British journal of anaesthesia最新文献

{"title":"Motor-sparing regional anaesthesia for total knee arthroplasty: a narrative and systematic literature review","authors":"Leigh White ,&nbsp;Michael Kerr ,&nbsp;Christopher Thang ,&nbsp;Amit Pawa","doi":"10.1016/j.bja.2024.10.041","DOIUrl":"10.1016/j.bja.2024.10.041","url":null,"abstract":"<div><div>Total knee arthroplasty is a life-changing surgical procedure that is associated with a high incidence of severe postoperative pain. Key to enhancing recovery after surgery is effective analgesia and early mobilisation. Innovations in motor-sparing regional anaesthesia techniques that have improved recovery include targeted surgical local infiltration analgesia, adductor canal blockade, genicular nerve blocks, and the infiltration between the popliteal artery and posterior capsule of the knee (iPACK) block. This narrative review discusses the current available motor-sparing regional anaesthetic techniques and assesses the evidence supporting each.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 510-522"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926738","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":"Retrospective analysis of the clinical, financial, and solid waste performance of reusable active intraoperative normothermia warming pads for cardiac surgery","authors":"Jihad Abou Jamous ,&nbsp;Nicolas Rousseau-Saine ,&nbsp;Jean-Sébastien Lebon ,&nbsp;Stephan Williams","doi":"10.1016/j.bja.2024.11.032","DOIUrl":"10.1016/j.bja.2024.11.032","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 610-612"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963887","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":"Fast is fine, but accuracy is everything: making intraoperative transfusion decisions using point-of-care testing","authors":"Lachlan F. Miles ,&nbsp;Erica M. Wood","doi":"10.1016/j.bja.2024.12.002","DOIUrl":"10.1016/j.bja.2024.12.002","url":null,"abstract":"<div><div>Accurate and timely diagnostic information is a vital adjunct to clinical assessment to inform therapeutic decision-making, including decisions to transfuse, or not transfuse, blood components. A prospective cohort study of diagnostic point-of-care (POC) haemoglobin measurements on arterial or central venous samples from adults undergoing major noncardiac surgery compared three widely used devices, HemoCue®, i-STAT™, and the Rad-67™ pulse CO-Oxymeter® finger sensor device, against standard laboratory haemoglobin measurements, but importantly not against a blood gas analyser. The study focused on haemoglobin results below 100 g L⁻¹ to establish the utility of these devices to guide red cell transfusion decisions. None of the limits of agreement between POC device and laboratory results were within the allowable difference of plus or minus 4 g L⁻¹, and no device consistently over- or underestimated laboratory haemoglobin results in the same direction. However, results from the HemoCue® had the lowest likelihood to lead to inappropriate red cell transfusion. Clinicians should be aware of the patient, sample, and device factors that can influence the accuracy of POC haemoglobin testing results.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 274-276"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063813","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":"Histone and HMGB1 released by cancer cells contribute to astrocyte activation in vitro","authors":"Yiwen Zhang ,&nbsp;Ryan Wong ,&nbsp;Qian Chen ,&nbsp;Hailin Zhao ,&nbsp;Daqing Ma","doi":"10.1016/j.bja.2024.11.008","DOIUrl":"10.1016/j.bja.2024.11.008","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Page 618"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139395","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":"Research awards and outputs by the National Institute of Academic Anaesthesia (NIAA): a 5-year analysis","authors":"Naomi Watson ,&nbsp;Gudrun Kunst","doi":"10.1016/j.bja.2024.11.009","DOIUrl":"10.1016/j.bja.2024.11.009","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 618-619"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139396","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":"Evaluation of the need for dosing adaptations in obese patients for surgical antibiotic prophylaxis: a model-based analysis of cefazolin pharmacokinetics","authors":"Davide Bindellini ,&nbsp;Philipp Simon ,&nbsp;David Busse ,&nbsp;Robin Michelet ,&nbsp;David Petroff ,&nbsp;Linda B.S. Aulin ,&nbsp;Christoph Dorn ,&nbsp;Markus Zeitlinger ,&nbsp;Wilhelm Huisinga ,&nbsp;Hermann Wrigge ,&nbsp;Charlotte Kloft","doi":"10.1016/j.bja.2024.11.044","DOIUrl":"10.1016/j.bja.2024.11.044","url":null,"abstract":"<div><h3>Background</h3><div>Cefazolin is used as a prophylactic antibiotic to reduce surgical site infections (SSIs). Obesity has been identified as a risk factor for SSIs. Cefazolin dosing recommendations and guidelines are currently inconsistent for obese patients. As plasma and target-site exposure might differ, pharmacokinetic data from the sites of SSIs are essential to evaluate treatment efficacy: these data can be obtained via tissue microdialysis. This analysis was designed to evaluate the need for dosing adaptations in obese patients for surgical prophylaxis.</div></div><div><h3>Methods</h3><div>Data from 15 obese (BMI_median = 52.6 kg m⁻²) and 15 age- and sex-matched nonobese patients (BMI_median = 26.0 kg m⁻²) who received 2 g cefazolin i.v. infusion for infection prophylaxis were included in the analysis. Pharmacokinetic data from plasma and interstitial space fluid (ISF) of adipose tissue were obtained and analysed simultaneously using nonlinear mixed-effects modelling. Dosing regimens were evaluated by calculating the probability of target attainment (PTA) and the cumulative fraction of response (CFR) for plasma and ISF using unbound cefazolin concentration above minimum inhibitory concentration 100% of the time as target (<em>f</em>T_&gt;MIC = 100%). Dosing regimens were considered adequate when PTA and CFR were ≥90%.</div></div><div><h3>Results</h3><div>Evaluation of cefazolin doses of 1 and 2 g with redosing at either 3 or 4 h by PTA and CFR in plasma and ISF found 2 g cefazolin with redosing at 4 h to be the most suitable dosing regimen for both obese and nonobese patients (PTA &gt;90% and CFR &gt;90% for both).</div></div><div><h3>Conclusions</h3><div>This model-based analysis, using <em>f</em>T_&gt;MIC = 100% as a target, showed that cefazolin dosing adaptations are not required for surgical prophylaxis in obese patients.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 1041-1049"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078632","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":"Evaluation of point-of-care haemoglobin measurement accuracy in surgery (PREMISE) and implications for transfusion practice: a prospective cohort study","authors":"Karine Brousseau ,&nbsp;Leah Monette ,&nbsp;Daniel I. McIsaac ,&nbsp;Christopher Wherrett ,&nbsp;Ranjeeta Mallick ,&nbsp;Aklile Workneh ,&nbsp;Tim Ramsay ,&nbsp;Alan Tinmouth ,&nbsp;Julie Shaw ,&nbsp;Justin Presseau ,&nbsp;Julie Hallet ,&nbsp;François M. Carrier ,&nbsp;Dean A. Fergusson ,&nbsp;Guillaume Martel","doi":"10.1016/j.bja.2024.09.033","DOIUrl":"10.1016/j.bja.2024.09.033","url":null,"abstract":"<div><h3>Background</h3><div>Point-of-care testing devices to measure haemoglobin (Hgb) frequently inform transfusion decision-making in surgery. This study aimed to examine their accuracy in surgery, focusing on Hgb concentrations of 60–100 g L⁻¹, a range with higher potential for transfusion.</div></div><div><h3>Methods</h3><div>This was a prospective diagnostic cohort study focused on method comparison, conducted at two academic hospitals. Consecutive patients undergoing noncardiac surgery and requiring point-of-care Hgb measurements were eligible. Hgb concentrations from arterial and central venous blood samples were measured concurrently using three devices and compared with laboratory Hgb. The primary outcome was individual pairwise comparisons between point-of-care and laboratory Hgb values; agreement was determined based on a threshold of within 4 g L⁻¹. The primary analysis consisted of computing limits of agreement.</div></div><div><h3>Results</h3><div>A total of 1735 intraoperative blood samples were collected (1139 participants); 680 samples had a laboratory Hgb &lt;100 g L⁻¹. The limits of agreement among those with Hgb &lt;100 g L⁻¹ were –9.5 to 8.0 g L⁻¹ for HemoCue®, –16.2 to 11.5 g L⁻¹ for i-STAT®, and –14.7 to 40.5 g L⁻¹ for Rad-67®. HemoCue was associated with a 5.8% incidence of potentially clinically significant transfusion error, whereas i-STAT and Rad-67 were associated with 25.3% and 28.2%, respectively. HemoCue yielded Hgb measurements within 10 g L⁻¹ in 98% of intraoperative blood samples.</div></div><div><h3>Conclusions</h3><div>No point-of-care Hgb device demonstrated limits of agreement that were smaller than the agreement difference of 4 g L⁻¹. Despite this, HemoCue can be safely used to inform transfusion decisions in surgery, given its error probability of &lt;4% in transfusion scenarios.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 341-349"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142963879","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":"Improving lung protective mechanical ventilation: the individualised intraoperative open-lung approach","authors":"Carlos Ferrando ,&nbsp;Jordi Vallverdú ,&nbsp;Luigi Zattera ,&nbsp;Gerardo Tusman ,&nbsp;Fernando Suárez-Sipmann","doi":"10.1016/j.bja.2024.10.007","DOIUrl":"10.1016/j.bja.2024.10.007","url":null,"abstract":"<div><div>Despite the maturity and sophistication of anaesthesia workstations, improvements in our understanding of intraoperative mechanical ventilation, and use of less invasive surgical techniques, postoperative pulmonary complications (PPCs) are still a common problem in surgical patients of all ages. PPCs are associated with a higher incidence of perioperative morbidity and mortality, longer hospital stays, and higher healthcare costs. PPCs are strongly associated with anaesthesia-induced atelectasis, which predisposes to lung damage when partially collapsed lungs are subjected to mechanical ventilation. Lung protective ventilation is thus a modifiable factor that can positively impact the incidence of PPCs after surgery. Intraoperative protective ventilation strategies have been based on two main but intrinsically different hypotheses: one based on sole reduction of tidal volume and pressures, using minimal positive end-expiratory pressure (PEEP), tolerating the presence of lung collapse, and the other also limiting tidal volume and pressures after actively resolving atelectasis by lung recruitment and PEEP individualisation, the individualised open-lung approach. We review the concepts of the individualised open-lung approach, its potential benefits, and outstanding questions. We conclude with a proposal for personalised lung protective ventilation.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 281-287"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063822","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":"Regulation of states of consciousness by supramammillary nucleus glutamatergic neurones during sevoflurane anaesthesia in mice","authors":"Jia-Yi Wu ,&nbsp;Wei Wang ,&nbsp;Xin-Yi Dai ,&nbsp;Si He ,&nbsp;Fan-He Song ,&nbsp;Shao-Jie Gao ,&nbsp;Long-Qing Zhang ,&nbsp;Dan-Yang Li ,&nbsp;Lin Liu ,&nbsp;Dai-Qiang Liu ,&nbsp;Ya-Qun Zhou ,&nbsp;Pei Zhang ,&nbsp;Bo Tian ,&nbsp;Wei Mei","doi":"10.1016/j.bja.2024.10.023","DOIUrl":"10.1016/j.bja.2024.10.023","url":null,"abstract":"<div><h3>Background</h3><div>The supramammillary nucleus (SuM), located in the caudal hypothalamus, includes wake-promoting glutamatergic neurones. Their potential role in regulating states of consciousness during general anaesthesia remains unknown.</div></div><div><h3>Methods</h3><div>We used <em>in vivo</em> fibre photometry, c-Fos staining, chemogenetic and optogenetic manipulations, and electroencephalography/electromyography to explore the roles of glutamatergic SuM neurones (SuM^Vglut2 neurones) at different phases of sevoflurane anaesthesia. Rabies-mediated retrograde and anterograde tract tracing were used to investigate the monosynaptic glutamatergic inputs from the medial septum (MS) to SuM. Their roles in sevoflurane anaesthesia were investigated by <em>in vivo</em> fibre photometry and optogenetic manipulations.</div></div><div><h3>Results</h3><div>The population activity of SuM^Vglut2 neurones decreased at loss of consciousness but increased during recovery of consciousness under sevoflurane anaesthesia. Their activity also decreased during suppression but increased during bursts in sevoflurane-induced burst-suppression oscillations. Activating SuM^Vglut2 neurones chemogenetically or optogenetically decreased sensitivity to sevoflurane, induced behavioural arousal and cortical activation during continuous steady-state anaesthesia, and stable burst-suppression oscillations under sevoflurane. In contrast, chemogenetic or optogenetic inhibition of SuM^Vglut2 neurones increased sensitivity to sevoflurane or intensified cortical inhibition during sevoflurane anaesthesia. Retrograde and anterograde tracing verified monosynaptic projections from MS^Vglut2 neurones to SuM^Vglut2 neurones. The activity of MS^Vglut2 SuM terminals increased during loss of consciousness but recovered during recovery of consciousness. Optogenetic activation or inhibition of MS^Vglut2 SuM terminals induced cortical activation or inhibition, respectively, during sevoflurane anaesthesia.</div></div><div><h3>Conclusions</h3><div>Activation of SuM^Vglut2 neurones or the glutamatergic septo-supramammillary circuit induces behavioural arousal and cortical activation during sevoflurane anaesthesia.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 425-440"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791446","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 adverse childhood experiences on analgesia-related outcomes: a systematic review","authors":"Dhaneesha N.S. Senaratne ,&nbsp;Mia Koponen ,&nbsp;Karen N. Barnett ,&nbsp;Blair H. Smith ,&nbsp;Tim G. Hales ,&nbsp;Louise Marryat ,&nbsp;Lesley A. Colvin","doi":"10.1016/j.bja.2024.09.015","DOIUrl":"10.1016/j.bja.2024.09.015","url":null,"abstract":"<div><h3>Background</h3><div>There is well-established evidence linking adverse childhood experiences (ACEs) and chronic pain in adulthood. It is less clear how ACE exposure might influence the response to chronic pain treatment. In this systematic review, we synthesise the literature assessing the impact of ACE exposure on outcomes relating to the use, benefits, and harms of analgesic medications (analgesia-related outcomes).</div></div><div><h3>Methods</h3><div>We searched seven databases from inception to September 26, 2023, for studies investigating adverse events in childhood (&lt;18 yr) and any analgesia-related outcome during adulthood (≥18 yr). Title/abstract screening, full-text review, data extraction, and risk of bias assessment were performed independently by two authors. Given the high degree of study heterogeneity, a narrative synthesis was performed.</div></div><div><h3>Results</h3><div>From 7531 records, 66 studies met inclusion criteria, involving 137 395 participants. Analgesia-related outcomes were classed into six categories: use of analgesics (<em>n</em>=12), analgesic side-effects (<em>n</em>=4), substance misuse (<em>n</em>=45), lifetime drug overdose (<em>n</em>=2), endogenous pain signalling (<em>n</em>=4), and other outcomes (<em>n</em>=2). No studies assessed the effect of ACE exposure on the potential benefits of analgesics. ACE exposure was associated with greater use of analgesic medication, higher incidence of analgesic medication side-effects, greater risk and severity of substance misuse, greater risk of drug overdose, and greater risk of attempted suicide in opioid dependency.</div></div><div><h3>Conclusions</h3><div>Adverse childhood experience exposure is associated with poor analgesia-related outcomes, so individual assessment adverse childhood experiences is important when considering the treatment of chronic pain. However, significant gaps in the literature remain, especially relating to the use and harms of non opioid analgesics.</div></div><div><h3>Systematic review protocol</h3><div>CRD42023389870 (PROSPERO).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 461-491"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488290","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}