British journal of anaesthesia最新文献

{"title":"Accuracy of continuous glucose monitoring during noncardiac surgery: a prospective, blinded observational multicentre cohort study.","authors":"Henrike Janssen,Priyanthi Dias,Sanjali Ahuja,Saja Alharbi,Louise Hiller,Kamran Khan,Karthik Iyer,Ashok Sundar,Islam Abousharkh,Caroline Thomas,Shaman Jhanji,Nick S Oliver,Gareth L Ackland, ","doi":"10.1016/j.bja.2025.05.057","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.057","url":null,"abstract":"BACKGROUNDHyperglycaemia after noncardiac surgery is rarely detected outside of the critical care environment, yet occurs commonly and is associated with excess complications including infections and myocardial injury. Systematic, prospectively collected data regarding the accuracy of continuous glucose monitoring commenced immediately before surgery and throughout the early perioperative period are lacking.METHODSWe prospectively enrolled patients aged >50 yr undergoing noncardiac surgery who required at least 24 h of hospital stay. We used real-time continuous glucose monitoring (Dexcom G7 sensor, placed in the upper outer arm) (Dexcom, San Diego, CA, USA) with reference values from arterial blood glucose measurements by amperometry. The primary outcome was the overall mean difference (bias) before surgery, at end of surgery, and 24 h after surgery (Bland-Altman analysis). Secondary outcomes included the mean absolute relative difference and surveillance error grid analyses.RESULTSWe compared paired blood (73% arterial) and continuous glucose monitoring glucose values at each prespecified timepoint in 118 participants (64/118 [54%] female; mean age: 66 [range: 51-89] yr; 25% with diabetes mellitus). The overall bias between continuous glucose monitoring and blood glucose from measurements at each of the three timepoints in the first 24 h after induction of anaesthesia was 0.38 mM (95% confidence interval [95% CI]: 0.23-0.53; n=340 paired readings). Bias decreased from before the start of surgery (1.08 mM [95% CI: 0.87-1.29]; n=116) to 0.15 mM at the end of surgery (95% CI: -0.15 to 0.46; n=113). Mean absolute relative difference ranged from 12.0% to 18.3%. Error grid analyses found that >98% continuous glucose monitoring values were within acceptable risk ranges.CONCLUSIONSThe accuracy of state-of-the-art continuous glucose monitoring is sufficient for perioperative use and could enhance perioperative surveillance of dysglycaemia.CLINICAL TRIAL REGISTRATIONISRCTN46862025.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"704 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701292","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":"Erector spinae plane block versus paravertebral block for major oncological breast surgery: a multicentre randomised controlled trial.","authors":"Julien Raft,Sylvain Dureau,Régis Fuzier,Marion Augé,Anne-Sophie Lamotte,Adrien Lemoine,Aline Albi-Feldzer","doi":"10.1016/j.bja.2025.05.051","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.051","url":null,"abstract":"BACKGROUNDBreast cancer is the most common cancer in women, and oncological breast surgery often results in significant postoperative pain. Regional analgesia techniques such as thoracic paravertebral block (PVB) are effective but carry risks, whereas the erector spinae plane block (ESPB) is a newer, potentially safer alternative. We compared the efficacy of ESPB and PVB for managing acute pain after major breast cancer surgery.METHODSThis prospective, multicentre, randomised, double-blind trial involved 292 women who underwent major breast surgery. Patients were randomised to receive either ESPB or PVB. The primary outcome was the percentage of participants requiring morphine within the first 2 h after surgery, and the secondary outcomes included pain scores, morphine consumption, complications, and participants satisfaction.RESULTSA total of 75.2% and 50.3% of the participants in the ESPB and PVB groups, respectively, required morphine, and the noninferiority criterion for ESPB was not met. However, morphine consumption was similar between the groups. Pain scores were greater in the ESPB group, especially during mobilisation, and ESPB provided less reliable dermatomal coverage than PVB, with the required area was not covered in 55.9% of participants in the ESPB group compared with 20.4% of participants in the PVB group. Satisfaction was similar between groups, with participants in both groups reporting high satisfaction. No major complications were observed.CONCLUSIONSCompared with thoracic paravertebral block, erector spinae plane block did not meet the noninferiority criteria and was less effective for complete analgesia. Thoracic paravertebral block remains the preferred technique for major breast surgery.CLINICAL TRIAL REGISTRATIONClinicalTrials.gov (NCT04827030).","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"53 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701071","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":"DAGs for dummies: how to extract causation from correlation.","authors":"Amy Gaskell,Jamie Sleigh","doi":"10.1016/j.bja.2025.07.001","DOIUrl":"https://doi.org/10.1016/j.bja.2025.07.001","url":null,"abstract":"Directed acyclic graphs (DAGs) offer a clear, structured approach to depicting causal relationships in observational research, helping to distinguish likely causation from mere association. By explicitly mapping assumptions about confounders, mediators, and colliders, DAGs guide appropriate variable selection for adjustment and help avoid common sources of bias and confounding. This transparent framework supports more rigorous causal inference and serves as a compelling complement or alternative to large randomised controlled trials. Here we introduce some foundational principles of DAGs in support of recent DAG-guided work published around the SNAP-3 project.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"23 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701067","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":"Intra-arterial lidocaine improves long-term survival in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolisation. Response to Br J Anaesth 2025; 135: 509-10.","authors":"Fang Yan, Wei Xing","doi":"10.1016/j.bja.2025.06.028","DOIUrl":"https://doi.org/10.1016/j.bja.2025.06.028","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706374","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":"Microglia-neuronal communication mediated by P2X4R-BDNF-TrkB promotes synaptic plasticity and anterior cingulate cortex hyperactivity in muscle pain chronicity.","authors":"Yanan Liang,Meiling Luo,Qianxi Xu,Siqi Zhang,Shuangyang Niu,Xiaohe Li,Weizhen Sun,Menghan Song,Likai Wang,Xiangxin Xing,Jie Wang,Mengqi Feng,Linlin Zhao,Handong Chen,Run Sheng,Yonghui Wang","doi":"10.1016/j.bja.2025.04.048","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.048","url":null,"abstract":"BACKGROUNDMicroglia-neuronal communication is crucial for the development and maintenance of pain. However, the exact mechanisms underlying this interaction and its role in anterior cingulate cortex (ACC) circuitry in pain regulation are under exploration.METHODSWe explored the role of P2X4R-brain-derived neurotrophic factor (BDNF)-TrkB signalling of ACC in regulating muscle pain (MP). Mechanical and thermal pain thresholds along with open field tests were used to assess pain and anxiety-like behaviours. Golgi staining, transmission electron microscopy, and patch-clamp recordings were performed to evaluate synaptic plasticity changes. Meanwhile, cFos staining and calcium imaging substantiate the neuronal excitability. In addition, we used chemogenetic and optogenetic approaches to manipulate ACC neuronal activity.RESULTSThe ACC exhibited increased excitability, together with enhanced synaptic plasticity in rats with chronic MP. Microglial inhibition alleviated pain and anxiety-like behaviours. Furthermore, microglial P2X4R promoted BDNF expression, which acted on TrkB to regulate neuronal excitability and synaptic plasticity in ACC; these effects were reversed by P2X4R knockdown and TrkB inhibition in MP. Chemogenetic and optogenetic suppression of ACC hyperactivity relieved chronic MP and anxiety-like behaviours.CONCLUSIONSOur findings highlight a critical microglia-neuronal communication via the P2X4R-BDNF-TrkB signalling, which enhances synaptic plasticity and cortical excitability in the anterior cingulate cortex, thereby participating in the regulation of muscle pain. Understanding how to assess and modulate microglia-neuronal communication and abnormal cortical activity will be key to developing novel therapies for MP disorders.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"11 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701065","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 'Epidural analgesia versus dural puncture epidural analgesia in labouring parturients: a meta-analysis of randomised controlled trials'(Br J Anaesth 2025; 134: 1402-14).","authors":"Preet Mohinder Singh,David T Monks,Adithya D Bhat,Anuradha Borle,Manpreet Kaur,Phillip Yang,Muthuraj Kanakaraj","doi":"10.1016/j.bja.2025.07.032","DOIUrl":"https://doi.org/10.1016/j.bja.2025.07.032","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"54 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701066","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":"Technology, evidence, and continuing clinical education: a role for self-directed learning?","authors":"Craig S Webster,Jennifer M Weller","doi":"10.1016/j.bja.2025.07.004","DOIUrl":"https://doi.org/10.1016/j.bja.2025.07.004","url":null,"abstract":"Clinical technology in anaesthesia is rapidly advancing, challenging clinicians to find the time for the vital task of keeping up-to-date with new equipment. Self-directed learning using video has been shown to be an effective and flexible method to meet this training challenge, but this mode of learning seems unlikely to entirely replace instructor-led learning.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"19 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701063","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 black swan spotted during emergence from general anaesthesia: alpha and delta oscillations present in a conversing patient.","authors":"Adam W Kaplon,Sebastian Gallo,Christian S Guay,Keith H Baker","doi":"10.1016/j.bja.2025.06.029","DOIUrl":"https://doi.org/10.1016/j.bja.2025.06.029","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"704 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701064","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":"Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the perioperative period: withdraw or continue? A multicentre randomised controlled trial.","authors":"Lynn A Miggelbrink,Wilton A van Klei,Marianne C Verhaar,Folkert W Asselbergs,Wilko Spiering,Wolfgang F F A Buhre,Markus W Hollmann,Felix van Lier,Eric H P A van Dongen,Patrick Schober,Thijs C D Rettig,Hans J B Reitsma,Eva P C van Schaik,Lisette M Vernooij,Judith A R van Waes","doi":"10.1016/j.bja.2025.05.056","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.056","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"17 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693499","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":"Factors associated with a reduction in the preventive effect of intravenous dexamethasone on rebound pain after axillary brachial plexus block.","authors":"Nassim Touil,Athanasia Pavlopoulou,Olivier Barbier,Xavier Libouton,Damien Gruson,Jean-Luc Gala,Patricia Lavand'homme","doi":"10.1016/j.bja.2025.05.055","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.055","url":null,"abstract":"BACKGROUNDRebound pain after regional anaesthesia remains a significant clinical problem. Intravenous dexamethasone is commonly used as an adjuvant to prevent rebound pain although its effectiveness varies among patients. We aimed to identify phenotypic and biological factors influencing glucocorticoid sensitivity contributing to dexamethasone resistance in the prevention of rebound pain.METHODSPatients undergoing ambulatory upper limb surgery with an axillary brachial plexus block were enrolled prospectively to receive dexamethasone (0.1 mg kg-1 i.v.) before surgery. Preoperative factors analysed encompassed clinical aspects (central sensitivity, anxiety, and pain scores) and biological parameters (salivary cortisol, annexin-A1, and blood inflammatory markers). Postoperative outcomes comprised rebound pain incidence (numerical rating scale >7 within the first 24 h) and persistent pain at 3 months.RESULTSOf the 104 patients included, 36 (34.6%) developed rebound pain. Preoperative nocturnal awakening pain (odds ratio [OR]=3.09, P=0.03), severe anxiety (OR=3.54, P=0.01), high catastrophising score (OR=4.14, P=0.01), and low salivary cortisol levels (<1147 pg ml-1) (OR=3.33, P=0.02) were associated with an increased risk of rebound pain. Persistent pain at 3 months (27%) was associated with the presence of postoperative rebound pain (P=0.04).CONCLUSIONSPreoperative nocturnal pain, severe anxiety, high catastrophising, and low salivary cortisol levels are factors that might reduce the efficacy of dexamethasone in preventing rebound pain. These findings support the development of personalised preventive strategies.CLINICAL TRIAL REGISTRATIONNCT05763433.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"98 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693498","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}