British journal of anaesthesia最新文献

{"title":"A core outcome set of measurement instruments for assessing effectiveness and efficacy of perioperative pain management: results of the international IMI-PainCare PROMPT Delphi consensus process.","authors":"Esther M Pogatzki-Zahn, Sarah De Lucia, Claudia Weinmann, Hauke Heitkamp, Lone Hummelshoj, Hiltrud Liedgens, Winfried Meissner, Katy Vincent, Jan Vollert, Peter Zahn, Ulrike Kaiser, Daniela C Rosenberger","doi":"10.1016/j.bja.2025.01.029","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.029","url":null,"abstract":"<p><strong>Background: </strong>Effective perioperative pain management is crucial to prevent patient suffering, delayed recovery, chronic postsurgical pain, and long-term opioid use. However, the heterogeneous use of outcomes in studies complicates evidence synthesis and might not accurately reflect the experiences of individual patients. We initiated a consensus process to establish a core outcome set (COS) of patient-reported outcome measures (PROMs) in postoperative pain, building upon the earlier consensus on a COS of domains.</p><p><strong>Methods: </strong>Potential PROMs were identified via systematic literature searches for the domains pain intensity (with subdomains at rest and during activity), physical function, self-efficacy, and adverse events, followed by appraisal of psychometric properties according to the COnsensus-based Standards for the selection of health Measurement INstruments methodology. Then, a consensus meeting was convened, followed by a Delphi process with an international, multiprofessional panel of stakeholders, including those with lived experience. A conclusive consensus meeting approved the final COS of PROMs.</p><p><strong>Results: </strong>The final COS consists of one unidimensional numerical rating scale for assessing pain intensity on average, worst pain intensity, pain intensity at rest, and procedure-specific pain intensity during activity; one unidimensional scale for pain interfering with activities in bed; one procedure-specific scale for assessing physical function; the IMI-PainCare PROMPT adaptation of the Arthritis Self-Efficacy Scale for assessing self-efficacy; and the IMI-PainCare PROMPT adaptation of the Opioid-Related Symptom Distress Scale for assessing adverse events.</p><p><strong>Conclusions: </strong>Comprehensive use of a core outcome set will help harmonise outcome assessment, facilitate comparisons between studies, promote patient-centred research, and improve postoperative pain care.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633719","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":"Etomidate and its derivatives: time to say goodbye? Br J Anaesth 2024; 134: 11-13.","authors":"Andrew Bowdle, Evan D Kharasch","doi":"10.1016/j.bja.2025.02.011","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.011","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633679","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":"Pulmonary complications associated with sugammadex or neostigmine in patients recovering from advanced diagnostic or interventional bronchoscopy: a retrospective two-centre analysis.","authors":"Ehab Farag, Karan Shah, Maged Argalious, Basem Abdelmalak, Thomas Gildea, John Seif, Shuyi Li, Edward J Mascha, Daniel I Sessler","doi":"10.1016/j.bja.2025.01.039","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.039","url":null,"abstract":"<p><strong>Background: </strong>Many diagnostic and interventional procedures are performed in bronchoscopy suites in high-risk patients. Minor impairment in respiratory muscle function caused by incomplete reversal of neuromuscular block can contribute to postoperative pulmonary complications (PPCs). We assessed whether there are fewer serious PPCs after diagnostic or therapeutic bronchoscopy when neuromuscular block is reversed with sugammadex rather than neostigmine.</p><p><strong>Methods: </strong>This is a retrospective cohort study for bronchoscopy under general anaesthesia with the use of neuromuscular blockers between July 2016 and June 2022. The primary outcome was a composite of PPCs. The secondary outcome was hypoxaemia. We used inverse probability of treatment weighting (IPTW) to adjust for confounding, fitting weighted outcome regression models to evaluate the association between the treatment and outcomes.</p><p><strong>Results: </strong>We analysed 8557 bronchoscopies across 6123 patients for the primary analysis. Adequate balance was achieved on all potential confounders after IPTW. The unweighted PPC incidence was 85/3830 (2.2%) for sugammadex and 93/4727 (2.0%) for neostigmine. The weighted PPC incidence was 2.7% for sugammadex and 1.9% for neostigmine. Sugammadex was associated with higher odds of experiencing the primary outcome of PPCs (odds ratio [OR]: 1.44; 95% confidence interval [CI]: 1.02-2.05; P=0.038), but not the secondary outcome of hypoxaemia (OR: 0.98; 95% CI: 0.81-1.20; P=0.878).</p><p><strong>Conclusions: </strong>Sugammadex was associated with a higher risk of PPCs than neostigmine. However, the absolute difference observed (0.8%) might not be clinically meaningful. Randomised trials are needed to more accurately determine the effect of neuromuscular block reversal agent selection on respiratory complications.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633686","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":"Motor cortex repetitive transcranial magnetic stimulation in fibromyalgia: a multicentre randomised controlled trial.","authors":"Valquíria A Silva, Abrahão F Baptista, Alessandra S Fonseca, Adriana M Carneiro, André R Brunoni, Paulo E M Carrilho, Catarina C Lins, Gabriel T Kubota, Ana Mércia B L Fernandes, Jorge D S Lapa, Lucas M Dos Santos, Ivo Sasso, Katia Monte-Silva, Frédérique Poindessous-Jazat, Nobuhiko Mori, Kenji Miki, Adriana Baltar, Clarice Tanaka, Manoel J Teixeira, Koichi Hosomi, Didier Bouhassira, Nadine Attal, Daniel Ciampi de Andrade","doi":"10.1016/j.bja.2024.12.045","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.045","url":null,"abstract":"<p><strong>Background: </strong>Despite affecting 2-4% of the population worldwide, fibromyalgia often remains refractory to treatment. Here we report the first international randomised double-blind, sham-controlled trial developed to assess the efficacy of repetitive transcranial magnetic stimulation (rTMS) as an add-on therapy for fibromyalgia.</p><p><strong>Methods: </strong>Women aged ≥18 yr with fibromyalgia refractory to best available treatment were enrolled in Brazil, France, and Japan, and randomised to 10 Hz motor cortex (M1) rTMS, 3000 pulses day^-1, or sham stimulation. This included 10 induction sessions over 2 weeks, followed by weekly maintenance (6 weeks), and fortnightly extended maintenance (8 weeks). Primary outcome was ≥50% pain reduction at week 8 compared with baseline. Secondary outcomes included pain interference, mood, global impression of change, and Fibromyalgia Impact Questionnaire (FIQ) scores at weeks 8 and 16.</p><p><strong>Results: </strong>We randomised 101 women (mean age 48 [range 25-83] yr) into active (n=52) or sham (n=49) arms. Bayesian analysis revealed a 99.4% probability of ≥50% pain reduction at week 8 in the active group vs sham (odds ratio [OR] 3.04; 95% credible interval [95% CrI] 1.26-8.06), with a number needed to treat of 4.54. Frequentist analysis confirmed that relative pain reduction was higher in the active than in the sham group (40.4% vs 18.4%, P=0.028). At week 16, this probability reduced to 34.2% (OR 0.815; 95% CrI 0.313-2.1), but the likelihood of FIQ score reduction was 79.1%. The intervention appeared safe.</p><p><strong>Conclusions: </strong>Add-on M1-repetitive transcranial magnetic stimulation reduced pain intensity up to 8 weeks in women with fibromyalgia. Although analgesic effects waned, functional improvements remained during extended maintenance at week 16.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630196","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":"Neurodevelopmental and behavioural disorders after perioperative invasive mechanical ventilation in paediatric surgical admissions.","authors":"Oliver G Isik, Ling Guo, Ariel Ben-Ezra, Sandya Ganesh, May Hua, Caleb H Miles, Mark Olfson, Andrew S Geneslaw, Caleb Ing","doi":"10.1016/j.bja.2024.12.042","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.042","url":null,"abstract":"<p><strong>Background: </strong>Children with a respiratory disease requiring invasive mechanical ventilation (IMV) in the paediatric intensive care unit (PICU) have an elevated risk for subsequent neurodevelopmental and behavioural disorders (NDBD). This study evaluates NDBD in children receiving IMV during surgical admissions.</p><p><strong>Methods: </strong>Children enrolled in Texas Medicaid between 1999 and 2012 with a surgical admission were evaluated. Children in the PICU receiving IMV, in the PICU not receiving IMV, and in the intermediate medical care unit (IMCU) were identified and matched to children admitted to the general ward. The primary outcome was post-discharge NDBD. Secondary analyses evaluated NDBD risk by IMV duration and post-discharge psychotropic medication use.</p><p><strong>Results: </strong>Of 35 161 children with surgical admissions meeting eligibility criteria, 993 were in the PICU with IMV, 7670 in the PICU without IMV, and 1027 in the IMCU. Increased rates of NDBD were observed in children receiving IMV (hazard ratio [HR] 1.91, 95% confidence interval [CI] 1.27-2.89, P=0.002), but not in those in the PICU without IMV (HR 1.12, 95% CI 0.98-1.29, P=0.10) or IMCU (HR 0.88, 95% CI 0.61-1.26, P=0.48). Elevated rates of NDBD were detected primarily in children receiving IMV for 96 h or more. Increased psychotropic medication use was observed only in the IMV group.</p><p><strong>Conclusions: </strong>Children receiving invasive mechanical ventilation during a surgical admission are at increased risk of neurodevelopmental and behavioural disorders after hospital discharge. Further research is needed to clarify the mechanisms behind this association and to identify potentially modifiable risk factors.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630032","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":"Updates on perioperative cessation of SGLT2 inhibitors.","authors":"Xiao Q Li, Niloofar Mirsaidi, Jonathan Bauman, Joseph Marino, Yael T Harris, Rifka Schulman-Rosenbaum","doi":"10.1016/j.bja.2025.01.037","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.037","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630054","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 mixed-methods study to identify the top 10 research priorities for perioperative medicine in Australia.","authors":"Sophie K A Wallace, Tracey K Bucknall, Andrew Forbes, Paul S Myles","doi":"10.1016/j.bja.2024.12.044","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.044","url":null,"abstract":"<p><strong>Background: </strong>Health and medical research leads to improvements in healthcare globally. Identifying research priorities is important to researchers, funders, our patients, and other end users. This can ensure that the research is more broadly accepted and has greater impact.</p><p><strong>Methods: </strong>An adapted version of the James Lind Alliance method was used to identify research priorities. An initial survey was promoted via social media, print media, clinic visits, and an emailed invitation to active researchers. Individuals were asked to list three questions or priorities for research in perioperative medicine. These responses were then collated into themes to match recommended standardised trial endpoints, followed by informal systematic reviews to identify the unanswered questions (priorities). These were then added to a 1000minds priority survey, and a working group then met to discuss and agree on the top 10 priorities.</p><p><strong>Results: </strong>The first surveys resulted in 200 individual responses and 544 lines of text for analysis, with 60% of respondents being consumers (patients, carers, or knew someone who underwent surgery). The second survey consisted of 100 respondents, with 45% as patients/consumers. The top 10 research priorities covered equitable access to information and quality of care for culturally and linguistically diverse populations, preoperative decision-making, partnering in care, reducing infections after surgery, preanaesthetic health questionnaires, patient-centred care, preoperative fasting, prehabilitation, postoperative analgesic effectiveness, and risk prediction.</p><p><strong>Conclusions: </strong>Research priorities are best determined in partnership between researchers, patients, clinicians, and other stakeholders. Our findings provide guidance for perioperative researchers in Australia, and elsewhere, when planning further research.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623665","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":"Dexmedetomidine mitigation of renal ischaemia-reperfusion injury: comprehensive insights from cellular mechanisms to clinical application.","authors":"Kevin Chotinaruemol, Prangmalee Leurcharusmee, Siriporn C Chattipakorn, Nipon Chattipakorn, Nattayaporn Apaijai","doi":"10.1016/j.bja.2025.02.006","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.006","url":null,"abstract":"<p><p>Renal ischaemia-reperfusion injury (IRI) is a critical cause of acute kidney injury (AKI) after major surgery, leading to elevated morbidity, mortality, and long-term renal dysfunction. Despite advances in perioperative care, the occurrence of IRI remains high. The renoprotective properties of dexmedetomidine (DEX), a selective α2-adrenergic receptor agonist, have been demonstrated, reducing oxidative stress, inflammation, apoptosis, ferroptosis, cellular senescence, and renal fibrosis while enhancing mitochondrial function and autophagy. From cellular studies to clinical applications, DEX has been effective in mitigating renal IRI, enhancing postoperative renal outcomes, and lowering the incidence of AKI in various surgical settings. This review comprehensively discusses and summarises the renoprotective effects and the underlying mechanisms of DEX, with a focus on its application across various surgical and clinical scenarios. In conclusion, DEX effectively mitigates renal IRI, as evidenced by robust in vitro, in vivo, and clinical studies. It significantly reduces kidney damage and improves surgical outcomes. However, its efficacy is less pronounced in kidney transplantation, suggesting that its renoprotective effects vary depending on the clinical context.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623666","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":"Safety and recovery profile of patients after inhalational anaesthesia versus target-controlled or manual total intravenous anaesthesia: a systematic review and meta-analysis of randomised controlled trials.","authors":"Nicolas Daccache, Yichen Wu, Sean D Jeffries, Joe Zako, Robert Harutyunyan, Eric D Pelletier, Pascal Laferrière-Langlois, Thomas M Hemmerling","doi":"10.1016/j.bja.2025.02.007","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.007","url":null,"abstract":"<p><strong>Background: </strong>In the UK, total intravenous anaesthesia (TIVA) is used in 25% of general anaesthetics and is gaining traction because of its lower environmental impact and effectiveness in reducing postoperative nausea and vomiting (PONV). Although meta-analyses have compared TIVA and inhalational anaesthesia (IA), the optimal delivery method-manual infusion or target-controlled infusion (TCI)-remains underexplored. This review addresses this gap, leveraging the rapidly growing body of evidence to guide optimal anaesthetic practice.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane CENTRAL and Web of Science from inception to October 10, 2024. Studies comparing TIVA and IA across several patient-related and efficiency outcomes were included. Meta-analyses were performed for all outcomes. Subgroup analyses were performed to assess the contribution of different factors including a comparison of TCI with manual infusion in TIVA.</p><p><strong>Results: </strong>In total, 385 RCTs were included. No significant difference in ClassIntra grade 3-4 adverse events was observed between TIVA and IA (risk ratio [RR]: 1.00, 95% confidence interval [CI]: 0.88-1.12; P=0.97). Subgroup analysis also showed no significant difference for TCI (RR: 0.89, 95% CI: 0.66-1.21; P=0.46) or manual infusion (RR: 1.03, 95% CI: 0.90-1.17; P=0.70) groups. IA was favoured in recovery times and costs, whereas the incidence of PONV and agitation on emergence favoured TIVA. No statistical difference was observed in our other outcomes.</p><p><strong>Conclusions: </strong>TIVA and IA are comparably safe, with TIVA reducing PONV and agitation, whereas IA offers faster recovery and lower costs. The use of TCI in TIVA might decrease postoperative cognitive dysfunction and increase recovery time, highlighting the need for a systematic review directly comparing TCI and manual infusion.</p><p><strong>Systematic review protocol: </strong>This review was registered prospectively with PROSPERO (CRD42024413368) on October 10, 2024. A single amendment to the title and order of outcomes was performed on November 21, 2024.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613462","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 driving pressure-guided ventilation and postoperative pulmonary complications in surgical patients: dealing with zero-events in evidence synthesis. Comment on Br J Anaesth 2024; 133: 647-57.","authors":"Qing Wang, Ji-Xuan Lang, Chun-Dong Zhang","doi":"10.1016/j.bja.2025.01.035","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.035","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613458","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}