British journal of anaesthesia最新文献

{"title":"Balanced electrolyte solution with 1% glucose as intraoperative maintenance fluid in infants: a prospective study of glucose, electrolyte, and acid-base homeostasis.","authors":"Ulf Lindestam, Åke Norberg, Peter Frykholm, Olav Rooyackers, Andreas Andersson, Urban Fläring","doi":"10.1016/j.bja.2024.08.041","DOIUrl":"https://doi.org/10.1016/j.bja.2024.08.041","url":null,"abstract":"<p><strong>Background: </strong>Optimal composition and infusion rates of intravenous maintenance fluids for children undergoing surgery are not well defined. Avoidance of hypoglycaemia, ketosis, and hyponatraemia is important, and current guidelines recommend isotonic fluids containing 1.0-2.5% glucose. However, evidence for its safe use in infants is insufficient. The aim of this study was to investigate whether normoglycaemia is maintained in infants using a balanced electrolyte maintenance infusion with 1% glucose.</p><p><strong>Methods: </strong>Infants 1-12 months of age undergoing surgery were included in this prospective two-centre study. Intravenous maintenance fluid was given with infusion rates of 4-8 ml kg^-1 h^-1. Blood gas and ketone body analysis were performed at induction and at the end of anaesthesia. Plasma glucose concentration was monitored intraoperatively.</p><p><strong>Results: </strong>For the 365 infants included in this study, the median infusion rate of maintenance fluid was 3.97 (interquartile range 3.21-5.35) ml kg^-1 h^-1. Mean plasma glucose concentration increased from 5.3 mM at induction to 6.1 mM at the end of anaesthesia (mean difference 0.8 mM; 95% confidence interval 0.6-0.9, P<0.001). No cases of hypoglycaemia (<3.0 mM) occurred. Mean sodium concentration remained stable during anaesthesia. Chloride and ketone body concentration increased and base excess decreased, but these were within the normal range.</p><p><strong>Conclusions: </strong>In infants undergoing surgery, maintenance infusion with a balanced electrolyte solution containing 1% glucose, at rates similar to those proposed by Holliday and Segar is a safe alternative with regards to homeostasis of glucose, electrolytes, and acid-base balance.</p><p><strong>Clinical trial registration: </strong>ACTRN12619000833167.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590084","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 resuscitation tool for major obstetric haemorrhage: a nomogram that expresses quantitative blood loss relative to effective circulating blood volume.","authors":"Cian Hurley","doi":"10.1016/j.bja.2024.09.025","DOIUrl":"https://doi.org/10.1016/j.bja.2024.09.025","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590083","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":"It is time to take a broader equity lens to highlight health inequalities in people with pain.","authors":"Emma L Karran, Aidan G Cashin, Trevor Barker, Mark A Boyd, Alessandro Chiarotto, Vina Mohabir, Jennifer Petkovic, Saurab Sharma, Peter Tugwell, G Lorimer Moseley","doi":"10.1016/j.bja.2024.09.026","DOIUrl":"https://doi.org/10.1016/j.bja.2024.09.026","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590135","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":"The role of wearable technology in home-based prehabilitation: a scoping review.","authors":"Yuhe Ke, Victoria Yj Tay, Yun Hao Leong, Chun Ju Tan, Phui-Sze Au-Yong, Jacqueline Xl Sim, Murugananth Nithiyananthan, Liyuan Jin, Roderica Rg Ng, Marcus Ho Eng, Hairil R Abdullah","doi":"10.1016/j.bja.2024.09.024","DOIUrl":"https://doi.org/10.1016/j.bja.2024.09.024","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590137","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":"Recognition and management of a malignant hyperthermia crisis: updated 2024 guideline from the European Malignant Hyperthermia Group.","authors":"Klaus P E Glahn, Thierry Girard, Anna Hellblom, Philip M Hopkins, Stephan Johannsen, Henrik Rüffert, Marc M Snoeck, Albert Urwyler","doi":"10.1016/j.bja.2024.09.022","DOIUrl":"https://doi.org/10.1016/j.bja.2024.09.022","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557223","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 \"Effect of prolonged sedation with dexmedetomidine, midazolam, propofol, and sevoflurane on sleep homeostasis in rats\" [Br J Anaesth 132 (2024) 1248-1259].","authors":"Brian H Silverstein, Anjum Parkar, Trent Groenhout, Zuzanna Fracz, Anna M Fryzel, Christopher W Fields, Amanda Nelson, Tiecheng Liu, Giancarlo Vanini, George A Mashour, Dinesh Pal","doi":"10.1016/j.bja.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.bja.2024.10.004","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557221","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":"Postoperative respiratory complications in children: from prediction to clinical action.","authors":"Nicola Disma, Walid Habre","doi":"10.1016/j.bja.2024.10.001","DOIUrl":"https://doi.org/10.1016/j.bja.2024.10.001","url":null,"abstract":"<p><p>The score for prediction of postoperative respiratory complications in infants and children (SPORC-C) was recently reported. The score was developed using a large cohort of patients by applying a multivariate model, then internally and externally validated on a different cohort of patients. In order to encourage use of this score, an online calculator (https://sites.google.com/view/sporc-for-children/home) was also developed, allowing identification of patients at low and high risk for postoperative respiratory complications. We review current evidence on algorithms developed to predict postoperative respiratory complications, including how and when such scoring systems should be used in daily practice to improve the overall safety of paediatric patients.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557222","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":"Phase 1 single-centre placebo- and etomidate-controlled study in healthy volunteers to assess safety, tolerability, clinical effects, and pharmacokinetics of intravenous methoxyethyl etomidate hydrochloride (ET-26).","authors":"Qinqin Yin, Yang Yang, Jin Liu, Lize Li, Xiaoran Yang, Lei Diao, Yi Sun, Wensheng Zhang, Xiaoqian Deng","doi":"10.1016/j.bja.2024.09.009","DOIUrl":"https://doi.org/10.1016/j.bja.2024.09.009","url":null,"abstract":"<p><strong>Background: </strong>Methoxyethyl etomidate hydrochloride (ET-26) is a novel etomidate analogue. This is the first-in-human study of a bolus i.v. formulation of ET-26 to assess its safety, tolerability, hypnotic effects, and pharmacokinetics.</p><p><strong>Methods: </strong>We enrolled 58 subjects in a dose-escalating study (stage 1a, 10 cohorts, ET-26 0.05-2.8 mg kg^-1) and 40 subjects in a head-to-head study (stage 1b, four cohorts). Safety estimates included vital signs, adverse events, physical examination, and laboratory tests. Hypnotic effects were evaluated using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale, bispectral index, loss of eyelash reflex, and response to pain. Adrenocortical function was assessed using plasma total cortisol (PTC), and area above the PTC baseline (AUC_PTC) after adrenocorticotropic hormone stimulation. Pharmacokinetics of plasma ET-26 concentrations were investigated.</p><p><strong>Results: </strong>No severe adverse events occurred; the most common adverse events were myoclonus (53.8%) and injection pain (47.4%), which were transient and resolved spontaneously. Vital signs remained stable. ET-26 produced rapid-onset, short-duration unconsciousness. At the 95% effective dose (ED₉₅, 0.8 mg kg^-1), ET-26 produced unconsciousness with a similar onset time (1.9 [0.6] min vs 2.1 [1.3] min) and slightly shorter duration (2.9 [0.9] vs 4.8 [1.8]) compared with etomidate 0.3 mg kg^-1, and resulted in higher AUC_PTC (614 [454] vs -932 [555] nmol h^-1). ET-26 showed linear pharmacokinetics, and a two-compartment model best described the pharmacokinetics.</p><p><strong>Conclusions: </strong>ET-26 was tolerated in healthy volunteers up to 2.8 mg kg^-1. It produced rapid-onset, short-acting unconsciousness with stable cardiovascular and respiratory properties. Adrenocortical function was better preserved compared with etomidate 0.3 mg kg^-1.</p><p><strong>Clinical trial registration: </strong>ChiCTR2100047525 (https://www.chictr.org.cn/index.aspx, ChiCTR2100047525).</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543820","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":"International multi-institutional external validation of preoperative risk scores for 30-day in-hospital mortality in paediatric patients.","authors":"Virginia E Tangel, Sanne E Hoeks, Robert Jan Stolker, Sydney Brown, Kane O Pryor, Jurgen C de Graaff","doi":"10.1016/j.bja.2024.09.003","DOIUrl":"https://doi.org/10.1016/j.bja.2024.09.003","url":null,"abstract":"<p><strong>Background: </strong>Risk prediction scores are used to guide clinical decision-making. Our primary objective was to externally validate two patient-specific risk scores for 30-day in-hospital mortality using the Multicenter Perioperative Outcomes Group (MPOG) registry: the Pediatric Risk Assessment (PRAm) score and the intrinsic surgical risk score. The secondary objective was to recalibrate these scores.</p><p><strong>Methods: </strong>Data from 56 US and Dutch hospitals with paediatric caseloads were included. The primary outcome was 30-day mortality. To assess model discrimination, the area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUC-PR) were calculated. Model calibration was assessed by plotting the observed and predicted probabilities. Decision analytic curves were fit.</p><p><strong>Results: </strong>The 30-day mortality was 0.14% (822/606 488). The AUROC for the PRAm upon external validation was 0.856 (95% confidence interval 0.844-0.869), and the AUC-PR was 0.008. Upon recalibration, the AUROC was 0.873 (0.861-0.886), and the AUC-PR was 0.031. The AUROC for the external validation of the intrinsic surgical risk score was 0.925 (0.914-0.936) and AUC-PR was 0.085. Upon recalibration, the AUROC was 0.925 (0.915-0.936), and the AUC-PR was 0.094. Calibration metrics for both scores were favourable because of the large cluster of cases with low probabilities of mortality. Decision curve analyses showed limited benefit to using either score.</p><p><strong>Conclusions: </strong>The intrinsic surgical risk score performed better than the PRAm, but both resulted in large numbers of false positives. Both scores exhibited decreased performance compared with the original studies. ASA physical status scores in sicker patients drove the superior performance of the intrinsic surgical risk score, suggesting the use of a risk score does not improve prediction.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543819","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 manual and syringe pump induction of total intravenous anaesthesia on propofol waste: a single-centre retrospective analysis.","authors":"Florian Windler, Mark Coburn, Birgit Bette, Dirk Fingerhut, Anke Jacobi, Philippe Kruse","doi":"10.1016/j.bja.2024.10.002","DOIUrl":"https://doi.org/10.1016/j.bja.2024.10.002","url":null,"abstract":"<p><strong>Background: </strong>Propofol accounts for a substantial proportion of medication waste. Evidence-based waste reduction methods are scarce.</p><p><strong>Methods: </strong>In a retrospective analysis of 331 procedures, the total propofol waste per surgery was compared between manual and syringe pump induction of anaesthesia during total intravenous anaesthesia (TIVA), with a syringe pump used to maintain TIVA after induction. The secondary endpoint was the amount of propofol administered. Subgroup analyses examined the influence of biological sex, age, weight or BMI, American Society of Anesthesiologists (ASA) physical status, substance use, and anaesthesia duration on propofol waste.</p><p><strong>Results: </strong>Syringe pump induction was associated with 32.8% less waste of propofol (P<0.001); this effect was most pronounced in procedures lasting 20-60 min (up to 46.9% less in procedures lasting 20-40 min, P<0.001) and 80-120 min (up to 48.8% less in procedures lasting 100-120 min, P=0.003). The amount of waste was not affected by biological sex, age, weight, BMI, or ASA physical status. Syringe pump induction was consistently associated with less waste, except in patients with obesity. Patients with active substance use had 27.6% more waste with manual induction (P=0.031) but not with syringe pump induction. In patients with and without active substance use, syringe pump induction resulted in less waste (substance use: 48.7% less, P=0.0015; without substance use: 22.7% less, P=0.0045).</p><p><strong>Conclusions: </strong>Syringe pump induction reduced propofol waste during TIVA, regardless of patient characteristics. Manual induction using a separate syringe should be reconsidered from an environmental and economic viewpoint.</p><p><strong>Clinical trial registration: </strong>DRKS00032518I.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543818","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}