British journal of anaesthesia最新文献

{"title":"Epidural analgesia versus dural puncture epidural analgesia in labouring parturients: a meta-analysis of randomised controlled trials.","authors":"Preet Mohinder Singh, David T Monks, Adithya D Bhat, Anuradha Borle, Manpreet Kaur, Phillip Yang, Muthuraj Kanakaraj","doi":"10.1016/j.bja.2025.01.033","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.033","url":null,"abstract":"<p><strong>Background: </strong>Epidural analgesia and dural puncture epidural (DPE) analgesia are widely used techniques for alleviating labour pain. This meta-analysis compared clinical outcomes between parturients receiving epidural analgesia vs DPE analgesia for labour pain.</p><p><strong>Methods: </strong>Medical databases were searched to identify randomised controlled trials comparing epidural analgesia with DPE analgesia in labouring parturients published up to October 2024. Results were pooled using an inverse variance random-effects model, and 95% prediction intervals were calculated. Clinical outcomes were used as defined by individual trials. The primary outcome was time to onset of analgesia. Secondary outcomes were unilateral block, motor block, sacral sparing, adequate analgesia, Caesarean/operative vaginal delivery, additional doses, and hypotension. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation guidelines, and subgroup analyses were performed based on the types of local anaesthetics used.</p><p><strong>Results: </strong>Eighteen trials involving 2144 parturients were included. DPE labour analgesia slightly reduced the time to onset (mean difference: 3.4 min, 95% confidence interval: 2.1-4.7, P<0.01, I²=97%; moderate certainty). All statistically significant results demonstrated clinical advantages for DPE analgesia, including fewer unilateral blocks, reduced motor block, improved sacral coverage, and higher rates of adequate analgesia. Substantial heterogeneity was observed in the outcome data for time to onset of analgesia, unilateral block, and sacral sparing. Pooled results for Caesarean/operative vaginal delivery, additional doses, and hypotension failed to achieve statistical significance.</p><p><strong>Conclusions: </strong>DPE labour analgesia offers a slightly faster onset and reduced incidence of motor and unilateral blocks compared with traditional epidural analgesia. However, high heterogeneity in some outcomes, likely attributable to clinical and dosing variability, requires cautious interpretation. Although the clinical relevance of the faster onset with DPE analgesia might be modest, when considered alongside its benefits in secondary outcomes it supports the use of DPE analgesia over traditional epidural analgesia. Imputed prediction intervals cross zero for many outcomes, and further studies might alter these findings.</p><p><strong>Clinical trial registration: </strong>PROSPERO- CRD42024602115.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691007","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":"Cardiac index-guided therapy to maintain optimised postinduction cardiac index in high-risk patients having major open abdominal surgery. Comment on Br J Anaesth 2024; 133: 277-87.","authors":"Filippo D'Amico, Alessandro Belletti, Giovanni Landoni","doi":"10.1016/j.bja.2025.02.027","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.027","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691004","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":"Plasma pharmacokinetics of intravenous and intranasal oxytocin in nonpregnant adults.","authors":"Steven L Shafer, Douglas G Ririe, Scott Miller, Regina S Curry, David T Hsu, Gregory M Sullivan, James C Eisenach","doi":"10.1016/j.bja.2024.12.046","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.046","url":null,"abstract":"<p><strong>Background: </strong>The development of oxytocin as a therapeutic agent outside of obstetrics has been hampered by antibody-based assays that lack specificity, leading to inconsistent and incompletely reported pharmacokinetic models to guide drug dosing. This study describes the population plasma pharmacokinetics of intravenous and intranasal oxytocin using a sensitive and specific liquid chromatography-tandem mass spectroscopy (LC/MS) assay.</p><p><strong>Methods: </strong>Two studies in healthy adult men and nonpregnant women were performed, the first with intravenous oxytocin 16.7 μg over 1 or 10 min and the second with intravenous oxytocin 13.7 μg over 30 min and, on a separate day, intranasal oxytocin 100 μg (n=24). Venous plasma oxytocin concentration was measured using LC/MS and enzyme-linked immunosorbent assay. Pharmacokinetic parameters were estimated using NONMEM.</p><p><strong>Results: </strong>The pharmacokinetics of intravenous oxytocin were well described by a two-compartment model (0% bias, 18% median inaccuracy). The two-compartment model for intranasal oxytocin was characterised by substantial subject-to-subject variability (9% median bias, 47% median inaccuracy). Nasal oxytocin bioavailability was 0.7%. Oxytocin samples assayed with LC/MS were systematically higher than simultaneous samples assayed with enzyme-linked immunosorbent assay.</p><p><strong>Conclusions: </strong>The pharmacokinetics of intravenous oxytocin are well described by a two-compartment model. The low bioavailability (<1%) and large intersubject variability in plasma oxytocin after intranasal dosing could partially explain the inconsistent reports of oxytocin efficacy in the clinical literature with this delivery method. A publicly available simulator was created to guide oxytocin dosing in future studies.</p><p><strong>Clinical trial registration: </strong>NCT03929367 (Study 1) and NCT05672667 (Study 2).</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691026","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":"Responding to clinical alarms in unfolding simulated clinical scenarios: auditory icons perform better than tonal alarms.","authors":"Judy Reed Edworthy, Natasha Talbot, Nicole Martin","doi":"10.1016/j.bja.2024.12.047","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.047","url":null,"abstract":"<p><strong>Background: </strong>The international medical device safety standard IEC 60601-1-8 now recommends use of auditory icon alarms. Auditory icon alarms are alarms that act as metaphors for the problems that they signal. These are compared with traditional tonal alarms.</p><p><strong>Methods: </strong>Two sets of three auditory alarms were compared, one consisting of auditory icons and one consisting of variants of older tonal alarms. Volunteer participants were required to monitor three clinical scenarios each lasting 4 min with different problems (cardiac, oxygenation, and technical) occurring during each of these scenarios that triggered alarms multiple times. Participants were required to respond to those alarms while performing a separate vigilance task. Participants were taught the alarms before the tasks, learning the alarms either by the name of the problem (Hazard) or the position of the alarms in the sequence of events (Sequence).</p><p><strong>Results: </strong>Participants responded more accurately (F=23.48, P<0.05, eta²=0.32) and more quickly (F=20.357, P<0.001, eta²=0.51) to auditory icon alarms than to tonal alarms. This higher performance was not at the expense of performance on the vigilance task. The results showed no effect of learning the sounds as Hazards or as a Sequence.</p><p><strong>Conclusions: </strong>Auditory icons are more effective than tonal alarms. New alarms as indicated by the standard should be adopted by manufacturers wherever possible.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673362","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":"Intra-arterial lidocaine improves long-term survival in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolisation: a retrospective propensity score-matched study.","authors":"Fang Yan, Wanyu Wang, Zhiwen Yang, Yang Huang, Yan Rao, Ge Qu, Hui Peng, Ming Shi, Weian Zeng, Dongtai Chen, Wei Xing","doi":"10.1016/j.bja.2025.01.042","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.042","url":null,"abstract":"<p><strong>Background: </strong>Lidocaine, the most widely used local anaesthetic, has anticancer effects in both laboratory findings and retrospective clinical studies. We explored the potential benefits of intra-arterial lidocaine on long-term survival in patients with hepatocellular carcinoma (HCC) undergoing transcatheter arterial chemoembolisation (TACE).</p><p><strong>Methods: </strong>This retrospective cohort study included patients with HCC who received TACE as initial treatment from August 2011 to October 2016. Eligible patients were categorised into no lidocaine and lidocaine groups. Propensity score matching was undertaken. Progression-free survival (PFS) and overall survival were compared between the two groups. Subgroup analysis was performed to explore the survival benefit of combining intra-arterial lidocaine with platinum-based chemotherapy during TACE.</p><p><strong>Results: </strong>Of 374 eligible patients, 96 were in the lidocaine group and 278 were in the no lidocaine group. Survival analysis showed that intra-arterial lidocaine was associated with longer PFS (P=0.004) and overall survival (P<0.001). After propensity score matching, PFS (P<0.001) and overall survival (P=0.001) benefits of lidocaine remained. Multivariate analysis showed that intra-arterial lidocaine was an independent prognostic factor for PFS (P=0.011) and overall survival (P=0.044). The impact of intra-arterial lidocaine was similar in patients receiving the TACE regimen with platinum (PFS: P=0.014; overall survival: P=0.023).</p><p><strong>Conclusions: </strong>Intra-arterial lidocaine might improve long-term survival in patients with HCC undergoing TACE and in the subgroup of patients receiving platinum. The study highlights the potential antitumour benefits of combining lidocaine and chemotherapeutics in patients with cancer.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673350","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":"Review of the anaesthetic management of patients with post-polio syndrome.","authors":"Olivia Henry, Patricia Mack, Hannah Wunsch","doi":"10.1016/j.bja.2025.02.017","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.017","url":null,"abstract":"<p><p>Post-polio syndrome (PPS) is a condition affecting individuals who have previously contracted and recovered from poliomyelitis. It is estimated that up to 20 million people worldwide are still living with the sequelae of polio, and 20-85% of these people may develop PPS. PPS, a diagnosis of exclusion, includes symptoms of new-onset muscle weakness, fatigue, pain, and muscular atrophy that occurs at least 15 yr after an acute polio infection. These patients may present for surgery with or without a formal diagnosis of PPS, requiring anaesthesia clinicians to understand the specific considerations for patients with, or at risk of, PPS. This review addresses specific anaesthetic concerns in PPS care, assessing current research to guide management and highlighting significant evidence gaps. The topics reviewed include the pathophysiology and characteristics of PPS with potential anaesthetic implications, and relevant outcomes data for patients with PPS undergoing anaesthesia. Key areas of concern in the PPS literature included respiratory function, dysphagia, cold intolerance, and sensitivity to anaesthetic agents. Existing studies on patients with PPS receiving anaesthesia were primarily case reports, with a lack of large-scale, controlled studies. Areas of continued controversy include ambiguity regarding tolerance to opioids, the use of neuraxial anaesthesia, and sensitivity to anaesthetic agents and neuromuscular blocking agents. Preoperative evaluation should include careful assessment of respiratory and swallowing function, with advanced planning for intraoperative and postoperative management using a multidisciplinary approach. Further research is needed to understand anaesthetic risks and develop evidence-based guidelines for this unique patient population.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673332","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 between inspired oxygen fraction and development of postoperative pulmonary complications in thoracic surgery. Comment on Br J Anaesth 2024; 133: 1073-84.","authors":"Qian Liu, Peng Li","doi":"10.1016/j.bja.2025.02.021","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.021","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673274","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":"Multimorbidity and analgesic-related harms: a systematic review.","authors":"Christopher H Grant, Heather Walker, Karen N Barnett, Patrick B Mark, Lesley A Colvin, Samira Bell","doi":"10.1016/j.bja.2025.02.012","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.012","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity is the presence of two or more long-term medical conditions. Chronic pain affects more than half of people with multimorbidity, and optimal treatment strategies are unknown. We aimed to quantify the risk of adverse outcomes from the following analgesics: opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and gabapentinoids in adults with multimorbidity.</p><p><strong>Method: </strong>The review was registered on PROSPERO (CRD42023462592). We searched Medline, CINAHL, Web of Science, Embase, and CENTRAL for studies reporting analgesic-related harms in people with multimorbidity or the impact of multimorbidity on harms in adults exposed to analgesics. Two researchers independently screened titles/abstracts, completed full-text reviews, extracted data, and assessed risk of bias using the Newcastle-Ottawa scale. Studies were synthesised narratively, grouping by analgesic class and direction of effect.</p><p><strong>Results: </strong>We screened 6690 records and 344 full texts, with 27 studies included (n=2 671 958 patients). Studies were heterogenous, with variable quality (high risk of bias, n=11). Most studies on opioids reported adverse outcomes (12/16). Opioid use compared with non-use was associated with increased mortality in adults with multimorbidity. Multimorbidity was associated with opioid overdose and death among adults prescribed opioids for pain. Half of studies of NSAIDs reported adverse outcomes (6/11) including gastrointestinal bleeding. Only one study assessed gabapentinoids which found an association with delirium and pneumonia, but not mortality in people with multimorbidity.</p><p><strong>Conclusions: </strong>There is evidence of harms associated with opioids in adults with multimorbidity, including overdose and increased mortality. There is a lack of evidence on gabapentinoids. Further research is required to understand optimal analgesic management in people with multimorbidity.</p><p><strong>Systematic review protocol: </strong>PROSPERO (CRD42023462592).</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669096","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)00119-9","DOIUrl":"10.1016/S0007-0912(25)00119-9","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Page ii"},"PeriodicalIF":9.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643780","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":"Psychomotor Responses to Independent Visual, Auditory and Tactile Electrical stimuli during Sevoflurane sedation (PRIVATES).","authors":"Vivien C Hollmann, Alastair R J Darwood, Pawandeep S Sarai, Paul H Strutton, William Harrop-Griffiths, Christopher J Mullington","doi":"10.1016/j.bja.2025.01.034","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.034","url":null,"abstract":"<p><strong>Background: </strong>Patient-controlled sedation has potential benefits, including rapid recovery and improved patient satisfaction. During patient-controlled sedation, the recipient presses a button to self-administer the sedative. The safety and efficacy of this method is dependent upon the dose relationships between the sedative's desired effects, its impact on the ability to press a button, and adverse effect occurrence. This study aimed to investigate the relationship between sedation, psychomotor function, and adverse effect occurrence during clinician-controlled sevoflurane sedation.</p><p><strong>Methods: </strong>15 healthy participants (10 males) were administered a sevoflurane dose-escalation protocol starting at 0 kPa and increasing in 0.2 kPa increments until a protocol endpoint occurred. Sevoflurane was delivered using conventional anaesthetic apparatus. At each sevoflurane dose, Richmond Agitation-Sedation Scale (RASS) and psychomotor function were assessed. Protocol endpoints included airway, respiratory, or cardiovascular compromise; agitation (RASS ≥+2); and sedation >3 h.</p><p><strong>Results: </strong>The protocol endpoint was sedation >3 h for nine (60%) participants, agitation for five (33%) participants, and tonic movements for one (7%) participant. The median [range] sevoflurane dose was 0.4 [0.2-1.0] kPa when RASS <0 (sedation dose), 1.2 [0.6-2.0] kPa when participants were unable to complete reaction time testing (button-press dose), and 1.6 [1.2-2.2] kPa at the protocol endpoint (endpoint dose). The sedation dose was less than the button-press dose (P<0.0001), and the button-press dose was less than the endpoint dose (P=0.002).</p><p><strong>Conclusions: </strong>Patient-controlled sevoflurane sedation is potentially feasible in a healthy population within the dose range 0.4-1.2 kPa. Concurrent reaction time monitoring could minimise the risk of agitation.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669100","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}