Anaesthesia最新文献

{"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,&nbsp;Salmaan-Javed Mughal,&nbsp;Dhruv Parekh,&nbsp;Jaimin M. Patel,&nbsp;David McNulty,&nbsp;Mansoor N. Bangash","doi":"10.1111/anae.16568","DOIUrl":"10.1111/anae.16568","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All elective major non-cardiac surgical episodes, occurring between 2015 and 2020, were identified retrospectively. Patients without measured peri-operative renal parameters were not studied. Our primary outcome was 7-day postoperative acute kidney injury rate, defined using Kidney Disease Improving Global Outcomes criteria. Multivariable logistic regression modelling was used to assess risk factors for postoperative acute kidney injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Postoperative acute kidney injury occurred in 1334/13,790 (9.7%) episodes, with 663 (49.7%) occurring on day 1. Postoperative acute kidney injury was associated with increased peri-operative complications (OR 1.8, 95%CI 1.6–2.1, p &lt; 0.001), unanticipated critical care admissions (OR 2.4, 95%CI 1.6–3.5, p &lt; 0.001) and in-hospital mortality (OR 8.0, 95%CI 5.1–12.5, p &lt; 0.001). Independent risk factors for postoperative acute kidney injury include: raised creatinine; hypertension; anaemia; platelet: lymphocyte ratio; heart rate; male sex: renin-angiotensin-aldosterone system blockade; and intra-abdominal surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Postoperative acute kidney injury is common and is associated with adverse outcomes. Prevalence peaks initially within the first 48 h, with a secondary rise seen from day 5 onwards, suggesting a different aetiology. It is determined by a combination of patient and surgical risk factors, with the former relating to physiological, rather than chronological, renal age. In common with peri-operative myocardial injury, postoperative acute kidney injury is independently associated with factors affecting autonomic tone and myeloid skewing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 6","pages":"662-672"},"PeriodicalIF":7.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16568","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":"OA","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}

{"title":"Videolaryngoscope designs for tracheal intubation in adults: a systematic review with network meta-analysis of randomised controlled trials","authors":"Clístenes C. de Carvalho, Idrys H. L. Guedes, Maria V. M. Dantas, Pedro H. A. Batista, João B. L. Neto, Ana V. R. França, Danilo B. G. Souza, Kariem El-Boghdadly","doi":"10.1111/anae.16597","DOIUrl":"https://doi.org/10.1111/anae.16597","url":null,"abstract":"Videolaryngoscopy improves tracheal intubation outcomes compared with direct laryngoscopy in various scenarios. However, the range of videolaryngoscope designs makes it challenging to identify the most effective device. We conducted a systematic review and network meta-analysis to compare different laryngoscope designs when used for tracheal intubation of adults under general anaesthesia.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"37 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599613","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":"Outcomes for patients with alcohol-related liver disease admitted to Scottish intensive care units 2010–2018","authors":"Alaina Shariff, Stella Rhode, Stuart J. Forbes, Nazir Lone, Annemarie Docherty","doi":"10.1111/anae.16599","DOIUrl":"https://doi.org/10.1111/anae.16599","url":null,"abstract":"Alcohol-related liver disease is recognised as a major cause of liver-related morbidity and mortality. Our aim was to report the prevalence of, and outcomes from, alcohol-related liver disease after admission to ICUs in Scotland.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"47 7 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599375","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":"Regional anaesthesia for awake urgent upper limb surgery in children: a prospective cohort study","authors":"Olivier Maupain, Bernard Delvaux, Davy Huynh, Franck Ehooman, Nabil Zanoun, Thierry Garnier, Bertrand Morel, Clémence Franck, Thomas Giral","doi":"10.1111/anae.16594","DOIUrl":"https://doi.org/10.1111/anae.16594","url":null,"abstract":"Peripheral regional anaesthesia is used rarely as the sole anaesthetic technique in children and is often combined with deep sedation or general anaesthesia for analgesic purposes. No literature addresses the minimum age at which regional anaesthesia can be considered to facilitate awake surgery in children. We hypothesised that children of school age could undergo awake urgent upper limb surgery with regional anaesthesia supported by anxiety-reduction strategies.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"213 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599373","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":"Neuromuscular blockade and BMI-related postoperative pulmonary complications","authors":"Yusuke Miyazaki","doi":"10.1111/anae.16592","DOIUrl":"10.1111/anae.16592","url":null,"abstract":"<p>We read with great interest the large retrospective cohort study by Qin et al. [<span>1</span>], which provides valuable insights into the association between BMI and postoperative pulmonary complications in adults undergoing non-cardiac, non-obstetric surgery. It highlights the so-called ‘obesity paradox’ and its possible influence on postoperative pulmonary complications, and challenges conventional assumptions that being overweight and living with obesity are unequivocal risk factors.</p><p>Given that postoperative pulmonary complications arise from multifactorial influences—anaesthetic, surgical and patient-related—neuromuscular considerations may be a relevant addition to the discussion on BMI-related risk [<span>2</span>]. A large, single-centre investigation showed a dose-dependent rise in postoperative pulmonary complications following the use of intermediate-acting neuromuscular blocking drugs [<span>3</span>]. Moreover, sugammadex should be dosed according to total body weight [<span>4</span>]. Quantitative neuromuscular monitoring is vital to confirm complete recovery from neuromuscular blockade and prevent potential complications [<span>5</span>].</p><p>Further investigation of how pharmacological and monitoring strategies interact with BMI-related risk could provide deeper insights into the authors' findings. In particular, optimising neuromuscular blocking drug dosing, ensuring appropriate antagonism of neuromuscular blockade and employing quantitative neuromuscular monitoring warrant closer examination to elucidate the impact of obesity on postoperative pulmonary complications.</p><p>We suggest that a more detailed analysis of neuromuscular blocking drug choice, dosing regimen, monitoring technique and timing of antagonism could further strengthen this important work.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 6","pages":"727-728"},"PeriodicalIF":7.5,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16592","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596074","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":"Assessing the influence of after-hours surgery: concerns with the confounders and conclusion","authors":"Kotaro Sakurai,&nbsp;Chikashi Takeda","doi":"10.1111/anae.16591","DOIUrl":"10.1111/anae.16591","url":null,"abstract":"<p>Oh et al. [<span>1</span>] used a large sample size to analyse short-term complications and long-term outcomes of after-hours surgery, providing valuable insights into operating theatre management. The use of propensity scores to adjust for the higher likelihood of high-urgency patients and those with severe comorbidities being managed after-hours is commendable. However, critical potential confounders and analytical errors introduce complexities that hinder clear interpretation of the results.</p><p>Given the well-established impact of emergency surgeries on patient outcomes [<span>3, 4</span>], it is likely that the increased frequency of emergency surgeries contributed to the poorer after-hours outcomes observed. Additional discrepancies between the exposure rates and absolute standardised mean difference results for other factors, such as solid organ transplantation or surgeries for severe trauma, highlight the need for further clarification. Table S5 includes the essential background factors for discussing the generalisability of the results [<span>1</span>]. We hope that these errors will be addressed.</p><p>Second, the dataset lacks detailed information on the surgical procedures. Certain surgeries, particularly life-saving ones, are more likely to occur after-hours [<span>5</span>], which could lead to an overestimation of the association between after-hours surgery and increased 90-day and 1-year mortalities. The authors should consider identifying the most common surgeries performed in-hours and after-hours. If this is not feasible owing to database limitations, it should be explicitly acknowledged as a significant constraint.</p><p>Finally, the conclusion, “<i>The results of our study serve as evidence to inform policy decisions on which surgeries should be performed after-hours, considering patient safety</i>”, may not apply to this patient group, which includes emergency surgeries. These, by nature, require immediate intervention regardless of the time of the day, making it challenging to derive policy recommendations based on this dataset. A more appropriate approach would be to analyse patient groups restricted to elective surgeries. As they can be scheduled flexibly, obtaining similar results in these cases would provide a stronger foundation for policy decisions. To address the concern regarding the influence of emergency surgeries on outcomes, an additional analysis could further strengthen the validity of the conclusions.</p><p>We concur with the authors that their discussion on the impact of anaesthetist and surgeon fatigue, limited night-time resources and circadian rhythm effects is crucial for optimising surgical scheduling to improve patient safety. Fixing the errors and adding more analyses would strengthen this argument greatly.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 5","pages":"596-597"},"PeriodicalIF":7.5,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16591","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582807","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}