British journal of anaesthesia最新文献

{"title":"Microaxial mechanical circulatory support in cardiogenic shock: ready for prime time?","authors":"Matthias Heringlake, Sascha Treskatsch","doi":"10.1016/j.bja.2025.02.010","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.010","url":null,"abstract":"<p><p>Randomised controlled studies on the use of intra-aortic balloon counterpulsation and veno-arterial extracorporeal life support have failed to offer a survival benefit compared with standard therapy in patients with myocardial infarction-associated cardiogenic shock. Thus, the results of a recent study using microaxial mechanical circulatory support showing a survival benefit in the intention-to-treat analysis will likely immediately enter treatment guidelines. We express the need for some caution regarding an even broader clinical implementation of these devices by pointing out the statistical fragility of existing data and the contrasting results of numerous large observational studies which almost all demonstrate a higher mortality of using microaxial pumps or extracorporeal life support instead of intra-aortic balloon counterpulsation. Additionally, we discuss confounding bias in recent publications on microaxial mechanical circulatory support.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779040","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":"Weaning failure from mechanical ventilation: a scoping review of the utility of ultrasonography in the weaning process.","authors":"Patrick Sepúlveda, Adrián Gallardo, Ricardo Arriagada, Bruno Souza, Nicolò Patroniti, Denise Battaglini","doi":"10.1016/j.bja.2025.02.024","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.024","url":null,"abstract":"<p><strong>Background: </strong>Weaning failure has been associated with increased hospital stay and higher mortality. Identification of the risk factors that may affect weaning outcome is paramount. Ultrasonography is an excellent tool for pulmonary and diaphragmatic monitoring during mechanical ventilation, allowing real-time evaluation of anatomical structures and function. We performed a scoping review to highlight the usefulness and limitations of ultrasonography as a tool for detecting weaning failure.</p><p><strong>Methods: </strong>The Joanna Briggs Institute recommendations, the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist, and the methodological framework by Arksey and O'Malley were followed. We searched PubMed, Scopus, and Cochrane databases for observational and randomised studies published from inception to August 12, 2024. Inclusion criteria were articles written in English, intensive care unit setting, mechanical ventilation, adults, and those that described a measure for burden of weaning failure using ultrasonography.</p><p><strong>Results: </strong>The search revealed 3573 records. After removal of duplicates, 3117 articles were screened for potential inclusion, of which 89 articles were finally included. These comprised six clinical trials, 80 observational prospective studies, and three retrospective studies. In total, 6841 subjects were included, with a weaning failure rate of 28.2%. The parameters most associated with weaning failure were higher ratio of early diastolic mitral inflow velocity to early diastolic septal mitral annulus velocity, diaphragmatic excursion, diaphragm thickening fraction, diaphragmatic rapid shallow breathing index, ratio between ventilatory frequency, diaphragmatic displacement, excursions, and contraction velocity on coughing. Loss of aeration, pulmonary oedema, and pleural effusion detected with ultrasound were associated with weaning failure and airway obstruction caused by post-extubation laryngeal oedema.</p><p><strong>Conclusions: </strong>Ultrasound represents a valuable tool for optimising the weaning process. It enables precise assessment of lung function and diaphragmatic performance, underscoring the need for its implementation in ICU setting.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728689","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":"Maternal mortality associated with anaesthetic interventions. Comment on Br J Anaesth 2025.","authors":"Ayumi Maeda, William Camann","doi":"10.1016/j.bja.2025.02.028","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.028","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717994","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":"Effect of a driving pressure-limiting strategy for patients with acute respiratory distress syndrome secondary to community-acquired pneumonia. Comment on Br J Anaesth 2025; 134: 637-702.","authors":"Yujiao Wu, Zhengyu Zhang, Yaling Li, Jun Li","doi":"10.1016/j.bja.2025.01.041","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.041","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717967","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":"Effects of opioids on tumour growth and metastasis in animal models: a systematic review.","authors":"Olivia Welch, Natalia Hefteh, Mahdi Sheikh, Adam La Caze, Marie-Odile Parat","doi":"10.1016/j.bja.2025.02.030","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.030","url":null,"abstract":"<p><strong>Background: </strong>The International Agency for Cancer Research monographs recently classified opium consumption as carcinogenic to humans, with sufficient evidence for carcinogenicity in the larynx, lung, and urinary bladder and limited evidence in the oesophagus, pancreas, stomach, and pharynx. This causes concerns of a potential cancer-promoting effect in the same organs associated with the use of pharmaceutical opioids.</p><p><strong>Methods: </strong>We performed a systematic review (registered in the Open Science Framework: osf.io/xyg9p) of the published in vivo preclinical literature to determine whether the effects of opioids on tumour growth and metastasis are organ specific. We investigated whether the opioid category (agonist, antagonist, or peptide), organ of origin of the cancer cells, site of tumour measurement, immune status of rodents, opioid dose, or duration of opioid exposure was associated with reported cancer outcomes.</p><p><strong>Results: </strong>A total of 118 studies, representing 168 experiments, were included. Most animal experiments (94/168, 56%) reported an anti-cancer effect of opioids and 31 (18%) reported a pro-cancer effect. Of the assessed parameters, opioid category (P<0.001) and opioid dose (P=0.0056) were the only factors significantly associated with the reported cancer outcome. In studies testing morphine, experiments showing a cancer-promoting effect predominantly administered low doses of morphine (the proportion of studies using low-dose morphine was 65% among those reporting pro-cancer outcomes vs 8% among those reporting anti-cancer outcomes).</p><p><strong>Conclusions: </strong>We found no relationship indicative of an organ-specific, cancer-promoting effect of opioids.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717991","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":"An updated systematic review and consensus definitions for standardised endpoints in perioperative medicine: patient comfort and pain relief.","authors":"Paul S Myles, Sophie Wallace, Oliver Boney, Mari Botti, Frances Chung, Allan M Cyna, Tong J Gan, Michael P W Grocott, Mark P Jensen, Henrik Kehlet, Andrea Kurz, Maxime Leger, Ulrica Nilsson, Phillip Peyton, Daniel I Sessler, Martin R Tramèr, Christopher L Wu","doi":"10.1016/j.bja.2025.02.025","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.025","url":null,"abstract":"<p><strong>Background: </strong>Improving comfort during and after surgery is a key concern for anaesthetists and other clinicians. With the inclusion of patient and public involvement, we undertook a Delphi consensus process to update previously recommended endpoints to be used in clinical trials evaluating treatments aiming to improve patient comfort after surgery.</p><p><strong>Methods: </strong>We undertook a systematic review to identify domains and outcome measures of patient comfort used in perioperative studies. Focus groups, workshops, and a multi-round Delphi consensus process that included clinician-researchers and a patient experience and consumer group updated a recommended list of standardised endpoints focused on patient comfort. Consensus was defined as a median item score of 7 or greater and at least 70% of responses achieving a score of 7 or greater on a 9-point Likert scale. Additional ratings were done to determine validity, reliability, feasibility, and patient-centredness. Qualitative analyses were undertaken to identify themes.</p><p><strong>Results: </strong>Response rates for each of the Delphi rounds were 100%. A final list of eight defined endpoints was identified: supplementary analgesic use, subjective analgesic effectiveness, pain intensity (at rest, during movement, and at 12, 24, and 72 h), postoperative nausea and vomiting (PONV, at 0-6 h, at 6-24 h, and overall), postdischarge nausea and vomiting (PDNV), severe PONV, quality of recovery (QoR-15), and time to mobilisation. All endpoints were assessed as valid, reliable, and feasible measures of patient comfort and were considered patient-centred. Patient and public involvement highlighted the importance of clear communication and shared decision-making to enhance comfort through the surgical journey.</p><p><strong>Conclusions: </strong>We recommend that at least some of these standardised endpoints be included as outcome measures in clinical trials assessing patient comfort and pain after surgery.</p><p><strong>Systematic review protocol: </strong>Open Science Framework (10.17605/OSF.IO/DJQFE).</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708571","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":"Assessing risk factors for epidural catheter infections in paediatric surgery: a retrospective study on prolonged catheter use.","authors":"Frank Fideler, Julian Hofmann, Andreas Schmidt, Gunnar Blumenstock, Christian Grasshoff","doi":"10.1016/j.bja.2025.02.029","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.029","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708635","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":"Epidural analgesia versus dural puncture epidural analgesia in labouring parturients: a meta-analysis of randomised controlled trials.","authors":"Preet Mohinder Singh, David T Monks, Adithya D Bhat, Anuradha Borle, Manpreet Kaur, Phillip Yang, Muthuraj Kanakaraj","doi":"10.1016/j.bja.2025.01.033","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.033","url":null,"abstract":"<p><strong>Background: </strong>Epidural analgesia and dural puncture epidural (DPE) analgesia are widely used techniques for alleviating labour pain. This meta-analysis compared clinical outcomes between parturients receiving epidural analgesia vs DPE analgesia for labour pain.</p><p><strong>Methods: </strong>Medical databases were searched to identify randomised controlled trials comparing epidural analgesia with DPE analgesia in labouring parturients published up to October 2024. Results were pooled using an inverse variance random-effects model, and 95% prediction intervals were calculated. Clinical outcomes were used as defined by individual trials. The primary outcome was time to onset of analgesia. Secondary outcomes were unilateral block, motor block, sacral sparing, adequate analgesia, Caesarean/operative vaginal delivery, additional doses, and hypotension. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation guidelines, and subgroup analyses were performed based on the types of local anaesthetics used.</p><p><strong>Results: </strong>Eighteen trials involving 2144 parturients were included. DPE labour analgesia slightly reduced the time to onset (mean difference: 3.4 min, 95% confidence interval: 2.1-4.7, P<0.01, I²=97%; moderate certainty). All statistically significant results demonstrated clinical advantages for DPE analgesia, including fewer unilateral blocks, reduced motor block, improved sacral coverage, and higher rates of adequate analgesia. Substantial heterogeneity was observed in the outcome data for time to onset of analgesia, unilateral block, and sacral sparing. Pooled results for Caesarean/operative vaginal delivery, additional doses, and hypotension failed to achieve statistical significance.</p><p><strong>Conclusions: </strong>DPE labour analgesia offers a slightly faster onset and reduced incidence of motor and unilateral blocks compared with traditional epidural analgesia. However, high heterogeneity in some outcomes, likely attributable to clinical and dosing variability, requires cautious interpretation. Although the clinical relevance of the faster onset with DPE analgesia might be modest, when considered alongside its benefits in secondary outcomes it supports the use of DPE analgesia over traditional epidural analgesia. Imputed prediction intervals cross zero for many outcomes, and further studies might alter these findings.</p><p><strong>Clinical trial registration: </strong>PROSPERO- CRD42024602115.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691007","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":"Cardiac index-guided therapy to maintain optimised postinduction cardiac index in high-risk patients having major open abdominal surgery. Comment on Br J Anaesth 2024; 133: 277-87.","authors":"Filippo D'Amico, Alessandro Belletti, Giovanni Landoni","doi":"10.1016/j.bja.2025.02.027","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.027","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691004","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":"Plasma pharmacokinetics of intravenous and intranasal oxytocin in nonpregnant adults.","authors":"Steven L Shafer, Douglas G Ririe, Scott Miller, Regina S Curry, David T Hsu, Gregory M Sullivan, James C Eisenach","doi":"10.1016/j.bja.2024.12.046","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.046","url":null,"abstract":"<p><strong>Background: </strong>The development of oxytocin as a therapeutic agent outside of obstetrics has been hampered by antibody-based assays that lack specificity, leading to inconsistent and incompletely reported pharmacokinetic models to guide drug dosing. This study describes the population plasma pharmacokinetics of intravenous and intranasal oxytocin using a sensitive and specific liquid chromatography-tandem mass spectroscopy (LC/MS) assay.</p><p><strong>Methods: </strong>Two studies in healthy adult men and nonpregnant women were performed, the first with intravenous oxytocin 16.7 μg over 1 or 10 min and the second with intravenous oxytocin 13.7 μg over 30 min and, on a separate day, intranasal oxytocin 100 μg (n=24). Venous plasma oxytocin concentration was measured using LC/MS and enzyme-linked immunosorbent assay. Pharmacokinetic parameters were estimated using NONMEM.</p><p><strong>Results: </strong>The pharmacokinetics of intravenous oxytocin were well described by a two-compartment model (0% bias, 18% median inaccuracy). The two-compartment model for intranasal oxytocin was characterised by substantial subject-to-subject variability (9% median bias, 47% median inaccuracy). Nasal oxytocin bioavailability was 0.7%. Oxytocin samples assayed with LC/MS were systematically higher than simultaneous samples assayed with enzyme-linked immunosorbent assay.</p><p><strong>Conclusions: </strong>The pharmacokinetics of intravenous oxytocin are well described by a two-compartment model. The low bioavailability (<1%) and large intersubject variability in plasma oxytocin after intranasal dosing could partially explain the inconsistent reports of oxytocin efficacy in the clinical literature with this delivery method. A publicly available simulator was created to guide oxytocin dosing in future studies.</p><p><strong>Clinical trial registration: </strong>NCT03929367 (Study 1) and NCT05672667 (Study 2).</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691026","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}