British journal of anaesthesia最新文献

{"title":"Carbon footprint of anaesthesia pharmaceuticals and disposable products during Caesarean delivery: a single-centre prospective observational study.","authors":"Lisanne H J A Kouwenberg, Melisa Demir, Lisa van Bodegraven, Elisabeth C A Colenbrander, Florine I de Haes, Eva S Cohen, Wouter J K Hehenkamp, Nicolaas H Sperna Weiland, Dorien A Salentijn","doi":"10.1016/j.bja.2026.07.034","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.034","url":null,"abstract":"<p><strong>Background: </strong>The healthcare sector, particularly surgical care, is a major contributor to greenhouse gas emissions. This study aimed to investigate the carbon footprint of anaesthesia during Caesarean delivery, considering the impact of disposable products and pharmaceuticals, to identify environmental hotspots.</p><p><strong>Methods: </strong>A prospective observational study was conducted in a Dutch tertiary hospital, based on 50 Caesarean deliveries between July and October 2025. The carbon footprint of anaesthesia pharmaceuticals and disposable products was calculated using estimated kilograms of carbon dioxide equivalents (kg CO₂-eq) from life-cycle assessment data and for pharmaceuticals using active pharmaceutical ingredients from life-cycle inventory data.</p><p><strong>Results: </strong>The mean carbon footprint of anaesthesia pharmaceuticals and disposable products was 5.6 kg CO₂-eq per Caesarean delivery. Disposables accounted for 80% (4.5 kg CO₂-eq) of the total footprint. The prepackaged neuraxial tray, syringes, and warming blanket were the largest contributors, and ∼4% of the impact stemmed from unused disposable products. Pharmaceuticals contributed 1.1 kg CO₂-eq, with i.v. fluids, cefazolin, and i.v. paracetamol being the highest.</p><p><strong>Conclusions: </strong>Disposable products were the main contributor to the carbon footprint of anaesthesia during Caesarean delivery. Addressing unnecessary use of disposable products is an achievable goal for reducing emissions. In addition, minimising wasted pharmaceuticals or unused disposable products is important, given that they significantly amplify the carbon footprint without providing clinical benefit.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850029","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":"Translational simulation in anaesthesia: a systematic review of applications, processes, outcomes, and implementation factors.","authors":"Jake Vernon-Elliot, Zachary Hollo, Lahiru Amaratunge, Nancy Sadka, Priya Rao","doi":"10.1016/j.bja.2026.07.027","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.027","url":null,"abstract":"<p><strong>Background: </strong>Translational simulation is an emerging approach that operationalises simulation as a tool to explore and improve healthcare systems. Anaesthesia represents a well-suited context for translational simulation; however, the applications, processes, outcomes, and factors influencing the implementation of translational simulation in anaesthesia are poorly characterised.</p><p><strong>Methods: </strong>MEDLINE, Embase, Scopus, the Cumulative Index to Nursing and Allied Health Literature, and Google Scholar were searched for studies using translational simulation approaches to explore or improve multidisciplinary anaesthetic care. Two independent reviewers performed study selection. Data extraction and risk of bias assessment were performed using Thomas and Harden's approach to inductive qualitative synthesis.</p><p><strong>Results: </strong>Of 5760 unique citations, 149 were included, involving more than 3300 anaesthesia staff across 37 countries. Most studies used translational simulation to identify latent safety threats and optimise protocols, resulting in structural or procedural modifications in 113 studies. A total of nine process domains, including 90 translational processes, were identified. Applications of translational simulation predominantly focused on crisis management rather than routine perioperative care, and the involvement of conceptual frameworks and contemporary safety sciences (e.g. Safety-II) was infrequent. Although signals of improved patient outcomes were reported, causal attribution remains limited by a predominance of quasi-experimental designs. Implementation relied heavily upon executive sponsorship and integration into clinical governance to overcome workforce and logistical barriers.</p><p><strong>Conclusions: </strong>Translational simulation has been widely operationalised in anaesthesia as a pragmatic systems engineering tool. To mature as a scientific discipline, future translational simulation initiatives must adopt standardised nomenclature, explore high-volume routine perioperative care, and transition from ad hoc projects to theory-informed programmes embedded within hospital quality and safety structures.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD420251013645.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850069","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":"Impact of pre-admission functional status on intensive care patient outcomes: a systematic review and meta-analysis.","authors":"Lone M Poulsen, Praleene Sivapalan, Camilla B Mortensen, Sophus E H Teisen, Mohammad M Alwan, Louise S Herløv, Lisbeth Christiansen, Sarah Weihe, Stine Estrup, Bodil S Rasmussen, Ole Mathiesen","doi":"10.1016/j.bja.2026.07.026","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.026","url":null,"abstract":"<p><strong>Background: </strong>Pre-admission functional status might be associated with mortality in critically ill patients admitted to the ICU. With this systematic review, we aimed to investigate the association of pre-admission functional domains with mortality after ICU admission and which functional measures were used.</p><p><strong>Methods: </strong>We searched PubMed, Embase, and the Cochrane Register of Controlled Trials for studies of acutely admitted adult ICU patients reporting pre-admission functional status and mortality. Exploratory outcomes were mechanical ventilation, renal replacement therapy, delirium, ICU and hospital length of stay, discharge destination, and health-related quality of life. Screening, data extraction, and risk-of-bias evaluation were performed in duplicate. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation.</p><p><strong>Results: </strong>Of the 55 observational studies included, 21 contributed to the meta-analyses. Overall, 26.7% of the participants were deceased at variable follow-up (ICU to 1 yr). Frailty prevalence ranged from 3.6% to 76.8%, and functional dependency from 10.6% to 68.7%. Meta-analysis showed a risk ratio (RR) of 0.62 (95% confidence interval [CI] 0.58-0.67, P<0.01) for all-cause mortality between non-frail and frail participants and an RR of 0.47 (95% CI 0.40-0.54, P<0.01) between independent and dependent participants. No statistically significant association was found in the subgroup analysis of exploratory outcomes. Statistical and clinical heterogeneity were substantial, and overall certainty of evidence was very low.</p><p><strong>Conclusions: </strong>Pre-admission frailty and functional dependency were associated with higher mortality after ICU admission. Overall, the evidence is very uncertain, and the true effect could differ substantially from our estimates.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850020","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":"Atlas of Ultrasound-Guided Regional Anesthesia, 4th Edition","authors":"Joseph Brandreth, Ching L. Pang","doi":"10.1016/j.bja.2026.07.036","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.036","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"52 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148885169","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":"Minding the gaps: AGREEing to harmonise clinical guidelines to enhance healthcare and the research agenda.","authors":"Gareth L Ackland, Michelle S Chew, Brett Doleman, Eoin Kelleher, Nicola J Cooper","doi":"10.1016/j.bja.2026.08.004","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.004","url":null,"abstract":"<p><p>Clinical practice guidelines and consensus statements are increasingly influential in anaesthesia, perioperative medicine, pain medicine, and critical care. Despite drawing upon similar evidence bases, recommendations frequently differ across countries, professional societies, and healthcare systems. Such variation may reflect differences in methodology, evidence appraisal, resource availability, patient populations, health policy, cultural context, and stakeholder priorities. To address this challenge, the British Journal of Anaesthesia is launching a new series that will systematically compare and synthesise international guideline documents, using structured appraisal frameworks.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849987","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 and experiential drivers of safety planning in tracheal intubation: a single centre focus group analysis.","authors":"Caoimhe C Duffy, Gary A Bass, Justin T Clapp, Christa-Maria Ngam, Lewis J Kaplan, Joshua H Atkins, Kenneth Catchpole, Mark D Neuman","doi":"10.1016/j.bja.2026.07.039","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.039","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849989","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":"Individualised positive end-expiratory pressure to minimise driving pressure and postoperative pulmonary complications in minimally invasive thoracic and abdominal surgery: have we found the Holy grail of protective ventilation?","authors":"Wenting Ma, Julien Fessler","doi":"10.1016/j.bja.2026.08.005","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.005","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850063","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":"Intraoperative corticosteroid administration and postoperative pulmonary complications: a secondary analysis of the iPROVE clinical trials.","authors":"Andres Zorrilla-Vaca, Daniel A Zapata-Pena, Matthew B Allen, Miguel Linares, Pepe Sanahuja, Juan Librero, Carlos Ferrando","doi":"10.1016/j.bja.2026.08.001","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.001","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to explore the effect of intraoperative corticosteroid administration at antiemetic doses on postoperative pulmonary complications in adult patients undergoing major surgery.</p><p><strong>Methods: </strong>We designed a post hoc analysis of two clinical trials conducted across 30 hospitals that included adult patients undergoing major abdominal or thoracic surgeries. Patients who received intraoperative corticosteroids were identified and balanced with those who did not receive corticosteroids using inverse probability of treatment weighting based on preoperative confounders. The primary outcome was a composite of postoperative pulmonary complications within 30 days after surgery. Generalised mixed-effects models with random intercepts at each hospital were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>A total of 1963 patients were included. Before weighting for potential confounders, the incidence of severe postoperative pulmonary complications was lower in those who received corticosteroids than those who did not (9.3% [107/1142] vs 14.0% [113/821], P=0.002). After weighting, intraoperative corticosteroids were not associated with a significant reduction in the incidence of postoperative pulmonary complications (OR 0.86, 95% CI 0.62-1.18, P=0.347), but there was a modest improvement in partial pressure of oxygen in arterial blood-to-fraction of inspired oxygen ratios in the PACU in those who received intraoperative corticosteroids compared with those who did not (adjusted mean difference 19.9 mm Hg, 95% CI 0.64-39.1, corrected P=0.043).</p><p><strong>Conclusions: </strong>Corticosteroid administration at antiemetic doses in adult patients having major abdominal or thoracic surgery was not associated with a lower incidence of postoperative pulmonary complications. Postoperative pulmonary gas exchange marginally improved in patients receiving intraoperative corticosteroids.</p><p><strong>Clinical trial registration: </strong>NCT03182062 and NCT02798133.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839046","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":"Perioperative mechanical ventilation strategies in adult cardiac surgery with cardiopulmonary bypass: a meta-analysis of randomised controlled trials.","authors":"Chiara Mariotti, Marcello Guarnieri, Stefano Lazzari, Rosario Losiggio, Paola Suriano, Giovanna Pedrazzini, Christian Stoppe, Lu Ke, Zhichang Wang, Alberto Zangrillo, Giovanni Landoni, Alessandro Belletti","doi":"10.1016/j.bja.2026.07.025","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.025","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary complications occur frequently after cardiac surgery. Various intraoperative and perioperative mechanical ventilation strategies were investigated to reduce postoperative lung injury. Evidence of their benefits remains inconclusive.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of RCTs investigating ventilation strategies applied during the preoperative, intraoperative, or postoperative period of cardiac surgery requiring cardiopulmonary bypass. The primary outcome was all-cause mortality. Secondary outcomes included the rate of infections, postoperative pulmonary complications, and the duration of mechanical ventilation.</p><p><strong>Results: </strong>We identified 105 RCTs. We conducted a meta-analysis of the 39 studies suitable for quantitative synthesis. Postoperative pulmonary complications were reduced when using ventilation during cardiopulmonary bypass (risk ratio [RR]=0.87; 95% confidence interval [CI]=0.79 to 0.96; P=0.005; I²=0%, with 15 studies included). Mortality was 17/414 (4.1%) in patients receiving postoperative noninvasive respiratory support vs 24/377 (6.4%) in control group patients (RR=0.60; 95% CI=0.34 to 1.08; P=0.09; I²=0%, with five studies included). Pressure-controlled vs volume-controlled ventilation during surgery and adaptive support ventilation vs conventional ventilation in the postoperative period were not associated with improvements in primary or secondary outcomes.</p><p><strong>Conclusions: </strong>Ventilation strategies in cardiac surgery remain highly heterogeneous regarding protocols and timing. Ventilation during cardiopulmonary bypass significantly reduced postoperative pulmonary complications. Postoperative noninvasive respiratory support showed a non-significant trend toward improved survival and remains hypothesis-generating. Additional evidence is required to validate these results.</p><p><strong>Registration: </strong>PROSPERO registration number CRD420251057156.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839164","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":"Perioperative discontinuation of sodium-glucose cotransporter-2 inhibitors and cardiac complications after noncardiac surgery: stopping is only half the question. Comment on Br J Anaesth 2026; 137: 440-9.","authors":"Fangrong Jiang, Ting Shen","doi":"10.1016/j.bja.2026.07.038","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.038","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825204","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}