Anaesthesia最新文献

{"title":"Genome‐wide association study on chronic postsurgical pain after abdominal surgeries in the UK Biobank","authors":"Song Li, Masja K. Toneman, Judith P. M. Mangnus, Stefano Strocchi, Regina L. M. van Boekel, Kris C. P. Vissers, Richard P. G. ten Broek, Marieke J. H. Coenen","doi":"10.1111/anae.16528","DOIUrl":"https://doi.org/10.1111/anae.16528","url":null,"abstract":"SummaryIntroductionChronic pain is one of the most common and severe complications after surgery, affecting quality of life and overall wellbeing of patients. Several risk factors have been identified but the mechanisms of chronic postsurgical pain development remain unclear. This study aimed to identify single‐nucleotide polymorphisms associated with developing chronic postsurgical pain after abdominal surgery, one of the most common types of surgery.MethodsA genome‐wide association study was performed on 27,603 patients from the UK Biobank who underwent abdominal surgery. The robustness of identified loci was validated by split‐half validation analysis. Functionally related top loci were selected for expression validation in clinical samples of adhesions from patients with and without pain.ResultsOne locus (rs185545327) reached genome‐wide significance for association with chronic postsurgical pain development, and 10 loci surpassed the suggestively significant threshold (p &lt; 1 × 10<jats:sup>‐6</jats:sup>). In the robustness analysis, eight loci had at least nominal significance. The loci passing the suggestively significant threshold were mapped to 15 genes, of which two loci contained pain‐related genes (<jats:italic>SRPK2</jats:italic>, <jats:italic>PDE4D</jats:italic>). Although marginally approaching statistical significance in the expression validation of clinical samples, the detection rate and expression level of PDE4D were modestly higher in patients with pain compared with those in the control group.DiscussionThis study provides preliminary evidence for genetic risk factors implicated in chronic postsurgical pain following abdominal surgery, particularly the <jats:italic>PDE4D</jats:italic> gene, which has been associated with pain in previous studies. The findings add to evidence suggesting potential for the future development of a clinically applicable tool for personalised risk prediction, aiding clinicians in stratifying patients and enhancing clinical decision‐making through individualised risk assessments.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"30 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901651","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":"Parental presence in the operating room during emergency laparotomy","authors":"Loes Bruijstens, Marieke Stulp, Solange Pans, Jan Bollen","doi":"10.1111/anae.16534","DOIUrl":"https://doi.org/10.1111/anae.16534","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"41 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901652","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":"Do some operations still need more diamorphine?","authors":"D. Leslie, N. Stranix","doi":"10.1111/anae.16535","DOIUrl":"https://doi.org/10.1111/anae.16535","url":null,"abstract":"<p>The systematic review and meta-analysis by Grape et al. [<span>1</span>] suggests that there is no evidence of benefit to doses of intrathecal diamorphine exceeding 0.2 mg. Their systematic review identified 12 trials (712 patients), 11 of which included only patients undergoing orthopaedic or obstetric procedures. There was a single trial including 30 patients having inguinal hernia repair, lower limb arterial or transurethral surgery [<span>2</span>].</p>\u0000<p>A review of 20 major general surgical procedures in our department from the last 2 months (bowel resections, open, and laparoscopic and robot assisted laparoscopic cystectomies) where we use intrathecal diamorphine for analgesia rather than as a sole technique, found a median (IQR [range]) intrathecal diamorphine dose of 0.73 mg (0.50–0.85 [0.40–1.00]). Such dosing has been typical for years and has produced good results. Recognising the significant evidential shortcomings of a small 20 patient retrospective cohort, 17 out of 20 had nil or mild pain, and moderate pain was only found in those with below average dosing. In total, 90% of patients did not experience nausea or vomiting in the post-anaesthesia care unit, none needed naloxone and there were no unplanned ICU admissions or need for chlorphenamine for pruritus.</p>\u0000<p>The included article by Abuzaid et al. detailed general surgical and vascular operations and was published in 1993 [<span>2</span>]. We are concerned it may not represent the current patient cohort for whom single-shot spinal analgesia is administered specifically to cover long and complex abdominal surgeries. There have been substantial developments in surgical practice since 1993; the growth of laparoscopic and robotic surgery, along with enhanced recovery pathways has meant that operations that might historically have used a thoracic epidural, are now having intrathecal opioid administration. Epidurals are known to have a failure rate of around 30% and can cause hypotension and leg weakness [<span>3</span>]. Anecdotally, there is a fear that they will reduce patient mobilisation postoperatively and prolong hospital stay. Single-shot spinals are a middle ground, providing good analgesia in the immediate postoperative period but allowing patients to mobilise with full leg strength the next day, unencumbered by syringe pumps.</p>\u0000<p>Considering this systematic review, we acknowledge that further dose-finding trials could be conducted. However, it is unlikely that we will convince our colleagues to reduce their dose of intrathecal diamorphine for major abdominal procedures.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"33 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902143","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":"Cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures","authors":"Mark Griffin, Cathy O'Donoghue","doi":"10.1111/anae.16526","DOIUrl":"https://doi.org/10.1111/anae.16526","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"8 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142841070","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":"Considerations on peri-operative management of GLP-1 receptor agonists","authors":"Glenio B. Mizubuti,&nbsp;Rafael S. F. Nersessian,&nbsp;Leopoldo M. da Silva,&nbsp;Anthony M.-H. Ho","doi":"10.1111/anae.16524","DOIUrl":"10.1111/anae.16524","url":null,"abstract":"&lt;p&gt;We thank Hulst et al. [&lt;span&gt;1&lt;/span&gt;] and Levy et al. [&lt;span&gt;2&lt;/span&gt;] for their comments on our work [&lt;span&gt;3&lt;/span&gt;]. Peri-operative use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has gained much attention recently.&lt;/p&gt;&lt;p&gt;We acknowledge the significance of power calculations in trial design to minimise type 2 error. It is essential to recognise, however, that power can be considered adequate with a smaller sample size if the effect size is large [&lt;span&gt;4&lt;/span&gt;], as evidenced by our observed (clinically significant) differences between semaglutide users (40% incidence of increased residual gastric content) and non-users (3%, p &lt; 0.001). For further clarification, we performed a post hoc power analysis based on our studied patients and parameter estimates. For an effect size of 0.7 based on the presence of increased residual gastric content in 43/107 semaglutide users and 3/113 non-users, and a significance level of 5%, using a χ&lt;sup&gt;2&lt;/sup&gt; test, we achieved a critical χ&lt;sup&gt;2&lt;/sup&gt; = 11.07 and a power (1-β error probability) &gt; 0.9.&lt;/p&gt;&lt;p&gt;Our exclusion criteria accounted for conditions known to affect gastric emptying; hence our observed increased residual gastric content can be attributed primarily to semaglutide use. These exclusions strengthen, rather than limit, our findings' applicability. While we did not study patients with diabetes, we agree that future guidelines should focus on peri-operative management of GLP-1 RAs based on their primary use (weight loss vs. diabetes).&lt;/p&gt;&lt;p&gt;As for other classes of medications that can delay gastric emptying, it is impossible to call for revised societal guidelines for their peri-operative use when such guidelines do not exist. The impaired gastric emptying from these drugs has not been considered sufficiently relevant (unlike that induced by GLP-1 RAs) to warrant the attention of medical or anaesthesia societies to create specific guidelines.&lt;/p&gt;&lt;p&gt;Recently, several case reports have been published linking peri-operative GLP-1 RA use with bronchoaspiration and/or near misses [&lt;span&gt;5&lt;/span&gt;]. Although anecdotal, it would be imprudent to disregard these reports and the growing body of evidence demonstrating a correlation between GLP-1 RA use and increased peri-operative residual gastric content [&lt;span&gt;3, 6&lt;/span&gt;] as “&lt;i&gt;lacking evidence&lt;/i&gt;” [&lt;span&gt;2&lt;/span&gt;]. The recent development of multi-societal guidelines for the peri-operative management of GLP-1 RA [&lt;span&gt;7&lt;/span&gt;] reflects this linkage.&lt;/p&gt;&lt;p&gt;Due to constraints inherent to our institutional protocol, we did not evaluate periods of discontinuation longer than 10 days and, consequently, were unable to make recommendations beyond this timeframe. Nevertheless, based on our findings (and other recent reports [&lt;span&gt;6&lt;/span&gt;]), it does appear that 1-week pre-operative discontinuation suggested by the American Society of Anesthesiologists and other medical societies [&lt;span&gt;7&lt;/span&gt;] may be insufficient to ensure an empty sto","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 3","pages":"340-341"},"PeriodicalIF":7.5,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16524","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142841072","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":"Total intravenous or inhalational volatile anaesthesia and survival after colorectal cancer surgery: a Swedish national registry study","authors":"Anna Enlund, Maziar Nikberg, Anders Berglund, Erland Östberg, Mats Enlund","doi":"10.1111/anae.16495","DOIUrl":"https://doi.org/10.1111/anae.16495","url":null,"abstract":"Retrospective studies suggest that inhalational volatile anaesthetic agents may contribute to an increased risk of metastasis and reduction in survival rates when used during cancer surgery. This relationship may vary between cancer types due to different tumour biology and differences in surgical procedures. This study aimed to investigate the relationship between the type of anaesthetic used for maintenance of anaesthesia (propofol or inhalational volatile anaesthetic agent) and survival in patients with stage 1–3 colorectal cancer who underwent resection surgery under general anaesthesia in Sweden between 2014 and 2019.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"39 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825468","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":"Voices from the ground: transformative health research in low- and middle-income countries","authors":"Navniel Kaur,&nbsp;Andre Vercueil,&nbsp;Melissa Taylor","doi":"10.1111/anae.16523","DOIUrl":"10.1111/anae.16523","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 2","pages":"138-141"},"PeriodicalIF":7.5,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142832770","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":"Impact of general vs. regional anaesthesia on one-year clinical outcomes and healthcare utilisation after lower limb arthroplasty: a retrospective study","authors":"Chun-Ning Ho, Wei-Ting Wang, Kuo-Chuan Hung, Wei-Cheng Liu, Shu-Wei Liao, Jen-Yin Chen, Kuo-Mao Lan","doi":"10.1111/anae.16511","DOIUrl":"https://doi.org/10.1111/anae.16511","url":null,"abstract":"General anaesthesia and regional anaesthesia are used for hip and knee arthroplasty but their impact on long-term outcomes remains unclear. This study aimed to compare one-year clinical outcomes and healthcare utilisation in patients receiving general or regional anaesthesia for hip or knee arthroplasty.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"42 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816262","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":"Mechanisms underlying neurocognitive dysfunction following critical illness: a systematic review","authors":"Mark Andonovic,&nbsp;Holly Morrison,&nbsp;William Allingham,&nbsp;Robert Adam,&nbsp;Martin Shaw,&nbsp;Tara Quasim,&nbsp;Joanne McPeake,&nbsp;Terence Quinn","doi":"10.1111/anae.16494","DOIUrl":"10.1111/anae.16494","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cognitive impairment is a significant healthcare problem globally and its prevalence is projected to affect over 150 million people worldwide. Survivors of critical illness are impacted frequently by long-term neurocognitive dysfunction regardless of presenting illness, but the mechanisms are poorly understood. The goal of this review was to synthesise the existing evidence regarding potential mechanisms underlying neurocognitive dysfunction following critical illness in order to guide potential avenues for future research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a systematic search of the literature for studies published between 1 January 1974 and 15 July 2023. We included publications involving adult patients with critical illness due to any aetiology that assessed for cognitive impairment following recovery from illness, and explored or investigated potential underlying causative mechanisms. The quality and risk of bias of the individual studies was assessed using the Newcastle-Ottawa scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 7658 reviewed references, 37 studies comprising 4344 patients were selected for inclusion. Most studies were single centre with sample sizes of &lt; 100 patients. The proportion of patients with long-term cognitive impairment ranged from 13% to 100%. A wide variety of theoretical mechanisms were explored, with biomarkers and neuroimaging utilised most frequently. Many studies reported associations between investigated mechanisms and reduced cognition; several of these mechanisms have been implicated in other forms of long-term neurodegenerative conditions. Increased levels of inflammatory cytokines during acute illness and white matter hyperintensities on neuroimaging following recovery were the associations reported most commonly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The underlying pathophysiology of neurocognitive decline after critical illness is not yet understood fully. The mechanisms implicated in other neurodegenerative conditions suggest that this may represent an accelerated version of the same processes. Large scale studies are required to further elucidate the cause of this significant problem for survivors of critical illness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 2","pages":"188-196"},"PeriodicalIF":7.5,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16494","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816261","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":"Associations between pre-operative iron deficiency and postoperative infection in patients undergoing major surgery (CARIPO): a prospective observational study","authors":"Maëva Campfort,&nbsp;Tristan Perrault,&nbsp;Aymeric Blanchard-Daguet,&nbsp;Emmanuel Rineau,&nbsp;Sigismond Lasocki","doi":"10.1111/anae.16498","DOIUrl":"10.1111/anae.16498","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Iron deficiency, with or without anaemia, is common during the peri-operative period. It has been hypothesised that pre-operative iron deficiency is associated with an increased incidence of postoperative infection. We designed the CARIPO prospective observational study to assess the incidence of postoperative infection in patients with and without iron deficiency undergoing a variety of major surgeries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-centre study in a tertiary, university-affiliated hospital in France. Iron deficiency was defined as a ferritin &lt; 100 μg.l^-1 or &lt; 300 μg.l^-1 with a transferrin saturation &lt; 20%. The primary outcome was incidence of any postoperative infectious complication measured at 90 days after surgery. Secondary endpoints included the incidence of individual infectious complications: surgical site infection; bacteraemia; pneumonia; urinary tract infection; peripheral line-associated bacterial infection; and all-cause postoperative complication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We recruited 390 patients. Of these, 170 (44%) had pre-operative iron deficiency and 220 (66%) were iron replete; 27 (16%) patients in the iron deficient group developed a postoperative infection compared with 26 (12%) in the iron replete group (p = 0.25). Surgical site infections occurred in 11 (7%) iron deficient patients and 3 (1%) iron replete patients (p = 0.01). Other types of infectious complication and all-cause postoperative complication were similar between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Iron deficiency was not associated with a higher rate of postoperative infection relative to an iron replete state. While iron deficiency was associated with a higher rate of surgical site infection, this result is hypothesis-generating, and further prospective studies are required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 2","pages":"142-150"},"PeriodicalIF":7.5,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816260","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}