Anaesthesia最新文献_第9页

Cultural structures that perpetuate silence: an East Asian reflection on bullying in the operating theatre. 使沉默永久化的文化结构：东亚对手术室欺凌的反思。

IF 10.7 1区医学

Anaesthesia Pub Date : 2025-08-15 DOI: 10.1111/anae.16742

Pei-Yi Hung,Shu-Yueh Cheng,Ming-Hui Hung

引用次数: 0

Consent in labour: beyond the legal aspects and epidurals: a reply 劳动中的同意：超越法律方面和硬膜外麻醉：一个回答。

IF 6.9 1区医学

Anaesthesia Pub Date : 2025-08-15 DOI: 10.1111/anae.16743

Jacqueline Nicholls, the authors

{"title":"Consent in labour: beyond the legal aspects and epidurals: a reply","authors":"Jacqueline Nicholls, the authors","doi":"10.1111/anae.16743","DOIUrl":"10.1111/anae.16743","url":null,"abstract":"We are grateful to Impiumi and Kearsley for their comment [1] on our article [2]. As they rightly remind us, consent is the legal device to give effect to patient autonomy. We agree that the vexed question of whether any or all consent provided by a woman in labour can be said to reflect a genuinely autonomous choice-making consent process merits much more comprehensive attention; we are actively considering expanding this across a range of decisions.Recognising and responding to capacity concerns is a significant consideration. However, we consider the absence of a consensus on capacity entirely appropriate and in line not only with the statutory provisions of the Mental Capacity Act 2005 (England and Wales), but also with patient-centric care per se. We would be extremely concerned if a consensus view were ever to be proposed. Not surprisingly, the appreciation of capacity issues among healthcare professionals working in areas outside neurology is limited [3] and we do think there may be merit in providing more opportunities for healthcare professionals in the obstetric setting to undergo explicit training in capacity.The ethical tension created between the desire to relieve pain and respect autonomy in a person whose decision-making capacity may be questionable is undoubtedly challenging, both professionally and personally. We wonder whether it may be worthwhile to reconsider our professional understanding of autonomous decision-making to allow for a less binary approach. For example, David Enoch refers to autonomy in two senses: as sovereignty, signifying the act of making a final decision; and as non-alienation, reflecting a decision-making process which accords with a woman's core values and commitments [4]. If the clinical record contained some explicit indication of a woman's values this might be a way to start thinking about a more authentic consent process. Building on this pragmatically we share the view that there is a need to improve ways of fostering discussion in advance of decisions which a woman might need to make during labour. Designing and tailoring such discussions to make them helpful and meaningful to individual women is a profound challenge which goes beyond mere information provision. Control and a sense of agency are more strongly related to women's positive reports of birth experience than are specific details of the birth experience [5], so optimising the design of such advance discussions is a challenge which should not be ignored.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 10","pages":"1276-1277"},"PeriodicalIF":6.9,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16743","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850923","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}

引用次数: 0

Stress, simulation and skill retention: addressing gaps in eFONA training models: a reply 压力，模拟和技能保留：解决eFONA培训模式的差距：答复。

IF 6.9 1区医学

Anaesthesia Pub Date : 2025-08-15 DOI: 10.1111/anae.16744

Tamryn Miller, Peter Groom

{"title":"Stress, simulation and skill retention: addressing gaps in eFONA training models: a reply","authors":"Tamryn Miller, Peter Groom","doi":"10.1111/anae.16744","DOIUrl":"10.1111/anae.16744","url":null,"abstract":"We thank Bhandari and Hao for their thoughtful and constructive commentary [1] on our article [2]. We feel our adaption is practicable, scalable and potentially transformative. A randomised crossover design would have strengthened our methodology, and we are pleased to share that we are currently designing a multicentre randomised crossover study to address this very limitation and further validate our pilot findings.We agree wholeheartedly on human factors and the importance of high-fidelity ‘cannot intubate cannot oxygenate’ (CICO) simulation training for the whole multidisciplinary team, but this was outside the scope of our study. Currently, high-fidelity CICO training is not mandated in the UK and is only recommended when available [3]. In contrast, low-fidelity, workplace-delivered ‘tea trolley’ scalpel cricothyrotomy training has gained popularity because it is practical, accessible and enables compliance with national training requirements [3]. We agree that such training may be unfamiliar or impractical elsewhere in the world and that cultural sensitivity in scalpel cricothyrotomy training is required. As with many other simple but effective innovations, this model may find broader appeal, particularly given its portability and minimal disruption to workflow.Regarding the cost implications, we provided manufacturer details for transparency and to allow others to benchmark or source equivalent alternatives suitable for their own settings.We believe one of the strengths of our study was its quantitative and qualitative assessments of the stress of participants. We consider the measurement of salivary cortisol to be a widely accepted, non-invasive method of quantitatively measuring stress with precision and accuracy [4]. We took steps to control for confounders such as diurnal variation and pre-test activity. While subjective stress assessments such as the NASA Task Load Index or Surgery Task Load Index are validated and widely used [5], we chose to incorporate rich qualitative data from semi-structured interviews, which we found to provide a more nuanced insight into the lived experiences under stress of participants. Nonetheless, the inclusion of both subjective and objective stress measures is an important consideration for future studies, and we thank the authors for the suggestion.We acknowledge the limitations of our fixed-sequence design and agree that it may have introduced a learning effect. However, this was not our participants' first exposure to scalpel cricothyrotomy technical skills training, which is delivered biannually to all anaesthetists in our institution. The observed improvement in performance during the second session, despite evidence of both physiological and subjective stress, was not accompanied by a decline in accuracy. This may suggest consolidation of procedural memory that is resilient to stress and can","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 10","pages":"1282-1283"},"PeriodicalIF":6.9,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16744","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854257","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}

引用次数: 0

Adjustment of positive end-expiratory pressure based on body mass index during general anaesthesia: a reply. 全身麻醉时基于身体质量指数的呼气末正压调整：回复。

IF 10.7 1区医学

Anaesthesia Pub Date : 2025-08-15 DOI: 10.1111/anae.16740

Tobias Becher,

引用次数: 0

Positive end-expiratory pressure based on body mass index. 基于体重指数的呼气末正压。

IF 10.7 1区医学

Anaesthesia Pub Date : 2025-08-15 DOI: 10.1111/anae.16739

Guanyu Yang,Qinjun Chu

引用次数: 0

Improving consent and patient education in the obstetric population. 改善产科人口的同意和患者教育。

IF 10.7 1区医学

Anaesthesia Pub Date : 2025-08-15 DOI: 10.1111/anae.16736

Thomas Gower,George Clews,Samantha Black

引用次数: 0

Study outcome measurements: statistically insignificant or non-inferior? 研究结果测量：统计上不显著还是非劣势？

IF 6.9 1区医学

Anaesthesia Pub Date : 2025-08-15 DOI: 10.1111/anae.16741

Raghuraman M. Sethuraman

{"title":"Study outcome measurements: statistically insignificant or non-inferior?","authors":"Raghuraman M. Sethuraman","doi":"10.1111/anae.16741","DOIUrl":"10.1111/anae.16741","url":null,"abstract":"I read with interest the article by Sim et al. comparing remimazolam vs. propofol in older patients undergoing gastrectomy [1] and would like to add a few insights.First, Sim et al. state that ‘Evidence suggesting that remimazolam increases the incidence of delirium in older patients compared with propofol is unavailable’ [1]. However, a meta-analysis based on many previous studies observed that the incidence of delirium was similar to other drugs [2]. Therefore, it is a well-established fact that remimazolam neither increases nor decreases the incidence of delirium significantly. Interestingly, this meta-analysis was cited by Sim et al. [1]. Consequently, the statement, ‘the incidence of delirium in older patients undergoing general anaesthesia with remimazolam was assumed to be non-inferior to that in those receiving general anaesthesia with propofol’ [1] is questionable, suggesting that the concept of the study is flawed.Second, this was published as a ‘randomised non-inferiority study’ [1]. However, it does not adhere to the protocols of a non-inferiority study [3], right from registration to publication. There was no mention of non-inferiority in the study design in the trial registration. Furthermore, the non-inferiority margin should be calculated depending on a previously published superiority trial. There are many studies published on this topic as per the meta-analysis [2]. Unfortunately, Sim et al. fixed the margin as 10 without considering these points which was a violation of the protocol. In addition, as the figure illustrating the ‘position of the confidence interval in relation to the non-inferiority margin, and null value’ [3] was not provided, it is difficult to draw firm conclusions. This raises the question of whether Sim et al. used non-inferiority in the title purely for effect, and it was done merely because of the insignificant p values.Third, ‘A non-inferiority trial seeks to determine whether a new treatment is not worse than a reference treatment by more than an acceptable amount’ [3]. In addition, the focus should be on whether ‘the new treatment has some other advantage, such as greater availability, reduced cost, less invasiveness, fewer adverse effects or greater ease of administration’ [3]. The study did not examine pharmaco-economics; notably, remimazolam costs about four times more than propofol.In summary, a non-inferiority study is more complex and challenging [4] than simple randomised trials. It might not be feasible or rather impossible to apply this study design for most clinical studies in our specialty. Clinicians should be aware of the specific protocols of this type of study [3] and adhere to them.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 10","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16741","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851084","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}

引用次数: 0

The VIDIAC score: a point of view, but does it reflect the whole picture? VIDIAC评分：一个观点，但它反映了整个画面吗？

IF 10.7 1区医学

Anaesthesia Pub Date : 2025-08-15 DOI: 10.1111/anae.16738

Nisha Abraham-Thomas,David Vaughan,Rajinder Singh Chaggar

引用次数: 0

Closing the peri-operative heart failure gap: insights and imperatives from METREPAIR. 缩小围手术期心力衰竭差距：METREPAIR的见解和必要性。

IF 10.7 1区医学

Anaesthesia Pub Date : 2025-08-15 DOI: 10.1111/anae.16737

John Choi

引用次数: 0

Issue Information – Editorial Board 发行信息-编辑委员会