British journal of anaesthesia最新文献

{"title":"Multimorbidity in patients undergoing day surgery: a retrospective cohort study","authors":"Alexander Tracy, John Cafferkey, Filip Smola, John Masterson, Jacques Fleuriot, Atul Anand, Bruce Guthrie, Nazir Lone","doi":"10.1016/j.bja.2026.07.074","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.074","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"8 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086993","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":"Dynamic risk evaluation or preoperative prediction for postoperative delirium? Comment on Br J Anaesth 2026; 136: 1495–508","authors":"Kunsheng Wu, Gaohua Cao, Yulong Yu","doi":"10.1016/j.bja.2026.07.032","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.032","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"403 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086995","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":"Cannabis use and anaesthetic agent dosing in patients undergoing surgery or interventional procedures: a single-centre retrospective cohort study.","authors":"Nikolai Ratajczak, Elena Ahrens, Luca J Wachtendorf, Ricardo Munoz-Acuna, Simone Redaelli, Aiman Suleiman, Eva-Lotte Seibold, Max Hentges, Theresa Tenge, Dario von Wedel, Sarah Ashrafian, Béla-Simon Paschold, Guanqing Chen, Kevin P Hill, Maximilian S Schaefer","doi":"10.1016/j.bja.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.bja.2026.09.001","url":null,"abstract":"<p><strong>Background: </strong>There is limited evidence that habitual cannabis consumption increases anaesthetic requirements. We hypothesised that cannabis use affects anaesthetic dosing among patients undergoing surgery or interventional procedures.</p><p><strong>Methods: </strong>A total of 341 199 adult patients undergoing propofol sedation or volatile-based general anaesthesia at Beth Israel Deaconess Medical Center, Boston, USA, between 2008 and 2024 were included. The primary exposure was cannabis use, differentiated into medical or non-medical use (recreational use or cannabis use disorder). Primary outcomes were propofol dose (μg kg^-1 min^-1) for monitored anaesthesia care and mean end tidal age-adjusted minimum alveolar concentration (MAC) values for general anaesthesia. In multivariable analyses, we estimated the adjusted difference in mean primary anaesthetic agent dosing.</p><p><strong>Results: </strong>A total of 23 896 patients (7.0%) were identified as non-medical cannabis users, and 3193 (0.9%) held a certification for medical cannabinoids. In adjusted analyses, both non-medical and medical cannabis use were associated with increased propofol doses (non-medical, +6.85 μg kg^-1 min^-1^, 95% CI 6.07-7.63, P<0.001; medical, +2.87 μg kg^-1 min^-1, 95% CI 0.88-4.86, P=0.005) and doses of volatile anaesthetics (non-medical, +0.01 MAC, 95% CI 0.01-0.02, P<0.001; medical, +0.02 MAC, 95% CI 0.01-0.03, P=0.002). Estimated effects were strongest among frequent users (daily recreational users, +8.41 μg kg^-1 min^-1 propofol, 95% CI 7.00-9.81, P<0.001). At comparable propofol induction doses, non-medical cannabis users experienced greater heart rate increase after tracheal intubation (+1.45 beats min^-1, 95% CI 1.10-1.79, P<0.001).</p><p><strong>Conclusions: </strong>Cannabis use was associated with modestly higher propofol and volatile anaesthetic doses. However, effect sizes were smaller than previously reported, and future studies should investigate the clinical relevance.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079877","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 future of nonintubated thoracic surgery: from airway avoidance to preservation of respiratory function.","authors":"Yoann Elmaleh, Karim Guessous, Nabil Zanoun","doi":"10.1016/j.bja.2026.09.008","DOIUrl":"https://doi.org/10.1016/j.bja.2026.09.008","url":null,"abstract":"<p><p>Nonintubated thoracic surgery can be performed in selected patients and procedures, but its current role should be defined by comparative value rather than by absence of a tracheal tube alone. The early focus on feasibility and avoidance of tracheal intubation was appropriate; the next question is whether nonintubated approaches preserve respiratory function, maintain safety during rare complications, and improve recovery compared with contemporary video-assisted or robotic thoracic surgery embedded in enhanced recovery care. Future studies should report pathway fidelity, regional anaesthesia and sedation performance, conversion readiness, postoperative pulmonary complications, complication severity, quality of recovery, and pragmatic respiratory measurements including diaphragm ultrasound at standardised time points. Therefore, nonintubated thoracic surgery should be neither dismissed as a niche technique nor promoted as a universal alternative, but rather evaluated as a team-dependent, procedure-specific option requiring rigorous selection, training, rescue algorithms, and clinically meaningful endpoints.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080025","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":"Restrictive versus liberal perioperative intravenous fluid therapy and long-term renal function after major abdominal surgery: handling of missing data and shift in target estimand. Comment on Br J Anaesth 2026; 137: 479-89.","authors":"Pei-Bin Su, Guan-Yu Chen","doi":"10.1016/j.bja.2026.08.045","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.045","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079955","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 supraglottic airway device use and respiratory adverse events during airway management in children with airway hyperresponsiveness: a report from the Japan Paediatric Difficult Airway in Anaesthesia (J-PEDIA) registry.","authors":"Yuka Uchinami, Takashi Soejima, Shingo Nishida, Yusuke Yamauchi, Fumio Watanabe, Shogo Ichiyanagi, Yu Kaiho, Taiki Kojima","doi":"10.1016/j.bja.2026.07.046","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.046","url":null,"abstract":"<p><strong>Background: </strong>Children with airway hyperresponsiveness face higher risks of perioperative respiratory adverse events. Although the use of supraglottic airway devices (SADs) is associated with fewer perioperative respiratory adverse events than tracheal intubation in selected paediatric populations, evidence remains limited regarding induction-phase airway management in children with airway hyperresponsiveness. We aimed to investigate the association between SAD placement (vs tracheal intubation) and respiratory adverse events during induction-phase airway management in children with airway hyperresponsiveness using propensity score-based inverse probability of treatment weighting.</p><p><strong>Methods: </strong>This multicentre retrospective cohort study was conducted at 12 tertiary-care institutions (six paediatric and six mixed adult-paediatric university hospitals) in the Japan Paediatric Difficult Airway in Anaesthesia registry between July 2022 and February 2025. We included children aged <18 yr undergoing general anaesthesia who had an active upper respiratory tract infection, an upper respiratory tract infection within the preceding 14 days, asthma exacerbation, or household smoking exposure. The primary outcome was the occurrence of respiratory adverse events.</p><p><strong>Results: </strong>Of the 27 844 encounters, 4878 were analysed (tracheal intubation 3005 of 4878 [61.6%]; SAD 1873 of 4878 [38.4%]). After adjustment, SAD placement was associated with a lower risk of respiratory adverse events (adjusted risk ratio [aRR] 0.41; 95% confidence interval [CI] 0.19-0.62; P<0.001), airway management-related adverse events (aRR 0.32; 95% CI 0.19-0.45; P<0.001), and severe oxygen desaturation (aRR 0.47; 95% CI 0.19-0.75; P<0.001).</p><p><strong>Conclusions: </strong>Overall, SAD use during induction of anaesthesia was associated with a lower risk of adverse respiratory events in children with airway hyperresponsiveness. These findings support consideration of SADs when clinically appropriate while acknowledging potential residual confounding.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079899","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":"Continuous superficial parasternal intercostal plane block after cardiac surgery: a systematic review of preliminary evidence.","authors":"Burhan Dost, Esra Turunc, Yunus Emre Karapinar, Alessandro De Cassai","doi":"10.1016/j.bja.2026.07.068","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.068","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079845","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 of a perioperative core structure and process indicator set using modified Core Outcome Measures in Effectiveness Trials (COMET) methodology and participatory approaches.","authors":"Kristina Wanyonyi-Kay, Oliver Boney, Paige Cunnington, Katie Richards, Sarah Ball, Hussein Wahedally, Graham Martin, S Ramani Moonesinghe, Mary Dixon-Woods","doi":"10.1016/j.bja.2026.07.066","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.066","url":null,"abstract":"<p><strong>Background: </strong>Robust, patient-centred indicators are important to quality of care. We developed a core indicator set for structure and process in perioperative care using a participatory, evidence-informed approach.</p><p><strong>Methods: </strong>We conducted a three-phase project based on the modified Core Outcome Measures in Effectiveness Trials methodology. Indicators of structure and process in perioperative care were identified from a systematic review and mapped to a 10-domain conceptual framework developed in parallel. Stakeholders, including patients, carers, and clinicians, took part in indicator refinement and prioritisation through four rounds of surveys. Quantitative analyses assessed rank stability, attrition bias, and consensus strength, whereas qualitative comments were thematically analysed. A consensus workshop and consultation were used to finalise the indicator set.</p><p><strong>Results: </strong>From 657 sources in the systematic review, 615 perioperative indicators were identified (324 process, 248 structure, 43 unclear) and mapped onto the conceptual framework. Four survey ranking rounds involving more than 250 stakeholders reduced the number of indicators to 142, showing high stability (ρ=0.89; W=0.712) and increasing agreement. A consensus workshop with 26 participants produced a final set of 56 indicators (28 core and 28 desirable) that aimed to balance feasibility, impact, and patient-centredness.</p><p><strong>Conclusions: </strong>This participatory process produced a consensus-based, multidimensional core set of perioperative structure and process indicators reflecting both clinical relevance and lived experience. The indicator set is likely to be valuable in quality-related activities. Our methodology offers a potentially transferable model for developing indicator sets of structure and process.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079981","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":"Antiemetic doses of dexamethasone do not affect pulmonary complications after noncardiac surgery: a matter of pathophysiology?","authors":"Elena Ahrens, Maximilian S Schaefer","doi":"10.1016/j.bja.2026.09.009","DOIUrl":"https://doi.org/10.1016/j.bja.2026.09.009","url":null,"abstract":"<p><p>Postoperative pulmonary complications (PPCs) remain common and are exacerbated by perioperative systemic inflammation. Dexamethasone, administered to millions of patients each year for prophylaxis against postoperative nausea and vomiting, effectively attenuates systemic inflammatory responses, rendering it a plausible adjunct for PPC prevention. In a recent issue of the British Journal of Anaesthesia, Zorrilla-Vaca and colleagues present a well-designed secondary analysis of the individualised, perioperative open-lung ventilation strategy trials showing that antiemetic doses of dexamethasone (4-8 mg i.v.) did not reduce patients' risk of PPCs. In the underlying iPROVE (Individualised, Perioperative Open-Lung Ventilation Strategy) studies, other landmark trials, and clinical routine practice across general patient populations, the key driver and major contributor to PPCs is perioperative atelectasis, which is predominantly determined by surgery, induction of general anaesthesia, and ventilatory management rather than systemic inflammation. The findings by Zorrilla-Vaca and colleagues emphasise the importance of differentiating the pathophysiological pathway of composite clinical outcomes including PPCs when designing preventive strategies, while reaffirming the established safety of dexamethasone at standard doses.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073576","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":"Glucagon-like peptide-1 receptor agonists and pulmonary aspiration. Comment on Br J Anaesth 2026; 137: 628-30.","authors":"Nils Vlaeminck, Vera Saldien","doi":"10.1016/j.bja.2026.07.075","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.075","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073592","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}