Anaesthesia最新文献

{"title":"Temporal characteristics of remimazolam‐induced sedation in paediatric anaesthesia: observations from a multicentre trial","authors":"Xiaoyu Li, Bo Lu","doi":"10.1111/anae.16614","DOIUrl":"https://doi.org/10.1111/anae.16614","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"38 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797916","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":"In‐theatre TIVA rapid sequence induction: what are we doing?","authors":"William Musselbrook","doi":"10.1111/anae.16613","DOIUrl":"https://doi.org/10.1111/anae.16613","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"57 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797915","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":"Videolaryngoscopy vs. direct laryngoscopy in class 2 and 3 obesity: a systematic review, meta‐analysis and trial sequential analysis of randomised controlled trials*","authors":"Zhi Jie Goh, Aaron Ang, Si‐Xian Nicole Ang, Shermaine See, Jinbin Zhang, Kumaresh Venkatesan, Wan‐Ling Alyssa Chiew","doi":"10.1111/anae.16578","DOIUrl":"https://doi.org/10.1111/anae.16578","url":null,"abstract":"SummaryIntroductionThe 7th National Audit Project of the Royal College of Anaesthetists revealed an increase in rates of tracheal intubation over the last decade, partially contributed to by the rise in people living with obesity. Notably, airway and respiratory complications were over‐represented in patients living with class 2 or 3 obesity (BMI ≥ 35 kg.m<jats:sup>‐2</jats:sup>). Hence, it is timely to evaluate if videolaryngoscopy might improve tracheal intubation‐related outcomes when compared with direct laryngoscopy in this high‐risk patient group.MethodsWe conducted a systematic review and meta‐analysis of randomised controlled trials published in the last 15 years. We searched five databases for trials comparing videolaryngoscopy with direct laryngoscopy in adult patients living with class 2 or 3 obesity undergoing elective general surgery. Primary outcomes were the incidence of failed tracheal intubation; hypoxaemia; and first attempt tracheal intubation failure. Secondary outcomes were glottic visualisation; time to tracheal intubation; incidence of sore throat; and intubation difficulty scale.ResultsWe included 10 trials with 955 patients, of whom 481 received videolaryngoscopy and 474 direct laryngoscopy. Videolaryngoscopy significantly reduced failed tracheal intubation (relative risk (95%CI) 0.15 (0.05–0.35), p &lt; 0.001, nine studies); hypoxaemia (relative risk (95%CI) 0.21 (0.10–0.43), p &lt; 0.001, seven studies); and first attempt failure (relative risk (95%CI) 0.44 (0.25–0.76), p = 0.004, seven studies). While glottic visualisation was also significantly improved, there was no significant difference in time to tracheal intubation, incidence of sore throat or intubation difficulty scale.ConclusionsIn patients living with class 2 or 3 obesity, videolaryngoscopy significantly reduced failed tracheal intubation incidence, first‐attempt failure incidence, incidence of hypoxaemia and poor glottic visualisation. Patients living with class 2 or 3 obesity are likely to benefit from the use of videolaryngoscopy compared with direct laryngoscopy.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"64 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797922","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":"Breaking point or turning point? Harnessing artificial intelligence to combat burnout","authors":"Cathriona Murphy","doi":"10.1111/anae.16610","DOIUrl":"https://doi.org/10.1111/anae.16610","url":null,"abstract":"&lt;p&gt;I read with interest the article by Gale et al. which identifies several factors that contribute to the high levels of stress and burnout among anaesthesia residents [&lt;span&gt;1&lt;/span&gt;]. Burnout, as outlined by the World Health Organisation's International Classification of Diseases, is recognised as an occupational phenomenon and is characterised by three key domains: energy depletion; job-related negativity and reduced professional efficacy [&lt;span&gt;2&lt;/span&gt;]. Fatigue among anaesthetists has been shown to affect both clinician well-being and patient safety negatively. It results in diminished alertness, slower decision-making and a higher risk of errors, all of which compromise patient safety [&lt;span&gt;3&lt;/span&gt;]. With the rapid advancement of artificial intelligence (AI) in healthcare, one must question whether there is now a unique and unprecedented opportunity to combat the impending global crisis of burnout and workforce attrition in the healthcare system, specifically among anaesthesia residents.&lt;/p&gt;\u0000&lt;p&gt;A major concern raised by Gale et al. was difficulty with rostering, including limited flexibility and challenges in accommodating leave for important life events, even when requests were made in advance, resulting in unnecessary stress and anxiety for residents [&lt;span&gt;1&lt;/span&gt;]. The introduction of a ‘request rota’ was a positive adjunct for residents where implemented, although, notably, added an increased rostering workload. A recent initiative has highlighted the instrumental role that AI can play in generating a fair and balanced roster, addressing the specific requirements of an anaesthetic department promptly [&lt;span&gt;4&lt;/span&gt;]. Therefore, could AI potentially reduce the stress linked to rostering and service provision by creating a reliable and supportive schedule in a timely manner that benefits residents? Artificial intelligence has the potential to allocate working hours and training time appropriately whilst facilitating requested leave, ensuring residents have the necessary time with their support networks [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;A common issue among healthcare providers is low morale from the perception of being overworked and burdened excessively in the workplace [&lt;span&gt;1&lt;/span&gt;]. Residents often face difficulty in balancing clinical commitments with non-clinical tasks, such as completing examinations and expanding their portfolios, which can leave them feeling overwhelmed and undervalued. Artificial intelligence enhances documentation by using speech recognition and natural language processing to capture physician-patient interactions and summarise them in electronic patient records automatically. Artificial intelligence-driven diagnostic tools enhance the accuracy and efficiency of patient care. They also reduce the cognitive load on healthcare providers when making decisions, helping to lower workplace stress [&lt;span&gt;5&lt;/span&gt;]. Artificial intelligence has the potential to unburden a massive cognitive load through its unparalleled ","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"108 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789515","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":"Optimising peri-operative intravenous lidocaine dosing regimens","authors":"Angela Tognolini, Jason A. Roberts, Victoria A. Eley","doi":"10.1111/anae.16611","DOIUrl":"https://doi.org/10.1111/anae.16611","url":null,"abstract":"<p>We thank Dr Hansel for his interest and comments [<span>1</span>] related to our publication [<span>2</span>]. This discussion highlights the ongoing debate regarding dosing of intravenous lidocaine infusions and ongoing concerns with the lack of safety data. The aim of our observational pharmacokinetic study and dosing simulations was to improve the understanding of intravenous lidocaine pharmacokinetics and, ultimately, to improve safety and efficacy of dosing of this commonly used (albeit ‘off-label’) peri-operative drug.</p>\u0000<p>We acknowledge this is a simulated regimen that requires external validation and evaluation in the clinical setting for safety and efficacy. Our proposed simulated dose regimen is specific to our studied population, carefully considers covariates and body weight metrics, and shows (simulated) concentrations &lt; 5 μg.ml^-1. Our proposed dosing aligns with other regimens used clinically, with infusions ranging from 1–5 mg.kg^-1.h^-1 [<span>3, 4</span>]. Importantly, in patients with obesity, dosing should be adjusted based on lean body weight. We have not examined infusions &gt; 3 h and have not made any comments regarding postoperative dosing and administration.</p>\u0000<p>The use of intravenous lidocaine for peri-operative pain management is common in Australia and parts of the UK. We agree that it requires careful individual patient assessment of risk vs. benefit, should consider the clinical context, and close monitoring is required to pick up adverse events. Consensus statements, such as that published by Foo et al. [<span>5</span>] and focused on postoperative lidocaine infusions, can be a useful guide for clinicians. Ensuring patient safety is paramount and, with intra-operative administration, intravenous lidocaine can be delivered carefully and monitored by the anaesthetist. Large anaesthesia incident reporting systems, such as WebAIRS in Australia, remain important in identifying safety data related to infrequent anaesthesia-related events, but are limited by reliance on self-reporting.</p>\u0000<p>We agree with Hansel and others [<span>6</span>] that robust evidence is needed through large clinical trials with carefully considered safety and outcome measures. We believe dosing strategies such as those proposed in this study may help enable optimal peri-operative use of intravenous lidocaine infusions and look forward to prospective evaluation.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"34 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789519","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":"Optimising mechanical ventilation: integrating clinical needs with mechanical power reduction strategies","authors":"Wei Cao","doi":"10.1111/anae.16612","DOIUrl":"https://doi.org/10.1111/anae.16612","url":null,"abstract":"<p>The study by Buiteman-Kruizinga et al. provides valuable insights into the determinants of mechanical power during mechanical ventilation [<span>1</span>]. The authors highlight the importance of limiting respiratory rate and peak pressures to reduce mechanical power and, potentially, ventilator-induced lung injury. We would like to discuss some aspects that merit further exploration.</p>\u0000<p>First, the study suggests that reducing respiratory rate may be a viable strategy to lower mechanical power. However, the potential trade-off between reduced mechanical power and increased carbon dioxide retention remains underexplored [<span>2</span>]. In patients with impaired carbon dioxide clearance, such as those with chronic obstructive pulmonary disease or a metabolic acidosis, a lower respiratory rate might exacerbate hypercapnia, leading to respiratory acidosis and haemodynamic instability [<span>3</span>]. Future studies could investigate optimal mechanical power thresholds that balance lung protection with adequate carbon dioxide elimination.</p>\u0000<p>Second, while mechanical power is linked to lung injury, its direct contribution to alveolar stress and strain was not assessed explicitly. In addition to pressure- and volume-related parameters, lung compliance plays a crucial role in determining the actual stress imposed on the lung parenchyma [<span>4</span>]. A stratified analysis based on compliance levels could provide a more granular understanding of how mechanical power interacts with lung mechanics, particularly in heterogeneous conditions such as acute respiratory distress syndrome.</p>\u0000<p>Lastly, the study focuses primarily on short-term ICU outcomes. However, the impact of mechanical power modulation on long-term respiratory function and weaning success is unknown. Given that prolonged exposure to high mechanical power may contribute to persistent lung fibrosis or impaired ventilatory mechanics, follow-up studies assessing post-ICU pulmonary function could enhance our understanding of its clinical consequences [<span>5</span>].</p>\u0000<p>In conclusion, while this study is an important step toward optimising mechanical ventilation strategies, addressing the interplay between mechanical power, gas exchange and long-term respiratory outcomes could further refine lung-protective ventilation strategies.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"23 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789516","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: a randomised controlled trial","authors":"Manuel Taboada, Agustín Cariñena, Ana Estany-Gestal, Manuela de Miguel, Rocío Iraburu, Sara Alonso, Fátima García, Laura Dos Santos, María Eiras, Salomé Selas, Adrián Martínez, Ana Tubio, Olga Campaña, María Diaz-Vieito, Jorge Miguel Alcántara, Julián Alvarez, Teresa  Seoane-Pillado","doi":"10.1111/anae.16574","DOIUrl":"https://doi.org/10.1111/anae.16574","url":null,"abstract":"The optimal introducer for tracheal intubation with a hyperangulated blade videolaryngoscope for patients in the ICU remains uncertain. Both stylets and flexible-tip bougies have been used, yet there is limited evidence on which is more efficacious.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"4 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737076","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":"Intra-operative ventilation strategies and their impact on clinical outcomes: a systematic review and network meta-analysis of randomised trials","authors":"Naheed K. Jivraj, Ines Lakbar, Behnam Sadeghirad, Mattia M. Müller, Sei Yon Sohn, John K. Peel, Arzina Jaffer, Vorakamol Phoophiboon, Vatsal Trivedi, Dipayan Chaudhuri, Cong Lu, Yunting Liu, Benedetta Giammarioli, Sharon Einav, Karen E. A. Burns","doi":"10.1111/anae.16600","DOIUrl":"https://doi.org/10.1111/anae.16600","url":null,"abstract":"Postoperative pulmonary complications are common and associated with significant morbidity and mortality; however, the optimal intra-operative ventilation strategy to prevent postoperative pulmonary complications remains unclear. The aim of this study was to evaluate the effect of intra-operative ventilation strategy, including tidal volumes, positive end-expiratory pressure (PEEP) and use of recruitment manoeuvres on the incidence of postoperative pulmonary complications in adults having non-cardiothoracic surgery.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"61 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143703047","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 use of iron after surgery: a systematic review and meta-analysis","authors":"Jayne Lim, Judie Joo, Beth MacLean, Toby Richards","doi":"10.1111/anae.16605","DOIUrl":"https://doi.org/10.1111/anae.16605","url":null,"abstract":"Anaemia in patients having surgery is associated with worse postoperative outcomes. Management with intravenous iron is an attractive therapeutic option, however, pre-operative intravenous iron administration is challenging. Evidence from interventional trials suggests that the greatest benefit is after hospital discharge. As anaemia is common after surgery, this meta-analysis aimed to evaluate the efficacy of postoperative iron therapy to increase haemoglobin levels.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"183 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695095","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":"Development of a brief test protocol for assessing cognitive change in the peri-operative period in older adults undergoing elective surgery","authors":"Annerixt Gribnau, Gert J. Geurtsen, Hanna C. Willems, Jeroen Hermanides, Mark L. van Zuylen","doi":"10.1111/anae.16604","DOIUrl":"https://doi.org/10.1111/anae.16604","url":null,"abstract":"&lt;p&gt;Many patients are afraid of permanent cognitive impairment after general anaesthesia [&lt;span&gt;1&lt;/span&gt;]. However, there is no uniform method to diagnose postoperative neurocognitive disorders extending beyond 1 month after surgery [&lt;span&gt;2&lt;/span&gt;]. The gold standard is a time-consuming neuropsychological assessment [&lt;span&gt;3&lt;/span&gt;]. We aimed to identify and validate internally the best predictive subset of neuropsychological assessment tests, balancing accuracy and utility suitable for both research and clinical purposes.&lt;/p&gt;\u0000&lt;p&gt;This study used data from a previous study [&lt;span&gt;3&lt;/span&gt;]. After ethical approval and informed consent, patients aged ≥ 65 y undergoing elective surgery were enrolled. Patients with hearing impairment, multiple procedures under anaesthesia or pre-existent cognitive impairment were not studied. Neuropsychological assessment was done pre-operatively and 4–8 weeks postoperatively. It covered five cognitive domains, with outcomes for 17 individual subtests and four combined scores (online Supporting Information Appendix S1). Outcomes were reported in T-scores, corrected for age and educational level compared with a healthy Dutch patient group [&lt;span&gt;4&lt;/span&gt;]. Missing outcomes were imputed.&lt;/p&gt;\u0000&lt;p&gt;Our previous study used a definition based on composite cognitive domain scores, yielding an 18% incidence of postoperative neurocognitive disorder [&lt;span&gt;3&lt;/span&gt;]. However, as predictors would be based on the results of individual tests, we defined postoperative neurocognitive disorder in this analysis as a decline of ≥ 1 SD on ≥ two tests in at least one cognitive domain, or a decline of ≥ 1 SD in total cognitive domain score, aligning with the most used research definition [&lt;span&gt;5&lt;/span&gt;]. After checking for multicollinearity, we aimed to create a logistic regression model (online Supporting Information Appendix S2). All 17 individual delta test scores were included, and backward selection based on the Akaike Information Criterion was performed, using different cut-offs. When backward selection included the middle or last subtest from a test, we deemed it necessary to also include the other subtest (e.g. Stroop 1, 2 and 3). When this would make the test protocol too time-consuming, we selected the tests with the lowest p values and their subtests, while also checking AUROC, so time of administration would be acceptable. Internal validation was done using bootstrapping, where AUROC and regression coefficients were corrected uniformly for measured optimism. Calibration was assessed and thresholds determined. Predictions were made using the formula &lt;span data-altimg=\"/cms/asset/ac8d0f76-5631-49e2-8f60-0d81353ffa70/anae16604-math-0001.png\"&gt;&lt;/span&gt;&lt;math altimg=\"urn:x-wiley:00032409:media:anae16604:anae16604-math-0001\" display=\"inline\" location=\"graphic/anae16604-math-0001.png\" overflow=\"scroll\"&gt;\u0000&lt;semantics&gt;\u0000&lt;mrow&gt;\u0000&lt;mfrac&gt;\u0000&lt;mn&gt;1&lt;/mn&gt;\u0000&lt;mrow&gt;\u0000&lt;mn&gt;1&lt;/mn&gt;\u0000&lt;mo&gt;+&lt;/mo&gt;\u0000&lt;msup&gt;\u0000&lt;mi&gt;e&lt;/mi&gt;\u0000&lt;mrow&gt;\u0000&lt;mo&gt;−&lt;/mo&gt;\u0000&lt;mfenced close=\")\" open=\"(\"&gt;\u0000&lt;mro","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"7 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695102","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}