Anaesthesia最新文献

{"title":"The association between BMI and postoperative pulmonary complications in adults undergoing non-cardiac, non-obstetric surgery: a retrospective cohort study.","authors":"Pei-Pei Qin, Zhi-Qiao Wang, Ling Liu, Qiu-Ju Xiong, Dan Liu, Su Min, Ke Wei","doi":"10.1111/anae.16573","DOIUrl":"https://doi.org/10.1111/anae.16573","url":null,"abstract":"<p><strong>Introduction: </strong>Conflicting results have been reported regarding the influence of BMI on postoperative adverse events. The aim of this study was to investigate the association between BMI and postoperative pulmonary complications in adults undergoing non-cardiac, non-obstetric surgical procedures.</p><p><strong>Methods: </strong>This large-scale retrospective study included 125,082 adults who underwent surgery at a university-affiliated tertiary care hospital between 2019 and 2023. The primary endpoint was the incidence of postoperative pulmonary complications. Multivariable logistic regression analyses, subgroup analyses, sensitivity analyses and restricted cubic splines were used to assess the association between BMI and postoperative pulmonary complications.</p><p><strong>Results: </strong>A total of 6671 patients (5.3%) developed one or more postoperative pulmonary complications. After adjusting for confounders, compared with those patients with a normal weight (BMI 18.5-24.9 kg.m^-2), patients who were underweight (BMI < 18.5 kg.m^-2) had an increased risk of postoperative pulmonary complications (OR 1.24, 95%CI 1.12-1.39, p < 0.001). Patients who were overweight (BMI 25.0-29.9 kg.m^-2) or living with class 1 obesity (BMI 30.0-34.9 kg.m^-2) had a lower risk of postoperative pulmonary complications (OR 0.88, 95%CI 0.83-0.94, p < 0.001 and OR 0.82, 95%CI 0.70-0.96; p = 0.01, respectively). Patients living with obesity class 2/3 (BMI ≥ 35 kg.m^-2) had a similar risk of postoperative pulmonary complications as patients with a normal weight (OR 1.23, 95%CI 0.91-1.66, p = 0.17). There was a J-shaped association between BMI and incidence of postoperative pulmonary complications with the lowest risk at a BMI of 27.4 kg.m^-2.</p><p><strong>Discussion: </strong>Patients who were overweight or living with class 1 obesity undergoing non-cardiac, non-obstetric surgery had paradoxically lower risks of postoperative pulmonary complications compared with those of a normal weight. These findings may contradict traditional assumptions about surgical risk and obesity, highlighting the need to re-evaluate the relationship between BMI and postoperative pulmonary complications.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447908","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":"Causes of and risk factors for unplanned readmission in a large cohort of patients undergoing major surgery: a retrospective cohort study","authors":"Kirstie Evans, Tim Makar, Tom Larsen, Rudranil Banerjee, Hai Tran, Lachlan F. Miles","doi":"10.1111/anae.16567","DOIUrl":"https://doi.org/10.1111/anae.16567","url":null,"abstract":"SummaryIntroductionUnplanned hospital readmissions after surgery are substantial drivers of expenditure and bed occupancy within the healthcare system. As a result, any targeted interventions that reduce readmission in this population can have a significant impact on patient well‐being and the health budget.MethodsWe performed a large retrospective cohort study analysing data from patients from our institution who underwent major surgery between 1 May 2011 and 1 February 2022. We aimed primarily to study the epidemiology of patients who were readmitted within 90 days of discharge following an index procedure, as well as the reason(s) and risk factors for readmission. These complex, non‐linear relationships were modelled with restricted cubic splines.ResultsWe identified 22,143 patients undergoing major surgery within the defined study period, of whom 1801 (12%) had an unplanned readmission. The most common reason for unplanned readmission across the entire cohort was wound complication, which was the primary cause identified in 232 (11%) readmissions. Ileus or small bowel obstruction was the primary cause of readmission identified following abdominal surgery, compared with pneumonia following thoracic surgery, mechanical injury following orthopaedic surgery and wound complication following cardiac surgery. A discharge haemoglobin concentration of &lt; 100 g.l<jats:sup>‐1</jats:sup> (p &lt; 0.001), duration of hospital stay of 14–30 days (p &lt; 0.001) and Charlson comorbidity index score ≥ 2 (p &lt; 0.001) were associated with increased odds of unplanned readmission. No association was found with patient age or duration of surgery.DiscussionOur study identified the causes of readmission after major surgery from a range of surgical specialties. An improved understanding of the causes of and risk factors for unplanned readmissions will enable the development of targeted interventions that can minimise the burden of unplanned readmissions after major surgery on patients and the larger healthcare system.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"10 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426896","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":"Artificial intelligence in healthcare: medical technology or technology medical?","authors":"James S. Bowness, Simon Kos, Matthew D. Wiles","doi":"10.1111/anae.16565","DOIUrl":"https://doi.org/10.1111/anae.16565","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"4 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426897","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":"Toxic leadership: when culture sabotages clinical excellence","authors":"Britta S von Ungern-Sternberg,&nbsp;Karin Becke-Jakob","doi":"10.1111/anae.16561","DOIUrl":"10.1111/anae.16561","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 5","pages":"480-483"},"PeriodicalIF":7.5,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426898","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":"Obesity may present challenges during gastric ultrasound","authors":"Rafet Yarımoglu,&nbsp;Betul Basaran,&nbsp;Usame Omer Osmanoglu","doi":"10.1111/anae.16572","DOIUrl":"10.1111/anae.16572","url":null,"abstract":"<p>We read with interest the article by Nersessian et al., which speculates on the relationship between residual gastric content and peri-operative semaglutide use [<span>1</span>].</p><p>As noted by the authors, one mechanism of action of GLP-1 receptor agonists is the delay in gastric emptying. Patients using GLP-1 receptor agonists face a risk of aspiration during the peri-operative period [<span>2</span>]. Nersessian et al. stated that exclusion criteria were patients with a BMI &gt; 40 kg.m^-2 and ASA physical status of 3 and above. However, the data in table 1 show that the upper range limit of BMI is 46.4 kg.m^-2 in the semaglutide group and 40.1 kg.m^-2 in the control group. This may complicate the results. As per the ASA criteria, patients with a BMI &gt; 40 kg.m^-2 are classified as being morbidly obese and are rated as ASA physical status 3 [<span>3</span>].</p><p>Using gastric ultrasound to assess gastric emptying is potentially challenging in patients with morbid obesity, for example, it can lead to significantly different baseline and average gastric volume measurements, which may create technical difficulties for the ultrasonographer [<span>4</span>]. The potential for an unbalanced distribution of morbidly obese patients among the study cohort groups may have impacted the study results.</p><p>Based on the above, it may be more suitable to state the number of patients with morbid obesity. It would be more appropriate to report the number and distribution of these patients in groups to demonstrate a statistically insignificant difference.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 5","pages":"594"},"PeriodicalIF":7.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16572","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412826","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":"Puncturing the dura: a true clinical benefit or a distraction? A reply","authors":"Ashraf S. Habib,&nbsp;Matthew Fuller","doi":"10.1111/anae.16571","DOIUrl":"10.1111/anae.16571","url":null,"abstract":"&lt;p&gt;We appreciate the opportunity to respond to the comments by Fung and Preston [&lt;span&gt;1&lt;/span&gt;] about our study comparing the quality of labour analgesia following initiation with a combined spinal epidural (CSE) vs. a dural puncture epidural (DPE) technique [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Their first comment relates to the sample size calculation for the study. At the time of designing our protocol, the only study comparing the two techniques was a well-conducted randomised controlled trial by Chau et al. that reported a reduction in the need for top up interventions from 50% in patients allocated to the CSE group to 22.5% in those allocated to DPE [&lt;span&gt;3&lt;/span&gt;]. Chau et al. had plausible explanations for this large effect and suggested that it could be related to the need for more top-ups during the transition from spinal to epidural analgesia or increased uterine contractions following CSE resulting in more analgesic needs. Those numbers were, therefore, used for our power analysis, which was based on existing valid literature and not done “&lt;i&gt;arbitrarily&lt;/i&gt;” or “&lt;i&gt;to calculate the minimum required sample size&lt;/i&gt;” as suggested by Fung and Preston. While we did not find such a large effect size, it is possible that our study was underpowered to detect smaller effect sizes that could be considered clinically relevant by some. Based on our findings, a future study with a sample size of 976 patients would have 80% power to detect a statistically significant difference in our primary outcome at α = 0.05.&lt;/p&gt;&lt;p&gt;The second comment relates to the choice of primary and secondary outcomes focusing on anaesthetists' workload and lack of patient-reported outcomes. There are currently no validated tools for assessing patient-reported outcome measures associated with labour analgesia. In the absence of such tools, we tried to capture outcomes that are important to patients and providers and that are in line with previously published studies investigating neuraxial labour analgesia. It could be argued that the more interventions that are needed reflect inadequate analgesia negatively impacting the desired pain relief by the mothers, which was recently reported to be the highest outcome preference by patients regarding labour epidural analgesia [&lt;span&gt;4&lt;/span&gt;]. We agree that the mode of delivery is an important outcome (which we report in our table S2 [&lt;span&gt;2&lt;/span&gt;]) but seems to have been missed by Fung and Preston. We also agree on the need for developing validated tools for capturing patient-reported outcomes associated with labour analgesia, as well as develop recommendations for a set of core measures to be included in labour analgesia studies.&lt;/p&gt;&lt;p&gt;The third and final comment from Fung and Preston points to the need for efforts to address disparities in access to labour analgesia. Similar to what has been reported in Scotland [&lt;span&gt;5&lt;/span&gt;], a recent study using the 2017 natality data from the USA reported lower neuraxial labour analgesia use in no","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 5","pages":"592-593"},"PeriodicalIF":7.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16571","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412869","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":"Issue Information – Editorial Board","authors":"","doi":"10.1111/anae.16332","DOIUrl":"https://doi.org/10.1111/anae.16332","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 3","pages":"227"},"PeriodicalIF":7.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16332","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143404460","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":"Efficacy of different routes of dexamethasone administration for preventing rebound pain following peripheral nerve blocks in adult surgical patients: a systematic review and network meta‐analysis","authors":"Jeetinder K. Makkar, Narinder Pal Singh, Bisman J. K. Khurana, Janeesha K. Chawla, Preet M. Singh","doi":"10.1111/anae.16566","DOIUrl":"https://doi.org/10.1111/anae.16566","url":null,"abstract":"SummaryIntroductionRebound pain, characterised by intense pain or discomfort as the effects of a peripheral nerve block diminish, remains a clinical problem. Peri‐operative dexamethasone administration may reduce the incidence of rebound pain. This systematic and network meta‐analysis aimed to determine the optimal route of dexamethasone administration for the prevention of rebound pain.MethodsWe searched databases for randomised controlled trials according to pre‐determined criteria. We compared intravenous and perineural dexamethasone as an adjunct to peripheral nerve blocks, with the control group as a common comparator. The primary outcome was the incidence of rebound pain. The likelihood of an intervention ranking highest was calculated using the surface area under the cumulative ranking curve.ResultsIn total, 14 studies with 1058 patients were included. When compared with the comparator group, we found that intravenous dexamethasone ranked the highest, with an anticipated effect of 298 fewer cases of rebound pain per 1000 people (odds ratio (OR) (95% credible interval (CrI) 0.12 (0.03–0.44)); moderate certainty evidence). This was followed by perineural dexamethasone with an anticipated effect of 190 fewer cases per 1000 people (OR (95%CrI) 0.34 (0.07–1.32); low certainty evidence). There was no evidence of an effect between the route of administration and time to onset of rebound pain.DiscussionIntravenous dexamethasone was associated with a high probability of decreasing the incidence of rebound pain following peripheral nerve block. This is based on moderate certainty of evidence. Future studies on identifying the optimal dose are now warranted.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"16 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385469","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 of after-hours surgeries performed under general anaesthesia: a South Korean nationwide cohort study","authors":"Tak Kyu Oh, In-Ae Song","doi":"10.1111/anae.16559","DOIUrl":"https://doi.org/10.1111/anae.16559","url":null,"abstract":"The day of the week or time of day that surgery is performed may influence postoperative mortality or complications. We aimed to examine whether surgery under general anaesthesia performed after-hours was associated with increased rates of mortality and morbidity, compared with surgery performed in-hours.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"84 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385801","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":"High-flow nasal oxygen in obstetric practice – where do we stand?","authors":"Craig Lyons,&nbsp;Yavor Metodiev","doi":"10.1111/anae.16564","DOIUrl":"10.1111/anae.16564","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 4","pages":"349-352"},"PeriodicalIF":7.5,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375655","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}