Anaesthesia and Intensive Care最新文献

{"title":"The physiologists who 'oxygenised' sport.","authors":"Peter J Featherstone, Christine M Ball","doi":"10.1177/0310057X241311823","DOIUrl":"10.1177/0310057X241311823","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"80-82"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mimicking the Eleveld propofol target-controlled infusion model using the Marsh model with weight adjustment in a super-obese patient.","authors":"George Zhong, Sarah J Wong","doi":"10.1177/0310057X241275122","DOIUrl":"10.1177/0310057X241275122","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"139-141"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of type of anaesthetic on delirium after surgery for acute hip fracture: An instrumental variable analysis to assess causation.","authors":"Anna-Marie G Tanios, Emily L Gallagher, Michael S McManus, John A Riordan, Ian A Harris, Lara A Harvey","doi":"10.1177/0310057X241275116","DOIUrl":"10.1177/0310057X241275116","url":null,"abstract":"<p><p>Delirium is the most common in-hospital complication affecting older adults with acute hip fractures. Current evidence demonstrates inconsistent associations between anaesthetic type for acute hip fracture surgery and postoperative delirium. Using the Australian and New Zealand Hip Fracture Registry database, we conducted a retrospective cohort study of patients aged 50 years and over who underwent acute hip fracture surgery between 2015 and 2020. The incidence of delirium in patients who received general anaesthesia alone or combined with a regional technique, versus those who received spinal or regional anaesthesia was assessed. Multivariable multilevel logistic regression was used to test associations between anaesthetic type and delirium controlling for known confounders. Finally, given hospital variation in preference for anaesthetic type, an instrumental variable analysis was performed to include the effect of both known and unknown confounding. Of 35,252 patients, 25,682 (72.9%) patients received general anaesthesia, and 9570 (27.2%) patients received spinal or regional anaesthesia for their hip fracture surgery. A higher proportion of patients who received general anaesthesia developed delirium than those who received spinal or regional anaesthesia (40.6% vs. 35.7%, odds ratio (OR) 1.23, 95% confidence intervals (CI) 1.18 to 1.30, <i>P</i> < 0.0001). After adjusting for known confounders, general anaesthesia patients were at slightly increased odds of developing delirium (OR 1.14, 95% CI 1.04 to 1.25, <i>P</i> = 0.0052). However, the instrumental variable analysis found no statistically significant difference between groups (OR 1.03, 95% CI 0.99 to 1.07, <i>P</i> = 0.141). Therefore, while a weak association was found between general anaesthesia exposure and postoperative delirium, an instrumental variable analysis to compensate for unmeasured confounding showed no causal association between general anaesthesia and postoperative delirium.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"116-124"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with poor intraoperative perfusion and postoperative complications in otolaryngological autologous tissue transfers: A single-centre retrospective observational study.","authors":"Steven C Eastlack, Adriano A Bellotti, Wesley H Stepp, Joshua B Cadwell, Alan M Smeltz","doi":"10.1177/0310057X241275112","DOIUrl":"10.1177/0310057X241275112","url":null,"abstract":"<p><p>The purpose of this study was to identify haemodynamic factors that are associated with tissue hypoperfusion in flap/graft surgical patients that might be modified to reduce perioperative morbidity. We conducted a single-centre, retrospective, observational study of 1355 patients undergoing head and neck flap reconstructions. Logistic regression and chi-square analyses were employed to identify factors which signal perioperative complications. Study endpoints included postoperative lactic acidosis, acute kidney injury (AKI) and early surgical flap revision surgery. Intraoperative data were collected as time-weighted averages of the haemodynamic variables, including pulse pressure variation (PPV), mean arterial pressure, and vasopressor doses. Cumulative volume was used for intravenous (IV) fluids. Relevant patient comorbidities were also included in the analysis. The most common complication was hyperlactataemia (22.9%), followed by AKI (14.1%) and take-back surgery (3.3%). No patient factors were significantly correlated with flap complications. Elevated max PPV was significantly associated with elevated lactate and AKI in univariate regression, but only AKI in the multivariate analysis (<i>P</i> = 0.003). Case duration was the only variable associated with take-back surgery in the multivariate regression (<i>P</i> = 0.007); it was also associated with lactic acidosis (<i>P</i> = 0.003). Neither IV fluid administration nor the use of vasopressors appeared to be associated with study outcomes in the multivariate analysis.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"83-91"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibreoptic intubation in children and young people in resource-limited settings: A case series during a humanitarian aid operation in Guinea.","authors":"Raphael Laurent, Eva Kardous, Oumar R Diallo, Charles Collet, Hervé Benateau, René Allary, Florent Baudin","doi":"10.1177/0310057X241272111","DOIUrl":"10.1177/0310057X241272111","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"142-144"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of Australian anaesthetists and anaesthetic trainees of working whilst pregnant: Results of a national survey.","authors":"Rosmarin Zacher, Isabelle L Cooper, Anna F Pietzsch, Lachlan Webb, Anita M Pelecanos, Victoria A Eley","doi":"10.1177/0310057X241263116","DOIUrl":"10.1177/0310057X241263116","url":null,"abstract":"<p><p>Changing medical workforce demographics emphasise the need to understand and effectively manage pregnancy in the workplace. An Australian survey exploring pregnancy experiences of specialists and trainees working in anaesthesia received 242 responses describing 549 pregnancies. One hundred and sixty-two (67%) of these respondents were aged 31-40 years, 185 (76%) were specialists and 159 (66%) reported one or two pregnancies. Reported pregnancy complication rates were similar to national averages. Potentially harmful exposures included working >40 h per week (<i>n</i> = 298, 55%), ionising radiation and unscavenged gases. Other than ergonomic hazards and stress, exposures were not associated with an increase in self-reported complications. Moving heavy patients on a daily to weekly basis (<i>n = </i>278, 53%) was associated with an increased risk for any maternal complication; odds ratio (OR) 2.13, 95% confidence interval (CI) 1.37 to 3.33, <i>P < </i>0.001. High or debilitating stress levels were associated with any maternal complication, OR 2.93, 95% CI 2.06 to 4.17, <i>P < </i>0.001, and any adverse neonatal/fetal outcome, OR 1.72, 95% CI 1.10 to 2.69, <i>P</i> = 0.018. The most common stress contributors were 'work-related', 'exams' and 'pregnancy anxiety'. Ninety-one (38%) respondents reported experiencing stigma or negative attitudes toward their pregnancy from anaesthetic colleagues. Overall, 171 (71%) of respondents were satisfied with their experience of working in anaesthesia whilst pregnant. Thematic analysis of free text comments identified three major themes: workplace culture, maternal and fetal wellbeing, and career impacts on both pregnancy and family planning. Development of multilevel mechanisms to guide and support pregnant trainees and specialists in anaesthesia is recommended to address these findings.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"103-115"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of polymyxin B haemoperfusion on septic shock caused by Gram-positive bacteria.","authors":"Soichi Tanaka, Junpei Haruna, Satoshi Kazuma, Hiroomi Tatsumi, Yoshiki Masuda","doi":"10.1177/0310057X241284300","DOIUrl":"10.1177/0310057X241284300","url":null,"abstract":"<p><p>Polymyxin B haemoperfusion is commonly used to adsorb endotoxins in septic shock caused by Gram-negative bacterial infections. Polymyxin B haemoperfusion has been reported to improve hypotension in Gram-positive bacterial infections; however, its efficacy and mechanism in treating such cases are unclear. We hypothesised that polymyxin B haemoperfusion would be equally effective in improving haemodynamics during Gram-positive bacterial infections as in Gram-negative bacterial infections. We conducted a retrospective study that included patients with septic shock admitted to the intensive care unit. The patients were divided into two groups according to bacterial culture results: Gram-negative rod (GNR) and Gram-positive coccus (GPC). We calculated the vasoactive inotropic score (VIS) before (0 h) and 2, 6, 12 and 24 h after polymyxin B haemoperfusion therapy. Data were analysed using two-way analysis of variance and post hoc tests for the associations between infection type and treatment time. Overall, 157 patients with septic shock were enrolled in the study: 81 and 76 patients were treated or not treated with extracorporeal haemoperfusion therapy, respectively. Although there was no significant difference in the VIS in polymyxin B haemoperfusion between patients with GNR and GPC infections, there was a significant decrease in the VIS over time, even when GPC was the causative organism. In addition, the degree of reduction in the VIS was significantly different in both the GNR and GPC groups compared with that in the non-extracorporeally treated group. Thus, polymyxin B haemoperfusion for septic shock caused by GNR reduced the VIS and could be effective even in cases of GPC infection.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"125-135"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the efficiency of sevoflurane delivery during general anaesthesia by educating and motivating anaesthetists to utilise the Volatile Efficiency Ratio.","authors":"Samuel T Costello, Blake J Vorias, Roman Kluger","doi":"10.1177/0310057X241296574","DOIUrl":"https://doi.org/10.1177/0310057X241296574","url":null,"abstract":"<p><p>Volatile anaesthetic agents such as sevoflurane contribute to greenhouse gas emissions, and selecting low fresh gas flows on anaesthetic machines minimises their waste. Facilitating improvements in sevoflurane use requires the education, motivation, and standardised evaluation of anaesthetists. There is currently no standard of practice related to the efficiency of anaesthetic gas delivery per case. We conducted a multi-component study termed 'Low With The Flow' (LWTF) to directly address these requirements by educating and motivating anaesthetists to reduce fresh gas flow and thereby sevoflurane use. We introduced a novel metric, the 'volatile efficiency ratio' (VER), able to be calculated on Draeger Primus™, the Draeger Atlan™ family and Draeger Perseus A500™ machines, to audit sevoflurane use in a case-by-case fashion, and assess whether the intervention could achieve a set VER target. The LWTF intervention significantly improved the efficiency of sevoflurane delivery (VER 0.46 pre-intervention (<i>n</i> = 518) versus VER 0.57 post-intervention (<i>n</i> = 531), 95% confidence interval 0.092 to 0.129, <i>P < </i>0.0001) resulting in a calculated average of 1.3 kg carbon dioxide equivalent emissions reduction and approximately AUD 3.50 saving per case. Consequently, the financial and environmental outcomes from sevoflurane delivery were considerably reduced. Our LWTF intervention provides a valuable model for other anaesthetic departments to investigate and address the global environmental and financial burdens related to their volatile anaesthetic use. For anaesthetists using anaesthesia machines that do not facilitate calculation of VER, an approach using components of our LWTF intervention may still reduce the environmental and financial impacts associated with administration of volatile anaesthesia.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X241296574"},"PeriodicalIF":1.1,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thanks to Reviewers.","authors":"","doi":"10.1177/0310057X251317125","DOIUrl":"https://doi.org/10.1177/0310057X251317125","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251317125"},"PeriodicalIF":1.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaesthetic practice and mortality in Scotland compared to England from 1847 to 1914.","authors":"Alistair G McKenzie","doi":"10.1177/0310057X241304419","DOIUrl":"https://doi.org/10.1177/0310057X241304419","url":null,"abstract":"<p><p>In the second half of the nineteenth century and up to the First World War, anaesthetic practice in Scotland differed markedly from that in England. Chloroform was invariably used in Scotland with apparent disregard for reports of deaths under its influence. By contrast, in England concern about chloroform deaths, which were subject to inquests there, led to ether often being chosen instead. This article examines the different interpretations and handling of chloroform deaths in the two countries, drawing on the medical journals of the period and archived documents. Quite symmetrical claims were made. Whereas in England the danger of chloroform was perceived to be an inherent property of the agent itself, in Scotland the blame was thrown on a timid method of administration. The interpretation in Scotland was supported by a network of doctors who promoted chloroform as effective, safe and easy to administer; manufacturers who had monopoly of its manufacture; and legal practitioners who were uninterested in investigating anaesthetic deaths. Although the reporting of anaesthetic deaths was flawed in England, underreporting was far worse in Scotland. The fear of anaesthetic deaths in England allowed the seeds of specialisation in anaesthesia to germinate, whereas in Scotland the downplaying of anaesthetic risk obviated the notion of such specialisation.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X241304419"},"PeriodicalIF":1.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}