Anaesthesia最新文献_第5页

Regional anaesthesia for awake children 清醒儿童局部麻醉。

IF 7.5 1区医学

Anaesthesia Pub Date : 2025-06-27 DOI: 10.1111/anae.16667

Baiping Mao, Pinguo Fu

{"title":"Regional anaesthesia for awake children","authors":"Baiping Mao, Pinguo Fu","doi":"10.1111/anae.16667","DOIUrl":"10.1111/anae.16667","url":null,"abstract":"We read with great interest the study by Maupain et al. [1], which investigated the feasibility of awake regional anaesthesia for urgent upper limb surgery in children aged 6–12 y. The conclusions concur with our experience at a regional tertiary centre specialising in paediatric care where we perform many such urgent procedures, almost invariably under general anaesthesia. The potential impact of general anaesthesia on the developing nervous system [2] and on children's psychological wellbeing and cognitive or behavioural trajectories remains a matter of concern. We appreciate the authors proposing alternative techniques for these operations and would like clarification on several points.The authors report that there were no significant differences between those patients who received regional anaesthesia alone in terms of female sex (35 vs. 5, p = 0.228). However, it is well recognised that, in childhood, girls typically achieve certain psychological and developmental milestones 1–2 years earlier than boys. In the youngest age stratum, specifically 6-year-olds, the success rate of awake regional anaesthesia was only 12/18 (≈ 67%), substantially below the 80% assumed for sample-size calculation. It follows that 6-year-old boys might have an even lower success rate, yet no sex- or age-specific data are provided. Without these subgroup data, it is difficult to accept the general conclusion that awake regional anaesthesia is uniformly feasible across both sexes and the full 6–12 y age range.The Methods state that anaesthetic skin patches were applied to the intended venous access and peripheral regional anaesthesia sites at least 2 h before surgery. Yet, in practice, the block types included axillary, forearm/wrist, supraclavicular and digital approaches, each with a distinct puncture site, and the chosen vein for cannulation may vary with individual anatomy and clinician preference. How did the authors ensure that the patches were positioned reliably over the correct sites for both venous access and nerve block?The potential neurocognitive and psychological effects of surgery and anaesthesia in children may emerge only after months or years [2]. In this study, behavioural changes were assessed using the post-hospitalisation behaviour questionnaire at 2 weeks only, which may be insufficient to capture medium- or long-term alterations in cognition or behaviour.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 8","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16667","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504525","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}

引用次数: 0

Time to surgery as a prehabilitation window: insights from United States Medicare data 将手术作为康复窗口的时间：来自美国医疗保险数据的见解。

IF 7.5 1区医学

Anaesthesia Pub Date : 2025-06-27 DOI: 10.1111/anae.16675

Kailin Xu, Steve Kwon, Chan Mi Park, Dae Hyun Kim

引用次数: 0

Expanding the discussion on airway management with glucagon-like peptide-1 receptor agonist use. 扩大胰高血糖素样肽-1受体激动剂在气道管理中的应用探讨。

IF 7.5 1区医学

Anaesthesia Pub Date : 2025-06-27 DOI: 10.1111/anae.16676

Jenny E Pennycuff, Katherine Hagan, Juan Cata

引用次数: 0

Regional anaesthesia for awake children: a reply 清醒儿童的局部麻醉：答复。

IF 7.5 1区医学

Anaesthesia Pub Date : 2025-06-27 DOI: 10.1111/anae.16668

Olivier Maupain

{"title":"Regional anaesthesia for awake children: a reply","authors":"Olivier Maupain","doi":"10.1111/anae.16668","DOIUrl":"10.1111/anae.16668","url":null,"abstract":"We thank Dr Mao and Dr Fu for their interest in our article [1] and for their thoughtful and constructive comments [2]. We are pleased to respond to the points they raised.Although the hypothesis regarding sex-based differences in psychological maturity is reasonable, we did not observe any difference in success rates between boys and girls in our cohort. In the youngest 6-year-old subgroup, 10/15 boys and 2/3 girls underwent awake surgery with regional anaesthesia successfully, corresponding to identical success rates of 67%. However, our study was not powered nor designed to assess sex as an influencing factor specifically. Further research is needed to explore such factors and should also consider that boys are affected more frequently by upper limb trauma at school age [3].We would also like to clarify that our sample size was calculated based on an anticipated 80% success rate in the 6–12 y age group, not to enable subgroup comparisons. Given the non-comparative design of the study, our sample size was determined to allow sufficiently narrow confidence intervals for interpreting the overall feasibility with acceptable statistical precision. This approach aligns with standard practice for cohort prospective observational studies.We confirm that the anaesthetic skin patches were placed at the intended sites for venous access and regional anaesthesia by the anaesthetist performing the procedure during the pre-operative consultation. This allowed precise anticipation of the puncture sites based on anatomical landmarks and planned technique (e.g. axillary, forearm or supraclavicular block). The only scenario where patch placement might have been more challenging is in the case of digital blocks. However, in our study, the only digital block was performed under general anaesthesia in the one patient who received general anaesthesia and was thus not subject to this limitation.We agree that long-term neurocognitive and behavioural outcomes after anaesthesia exposure remain an area of active research. However, the primary aim of our 2-week follow-up using the post-hospitalisation behaviour questionnaire (PHBQ) was not to assess neurodevelopmental changes but to identify signs of emotional or behavioural distress that might reflect a negative peri-operative experience. The PHBQ is a validated tool in paediatric anaesthesia and has been used widely to screen for short-term behavioural disturbances in children [4-6]. We felt that this timeframe was relevant to assess whether our awake regional anaesthesia protocol had been well tolerated from the child's perspective.We appreciate the opportunity to clarify these points and thank the authors for their engagement with our work.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 8","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16668","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504526","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}

引用次数: 0

Regional anaesthesia for awake children 清醒儿童局部麻醉

IF 10.7 1区医学

Anaesthesia Pub Date : 2025-06-27 DOI: 10.1111/anae.16667

Baiping Mao, Pinguo Fu

引用次数: 0

Machine learning for mortality prediction: do we need yet another model? 机器学习预测死亡率：我们还需要另一个模型吗？

IF 10.7 1区医学

Anaesthesia Pub Date : 2025-06-27 DOI: 10.1111/anae.16673

Alfie Lloyd, Martin Shaw

引用次数: 0

Rates of discontinuation and non‐publication of regional anaesthesia clinical trials: a registry‐based cross‐sectional analysis 区域麻醉临床试验的中止率和未发表率：基于注册表的横断面分析