British journal of anaesthesia最新文献

{"title":"A pharmacokinetic/pharmacodynamic analysis of intravenous tranexamic acid in adult patients undergoing elective total hip arthroplasty (ORACLE).","authors":"Usha Gurunathan, Robert L Medcalf, Lily Chiang, Zikou Liu, Xin Liu, Charithani B Keragala, Maria Patricia Hernandez-Mitre, Paul Brady, Steven C Wallis, Jason A Roberts, Daniel Mullany, Harshal Nandurkar, Victoria Eley, Suzanne L Parker","doi":"10.1016/j.bja.2024.12.004","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.004","url":null,"abstract":"<p><strong>Background: </strong>Uncertainty about optimal tranexamic acid (TXA) dosage has led to significant practice variation in hip arthroplasty. We aimed to identify the optimal i.v. dosage of TXA using a population pharmacokinetic/pharmacodynamic (PK/PD) approach in adults undergoing primary elective hip arthroplasty.</p><p><strong>Methods: </strong>Participants received an i.v. TXA bolus dose of 15 mg kg^-1 of total body weight, 30 min before skin incision (maximum dose 1500 mg). Blood samples were collected at baseline, 5 min post-TXA, skin incision, skin closure, and 3, 6, and 24 h post-TXA administration. TXA activity was measured ex vivo using a tissue plasminogen activator-induced clot lysis assay, targeted to achieve 90% maximal antifibrinolysis, based on maximum lysis rate. A nonlinear mixed-effects population PK/PD model was developed. Monte Carlo simulations (n=1000) identified the dosing regimens to achieve the PK/PD target over 24 h.</p><p><strong>Results: </strong>There were 24 participants (18 females, 6 males), with a median (range) age of 62 (56.5-72) yr and BMI of 31.1 (23.0-41.8) kg m^-2. A three-compartment model best described the 24-h data. The 15 mg kg^-1 of i.v. bolus maintained TXA concentrations above the PK/PD target of 10 mg L^-1 for a median duration of 4.94 h (IQR: 3.76-8.21 h). Of the various simulated regimens, only 30 mg kg^-1 of i.v. TXA infusion after this bolus achieved the 24-h PK/PD target in 76-100% of patients, varying with their estimated glomerular function rates.</p><p><strong>Conclusions: </strong>The PK/PD modelling indicated that 15 mg kg^-1 of i.v. TXA bolus followed by a continuous i.v. infusion achieves the 24-h antifibrinolytic target.</p><p><strong>Clinical trial registration: </strong>https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377339&isClinicalTrial=False (ACTRN12619000670178); registered on May 6, 2019.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027989","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":"Maternal mortality associated with anaesthetic interventions: nationwide analysis of maternal mortality in Japan from 2010 to 2022.","authors":"Junichi Hasegawa, Rie Kato, Katsuo Terui, Hiroaki Tanaka, Kayo Tanaka, Toshiyuki Okutomi, Hiroyuki Sumikura, Masamitsu Nakamura, Masahiko Nakata, Takeshi Murakoshi, Akihiko Sekizawa, Akihito Nakai, Isamu Ishiwata, Tomoaki Ikeda","doi":"10.1016/j.bja.2024.12.011","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.011","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000519","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":"Evaluating the efficacy of near-infrared spectroscopy in cerebrovascular autoregulation measurement. Comment on Br J Anaesth 2024; 133: 550-64.","authors":"Marta Frydrych, Marceli Lukaszewski","doi":"10.1016/j.bja.2024.12.012","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.012","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022303","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":"Efficacy and safety of intraoperative controlled hypotension. Comment on Br J Anaesth 2024; 133: 940-54.","authors":"Abdul-Rahman Hudaib","doi":"10.1016/j.bja.2024.11.036","DOIUrl":"https://doi.org/10.1016/j.bja.2024.11.036","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022301","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":"Opioid use in treated and untreated obstructive sleep apnoea: remifentanil pharmacokinetics and pharmacodynamics in adult volunteers.","authors":"Anil R Maharaj, Michael C Montana, Christoph P Hornik, Evan D Kharasch","doi":"10.1016/j.bja.2024.10.042","DOIUrl":"https://doi.org/10.1016/j.bja.2024.10.042","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patients with obstructive sleep apnoea (OSA) are considered more sensitive to opioids and at increased risk of opioid-induced respiratory depression. Nonetheless, whether OSA treatment (continuous positive airway pressure, CPAP; or bilevel positive airway pressure, BIPAP) modifies this risk remains unknown. Greater opioid sensitivity can arise from altered pharmacokinetics or pharmacodynamics. This preplanned analysis of a previous cohort study of remifentanil clinical effects in OSA tested the null hypothesis that the pharmacokinetics, pharmacodynamics, or both of remifentanil, a representative μ-opioid agonist, are not altered in adults with treated or untreated OSA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A single-centre, prospective, open-label, cohort study administered a stepped-dose, target-controlled remifentanil infusion (target effect-site concentrations 0.5, 1, 2, 3, 4 ng ml&lt;sup&gt;-1&lt;/sup&gt;) to awake adult volunteers (median age 52 yr, range 23-70) without OSA (n=20), with untreated OSA (n=33), or with treated OSA (n=21). Type III (in-home) polysomnography verified OSA. Remifentanil plasma concentrations, end-expired CO&lt;sub&gt;2&lt;/sub&gt;, thermal heat tolerance, and pupil diameter (miosis) were assessed. Population pharmacokinetic (clearance, volume of distribution) and pharmacodynamic (miosis, thermal heat tolerance, end-expired CO&lt;sub&gt;2&lt;/sub&gt;) models were developed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Remifentanil clearance (median) was 147, 143, and 155 L h&lt;sup&gt;-1&lt;/sup&gt; (P=0.472), and volume of distribution was 19.6, 15.5, and 17.7 L (P=0.473) for subjects without OSA, untreated OSA, or treated OSA, respectively. Total body weight was an influential covariate on both remifentanil clearance and central volume of distribution. There were no statistically or clinically significant differences between the three groups in miosis EC&lt;sub&gt;50&lt;/sub&gt; or Emax, or the slopes of thermal heat tolerance or end-expired CO&lt;sub&gt;2&lt;/sub&gt;vs remifentanil concentration. At a plasma remifentanil concentration of 4 ng ml&lt;sup&gt;-1&lt;/sup&gt;, in participants without OSA, with untreated OSA, or with treated OSA, respectively, model-estimated pupil area (12%, 13%, and 17% of baseline, P=0.086), thermal heat tolerance (50°C, 51°C, and 51°C, P=0.218), and end-expired CO&lt;sub&gt;2&lt;/sub&gt; (6.3 kPa, 6.4 kPa, and 6.7 kPa, P=0.257) were not statistically different between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;OSA (untreated or treated) did not influence remifentanil pharmacokinetics or pharmacodynamics (miosis, analgesia, respiratory depression). Results support the null hypothesis that neither pharmacokinetics nor pharmacodynamics of remifentanil, a representative μ-opioid, are altered in adults with treated or untreated OSA. These findings provide a mechanistic explanation for the lack of influence of OSA or OSA treatment on the clinical miotic, sedative, analgesic, or respiratory depressant response to remifentanil in awake adults. The conventional notion that","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000448","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":"Impact of intravenous antihypertensive therapy on cerebral blood flow and neurocognition: a systematic review and meta-analysis.","authors":"Kylie S Meacham, Jacob D Schmidt, Yanhua Sun, Mads Rasmussen, Ziyue Liu, David C Adams, Kevin M Backfish-White, Lingzhong Meng","doi":"10.1016/j.bja.2024.12.007","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.007","url":null,"abstract":"<p><strong>Background: </strong>Intravenous antihypertensivedrugs are commonly used in acute care settings, yet their impact on cerebral blood flow (CBF) remains uncertain.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of 50 studies evaluated the effects of commonly used i.v. antihypertensive agents on CBF in normotensive, hypertensive, and intracranial pathology populations. Meta-analyses used standardised mean differences (SMD), stratified by population type, consciousness state, antihypertensive agent, and CBF measurement method.</p><p><strong>Results: </strong>Intravenous antihypertensivedrug therapy significantly reduced CBF in normotensive individuals without intracranial pathology (SMD -0.31, 95% confidence interval -0.51 to -0.11), primarily driven by nitroprusside and nitroglycerin in awake subjects (SMD -0.80, 95% confidence interval -1.15 to -0.46), with a median CBF decrease of 14% (interquartile range 13-16%) and a median mean arterial pressure reduction of 17% (interquartile range 9-22%). Other antihypertensives showed no significant effects on CBF in normotensive individuals, nor were changes observed in hypertensive patients or those with intracranial pathology when the median mean arterial pressure reduction was ∼20%. No correlation was found between mean arterial pressure reduction and CBF change, supporting intact cerebral autoregulation. Historical data revealed neurocognitive changes when CBF fell to ∼30 ml 100 g^-1 min^-1, associated with a 58% mean arterial pressure reduction and a 38% CBF reduction.</p><p><strong>Conclusions: </strong>Most i.v. antihypertensive agents do not significantly affect CBF in clinical dose ranges; however, nitroprusside and nitroglycerin can reduce CBF under specific clinical conditions. The certainty of evidence remains low. Neurocognitive changes appear to depend on the magnitude of blood pressure and CBF reductions.</p><p><strong>Systematic review protocol: </strong>PROSPERO (CRD42024511954).</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000518","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 a bundle intervention to address fluid shortages with intraoperative fluid use, total fluid balance, and postoperative outcomes.","authors":"Felix Borngaesser, Annika Bald, Ling Zhang, Tina Ramishvili, Stephen J Lorenzen, Michael L Rinke, Simon T Schaefer, Jeffrey Freda, Philipp Fassbender, Raja Thota, Michael E Kiyatkin, Andrew D Racine, Matthias Eikermann","doi":"10.1016/j.bja.2024.12.014","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.014","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000517","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":"Corrigendum to 'Effect of transauricular nerve stimulation on perioperative pain: a single-blind, analyser-masked, randomised controlled trial' (Br J Anaesth 2023; 130: 458-76).","authors":"Amour B U Patel,Phillip P W M Bibawy,Juri Ibrahim M Althonayan,Zehra Majeed,Weng L Gan,Tom E F Abbott,Gareth L Ackland","doi":"10.1016/j.bja.2024.12.006","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.006","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"466 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991668","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 hydroxyethyl starch in perioperative acute kidney injury. Comment on Br J Anaesth 2024; 133: 1263-75.","authors":"Csaba Kopitkó,Tibor Fülöp,Tibor Gondos","doi":"10.1016/j.bja.2024.11.037","DOIUrl":"https://doi.org/10.1016/j.bja.2024.11.037","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"10 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991669","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":"Ophthalmic regional anaesthesia: ANZCA survey of practice in Australia and New Zealand.","authors":"Annabel Lim,Yasmin Lennie,Zoe Keon-Cohen","doi":"10.1016/j.bja.2024.11.027","DOIUrl":"https://doi.org/10.1016/j.bja.2024.11.027","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"22 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991670","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}