Anaesthesia最新文献

{"title":"Patient perception of consent processes for epidural analgesia in induction of labour: a qualitative study.","authors":"Danna Nitzani,Jacqueline Nicholls,Katherine Maslowski,Robert Craig,Sohail Bampoe,Melissa Whitten,Anne Lanceley","doi":"10.1111/anae.16637","DOIUrl":"https://doi.org/10.1111/anae.16637","url":null,"abstract":"INTRODUCTIONWomen undergoing induction of labour often utilise epidural analgesia. Obtaining consent for labour epidural presents a unique challenge for the obstetric anaesthetist, who must comply with the legal standards of consent. This study explores how women perceive the consent process for epidural analgesia during induction of labour.METHODSThis was a qualitative, single-centre, interview-based study. Fourteen women who received an epidural for labour analgesia were interviewed using a semi-structured interview guide. Data were analysed using thematic analysis.RESULTSFour themes described women's experience of the consent process. Understanding alternatives, risks and benefits; for example, time constraints hindering the effective communication of information around epidural analgesia, including alternative analgesic options. Timing of information; for example, the value of information was diminished by pain, fatigue and the imminence of the procedure. Timing of consent; for example, physiological and psychological demands of labour negatively impacted patients' ability to engage with the consent process. Anaesthetists' assessment of patient understanding; for example, confirmation of patient understanding by anaesthetists was lacking.DISCUSSIONWomen's experiences of the consent process for induction of labour suggest that in the context of the pain and exhaustion of labour, inadequate and untimely information provision and dialogue between women and their anaesthetists can undermine the implementation of lawful consent.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"140 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932778","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":"Analgesia for elective midline laparotomy","authors":"Rhona C. F. Sinclair, Victoria Peacock, Joyce Yeung, Caroline Thomas","doi":"10.1111/anae.16640","DOIUrl":"https://doi.org/10.1111/anae.16640","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"2 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143933115","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":"Functional capacity, frailty and the future of peri-operative risk stratification.","authors":"Elnè Noppè,Aoife Lavelle","doi":"10.1111/anae.16639","DOIUrl":"https://doi.org/10.1111/anae.16639","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"30 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative exploration of stressors in anaesthesia training in the UK and mechanisms to improve resident wellbeing","authors":"Nicola S. Crowther, Francesca Millinchamp","doi":"10.1111/anae.16641","DOIUrl":"https://doi.org/10.1111/anae.16641","url":null,"abstract":"<p>We commend Gale et al. on their investigation into resident doctor stressors and wellbeing in years 2–5 of training [<span>1</span>]. This work complements a recent survey undertaken by the Severn Deanery Training Program Director and ST4+ resident representatives exploring anaesthesia resident doctors' welfare and burnout risk, alongside seeking feedback on how to improve the training experience. Our survey received a 96% response rate from stage 2 and 3 resident doctors (89/93). The 2017 Royal College of Anaesthetists' survey of trainee morale and welfare found that, nationally, 85% of anaesthetic resident doctors were at a high risk of burnout [<span>2</span>]. Our findings identified this risk as 67% (60/89), with a comprehensive picture of issues experienced locally. We aim to address these concerns and want to compare our findings with those of Gale et al. to highlight resident doctors' wellbeing.</p>\u0000<p>Our results largely reflect the national picture, with most resident doctors feeling satisfied overall in their job (72/89, 81%). Common stressors were related to training and career progression, including exam preparation; consultant applications; work–life balance; financial wellbeing; and incorrect pay. The desire for a single lead employer was the most cited suggestion to improve wellbeing. Although there is national guidance to support a lead employer model, there appear to be many barriers to implementation, and we hope the drive to achieve this is not neglected with the abolition of NHS England. Lack of support (including peer support) and rota problems were cited rarely as stressors but, interestingly, were common themes in suggestions on how to improve training experiences. Particularly prevalent was the theme of improving the sense of the resident community, echoing the importance of social spaces recognised in the work by Gale et al.</p>\u0000<p>These two pieces of work illustrate how stressors can evolve throughout training. In the survey, clinical stressors such as intensive care medicine and obstetrics were mentioned rarely. This may indicate the higher clinical confidence of the senior resident doctors who participated. The burden of participating in ‘tick box’ projects was also not mentioned, possibly because our survey participants were more senior than the cohort in the study by Gale et al. and, therefore, more likely to be assigned projects aligning with their interests. Conversely, concerns around consultant job applications were more frequent, as well as the pressure to improve portfolios and inter-trainee competition. Meeting wellbeing needs will require tailored approaches for each stage of training; a universal solution is unrealistic.</p>\u0000<p>Resident doctors had varied levels of confidence in discussing their mental health with supervisors and their knowledge of workplace mental health resources. Despite this, mental health support was listed rarely as a suggestion for ways to improve the quality of training. We feel ","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"2 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143933067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flexible-tip bougie vs. stylet for tracheal intubation with a hyperangulated videolaryngoscope in critical care.","authors":"Timothy Makar,Andrew Downey,Jon M Graham","doi":"10.1111/anae.16642","DOIUrl":"https://doi.org/10.1111/anae.16642","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"28 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An analysis of publication trends in Science Letters published in Anaesthesia.","authors":"Navniel Kaur,Michael G Irwin,Ben Morton","doi":"10.1111/anae.16638","DOIUrl":"https://doi.org/10.1111/anae.16638","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"26 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Issue Information – Editorial Board","authors":"","doi":"10.1111/anae.16338","DOIUrl":"https://doi.org/10.1111/anae.16338","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 6","pages":"605"},"PeriodicalIF":7.5,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16338","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of honey on post‐tonsillectomy pain in children (BEE PAIN FREE Trial): a multicentre, double‐blind, randomised controlled trial*","authors":"David Sommerfield, Aine Sommerfield, Daisy Evans, Neil Hauser, Shyan Vijayasekaran, Paul Bumbak, Hayley Herbert, Cornelia Locher, Lee Yong Lim, R. Nazim Khan, Britta S. von Ungern‐Sternberg","doi":"10.1111/anae.16619","DOIUrl":"https://doi.org/10.1111/anae.16619","url":null,"abstract":"SummaryIntroductionTonsillectomy, a common childhood surgery, is associated with difficult postoperative recovery. Previous reviews provided low‐grade evidence that honey may improve recovery. The BEE PAIN FREE study investigated whether honey alongside multimodal analgesia improved the recovery trajectory in children following tonsillectomy.MethodsA prospective randomised controlled trial was conducted across three centres in Western Australia. Children undergoing extracapsular tonsillectomy by coblation were allocated randomly to one of four postoperative treatment groups: standard treatment alone; Marri honey (from Western Australia); Manuka honey (from Western Australia); or placebo. The intervention groups took 5 ml of honey or placebo, six times a day, for at least 7 days, in addition to usual discharge analgesia (standard treatment). Data for daily pain scores, Parents' Postoperative Pain Measure scores, medications and unplanned re‐presentations were collected.ResultsA total of 400 children were recruited; 20% were lost to follow‐up or withdrew. The mean number of honey doses taken varied between 2 and 3 doses per day over 7 days. Treatment with honey at this frequency did not impact postoperative pain scores significantly, with all groups showing similar trajectories. These findings did not alter with as‐treated analysis or using imputed models for missing data. Most children experienced significant pain until around postoperative day 8. Children allocated to the honey and placebo groups showed some improved oral tolerance around day 6 but had increased vomiting during earlier days. There were no clinically significant differences in medical re‐presentations, simple analgesia or oxycodone usage between groups.DiscussionTwo to three doses daily of oral honey/placebo in children post‐extracapsular tonsillectomy for 7 days, in addition to regular paracetamol, ibuprofen and as required oxycodone did not result in a clinical improvement in pain or recovery over a 14‐day follow‐up period.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"58 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143905720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Private equity consolidation in anaesthesiology: trends and sector‐specific investment patterns from 2006 to 2024","authors":"Ravi Dhawan, Johnathan J. Choi, Dario von Wedel, Maximilian S. Schaefer, Denys Shay","doi":"10.1111/anae.16630","DOIUrl":"https://doi.org/10.1111/anae.16630","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"82 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient positioning and dural puncture epidural","authors":"Reginald Edward","doi":"10.1111/anae.16627","DOIUrl":"https://doi.org/10.1111/anae.16627","url":null,"abstract":"<p>I commend Drs Bamber and Lucas for their insightful commentary on the universal adoption of combined spinal–epidural techniques in labour analgesia [<span>1</span>]. Their points regarding patient-centric care and the balance between analgesia quality, onset time and complication risks, particularly postdural puncture headache, are pertinent [<span>2</span>].</p>\u0000<p>Recent evidence and physiological insights into the dural puncture epidural technique provide additional clarity. The faster onset of analgesia associated with dural puncture epidural appears attributable primarily not just to diffusion but also to pressure-driven bulk flow of local anaesthetic into the intrathecal space. This is facilitated by transient elevations in epidural pressures during bolus administration [<span>3, 4</span>].</p>\u0000<p>The supine position is associated with higher epidural pressures due to posterior epidural venous engorgement and tissue compression compared with lateral or sitting positions [<span>5, 6</span>]. Consequently, it is plausible that administering the initial epidural bolus in the supine position following dural puncture may enhance the pressure gradient, potentially accelerating intrathecal drug migration and analgesia onset. This mechanism, however, does not diminish the significance of postdural puncture headache risk, which remains a vital consideration in patient-centred care [<span>2</span>]. Instead, it highlights a nuanced opportunity to optimise analgesic efficacy through strategic positioning and careful bolus administration. Vigilant clinical management and incremental dosing may help balance the benefits of enhanced analgesia with potential complication risks, without necessitating universal adoption of the combined spinal–epidural approach.</p>\u0000<p>Future research exploring the relationship between patient positioning, epidural pressures and analgesic outcomes in the context of dural puncture epidural would provide valuable insights to further refine labour analgesia practices.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"11 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}