org/10.1111/anae.70331","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"16 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148767508","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}