Anaesthesia最新文献

{"title":"Bullying: a silent threat to clinician well-being and patient safety.","authors":"Todd Nelson","doi":"10.1111/anae.16660","DOIUrl":"https://doi.org/10.1111/anae.16660","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281999","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":"Mandatory training for rare anaesthetic events – a virtue ethics view","authors":"Thomas Donaldson","doi":"10.1111/anae.16659","DOIUrl":"https://doi.org/10.1111/anae.16659","url":null,"abstract":"<p>I read with interest the letters by Murphy [<span>1</span>] and Frerk and Evans [<span>2</span>] about philosophical approaches to mandatory training for rare anaesthetic events. The utilitarian and Kantian philosophical approaches that they advocate highlight the importance of striving for good outcomes when rare anaesthetic emergencies occur, as well as aiming for universal anaesthetic competence in managing these situations. However, as duty-based philosophical approaches, both utilitarianism and Kantianism consider the right action to be solely an individual's responsibility. Systems-based and human factors approaches to the management of anaesthetic emergencies highlight that the factors that influence decision-making, performance and outcome in these situations are much more extensive than the decision-making of individuals in the moment [<span>3</span>]. Virtue ethics offers a different philosophical approach, emphasising the importance of mandatory training and simulation that provide opportunities to prepare to respond correctly to rare anaesthetic events as clinical teams, not just as individuals.</p>\u0000<p>Virtue ethics seeks to understand correct action in the context of being a good (or virtuous) person. Aristotle, one of the most influential ancient virtue ethicists, considered education and training to be fundamental to the development of both excellence in practical skills and virtuous characters, which may both be necessary to respond rightly to life's moral challenges [<span>4</span>]. This means that virtuous action is not something that can simply be achieved in the moment that an ethical dilemma arises. Virtuous acts occur when people who have trained in skills and developed good character traits are prepared to respond appropriately to the challenges they face. This suggests that virtuous anaesthetists should be interested in developing excellent technical skills and virtuous characteristics, like vigilance, composure and adaptability, so they are prepared to respond to rare anaesthetic events correctly.</p>\u0000<p>Swanton (a modern virtue ethicist) has argued that developing team-working (dialogic) virtues promotes the collaboration required to overcome the complex problems we encounter in life and our own individual limitations [<span>5</span>]. Simulation training offers an important opportunity to grow in these virtues and to develop ways of working together effectively as teams to identify and manage rare anaesthetic events. Virtue ethics highlight the moral importance of ensuring good human factors approaches to our multidisciplinary team-working, if we hope to respond with excellence and virtue when rare anaesthetic events occur. Mandatory training and simulation can both be ways in which anaesthetists and the teams they work within can prepare virtuously for rare anaesthetic emergencies.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"4 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144252846","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":"Top 10 research priorities for sepsis research determined by patients, carers and clinicians","authors":"Joanne McPeake, Nahid Ahmad, Kimberley Bradley, Andrew Conway Morris, Paul Dark, Colin Graham, Walter Hall, Susan Moug, Mark Oakes, Emily Perry, Simon Stockley, Jane Weaver, Bronwen Connolly, Nazir Lone","doi":"10.1111/anae.16634","DOIUrl":"https://doi.org/10.1111/anae.16634","url":null,"abstract":"SummaryIntroductionSepsis is a high burden syndrome associated with increased morbidity and mortality in both the acute and longer‐term phases of illness. Multiple treatment uncertainties remain that require resolution through high‐quality research. This study aimed to identify the top 10 research priorities for sepsis research in the UK.MethodsWe conducted a priority setting partnership study co‐produced by sepsis survivors, carers and clinicians. This included five stages: initiation of steering group formation and confirmation of the scope of the priority setting partnership; identification of clinical uncertainties through an electronic survey; analysis and verification of uncertainties; interim prioritisation to the top 25 ranked questions; and final prioritisation to determine the top 10 research priorities, using the nominal group technique.ResultsOur initial survey respondents comprised 447/718 (62.3%) people who had survived sepsis, their friends and family members; 218/718 (30.4%) clinicians; and 53/718 (7.1%) multiple/other roles who identified 53 distinct research uncertainties. Our interim prioritisation survey comprised 429/941 (45.8%) people who had survived sepsis, their friends and family members; 431/941 (46.0%) clinicians; and 73/941 (8.2%) multiple/other roles, with the top 25 ranked summary questions taken forwards for final prioritisation. From these, final workshop participants (n = 27) agreed a top 10 list of research priorities. Improved sepsis diagnosis; characterisation and management of the post‐sepsis syndrome; and non‐antibiotic treatment of sepsis were the top three priorities.DiscussionWe establised priorities for sepsis research through a rigorous process of consensus involving sepsis survivors, carers and clinicians. These priorities will support future delivery of meaningful research to improve outcomes from sepsis.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"18 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228452","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":"Airway management in patients living with obesity: best practice recommendations from the Society for Obesity and Bariatric Anaesthesia","authors":"Andrew McKechnie, Helen A. Iliff, Rebecca Black, Imran Ahmad, Angela Chesworth, Paul Chesworth, Nordene Davis, Catherine Griffiths","doi":"10.1111/anae.16647","DOIUrl":"https://doi.org/10.1111/anae.16647","url":null,"abstract":"Patients living with obesity present specific challenges for airway management. They have been overrepresented repeatedly in studies looking at complications associated with airway management. Whilst generic airway guidelines offer assistance, there are no evidence-based guidelines specific to this group of patients to support safe and effective airway management.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"359 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144219490","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":"Surgical precision? Cutting through the hype of AI-augmented peri-operative risk prediction","authors":"Mayur Murali, Jason Mann, Sonali Parbhoo","doi":"10.1111/anae.16662","DOIUrl":"https://doi.org/10.1111/anae.16662","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"17 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144219489","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":"Functional capacity, frailty and the future of peri‐operative risk stratification: a reply","authors":"Kyosuke Takahashi, Tokujiro Uchida","doi":"10.1111/anae.16657","DOIUrl":"https://doi.org/10.1111/anae.16657","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"17 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144219062","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":"Analysing the obesity paradox? Mind the adiposity distribution!","authors":"Wenjing Du, Hongjie Tang","doi":"10.1111/anae.16658","DOIUrl":"https://doi.org/10.1111/anae.16658","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"52 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144219339","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":"Measurement and interpretation of central venous pressure: a narrative review.","authors":"Patryck Lloyd-Donald, Midori Fujino, Boris Waldman, Lachlan F Miles","doi":"10.1111/anae.16633","DOIUrl":"https://doi.org/10.1111/anae.16633","url":null,"abstract":"<p><strong>Introduction: </strong>Central venous pressure has been a key component of haemodynamic monitoring for several decades, but its clinical utility is still debated. While central venous pressure has been used traditionally to assess intravascular volume status and fluid responsiveness, mounting evidence suggests that its absolute value alone is an unreliable predictor of such states. This narrative review explores the historical development and physiological foundations of central venous pressure, its measurement techniques and the available evidence regarding central venous pressure monitoring in various clinical scenarios.</p><p><strong>Methods: </strong>We conducted a literature search to identify relevant articles. The abstracts of identified articles were assessed for relevance, and their references were screened for further relevant publications.</p><p><strong>Results: </strong>We identified 229 articles, with 72 undergoing full text extraction and data synthesis. Preliminary work in central venous pressure monitoring began in canines, before early human studies and the development of Guytonian principles of haemodynamics. Physiologically, central venous pressure reflects intraluminal pressure of the superior vena cava, with measurement affected significantly by transducer position, catheter position and intrathoracic pressures. In right ventricular dysfunction, the central venous pressure waveform loses its x-descent, as the y-descent becomes exaggerated. Central venous pressure in isolation is considered a poor predictor of volume responsiveness; however, elevated central venous pressure is linked with impaired tissue perfusion and poor clinical outcomes, including acute kidney injury and higher risk of mortality in certain patient cohorts.</p><p><strong>Discussion: </strong>Although reliance on central venous pressure as a singular guide for fluid resuscitation is discouraged, it remains a valuable tool when interpreted in conjunction with waveform analysis and trend monitoring, offering insights into right heart function, venous congestion and organ perfusion. As patient cohorts grow increasingly complex, a nuanced understanding of central venous pressure waveforms and trends is essential for optimising management strategies in peri-operative and critical care settings.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207416","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":"Anaesthesia support for transcatheter heart valve interventions: a narrative review","authors":"Mike Charlesworth, Tim Hayes, Mamta H. Buch, Eryl A. Davies","doi":"10.1111/anae.16635","DOIUrl":"https://doi.org/10.1111/anae.16635","url":null,"abstract":"SummaryIntroductionThere have been few other areas of medical practice in the last two decades that have evolved at the same pace as transcatheter heart valve interventions. As well as providing peri‐operative care, anaesthetists are core members of ‘Heart Teams’, who plan the care of and manage patients with valvular heart disease. This review aims to summarise core information on these procedures for anaesthetists.MethodsWe conducted a literature review to identify highly cited or high Altmetric scoring articles published in the last five years on the peri‐operative management of patients undergoing transcatheter aortic, mitral, pulmonary and tricuspid valve interventions.ResultsThere was little contemporary published evidence comparing or recommending anaesthetic techniques and describing their effect on peri‐operative outcomes. Instead, there is a wealth of evidence on outcomes in specific patient risk groups undergoing transcatheter procedures. However, these trials focussed mainly on mortality and complications, received substantial industry funding and pooled adverse outcomes as a composite using frequentist non‐inferiority methods. Most real‐world patients would likely be excluded from these trials and clinicians therefore should apply evidence, expertise and local experience to make risk/benefit judgements for individual patients referred to the Heart Team. Knowledge of the issues around diagnosis, patient selection, procedural steps and device design characteristics are arguably of more importance to the anaesthetist than the specifics of techniques for local anaesthesia infiltration, conscious sedation and general anaesthesia, which are transferrable skills for all adult anaesthetists.DiscussionThere is a need for new peri‐operative research with a focus on patient‐centred metrics, rather than complication composites and mortality outcomes. Clinically, there is increasing focus on patient‐centred treatment, timing of interventions and a team‐based approach with greater emphasis placed on comorbidities and their aggressive management.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"7 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201645","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":"Evaluation of five static or dynamic tracheal tube introducers during standard and difficult intubations with C-MAC® D-blade videolaryngoscopy in a manikin*","authors":"Benjamin Dallyn, Ronan Hanratty, Matthew Hillier, Matthew Ainsworth, Jan Hansel, Tim M. Cook","doi":"10.1111/anae.16632","DOIUrl":"https://doi.org/10.1111/anae.16632","url":null,"abstract":"Tracheal tube introducers facilitate tracheal intubation and include stylets and static/dynamic bougies. There is uncertainty over the most efficacious introducer with hyperangulated videolaryngoscopy.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"239 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153530","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}