British journal of anaesthesia最新文献

{"title":"Brain-derived tau in plasma and cerebrospinal fluid after surgery: a prospective cohort substudy.","authors":"Martin Thorsson, Lars I Eriksson, Mattias Danielson, Andreas Wiklund, Helena O Hergès, Bengt Nellgård, Henrik Zetterberg, Anna Schening, Anna Granström, Sven-Erik Ricksten, Jonatan Oras","doi":"10.1016/j.bja.2026.08.055","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.055","url":null,"abstract":"<p><strong>Background: </strong>Postoperative increases in plasma total tau (t-tau) protein have raised concerns that surgery can cause CNS injury. Brain-derived tau (BD-tau) is a novel biomarker that quantifies CNS-derived tau. We assessed BD-tau concentrations in plasma and CSF after surgery to investigate neuronal injury and mechanisms driving increases in plasma t-tau.</p><p><strong>Methods: </strong>This was a substudy of a previous prospective cohort study enrolling adult patients undergoing hip and knee arthroplasty. We measured plasma and CSF BD-tau and t-tau before neuraxial anaesthesia (baseline) and at 4, 8, 24, 32, and 48 h after surgery and assessed cognitive performance at baseline and 3 months. Biomarker concentrations are reported as median (IQR) percentage change from baseline.</p><p><strong>Results: </strong>Plasma BD-tau peaked at 4 h with a 254% increase (137-382%, P<0.001) and remained elevated by 31% (6-75%, P<0.001) at 48 h. CSF BD-tau was unchanged at 4 h but increased by 51% (21-82%, P=0.004) at 48 h. Plasma BD-tau was associated with plasma t-tau (β=1.09, 95% CI 0.95-1.23, P<0.001), whereas plasma BD-tau and CSF BD-tau were inversely associated (β=-0.71, -0.97 to -0.45, P<0.001). Higher postoperative plasma BD-tau was associated with both higher CSF albumin and worse cognitive performance at 3 months.</p><p><strong>Conclusions: </strong>Early postoperative increases in plasma t-tau are consistent with a CNS origin but not concomitant neuronal injury. Instead, the early plasma BD-tau increase and the inverse association between CSF and plasma BD-tau could indicate a redistribution of tau from the CNS to plasma.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223435","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":"Electrolyte redistribution during acute respiratory acid-base changes: an in vivo study using apnoea testing.","authors":"Micah L A Heldeweg, Martin Krbec, Martin Vancura, Petr Waldauf, Paul Elbers, Thomas Langer, Francesco Zadek, František Duška, Lorenzo Giosa","doi":"10.1016/j.bja.2026.09.015","DOIUrl":"https://doi.org/10.1016/j.bja.2026.09.015","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory acid-base changes induce pH-dependent electrolyte redistribution. Although this response has been characterised in vitro, the in vivo changes depend on multicompartment buffering and remain poorly defined.</p><p><strong>Methods: </strong>We conducted a multicentre retrospective study of patients undergoing apnoea testing for organ donation after determination of brain death, a clinical model allowing in vivo study of acute ventilatory changes. The primary outcome was the pH-dependent change in strong ion difference (SID). Secondary analyses examined individual electrolytes, pH-SID effect modification by physiological variables, and how well the derived model agreed with observed SID changes compared with a simple bedside pH-correction method (ΔSID=-15×ΔpH).</p><p><strong>Results: </strong>In 263 participants, pH decreased from 7.40 (0.07) to 7.23 (0.07) and returned to 7.40 (0.08). Per pH unit increase, SID changed by -11.7 meq L^-1 (95% CI -13.1 to -10.3; P<0.001), driven primarily by sodium ion (Na) (52% of change -7.2 mM; P<0.001) and chloride ion (Cl) (36% of change +3.7 mM; P<0.001). Higher haemoglobin concentration was associated with a higher pH-dependent SID change, together explaining 53% of within-patient variability. Agreement between predicted and observed SID changes was only modestly improved by using the derived model vs a simplified pH-correction model (sd of differences 1.74 vs 1.92 meq L^-1).</p><p><strong>Conclusions: </strong>Acute respiratory acid-base disturbances produce in vivo Na and Cl redistribution associated with pH change that are modulated by haemoglobin concentration. The observed pH-dependent electrolyte redistribution is consistent with physiological buffering and can be reasonably approximated using a simple bedside pH-correction model.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206448","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":"Discrepancies between knowledge, attitudes, and practices on sustainability in anaesthesia: a national survey of anaesthetists in Israel.","authors":"Alexander Avidan, Yair Binyamin, Efrat Golovenzitz, Lena Novack, Naama Schor, Raanan Raz","doi":"10.1016/j.bja.2026.08.057","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.057","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206511","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":"Socioeconomic position and preoperative characteristics in Perioperative Quality Improvement Programme participants: a UK national observational study.","authors":"James Durrand, Bo Hou, Adam Hunt, Eimear Lusby, Eleanor Warwick, Duncan Wagstaff, Scott Weerasuriya, Suneetha Ramani Moonesinghe","doi":"10.1016/j.bja.2026.09.002","DOIUrl":"https://doi.org/10.1016/j.bja.2026.09.002","url":null,"abstract":"<p><strong>Background: </strong>Patients from more deprived backgrounds experience poorer postoperative outcomes. We analysed preoperative characteristics in UK Perioperative Quality Improvement Programme participants according to socioeconomic position to explore opportunities for targeted interventions.</p><p><strong>Methods: </strong>Participants were adults aged ≥18 yr undergoing major elective surgery at UK Perioperative Quality Improvement Programme sites. Socioeconomic position was determined using postcode data and the Index of Multiple Deprivation (IMD) standardised aggregate scale of area-level deprivation. Associations between IMD position and patient characteristics, health behaviours, and comorbidities were analysed using descriptive statistics with appropriate parametric and nonparametric testing.</p><p><strong>Results: </strong>Of 55 938 participants included, quintile 1 (most deprived) represented the smallest subgroup (14.2%), with recruitment varying by region and site. Median age was 66 yr with IMD 1 participants 5 yr younger (62 yr) than IMD 5 (67 yr). Deprivation gradients (IMD 5 to 1) were seen for home ownership, occupation, and educational attainment. Prevalences of smoking, inactivity, and obesity increased from IMD 5 to 1. Higher prevalences of major long-term conditions including diabetes mellitus, heart failure, stroke, and ASA physical status 3-4 were observed in more deprived quintiles. Prevalence rates of dementia and renal impairment were similar across quintiles despite the age gradient. Notably, the proportions of patients living with frailty and disability increased with deprivation.</p><p><strong>Conclusions: </strong>Patients presenting for major surgery from more deprived backgrounds do so in poorer overall health. They can encounter barriers to both research participation and available preoperative support. Addressing this unmet need to prevent widening perioperative health inequalities requires interventions tailored to the patient's socioeconomic context.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206496","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 association between pain intensity during epidural labour analgesia and intrapartum hyperthermia: a multicentre prospective observational study.","authors":"Ke-Xin Jin, Shuo Wang, Xing-Rong Song, Jun-Li Zhang, Jing Yan, Bing Li, Zi-Wen Shi, Qian Luo, Xiang-Dong Wang, Feng Jiang, Xu Ding, Yuan Zeng, Yao-Wu Bai, Jin Zhang, Jun-Xiang Jia, Yuan-Yan Tu, Bo Lei, Ai-Rong Bao, Chun-Mei Deng, Ting Ding, Daniel I Sessler, Dong-Xin Wang","doi":"10.1016/j.bja.2026.08.059","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.059","url":null,"abstract":"<p><strong>Background: </strong>Some women receiving epidural labour analgesia become hyperthermic. Assuming a causal mechanism, denser and more extensive sympathetic blocks might promote hyperthermia by inhibiting sweating. We therefore tested the hypothesis that hyperthermia is most common when epidural blocks are particularly effective, as indicated by excellent analgesia.</p><p><strong>Methods: </strong>In this multicentre prospective observational study, we enrolled nulliparous women with term cephalic singleton pregnancies who planned vaginal delivery with epidural analgesia. Pain intensity was assessed using an 11-point numerical rating scale (0-10) during uterine contractions before analgesia, at 10, 30, and 60 min after initiating analgesia, and then hourly until the end of the third stage, and calculated as time-weighted average, average, area under the curve, and peak scores. Our primary endpoint was intrapartum hyperthermia (≥38°C).</p><p><strong>Results: </strong>Intrapartum hyperthermia occurred in 13% (124/952) of participants (median age 29 yr). After adjustment for confounding factors, lower pain intensity was associated with higher odds of intrapartum hyperthermia across all four measures: time-weighted average (odds ratio 1.64; 95% CI 1.40-1.91; P<0.001), average (1.56; 1.35-1.81; P<0.001), area under the curve (1.05; 1.03-1.07; P<0.001), and peak scores (1.19; 1.09-1.30; P<0.001). The identified inflection points were a time-weighted average score ≤3 points (odds ratio 8.67; 95% CI 4.19-17.9; P<0.001), average score ≤3 points (6.63; 3.56-12.3; P<0.001), area under the curve ≤30 point⋅h (13.0; 3.75-45.0; P<0.001), and peak score ≤4 points (2.53; 1.65-3.89; P<0.001), all of which were associated with increased intrapartum hyperthermia.</p><p><strong>Conclusions: </strong>Among nulliparous women receiving epidural analgesia for labour, lower pain scores were associated with higher odds of hyperthermia. Extensive sympathetic blockade may promote maternal hyperthermia.</p><p><strong>Clinical trial registration: </strong>NCT04940091.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206455","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":"Bispectral index-suppression ratio discordance during general anaesthesia.","authors":"Darnell K Adrian Williams, Gowri Gowda, Daniel Katz, Myca-Lee McComie, Julia Scarpa, Seyed A Safavynia, Joseph R Scarpa","doi":"10.1016/j.bja.2026.09.014","DOIUrl":"https://doi.org/10.1016/j.bja.2026.09.014","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206439","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":"Haemodynamic effects of induction agents are context-dependent. Comment on Br J Anaesth Advance Access published on Apr 7, 2026, doi: 10.1016/j.bja.2026.02.023.","authors":"Chaopeng Chen, Yilin Yang, Peng Wang, Tongtong Ma","doi":"10.1016/j.bja.2026.08.058","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.058","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191284","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":"Remimazolam-induced dysfunction of thalamic reticular nucleus impairs auditory gating during postanaesthetic recovery in mice: auditory gating and auditory orientation during emergence. Response to Br J Anaesth 2026; 137: 1274-6.","authors":"Shuai Wang, Shiyue Fan, Ping Zhao","doi":"10.1016/j.bja.2026.08.060","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.060","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191235","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 hypotension in patients recovering from noncardiac surgery: from detection to clinically meaningful interpretation. Comment on Br J Anaesth 2026; 137: 66-73.","authors":"Guanghan Wu, Peipei Zhang, Yufei Li, Jianbo Wu","doi":"10.1016/j.bja.2026.08.043","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.043","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179524","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 prehabilitation in surgical patients: distinguishing adherence from efficacy. Comment on Br J Anaesth 2026; 137: 695-707.","authors":"Tong Li, Shengchao Zhang, Yong Liu","doi":"10.1016/j.bja.2026.07.045","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.045","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179536","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}