British journal of anaesthesia最新文献

{"title":"Chronic postsurgical inguinal pain: incidence and diagnostic biomarkers from a large German national claims database.","authors":"Eva Herrmann, Magnus Schindehütte, Gudrun Kindl, Ann-Kristin Reinhold, Felix Aulbach, Norman Rose, Johannes Dreiling, Daniel Schwarzkopf, Michael Meir, Yuying Jin, Karolin Teichmüller, Anna Widder, Robert Blum, Abdelrahman Sawalma, Nadine Cebulla, Michael Sendtner, Winfried Meissner, Alexander Brack, Mirko Pham, Claudia Sommer, Nicolas Schlegel, Heike L Rittner","doi":"10.1016/j.bja.2024.11.048","DOIUrl":"https://doi.org/10.1016/j.bja.2024.11.048","url":null,"abstract":"<p><strong>Background: </strong>Chronic postsurgical inguinal pain (CPIP) is the most common complication of groin hernia surgery. The characteristics of patients, their medical care, and choice of diagnostic tools remain to be defined to optimise preventive and therapeutic interventions.</p><p><strong>Methods: </strong>Claims data from 2018 and a 1-yr follow-up were analysed for incidence and medical care. A separate cohort (141 healthy controls and 17 CPIP patients) was examined by deep phenotyping. This included sensory testing, blood and skin biopsies, MRI of the dorsal root ganglion (DRG), and patient-reported outcomes.</p><p><strong>Results: </strong>Of 11,221 patients with hernia surgery in 2018 identified, 8.5% had pain before that was relieved by surgery, but a similar percentage had novel pain in this region. Deep phenotyping of 141 healthy controls provided a map of the inguinal sensory system. The following analysis of patients with CPIP revealed that they suffered from moderate pain with neuropathic features, individual sensory abnormalities, and unilateral L1 DRG atrophy. In the blood, levels of C-C-motif chemokine ligand (CCL2) and brain-derived neurotrophic factor (BDNF) were upregulated, whereas apolipoprotein A1 (ApoA1) concentration was reduced. A cluster of DRG atrophy, BDNF, ApoA1, and anxiety correlated best with the diagnosis. CPIP patients with novel pain had significantly more DRG atrophy (-24% ipsilateral vs contralateral volume).</p><p><strong>Conclusions: </strong>CPIP is often newly acquired after surgery. A combination of DRG imaging, serum markers, and anxiety screening can support the diagnosis. In the future, this could guide clinicians towards more personalised therapies (e.g. targeting anxiety or lipid profiles) and possible altered surgical techniques.</p><p><strong>Clinical trial registration: </strong>German Trial Registry DRKS00024588 and DRKS00016790.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254875","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":"Role of brain-derived neurotrophic factor in dysfunction of short-term to long-term memory transformation after surgery and anaesthesia in older mice.","authors":"Qiang Liu, Hai-Bi Wang, Jia-Tao Lin, Xin-Hao Jiao, Yan-Ping Liu, Tian-Zuo Li, Zhongcong Xie, Cheng-Hua Zhou, Yu-Qing Wu, Hui-Hui Miao","doi":"10.1016/j.bja.2024.11.045","DOIUrl":"https://doi.org/10.1016/j.bja.2024.11.045","url":null,"abstract":"<p><strong>Background: </strong>Memory decline is one of the main manifestations in perioperative neurocognitive disorder. Short-term memory (STM) to long-term memory (LTM) transformation is one aspect of memory consolidation. Early-phase long-term potentiation (E-LTP) to late-phase long-term potentiation (L-LTP) is the molecular correlate of STM to LTM transformation. We examined whether the STM to LTM transformation was impaired after anaesthesia and surgery in older mice.</p><p><strong>Methods: </strong>Optogenetics and chemogenetics were used to confirm the role of Vglut1+ glutamatergic neurones in the STM to LTM transformation in older mice. Synaptosomes were isolated to analyse expression of brain-derived neurotrophic factor (BDNF). Golgi-Cox staining and hippocampal field potential recordings were also used to measure synaptic plasticity.</p><p><strong>Results: </strong>We found that the STM to LTM and E-LTP to L-LTP transformations were impaired after anaesthesia and surgery in older mice, and Vglut1+ excitatory neurone activity in the hippocampal CA1 region was reduced. BDNF expression decreased in the postsynaptic fraction, especially in Vglut1+ neurones, whereas cell-type specific overexpression of BDNF in Vglut1+ neurones reversed postoperative STM to LTM transformation dysfunction in older mice.</p><p><strong>Conclusions: </strong>Reduced BDNF expression was involved in anaesthesia and surgery-induced impairment of the STM to LTM transition involving glutamatergic neurones in the hippocampal CA1 region of older mice. This provides a potential target that might be helpful for understanding and developing treatments for postoperative neurocognitive dysfunction.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254885","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 role of ChatGPT in perioperative pain management: importance of version and prompt sensitivity. Comment on Br J Anaesth 2024; 133: 1318-20.","authors":"Michel Abdel Malek, Nadia du Fosse, Martijn Boon","doi":"10.1016/j.bja.2024.12.034","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.034","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254879","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 misunderstood P-value: why statistical significance is not enough in clinical practice.","authors":"Ebadullah S Ahmed, Mohsin N Butt","doi":"10.1016/j.bja.2025.01.008","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.008","url":null,"abstract":"<p><p>P-values have traditionally guided clinical research, but over-reliance on them can lead to misinterpretation and poor decision-making. This article highlights common misconceptions about P-values and suggests incorporating the minimum clinically important difference (MCID) along with other metrics such as effect sizes and Bayesian methods. Evidence-based practice is essential in anaesthesiology, and research findings should be evaluated in the context of patient outcomes to guide clinical decisions.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254900","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 age on the reliability of GE Entropy™ module indices for guidance of maintenance of anaesthesia in adult patients: a single-centre retrospective analysis.","authors":"Max Ebensperger, Matthias Kreuzer, Stephan Kratzer, Gerhard Schneider, Stefan Schwerin","doi":"10.1016/j.bja.2024.11.050","DOIUrl":"https://doi.org/10.1016/j.bja.2024.11.050","url":null,"abstract":"<p><strong>Background: </strong>The GE Entropy™ module uses frontal EEG to compute the processed indices state entropy (SE), response entropy (RE), and burst suppression ratio (BSR) to guide maintenance of anaesthesia by supposedly minimising overly 'deep' or 'light' anaesthesia. It remains unclear whether the manufacturer-recommended index ranges accurately reflect anaesthesia levels or prevent complications such as burst suppression or arousal reactions.</p><p><strong>Methods: </strong>We retrospectively analysed 15 608 patient records, evaluating 14 770 adult patients (18-90 yr old) undergoing general anaesthesia. Age-dependent effects on processed index values were assessed using linear regression and Spearman's correlation coefficients (rho).</p><p><strong>Results: </strong>During steady-state anaesthesia (BSR=0), only 38.4% (32.5-42.4%) of SE values were within the recommended range, with most values below the target. Age was positively associated with an increase in age-adjusted minimal alveolar concentration for volatile anaesthetics (adjusted [adj.] R²=0.18, P<0.001, rho=0.47 [0.20-0.70]). Despite this, SE paradoxically increased with age (adj. R²=0.45, P<0.001, rho=0.67 [0.51-0.79]). This trend persisted even during periods with positive BSR despite supposedly adequate SE values (adj. R²=0.73, P<0.001, rho=0.90 [0.80-0.95]). Maintaining anaesthesia within the recommended index range did not prevent positive BSR. Additionally, both frequency (adj. R²=0.70, P<0.001, rho=0.92 [0.85-0.95]) and duration (adj. R²=0.73, P<0.001, rho=0.89 [0.82-0.93]) of ΔRE-SE≥10, indicating arousal, increased with age.</p><p><strong>Conclusions: </strong>Despite their intuitive appeal, the processed EEG index values SE, RE, ΔRE-SE, and BSR showed limited reliability in guiding maintenance of anaesthesia, especially in older patients. Anaesthesiologists should not rely exclusively on the recommended index value range, as it is often unattainable and does not prevent burst suppression or arousal indicators.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254882","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":"Evaluation of the need for dosing adaptations in obese patients for surgical antibiotic prophylaxis: a model-based analysis of cefazolin pharmacokinetics.","authors":"Davide Bindellini, Philipp Simon, David Busse, Robin Michelet, David Petroff, Linda B S Aulin, Christoph Dorn, Markus Zeitlinger, Wilhelm Huisinga, Hermann Wrigge, Charlotte Kloft","doi":"10.1016/j.bja.2024.11.044","DOIUrl":"https://doi.org/10.1016/j.bja.2024.11.044","url":null,"abstract":"<p><strong>Background: </strong>Cefazolin is used as a prophylactic antibiotic to reduce surgical site infections (SSIs). Obesity has been identified as a risk factor for SSIs. Cefazolin dosing recommendations and guidelines are currently inconsistent for obese patients. As plasma and target-site exposure might differ, pharmacokinetic data from the sites of SSIs are essential to evaluate treatment efficacy: these data can be obtained via tissue microdialysis. This analysis was designed to evaluate the need for dosing adaptations in obese patients for surgical prophylaxis.</p><p><strong>Methods: </strong>Data from 15 obese (BMI_median = 52.6 kg m^-2) and 15 age- and sex-matched nonobese patients (BMI_median = 26.0 kg m^-2) who received 2 g cefazolin i.v. infusion for infection prophylaxis were included in the analysis. Pharmacokinetic data from plasma and interstitial space fluid (ISF) of adipose tissue were obtained and analysed simultaneously using nonlinear mixed-effects modelling. Dosing regimens were evaluated by calculating the probability of target attainment (PTA) and the cumulative fraction of response (CFR) for plasma and ISF using unbound cefazolin concentration above minimum inhibitory concentration 100% of the time as target (fT_>MIC = 100%). Dosing regimens were considered adequate when PTA and CFR were ≥90%.</p><p><strong>Results: </strong>Evaluation of cefazolin doses of 1 and 2 g with redosing at either 3 or 4 h by PTA and CFR in plasma and ISF found 2 g cefazolin with redosing at 4 h to be the most suitable dosing regimen for both obese and nonobese patients (PTA >90% and CFR >90% for both).</p><p><strong>Conclusions: </strong>This model-based analysis, using fT_>MIC = 100% as a target, showed that cefazolin dosing adaptations are not required for surgical prophylaxis in obese patients.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078632","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":"Federated learning and pain management: artificial intelligence to allow continuous learning while preserving privacy","authors":"Linghua Yu","doi":"10.1016/j.bja.2024.10.036","DOIUrl":"10.1016/j.bja.2024.10.036","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 581-583"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821930","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":"Educational outcomes of simulation-based training in regional anaesthesia: a scoping review","authors":"Balakrishnan Ashokka ,&nbsp;Lawrence Siu-Chun Law ,&nbsp;Archana Areti ,&nbsp;David Burckett-St Laurent ,&nbsp;Roman Oliver Zuercher ,&nbsp;Ki-Jinn Chin ,&nbsp;Reva Ramlogan","doi":"10.1016/j.bja.2024.07.037","DOIUrl":"10.1016/j.bja.2024.07.037","url":null,"abstract":"<div><h3>Background</h3><div>Structured training in regional anaesthesia includes pretraining on simulation-based educational platforms to establish a safe and controlled learning environment before learners are provided clinical exposure in an apprenticeship model. This scoping review was designed to appraise the educational outcomes of current simulation-based educational modalities in regional anaesthesia.</div></div><div><h3>Methods</h3><div>This review conformed to PRISMA-ScR guidelines. Relevant articles were searched in PubMed, Scopus, Google Scholar, Web of Science, and EMBASE with no date restrictions, until November 2023. Studies included randomised controlled trials, pre–post intervention, time series, case control, case series, and longitudinal studies, with no restrictions to settings, language or ethnic groups. The Kirkpatrick framework was applied for extraction of educational outcomes.</div></div><div><h3>Results</h3><div>We included 28 studies, ranging from 2009 to 2023, of which 46.4% were randomised controlled trials. The majority of the target population was identified as trainees or residents (46.4%). Higher order educational outcomes that appraised translation to real clinical contexts (Kirkpatrick 3 and above) were reported in 12 studies (42.9%). Two studies demonstrated translational patient outcomes (Level 4) with reduced incidence of paraesthesia and clinical complications. The majority of studies appraised Level 3 outcomes of performance improvements in either laboratory simulation contexts (42.9%) or demonstration of clinical performance improvements in regional anaesthesia (39.3%).</div></div><div><h3>Conclusions</h3><div>There was significant heterogeneity in the types of simulation modalities used, teaching interventions applied, study methodologies, assessment tools, and outcome measures studied. When improvisations were made to regional anaesthesia simulation platforms (hybrid simulation), there were sustained educational improvements beyond 6 months. Newer technology-enhanced innovations such as virtual, augmented, and mixed reality simulations are evolving, with early reports of educational effectiveness.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 523-534"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364458","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":"Neural correlates of systemic lidocaine administration in healthy adults measured by functional MRI: a single arm open label study","authors":"Keith M. Vogt ,&nbsp;Alex C. Burlew ,&nbsp;Marcus A. Simmons ,&nbsp;Sujatha N. Reddy ,&nbsp;Courtney N. Kozdron ,&nbsp;James W. Ibinson","doi":"10.1016/j.bja.2024.07.039","DOIUrl":"10.1016/j.bja.2024.07.039","url":null,"abstract":"<div><h3>Introduction</h3><div>Intravenous lidocaine is increasingly used as a nonopioid analgesic, but how it acts in the brain is incompletely understood. We conducted a functional MRI study of pain response, resting connectivity, and cognitive task performance in volunteers to elucidate the effects of lidocaine at the brain-systems level.</div></div><div><h3>Methods</h3><div>We enrolled 27 adults (age 22–55 yr) in this single-arm, open-label study. Pain response task and resting-state functional MRI scans at 3 T were obtained at baseline and then with a constant effect-site concentration of lidocaine. Electric nerve stimulation, titrated in advance to 7/10 intensity, was used for the pain task (five times every 10 s). Group-level differences in pain task-evoked responses (primary outcome, focused on the insula) and in resting connectivity were compared between baseline and lidocaine conditions, using adjusted <em>P</em>&lt;0.05 to account for multiple comparisons. Pain ratings and performance on a brief battery of computer-based tasks were also recorded.</div></div><div><h3>Results</h3><div>Lidocaine infusion was associated with decreased pain-evoked responses in the insula (left: Z=3.6, <em>P</em>&lt;0.001, right: Z=3.6, <em>P</em>=0.004) and other brain areas including the cingulate gyrus, thalamus, and primary sensory cortex. Resting-state connectivity showed significant diffuse reductions in both region-to-region and global connectivity measures with lidocaine. Small decreases in pain intensity and unpleasantness and worse memory performance were also seen with lidocaine.</div></div><div><h3>Conclusions</h3><div>Lidocaine was associated with broad reductions in functional MRI response to acute pain and modulated whole-brain functional connectivity, predominantly decreasing long-range connectivity. This was accompanied by small but significant decreases in pain perception and memory performance.</div></div><div><h3>Clinical trial registration</h3><div>NCT 05501600.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 414-424"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495476","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":"Surgical smoke plume: ongoing exposure of anaesthetic and surgical staff to a preventable harm","authors":"Daniel Rodger","doi":"10.1016/j.bja.2024.11.014","DOIUrl":"10.1016/j.bja.2024.11.014","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 595-596"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817350","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}