Anaesthesia最新文献

{"title":"Identifying the caudal space – if it doesn't itch don't scratch","authors":"A.J. Ball","doi":"10.1111/j.1365-2044.1997.tb00102.x","DOIUrl":"https://doi.org/10.1111/j.1365-2044.1997.tb00102.x","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":10.7,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142085458","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":"Apnoea testing in children","authors":"A. Sharples, O. R. Dearlove, R. Yates, D. Stewart","doi":"10.1111/j.1365-2044.1997.tb00096.x","DOIUrl":"https://doi.org/10.1111/j.1365-2044.1997.tb00096.x","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":10.7,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142085459","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 oldest patient?","authors":"W. J. Wraight","doi":"10.1111/j.1365-2044.1997.tb00110.x","DOIUrl":"https://doi.org/10.1111/j.1365-2044.1997.tb00110.x","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":10.7,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142084773","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 cardiology patients receiving anaesthetic care: analysis from the 7th National Audit Project (NAP7) of the Royal College of Anaesthetists","authors":"Seema Agarwal,&nbsp;Richard A. Armstrong,&nbsp;Emira Kursumovic,&nbsp;Andrew D. Kane,&nbsp;Tim M. Cook,&nbsp;Jasmeet Soar,&nbsp;Simon J. Finney,&nbsp;Gudrun Kunst,&nbsp;collaborators","doi":"10.1111/anae.16413","DOIUrl":"10.1111/anae.16413","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest because of existing knowledge gaps in this important topic. This applies in particular to cardiology patients receiving anaesthetic care, because numbers, types and complexity of minimally invasive interventional procedures requiring planned and unplanned anaesthesia in the cardiac intervention suite is increasing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed collected data to determine the epidemiology, clinical features, management and outcomes of peri-operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 54 reports of peri-operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures, accounting for 54/881 (6.1%) of all reports to NAP7. The estimated incidence (95%CI) of cardiac arrests in this group was 1/450 or 0.22 (0.17–0.29)%. These patients were older than other adult patients in the NAP7 population, with a notably high proportion of patients of Asian ethnicity when compared with the remaining NAP7 cohort (9/54, 17% vs. 35/709, 5%). Rates of extracorporeal membrane oxygenation cardiopulmonary resuscitation were low (3/53, 6%). A common theme was that of logistical issues and teamworking, with reporters commenting on the difficulties of remote and/or unfamiliar locations and communication issues between specialties, on occasion resulting in poor teamworking and a lack of focus. The NAP7 panel review identified several other common themes which included: cardiogenic shock; late involvement of anaesthesia in the case; and transcatheter aortic valve implantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Cardiology procedures requiring anaesthesia care account for &lt; 1% of anaesthesia activity but generate 6% of all peri-operative cardiac arrests. The incidence of cardiac arrest was disproportionately high in cardiological procedures requiring anaesthetic care. The nature of the cardiac arrest reports to NAP7 indicate that logistical and human factors in multidisciplinary teams in the cardiac intervention suite merit addressing to improve care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035024","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 controversy of pre-operative opioid tapering and an opportunity to advance personalised, patient-centred pain medicine","authors":"Dáire N. Kelly,&nbsp;Edward R. Mariano,&nbsp;Kellie M. Jaremko","doi":"10.1111/anae.16412","DOIUrl":"10.1111/anae.16412","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981527","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":"First-choice videolaryngoscopy for paediatric intubation","authors":"Fu-Shan Xue, Dan-Feng Wang, Xiao-Chun Zheng","doi":"10.1111/anae.16419","DOIUrl":"https://doi.org/10.1111/anae.16419","url":null,"abstract":"<p>In a study of 904 tracheal intubations in 809 children, Sasu et al. showed that using a C-MAC® videolaryngoscope (Karl Storz, Tuttlingen, Germany) reduced the incidence of poor glottic views from 13% to 4% [<span>1</span>]. They also found the modified six-grade Cormack and Lehane system ineffective for predicting the ease of videolaryngoscopic tracheal intubation. The primary outcome of this study was defined as vocal cords only just or not visible. Restricted glottic views in the modified Cormack and Lehane classifications 2b, 2c and 3 during videolaryngoscopy in adult and paediatric patients are typically due to an enlarged epiglottis and impaired epiglottic movement. Such issues can be resolved by correct head positioning, increased lifting force, directly lifting the epiglottis or external laryngeal manipulation [<span>2-4</span>]. However, the results do not specify whether these techniques were applied to enhance the view of the glottis, leaving us unsure if the observed glottic view grades represent the best possible outcome using both modes of laryngoscopy, particularly direct laryngoscopy that requires aligning the three airway axes for proper visualisation.</p>\u0000<p>Difficult videolaryngoscopic tracheal intubation was documented as a difficult airway alert based on the videolaryngoscopic intubation and difficult airway classification (VIDIAC) score in adult patients with anticipated difficult airways. Kohse et al. classified difficulty into four levels using VIDIAC scores [<span>2</span>], but it is unclear whether a score of 1, which indicates a 50% probability of a difficult airway, was counted as difficult in this study. Although the VIDIAC score was a secondary outcome, its results were not reported, nor was its effectiveness in differentiating easy from difficult videolaryngoscopic tracheal intubations in paediatric patients analysed, despite most having normal airways. Clarifying these aspects could strengthen the conclusions.</p>\u0000<p>The overall first attempt tracheal intubation success rate is significantly lower at 67% compared with a rate of 86.8% in a previous study, which focused on children undergoing elective airway management using videolaryngoscopes with standard blades [<span>5</span>]. Similarly, the success rate for first attempt tracheal intubation in children aged ≤ 1 y (48%) is much lower than the rate in a recent trial studying urgent tracheal intubations in newborns using C-MAC videolaryngoscopy (74%) [<span>6</span>]. Based on our own experience and existing studies [<span>7</span>], a stylet aids in directing the tracheal tube tip to the glottis and enhances tracheal intubation performance with the C-MAC videolaryngoscopy, even when there is a clear view of a child's vocal cords. Hence, we would like to know if a stylet was used in all cases.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":10.7,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141974201","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":"Time for mandatory safety preparedness: a responsibility for individuals, hospitals and national bodies.","authors":"Andrew D Kane, Jasmeet Soar, Tim M Cook","doi":"10.1111/anae.16418","DOIUrl":"https://doi.org/10.1111/anae.16418","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141915911","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 cardiac arrests in Sweden 2013–2022: data analysis of incidence and trends","authors":"Malin Sunborger,&nbsp;Jan G. Jakobsson","doi":"10.1111/anae.16396","DOIUrl":"10.1111/anae.16396","url":null,"abstract":"&lt;p&gt;In Europe, out-of-hospital cardiac arrests have an annual incidence rate of 7–17/10,000 per capita and in-hospital cardiac arrests have an annual incidence rate of 15–28/10,000 hospital admissions [&lt;span&gt;1&lt;/span&gt;]. The incidence of in-hospital cardiac arrests in Sweden is 16/10,000 hospital admissions [&lt;span&gt;2&lt;/span&gt;]. We conducted a study assessing if the incidence of peri-operative cardiac arrest had decreased in Sweden from 2013 to 2022. We also assessed the association between 30-day mortality, patient characteristics and urgency of surgery. All patients aged ≥ 18 y experiencing peri-operative cardiac arrest in the Swedish Perioperative Register (SPOR) between January 2013 and June 2022 were included. Total number of surgical procedures with complete data for patients aged ≥ 18 y registered in SPOR from 2013 to 2022 was used as the denominator (n = 3,049,782).&lt;/p&gt;&lt;p&gt;The primary outcome was the incidence of peri-operative cardiac arrest in 2022 compared with 2013. Secondary outcomes were 30-day all-cause mortality and association of peri-operative cardiac arrest with patient characteristics and urgency. Descriptive and regression analysis was performed. In total, 749 patients (51.6% male, mean (SD) age 69 (17.4) y) experienced peri-operative cardiac arrest during the study period. Patient characteristics and urgency are presented in Table 1. Year was missing for 13 cases of peri-operative cases leaving 736 for analysis. This equates to an overall annual incidence of peri-operative cardiac arrest of 2.4/10,000 procedures (95%CI 2.2–2.6). There was no significant difference over the period studied: 2.9/10,000 procedures in 2013 vs. 1.8/10,000 procedures in 2022. The highest incidence of peri-operative cardiac arrest and highest 30-day mortality rate was seen in patients who underwent emergency surgeries (54%). Hip fracture surgery was the most common planned surgical intervention, (n = 120, 16%) during the study period, followed by abdominal surgery (n = 118, 16%). 30-day mortality following cardiac arrest was 48% and mortality rate was 1.2/10,000 procedures (95%CI 0.7–1.5). Odds ratio (OR) for 30-day mortality increased with age (65–80 y, OR 2.32 (95%CI 1.43–3.77), &gt; 80 y, OR 6.11 (95%CI 3.57–10.45)); ASA physical status 3–5 (OR 2.81 (95%CI 1.74–4.54)); and surgical urgency (emergent OR 2.89 (95%CI 1.85–4.51), immediate 9.20 (95%CI 4.80–17.65)) but showed no significant change over time when adjusted for co-factors.&lt;/p&gt;&lt;p&gt;The overall incidence of peri-operative cardiac arrest in Sweden among adult patients (2.4 per 10,000 procedures) is lower compared with previous studies which ranged between 3–7 per 10,000 [&lt;span&gt;3, 4&lt;/span&gt;]. A recent UK study found incidence rates of 3.0–3.5 per 10,000 interventions [&lt;span&gt;4&lt;/span&gt;]. In that cohort, however, patients from infancy up to age 18 y (n = 12%) were included in the study. The Royal College of Anaesthetists, in its updated National Audit project (NAP7), defined peri-operative cardiac arrest a","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16396","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905557","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":"NAP7 – have we lost the point?","authors":"William Ward,&nbsp;Helen Aoife Iliff","doi":"10.1111/anae.16404","DOIUrl":"10.1111/anae.16404","url":null,"abstract":"<p>We would like to thank and applaud the authors and contributors to the 7th National Audit Project (NAP7) for such a thorough investigation and <i>Anaesthesia</i> for its dissemination and sharing of content [<span>1</span>]. However, we must ask if the primary purpose of the project has been lost among the volume of papers (we think this is the 12th)? Having spoken to a number of colleagues, none of them admit to having read all of them. Rather, comments include how long the report [<span>2</span>] is (567 pages compared with the 219 pages of NAP4 [<span>3</span>]); how many papers have been published (12 compared with 2 for NAP4); and the confusion as to what they should read.</p><p>We appreciate there are a lot of data and discussion points, but we fear the key messages relating to the primary purpose of the project may have been missed or lost in the volume of published materials. We believe the authors would have been better focusing more on the primary outcome rather than the overwhelming number of secondary outcomes and publication noise.</p><p>That said, the additional materials produced are excellent, namely the infographic [<span>4</span>] and overview slides [<span>5</span>]. We very much hope to continue seeing these being produced in future NAPs.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16404","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900730","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.16273","DOIUrl":"10.1111/anae.16273","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16273","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141904609","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}