British journal of anaesthesia最新文献

{"title":"Technology, evidence, and continuing clinical education: a role for self-directed learning?","authors":"Craig S Webster,Jennifer M Weller","doi":"10.1016/j.bja.2025.07.004","DOIUrl":"https://doi.org/10.1016/j.bja.2025.07.004","url":null,"abstract":"Clinical technology in anaesthesia is rapidly advancing, challenging clinicians to find the time for the vital task of keeping up-to-date with new equipment. Self-directed learning using video has been shown to be an effective and flexible method to meet this training challenge, but this mode of learning seems unlikely to entirely replace instructor-led learning.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"19 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701063","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":"A black swan spotted during emergence from general anaesthesia: alpha and delta oscillations present in a conversing patient.","authors":"Adam W Kaplon,Sebastian Gallo,Christian S Guay,Keith H Baker","doi":"10.1016/j.bja.2025.06.029","DOIUrl":"https://doi.org/10.1016/j.bja.2025.06.029","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"704 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701064","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":"Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the perioperative period: withdraw or continue? A multicentre randomised controlled trial.","authors":"Lynn A Miggelbrink,Wilton A van Klei,Marianne C Verhaar,Folkert W Asselbergs,Wilko Spiering,Wolfgang F F A Buhre,Markus W Hollmann,Felix van Lier,Eric H P A van Dongen,Patrick Schober,Thijs C D Rettig,Hans J B Reitsma,Eva P C van Schaik,Lisette M Vernooij,Judith A R van Waes","doi":"10.1016/j.bja.2025.05.056","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.056","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"17 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693499","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":"Factors associated with a reduction in the preventive effect of intravenous dexamethasone on rebound pain after axillary brachial plexus block.","authors":"Nassim Touil,Athanasia Pavlopoulou,Olivier Barbier,Xavier Libouton,Damien Gruson,Jean-Luc Gala,Patricia Lavand'homme","doi":"10.1016/j.bja.2025.05.055","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.055","url":null,"abstract":"BACKGROUNDRebound pain after regional anaesthesia remains a significant clinical problem. Intravenous dexamethasone is commonly used as an adjuvant to prevent rebound pain although its effectiveness varies among patients. We aimed to identify phenotypic and biological factors influencing glucocorticoid sensitivity contributing to dexamethasone resistance in the prevention of rebound pain.METHODSPatients undergoing ambulatory upper limb surgery with an axillary brachial plexus block were enrolled prospectively to receive dexamethasone (0.1 mg kg-1 i.v.) before surgery. Preoperative factors analysed encompassed clinical aspects (central sensitivity, anxiety, and pain scores) and biological parameters (salivary cortisol, annexin-A1, and blood inflammatory markers). Postoperative outcomes comprised rebound pain incidence (numerical rating scale >7 within the first 24 h) and persistent pain at 3 months.RESULTSOf the 104 patients included, 36 (34.6%) developed rebound pain. Preoperative nocturnal awakening pain (odds ratio [OR]=3.09, P=0.03), severe anxiety (OR=3.54, P=0.01), high catastrophising score (OR=4.14, P=0.01), and low salivary cortisol levels (<1147 pg ml-1) (OR=3.33, P=0.02) were associated with an increased risk of rebound pain. Persistent pain at 3 months (27%) was associated with the presence of postoperative rebound pain (P=0.04).CONCLUSIONSPreoperative nocturnal pain, severe anxiety, high catastrophising, and low salivary cortisol levels are factors that might reduce the efficacy of dexamethasone in preventing rebound pain. These findings support the development of personalised preventive strategies.CLINICAL TRIAL REGISTRATIONNCT05763433.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"98 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693498","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":"Predicting arterial pressure without prejudice: towards effective hypotension prediction models","authors":"Simon Tilma Vistisen, Paul Elbers","doi":"10.1016/j.bja.2025.06.016","DOIUrl":"https://doi.org/10.1016/j.bja.2025.06.016","url":null,"abstract":"Selection bias has been identified in hypotension prediction models, but its impact on an algorithm’s ability to learn relevant information from the arterial waveform remains unclear. The recent study by Yang and colleagues sheds considerable light on this by training and evaluating a deep learning prediction model with biased and unbiased data selections. Unbiased training data allowed an algorithm to learn modestly more than just current blood pressure and the bias significantly distorted and inflated the positive predictive value. We discuss these findings and offer suggestions for further developing effective hypotension prediction algorithms.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"13 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664992","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":"Solving the enigma of burst suppression. Response to Br J Anaesth 2025.","authors":"Jyun-You Liou,M Bruce Maciver,Jamie W Sleigh","doi":"10.1016/j.bja.2025.06.019","DOIUrl":"https://doi.org/10.1016/j.bja.2025.06.019","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"8 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664261","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":"Response of the Conox quantitative electroencephalographic monitor to neuromuscular block in awake volunteers.","authors":"Peter J Schuller,Jan P G Pretorius,Kym B Newbery","doi":"10.1016/j.bja.2025.05.023","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.023","url":null,"abstract":"BACKGROUNDThe Conox monitor analyses the frontal EEG to generate two indices of anaesthetic effects: qCON, intended to indicate the level of consciousness, and qNOX, designed to reflect responsiveness to noxious stimuli. Two similar quantitative EEG devices, BIS and Entropy, have been shown to require muscle activity (EMG) to generate accurate index values in awake individuals. Without EMG, these devices produce misleadingly low values and incorrectly suggest sedation or anaesthesia despite the cortical EEG showing the subjects are awake. As EMG affects frequency bands used by Conox, it too could be incorporating muscle activity to generate high values in awake individuals.METHODSWe replayed EEGs recorded during awake paralysis to the Conox monitor via an electronic playback system to test whether it requires EMG to generate accurate values in awake subjects.RESULTSBoth qCON and qNOX decreased after neuromuscular block to values consistent with sedation or anaesthesia, despite subjects being fully awake. qCON decreased below 60 in 15 of 19 trials, and qNOX decreased below 60 in 11 of 19 trials. Overall, 42% of qCON values during paralysis were <60, the level supposedly indicating anaesthesia.CONCLUSIONSConox requires muscle activity to generate accurate values in awake individuals. Consequently, it might be an unreliable indicator of awareness in patients who have received neuromuscular blocking drugs. Studies conducted without neuromuscular block can provide misleading guidance when applied to Conox use in paralysed patients. Clinicians should approach manufacturer guidelines with caution and not rely solely on index values to guide dosing of anaesthetic drugs.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"672 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664260","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)00392-7","DOIUrl":"10.1016/S0007-0912(25)00392-7","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"135 2","pages":"Page ii"},"PeriodicalIF":9.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654263","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":"EEG power spectra encode both labour pain intensity and uterine contractions during the latent phase of labour.","authors":"Yan Wang,Haidi Wu,Ning Wei,Junwen Liu,Shilei Pan,Fengxian Li,Feng Yang,Yi Wan,Jun-Peng Zhang,Chang'an A Zhan,Hong-Fei Zhang","doi":"10.1016/j.bja.2025.06.024","DOIUrl":"https://doi.org/10.1016/j.bja.2025.06.024","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"109 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664151","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":"Development and validation of a predictive model for transfusion in major abdominal surgery: a multicentre retrospective study.","authors":"Ji-Hoon Sim,Ah Ran Oh,Seonok Kim,Yong-Seok Park,Seungil Ha,Joung Uk Kim","doi":"10.1016/j.bja.2025.05.048","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.048","url":null,"abstract":"BACKGROUNDBlood products are limited resources and preoperative transfusion often relies on protocols or clinical experience rather than objective risk assessment. Thus a systematic and accurate prediction strategy is needed for efficient blood utilisation and timely administration. We developed and validated a nomogram to predict intraoperative red blood cell (RBC) transfusion.METHODSWe developed a nomogram that integrates preoperative variables to predict intraoperative RBC transfusion in patients undergoing major abdominal surgery at a tertiary care hospital (2012-21). The model was externally validated with datasets from other tertiary hospitals and an open dataset. Variables were selected using least absolute shrinkage or selection operator logistic regression. Discriminative ability was assessed with C-statistic, and calibration plots were used to evaluate the agreement between predicted and observed outcomes.RESULTSThis retrospective study included 128 749 patients for model development and 71 590 and 3701 patients in two external validation sets, respectively. Intraoperative RBC transfusion occurred in 6.0% of patients in the development set, and in 4.5% and 7.3% of patients in the two validation sets, respectively. The nomogram incorporated seven preoperative variables including age, American Society of Anesthesiologists physical status, European Society of Cardiology surgical risk, haemoglobin, concentration, platelet number, international normalised ratio, and albumin concentration. The nomogram showed good predictive ability with C-statistics of 0.857 (95% confidence interval [CI]: 0.852-0.861), 0.847 (95% CI: 0.840-0.854), and 0.848 (95% CI: 0.822-0.873) in the development and external validation sets, respectively, demonstrating good calibration across the predicted probability range.CONCLUSIONSThis nomogram, integrating seven preoperative variables, can effectively predict intraoperative transfusion in major abdominal surgery.CLINICAL TRIAL REGISTRATIONClinicalTrials.gov (NCT06847490).","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"203 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664265","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}