British journal of anaesthesia最新文献

{"title":"Preoperative estimated glomerular filtration rate to predict cardiac events in major noncardiac surgery: a secondary analysis of two large international studies","authors":"Pavel S. Roshanov ,&nbsp;Michael W. Walsh ,&nbsp;Amit X. Garg ,&nbsp;Meaghan Cuerden ,&nbsp;Ngan N. Lam ,&nbsp;Ainslie M. Hildebrand ,&nbsp;Vincent W. Lee ,&nbsp;Marko Mrkobrada ,&nbsp;Kate Leslie ,&nbsp;Matthew T.V. Chan ,&nbsp;Flavia K. Borges ,&nbsp;Chew Yin Wang ,&nbsp;Denis Xavier ,&nbsp;Daniel I. Sessler ,&nbsp;Wojciech Szczeklik ,&nbsp;Christian S. Meyhoff ,&nbsp;Sadeesh K. Srinathan ,&nbsp;Alben Sigamani ,&nbsp;Juan Carlos Villar ,&nbsp;Clara K. Chow ,&nbsp;P.J. Devereaux","doi":"10.1016/j.bja.2024.10.039","DOIUrl":"10.1016/j.bja.2024.10.039","url":null,"abstract":"<div><h3>Background</h3><div>Optimised use of kidney function information might improve cardiac risk prediction in noncardiac surgery.</div></div><div><h3>Methods</h3><div>In 35,815 patients from the VISION cohort study and 9219 patients from the POISE-2 trial who were ≥45 yr old and underwent nonurgent inpatient noncardiac surgery, we examined (by age and sex) the association between continuous nonlinear preoperative estimated glomerular filtration rate (eGFR) and the composite of myocardial injury after noncardiac surgery, nonfatal cardiac arrest, or death owing to a cardiac cause within 30 days after surgery. We estimated contributions of predictive information, C-statistic, and net benefit from eGFR and other common patient and surgical characteristics to large multivariable models.</div></div><div><h3>Results</h3><div>The primary composite occurred in 4725 (13.2%) patients in VISION and 1903 (20.6%) in POISE-2; in both studies cardiac events had a strong, graded association with lower preoperative eGFR that was attenuated by older age (<em>P</em>_interaction&lt;0.001 for VISION; <em>P</em>_interaction=0.008 for POISE-2). For eGFR of 30 compared with 90 ml min⁻¹ 1.73 m⁻², relative risk was 1.49 (95% confidence interval 1.26–1.78) at age 80 yr but 4.50 (2.84–7.13) at age 50 yr in female patients in VISION. This differed modestly (but not meaningfully) in men in VISION (<em>P</em>_interaction=0.02) but not in POISE-2 (<em>P</em>_interaction=0.79). eGFR contributed the most predictive information and mean net benefit of all predictors in both studies, most C-statistic in VISION, and third most C-statistic in POISE-2.</div></div><div><h3>Conclusions</h3><div>Continuous preoperative eGFR is among the best cardiac risk predictors in noncardiac surgery of the large set examined. Along with its interaction with age, preoperative eGFR would improve risk calculators.</div></div><div><h3>Clinical trial registration</h3><div>ClinicalTrials.gov <span><span>NCT00512109</span><svg><path></path></svg></span> (VISION) and <span><span>NCT01082874</span><svg><path></path></svg></span> (POISE-2).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 297-307"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypotension after general anaesthesia induction using remimazolam or propofol in geriatric patients undergoing sevoflurane anaesthesia with remifentanil. Comment on Br J Anaesth 2024;133:24–32","authors":"Ting Yan,&nbsp;Zhong-Meng Lai","doi":"10.1016/j.bja.2024.11.016","DOIUrl":"10.1016/j.bja.2024.11.016","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 599-600"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817344","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":"Balanced crystalloids in kidney transplantation: the unknown benefits following donation after circulatory arrest","authors":"Stephen R. Knight ,&nbsp;Colin C. Geddes","doi":"10.1016/j.bja.2024.10.038","DOIUrl":"10.1016/j.bja.2024.10.038","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 590-591"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821909","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":"Implementation of the TALK© clinical self-debriefing tool in operating theatres. Comment on Br J Anaesth 2024; 133: 853–61","authors":"Stephen Waite,&nbsp;Charlotte Jane Dewdney","doi":"10.1016/j.bja.2024.10.043","DOIUrl":"10.1016/j.bja.2024.10.043","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 606-607"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926736","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":"Characterising multimorbidity in patients undergoing cardiac surgery: a study of 1.6 million patients in the USA","authors":"Daniel James Drayton ,&nbsp;Jonathan Adam Batty ,&nbsp;Simon James Howell ,&nbsp;Marlous Hall","doi":"10.1016/j.bja.2024.11.010","DOIUrl":"10.1016/j.bja.2024.11.010","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Page 619"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139312","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":"Associate Editorial Board and cover image caption","authors":"","doi":"10.1016/S0007-0912(25)00031-5","DOIUrl":"10.1016/S0007-0912(25)00031-5","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Page ii"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139433","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":"Characteristics of older patients undergoing surgery in the UK: SNAP-3, a snapshot observational study","authors":"Claire Jane Swarbrick ,&nbsp;Karen Williams ,&nbsp;Bob Evans ,&nbsp;Helen Abigail Blake ,&nbsp;Thomas Poulton ,&nbsp;Samuel Nava ,&nbsp;Akshay Shah ,&nbsp;Peter Martin ,&nbsp;Judith Stephanie Louise Partridge ,&nbsp;Iain Keith Moppett ,&nbsp;SNAP-3 collaborators","doi":"10.1016/j.bja.2024.11.024","DOIUrl":"10.1016/j.bja.2024.11.024","url":null,"abstract":"<div><h3>Background</h3><div>Frailty and multimorbidity are common in older adults, but the prevalence and interaction of these conditions in surgical patients remain unclear. This study describes the clinical characteristics of a heterogeneous cohort of older UK surgical patients.</div></div><div><h3>Methods</h3><div>We conducted a prospective observational cohort study during 5 days in March 2022, aiming to recruit all UK patients aged 60 yr and older undergoing surgery, excluding minor procedures (e.g. cataract surgery). Data were collected on patient characteristics, clinical care, frailty, and multimorbidity measures.</div></div><div><h3>Results</h3><div>A total of 7134 patients from 214 NHS hospitals were recruited, with a mean (<span>sd</span>) age of 72.8 (8.1) yr. Of all operations, 69% (95% confidence interval [CI] 67.9–70.1%) were elective, and 34% (95% CI 32.7–34.8%) were day cases. Of the patients, 19% (95% CI 18.3–20.1%) were living with frailty (Clinical Frailty Score ≥5), and 63.1% (95% CI 62.0–64.3%) were living with multimorbidity (count of ≥2 comorbidities). Those living with frailty, multimorbidity, or both were typically older, were from lower socioeconomic backgrounds, and experienced greater polypharmacy and reduced independence. Patients living with frailty were less likely to undergo elective and day-case surgeries. Four out of five (78.8% [1079/1369]) of those who were living with frailty were also living with multimorbidity; 27.1% (1079/3978) of those who were living with multimorbidity were also living with frailty.</div></div><div><h3>Conclusions</h3><div>In the UK, one in five older patients undergoing surgery is living with frailty, and almost two-thirds of older patients are living with multimorbidity. These data highlight the importance of frailty screening. In addition, they can serve to guide resource allocation and provide comparative estimates for future research.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 328-340"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of neuromuscular block monitoring and reversal on postoperative pulmonary complications in thoracic surgery: a Bayesian analysis of the iPROVE-OLV trial.","authors":"Guido Mazzinari, Oscar Díaz-Cambronero, Ignacio Garutti, Carlos Luis Errando, Carlos Ferrando","doi":"10.1016/j.bja.2024.11.041","DOIUrl":"https://doi.org/10.1016/j.bja.2024.11.041","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pulmonary complications (PPCs) are a significant concern in thoracic surgery. A modifiable factor influencing PPCs is postoperative residual neuromuscular block (NMB), which impairs respiratory muscle function.</p><p><strong>Methods: </strong>We performed a post hoc Bayesian analysis of data from the iPROVE-OLV study, a multicentre randomised controlled trial involving patients undergoing thoracic surgery with one-lung ventilation. We compared participants managed with any neuromuscular monitoring and any reversal vs those managed without either. The primary outcome was the occurrence of a composite of PPCs within the first 7 postoperative days.</p><p><strong>Results: </strong>Of the 698 patients included, 657 received any neuromuscular monitoring and any reversal, while 41 did not. Patients managed with any neuromuscular monitoring and any reversal had a lower incidence of PPCs (20%) compared with those without either (34%). Bayesian random effect logistic regression indicated that the use of any neuromuscular monitoring and any reversal reduced PPCs with an odds ratio (OR) ranging from 0.67 (95% credibility interval, CrI, 0.39-1.11) to 0.84 (95% CrI 0.48-1.37), depending on the prior model used. The probability of benefit (OR <1) was between 77% and 94%. Subgroup analysis indicated that sugammadex was more effective than neostigmine in reducing PPCs, with a high probability of benefit (97%), and both neuromuscular monitoring and reversal reduced PCCs when evaluated separately with a high probability of benefit.</p><p><strong>Conclusion: </strong>Utilising neuromuscular monitoring and reversal agents significantly reduced the risk of PPCs in thoracic surgery. Sugammadex was more efficacious in reducing PPCs compared with neostigmine. These findings support the combined use of neuromuscular monitoring and reversal drugs.</p><p><strong>Clinical trial registration: </strong>NCT03182062.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073766","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":"Urine tests for THC in patients undergoing elective inpatient surgery: a nationwide longitudinal electronic health record study in US veterans.","authors":"Karthik Raghunathan, Srinivas Pyati, Sophia Dunworth, Ruba Sajdeya, Blair Costin, Dan Blalock, Karsten Bartels, Marc Pepin, William Bryan","doi":"10.1016/j.bja.2024.12.031","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.031","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073941","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":"Mechanisms of perioperative neuronal injury and the search for therapies.","authors":"Timothy J Marshall, Leiv O Watne, Robert D Sanders","doi":"10.1016/j.bja.2024.12.032","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.032","url":null,"abstract":"<p><p>Perioperative neuronal injury includes both delirium and postoperative cognitive decline, and has profound potentially long-term effects on surgical patients and an economic cost. Recent advances have been made in the underlying biological causes of these injuries, including validation of biomarkers of neuronal damage such as neurofilament light, further understanding of the inflammatory pathways and mediators responsible for neuronal injuries, metabolic triggers, and the role of ischaemia. Several novel approaches to perioperative protection of brain health are also being trialled. We summarise the current evidence regarding the causes of neuronal injury, and work taking place related to its prevention and treatment.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073767","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}