British journal of anaesthesia最新文献

{"title":"Evaluation of AI-based nerve segmentation on ultrasound: relevance of standard metrics in the clinical setting.","authors":"Bernard V Delvaux, Olivier Maupain, Thomas Giral, James S Bowness, Luc Mercadal","doi":"10.1016/j.bja.2024.12.040","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.040","url":null,"abstract":"<p><strong>Background: </strong>In artificial intelligence for ultrasound-guided regional anaesthesia, accurate nerve identification is essential. The technology community typically favours objective metrics of pixel overlap on still-frame images, whereas clinical assessments often use subjective evaluation of cine loops by physician experts. No clinically acceptable threshold of pixel overlap has been defined for nerve segmentation. We investigated the relationship between these approaches and identify thresholds for objective pixel-based metrics when clinical evaluations identify high-quality nerve segmentation.</p><p><strong>Methods: </strong>cNerve™ is a deep learning segmentation tool on GE Healthcare's Venue™ ultrasound systems. It highlights nerves of the interscalene-supraclavicular-level brachial plexus, femoral, and popliteal-level sciatic block regions. Expert anaesthesiologists subjectively rated overall segmentation quality of cNerve™ on ultrasound cine loop sequences using a 1-5 Likert scale (1 = poor; 5 = excellent). Objective assessments of nerve segmentation, using the Intersection over Union and Dice similarity coefficient metrics, were applied to frames from sequences rated 5.</p><p><strong>Results: </strong>A total of 173 still image frames were analysed. The median Intersection over Union for nerves was 0.49, and the median Dice similarity coefficient was 0.65, indicating variable performance based on objective metrics, despite subjective clinical evaluations rating the artificial intelligence-generated nerve segmentation as excellent.</p><p><strong>Conclusions: </strong>Variable objective segmentation metric scores correspond to excellent performance on clinically oriented assessment and lack the context provided by subjective expert evaluations. Further work is needed to establish standardised evaluation criteria that incorporate both objective pixel-based and subjective clinical assessments. Collaboration between clinicians and technologists is needed to develop these evaluation methods for improved clinical applicability.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522594","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 midazolam co-administered with oxycodone on ventilation: a randomised clinical trial in healthy volunteers.","authors":"Victoria Gershuny, Jeffry Florian, Rutger van der Schrier, Michael C Davis, Pablo Salcedo, Celine Wang, Keith Burkhart, Kristin Prentice, Aanchal Shah, Rebecca Racz, Vikram Patel, Murali Matta, Omnia Ismaiel, Rodney Boughner, Kevin A Ford, Rodney Rouse, Marc Stone, Carlos Sanabria, Albert Dahan, David G Strauss","doi":"10.1016/j.bja.2024.11.047","DOIUrl":"https://doi.org/10.1016/j.bja.2024.11.047","url":null,"abstract":"<p><strong>Background: </strong>Benzodiazepines can exacerbate opioid-induced respiratory depression by furthering the decrease in central respiratory drive and causing loss of upper airway patency potentially leading to airway obstruction. This study aimed to determine if co-administration of benzodiazepines and opioids significantly decreases hypercapnic ventilation compared with opioids alone.</p><p><strong>Methods: </strong>We conducted a randomised, double-blind, four-period crossover trial in 20 healthy participants to assess whether i.v. midazolam (0.0375 mg kg^-1 in the first five participants; 0.075 mg kg^-1 in 15 participants) plus oral oxycodone (10 mg), compared with oxycodone alone, decreases minute ventilation at an end-tidal carbon dioxide (Pco₂) of 7.3 kPa using modified Read rebreathing methodology.</p><p><strong>Results: </strong>Midazolam administered with oxycodone, compared with oxycodone alone, did not significantly decrease minute ventilation at an end-tidal Pco₂ of 7.3 kPa (23.5 vs 25.2 L min^-1; mean difference -1.7 L min^-1, one-sided 95% confidence interval -∞ to 1.6; P=0.21). However, midazolam plus oxycodone increased resting end-tidal Pco₂ compared with oxycodone alone (5.8 vs 5.6 kPa; mean difference 0.2 kPa, 95% confidence interval 0.0-0.4). Nine of 15 (60%) participants fell asleep or snored on midazolam plus oxycodone, compared with 0 of 15 (0%) on oxycodone alone.</p><p><strong>Conclusions: </strong>Midazolam co-administered with oxycodone did not decrease hypercapnic ventilation, compared with oxycodone alone, but did affect tidal volume, ventilatory frequency, and resting end-tidal Pco₂. These findings support the hypothesis that benzodiazepines influence ventilation by inducing relaxation of the respiratory muscles and highlight the need for additional investigations to elucidate the potential for upper airway obstruction when benzodiazepines and opioids are co-administered.</p><p><strong>Clinical trial registration: </strong>NCT04310579.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476127","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":"Does titration of anaesthesia using population-derived EEG indices overdose older patients?","authors":"Jamie W Sleigh","doi":"10.1016/j.bja.2025.01.002","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.002","url":null,"abstract":"<p><p>Compared with the young, the older patient group has increased high-frequency EEG power whilst under volatile general anaesthesia. This increased high-frequency power elevates the spectral entropy values above the recommended range. Thus, aggressive titration of general anaesthesia with volatile agents to achieve entropy values of 40-60 in older patients will commonly result in overdose, as manifest by burst suppression.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499453","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":"Non-pulmonary complications of intrathecal morphine administration. Comment on Br J Anaesth 2024; 133: 823-38.","authors":"Gillian O'Keeffe, Aoife Lavelle","doi":"10.1016/j.bja.2025.01.025","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.025","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472377","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":"Corrigendum to 'Family supplemented patient monitoring after surgery (SMARTER): a pilot stepped-wedge cluster-randomised trial' (Br J Anaesth 2024; 133: 846-52).","authors":"Adam Hewitt-Smith, Fred Bulamba, Akshaykumar Patel, Juliana Nanimambi, Lucy R Adong, Bernard Emacu, Mary Kabaleta, Justine Khanyalano, Ayub H Maiga, Charles Mugume, Joanitah Nakibuule, Loretta Nandyose, Martin Sejja, Winfred Weere, Timothy Stephens, Rupert M Pearse","doi":"10.1016/j.bja.2025.01.026","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.026","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472372","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":"A single-centre analysis of the sustainability and acceptance of actions to reduce the carbon footprint of anaesthesia practice.","authors":"Lionel Bouvet, Marie Naaim, Laurent Zieleskiewicz","doi":"10.1016/j.bja.2025.01.027","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.027","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472370","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":"Association of intraoperative hypotension and cumulative norepinephrine dose with postoperative acute kidney injury in patients having noncardiac surgery. Comment on Br J Anaesth 2024; 134: 54-62.","authors":"Ozan Akca","doi":"10.1016/j.bja.2025.02.001","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.001","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472371","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":"Methodologies for network meta-analysis of randomised controlled trials in pain, anaesthesia, and perioperative medicine: a narrative review.","authors":"Brett Doleman, Janus Christian Jakobsen, Ole Mathiesen, Nicola Cooper, Alex Sutton, Jonathan Hardman","doi":"10.1016/j.bja.2024.12.039","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.039","url":null,"abstract":"<p><p>Network meta-analysis has emerged as a method for analysing clinical trials, with a large increase in the number of publications over the past decade. Network meta-analysis offers advantages over traditional pairwise meta-analysis, including increased power, the ability to compare treatments not compared in the original trials, and the ability to rank treatments. However, network meta-analyses are inherently more complex than pairwise meta-analyses, requiring additional statistical expertise and assumptions. Many factors can affect the certainty of evidence from pairwise meta-analysis and can often lead to unreliable results. Network meta-analysis is prone to all these issues, although it has the additional assumption of transitivity. Here we review network meta-analyses, problems with their conduct and reporting, and methodological strategies that can be used by those conducting reviews to help improve the reliability of their findings. We provide evidence that violation of the assumption of transitivity is relatively common and inadequately considered in published network meta-analyses. We explain key concepts with clinically relevant examples for those unfamiliar with network meta-analysis to facilitate their appraisal and application of their results to clinical practice.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467047","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":"Ventilation strategies and risk factors for intraoperative respiratory critical events and postoperative pulmonary complications in neonates and small infants: a secondary analysis of the NECTARINE cohort^☆.","authors":"Alexander Fuchs, Nicola Disma, Thomas Engelhardt, Vanessa Marchesini, Thomas Riedel, Krisztina Boda, Walid Habre, Thomas Riva, Nicola Disma, Francis Veyckemans, Katalin Virag, Tom G Hansen, Karin Becke-Jakob, Pierre Harlet, Laszlo Vutskits, Suellen M Walker, Jurgen C de Graaff, Marzena Zielinska, Dusica Simic, Thomas Engelhardt, Walid Habre","doi":"10.1016/j.bja.2024.12.038","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.038","url":null,"abstract":"<p><strong>Background: </strong>Optimal ventilation strategies and use of neuromuscular blocking agents (NMBAs) in neonates and small infants undergoing anaesthesia remain unclear. We examined the association of perioperative ventilation strategies and administration of NMBAs on respiratory adverse events in the NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) cohort.</p><p><strong>Methods: </strong>We performed a secondary analysis of NECTARINE, which included infants up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures. The primary endpoint was the association between ventilation mode and intraoperative respiratory adverse events. Secondary endpoints were use of NMBA, and 30-day postoperative pulmonary complications (PPCs).</p><p><strong>Results: </strong>The dataset comprised 5609 patients undergoing 6542 procedures. Pressure-controlled ventilation was the primary ventilation modality, accounting for 52.4% (n=3428) of cases. The incidence of intraoperative respiratory critical events was 20.7% (95% confidence interval [CI] 19.7-21.7%), while PPCs were observed in 17% of cases (95% CI 16.0-18.1%). Preanaesthesia respiratory conditions and NMBA use after tracheal intubation were associated with higher incidence of PPCs. Of the children receiving NMBAs, reversal was reported in 29.8%. The absence of reversal was associated with a higher incidence of PPCs, with a relative risk of 1.50 (95% CI 1.17-1.93). Conversely, NMBA reversal was associated with a reduced relative risk of 0.43 (95% CI 0.26-0.70).</p><p><strong>Conclusions: </strong>Regardless of ventilation strategy used, mechanical ventilation and baseline respiratory conditions were risk factors for a greater incidence of adverse respiratory events and PPCs. Reversal of NMBAs before tracheal extubation was significantly associated with reduced PPCs in neonates and should be routine clinical practice.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov (NCT02350348).</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467049","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":"Acknowledgement of Assessors - 2023","authors":"","doi":"10.1016/j.bja.2025.02.002","DOIUrl":"10.1016/j.bja.2025.02.002","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 3","pages":"Pages 885-887"},"PeriodicalIF":9.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437819","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}