British journal of anaesthesia最新文献

{"title":"Impact of liberal preoperative clear fluid fasting regimens on the risk of pulmonary aspiration in children (EUROFAST): an international prospective cohort study.","authors":"Peter Frykholm,Ali-Reza Modiri,Anna Klaucane,Christiane E Beck,Lionel Bouvet,Rebecca S Isserman,Vimmi Oshan,Paul A Stricker,Vinícius C Quintão,Robert Frithiof,","doi":"10.1016/j.bja.2025.03.031","DOIUrl":"https://doi.org/10.1016/j.bja.2025.03.031","url":null,"abstract":"BACKGROUNDPreoperative fasting regimens designed to minimise the risk of pulmonary aspiration have undergone significant changes, but unequivocal evidence of the safety of reducing clear fluid fasting has been lacking. We compared the risk of pulmonary aspiration in children using three different recommendations for clear fluid fasting.METHODSIn this prospective multicentre cohort study, centres with >1000 paediatric anaesthesia cases per year were eligible. Regurgitation events, whether they were transient or led to consequences affecting postoperative care, were reported in detail. All centres also reported the number of anaesthetised children per year and which preoperative fasting regimen they used.RESULTSThe 31 participating centres contributed a total of 306 900 anaesthetic procedures. The incidence of confirmed pulmonary aspiration was 1.18:10 000 in the sip-til-send group, 0.96:10 000 in the ≥1 h group, and 1.83:10 000 in the control group. There was no mortality as a result of aspiration. The 95% confidence intervals of the differences in confirmed pulmonary aspiration between the control group and the ≥1 h clear fluid fasting and the sip-til-send group were -0.344 to 3.76 and -1.48 to 3.63, respectively. Both sip-til-send and ≥1 h clear fluid fasting were statistically noninferior to ≥2 h clear fluid fasting regarding the incidence of confirmed aspiration, transient regurgitation, and regurgitation leading to escalation of care or intensive care.CONCLUSIONSThe study provides evidence for the safety of reducing preoperative fasting time for clear fluids in children aged <16 yr from 2 h to ≤1 h.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"47 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130699","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":"Neurone-satellite glial cell interactions in dorsal root ganglia drive peripheral sensitisation in a mouse burn pain model.","authors":"Run Zhang,Nan Zhang,Dan Chen,Xuanran Hu,Mengna Zhang,Minhua Yao,Qinqin Zhang,Shuyuan Wu,Xiaodi Zhang,Yongtao He,Feiyun Gao,Biao Xu,Quan Fang","doi":"10.1016/j.bja.2025.04.014","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.014","url":null,"abstract":"BACKGROUNDAccumulating evidence suggests that glial mechanisms are pivotal in regulating chronic pain. Our previous findings revealed that the interactions between spinal microglia and astrocytes are crucial for burn-induced pain hypersensitivity. However, the mechanisms underlying burn-induced peripheral sensitisation remain incompletely understood.METHODSSensory neurone-satellite glial cell (SGC) interactions within peripheral dorsal root ganglia were investigated using in vitro and in vivo experiments. Behavioural tests were conducted to evaluate the therapeutic potential of targeting peripheral sensitisation mechanisms for burn pain management.RESULTSBurn injury upregulated calcitonin gene-related peptide (CGRP) expression in sensory neurones (1.5-fold; P=0.013) through transient receptor potential vanilloid 1 (TRPV1) channels. Pharmacological blockade of the TRPV1/CGRP signalling pathway effectively attenuated burn-induced mechanical allodynia and thermal hyperalgesia. Additionally, neurone-derived CGRP triggered SGC activation (from 6.8% pre-injury to 41.6% at day 5 post-injury), concomitant with enhanced gap junction-mediated SGC coupling (from 16.7% pre-injury to 40.5% at day 5 post-injury). Furthermore, chemokine expression (particularly CXCL1) in SGCs was elevated after burn injury, which potentiated sensory neurone excitability and exacerbated pain hypersensitivity. Blocking SGC coupling exerted potent analgesic effects in this burn pain model.CONCLUSIONSA novel neurone-SGC interaction mechanism drives burn-induced peripheral sensitisation, providing translational implications for burn pain therapeutics.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"31 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122026","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 non-anaemic iron deficiency with postoperative outcomes after fast-track hip and knee arthroplasty: a prospective cohort study.","authors":"Christoffer C Jørgensen,Martin Lindberg-Larsen,Kirill Gromov,Claus Varnum,Manuel J Bider,Søren Overgaard,Mikkel R Andersen,Toben B Hansen,Henrik Kehlet","doi":"10.1016/j.bja.2025.03.039","DOIUrl":"https://doi.org/10.1016/j.bja.2025.03.039","url":null,"abstract":"BACKGROUNDPreoperative iron deficiency anaemia is a common risk factor for worse postoperative outcomes. However, the influence of preoperative iron deficiency without anaemia on postoperative outcomes after hip and knee arthroplasty is uncertain.METHODSWe used the Fast-track Center for Hip and Knee Replacement Database registry from eight Danish departments for this prospective cohort study. Anaemia and iron deficiency were defined as haemoglobin of <130 g L-1 and transferrin saturation <20%, respectively. Patient characteristics were collected using patient-reported questionnaires and information on prescribed medication, laboratory results and follow-up using electronic healthcare records. Quantile regression was used to analyse changes in median days alive and at home at postoperative day 30 (DAH30) and day 90 (DAH90), adjusting for procedure, hospital, and comorbidity. Additional endpoints included length of hospital stay >2 days, 30-day readmission rate, and self-evaluated health (EuroQol Visual Analogue Scale [EQ-VAS]) at 90 days.RESULTSThe cohort included 964 iron deficient and 3919 iron replete participants undergoing primary unilateral hip or knee arthroplasty. Median DAH30 was 29.0 (interquartile range 29.0-30.0) days in both groups, but differently distributed (P<0.001). Adjusted difference in median DAH was -0.00 (95% confidence interval -0.00 to -0.00; P=0.001) and -0.00 (95% confidence interval -0.00 to -0.00; P=0.006) days for DAH30 and DAH90, respectively. There was no association between iron deficiency and any of the other endpoints.CONCLUSIONSThe influence of iron deficiency on days alive and at home at 30 and 90 days after fast-track hip or knee arthroplasty was statistically significant, but of minimal clinical importance. Correction of preoperative iron deficiency without anaemia is unlikely to improve common postoperative outcomes in these procedures.CLINICAL TRIAL REGISTRATIONNCT05613439.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"25 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122116","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":"Depression in older surgical patients: a multicentre prospective longitudinal study.","authors":"Yasmin Alhamdah,Ellene Yan,Nina Butris,Paras Kapoor,Leif Erik Lovblom,Tarek K Rajji,Corinne E Fischer,Linda Mah,Jean Wong,Sazzadul Islam,Aparna Saripella,David He,Frances Chung","doi":"10.1016/j.bja.2025.04.016","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.016","url":null,"abstract":"BACKGROUNDA longitudinal examination of postoperative depression is important for risk assessment. We aimed to explore the prevalence and trajectory of depression in older surgical patients, before surgery, and at 30, 90, and 180 days after surgery, associated risk factors, and clinical outcomes.METHODSThis prospective cohort study assessed 307 male and female surgical patients aged ≥65 yr in two preoperative clinics in Canada. All participants completed an online survey before and after surgery that contained the 15-item Geriatric Depression Scale with a ≥5 cut-off to define depression. We also assessed risk factors and clinical and patient-centred outcomes associated with depression.RESULTSPreoperative depression was present in 20.2% (95% confidence interval [CI]: 16.1-25.1) of participants and 17.6% had potentially unrecognised depression. Overall, 18.7% (95% CI: 14.1-24.3) reported depression at 180 days after surgery. Participants with preoperative cognitive impairment (odds ratio [OR]: 2.91, 95% CI: 1.29-6.61, P=0.010) and sleep disturbances (OR: 2.91, 95% CI: 1.29-7.07, P=0.013) each had three-fold higher odds of preoperative depression. Those with preoperative functional disability had four-fold higher odds of preoperative depression (OR: 4.15, 95% CI: 1.58-11.54, P=0.005) and six-fold higher odds of depression at 180 days after surgery (OR: 5.91, 95% CI: 1.43-29.07, P=0.019). The depression group had 2.5-fold higher odds for non-home discharge (OR: 2.40, 95% CI: 1.08-5.10, P=0.026).CONCLUSIONSThe prevalence of depression was 20.2% before surgery and 18.7% at 180 days after surgery. Our findings highlight the interconnectedness of mental health with factors such as function, cognition, and sleep.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"59 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122119","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":"No effect of tetracosactide for treatment of postdural puncture headaches in parturient women: a double-blind randomised controlled clinical trial.","authors":"Mikhail Dziadzko,Lionel Bouvet,Nadia Steer,Célia Depaulis,Pierre Pradat,Fanny Joubert,Laure Lalande,Dominique Chassard,Frederic Aubrun","doi":"10.1016/j.bja.2025.04.012","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.012","url":null,"abstract":"BACKGROUNDPostdural puncture headache (PDPH) is a common complication of neuraxial anaesthesia in obstetrics. Although epidural blood patch (EBP) remains the most effective treatment, less invasive alternatives are being explored. We assessed the efficacy and safety of tetracosactide, a synthetic adrenocorticotropic hormone analogue, for treating established PDPH in postpartum patients.METHODSA randomised, double-blind, placebo-controlled trial was conducted in two tertiary care maternal hospitals. Postpartum patients with PDPH after neuraxial anaesthesia were randomised to receive either tetracosactide 1 mg i.v. or placebo. The primary outcome was the rate of EBP within the 15-day follow-up. Secondary outcomes included headache duration and intensity, activity limitation, length of hospital stay, and the number of EBPs performed per patient. Interim analysis to determine futility and trial termination was planned at 50% enrolment.RESULTSAt interim analysis with 44 patients enrolled (23 in the treatment group and 21 in the placebo group) no significant difference was found for the primary outcome: 21 (91%) patients in the treatment group and 18 (86%) patients in the placebo group received EBP (P=0.6575). Secondary outcomes were comparable between groups, except for a 1-day longer hospital stay in the treatment group (P=0.0486). The study was terminated because of futility. No side-effects of tetracosactide administration were observed.CONCLUSIONSA single dose of tetracosactide did not demonstrate efficacy in preventing EBP needs in postpartum PDPH, and there was no effect on the intensity, duration of headaches, and physical activity limitations. Given these findings, adrenocorticotropic hormone analogues should not be considered for this indication.CLINICAL TRIAL REGISTRATIONEuropean Union Clinical Trials Register (2015-003357-17); ClinicalTrials.gov (NCT02813655); French Agence Nationale de Sécurité du Médicament et des Produits de Santé (160214A-31).","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"9 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103852","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":"Effects of a national team training intervention for operating theatre teams on patient and staff outcomes: a stepped-wedge cluster-randomised trial and mixed-methods study.","authors":"Jennifer M Weller,Jennifer Long,Matthew Moore,Kaylene Henderson,Jane Torrie,Ian Civil,Kate Fahey-Williams,Chris Frampton,Alan F Merry","doi":"10.1016/j.bja.2025.04.010","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.010","url":null,"abstract":"BACKGROUNDWe evaluated a national, multidisciplinary in situ simulation-based team training intervention in New Zealand public hospitals. We hypothesised that outcomes for surgical patients and staff perceptions of teamwork and observed teamwork behaviours would improve after the intervention.METHODSIn a stepped-wedge cluster trial, all New Zealand's 20 District Health Boards were semi-randomised into four cohorts. Training was progressively implemented with one cohort per year. Patient outcomes were derived from a national administrative dataset. Outcome measures were intervention uptake, days alive and out of hospital at 90 days (DAOH90), pre-post staff Teamwork Perceptions Survey scores, and pre-post measures of observed teamwork performance during administration of the World Health Organisation Surgical Safety Checklist.RESULTSNineteen District Health Boards implemented training, and 41% of the estimated 3800 eligible staff participated. Post-intervention, DAOH90 increased 0.12 days (n=436 785 surgical cases) but we could not separate the intervention's effect from other temporal factors. Teamwork Perceptions Survey scores improved by 0.35 (95% confidence interval, 0.10-0.59) (P=0.006), 0.37 (0.12-0.63) (P=0.006), and 0.50 (0.22-0.78) (P<0.001) on a 5-point scale for 'Overall', 'Communication and Shared Mental Model', and 'Trust and Accountability', respectively. There was no important effect on observed teamwork.CONCLUSIONSWe achieved small improvements in teamwork by involving 41% of New Zealand operating theatre staff in team training. Improved patient outcomes could not be solely attributed to our intervention, potentially reflecting high baseline levels of teamwork and surgical outcomes, diluting effects of the progressive uptake of the team training over intervention periods, and other confounders including the COVID-19 pandemic.CLINICAL TRIAL REGISTRATIONACTRN12617000017325.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"17 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087543","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":"Need for better age-adapted paediatric videolaryngoscopy equipment.","authors":"Phillip B Sasu,Thorsten Dohrmann,Martin Petzoldt","doi":"10.1016/j.bja.2025.04.024","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.024","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"8 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087505","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":"Sublingual ketamine for acute postoperative pain: an emerging addition to multimodal analgesia.","authors":"Ultan Watson,Todd Leckie,Jayne Mundy,Inge Bateman,James Smith,Howard Wakeling,Luke Hodgson","doi":"10.1016/j.bja.2025.04.011","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.011","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"65 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087506","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":"Local anaesthetic systemic toxicity presenting as cardiac arrest after subcutaneous infiltration of liposomal bupivacaine.","authors":"Alexandra L Belfar,Peter N Nguyen,Bing H Feng","doi":"10.1016/j.bja.2025.03.030","DOIUrl":"https://doi.org/10.1016/j.bja.2025.03.030","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"44 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087507","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":"Implementing sustainable anaesthesia: challenges and opportunities in education.","authors":"Enas Y Abdalla,Vincenzo F Tripodi,Anna Teresa Mazzeo","doi":"10.1016/j.bja.2025.04.022","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.022","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"25 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087504","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}