Anaesthesia最新文献

{"title":"Estimating the effect of frailty on longer-term survival following emergency laparotomy: an observational study using National Emergency Laparotomy Audit data*","authors":"Angeline Price, Lyndsay Pearce, Jane Griffiths, Jonathan Smith, Louise Tomkow, Peter Martin","doi":"10.1111/anae.16644","DOIUrl":"https://doi.org/10.1111/anae.16644","url":null,"abstract":"Approximately 30,000 emergency laparotomies are performed each year across the UK. Over half are in patients aged ≥ 65 y, with a third of this group living with frailty. The association between frailty and 90-day mortality following surgery is well documented, but the longer-term mortality risk has been studied less extensively, despite clear implications for person-centred care. This study aimed to estimate the influence of frailty on both short- (≤ 90 days) and longer-term (> 90 days) mortality following emergency laparotomy.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"24 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153489","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":"Rapid sequence induction: a modern‐day example of Theseus' Paradox?","authors":"Craig Lyons, Matthew D. Wiles","doi":"10.1111/anae.16636","DOIUrl":"https://doi.org/10.1111/anae.16636","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"34 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136738","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":"Universal videolaryngoscopy for tracheal intubation in the operating theatre: A prospective non-randomised clinical trial","authors":"Manuel Taboada, Jorge Fernández, María Bermúdez, Ana Estany-Gestal, Nieves Molins, María de los Ángeles Orallo, Eva Mosquera, Marcos Amor, Cora Díaz, Paula Mirón, Laura Dos Santos, Rosa Soto-Jove, María Concepción Alonso, Juan José Amate, Sergio Varela, Cristina Taboada, Jorge Miguel Alcántara, Teresa Seoane-Pillado","doi":"10.1111/anae.16643","DOIUrl":"https://doi.org/10.1111/anae.16643","url":null,"abstract":"Multiple trials have shown the advantages of videolaryngoscopy over direct laryngoscopy for tracheal intubation in the operating theatre. However, the effectiveness of universal videolaryngoscopy in real-world operating theatre settings remains uncertain.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"2 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136975","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":"Is it time to open the doors of the intensive care unit further for patients with alcohol-related liver disease?","authors":"Mark J. W. McPhail","doi":"10.1111/anae.16649","DOIUrl":"10.1111/anae.16649","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 8","pages":"892-894"},"PeriodicalIF":7.5,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136739","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":"Combined videolaryngoscopy and flexible bronchoscopy for difficult tracheal intubation in children: a retrospective observational cohort study.","authors":"Helen Lin,Craig Lyons,Kar-Binh Ong,Richard Lin","doi":"10.1111/anae.16624","DOIUrl":"https://doi.org/10.1111/anae.16624","url":null,"abstract":"INTRODUCTIONChildren with difficult airways are at high risk of complications. Alternative techniques to direct laryngoscopy for tracheal intubation include videolaryngoscopy, flexible bronchoscopy and the hybrid technique of simultaneous videolaryngoscopy and flexible bronchoscopy. This analysis aimed to compare the first-attempt success of each technique and assess the complications associated with difficult paediatric intubations in a quaternary paediatric institution.METHODSThe electronic health records of a single quaternary paediatric hospital were searched to identify anaesthesia encounters involving difficult paediatric intubation. This was defined either by the Pediatric Difficult Intubation Registry criteria or as tracheal intubation requiring ≥ 3 attempts. Primary outcomes were the first-attempt success rate and incidence of complications with each tracheal intubation technique.RESULTSFrom April 2019 to January 2024, 559 encounters involving difficult tracheal intubation were identified. First-attempt success was highest for the hybrid technique (70/94, 74.5%) compared with videolaryngoscopy (143/235, 60.9%, p = 0.020) or direct laryngoscopy (19/190, 10.0%, p < 0.001). The hybrid technique was used to rescue 19/27 (70.4%) encounters where videolaryngoscopy alone was unsuccessful and was successful in all these encounters. Eighty-six (15.4%) encounters had at least one complication. The complication rate was significantly higher for patients weighing < 10 kg (45/184, 24.5%) compared with those weighing ≥ 10 kg (41/375, 10.9%, p < 0.001). The hybrid technique was associated with a lower incidence of complications (5/94, 5.3%) compared with videolaryngoscopy (33/235, 14.0%, p = 0.025) or direct laryngoscopy (41/190, 21.6%, p < 0.001).DISCUSSIONIn children with difficult tracheal intubation, the hybrid technique was associated with a higher first-attempt success rate compared with videolaryngoscopy alone or direct laryngoscopy. Consideration should be given to the hybrid technique as a first-line approach when difficult tracheal intubation is anticipated and when there is a failed attempt with either direct laryngoscopy or videolaryngoscopy.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"136 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114262","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 double-edged scalpel: genome-wide association studies and chronic postsurgical pain","authors":"Andreas C. Themistocleous,&nbsp;Wenqianglong Li","doi":"10.1111/anae.16645","DOIUrl":"10.1111/anae.16645","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 7","pages":"753-756"},"PeriodicalIF":7.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114261","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":"Looking before we leap: treating postoperative anaemia with iron","authors":"Lachlan F. Miles","doi":"10.1111/anae.16646","DOIUrl":"10.1111/anae.16646","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 8","pages":"895-898"},"PeriodicalIF":7.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114260","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":"Stylet vs. flexible-tip bougie: interpreting intubation outcomes with hyperangulated videolaryngoscopy in the ICU","authors":"Manuel Taboada,&nbsp;the authors","doi":"10.1111/anae.16631","DOIUrl":"10.1111/anae.16631","url":null,"abstract":"&lt;p&gt;We thank Makar et al. [&lt;span&gt;1&lt;/span&gt;] and Hsu et al. [&lt;span&gt;2&lt;/span&gt;] for their thoughtful comments on our article [&lt;span&gt;3&lt;/span&gt;] and appreciate the opportunity to clarify and contextualise our findings.&lt;/p&gt;&lt;p&gt;As noted, the first-pass tracheal intubation success rate in the stylet group of our study was 83%, which Makar et al. [&lt;span&gt;1&lt;/span&gt;] found surprisingly low. However, this figure aligns closely with data from large-scale, high-quality studies conducted in intensive care settings. For example, in the DEVICE trial, which included over 1400 adults who were critically ill and undergoing tracheal intubation in emergency departments and ICUs, the first-pass tracheal intubation success rate using videolaryngoscopy was 85%, with standard geometry blades used in 86% of cases and hyperangulated blades in 14% [&lt;span&gt;4&lt;/span&gt;]. In that trial, a stylet was used in 55% of patients and a bougie in 42%. Similarly, in the INTUBE study of nearly 3000 patients who were critically ill, the first-pass tracheal intubation success rate with videolaryngoscopy was 84%, with a stylet used in 77% of cases and a bougie in 22% [&lt;span&gt;5&lt;/span&gt;]. These rates are consistent with those observed in our own study.&lt;/p&gt;&lt;p&gt;In contrast, the studies cited by the authors [&lt;span&gt;6, 7&lt;/span&gt;] were conducted in the operating theatre in elective surgical patients. This is fundamentally different from the ICU in terms of patient physiology, procedural urgency and available resources. Notably, both studies reported first-pass tracheal intubation success rates exceeding 97%, figures that are not representative of the realities and complexities of airway management in patients who are critically ill. To our knowledge, no large ICU-based series have reported first-pass intubation success rates &gt; 90%.&lt;/p&gt;&lt;p&gt;Airway management in the ICU is challenging due to physiological issues, haemodynamic instability and unpredictable anatomy. Although 73% of operators were residents who were familiar with hyperangulated videolaryngoscopes, this does not invalidate the study results or prevent meaningful device comparisons. Crucially, our study was designed to evaluate the performance of these two introducers (stylet vs. flexible-tip bougie) under ‘real-world’ ICU conditions, and we believe our findings reflect their clinical utility in such settings accurately.&lt;/p&gt;&lt;p&gt;We agree with the correspondents that operator training and technique are critical, particularly when using hyperangulated videolaryngoscopes with a stylet. Our protocol included a standardised approach to stylet shaping, with an angulation of at least 30–40° in the distal 5 cm of the tube. This is consistent with critical care practice and previously published studies. Operators were free to further increase the angulation if necessary, although a limitation of our study is that we did not record the exact angle used in each case. While alternative techniques such as shaping the stylet to match the blade curvature or adjusting g","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 7","pages":"877-878"},"PeriodicalIF":7.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16631","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982459","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":"Impact of tracheal extubation location after surgical procedures on peri-operative times: a prospective dual-centre observational study*","authors":"Thomas Godet,&nbsp;Charlotte Wajew,&nbsp;Morgane Fabrizi,&nbsp;Clément Monet,&nbsp;Yvan Pouzeratte,&nbsp;Mathilde Lapeyre,&nbsp;Samuel Adelou,&nbsp;Bruno Pereira,&nbsp;Marc Garnier,&nbsp;Gérald Chanques,&nbsp;Matthieu Jabaudon,&nbsp;Emmanuel Futier,&nbsp;Samir Jaber,&nbsp;Audrey De Jong","doi":"10.1111/anae.16620","DOIUrl":"10.1111/anae.16620","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Extubation of the trachea in the operating theatre may increase the time spent there. Conversely, tracheal extubation in the post-anaesthesia care unit may prolong the duration of anaesthesia and increase the incidence of complications. Our primary objective was to quantify the additional occupancy time associated with tracheal extubation in the operating theatre compared with the post-anaesthesia care unit. Secondary objectives were to assess the incidence of complications after tracheal extubation, including the need for ventilatory support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a prospective dual-centre observational cohort study of patients whose tracheas were intubated for surgery in the operating theatre of two university hospitals. The primary endpoint was operating theatre occupancy time between the end of surgical procedure and discharge from the operating theatre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 756 patients were included, and 494 (65.3%) tracheal extubations occurred in the operating theatre. Room occupancy time was increased by 7 min (95%CI 5–8 min, p = 0.001) when tracheal extubation was performed in the operating theatre compared with the post-anaesthesia care unit. After adjustment by matched or weighted propensity score, this time increased to 8 min (95%CI 6–10 min, p = 0.001) and 8 min (95%CI 6–9 min, p = 0.001), respectively. Desaturation after tracheal extubation (20.9% vs. 36.3%, p &lt; 0.001) and arterial hypotension (0.6% vs. 3.1%, p = 0.019) were less frequent when tracheal extubation took place in the operating theatre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Tracheal extubation in the operating theatre is associated with an increase in theatre occupancy of &lt; 8 min and a lower incidence of postoperative respiratory and cardiovascular complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 8","pages":"915-926"},"PeriodicalIF":7.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16620","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932777","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":"Patient perception of consent processes for epidural analgesia in induction of labour: a qualitative study.","authors":"Danna Nitzani,Jacqueline Nicholls,Katherine Maslowski,Robert Craig,Sohail Bampoe,Melissa Whitten,Anne Lanceley","doi":"10.1111/anae.16637","DOIUrl":"https://doi.org/10.1111/anae.16637","url":null,"abstract":"INTRODUCTIONWomen undergoing induction of labour often utilise epidural analgesia. Obtaining consent for labour epidural presents a unique challenge for the obstetric anaesthetist, who must comply with the legal standards of consent. This study explores how women perceive the consent process for epidural analgesia during induction of labour.METHODSThis was a qualitative, single-centre, interview-based study. Fourteen women who received an epidural for labour analgesia were interviewed using a semi-structured interview guide. Data were analysed using thematic analysis.RESULTSFour themes described women's experience of the consent process. Understanding alternatives, risks and benefits; for example, time constraints hindering the effective communication of information around epidural analgesia, including alternative analgesic options. Timing of information; for example, the value of information was diminished by pain, fatigue and the imminence of the procedure. Timing of consent; for example, physiological and psychological demands of labour negatively impacted patients' ability to engage with the consent process. Anaesthetists' assessment of patient understanding; for example, confirmation of patient understanding by anaesthetists was lacking.DISCUSSIONWomen's experiences of the consent process for induction of labour suggest that in the context of the pain and exhaustion of labour, inadequate and untimely information provision and dialogue between women and their anaesthetists can undermine the implementation of lawful consent.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"140 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932778","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}