Anaesthesia最新文献

{"title":"Rescuing failed direct laryngoscopy in children: one size does not fit all","authors":"Michael A. Evans, Thomas J. Caruso","doi":"10.1111/anae.16577","DOIUrl":"https://doi.org/10.1111/anae.16577","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"27 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143666638","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":"Comparing videolaryngoscopy and flexible bronchoscopy to rescue failed direct laryngoscopy in children: a propensity score matched analysis of the Pediatric Difficult Intubation Registry","authors":"Mary Lyn Stein, Julia Heunis Nagle, T. Wesley Templeton, Steven J. Staffa, Stephen G. Flynn, Martina Bordini, Sydney Nykiel-Bailey, Annery G. Garcia-Marcinkiewicz, Febina Padiyath, Maria Matuszczak, Angela C. Lee, James M. Peyton, Raymond S. Park, Britta S. von Ungern-Sternberg, Patrick N. Olomu, Agnes I. Hunyady, Clyde Matava, John E. Fiadjoe, Pete G. Kovatsis","doi":"10.1111/anae.16576","DOIUrl":"https://doi.org/10.1111/anae.16576","url":null,"abstract":"Flexible bronchoscopy is the gold standard for difficult airway management. Clinicians are using videolaryngoscopy increasingly because it is perceived to be easier to use with high success rates. We conducted this study to compare the success rates of the two techniques when used after failed direct laryngoscopy in children with difficult tracheal intubations.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"15 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143666640","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":"Intravenous lidocaine with propofol-based sedation for colonoscopy: a systematic review and meta-analysis with trial sequential analysis","authors":"Eduardo C. Barbosa, Júlia M. Aguirre, Paulo F. E. Bertoldi, Paula Santo, Stefano Baraldo, Angélica L. Nau, Gilmara C. Meine","doi":"10.1111/anae.16563","DOIUrl":"https://doi.org/10.1111/anae.16563","url":null,"abstract":"Intravenous lidocaine is a promising complementary strategy for sedation during surgical procedures. We performed a systematic review and meta-analysis to compare intravenous lidocaine with placebo as an adjuvant to propofol-based sedation in patients undergoing colonoscopy.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"91 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653594","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":"A UK-wide survey evaluation of capnography variation","authors":"Andrew A. Shepherd, Jennifer L. Proc, Patrick A. Ward, Alistair F. McNarry, Mathew Lyons","doi":"10.1111/anae.16603","DOIUrl":"https://doi.org/10.1111/anae.16603","url":null,"abstract":"<p>When interpreted correctly, waveform capnography can prevent morbidity and mortality during airway management. However, misidentification of capnography as other waveforms (e.g. pressure or flow) continues to cause preventable deaths [<span>1</span>] and has been implicated in a Coroner's Regulation 28 report [<span>2</span>]. Non-standardised monitor displays increase the risk of human error, leading to clinical delays or misjudgements [<span>3</span>]. Despite the capnography recommendations from the Association of Anaesthetists [<span>4</span>], Project for Universal Management of Airways and capnography safety campaigns, preventable deaths persist [<span>5</span>]. System design (removing the possibility of error) is the most effective form of error prevention [<span>6</span>]. In recognition of this, the Safe Anaesthesia Liaison Group (SALG) recommends standardising waveform capnography as a white solid filled-in graph at the bottom of the monitor display [<span>7</span>]. It is not known how widely this recommendation has been adopted. We aimed to establish the extent of variation in waveform capnography across the UK and assess compliance with the SALG standard.</p>\u0000<p>We devised a survey to collect capnography waveform and equipment data from participating hospitals (online Supporting Information Appendix S1). A website (https://cavastudy.co.uk) was established for hospital registration and respondent survey access. Participation was voluntary and open to all 420 NHS hospitals that provide anaesthesia services [<span>1</span>].</p>\u0000<p>Survey respondents were asked to identify distinct clinical areas in their hospital where waveform capnography was used, establish the number of different waveforms in each area, and categorise them according to 11 colours, two waveform types and three screen locations. These variants were chosen from a pilot survey in south-east Scotland. Departmental clinical directors of participating hospitals were asked to agree to their hospital's participation and state their personal awareness of the SALG standard. The survey was not anonymised. Research Ethics Committee and Caldicott Guardian approval were not required. Investigators registered the project via their local governance teams.</p>\u0000<p>Survey responses were collected from 9 September 2024 to 31 October 2024 using Microsoft Forms (Microsoft, Redmond, WA, USA). Analysis was conducted in R Studio (R version 4.4.1; R Foundation, Vienna, Austria).</p>\u0000<p>Data were received from 138/420 (33%) eligible hospitals (which were part of 65 NHS Trusts/health boards). We analysed 9052 individual capnography waveforms and identified 36 variants across nine colours, two morphologies (line and filled in) and three monitor locations (top, middle and bottom). The most common waveform was a white line at the bottom of the screen, followed by the SALG standard and then a white line in the middle. The remaining capnographs varied considerably in morphology (Table 1 and Fig.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"55 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143641137","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":"Stress, strain and mechanical power: let's not forget the shape of the flow","authors":"Aurio Fajardo-Campoverdi, Adrián Gallardo, Alejandro González-Castro","doi":"10.1111/anae.16602","DOIUrl":"https://doi.org/10.1111/anae.16602","url":null,"abstract":"<p>We read the work of Buiteman-Kruzinga et al. [<span>1</span>] and believe that it adds to the evidence regarding the relevance of respiratory rate in the energy transfer of the ventilatory system. For viscoelastic bodies, cyclicity is probably the most important factor to explain the disruption of their initial conformation, which has already been extrapolated to clinical studies [<span>2</span>], and this study confirms this. However, we believe it is necessary to clarify some points.</p>\u0000<p>Despite the rigour of the design and the robustness of the clinical trials included, the dichotomisation of initially continuous variables and imputation of the data (even when reducing the variance) can generate biased estimates, even using advanced techniques. The authors assert that the higher the peak pressure (P<sub>peak</sub>), the greater the mechanical power in patients without acute respiratory distress syndrome, except in the subgroup of patients with low V<sub>T</sub> and low programmed respiratory rates. Under this premise, it can be inferred that P<sub>peak</sub> may not be so important when gentle ventilation is ensured. However, this work does not specify the inspiratory flow delivery form, and despite the fact that in the original mechanical power equation this variable has no place, from a rheological and thermodynamic perspective, we know that it has relevance [<span>3</span>].</p>\u0000<p>Bodies that exhibit viscoelastic behaviour have the capacity to store or dissipate energy when deformed by stress. Under this argument, the strain is modified by the cyclicity, but also by the time and the way in which it is exposed to the stress. Anisotropic strain, defined as the rate of deformation under non-uniform stress, changes as a function of lung geography but is also sensitive to variations in flow. Thus, the higher the flow delivery velocity, the higher the P<sub>peak</sub>, which translates into a higher pulmonary viscoelastic rate with the resulting decrease in the slope of the strain-volume or strain-pressure curve. Several authors have already explored this hypothesis, and although there are no randomised clinical trials, the existence of its association with mechanotransduction cannot be ignored in healthy lungs, acute respiratory distress syndrome, or in paediatric patients [<span>4</span>].</p>\u0000<p>We performed a post hoc analysis of the “<i>mechanical power day</i>” [<span>5</span>] by means of multiple frequentist linear regression. We observed that ventilation with decelerated flow (coefficient 3.4, 95%CI 2.4–4.5, p < 0. 001) correlated independently with a higher probability of high energy mechanical power (> 17 J.min<sup>-1</sup>) in patients without acute respiratory distress syndrome (R<sup>2</sup> = 71%), when compared with constant flow ventilation (coefficient difference -3.4, 95%CI -4.4 to -2.3, p < 0.001). Figure 1 shows the correlation between decelerated flow with high energy mechanical power as a function of driving","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"92 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143641141","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 blood management – what's the problem with implementation?","authors":"Seema Agarwal, Craig Carroll","doi":"10.1111/anae.16584","DOIUrl":"https://doi.org/10.1111/anae.16584","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"42 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635321","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":"Surgery in patients aged ≥ 80 years: mortality and recovery in a nationwide cohort study*","authors":"Jesper Eriksson, Cornelia Sandberg, Naima Kilhamn, Max Bell, Anders Oldner, Emma Larsson","doi":"10.1111/anae.16580","DOIUrl":"https://doi.org/10.1111/anae.16580","url":null,"abstract":"SummaryIntroductionAs the global population ages, the demand for surgical interventions in older adults is rising. Older patients face increased risks due to age‐related physiological changes and comorbidities, making surgery and postoperative care challenging. This study aimed to assess short‐ and long‐term mortality, as well as patient‐centred outcomes such as days alive and at home 30 and 90 days after surgery, in patients aged ≥ 80 y undergoing surgical procedures.MethodsThis nationwide cohort study utilised data from the Swedish Perioperative Register, including surgeries in patients aged ≥ 80 y in Sweden from January 2019 to March 2023. We linked peri‐operative data with the National Patient Register for comorbidities and with the National Cause of Death Register. The primary outcome was all‐cause 30‐day mortality, with secondary outcomes of 365‐day mortality and days alive and at home 30 and 90 days after surgery.ResultsA total of 118,359 patients were included, with 54,320 undergoing elective and 64,039 acute surgeries. Thirty‐day mortality was 1.2% for elective and 9.9% for acute surgeries. Mortality increased significantly with age, particularly for patients aged ≥ 90 y compared with those aged 80–84 y. Days alive and at home 30 and 90 days after surgery were significantly lower for acute surgery patients, indicating longer recovery times and more postoperative complications.DiscussionOlder adults, especially those aged ≥ 90 y, experience high mortality and significant challenges in postoperative recovery after acute surgeries. Elective surgeries are associated with lower short‐term mortality, suggesting that age alone should not preclude surgical interventions. Tailored peri‐operative care and patient‐centred decision‐making are essential to improve outcomes in this vulnerable population.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"73 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607982","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":"Novel biological risk factors for 7-day postoperative kidney injury in elective major non-cardiac surgery: a retrospective observational study","authors":"Rosemary E. Worrall, Salmaan-Javed Mughal, Dhruv Parekh, Jaimin M. Patel, David McNulty, Mansoor N. Bangash","doi":"10.1111/anae.16568","DOIUrl":"https://doi.org/10.1111/anae.16568","url":null,"abstract":"Few UK studies have explored the epidemiology of postoperative acute kidney injury after diverse types of elective major non-cardiac surgery. Fewer still have compared postoperative acute kidney injury risk factors with conditions such as peri-operative myocardial injury that might have similar pathophysiology. This study aimed to characterise postoperative acute kidney injury and its clinical consequences in elective major non-cardiac surgery, and to assess risk factors for postoperative acute kidney injury including those related to peri-operative myocardial injury.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"86 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618227","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":"Provision of peri-operative patient blood management strategies in the UK: a national survey of practice","authors":"Samantha R. Warnakulasuriya, Kathleen Wolff, Simon J. Stanworth","doi":"10.1111/anae.16579","DOIUrl":"https://doi.org/10.1111/anae.16579","url":null,"abstract":"In UK hospitals, it is unclear how organisational structures are arranged to support effective implementation of peri-operative blood management practice strategies. The aim of this study was to conduct a national survey of organisations to describe local practices of peri-operative patient blood management and infrastructure availability in the UK.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"183 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143608377","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 of chronic postsurgical pain after caesarean delivery: a systematic review and meta-analysis","authors":"Li-Zhong Wang, Jia-Yue Huang, Hui-Jing Hu, Feng Xia","doi":"10.1111/anae.16596","DOIUrl":"https://doi.org/10.1111/anae.16596","url":null,"abstract":"Chronic postsurgical pain is recognised increasingly as a complication of caesarean delivery, with implications for a large cohort of patients. As interest in this area has grown, there has been more primary research into both the incidence and severity of pain. We aimed to synthesise all available evidence to evaluate the rate, features and severity of chronic postsurgical pain following caesarean delivery and whether it has changed over time.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"2 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599372","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}