Anaesthesia最新文献

{"title":"Non-anaemic iron deficiency: good news, bad news or no news at all?","authors":"Andrew A. Klein","doi":"10.1111/anae.16516","DOIUrl":"https://doi.org/10.1111/anae.16516","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"93 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816264","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":"Prevalence of neurocognitive disorders five years after elective orthopaedic surgery: a lesson for informed consent","authors":"Hannah Henderson","doi":"10.1111/anae.16505","DOIUrl":"https://doi.org/10.1111/anae.16505","url":null,"abstract":"<p>Elective orthopaedic surgery comprises a significant amount of the UK NHS elective workload. With an ageing population, the demand for these services is expected to increase [<span>1</span>]. A cohort study of patients aged &gt; 60 y undergoing elective orthopaedic surgery showed that more than half of all patients had some form of neurocognitive disorder five years after surgery, and this was major in 16.8% [<span>2</span>]. This is higher than the population prevalence of 6.8%, suggesting that anaesthesia and surgery may contribute to cognitive decline.</p>\u0000<p>These findings indicate that a considerable proportion of patients experience cognitive decline within five years of undergoing what is, typically, non-life-threatening or non-essential surgery. It is unlikely that we are counselling our patients adequately pre-operatively about this significant risk of morbidity.</p>\u0000<p>Consent in anaesthesia is a multifaceted and broad subject. The Association of Anaesthetists' 2017 guidelines recommend informing patients about common components of anaesthetic techniques, procedure-specific risks and common or significant adverse effects [<span>3</span>]. Ultimately, it is the responsibility of the clinician to decide what information is most relevant for each individual patient.</p>\u0000<p>In an editorial, Meek discusses the complexity of consent in the context of data from the 7th National Audit Project, which explored the incidence of potentially serious complications from anaesthesia [<span>4</span>]. The project captured extensive UK data, providing valuable information on complication rates [<span>5</span>]. However, interpreting the data and using them appropriately is where the challenges lie.</p>\u0000<p>The landmark Montgomery vs. Lanarkshire Health Board case in 2015 stressed the necessity of informed consent. The ruling clearly has a considerable impact on the way anaesthetists approach the consent process. The exhaustive list of anaesthesia risks, combined with the limited time often available for pre-operative discussions, makes it challenging to cover all potential risks in depth. Patients are also more likely to agree with the anaesthetist on the morning of surgery, feeling committed to the procedure despite possible risks [<span>6</span>].</p>\u0000<p>The study by Atkins et al. highlights the importance of informed consent for anaesthesia, indicating that the risk of cognitive decline may outweigh the risks of the surgery in some cases [<span>2</span>]. Pre-operative clinics and assessments should integrate these findings, allowing patients to consider their options as early as possible. The Association of Anaesthetists is currently reviewing its guidelines on consent and an updated version is forthcoming.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"240 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142804831","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":"Research setting in regional anaesthesia: a call for action","authors":"Alwin Chuan, Rebecca L. Johnson, Colin J. L. McCartney","doi":"10.1111/anae.16518","DOIUrl":"https://doi.org/10.1111/anae.16518","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"20 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142804834","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":"Laryngoscopy may identify but cannot exclude oesophageal intubation","authors":"Andy Higgs, Nicholas C. Chrimes, Tim M. Cook","doi":"10.1111/anae.16520","DOIUrl":"https://doi.org/10.1111/anae.16520","url":null,"abstract":"&lt;p&gt;We appreciate Drs Wright and Sudan's interest [&lt;span&gt;1&lt;/span&gt;] in the consensus guidelines for preventing unrecognised oesophageal intubation [&lt;span&gt;2&lt;/span&gt;] and agree with the principle of ‘precision intubation’, a process that should be deliberate, careful and appropriately paced. As such, we support their view that tracheal tube cuff inflation should be performed under vision, and removal of the videolaryngoscope blade, following passage of the tracheal tube, should not be rushed. However, we feel that the guidelines' existing recommendation that “&lt;i&gt;following intubation, the ability to see the tube between the cords and anterior to the arytenoids should be assessed prior to withdrawal of the laryngoscope blade&lt;/i&gt;” [&lt;span&gt;2&lt;/span&gt;] achieves the proposed benefits of their “&lt;i&gt;total videoscopic tracheal intubation&lt;/i&gt;” technique without the potential for unintended adverse consequences.&lt;/p&gt;\u0000&lt;p&gt;The suggestion by Wright and Sudan of total videoscopic tracheal intubation entails leaving the laryngoscope blade in position until sustained exhaled carbon dioxide is confirmed. As this requires at least seven breaths, the prolonged laryngoscopy may result in an extended stress response and an increased risk of airway trauma. Given most tracheal tubes are correctly located, the threat of these complications may outweigh any benefit. It also has the potential to make ergonomics awkward and impedes the airway operator managing other aspects of the induction process during this period. Conversely, once initial carbon dioxide return is observed, the guideline process would allow securing of the tracheal tube, confirmation of anaesthetic delivery, etc. while the first seven breaths are delivered, followed by a two-person check for sustained exhaled carbon dioxide. This process has been shown to be practical in a clinical setting [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Of greater concern is their suggestion that this technique could reduce the need to remove the tracheal tube. No matter how reassuring the view at laryngoscopy, the absence of sustained exhaled carbon dioxide mandates removal of the tracheal tube, unless it is considered dangerous to do so [&lt;span&gt;2&lt;/span&gt;]. Laryngoscopy in isolation cannot be used to exclude oesophageal intubation. Even in the rare circumstance where default removal of the tracheal tube is considered dangerous, repeat laryngoscopy is recommended only to more rapidly identify oesophageal intubation, while valid alternative techniques of flexible bronchoscopy, ultrasound or use of an oesophageal detector device are required to exclude it [&lt;span&gt;2&lt;/span&gt;]. Thus, repeat (or in this case sustained) laryngoscopy can only lower the threshold for removing the tracheal tube, not raise it. Leaving the tracheal tube in despite the absence of sustained exhaled carbon dioxide, based on continuous visualisation of the larynx, represents a potential fixation error that could increase the risk of unrecognised oesophageal intubation [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;\u0000","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"21 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142804833","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":"Universal adoption of combined spinal–epidural for labour analgesia is the antithesis of patient-centric care","authors":"James H. Bamber, D. N. Lucas","doi":"10.1111/anae.16515","DOIUrl":"https://doi.org/10.1111/anae.16515","url":null,"abstract":"&lt;p&gt;Zang et al. compared the quality of labour analgesia using dural puncture epidural (DPE) versus combined spinal–epidural (CSE) techniques [&lt;span&gt;1&lt;/span&gt;]. In an accompanying editorial, George and Landau assert that the superior labour analgesia provided by the CSE over standard epidurals is undeniable [&lt;span&gt;2&lt;/span&gt;]. They suggest that anaesthetists who do not universally adopt CSE are disadvantaging their patients [&lt;span&gt;2&lt;/span&gt;]; we disagree.&lt;/p&gt;\u0000&lt;p&gt;George and Landau cited three trials to support their assertion, but only one directly compared CSE with standard epidurals for quality of analgesia [&lt;span&gt;3&lt;/span&gt;]. This reported a statistically significant, yet clinically insignificant, mean pain score difference at 1 h and 5 h in favour of CSE over a 9-h period. A Cochrane review concluded that there was little basis for offering CSE over epidurals, as the only advantage was a slightly faster onset of analgesia [&lt;span&gt;4&lt;/span&gt;]. A recent systematic review was unable to conclude that CSE provided better labour analgesia quality than standard epidurals [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Zang et al. reported no significant differences between DPE and CSE for a composite measure of quality of analgesia or for post-procedure pain scores, with 29% of all patients reporting poor block quality and 24% requiring a supplemental epidural bolus [&lt;span&gt;1&lt;/span&gt;]. This small trial does not suggest that an intrathecal injection of bupivacaine and fentanyl in the CSE added any advantage to the dural puncture. The question remains whether the dural puncture adds any advantage to the quality of labour epidural analgesia. The dural puncture may provide faster onset initial analgesia, if the initial epidural loading volume of the low-dose local anaesthetic mixture is parsimonious, for example, 10 ml vs. 20 ml. With a 20-ml volume, there is minimal significant difference between a DPE and a standard epidural for onset of initial analgesia, and there is no difference in analgesia by 10 min [&lt;span&gt;6, 7&lt;/span&gt;]. When compared with DPE or CSE, a standard epidural provides more prolonged initial analgesia if an adequate loading volume is used. Additionally, a smaller subsequent dose is necessary to maintain analgesia [&lt;span&gt;8&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;The benefit of the dural puncture is postulated to be the conduit it provides for translocation of epidural local anaesthetic into the cerebrospinal fluid. Conduits can be bidirectional with cerebrospinal fluid leakage causing intracranial hypotension and postdural puncture headache (PDPH), a significant inherent risk with DPE and CSE techniques. Zhang et al. reported a PDPH incidence of 1% [&lt;span&gt;1&lt;/span&gt;]. The excess risk of PDPH with CSE has been estimated to be at least 0.3% [&lt;span&gt;9&lt;/span&gt;]. Universal use of CSE for labour analgesia would likely increase the burden of PDPH morbidity, which has recognised long-term postpartum health implications. The intrathecal opioids given with a CSE increase the risk of fetal bradycardia and mate","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"117 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142804835","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":"Associations between biological age and complications after major cancer surgery","authors":"Julia Dubowitz, Blake Cooper, Hilmy Ismail, Bernhard Riedel, Kwok M. Ho","doi":"10.1111/anae.16507","DOIUrl":"https://doi.org/10.1111/anae.16507","url":null,"abstract":"&lt;p&gt;Patients who are older are increasingly presenting for major cancer surgery. Postoperative complications are common after major surgery and are expensive for the patient (prolonged inpatient stay, increased hospital readmissions and inability to return to premorbid function) and healthcare institutions. Prehabilitation is reported to have substantial promise in reducing postoperative complications [&lt;span&gt;1&lt;/span&gt;]. However, choosing the most appropriate patients for prehabilitation before major cancer surgery to make it cost-effective remains a challenge, and whether prehabilitation improves medium- to long-term survival remains uncertain [&lt;span&gt;2, 3&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;As a proof-of-concept study, we aimed to identify novel factors that are predictive of postoperative complications in patients undergoing cancer surgery so that those most at risk of poorer long-term outcomes can be selected for a randomised controlled trial assessing the possible benefits of prehabilitation. We hypothesised that increased biological age, as a surrogate for poor predictive of postoperative complications within 30 days of cancer surgery.&lt;/p&gt;\u0000&lt;p&gt;Approval was obtained from the Division of Surgical Oncology Research Committee at Peter MacCallum Cancer Centre and we extracted data from the electronic medical records of adult patients who underwent major cancer surgery between 2018 and 2022. Duration of surgery had to have been at least 2 h and involved one overnight stay. We used the Levine PhenoAge model to determine biological age. This model is based on nine biomarkers and has been shown to predict short- and long-term outcomes of different patient cohorts [&lt;span&gt;4, 5&lt;/span&gt;]. Accelerated biological ageing (PhenoAgeAccel) was defined as a patient's biological age being older than their chronological age [&lt;span&gt;4&lt;/span&gt;]. Patients who had the complete set of nine baseline blood tests used to calculate PhenoAge were included in the analysis.&lt;/p&gt;\u0000&lt;p&gt;Postoperative complications were defined by organ type, with severity classified using the Clavien-Dindo score [&lt;span&gt;6&lt;/span&gt;]. These categorical outcomes were then converted into a numerical scale for comparison using the Comprehensive Complication Index [&lt;span&gt;7&lt;/span&gt;]. This uses a weighted calculation to assign patients a complication severity score out of 100, based on the number and severity of each recorded postoperative complication.&lt;/p&gt;\u0000&lt;p&gt;No power calculation was performed for this retrospective cohort study. Differences in patient characteristics, Comprehensive Complication Index and PhenoAge (and its individual components) between patients with and without postoperative complications were compared using either χ&lt;sup&gt;2&lt;/sup&gt; or Mann–Whitney U tests, as indicated. Quantitative association between PhenoAge and Comprehensive Complication Index was assessed by Pearson's correlation coefficient (r). All analyses were conducted by the MedCalc® software (MedCalc Software Ltd, Ostend, Belgium) and a p value &lt; 0.05 wit","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"14 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793382","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":"Routine peri-operative cessation of glucagon-like peptide-1 receptor agonists has unintended consequences","authors":"Nicholas A. Levy, Sarah L. Tinsley, Ketan Dhatariya","doi":"10.1111/anae.16509","DOIUrl":"https://doi.org/10.1111/anae.16509","url":null,"abstract":"&lt;p&gt;We read with interest the study by Nersessian et al., in which they showed that semaglutide use was associated with increased residual gastric content in patients having surgery [&lt;span&gt;1&lt;/span&gt;]. They call for urgent revision of current societal guidelines recommending a 1-week pre-operative discontinuation interval of semaglutide in patients undergoing elective procedures under anaesthesia [&lt;span&gt;1&lt;/span&gt;]. It is salutary to note that the exclusion criteria for the study were very extensive and included patients with diabetes; hiatus hernia; previous gastric surgery; chronic renal failure; and the pre-operative use of medication known to affect gastric emptying. The exclusion of so many patients and conditions has an impact on the suitability and applicability of the results of this study to influence routine practice.&lt;/p&gt;\u0000&lt;p&gt;There are many other drugs that can delay gastric emptying. These include opioids; anticholinergics; calcium channel blockers; and tricyclic antidepressants, and there is no call for revised societal guidelines on the peri-operative use of these drugs to reduce the risk of pulmonary aspiration. Furthermore, the evidence linking any potential increased residual gastric content associated with glucagon-like peptide-1 receptor agonist (GLP-1 RA) use to an increased risk of aspiration and regurgitation is lacking.&lt;/p&gt;\u0000&lt;p&gt;Peri-operative cessation of GLP-1 RAs has unintended consequences, particularly when used for the treatment of diabetes. This includes increasing the risk of further delays to surgery due to deranged pre-operative glucose and harm from peri-operative hyperglycaemia [&lt;span&gt;2&lt;/span&gt;]. Having the patient reviewed by a diabetologist and replacing the GLP-1 RAs with alternative drugs in the peri-operative period is an option, but this may lead to further delays in surgery and harm from hypoglycaemia [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;In response to the American Society of Anesthesiologists consensus-based guidance on the pre-operative management of patients on GLP-1 RAs, the Centre for Perioperative Care released UK guidance in September 2023 [&lt;span&gt;3&lt;/span&gt;]. This stated that anaesthetists should undertake individualised clinical assessment and precautions, which include regional anaesthesia; tracheal intubation; modified rapid sequence intubation; ramped position; awake tracheal extubation; avoidance of first-generation supraglottic airway devices; and pre-operative gastric ultrasound [&lt;span&gt;3&lt;/span&gt;]. A more recent clinical practice guideline also supports this stance, but with other caveats, including greater emphasis on shared decision-making and a pre-operative liquid diet for the 24 h before surgery for those at high risk [&lt;span&gt;4&lt;/span&gt;]. It is noteworthy that the American Society of Anesthesiologists has also approved this new guideline [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;Rather than curtailing the peri-operative use of GLP-1 RAs, we argue that the study by Nersessian et al. reinforces the stated position of the Centre for P","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"43 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782519","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":"Sick-day rules for the peri-operative clinician","authors":"Nicholas A. Levy, Claire Frank, Kariem El-Boghdadly","doi":"10.1111/anae.16510","DOIUrl":"https://doi.org/10.1111/anae.16510","url":null,"abstract":"&lt;p&gt;It is recommended that people receiving treatment for diabetes, renal disease, cardiovascular conditions and glucocorticoid deficiency are advised on how to manage their condition should they develop acute illness in the community [&lt;span&gt;1, 2&lt;/span&gt;]. For people receiving treatment for renal disease or cardiovascular conditions, this relates predominantly to new onset or worsening of diarrhoea and vomiting, whereas for people with diabetes or glucocorticoid deficiency, there is a broader application, including common cold and infections. These ‘sick-day rules’ aim to prevent complications that may otherwise lead to an unscheduled admission. The advice includes instructions such as: monitoring their blood sugars and ketones more frequently; drink more than usual; when to seek medical help; and how to modify their medicines (sick-day medication guidance). Certain classes of medicines should be omitted during concurrent illness, such as vomiting or diarrhoea, until patients are feeling better or are able to eat and drink for 24–48 h. Other medicines might require dose adjustment (Table 1).&lt;/p&gt;\u0000&lt;div&gt;\u0000&lt;header&gt;&lt;span&gt;Table 1. &lt;/span&gt;Examples of sick-day medication guidance for various medicines.&lt;/header&gt;\u0000&lt;div tabindex=\"0\"&gt;\u0000&lt;table&gt;\u0000&lt;thead&gt;\u0000&lt;tr&gt;\u0000&lt;th&gt;Medicine class&lt;/th&gt;\u0000&lt;th&gt;Risk with concurrent illness/dehydration&lt;/th&gt;\u0000&lt;th&gt;Sick-day medication guidance&lt;/th&gt;\u0000&lt;/tr&gt;\u0000&lt;/thead&gt;\u0000&lt;tbody&gt;\u0000&lt;tr&gt;\u0000&lt;td&gt;Angiotensin-2 receptor antagonists&lt;/td&gt;\u0000&lt;td&gt;Acute kidney injury and dehydration&lt;/td&gt;\u0000&lt;td&gt;Stop and restart 24–48 h after eating and drinking and feeling better&lt;/td&gt;\u0000&lt;/tr&gt;\u0000&lt;tr&gt;\u0000&lt;td&gt;Diuretics&lt;/td&gt;\u0000&lt;td&gt;Acute kidney injury and dehydration&lt;/td&gt;\u0000&lt;td&gt;Stop and restart 24–48 h after eating and drinking and feeling better&lt;/td&gt;\u0000&lt;/tr&gt;\u0000&lt;tr&gt;\u0000&lt;td&gt;Non-steroidal anti-inflammatory drugs&lt;/td&gt;\u0000&lt;td&gt;Acute kidney injury&lt;/td&gt;\u0000&lt;td&gt;Stop and restart 24–48 h after eating and drinking and feeling better&lt;/td&gt;\u0000&lt;/tr&gt;\u0000&lt;tr&gt;\u0000&lt;td&gt;Metformin&lt;/td&gt;\u0000&lt;td&gt;Lactic acidosis&lt;/td&gt;\u0000&lt;td&gt;Stop and restart 24–48 h after eating and drinking and feeling better&lt;/td&gt;\u0000&lt;/tr&gt;\u0000&lt;tr&gt;\u0000&lt;td&gt;Sulfonylureas&lt;/td&gt;\u0000&lt;td&gt;Hypoglycaemia&lt;/td&gt;\u0000&lt;td&gt;Check glucose more frequently and dose adjust&lt;/td&gt;\u0000&lt;/tr&gt;\u0000&lt;tr&gt;\u0000&lt;td&gt;Sodium-glucose co-transporter-2 inhibitors&lt;/td&gt;\u0000&lt;td&gt;Ketoacidosis&lt;/td&gt;\u0000&lt;td&gt;&lt;p&gt;Stop and restart 24–48 h after eating and drinking and feeling better&lt;/p&gt;\u0000&lt;p&gt;Check for ketones and seek medical advice if elevated&lt;/p&gt;\u0000&lt;/td&gt;\u0000&lt;/tr&gt;\u0000&lt;tr&gt;\u0000&lt;td&gt;Insulins&lt;/td&gt;\u0000&lt;td&gt;&lt;p&gt;Dysglycaemia&lt;/p&gt;\u0000&lt;p&gt;Diabetic ketoacidosis&lt;/p&gt;\u0000&lt;/td&gt;\u0000&lt;td&gt;Check glucose and ketones regularly. Dose-adjust insulins. Maintain carbohydrate and fluid intake&lt;/td&gt;\u0000&lt;/tr&gt;\u0000&lt;tr&gt;\u0000&lt;td&gt;Corticosteroids&lt;/td&gt;\u0000&lt;td&gt;Adrenal insufficiency crisis&lt;/td&gt;\u0000&lt;td&gt;Increase dose according to severity&lt;/td&gt;\u0000&lt;/tr&gt;\u0000&lt;/tbody&gt;\u0000&lt;/table&gt;\u0000&lt;/div&gt;\u0000&lt;div&gt;&lt;/div&gt;\u0000&lt;/div&gt;\u0000&lt;p&gt;In the surgical setting, accounting for sick-day rules is distinct from usual peri-operative medicine management. The latter refers predominantly to medicine considerations that may pose issues for surgery, anaesthesia or disease management. Sick-day rules, however,","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"138 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142777438","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":"Residual gastric content and peri-operative semaglutide use assessed by gastric ultrasound","authors":"Abraham H. Hulst, Jeroen Hermanides, Mark L. van Zuylen","doi":"10.1111/anae.16504","DOIUrl":"https://doi.org/10.1111/anae.16504","url":null,"abstract":"&lt;p&gt;We read with interest the study by Nersessian et al., which explores the relationship between peri-operative semaglutide use and increased residual gastric content as assessed by gastric ultrasound [&lt;span&gt;1&lt;/span&gt;]. This prospective study contributes to the emerging literature on GLP-1 receptor agonists (GLP-1 RAs) and delayed gastric emptying, raising important considerations for peri-operative management [&lt;span&gt;2&lt;/span&gt;]. However, these findings prompt a need for greater specificity within clinical guidelines, particularly regarding the differing needs of patients using GLP-1 RAs for weight loss and to those prescribed these drugs for type 2 diabetes.&lt;/p&gt;\u0000&lt;p&gt;Although it is relevant that data are now available on volume of pre-operative gastric contents in patients using GLP-1 RA for weight loss, there are several methodological limitations that hinder the applicability. The study employs a small sample size without formal power calculations, using convenience sampling that undermines the statistical robustness of the findings. In addition, only a small number of baseline variables is presented, making it difficult to assess the validity of comparing the study groups. Factors such as dose of semaglutide, duration of use and the presence of gastrointestinal symptoms are missing. All can significantly influence the risk of increased pre-operative residual gastric contents [&lt;span&gt;3&lt;/span&gt;]. Moreover, although BMI is reported, it remains unclear whether the semaglutide group represents patients with formerly higher BMIs, reduced following semaglutide treatment, being compared with a possibly healthier control group with distinct gastric function. Finally, the authors propose using gastric ultrasound as a pre-operative tool to evaluate gastric content. While valuable, the variability inherent in this subjective technique, which is also highlighted by the authors, limits its broad application.&lt;/p&gt;\u0000&lt;p&gt;Nersessian et al. suggest extending the pre-operative discontinuation period of GLP-1 RAs from 1 to 2–3 weeks. This recommendation, however, is not substantiated by their results, nor by the current literature. There is limited evidence supporting the efficacy of discontinuation in reducing volume of gastric content, which calls into question the proposed cessation periods for peri-operative settings. In addition, recent studies have suggested that GLP-1 RA use does not necessarily correlate with a clinically significant aspiration risk [&lt;span&gt;4&lt;/span&gt;]. Furthermore, GLP1 RAs with even longer half-lives than semaglutide are expected, which will be challenging to discontinue promptly and may not prevent delayed gastric emptying effectively even if cessation is attempted.&lt;/p&gt;\u0000&lt;p&gt;In addition, prolonged discontinuation in patients with type 2 diabetes, who rely on GLP-1 RAs for glycaemic control, could risk peri-operative hyperglycaemia, which itself may contribute to delayed gastric emptying [&lt;span&gt;5&lt;/span&gt;], further complicating peri-operative management","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"20 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142777397","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":"Association of anaesthesia-directed sedation with unplanned discharge to a nursing home following non-ambulatory interventional radiology and endoscopic procedures: a retrospective cohort study*","authors":"Annika Eyth, Felix Borngaesser, Osamah M. Zmily, Maíra I. Rudolph, Ling Zhang, Vilma A. Joseph, Oleg V. Evgenov, Jason Oliveira, Nicholas Kolmel, Seena Dehkharghani, Irene Osborn, Michael E. Kiyatkin, Andrew D. Racine, Peter P. Semczuk, Shweta Garg, Karuna Wongtangman, Matthias Eikermann, Ibraheem M. Karaye","doi":"10.1111/anae.16497","DOIUrl":"https://doi.org/10.1111/anae.16497","url":null,"abstract":"Interventional radiology procedures and endoscopies are performed commonly worldwide, often necessitating pharmacological sedation to optimise patient comfort. It is unclear to what extent non-anaesthetists should provide procedural sedation.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"226 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782520","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}