British journal of anaesthesia最新文献

{"title":"Continuous glucose monitoring for diabetes mellitus in the perioperative and intensive care setting: a prospective observational validation study^✰.","authors":"Casper Pedersen, Aslak B Johansen, Annelotte Philipsen, Kirsten Nørgaard, Theis S Itenov, Jonas P Eiberg, Lars N Jørgensen, Henrik Palm, Christian S Meyhoff, Eske K Aasvang","doi":"10.1016/j.bja.2026.08.014","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.014","url":null,"abstract":"<p><strong>Background: </strong>In-hospital diabetes mellitus management currently relies on intermittent glucose monitoring with point-of-care (POC) testing, rather than continuous glucose monitoring (CGM). Most studies on CGM have focused on its benefits and accuracy in the outpatient setting, in contrast to the hospital setting, where the accuracy may be different.</p><p><strong>Methods: </strong>In this prospective observational study (NCT06297850), we assessed the accuracy of CGM (Dexcom G7, Dexcom Inc.) compared with POC monitors in people with diabetes mellitus requiring glucose-lowering medication undergoing surgery or admission to the ICU. The primary outcome was agreement between CGM and POC measurements, defined as median absolute relative difference (MARD). Clarke error grid (CEG) and Bland-Altman analyses were used to quantify the accuracy. Secondary analyses assessed agreement during periods of hypoperfusion, defined as a mean arterial pressure of <65 mm Hg, infusions with vasopressors, or reduced peripheral perfusion index.</p><p><strong>Results: </strong>In 58 participants (mean [standard deviation] age 71 [11]yr; 34% female), the median MARD was 10.9% (5.1-19.4%); 1186 of 1212 paired POC and CGM measurements (98%) were within clinically acceptable ranges (CEG zones A and B). MARD was 4.5% higher (95% confidence interval 2.3-6.7%) during periods of hypoperfusion. Given that hypoglycaemia (<4 mM) did not occur, no paired readings were obtained. Bland-Altman analysis showed similar CGM and POC measurements, with a mean difference of -1 mM (95% limits of agreement -5.6 to 3.4 mM).</p><p><strong>Conclusions: </strong>For the vast majority of interstitial glucose measurements, CGM was accurate in people with diabetes mellitus. Although overall performance was good, caution may be warranted when interpreting CGM data during periods of impaired peripheral perfusion.</p><p><strong>Clinical trial registration: </strong>NCT06297850.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164099","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":"The role of fibrinogen concentrate in the reduction of allogeneic blood product requirements: a systematic review and meta-analysis.","authors":"Niels Rahe-Meyer, Roseny Rodrigues, Dietmar Fries, Dirk Steffen Schmidt, David Faraoni","doi":"10.1016/j.bja.2026.07.047","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.047","url":null,"abstract":"<p><strong>Background: </strong>Fibrinogen concentrate (FC) has a well-established safety profile and is recommended for treating acquired fibrinogen deficiency. However, its comparative effectiveness vs other treatments regarding transfusions and patient outcomes remains uncertain.</p><p><strong>Methods: </strong>Comparative studies from a range of clinical settings in which patients received FC for acquired hypofibrinogenaemia and that evaluated blood product needs, mortality, thromboembolic events, or hospital length of stay were included in a systematic literature review and meta-analysis (PROSPERO: CRD42024602804). Meta-analyses used pooled data to provide an estimate of the difference in outcome between FC and all other treatments; separate analyses were conducted for adult and paediatric patients.</p><p><strong>Results: </strong>Overall, 58 studies (N=13 530 patients) were analysed. Adult FC recipients received significantly fewer red blood cell, fresh frozen plasma, and platelet units than with other treatments: 28% (incidence rate ratio [IRR] 0.72; 95% confidence interval [CI] 0.59-0.89; P=0.002), 31% (IRR 0.69; 95% CI 0.54-0.89; P=0.004), and 44% less (IRR 0.56; 95% CI 0.33-0.95; P=0.03), respectively. These results were largely driven by cardiac surgery studies. In an RCT subanalysis, the use and quantity of blood products were significantly reduced with FC. No significant difference in mortality or thromboembolic events was found between treatments in adult patients or in any outcomes analysed in paediatric patients.</p><p><strong>Conclusion: </strong>This meta-analysis suggests FC administered for acquired hypofibrinogenaemia can reduce blood product transfusions in adults, with no obvious safety concerns, compared with other treatments.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164532","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":"Incidence of general anaesthesia according to urgency of surgery: a multicentre prospective cohort study of 9989 Caesarean deliveries in Europe.","authors":"Carolyn F Weiniger, Adam Lustig, Arash Afshari, Oscar F C van den Bosch, Carolina S Romero, Damien Hughes, Peter Kranke, Asaf Berman, Nicolas Brogly","doi":"10.1016/j.bja.2026.08.046","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.046","url":null,"abstract":"<p><strong>Background: </strong>Contemporary data on anaesthesia for Caesarean delivery across Europe remain limited. We aimed to describe general anaesthesia (GA) use according to Caesarean delivery urgency in participating European countries.</p><p><strong>Methods: </strong>We performed a multicentre prospective cohort study including all Caesarean deliveries, without exclusion criteria, in 361 centres across 31 European countries from September 1, 2023 to April 30, 2025. Anaesthesiologists reported case details, including urgency category according to a four-category classification (emergency, urgent, expedited, elective). The primary outcome was anaesthesia technique.</p><p><strong>Results: </strong>A total of 9989 Caesarean deliveries were included. The overall GA incidence was 14.8% (n=1474; 95% confidence interval 14.0-15.5). According to urgency categories, GA incidences were 54.0% (n=384) for emergency cases, 13.8% (n=335) for urgent cases, 11.3% (n=252) for expedited cases, and 10.9% (n=503) for elective cases. GA was the initial anaesthesia technique for 7.6% of cases (n=759; 95% confidence interval 7.1-8.2). In elective cases, initial GA was most commonly owing to maternal request (47.0%; n=110), whereas, in emergency cases, emergent reasons (insufficient time for neuraxial anaesthesia) were the leading indication (58.4%; n=167). Conversion to GA occurred in 7.7% of 9228 initial neuraxial anaesthesia cases (n=715), most frequently in emergency cases (23.1%; n=98), but also in elective cases (6.1%; n=269).</p><p><strong>Conclusions: </strong>This study provides a contemporary description of anaesthetic practice for Caesarean delivery in 31 participating countries in Europe. The GA incidence was five-fold higher for emergency than elective cases. However, our study cannot determine reasons for the differences or identify causal relationships.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147624","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":"Erratum to 'Effects of departmental green anaesthesia interventions on carbon dioxide equivalent emissions: a systematic review' (Br J Anaesth 2025; 135: 79-88).","authors":"Sascha Hammer, Michael Eichlseder, Christoph Klivinyi, Kordula Lang-Illievich, Angelika Moser, Alexander Pichler, Nikolaus Schreiber, Philipp Zoidl, Helmar Bornemann-Cimenti","doi":"10.1016/j.bja.2026.09.013","DOIUrl":"https://doi.org/10.1016/j.bja.2026.09.013","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135325","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":"From measurement to improvement: use of the Well-Being Influencers Survey for Healthcare to guide a departmental well-being strategy in anaesthesiology.","authors":"Kenneth E Higgins, Maxwell Mansolf, Theodora Wingert, Neil Shaw, Jose Hernandez Carcamo, Daniel Cole, Maxime Cannesson","doi":"10.1016/j.bja.2026.07.078","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.078","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126721","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":"Brain mechanisms supporting movement-evoked chronic low back pain: an observational brain imaging study","authors":"Morgan Gianola,Jon Dean,Conan Chen,Daniel Barrows,Gabriel Riegner,Thomas Liu,Fadel Zeidan","doi":"10.1016/j.bja.2026.08.010","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.010","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"10 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149092447","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":"Population ageing and divergent trends in intensive care utilisation","authors":"Sasa Rajsic, Marco Vergano, Barbara Sinner, Robert Breitkopf, Barbara Friesenecker","doi":"10.1016/j.bja.2026.09.007","DOIUrl":"https://doi.org/10.1016/j.bja.2026.09.007","url":null,"abstract":"Population ageing is expected to increase demand for intensive care, yet ICU use among older adults shows divergent trends. Absolute activity, case-mix proportions, treatment days, and population-based incidence can move in different directions. Challenging conventional assumptions about critical care utilisation, we examine the apparent paradox by exploring the potential contribution of healthier ageing, frailty-informed and goal-concordant decision-making, expanded alternative care pathways, and broader epidemiological, ethical, and healthsystem factors in intensive care utilisation.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086994","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":"The last breath of the aerosol-generating procedure? Implications for anaesthesia of Scotland’s new infection control guidance","authors":"Andrew J. Shrimpton,Jules M. Brown,Tim M. Cook,Bryan R. Bzdek,Nick M. Wilson,Fergus Hamilton,Jonathan P. Reid,Anthony E. Pickering","doi":"10.1016/j.bja.2026.09.003","DOIUrl":"https://doi.org/10.1016/j.bja.2026.09.003","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"22 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089164","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":"Functional impairment in patients undergoing major orthopaedic surgery under general anaesthesia with or without regional anaesthesia: heterogeneity within the general anaesthesia category of Japanese administrative claims data. Comment on Br J Anaesth 2026; 137: 849–57","authors":"Shingo Kawashima,Atsushi Kobayashi,Wakana Kawashima,Hiroyuki Kinoshita","doi":"10.1016/j.bja.2026.08.061","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.061","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"10 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208604","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":"Human brain assembloids as a model of anaesthetic-induced neural dynamics in vitro","authors":"Daniel Toker, Colin M. McCrimmon, Qing Cao, Anandita Pandey, Asia Guzman, Anjana Shriram, Andrew Hudson, Martin M. Monti, Ranmal A. Samarasinghe","doi":"10.1016/j.bja.2026.07.062","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.062","url":null,"abstract":"The mechanisms by which anaesthetics alter neurophysiological states remain poorly understood. Although some hypotheses emphasise thalamic suppression, others propose that cortical (Cx) circuits alone, comprising interconnected excitatory and inhibitory neurones expressing gamma-aminobutyric acid type A (GABA<ce:inf loc=\"post\">A</ce:inf>) receptors, are sufficient for anaesthetic-induced neural dynamics.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"23 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086996","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}