Anaesthesia最新文献

{"title":"PeriOperative Quality Initiative consensus statement recommendations on the definitions, aims and delivery of shared decision-making for major surgery.","authors":"Debra Leung,Alf Collins,Jennifer Philip,Michael P W Grocott,Bernhard Riedel,Denny Z H Levett, ","doi":"10.1111/anae.70205","DOIUrl":"https://doi.org/10.1111/anae.70205","url":null,"abstract":"INTRODUCTIONShared decision-making is a collaborative process whereby clinicians and patients work together to decide on a treatment plan that is informed by evidence, clinical experience and individual patient characteristics and preferences. This process is particularly important for complex surgical decisions when the risks and benefits of treatment are finely balanced. However, shared decision-making has not been implemented consistently in peri-operative pathways and structured shared decision-making for patients requiring enhanced decisional support is not widely available. We aimed to develop clinical practice recommendations for peri-operative shared decision-making through an international consensus process.METHODSA modified nominal group technique was utilised, comprising seven stages. Idea generation (stages 1 and 2) was conducted online. Stages 3-7 occurred in person over 2.5 days and involved iterative rounds of deliberation, refinement and voting to develop consensus statements and recommendations. An international multidisciplinary group of 22 experts was purposively selected to represent diverse perspectives across healthcare settings and reflected relevant stakeholders in peri-operative shared decision-making. Three consumer advisors were also recruited who had lived experience of major surgery either as a patient or carer.RESULTSConsensus for recommendations was defined a priori as 75% of all faculty indicating agreement across successive rounds of anonymous voting. Universal consensus was obtained on 25 recommendations, which included a definition of 'universal shared decision-making' for all patients contemplating surgery and referral criteria for 'specialised shared decision-making services' for patients with higher decisional-support needs. The core components of shared decision-making services and priority areas for research were also identified.DISCUSSIONThis is the first consensus statement recommendations for peri-operative shared decision-making co-created by consumers and clinicians. It will support the implementation of shared decision-making for patients contemplating surgery.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"37 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147625872","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":"Interpreting the afternoon disadvantage: accounting for mediation, weighting and secular trends: a reply.","authors":"Ji-Hoon Sim","doi":"10.1111/anae.70052","DOIUrl":"10.1111/anae.70052","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":"593-594"},"PeriodicalIF":6.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145385783","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":"Conscious sedation vs. general anaesthesia for the peri-operative management of patients undergoing transcatheter aortic valve implantation: a reply.","authors":"Mike Charlesworth","doi":"10.1111/anae.70051","DOIUrl":"10.1111/anae.70051","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":"597"},"PeriodicalIF":6.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145385779","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":"Lidocaine combined with low‐dose esketamine for movement‐evoked pain after hepatectomy: a double‐blind randomised controlled trial","authors":"Yan Xu, Li Zhou, Qianqian Tang, Feng Yu, Jingwen Wu, Siyu Yan, Min Cai, Jialu Wan, Yi Kang, Lajing Luowu, Mengmeng Zhou, Lulong Bo, Daniel I. Sessler, Chunling Jiang","doi":"10.1111/anae.70215","DOIUrl":"https://doi.org/10.1111/anae.70215","url":null,"abstract":"Summary Introduction Pain following hepatectomy may delay recovery and increase opioid use. We tested the primary hypothesis that combining lidocaine and low‐dose esketamine would reduce movement‐evoked pain 24 h after hepatic resection. We also evaluated whether this approach reduced opioid consumption and improved quality of recovery. Methods Patients having elective hepatic resections were allocated randomly to receive lidocaine‐esketamine or placebo from induction of anaesthesia until the end of surgery. After surgery, patients allocated to lidocaine‐esketamine were given a continuous infusion of lidocaine with esketamine for 72 h. All patients received transversus abdominis plane blocks with ropivacaine 2 mg.kg <jats:sup>‐1</jats:sup> after induction of anaesthesia. Postoperative analgesia was provided by patient‐controlled intravenous analgesia with sufentanil. Results In total, 304 patients were included, of whom 145 (48%) had open surgery. Lidocaine‐esketamine infusion reduced median (IQR [range]) pain scores with movement at 24 h (3 (2–4 [1–6]) vs. 4 (3–5 [1–9]), p &lt; 0.001); 48 h (3 (2–4 [0–7]) vs. 4 (3–5 [0–8]), p &lt; 0.001); and 72 h (2 (1–3 [0–6]) vs. 3 (2–4 [0–7]), p &lt; 0.001), respectively. Moderate‐to‐severe movement‐evoked pain at 24 h was evident in 52/152 (34%) patients who received lidocaine‐esketamine vs. 85/152 (56%) who received placebo (p &lt; 0.001). Cumulative sufentanil equivalents were significantly reduced at each measurement time and quality of recovery scores were significantly higher through the first 72 h for lidocaine‐esketamine compared with placebo, but these changes were clinically modest. Discussion The combination of lidocaine with esketamine reduced movement‐evoked pain and opioid consumption whilst improving quality of recovery during the initial 72 h after hepatic resection. However, treatment effects were modest and of limited clinical importance.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"6 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147577722","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":"Organisational practices in postoperative opioid prescribing at discharge in UK NHS day surgery units: the OPIOID ‐discharge survey","authors":"Ben Grodzinski, Dileep N. Lobo, Mark Rockett, Nicholas Levy","doi":"10.1111/anae.70206","DOIUrl":"https://doi.org/10.1111/anae.70206","url":null,"abstract":"Summary Introduction In March 2025, the Medicines and Healthcare products Regulatory Agency published a drug safety update removing the indication of postoperative pain from the licence of prolonged‐release opioids and mandated discussing risks with patients. Our study assessed compliance with these recommendations 6 months post‐publication. Methods A cross‐sectional survey on organisational discharge opioid prescribing practices was distributed via the National Confidential Enquiry into Patient Outcome and Death Local Reporter pathway to acute hospitals in England, Wales and Northern Ireland. Surveys targeted Day Surgery Unit managers and Drugs and Therapeutics Committee secretaries. Results We received responses from 83 Day Surgery Units and 70 Drug and Therapeutics Committees (approximately 68% response rate). Before March 2025, 51/70 (73%) Trusts routinely used modified‐release opioids. Following the drug safety update, 59/70 (84%) committees shared the guidance and, consequently, 38/51 (75%) organisations that previously used modified‐release opioids no longer do so. However, 10/70 (14%) units still dispensed modified‐release opioids. Among day surgery units dispensing opioids, only 19/60 (32%) provided discharge letters that advised general practitioners against repeat prescriptions and 17/60 (28%) units provided patient information on opioid risks. Formal training on acute postoperative pain management was confirmed for only 22/83 (27%) responding units. Discussion Six months after the drug safety update, there is evidence of significant impact, with most Trusts sharing the alert and moving away from modified‐release opioids. However, substantial work is still required. Key gaps include continued dispensing of modified‐release and combination opioids, and poor communication with patients and general practitioners regarding opioid risks and safe disposal.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"106 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147536360","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-reported outcomes, postoperative pain and pain relief after day-case surgery (POPPY): short-term peri-operative analgesic use.","authors":"Anna Ratcliffe,Martha Belete,Adam B Brayne,Harriet Daykin,Matthew Everson,William M Hare,Katy Samuel,Lexy Sorrell, ,Mark Rockett, ","doi":"10.1111/anae.70211","DOIUrl":"https://doi.org/10.1111/anae.70211","url":null,"abstract":"INTRODUCTIONAn increasing proportion of complex surgical procedures are being performed in the UK as day-cases, with variable and limited follow up. Discharge prescriptions must provide adequate analgesia, while considering the safety of the patient and public, following best practice guidance and good opioid stewardship.METHODSData were collected by the POPPY study, a national, prospective, observational study measuring short- and longer-term patient-reported outcomes relating to postoperative pain and pain relief after day-case surgery in adults. We aimed to describe pre-operative and early postoperative analgesia in the first 7 days following surgery alongside describing prescribing practices; analgesic use; patient satisfaction with pain relief; and the need for further healthcare support for pain management.RESULTSOf the 7839 patients recruited, 1985 (25.3%) were taking opioid analgesics pre-operatively, of whom 1366 (68.8%) reported pain of more than 3 months duration. After surgery, 3628 (46.4%) patients received opioid analgesics and 1229 (25.9%) reported taking opioid analgesics on day 7. Of those patients prescribed opioids after surgery, 474 (22.8%) reported never taking them. Over three-quarters of patients (3876, 76.7%) reported being satisfied with their analgesia, but 922 (18.2%) sought further help for pain relief, most commonly from their GP. Patients taking postoperative opioids reported higher pain scores; lower satisfaction scores; lower quality of recovery scores; and had higher rates of seeking help to manage pain after discharge.DISCUSSIONMost patients were satisfied with pain relief after surgery but a large proportion were still taking opioid medications on day 7. Nearly 1 in 5 patients sought additional help for pain relief, potentially constituting a significant burden on community health services. These findings suggest improvements could be made in the systems for day-case patient support after discharge.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"31 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147536502","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":"Cryoanalgesia for pain management after open thoracotomy: a reply","authors":"Marie‐Pierre Bonnet","doi":"10.1111/anae.70196","DOIUrl":"https://doi.org/10.1111/anae.70196","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"14 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147506769","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":"Cryoanalgesia for pain management after open thoracotomy","authors":"Hui Ju, Yi Feng","doi":"10.1111/anae.70176","DOIUrl":"https://doi.org/10.1111/anae.70176","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"20 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147506770","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":"Safer prehospital anaesthesia: updated guidelines from the Association of Anaesthetists.","authors":"David Lockey,Celestine Weegenaar,Imran Ahmad,Pascale Avery,Philip Cowburn,Richard M Lyon,Giles Nordmann,Andrew J Pountney,Cosmo F M Scurr,Matthew D Wiles","doi":"10.1111/anae.70191","DOIUrl":"https://doi.org/10.1111/anae.70191","url":null,"abstract":"INTRODUCTIONPrehospital emergency anaesthesia is recognised as a high-risk clinical intervention. These updated guidelines consider changes in prehospital practice and parallel changes in the practice of in-hospital emergency anaesthesia, with the aim of encouraging standardised safe anaesthetic practice in a challenging clinical area.METHODA working group was set up by the Association of Anaesthetists to include experts and resident doctors working in prehospital emergency medicine, anaesthesia, intensive care medicine and emergency medicine. There was also representation from relevant specialist groups and societies. We used a modified Delphi process and conducted targeted literature reviews to inform recommendations.RESULTSWe formulated recommendations in several key areas of prehospital emergency anaesthetic practice including general techniques; sedation before prehospital emergency anaesthesia; personnel and training; equipment and monitoring; prehospital emergency anaesthesia in children; and transport.DISCUSSIONClinical teams that provide prehospital emergency anaesthesia must be well trained and competent to deliver the procedure to the same standards as their colleagues in the receiving emergency department. Although patients requiring prehospital emergency anaesthesia are often physiologically unstable and have pathology associated with a high mortality, there is good evidence that prehospital emergency anaesthesia can be delivered safely and to high standards.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"17 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502193","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 effect of hospital‐level fine particulate matter exposure on surgical complications","authors":"John F. Pearson, Calvin S. Riss, Douglas A. Colquhoun, Yue Zhang, Matthew J. Strickland","doi":"10.1111/anae.70207","DOIUrl":"https://doi.org/10.1111/anae.70207","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"58 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478125","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}