British journal of anaesthesia最新文献

{"title":"Editorial commitment to trust and integrity in science: implications for pain and anesthesiology research.","authors":"Tonya M Palermo, Didier Bouhassira, Karen D Davis, Hugh C Hemmings, Robert W Hurley, Joel Katz, Jaideep J Pandit, Theodore J Price, Michael E Schatman, Stephan K W Schwarz, Dennis C Turk, Marc Van de Velde, Matthew D Wiles, Tony L Yaksh, David Yarnitsky","doi":"10.1016/j.bja.2025.05.007","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.007","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539005","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":"Cognitive errors in paediatric difficult airway management: a step into the unknown","authors":"Vanessa Marchesini, Takashi Asai, Nicola Disma","doi":"10.1016/j.bja.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.bja.2025.06.002","url":null,"abstract":"For many years, studies in airway management focused on different airway devices, techniques, and clinical approaches to manage the paediatric airway more effectively and avoid complications. In the last decade, the focus has broadened to include the impact of human factors on clinical practice. Little is known about the frequency of cognitive errors, their association with complications, and what mitigation strategies should be implemented to minimise potential harm to the patient.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"148 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503695","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":"Perioperative on-demand reversal with andexanet alfa: monitoring reversal and timing of re-anticoagulation","authors":"Jan Wienhold, Oliver Grottke","doi":"10.1016/j.bja.2025.05.029","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.029","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"22 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503694","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":"Frailty and perioperative outcomes: SNAP-3 as a call to action.","authors":"Daniel I McIsaac, Leandra Amado","doi":"10.1016/j.bja.2025.05.027","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.027","url":null,"abstract":"<p><p>Generalisable, prospectively collected data from 7800 older UK surgical patients in the 3^rd Sprint National Anesthesia Project (SNAP-3) confirm that the presence of frailty is a key risk factor for adverse outcomes among older surgical patients. What comes next? Anaesthetists should strive to identify all patients with a Clinical Frailty Scale score ≥4 as being at elevated risk. Researchers, in collaboration with patients, clinicians and health system leaders, should move from a scientific focus on frailty as a risk factor to developing and evaluating interventions to improve outcomes for the growing population of surgical patients with frailty.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504881","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":"Frailty and perioperative outcomes: SNAP-3 as a call to action","authors":"Daniel I. McIsaac, Leandra Amado","doi":"10.1016/j.bja.2025.05.027","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.027","url":null,"abstract":"Generalisable, prospectively collected data from 7800 older UK surgical patients in the 3<ce:sup loc=\"post\">rd</ce:sup> Sprint National Anesthesia Project (SNAP-3) confirm that the presence of frailty is a key risk factor for adverse outcomes among older surgical patients. What comes next? Anaesthetists should strive to identify all patients with a Clinical Frailty Scale score ≥4 as being at elevated risk. Researchers, in collaboration with patients, clinicians and health system leaders, should move from a scientific focus on frailty as a risk factor to developing and evaluating interventions to improve outcomes for the growing population of surgical patients with frailty.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503697","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":"Description and validation of the Postoperative Discharge Recovery State outcome: a patient-partnered population-based cohort study.","authors":"Emily Hladkowicz,Gurlavine Kidd,Alana Flexman,Allan Garland,Julie Hallet,Daniel Kobewka,Matthew McGarr,Robert Talarico,Carl van Walraven,Duminda N Wijeysundera,Camilla L Wong,Daniel I McIsaac,,","doi":"10.1016/j.bja.2025.05.020","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.020","url":null,"abstract":"BACKGROUNDOlder adults prioritise independent return home after surgery. Most discharge outcomes are binary composites that do not incorporate temporal information. We defined and validated a novel ordinal outcome, the Postoperative Discharge Recovery State, and prioritised its temporal measurement, to overcome these limitations.METHODSThis retrospective cohort study was conducted with patient partnership. Adults ≥65 yr having major, elective, noncardiac, non-orthopaedic surgery were identified from 2012 to 2022 using linked, routinely collected data in Ontario, Canada. Construct, convergent, and predictive validity were estimated. A multivariable ordinal regression model was derived and internally-externally validated.RESULTSWe included 84 422 older adult surgical patients. At the patient-prioritised postoperative day 90, the distribution of patients across Postoperative Discharge Recovery State categories was: (1) dead (2718; 3.2%); (2) hospitalised (1696; 2.0%); (3) in long-term care (179; 0.2%); (4) in rehabilitation (593; 0.7%); and (5) at home (79 236; 93.9%). Directionally expected associations with baseline characteristics supported construct validity. Consistency in associations over time supported reliability. Relationships with days alive and at home supported convergent (ρ=0.373) and predictive (fewer days at home with worse recovery state) validity. A prespecified ordinal logistic regression model had inadequate accuracy (c-statistic 0.700, poor calibration) to support its clinical use.CONCLUSIONSThe Postoperative Discharge Recovery State is a 5-level ordinal outcome that can be applied at key time points after surgery to quantify the proportion of patients in patient-prioritised discharge locations. Validity and reliability support utility, but further development will be required to maximise information gain relative to binary outcomes.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"635 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487996","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":"Perioperative polygenic and APOE-based genetic risk assessment for neurocognitive disorders: a biobank study of surgical patients.","authors":"Mariana Thedim,Jie Hu,Matthew Maher,Jeanine Wiener-Kronish,Richa Saxena,Susana Vacas","doi":"10.1016/j.bja.2025.05.014","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.014","url":null,"abstract":"BACKGROUNDPreoperative risk assessment is a critical step in developing targeted preventive and therapeutic strategies. Although genetic biomarkers have shown considerable promise in assessing and stratifying dementia risk, their application in the perioperative period remains unexplored. Given the recognised effects of surgery and anaesthesia on perioperative cognitive trajectories, this study aimed to evaluate the preoperative neurocognitive genetic risk profiles of a surgical population and their influence on postoperative outcomes.METHODSData from the Mass General Brigham Biobank were analysed for male and female surgical patients aged 40-89 yr without a previous diagnosis of Alzheimer's disease. The polygenic risk score for Alzheimer's disease was calculated, and apolipoprotein E (APOE) genotypes were inferred from the study participants. Logistic regression was used to examine the associations between APOE genotype and the polygenic risk score for Alzheimer's disease with neurocognitive disorders.RESULTSThe surgical population comprised 33 526 patients, of whom 86% had European ancestry and 25% carried at least one APOE-ε4 allele. Among patients of European ancestry, the polygenic risk score for Alzheimer's disease was associated with higher risk of Alzheimer's disease (odds ratio [OR], 2.25 [95% confidence interval, 1.64-3.09]; false discovery rate [FDR] <0.001). Patients carrying APOE-ε4 alleles had an increased risk of neurocognitive disorders (e.g. delirium: OR, 1.32 [1.19-1.47], FDR <0.001; mild cognitive impairment: OR, 1.70 [1.49-1.94], FDR <0.001; and Alzheimer's disease: OR, 3.42 [2.72-4.29], FDR <0.001).CONCLUSIONSAPOE genotypes and polygenic risk scores are valuable for exploring neurocognitive genetic risk profiles in surgical populations and have the potential to enhance preoperative risk assessment strategies.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"46 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487998","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":"Geographic isolation, rurality, and outcomes after critical illness: a retrospective cohort study of emergency admissions to critical care units in Scotland 2010-2021.","authors":"Ryan D McHenry,Christopher E J Moultrie,Alasdair R Corfield,Nazir I Lone,Rich Mitchell,Daniel F Mackay,Jill P Pell","doi":"10.1016/j.bja.2025.05.019","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.019","url":null,"abstract":"BACKGROUNDThe association between rurality, geographic isolation, and outcomes in critical care is complex, and important to the design and implementation of robust healthcare systems. We therefore conducted a retrospective cohort study of adult (≥16 yr) emergency admissions to critical care units in Scotland 2010-21.METHODSData were linked across national inpatient records, the critical care database, and mortality records. Geographic isolation was determined by modelled travel time to the intensive care unit (ICU) and emergency department, and rurality by the national eight-fold Urban Rural Classification. Standardised admission rates were calculated, alongside survival analysis for all-cause mortality by isolation and rurality with ICU and hospital length of stay, and emergency hospital readmissions in the year after critical care admission.RESULTSA total of 50 914 first emergency admissions to the ICU over the study period were included in the analyses. Age-sex standardised admissions were 24.2% (95% confidence interval 19.4-28.2%) lower for areas ≥180 min from the ICU compared with areas <30 min from the ICU. No significant associations were demonstrated between mortality and any category of isolation. Greater mortality was demonstrated in other urban areas (settlements of 10 000 to 124 999 people) compared with large urban areas (settlements of ≥125 000 people) (adjusted hazard ratio 1.05, 95% confidence interval 1.01-1.08).CONCLUSIONSAdmission rates to critical care were lower for patients in more isolated and more rural areas. Further research should explore the mechanisms for these findings and consider if strengthened access to critical care transfer and resource in remote areas might improve health outcomes.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"51 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487997","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":"Frailty in the perioperative setting: lessons from SNAP-3.","authors":"Simon J Howell,Jugdeep K Dhesi","doi":"10.1016/j.bja.2025.05.024","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.024","url":null,"abstract":"The third Sprint National Anaesthesia Project (SNAP-3) is the largest prospective, multicentre UK study to examine the impact of frailty, multimorbidity, and delirium on postoperative outcomes in patients aged ≥60 yr. Conducted across 214 National Health Service (NHS) hospitals, SNAP-3 enrolled 7134 surgical patients over 5 days in March 2022. The investigators identified frailty in one-fifth of patients using multiple tools, including the Clinical Frailty Scale (CFS). Frailty was especially prevalent in emergency surgery and socioeconomically deprived populations. Multimorbidity was present in two-thirds of patients but only partially overlapped with frailty. Frailty was strongly associated with increased length of stay, delirium, complications, and mortality, with adverse outcomes escalating with higher CFS scores. In contrast, multimorbidity (without frailty) had limited association with most adverse outcomes. Directed acyclic graphs guided causal analysis, but by assuming frailty and multimorbidity were independent, the investigators might have underestimated the impact of multimorbidity. SNAP-3 highlights the need for routine perioperative frailty screening, comprehensive perioperative services, and workforce development. The data inform service planning and support prioritisation of frailty-focused care, especially in high-burden specialties and deprived areas.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"36 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487999","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":"Differential nerve block: axons are not all the same, nor are local anaesthetics.","authors":"John Anthony Winston Wildsmith","doi":"10.1016/j.bja.2025.05.025","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.025","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"608 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335380","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}