British journal of anaesthesia最新文献

{"title":"Regional anaesthesia modalities for primary total hip arthroplasty: a systematic review and component network meta-analysis","authors":"Kun-Han Lee ,&nbsp;Jui-Chien Wang ,&nbsp;Cheng-Yang Chang ,&nbsp;Wei-Nung Teng ,&nbsp;Hsin-Yi Wang ,&nbsp;Chien-Ching Lee ,&nbsp;Shang-Wen Tsai ,&nbsp;Cheng-Fong Chen ,&nbsp;Po-Kuei Wu ,&nbsp;Wei-Ming Chen","doi":"10.1016/j.bja.2025.04.019","DOIUrl":"10.1016/j.bja.2025.04.019","url":null,"abstract":"<div><h3>Background</h3><div>Regional nerve blocks potentially offer superior pain control for patients undergoing primary total hip arthroplasty. However, the optimal single-shot regional anaesthesia modality remains unclear.</div></div><div><h3>Methods</h3><div>PubMed, Embase, Cochrane, and Web of Science databases were searched from inception to May 5, 2024. Randomised controlled trials comparing various single-shot regional anaesthesia modalities were included. Frequentist and component network meta-analyses were performed. The primary outcomes included static and dynamic pain (visual analogue scale [VAS]) at 6 and 12 h after operation and total morphine consumption at 24 h. Additional outcomes included opioid-related adverse effects, patient satisfaction, quality of recovery, and postoperative lower limb muscle power.</div></div><div><h3>Results</h3><div>Eighty-seven randomised controlled trials were included. In static VAS, femoral nerve block ranked best (surface under the cumulative ranking curve (SUCRA)=92.8%), followed by lumbar plexus block (LPB) plus local infiltrative analgesia (LIA) (SUCRA=85.7%) at 6 h after operation. At 12 h after operation, LPB plus LIA was top ranked (SUCRA=89.2%), followed by quadratus lumborum block plus fascia iliaca compartment block (FICB) (SUCRA=84.8%). In dynamic VAS, pericapsular nerve group (PENG) block plus LIA (SUCRA=86.3%) and LPB plus LIA (SUCRA=83.4%) ranked best at 6 and 12 h after operation, respectively. In total morphine consumption at 24 h after operation, quadratus lumborum block plus FICB ranked highest (SUCRA=85.5%), followed by LPB plus LIA (SUCRA=82.2%) and PENG plus LIA (SUCRA=76.5%). LPB, FICB, and femoral nerve block were associated with increased motor blockade affecting quadriceps or adductor muscles based on qualitative analysis.</div></div><div><h3>Conclusions</h3><div>Combined regional anaesthesia modalities, particularly PENG plus LIA, are favourable options for primary total hip arthroplasty procedures, as they result in lower pain scores, reduced opioid consumption, and motor-sparing effects in the early postoperative period.</div></div><div><h3>Systematic review protocol</h3><div>PROSPERO (CRD42024544358).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"135 2","pages":"Pages 469-482"},"PeriodicalIF":9.1,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246559","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":"Respiratory impact of local anaesthetic volume after interscalene brachial plexus block with extrafascial injection. Comment on Br J Anaesth 2025; 134: 1153–60","authors":"Reginald Edward","doi":"10.1016/j.bja.2025.04.049","DOIUrl":"10.1016/j.bja.2025.04.049","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"135 2","pages":"Pages 485-486"},"PeriodicalIF":9.1,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246560","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":"Airway fires during use of high-flow nasal oxygen: a cause for concern. Comment on Br J Anaesth 2025; 134: 893-7.","authors":"Balaji Vaithialingam","doi":"10.1016/j.bja.2025.05.011","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.011","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246548","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":"Direct inhibition of cystathionine-β-synthase by isoflurane contributes to delayed neurocognitive recovery after isoflurane general anaesthesia in mice","authors":"Feifei Xu ,&nbsp;Peng Zhang ,&nbsp;Huiqing Liu ,&nbsp;Rui Wang ,&nbsp;Ze Fan ,&nbsp;Yuan Gao ,&nbsp;Zhihong Lu ,&nbsp;Peilin Cong ,&nbsp;Haixia Chen ,&nbsp;Jinghao Wang ,&nbsp;Hailong Dong ,&nbsp;Lize Xiong ,&nbsp;Guangchao Zhao","doi":"10.1016/j.bja.2025.03.044","DOIUrl":"10.1016/j.bja.2025.03.044","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative neurocognitive disorders (PND) are severe complications of surgery and other invasive procedures. However, the underlying mechanisms by which general anaesthetics contribute to PND remain largely unknown. Based on our findings of a link between hyperhomocysteinaemia and increased risk of PND, we investigated functional alterations in cystathionine-β-synthase (CBS) and its role in memory function after general anaesthesia.</div></div><div><h3>Methods</h3><div>Mice were subjected to isoflurane 1.4 vol% anaesthesia for 2 h, and the levels of homocysteine, homocysteine-associated enzyme expression, and CBS activity were measured using ELISA. The time course of memory reconstruction after general anaesthesia was evaluated using the contextual fear conditioning test. WaterLOGSY was used to examine the interaction between isoflurane and CBS. A hydrogen sulfide (H₂S) probe, AZ-NO₂, was used for H₂S bioimaging, and RNA sequencing, sulfhydrome detection, and <em>in vivo</em> electrophysiological recordings were performed to explore the underlying mechanisms.</div></div><div><h3>Results</h3><div>The decline in cognitive function persisted for at least 8 h after isoflurane anaesthesia, which is attributed to the selective homocysteine accumulation in the brain via direct inhibition of CBS activity by isoflurane. Activation of CBS alleviates the reduction of H₂S and alters the sulfhydration of synaptic-related proteins, ultimately accelerating the restoration of neuronal firing rates in the hippocampus (saline, 1.42 [0.49] <em>vs</em> NaHS, 2.45 [0.68] Hz). Pretreatment with S-adenosylmethionine (SAM, CBS activator) could increase the freezing time of mice after isoflurane anaesthesia (control 4.86 [3.30]% <em>vs</em> SAM, 9.89 [3.03]%).</div></div><div><h3>Conclusions</h3><div>Isoflurane contributes to delayed cognitive recovery after isoflurane anaesthesia in mice by directly inhibiting CBS activity, providing novel insights into the involvement of isoflurane in PNDs and their underlying mechanisms.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"135 2","pages":"Pages 360-374"},"PeriodicalIF":9.1,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246553","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":"Patterns of prevention effectiveness in postoperative neurocognitive disorder and delayed neurocognitive recovery research: a systematic review with meta-regression of randomised trials","authors":"Niloy K. Lahiri ,&nbsp;Nikola Vuckovic ,&nbsp;Angad S. Sidhu ,&nbsp;Jiangqiong Li ,&nbsp;Yanhua Sun ,&nbsp;Semanti Naiken ,&nbsp;Samantha J. Curtis ,&nbsp;Emma Bisch ,&nbsp;Ryan Bolda ,&nbsp;Prabhnoor S. Nagra ,&nbsp;Gary Mann ,&nbsp;Aiden E. Gonzales ,&nbsp;Leah Smith ,&nbsp;Brendan P. Anderson ,&nbsp;Ziyue Liu ,&nbsp;David C. Adams ,&nbsp;Lingzhong Meng","doi":"10.1016/j.bja.2025.04.021","DOIUrl":"10.1016/j.bja.2025.04.021","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative neurocognitive disorder and delayed neurocognitive recovery (pNCD/dNCR) are common yet unresolved complications after surgery.</div></div><div><h3>Methods</h3><div>We conducted a systematic literature search in resources of Ovid MEDLINE, EMBASE, Web of Science, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> and multivariable meta-regression analyses of RCTs to identify trial-level characteristics associated with prevention effectiveness in pNCD/dNCR research. Trials investigating pNCD/dNCR prevention in adult surgical patients were eligible. Trials performed in paediatric patients or assessing cognitive changes on the same day of surgery were excluded. Effectiveness associated with trial-level characteristics was assessed using ratio of odds ratio (OR) and 95% confidence interval (CI).</div></div><div><h3>Results</h3><div>We analysed 187 eligible trials. Trials originating from the USA/Canada (ratio of OR, 3.04; 95% CI, 1.62–5.73; <em>P</em>=0.001), Europe/Australia/New Zealand (1.58; 1.04–2.40; <em>P</em>=0.033), and other regions (2.0; 1.19–3.36; <em>P</em>=0.009) were associated with reduced effectiveness compared with trials from China. Higher pNCD/dNCR incidence in control groups was associated with greater effectiveness (0.98; 0.97–0.99; <em>P</em>&lt;0.001). Trials involving volatile anaesthetics (2.12; 1.16–3.86; <em>P</em>=0.014) were associated with reduced effectiveness compared with dexmedetomidine and abdominal surgery, respectively. Registered trials exhibited enhanced effectiveness (0.69; 0.50–0.95; <em>P</em>=0.022), whereas those with power analyses reported reduced effectiveness (1.43; 1.06–1.94; <em>P</em>=0.021). Trials with a high risk of bias in the selection of the reported result were associated with reduced effectiveness (2.99; 1.04–8.59; <em>P</em>=0.041). Dexmedetomidine was the most studied intervention, showing potential benefits, though evidence certainty was very low.</div></div><div><h3>Conclusions</h3><div>Trial-level characteristics were significantly associated with prevention effectiveness in pNCD/dNCR research. Identifying and addressing the underlying causes of regional differences might enhance the quality and consistency of future trials on a global level.</div></div><div><h3>Systematic review protocol</h3><div>PROSPERO (CRD42024543584).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"135 2","pages":"Pages 340-359"},"PeriodicalIF":9.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246556","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":"Association of sugammadex, neostigmine, or pyridostigmine for reversal of neuromuscular block with postoperative bradycardia: a multicentre, retrospective observational study.","authors":"Hye-Bin Kim, Ah-Ran Oh, Jungchan Park, Heezoo Kim, Hyo Sung Kim, Dong Ju Lee, In Jung Kim, Jaeyeon Chung, Youn Joung Cho, Yunseok Jeon, Jae-Woo Ju, Karam Nam","doi":"10.1016/j.bja.2025.04.046","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.046","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to evaluate the risk of bradycardia after sugammadex administration for reversal of neuromuscular block compared with neostigmine and pyridostigmine.</p><p><strong>Methods: </strong>This multicentre retrospective observational study included adult patients who underwent surgery under general anaesthesia between 2011 and 2021 in three university hospitals in Korea. The risk of bradycardia, defined as relative (≥10%, ≥20%, ≥30%, or ≥40%) or absolute (≥5, ≥10, ≥15, or ≥20 beats min^-1) decreases in heart rate (HR) from baseline within 30 min after the administration of sugammadex, neostigmine, or pyridostigmine was compared using logistic regression with stabilised inverse probability of treatment weighting.</p><p><strong>Results: </strong>A total of 359 414 patients were analysed; sugammadex, neostigmine, and pyridostigmine were administered in 107 018, 97 754, and 154 642 patients, respectively. The overall incidence of bradycardia in the sugammadex group was similar to that of the neostigmine group. Specifically, the risk of a ≥20% decrease in HR was not significantly different between the sugammadex and neostigmine groups (9.8% vs 10.2%; odds ratio [95% confidence interval]: 1.00 [0.97-1.03]), though it was significantly higher in the sugammadex group than in the pyridostigmine group (9.8% vs 5.8%; 1.93 [1.87-1.98]). Restricted cubic spline curves suggested a linear increase in the risk of a ≥20% decrease in HR as the dose of sugammadex increased.</p><p><strong>Conclusions: </strong>The incidence of bradycardia after sugammadex administration was low, and its adjusted risk was not significantly different from that of neostigmine, the most commonly used acetylcholinesterase inhibitor for reversal of neuromuscular block.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246549","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":"Reversing the triad of anaesthesia in a cannot intubate, cannot oxygenate emergency. Comment on Br J Anaesth 2024; 133: 190-2.","authors":"Huw Garland, Graham Ladds","doi":"10.1016/j.bja.2025.04.044","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.044","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246561","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":"Prediction models for postoperative pulmonary complications: a systematic review and meta-analysis.","authors":"Zhiyu Huang, Yang Han, Huijia Zhuang, Jingyao Jiang, Cheng Zhou, Hai Yu","doi":"10.1016/j.bja.2025.04.025","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.025","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pulmonary complications (PPCs) increase mortality, hospital stays, and healthcare costs. Multivariable prediction models can guide patient care by identifying high-risk patients. The discriminative ability and potential for clinical impact of PPC prediction models remains unclear.</p><p><strong>Methods: </strong>We systematically searched Cochrane, Embase, and PubMed (up to June 2024) for studies developing or validating prediction models for PPCs that reported c-statistic. The primary outcome was the c-statistic of prediction models for composite PPCs, and the secondary outcome was the c-statistic for individual PPCs, including pneumonia, respiratory failure, reintubation, and others. Data were extracted using the CHARMS checklist, and bias was assessed with PROBAST. For models with data from three or more cohorts, discrimination was synthesised by pooling c-statistic using Bayesian meta-analysis, with heterogeneity assessed through prediction intervals.</p><p><strong>Results: </strong>A total of 123 studies were included, covering 116 prediction models for PPCs, with 14 models (1 004 029 patients) eligible for meta-analysis. The c-statistic of all models ranged from 0.614 to 0.996 (median 0.80), with 50% of models self-reporting good (c-statistic >0.8) discrimination. In meta-analysis, the ARISCAT PPC score (summary c-statistic 0.76, 95% CI 0.67-0.86), Xue's model (0.82, 0.75-0.89), and CARDOT score (0.73, 0.61-0.85) demonstrated moderate (c-statistic 0.7-0.8) to good discrimination for composite PPCs; the DAGDA score (0.81, 0.74-0.88), Wang's model (0.78, 0.70-0.86), and Jin's model (0.75, 0.68-0.82) for postoperative pneumonia; and Yoon's model (0.90, 0.84-0.96) and Nizamuddin's model (0.85, 0.78-0.92) for postoperative respiratory failure. The reliability of these models, however, is currently limited by the lack of external validation cohorts. Overall, 90.2% of models were assessed as having a high risk of bias.</p><p><strong>Conclusions: </strong>Many prediction models postoperative pulmonary complications have been developed, but the clinical utility of the vast majority remains uncertain.</p><p><strong>Clinical trial registration: </strong>PROSPERO database (CRD42024580216).</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233249","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":"Understanding patient perceptions, knowledge, and experience of perioperative allergic reactions: a qualitative interview study.","authors":"Louise Savic, Anoop Mistry, Sinisa Savic, Gururaj Arumugakani, Rupert Pearse, Lene Heise Garvey, Philp M Hopkins, Nikki Rousseau","doi":"10.1016/j.bja.2025.03.041","DOIUrl":"https://doi.org/10.1016/j.bja.2025.03.041","url":null,"abstract":"<p><strong>Background: </strong>Life-threatening allergic reactions can occur during surgery and anaesthesia. Patients' perceptions, knowledge, and experience of these events are largely unreported. Better understanding of patient perspectives might influence the design of future treatment pathways.</p><p><strong>Methods: </strong>Adult patients (≥18 yr) referred to the Yorkshire Perioperative Allergy Clinic for investigation were invited to semi-structured interviews 1 week before and 1 week after their clinic visit. Patients were recruited until thematic saturation was achieved. Codebook thematic analysis of transcripts was conducted in a continuous, iterative process.</p><p><strong>Results: </strong>We recruited 11 patients (22 interviews). We identified four key themes: (1) impact of being 'absent' (unconscious) during the reaction; (2) implications of the allergic reaction for the patient; (3) understanding of allergy and allergy testing; (4) perception of vulnerability during future surgery. For many, being 'absent' made it harder to process the event; for others this was protective. Many developed a profound sense of vulnerability affecting daily life. Other health concerns interacted with and modified the impact of the event. Understanding of allergy was generally poor; several patients had inaccurate recall of their diagnosis. Despite anxiety about future surgery, patients often appeared ambivalent about the need to tell healthcare professionals about their diagnosis, believing 'the system' would act on their behalf.</p><p><strong>Conclusions: </strong>Perioperative allergic events cause persistent anxiety, significantly impacting quality of life. Misunderstanding around the allergy diagnosis and its implications exposes patients to substantial risk during future surgery. There is a need for greater patient awareness to reduce this risk.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224382","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":"Use of accelerometry to measure the impact of remifentanil on sleep after mitral valve repair surgery","authors":"Janelle M. Wagnild ,&nbsp;Rebecca H. Maier ,&nbsp;Emmanuel Ogundimu ,&nbsp;Chris Bayliss ,&nbsp;Enoch F. Akowuah","doi":"10.1016/j.bja.2025.04.043","DOIUrl":"10.1016/j.bja.2025.04.043","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"135 1","pages":"Pages 281-283"},"PeriodicalIF":9.1,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224383","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}