Anaesthesia最新文献

{"title":"The controversy of pre-operative opioid tapering and an opportunity to advance personalised, patient-centred pain medicine.","authors":"Dáire N Kelly, Edward R Mariano, Kellie M Jaremko","doi":"10.1111/anae.16412","DOIUrl":"https://doi.org/10.1111/anae.16412","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981527","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":"First-choice videolaryngoscopy for paediatric intubation","authors":"Fu-Shan Xue, Dan-Feng Wang, Xiao-Chun Zheng","doi":"10.1111/anae.16419","DOIUrl":"https://doi.org/10.1111/anae.16419","url":null,"abstract":"<p>In a study of 904 tracheal intubations in 809 children, Sasu et al. showed that using a C-MAC® videolaryngoscope (Karl Storz, Tuttlingen, Germany) reduced the incidence of poor glottic views from 13% to 4% [<span>1</span>]. They also found the modified six-grade Cormack and Lehane system ineffective for predicting the ease of videolaryngoscopic tracheal intubation. The primary outcome of this study was defined as vocal cords only just or not visible. Restricted glottic views in the modified Cormack and Lehane classifications 2b, 2c and 3 during videolaryngoscopy in adult and paediatric patients are typically due to an enlarged epiglottis and impaired epiglottic movement. Such issues can be resolved by correct head positioning, increased lifting force, directly lifting the epiglottis or external laryngeal manipulation [<span>2-4</span>]. However, the results do not specify whether these techniques were applied to enhance the view of the glottis, leaving us unsure if the observed glottic view grades represent the best possible outcome using both modes of laryngoscopy, particularly direct laryngoscopy that requires aligning the three airway axes for proper visualisation.</p>\u0000<p>Difficult videolaryngoscopic tracheal intubation was documented as a difficult airway alert based on the videolaryngoscopic intubation and difficult airway classification (VIDIAC) score in adult patients with anticipated difficult airways. Kohse et al. classified difficulty into four levels using VIDIAC scores [<span>2</span>], but it is unclear whether a score of 1, which indicates a 50% probability of a difficult airway, was counted as difficult in this study. Although the VIDIAC score was a secondary outcome, its results were not reported, nor was its effectiveness in differentiating easy from difficult videolaryngoscopic tracheal intubations in paediatric patients analysed, despite most having normal airways. Clarifying these aspects could strengthen the conclusions.</p>\u0000<p>The overall first attempt tracheal intubation success rate is significantly lower at 67% compared with a rate of 86.8% in a previous study, which focused on children undergoing elective airway management using videolaryngoscopes with standard blades [<span>5</span>]. Similarly, the success rate for first attempt tracheal intubation in children aged ≤ 1 y (48%) is much lower than the rate in a recent trial studying urgent tracheal intubations in newborns using C-MAC videolaryngoscopy (74%) [<span>6</span>]. Based on our own experience and existing studies [<span>7</span>], a stylet aids in directing the tracheal tube tip to the glottis and enhances tracheal intubation performance with the C-MAC videolaryngoscopy, even when there is a clear view of a child's vocal cords. Hence, we would like to know if a stylet was used in all cases.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":10.7,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141974201","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":"Time for mandatory safety preparedness: a responsibility for individuals, hospitals and national bodies.","authors":"Andrew D Kane, Jasmeet Soar, Tim M Cook","doi":"10.1111/anae.16418","DOIUrl":"https://doi.org/10.1111/anae.16418","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141915911","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 how and the what of mandatory training.","authors":"Nisha Abraham-Thomas, Imran Ahmad, Kariem El-Boghdadly","doi":"10.1111/anae.16414","DOIUrl":"https://doi.org/10.1111/anae.16414","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141915910","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":"Withholding or continuing angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers on acute kidney injury after non-cardiac surgery.","authors":"Marike Rademan, Conall Hayes, Aoife Lavelle","doi":"10.1111/anae.16409","DOIUrl":"https://doi.org/10.1111/anae.16409","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141915912","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":"Peri-operative cardiac arrests in Sweden 2013–2022: data analysis of incidence and trends","authors":"Malin Sunborger,&nbsp;Jan G. Jakobsson","doi":"10.1111/anae.16396","DOIUrl":"10.1111/anae.16396","url":null,"abstract":"&lt;p&gt;In Europe, out-of-hospital cardiac arrests have an annual incidence rate of 7–17/10,000 per capita and in-hospital cardiac arrests have an annual incidence rate of 15–28/10,000 hospital admissions [&lt;span&gt;1&lt;/span&gt;]. The incidence of in-hospital cardiac arrests in Sweden is 16/10,000 hospital admissions [&lt;span&gt;2&lt;/span&gt;]. We conducted a study assessing if the incidence of peri-operative cardiac arrest had decreased in Sweden from 2013 to 2022. We also assessed the association between 30-day mortality, patient characteristics and urgency of surgery. All patients aged ≥ 18 y experiencing peri-operative cardiac arrest in the Swedish Perioperative Register (SPOR) between January 2013 and June 2022 were included. Total number of surgical procedures with complete data for patients aged ≥ 18 y registered in SPOR from 2013 to 2022 was used as the denominator (n = 3,049,782).&lt;/p&gt;&lt;p&gt;The primary outcome was the incidence of peri-operative cardiac arrest in 2022 compared with 2013. Secondary outcomes were 30-day all-cause mortality and association of peri-operative cardiac arrest with patient characteristics and urgency. Descriptive and regression analysis was performed. In total, 749 patients (51.6% male, mean (SD) age 69 (17.4) y) experienced peri-operative cardiac arrest during the study period. Patient characteristics and urgency are presented in Table 1. Year was missing for 13 cases of peri-operative cases leaving 736 for analysis. This equates to an overall annual incidence of peri-operative cardiac arrest of 2.4/10,000 procedures (95%CI 2.2–2.6). There was no significant difference over the period studied: 2.9/10,000 procedures in 2013 vs. 1.8/10,000 procedures in 2022. The highest incidence of peri-operative cardiac arrest and highest 30-day mortality rate was seen in patients who underwent emergency surgeries (54%). Hip fracture surgery was the most common planned surgical intervention, (n = 120, 16%) during the study period, followed by abdominal surgery (n = 118, 16%). 30-day mortality following cardiac arrest was 48% and mortality rate was 1.2/10,000 procedures (95%CI 0.7–1.5). Odds ratio (OR) for 30-day mortality increased with age (65–80 y, OR 2.32 (95%CI 1.43–3.77), &gt; 80 y, OR 6.11 (95%CI 3.57–10.45)); ASA physical status 3–5 (OR 2.81 (95%CI 1.74–4.54)); and surgical urgency (emergent OR 2.89 (95%CI 1.85–4.51), immediate 9.20 (95%CI 4.80–17.65)) but showed no significant change over time when adjusted for co-factors.&lt;/p&gt;&lt;p&gt;The overall incidence of peri-operative cardiac arrest in Sweden among adult patients (2.4 per 10,000 procedures) is lower compared with previous studies which ranged between 3–7 per 10,000 [&lt;span&gt;3, 4&lt;/span&gt;]. A recent UK study found incidence rates of 3.0–3.5 per 10,000 interventions [&lt;span&gt;4&lt;/span&gt;]. In that cohort, however, patients from infancy up to age 18 y (n = 12%) were included in the study. The Royal College of Anaesthetists, in its updated National Audit project (NAP7), defined peri-operative cardiac arrest a","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16396","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905557","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":"NAP7 - have we lost the point?","authors":"William Ward, Helen Aoife Iliff","doi":"10.1111/anae.16404","DOIUrl":"https://doi.org/10.1111/anae.16404","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900730","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":"Issue Information – Editorial Board","authors":"","doi":"10.1111/anae.16273","DOIUrl":"10.1111/anae.16273","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16273","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141904609","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":"Evaluation of the i-gel® Plus supraglottic airway device in elective surgery: a prospective international multicentre study.","authors":"Jakub Werner, Olga Klementova, Jan Bruthans, Jaromir Macoun, Tomasz Gaszynski, Tomas Henlin, Will Donaldson, Erik Lichnovsky, Shiva Arava, Ana M Lopez, Raquel Berge, Pavel Michalek","doi":"10.1111/anae.16401","DOIUrl":"https://doi.org/10.1111/anae.16401","url":null,"abstract":"<p><strong>Background: </strong>The i-gel® Plus is a modified version of the i-gel® supraglottic airway device. It contains a wider drainage port; a longer tip; ramps inside the breathing channel; and an additional port for oxygen delivery. There has been no prospective evaluation of this device in clinical practice.</p><p><strong>Methods: </strong>This international, multicentre, prospective cohort study aimed to evaluate the performance of the i-gel Plus in adult patients undergoing elective procedures under general anaesthesia. The primary outcome was overall insertion success rate, defined as the ability to provide effective airway management through the device from insertion until the end of the surgical procedure. Secondary outcomes included device performance and incidence of postoperative adverse events. Data from the first 1000 patients are reported.</p><p><strong>Results: </strong>In total, 1012 patients were enrolled; 12 forms were excluded from the final analysis due to incomplete data leaving 1000 included patients (545 female). Overall insertion success rate was 98.6%, with a first-attempt success rate of insertion of 88.2%. A significant difference between females and males was seen for the overall success rate (97.4% vs. 99.6% respectively) but not for first-attempt successful insertion. Mean (SD) oropharyngeal seal pressure was 32 (7) cmH₂O. The only independent factor that increased the risk of first-attempt failure was low operator experience. Complications included desaturation < 85% in 0.6%; traces of blood on the device in 7.4%; laryngospasm in 0.5%; and gastric contents inside the bowl in 0.2% of patients.</p><p><strong>Conclusions: </strong>The i-gel Plus appears to be an effective supraglottic airway device that is associated with a high insertion success rate and a reasonably low incidence of complications.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900728","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 time of day on outcomes in elective surgery: a systematic review.","authors":"Arjen J G Meewisse, Annerixt Gribnau, Steven E Thiessen, Dirk Jan Stenvers, Jeroen Hermanides, Mark L van Zuylen","doi":"10.1111/anae.16395","DOIUrl":"https://doi.org/10.1111/anae.16395","url":null,"abstract":"<p><strong>Background: </strong>The timing of elective surgery could affect clinical outcome because of diurnal rhythms of patient physiology as well as surgical team performance. Waiting times for elective surgery are increasing in many countries, leading to increasing interest in undertaking elective surgery in the evening or at night. We aimed to systematically review the literature on the effect of the timing of elective (but not urgent or emergency) surgery on mortality, morbidity and other clinical outcomes.</p><p><strong>Methods: </strong>We searched databases for relevant studies combining the terms 'circadian rhythm' and 'anaesthesia/surgery'. Additional relevant articles were found by hand-searching the references. All studies were screened for bias. Included studies examined daytime vs. evening/night-time surgery, morning vs. afternoon surgery, multiple timeslots or used time as a continuous variable.</p><p><strong>Results: </strong>Nineteen retrospective cohort studies, one prospective cohort study and one randomised controlled trial were included (n = 798,914). Evening/night-time elective surgery was associated with a higher risk of mortality when compared with daytime procedures in three studies (n = 611,230), with odds ratios (95%CI) for mortality ranging from 1.35 (1.16-1.56) to 3.98 (1.54-10.30), while no differences were found in three other studies (n = 142,355). No differences were found for morning vs. afternoon surgery (four studies, n = 3277). However, most studies had a low quality of evidence due to their retrospective nature and because not all studies corrected for patient characteristics. Moreover, the studies were heterogeneous in terms of the reported time slots and clinical outcomes.</p><p><strong>Conclusions: </strong>We found that evening/night-time elective surgery is associated with a higher risk of mortality compared with daytime surgery. However, the quality of evidence was graded as low, and thus, future prospective research should publish individual patient data and standardise outcome measures to allow firm conclusions and facilitate interventions.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896496","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}