Anaesthesia最新文献

{"title":"Adjustment of positive end-expiratory pressure based on body mass index during general anaesthesia: a randomised controlled trial.","authors":"Helene Selpien,Jann Penon,David Thunecke,Dirk Schädler,Ingmar Lautenschläger,Henning Ohnesorge,Christine Eimer,Caroline Wolf,Armin Sablewski,Tobias Becher","doi":"10.1111/anae.16656","DOIUrl":"https://doi.org/10.1111/anae.16656","url":null,"abstract":"INTRODUCTIONLung-protective ventilation is essential for preventing postoperative pulmonary complications. While maintaining a low driving pressure and optimising PEEP is of importance, the ideal strategy remains contentious. This study evaluated whether adjusting PEEP based on BMI, compared with standard PEEP, could reduce driving pressure and peri-operative loss of lung aeration.METHODSWe conducted a randomised controlled, patient-blinded, single-centre superiority trial with two parallel groups. Adult patients undergoing surgery with general anaesthesia who required tracheal intubation were assigned randomly to either standardised PEEP (PEEP = 5 cmH2O; group PEEP-5) or PEEP set according to BMI (PEEP = BMI/3 cmH2O; group PEEP-BMI/3). Patients' lungs were ventilated using a volume-controlled mode with tidal volumes of 7 ml.kg-1 predicted body weight. Lung aeration scores were assessed using ultrasound pre- and postoperatively.RESULTSSixty patients were enrolled and allocated randomly. Adjustment of PEEP according to BMI/3 was associated with a significantly lower driving pressure, with a median (IQR [range]) of 8.9 (7.1-10.4 [5.2-14.9]) cmH2O in group PEEP-5 and 7.9 (7.2-8.5 [5.9-14.1]) cmH2O in group PEEP-BMI/3 (p = 0.027) and higher mean (SD) respiratory system compliance (group PEEP-5, 0.83 (0.20) ml cmH2O-1 kg-1 predicted body weight vs. group PEEP-BMI/3, 0.95 (0.17) ml cmH2O-1 kg-1 predicted body weight; p = 0.020). Lung ultrasound revealed a reduced postoperative loss of lung aeration in patients allocated to the BMI/3 group. Patients allocated to the BMI-adjusted group required less supplemental oxygen, had less newly developed atelectasis and had higher oxygen saturations upon arrival in the post-anaesthesia care unit.DISCUSSIONIn patients without major pulmonary disease who were undergoing non-cardiothoracic surgeries with tracheal intubation, adjusting PEEP based on a calculation of BMI/3 improved lung mechanics and reduced postoperative loss of lung aeration. This approach provides a straightforward and pragmatic method for individualising PEEP in patients undergoing general anaesthesia.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"9 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370308","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 use of blood components and their alternatives: a comment","authors":"Bernhard Rohrbacher","doi":"10.1111/anae.16666","DOIUrl":"10.1111/anae.16666","url":null,"abstract":"<p>Following the publication of the <i>Association of Anaesthetists guidelines: the use of blood components and their alternatives</i> [<span>1</span>], we write to highlight a couple of inaccuracies for due consideration and correction.</p><p>We were pleased to note the mention of Fibryga^® (Octapharma Ltd, Manchester, UK) as the only fibrinogen concentrate with an acquired fibrinogen deficiency indication over the course of surgery. The guideline rightly highlights Fibryga's additional indication as complementary therapy for the management of uncontrolled severe haemorrhage in patients with acquired hypofibrinogenaemia during surgery. However, Table 2 mentions the use of fibrinogen concentrate for major haemorrhage as ‘<i>off label</i>’ [<span>1</span>]. In the context of these guidelines, which address the peri-operative use of blood components and their alternatives, this could be misunderstood and should be amended. As per the indication mentioned above, Fibryga can be used peri-operatively to manage major haemorrhage across specialties.</p><p>We acknowledge that there is currently no published superiority data for Fibryga vs. cryoprecipitate. However, many centres in the UK are opting to use it in specific circumstances due to its logistical benefits in reducing transfusion delays. These include a room temperature storage requirement (at a maximum of 25°C) that allows it to be kept at the point of use; speedier preparation time of around 5 min; 24 h stability at room temperature post reconstitution; and a lower volume per dose [<span>2</span>].</p><p>It would be good if the guidance could be amended to reflect this, particularly as we are seeing more UK centres protocolising the move towards fibrinogen concentrates in acquired fibrinogen deficiency, for the reasons stated above.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 8","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16666","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367795","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":"Clarifying the role of fibrinogen concentrate in major haemorrhage: a reply","authors":"Akshay Shah,&nbsp;Simon J. Stanworth,&nbsp;Andrew A. Klein,&nbsp;the Association of Anaesthetists' Working Party for the use of blood components and their alternatives","doi":"10.1111/anae.16672","DOIUrl":"10.1111/anae.16672","url":null,"abstract":"<p>We thank Dr Rohrbacher for his comments regarding the use of fibrinogen concentrate to manage major haemorrhage across specialties [<span>1</span>]. We agree that its use is no longer ‘off-label’ and have corrected this accordingly in Table 1 here and a corrigendum will be issued to accompany the guidelines [<span>2</span>]. However, we would like to highlight that the current indication listed in the Summary of Product Characteristics: “<i>treatment of bleeding episodes and peri-operative prophylaxis in patients with congenital hypo- or afibrinogenaemia with bleeding tendency</i>”, is subject to interpretation.</p><p>We agree that there are currently no published superiority clinical effectiveness data for human fibrinogen concentrate (Fibryga^®, Octapharma Ltd, Manchester, UK) over cryoprecipitate. This should be balanced against the putative benefits of fibrinogen concentrate (logistical advantages, storage requirements, preparation times). Previous systematic reviews have shown a paucity of high-quality data [<span>3</span>], but the evidence-base is shifting. Recently, the FIBRES trial showed that fibrinogen concentrate was non-inferior to cryoprecipitate in patients undergoing cardiac surgery [<span>4</span>]. A within-trial health economic evaluation of FIBRES found that fibrinogen concentrate was cost-effective when compared with cryoprecipitate [<span>5</span>]. An ongoing phase-3 randomised trial, FEISTY-2 [<span>6</span>], will allocate 850 patients randomly from Australian and New Zealand major trauma centres to receive either fibrinogen concentrate or cryoprecipitate.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 8","pages":"1015-1016"},"PeriodicalIF":7.5,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16672","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367794","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":"Perioperative Quality Initiative consensus statement recommendations on the definition, development, implementation and outcomes of pre-operative surgery schools.","authors":"Imogen Fecher-Jones,Ben Ainsworth,Tong J Gan,S Ramani Moonesinghe,Andrew D Shaw,Michael P W Grocott,Denny Z H Levett,","doi":"10.1111/anae.16648","DOIUrl":"https://doi.org/10.1111/anae.16648","url":null,"abstract":"INTRODUCTIONPre-operative group sessions incorporating patient education and behaviour change interventions, known as 'surgery schools', are becoming increasingly common before major elective surgery across the world. However, there is a lack of conclusive evidence regarding the effectiveness of surgery schools, and the development and delivery of these complex interventions lacks standardisation.METHODSIn collaboration with the Perioperative Quality Initiative, we aimed to develop evidence- and expertise-based consensus statements and recommendations regarding the definition, design, content, and outcomes of surgery schools. Thirty-two international multidisciplinary experts in surgery school and pre-operative preparation attended a series of virtual meetings based on a modified Delphi methodology. A systematic review and additional targeted literature searches were used to propose statements for the definition, design, content and outcomes of surgery schools. Statements and recommendations were discussed iteratively and refined in multiple rounds, until agreement was reached.RESULTSConsensus was reached on a definition of surgery school, as well as three statements and 18 recommendations in relation to: scope; outcomes; intervention development; delivery; inclusivity; and educational content of surgery schools. Seventeen areas were highlighted as priorities for future research.DISCUSSIONThese consensus statements and recommendations are intended to help clinicians and service managers who plan to develop and implement surgery schools. They may improve the quality of those programmes and help to standardise their content. We also hope that this work will influence government strategy and policy in relation to the design, delivery and funding of peri-operative optimisation pathways.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"15 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337477","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 use of high-flow nasal oxygen in obstetric patients: a systematic review.","authors":"Robert Craig,Lucy Curran,Sohail Bampoe,Peter Odor,Lindsay Blake,Brendan Carvalho,James O'Carroll","doi":"10.1111/anae.16665","DOIUrl":"https://doi.org/10.1111/anae.16665","url":null,"abstract":"INTRODUCTIONHigh-flow nasal oxygen devices have gained interest in pre-oxygenation and peri-operative oxygenation strategies. However, their role in obstetric anaesthesia remains poorly defined. This systematic review aimed to evaluate the use of high-flow nasal oxygen in obstetric patients during the peri-operative period, focusing on maternal oxygenation and clinical outcomes.METHODSWe included studies published in any language, conducted in all countries. Search terms included terminology concerning obstetric anaesthesia related to the use of high-flow nasal oxygen in the peri-operative period. Included papers were assessed for risk of bias. Studies were included for detailed review if they evaluated the use of high-flow nasal oxygen as a pre-oxygenation strategy in obstetric patients and reported maternal or neonatal outcomes.RESULTSA total of 649 abstracts were screened with 11 articles included. There was variation in pre-oxygenation strategies and primary outcomes. Available evidence suggests that high-flow nasal oxygen was not superior to facemask pre-oxygenation in achieving target end-tidal oxygen concentrations. High-flow nasal oxygen may increase the partial pressure of oxygen in arterial blood, but the evidence of increased apnoea time was inconsistent. There were no reported adverse maternal effects or differences in neonatal Apgar scores, umbilical cord gases or fetal heart rate assessments.DISCUSSIONThe advantages of peri-operative high-flow nasal oxygen over conventional oxygenation methods for obstetric patients remain uncertain. Current evidence does not show a clear benefit of high-flow nasal oxygen in achieving pre-oxygenation targets or prolonging time to desaturation in low-risk patients, whilst the benefits in high-risk patients remain uncertain and warrant further investigation.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"11 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311578","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.16340","DOIUrl":"https://doi.org/10.1111/anae.16340","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 7","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16340","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300186","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":"What's a woman got to do to get an epidural round here? Testing mothers and their capacity to the limits","authors":"David G. Bogod, Kate McCombe","doi":"10.1111/anae.16663","DOIUrl":"https://doi.org/10.1111/anae.16663","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"153 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144305176","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":"An obituary for postoperative use of modified‐release opioids","authors":"Nicholas Levy, Dileep N. Lobo, Pamela E. Macintyre","doi":"10.1111/anae.16661","DOIUrl":"https://doi.org/10.1111/anae.16661","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"145 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311315","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":"Enhancing emergency front-of-neck airway training: a mixed methods study on the impact of external noise and startle stressors","authors":"James Cassidy, Jennifer Reynolds, Tamryn Miller, Thomas Miller, Jeremy M Brown, Ben Morton, Peter Groom","doi":"10.1111/anae.16650","DOIUrl":"https://doi.org/10.1111/anae.16650","url":null,"abstract":"Our aim was to investigate whether emergency front-of-neck airway training utilising low-fidelity manikins in a ‘tea-trolley’ format could be improved by the incorporation of stress inoculation training. This would be an important advance as clinicians report that cognitive overload impairs performance during real emergencies. We hypothesised that environmental noise and simulated blood splatter would result in a heightened stress experience.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"23 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144305167","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":"Intra-operative ventilation: searching for the Holy Grail","authors":"Harish Venkatesh,&nbsp;Kindha McLaren,&nbsp;Akshay Shah,&nbsp;Sanooj Soni","doi":"10.1111/anae.16664","DOIUrl":"10.1111/anae.16664","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 8","pages":"887-891"},"PeriodicalIF":7.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144305213","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}