Anaesthesia and Intensive Care最新文献

{"title":"Survey of administration of intravenous ketamine for perioperative pain management in Australia and New Zealand.","authors":"Patryck J Lloyd-Donald, Philip J Peyton","doi":"10.1177/0310057X241309655","DOIUrl":"10.1177/0310057X241309655","url":null,"abstract":"<p><p>Ketamine is an N-methyl-d-aspartate receptor antagonist approved for use in anaesthesia, with analgesic properties. Despite publication of numerous trials and expert guidelines on its use for pain management, administration of ketamine as part of multimodal perioperative analgesia remains 'off-label'. We conducted an online, prospective survey of ANZCA Fellows, exploring current prescribing practices of intravenous ketamine for perioperative analgesia. We surveyed 2000 Fellows and received 806 responses. The factors mostly likely to influence their administration of perioperative ketamine included pre-existing chronic pain, and heavy or multiple opioid use by patients preoperatively. Amongst respondents, less senior anaesthetists and those working in public hospitals were more likely to administer intraoperative ketamine. The surgical procedures most likely to result in ketamine administration intraoperatively were open pelvic/abdominal, thoracic and major spinal surgery, where ketamine administration was likely practice for the majority of respondents, with typical loading doses that ranged widely. The commonest choices of intraoperative loading dose were between 0.2 mg kg^-1 and 0.6 mg kg^-1. The commonest choice of intraoperative and postoperative infusion rate was in the range of 0.1-0.2 mg kg^-1 h^-1. Postoperative ketamine infusion was most commonly prescribed as third-line or rescue analgesia. The majority of respondents thought it either 'likely' or 'very likely' ketamine would reduce postoperative chronic pain after thoracic surgery, but not in other surgical categories. Our findings suggest that off-label perioperative administration of ketamine at analgesic dose ranges is routine or common practice in major surgery for a majority of specialist anaesthetists in Australia and New Zealand.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"190-198"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405387","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":"A randomised trial to assess the impact of midodrine on early mobilisation after elective primary hip replacement surgery.","authors":"Adam C Cammerman, Daniel Wl Haslam, Dale A Currigan, Mark J Lennon","doi":"10.1177/0310057X241290536","DOIUrl":"10.1177/0310057X241290536","url":null,"abstract":"<p><p>Early mobilisation following elective total hip arthroplasty (THA) facilitates quicker rehabilitation, and reduces complications and hospital length of stay. Reasons for delayed mobilisation are multifactorial, but the most common cause is orthostatic intolerance. Midodrine, an oral alpha-1 agonist, is used off-label for perioperative hypotension. However, there are few randomised trials assessing its use in the perioperative setting to improve patient outcomes. The aim of the study was to determine whether midodrine improves early mobilisation following primary THA, and whether this relates to reduced orthostatic intolerance. This prospective, triple-blinded, multicentre study involved 42 patients randomised to either placebo or 20 mg midodrine, 2 h before physiotherapy, on Day 1 postoperatively. The inclusion criteria were adults undergoing elective unilateral THA under spinal anaesthesia. The primary endpoint was the ability to walk 5 m with physiotherapists. Secondary endpoints included the incidence of orthostatic intolerance and hypotension. A preplanned interim analysis showed no statistical difference in ability to mobilise 5 m (78.26% vs 78.95%, <i>P</i> = 1.0). There was no statistically significant difference in the incidence of orthostatic intolerance between the groups 17.4% vs 31.6% (<i>P</i> = 0.45). Pre-emptive use of midodrine did not improve patient mobilisation the morning after elective primary THA and had no significant effect on the incidence of orthostatic hypotension.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"151-160"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373642","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":"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":"161-170"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","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":"Two episodes of delayed emergence in a healthy young man.","authors":"James R Nielsen, Anil Keshava","doi":"10.1177/0310057X241275126","DOIUrl":"10.1177/0310057X241275126","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"136-138"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456187","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 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":"A feasibility study of measuring maternal anaemia and postoperative outcomes after caesarean section.","authors":"Mark O'Donnell, Alicia T Dennis","doi":"10.1177/0310057X241275127","DOIUrl":"10.1177/0310057X241275127","url":null,"abstract":"<p><p>SummaryIron-deficiency anaemia (IDA) is a global health problem. The impact of IDA on outcomes in obstetric patients who undergo caesarean section (CS) is unknown. We assessed the feasibility of conducting a large study to investigate perioperative anaemia and outcomes after CS. With ethics approval and trial registration, 60 obstetric patients (30 planned CS, 30 emergency CS) were included. Feasibility categories were willingness to participate in a study, to undergo additional blood tests (haemoglobin, ferritin), to have weight measured and to undertake quality of recovery (QoR) questionnaires. Of eligible people approached, 100% agreed to participate and 100% would participate in a future study. Ninety percent (95% confidence interval (CI) 82.4% to 97.6%) and 83% (95% CI 73.9% to 92.7%) agreed to additional tests in hospital and after discharge, respectively. Ninety-eight per cent (95% CI 95.1% to 100%) consented to being weighed, and 100% completed QoR questionnaires. Preoperatively, 8.5% (95% CI 1.4% to 15.6%) of participants were anaemic. Postoperative haemoglobin was measured in only 22 (36.7%, 95% CI 24.5% to 48.9%) participants, and 40.9% (95% CI 20.4% to 61.5%) were anaemic, suggesting at least a quadrupling of the proportion of anaemic patients from pre- to postoperatively. Ferritin was not measured postoperatively in any participant. The prevalence of participants discharged with IDA was unquantifiable. Postoperative IDA in obstetric patients is likely to be a serious problem that is currently unrecognised. Our data suggest that a definitive study to determine associations between maternal anaemia and perioperative outcomes after CS surgery is feasible.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"92-102"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930618","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":"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":"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}