Anaesthesia最新文献

{"title":"Impact of clinical frailty on mortality after elective surgery in patients aged ≥ 90 years admitted to critical care: a binational intensive care registry analysis","authors":"Je Min Suh, Laurence Weinberg, Nattaya Raykateeraroj, Anoop Koshy, Fawaz Ahmed Prem Navaz, Ben Cailes, Jack L. Bradbury, David Pilcher, Dong‐Kyu Lee","doi":"10.1111/anae.70435","DOIUrl":"https://doi.org/10.1111/anae.70435","url":null,"abstract":"Summary Introduction Increasing numbers of patients aged ≥ 90 years require elective surgery. Frailty is increasingly recognised as a key determinant of peri‐operative risk, but high‐quality evidence to understand the impact on outcomes in this age group is limited. Methods We conducted a retrospective cohort study using the Australian and New Zealand Intensive Care Society Adult Patient Database. Patients aged ≥ 90 years admitted to ICU following elective surgery were included, encompassing planned and unplanned ICU admissions. Frailty was assessed at ICU admission using the Clinical Frailty Scale and patients categorised as non‐frail or frail. Propensity score matching was performed to balance age; sex; acute illness severity; and comorbidities. Primary outcome was 1‐year all‐cause mortality. Secondary outcomes included ICU mortality; in‐hospital mortality; return to pre‐admission residence; and ICU and duration of hospital stay. Results The matched cohort comprised 5398 patients (2699 without frailty (Clinical Frailty Scale 1–4) and 2699 living with frailty (Clinical Frailty Scale 5–8)), with good post‐matching covariate balance. Mortality in ICU was low and not significantly different between patients who were frail and non‐frail. Frailty was independently associated with higher in‐hospital mortality (matched hazard ratio (HR) 1.66, 95%CI 1.22–2.27, p = 0.001) and higher 1‐year mortality (matched HR 1.66, 95%CI 1.47–1.87, p < 0.001). Patients without frailty had higher odds of returning to their pre‐admission residence at hospital discharge than patients living with frailty (matched OR 1.45, 95%CI 1.29–1.62, p < 0.001). Patients who were frail experienced longer hospital stays and higher rates of postoperative complications, including delirium and acute renal failure. Discussion Among patients aged ≥ 90 years undergoing elective surgery with postoperative intensive care admission, frailty is strongly associated with prolonged recovery and worse short and long‐term outcomes. Incorporation of frailty assessment into peri‐operative pathways may improve risk stratification, shared decision‐making and personalised care for patients aged ≥ 90 years.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"9 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172541","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 pre-operative opioid use disorder and postoperative outcomes: a systematic review and meta-analysis.","authors":"Dereje Zewdu Assefa, Ting Xia, Yonas Getaye Tefera, Monica Jung, Suzanne Nielsen","doi":"10.1111/anae.70416","DOIUrl":"https://doi.org/10.1111/anae.70416","url":null,"abstract":"<p><strong>Introduction: </strong>Opioid use disorder may increase the risk of adverse postoperative outcomes, but the magnitude and consistency of this association remain unclear. We performed a systematic review and meta-analysis to evaluate the impact of opioid use disorder on postoperative outcomes across surgical populations.</p><p><strong>Methods: </strong>We searched electronic databases for studies comparing adults (aged ≥ 18 y) with and without opioid use disorder undergoing surgery. Primary outcomes were the incidence of any postoperative pain and composite adverse respiratory outcomes. Secondary outcomes included re-admission rates 30 and 90 days after surgery; in-hospital mortality; duration of hospital stay; and total healthcare costs.</p><p><strong>Results: </strong>From the 40 included studies, three reported postoperative pain, and 19 reported respiratory outcomes. People with opioid use disorder had higher odds of postoperative pain (OR 2.87, 95%CI 1.63-5.06) and composite adverse respiratory events (OR 2.10, 95%CI 1.64-2.68), both with moderate certainty. Subgroup analyses showed increased risk of pulmonary embolism, pneumonia and other respiratory and pulmonary complications (low to moderate certainty). Low certainty evidence indicated higher 30-day and 90-day re-admission rates, prolonged duration of hospitalisation and higher total healthcare costs associated with opioid use disorder, while in-hospital mortality did not differ significantly (very low certainty).</p><p><strong>Discussion: </strong>Our results suggest that opioid use disorder is associated with higher incidence of postoperative pain, increased postoperative complications and greater total healthcare costs, which supports the need for routine pre-operative screening for opioid use disorder and the application of patient-centred, multidisciplinary peri-operative care and pain management.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164889","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":"Incidence and reasons for cancellation on the day of elective surgery: a systematic review and meta-analysis.","authors":"Daoming Chen, Chenxi Li, Fang Wu, Xiaoru Fang, Nan Sun, Xiaoxiao Deng, Yubin Su","doi":"10.1111/anae.70407","DOIUrl":"https://doi.org/10.1111/anae.70407","url":null,"abstract":"<p><strong>Introduction: </strong>Cancellation on the day of elective surgery is a persistent challenge that compromises operating theatre efficiency, wastes resources and delays patient care. Existing evidence is difficult to interpret because definitions of cancellation vary across studies and reported reasons are classified inconsistently. We aimed to estimate the incidence of cancellation on the day of surgery and synthesise the reported reasons for cancellation.</p><p><strong>Methods: </strong>Databases were searched for observational studies reporting elective surgery cancellations. Studies explicitly defining cancellation on the day of surgery were included in a random-effects meta-analysis of proportions. Subgroup analyses examined variation by national income level and surgical speciality, with geographical region explored in supplementary analyses. Included studies were assessed for risk of bias using Joanna Briggs Institute critical appraisal tools. Reported reasons were synthesised narratively across four domains: patient; medical/anaesthesia; administrative/system; and surgery/staff.</p><p><strong>Results: </strong>Fifty-eight studies met the eligibility criteria, of which 37 (with a strict definition of on-the-day cancellation of surgery) were included. Pooled incidence of cancellation on the day of surgery was 14% (95%CI 13-16%), with substantial heterogeneity (I² = 99.91%). Rates varied by national income level and surgical speciality, with higher estimates reported in low- and lower-middle-income settings and in some specialities, including ophthalmology and neurosurgery. Reasons reported most commonly included: patient declining surgery; non-fasted; unstable medical condition; changes in clinical status; improper scheduling or overbooking; instrument unavailability; and staff shortages. Sensitivity analyses supported the robustness of the findings and no clear publication bias was detected. The certainty of evidence for the pooled incidence estimate was low.</p><p><strong>Discussion: </strong>Cancellation on the day of surgery remains a substantial and globally relevant peri-operative problem. Its burden and drivers are highly context-dependent and often reflect weaknesses in pre-operative preparation, organisational co-ordination and system capacity. Reducing avoidable cancellations may therefore require context-specific strategies targeting pathway reliability, timely pre-anaesthetic assessment and peri-operative resource alignment.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164712","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":"PUMA tracheal extubation guidelines: towards clarity or complexity?","authors":"Imran Ahmad, Tim M Cook","doi":"10.1111/anae.70436","DOIUrl":"https://doi.org/10.1111/anae.70436","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126479","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":"Effect of intensive care unit sedation strategy on patient‐reported experience: secondary mediation analysis of the\u0000 A2B\u0000 randomised controlled trial","authors":"John A. Masterson,Isabella Ritchie,Leanne M. Aitken,Bronagh Blackwood,Kalliopi Kydonaki,Cathrine A. McKenzie,Richard A. Parker,Christopher J. Weir,Timothy S. Walsh,Nazir I. Lone,the A2B trial investigators","doi":"10.1111/anae.70437","DOIUrl":"https://doi.org/10.1111/anae.70437","url":null,"abstract":"Summary Introduction The optimal ICU sedation strategy to improve patient‐reported experience is unknown. In a planned secondary analysis of the A2B randomised trial, we evaluated the effect of sedation strategy (dexmedetomidine, clonidine or propofol) on recalled patient experience at 90 days post‐randomisation. Using mediation analyses, we explored plausible mediators of the relationship between sedation strategy and patient experience. Methods We analysed data for all patients from A2B who completed the Intensive Care Experience Questionnaire (ICE‐Q) at 90 days. The primary outcome was patient‐recalled experience, measured by the four ICE‐Q domain scores (awareness, frightening memories, recall, satisfaction). Sedation strategy effect was evaluated using linear regression, adjusting for potential confounders. Mediation analyses were conducted for duration of mechanical ventilation; ICU stay; and days with pain behaviour, agitation and coma/delirium. Results Of 1404 patients included in the primary trial analysis, 1009 (71.9%) were alive at 90 days post‐randomisation with ICE‐Qs completed by 289/1009 (28.6%). Compared with propofol, dexmedetomidine sedation was associated with higher awareness of surroundings (median score 32 vs. 28, adjusted mean difference 3.6, 95%CI 1.0–6.2, p = 0.01), but clonidine sedation had no association (difference 2.4, 95%CI ‐0.2–5.0, p = 0.07). No associations were found with other ICE‐Q domains. The contribution of the five potential mediators on the dexmedetomidine–awareness relationship was small. Discussion Dexmedetomidine compared with propofol sedation strategy may be associated with increased recalled awareness of surroundings, which is considered a favourable indicator of ICU experience. Together with the primary A2B trial results, which showed no effect on ventilation duration, these hypothesis‐generating findings in a subgroup of the A2B cohort do not support the use of dexmedetomidine over propofol based on patient‐reported experience. Based on our findings, we advocate that a personalised approach to sedation strategies should continue to be used.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"26 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149092446","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":"Infiltration between the popliteal artery and the capsule of the knee (\u0000 IPACK\u0000 ) vs. selective tibial nerve block for analgesia after anterior cruciate ligament reconstruction: a randomised controlled trial","authors":"Ludovic Beun,Robin Martin,Trieu Hoai Nam Ngo,Jean‐Benoit Rossel,Matthieu André,Eric Albrecht","doi":"10.1111/anae.70433","DOIUrl":"https://doi.org/10.1111/anae.70433","url":null,"abstract":"Summary Introduction Infiltration between the popliteal artery and the capsule of the knee (IPACK) and the selective tibial nerve block both provide analgesia for the posterior aspect of the knee after anterior cruciate ligament reconstruction. This randomised controlled triple‐blinded trial tested the hypothesis that IPACK provides superior analgesia to a selective tibial nerve block after anterior cruciate ligament reconstruction. Methods Eighty patients having anterior cruciate ligament reconstruction under general anaesthesia with a femoral triangle block were allocated randomly to receive either IPACK with 20 ml ropivacaine 0.2% or a selective tibial nerve block with 5 ml ropivacaine 0.75%. Postoperative analgesia included paracetamol, ibuprofen and intravenous morphine patient‐controlled analgesia. Primary outcome was cumulative postoperative intravenous morphine consumption at 24 h. Secondary pain‐related outcomes included pain scores at rest and on movement at 2 h, 24 h and 48 h. Early functional outcomes evaluated were range of motion; quadriceps strength; and walking distance measured at 24 h and 48 h. Late functional outcomes included concentric quadriceps strength and single‐hop test, measured at 4 months and 8 months. Results Median (IQR [range]) cumulative intravenous morphine consumption at 24 h postoperatively was similar between IPACK (12 (6–20 [0–54]) mg) and selective tibial nerve block (16 (10–30 [0–66]) mg, p = 0.073). No significant differences between groups were seen in the secondary pain or functional outcomes. No complications were reported. Discussion The IPACK and selective tibial nerve block provide comparable postoperative analgesia after anterior cruciate ligament reconstruction under general anaesthesia with a femoral triangle block, with similar impact on functional outcomes.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"4 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089132","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 between glottic view and tracheal intubation during videolaryngoscopy: a prospective observational study","authors":"Miguel Ángel Fernández‐Vaquero,Pedro Charco‐Mora,Manuel Ángel Gómez‐Ríos,Jose A. Sastre,Nekari de Luis‐Cabezón,Robert Greif,Marc Vives,the VCISpain Trial Investigators Group","doi":"10.1111/anae.70417","DOIUrl":"https://doi.org/10.1111/anae.70417","url":null,"abstract":"Summary Introduction A good view of the glottis with videolaryngoscopy does not translate consistently into straightforward tracheal tube delivery, suggesting a dissociation between visualisation and procedural execution. When videolaryngoscopy documentation is based on laryngeal view alone, it does not reliably reflect the performance of tracheal intubation. We evaluated this relationship and the reproducibility of a structured classification framework for videolaryngoscopic tracheal intubation. Methods We conducted a prospective multicentre observational study across 44 hospitals. Videolaryngoscopic tracheal intubations were assessed independently by an airway operator and an observer using a three‐domain classification: blade geometry; glottic view using the percentage of glottic opening (POGO) score; and tracheal tube delivery. Inter‐rater reliability was assessed. The relationship between glottic view and tracheal tube delivery was analysed across predefined POGO categories. Results A total of 5302 tracheal intubations with paired assessments were analysed. The overall inter‐rater agreement for the three‐domain classification was high (Krippendorff's α = 0.86, 95% CI 0.85–0.87). Among tracheal intubations with poor view ( POGO &lt; 25%), 37/151 (24.5%) were classified as easy. Among tracheal intubations with POGO ≥ 25%, 527/5151 (10.2%) were classified as difficult or failed. Even with excellent glottic view ( POGO &gt; 75%), the initial strategy was classified as difficult or failed in 252/4025 (6.3%) of cases. Discussion The ease of tracheal intubation with videolaryngoscopy cannot be inferred from glottic view alone. A structured approach that incorporates what was used, what was seen and what was done may improve communication in clinical practice.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"103 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089160","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 hypotension threshold models and subdistribution hazard of postoperative pneumonia in patients having non‐cardiac surgery","authors":"Pingping Wang, Junming Gu, Yanyu Liu, Jing Zhuang, Shengkun Peng, Qian Xiang, Minhong Cai, Xiaobin Liu, Yu Lv","doi":"10.1111/anae.70426","DOIUrl":"https://doi.org/10.1111/anae.70426","url":null,"abstract":"Summary Introduction Intra‐operative hypotension is common during general anaesthesia, but its association with postoperative pneumonia remains uncertain, partly because hypotension has been defined using different thresholds. We evaluated whether absolute thresholds or relative reductions from baseline mean arterial pressure were associated more strongly with postoperative pneumonia after non‐cardiac surgery. Methods We conducted a retrospective multicentre cohort study of 151,036 adults undergoing non‐cardiac surgery under general anaesthesia at three Chinese hospitals. Intra‐operative hypotension was assessed using 12 metrics across nine thresholds, including absolute mean arterial pressure thresholds of &lt; 50 mmHg to &lt; 70 mmHg and relative reductions of 20–50% from baseline. The primary outcome was postoperative pneumonia within 30 days. Results Of 151,036 patients, postoperative pneumonia occurred in 3486 (2.3%). Relative reductions in mean arterial pressure were more consistently associated with postoperative pneumonia than absolute thresholds. At a 20% reduction from baseline, the number of intra‐operative hypotension episodes was associated with postoperative pneumonia (subdistribution hazard ratio (sHR) 1.079, 95%CI 1.050–1.109, p &lt; 0.001), as was the presen <jats:italic>c</jats:italic> e of intra‐operative hypotension (sHR 1.108, 95%CI 1.068–1.149, p &lt; 0.001). Absolute thresholds were not consistently associated with postoperative pneumonia after adjustment. Duration‐related metrics were generally less consistent than depth‐ or recurrence‐related metrics. Dose–response analyses showed that risk increased rapidly at low exposure levels and then plateaued across relative thresholds of 20–40%. Discussion Intra‐operative hypotension was associated with postoperative pneumonia when defined as a relative reduction from baseline mean arterial pressure, whereas conventional absolute thresholds were less informative. These findings suggest that maintaining intra‐operative blood pressure close to baseline may be more relevant to pulmonary risk than relying on fixed absolute thresholds alone.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"57 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086810","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":"Correction to \"Clinical effectiveness of procalcitonin- or C-reactive protein-guided antibiotic discontinuation protocols for adult patients who are critically ill with sepsis: a rapid systematic review and meta-analysis\".","authors":"","doi":"10.1111/anae.70355","DOIUrl":"10.1111/anae.70355","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":"1428"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757656","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":"Lidocaine-esketamine analgesia after hepatectomy: a reply.","authors":"Yan Xu, Chunling Jiang, Daniel I Sessler","doi":"10.1111/anae.70353","DOIUrl":"10.1111/anae.70353","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":"1455-1456"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766565","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}