Anaesthesia最新文献

{"title":"Hyperangulated videolaryngoscopy: styletiquette.","authors":"Jane L Orrock, Patrick A Ward","doi":"10.1111/anae.16408","DOIUrl":"https://doi.org/10.1111/anae.16408","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":"141900729","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":"Consensus on decommissioning piped nitrous oxide from UK and Ireland operating theatre suites: a rational approach to an increasingly ignoble gas.","authors":"Paul Southall, Cliff Shelton, Alifia Chakera","doi":"10.1111/anae.16407","DOIUrl":"https://doi.org/10.1111/anae.16407","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":"141896495","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":"Have anaesthetists' concerns about anaesthesia associates finally been justified?","authors":"Andreas Sotiriou, Stuart Edwardson, Sarah Marsden","doi":"10.1111/anae.16402","DOIUrl":"https://doi.org/10.1111/anae.16402","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":"141896497","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":"NAP7 - something for everyone.","authors":"Mike Charlesworth","doi":"10.1111/anae.16405","DOIUrl":"https://doi.org/10.1111/anae.16405","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":"141900731","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":"Prospective development and validation of a universal classification for paediatric videolaryngoscopic tracheal intubation: the PeDiAC score.","authors":"Thorsten Dohrmann, Nelly Gutsche, Rilana Kramer, Eva M Zeidler, Katharina Röher, Viktor A Wünsch, André Dankert, Linda Krause, Christian Zöllner, Phillip B Sasu, Martin Petzoldt","doi":"10.1111/anae.16394","DOIUrl":"https://doi.org/10.1111/anae.16394","url":null,"abstract":"<p><strong>Background: </strong>The VIDIAC score, a prospectively developed universal classification for videolaryngoscopy, has shown excellent diagnostic performance in adults. However, there is no reliable classification system for videolaryngoscopic tracheal intubation in children. We aimed to develop and validate a multivariable logistic regression model and easy-to-use score to classify difficult videolaryngoscopic tracheal intubation in children and to compare it with the Cormack and Lehane classification. A secondary aim was to externally validate the VIDIAC score in children.</p><p><strong>Methods: </strong>We conducted a prospective observational study within a structured universal videolaryngoscopy implementation programme. We used C-MAC™ videolaryngoscopes in all children undergoing tracheal intubation for elective surgical procedures. We validated the VIDIAC score externally and assessed its performance. We then identified eligible co-variables for inclusion in the PeDiAC score, developed a multivariable logistic regression model and compared its performance against the Cormack and Lehane classification.</p><p><strong>Results: </strong>We studied 809 children undergoing 904 episodes of tracheal intubation. The VIDIAC score outperformed the Cormack and Lehane classification when classifying the difficulty of videolaryngoscopic tracheal intubation, with an area under the receiver operating characteristic curve of 0.80 (95%CI 0.73-0.87) vs. 0.69 (95%CI 0.62-0.76), respectively, p = 0.018. Eight eligible tracheal intubation-related factors, that were selected by 100-times repeated 10-fold cross-validated least absolute shrinkage selector operator regression, were used to develop the PeDiAC model. The PeDiAC model and score showed excellent diagnostic performance and model calibration. The PeDiAC score achieved significantly better diagnostic performance than the Cormack and Lehane classification, with an area under the receiver operating characteristic curve of 0.97 (95%CI 0.96-0.99) vs. 0.69 (95%CI 0.62-0.76), respectively, p < 0.001.</p><p><strong>Conclusion: </strong>We developed and validated a specifically tailored classification for paediatric videolaryngoscopic tracheal intubation with excellent diagnostic performance and calibration that outperformed the Cormack and Lehane classification.</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":"141896498","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 functional capacity and motivation to engage in physical activity before surgery","authors":"Kyle Tingling,&nbsp;David E. Conroy,&nbsp;Margaret K. Danilovich,&nbsp;Daniel S. Rubin","doi":"10.1111/anae.16406","DOIUrl":"10.1111/anae.16406","url":null,"abstract":"&lt;p&gt;Functional capacity assessment before surgery identifies older adults at increased risk of functional decline after major surgery [&lt;span&gt;1&lt;/span&gt;]. Increasing physical activity before surgery has shown efficacy to mitigate functional decline afterwards [&lt;span&gt;2&lt;/span&gt;]. A key component necessary to initiate physical activity is motivation, defined as the processes that energises, orients and sustains behaviour. The COM-B model proposes that there are three necessary components for any behaviour change to occur: capability; opportunity; and motivation. As physical activity interventions before surgery vary in the amount of supervision and social support provided (i.e. facility based vs. home-based), individual differences in self-determined motivation may impact participation and improvements in functional capacity. It is unclear whether motivation for physical activity varies between patients with high vs. low functional capacity before surgery. Links between these determinants would indicate the need for multifaceted strategies and our aim was to explore the association between motivation and functional capacity.&lt;/p&gt;&lt;p&gt;Older adults (aged ≥ 60 y) were screened prospectively from the Anaesthesia Peri-operative Medicine Clinic at the University of Chicago Medical Center. Patients were included if they were able to walk with or without an assistive device. We did not study those patients who were non-English speaking or scheduled for ophthalmic surgery. The University of Chicago institutional review board approved the study and written informed consent was obtained. Patient characteristics, medical history and structured questionnaires were assessed. We used the 19-item Behavioural Regulation in Exercise Questionnaire [&lt;span&gt;3&lt;/span&gt;]. Patients rated each item on a 5-point Likert scale (0–4, 0 = not true for me; 4 = very true for me) to assess five reasons for engaging in physical activity. Scale scores were weighted and combined to estimate the relative autonomy index score, a cumulative score of level of self-determined motivation. Lower, negative scores indicated more controlled regulation whereas higher, positive scores indicated larger relative autonomy. We used the Fried frailty phenotype to evaluate frailty status and the Duke Activity Status Index (DASI) to measure functional capacity [&lt;span&gt;4, 5&lt;/span&gt;]. A DASI score &lt; 34 identified patients with a poor functional capacity who may benefit from exercise before surgery [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We performed descriptive analyses for patient characteristics, comorbidities, frailty, outcome expectations and motivation to exercise. We used χ&lt;sup&gt;2&lt;/sup&gt; tests for categorical variables or t-tests for continuous variables for comparisons between patients with low and high functional capacity. To evaluate for differences in relative autonomy index and motivation subtypes we used the Mann–Whitney U test. All analyses were performed using STATA v16.1 (StataCorp LLC, College Station, TX, USA).&lt;/p&gt;&lt;","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.16406","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900727","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":"A trainee perspective on anaesthesia associates and their scope of practice - caution and clarity are needed.","authors":"Wesley Channell","doi":"10.1111/anae.16403","DOIUrl":"https://doi.org/10.1111/anae.16403","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":"141900726","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":"Are we putting patients on steroid treatment at risk under anaesthesia?","authors":"Jeremy W. Tomlinson","doi":"10.1111/anae.16375","DOIUrl":"10.1111/anae.16375","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141892657","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 Replacement of Exogenous Steroids (PREdS): a national audit of current peri-operative prescribing for patients taking therapeutic steroids","authors":"Oliver J. H. Barker,&nbsp;Aravind V. Ramesh,&nbsp;Inthu Kangesan,&nbsp;Jonathan Barnes,&nbsp;Suzanne Harrogate,&nbsp;Swati Gupta,&nbsp;Barnaby C. Reeves,&nbsp;Ben Gibbison,&nbsp;the PREdS Trainee Research Network Collaborators","doi":"10.1111/anae.16388","DOIUrl":"10.1111/anae.16388","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Approximately 1% of the UK population take oral corticosteroids for ≥ 28 days each year, for broadly two reasons: deficiency in corticosteroid requiring replacement; or therapeutic corticosteroid for inflammatory conditions. Acute deficiency can occur at times of physiological stress (e.g. surgery), potentially leading to major complications. The Association of Anaesthetists' 2020 consensus guideline provides detailed advice for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency. This national audit aimed to assess compliance with this guideline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were collected from 59 Trusts over 14 consecutive days for all eligible patients undergoing procedures under the care of an anaesthetist. Patients who were prescribed ≥ 5 mg oral prednisolone equivalents pre-operatively, in whom supplementary corticosteroid would be indicated, were compared with those prescribed &lt; 5 mg oral prednisolone equivalents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Operations for 21,731 patients were audited: 277 (1.3%) patients were taking therapeutic corticosteroids. Detailed peri-operative data were collected for all patients receiving therapeutic corticosteroids: 201/277 (73%) were ASA physical status ≥ 3; 184/277 (66%) underwent elective procedures; and 252/277 (91%) were prescribed prednisolone pre-operatively, of whom 219/277 (79%) were prescribed ≥ 5 mg oral prednisolone equivalents. In the patients who were prescribed ≥ 5 mg oral prednisolone equivalents, 186/219 (85%) received pre-operative glucocorticoid supplementation and 97/219 (42%) received it postoperatively; however, only 67/219 (31%) and 43/219 (20%) respectively received glucocorticoid supplementation according to the guidelines. Overall, peri-operative prescribing was compliant in 19/219 (9%) patients. A similar proportion, 30/219 (14%), received no supplementation. In the patients taking &lt; 5 mg oral prednisolone equivalents pre-operatively, 28/58 (48%) received inappropriate supplementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite 125/277 (45%) of anaesthetists reporting Association of Anaesthetists' guidelines use, compliance remained low, with adherence in only 27/125 (22%) patients. Further research is required to identify the correct peri-operative strategy for patients taking therapeutic corticosteroids.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141880069","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":"Usability comparison scoring of video and direct laryngoscopes.","authors":"Stuart D Marshall","doi":"10.1111/anae.16397","DOIUrl":"https://doi.org/10.1111/anae.16397","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858834","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}