British journal of anaesthesia最新文献

{"title":"Prehospital whole blood for trauma: when two trials agree, the burden of proof shifts.","authors":"Amir L Butt, Kelsey C Waite, Kenichi A Tanaka","doi":"10.1016/j.bja.2026.09.010","DOIUrl":"https://doi.org/10.1016/j.bja.2026.09.010","url":null,"abstract":"<p><p>Two pragmatic randomised trials, published back-to-back in the same issue, tested whether prehospital low-titre group O whole blood improves survival after traumatic haemorrhage. TOWAR cluster-randomised 44 North American air medical bases, and SWiFT randomised individual patients across 10 English air ambulance services. Both returned the same null. At a dose of 2 units, whole blood was not superior to conventional components, and neither trial signalled meaningful harm. TOWAR's cluster allocation, which left the whole blood arm sicker at baseline and tied the product a patient received to the month of injury, can bias its point estimate but cannot explain why an independent, cleanly randomised trial reached the same endpoint. The operational case for whole blood, less wastage and functional platelets, is less well supported than it appears. Neither trial compared whole blood with goal-directed factor concentrate resuscitation, which may be the stronger strategy.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058546","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 environmental footprint and ecotoxicity of sevoflurane and propofol anaesthesia. Comment on Br J Anaesth 2026; 137: 89-98.","authors":"Cheng-Wei Lu, Kuo-Chen Chang","doi":"10.1016/j.bja.2026.07.069","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.069","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058541","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":"Airway ultrasound in anaesthesia training: a call for routine clinical implementation. Comment on Br J Anaesth 2026; 137: 244-53.","authors":"Filomena Di Vezza, Marco Sanvitti, Federico Bilotta","doi":"10.1016/j.bja.2026.08.044","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.044","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058560","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 inhalation anaesthesia versus target-controlled or manual total intravenous anaesthesia: are we comparing like with like? Comment on Br J Anaesth 2025; 134: 1474-85.","authors":"Andreas Sotiriou, Suji Pararajasingam, Danaja Zolger, Neel Desai","doi":"10.1016/j.bja.2026.07.073","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.073","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058465","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":"Functional impairment in patients undergoing major orthopaedic surgery under general anaesthesia with or without regional anaesthesia: clarifying the estimand when discharge determines measurement. Comment on Br J Anaesth 2026; 137: 849-57.","authors":"Jiaxuan Peng, Haoyang Hu","doi":"10.1016/j.bja.2026.07.077","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.077","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058496","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":"Closed-loop systems for automated hypnotic drug delivery during general anaesthesia. Comment on Br J Anaesth 2026; 136: 1811-21.","authors":"David J Gee","doi":"10.1016/j.bja.2026.07.067","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.067","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058507","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":"Cerebral autoregulation-guided blood pressure management to reduce delirium in adults: a meta-analysis of randomised controlled trials.","authors":"Jinxiang Xie, Chengying Ji, Bokang Yang, Jiayi Xie, Abdulrahman K Alwesabi, Yatao Liu","doi":"10.1016/j.bja.2026.07.057","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.057","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029721","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":"Videolaryngoscopy and first-attempt tracheal intubation success in neonates and infants: a retrospective cohort study using the Japan Pediatric Difficult Airway in Anesthesia (J-PEDIA) registry.","authors":"Tomoharu Ukiya, Fumio Watanabe, Megumi Okuyama, Yasuma Kobayashi, Yu Kaiho, Takahiro Imaizumi, Taiki Kojima","doi":"10.1016/j.bja.2026.07.070","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.070","url":null,"abstract":"<p><strong>Background: </strong>First-attempt tracheal intubation success is critical in neonates and infants. Although videolaryngoscopy (VL) is recommended for neonatal and infant intubation, uncertainty remains regarding its effectiveness in real-world practice. We evaluated the association between use of VL for the initial tracheal intubation attempt and first-attempt tracheal intubation success in neonates and infants using a multicentre airway registry.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the Japan Pediatric Difficult Airway in Anesthesia (J-PEDIA) registry, collected between June 2022 and February 2025. The primary outcome was first-attempt tracheal intubation success. Secondary outcomes included the percentage of glottic opening score, respiratory adverse events, and haemoglobin oxygen desaturation. Propensity score-based inverse probability of treatment weighting was applied to adjust for potential confounders.</p><p><strong>Results: </strong>Overall, 3250 encounters were analysed. After inverse probability of treatment weighting adjustment, VL was associated with a lower probability of first-attempt success than direct laryngoscopy (adjusted risk ratio 0.89, 95% confidence interval [CI] 0.83-0.96, P=0.001). VL was also associated with higher percentage of glottic opening scores (β 17.8, 95% CI 9.5-26.1, P<0.001), but increased risk of desaturation (adjusted risk ratio 2.18, 95% CI 1.57-2.79, P<0.001). The incidence of respiratory adverse events was similar between the groups (adjusted risk ratio -0.09, 95% CI -0.012 to 0.0097, P=0.86).</p><p><strong>Conclusions: </strong>VL use was associated with lower first-attempt tracheal intubation success and a higher risk of desaturation compared with direct laryngoscopy. These findings suggest an efficacy-effectiveness gap in non-standardised real-world practice. Structured VL implementation and targeted training might be required to translate improved visualisation into successful first-attempt tracheal intubation.</p><p><strong>Clinical trial registration: </strong>jRCT; registration number: 1040250033.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029763","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":"Age-related sex differences in intensive care treatment and outcome: a retrospective registry-based study in Australia and New Zealand. Comment on Br J Anaesth 2026; 136: 1217-25.","authors":"Ryan R Ling, Ruvini Vithanage, Lucy Modra, David Pilcher, Ashwin Subramaniam","doi":"10.1016/j.bja.2026.07.041","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.041","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029714","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":"Onslaught of the silver tsunami: cognitive impairment and frailty in older patients undergoing surgery.","authors":"Eric Cheuk, Frances Chung","doi":"10.1016/j.bja.2026.08.012","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.012","url":null,"abstract":"<p><p>Cognitive impairment and frailty are common and frequently coexist among older patients undergoing surgery, and each independently predicts adverse postoperative outcomes. Yet, both remain under-recognised and their combined perioperative impact is poorly understood. The retrospective cohort study by Weiss and colleagues used the Mini-Cog and Clinical Frailty Scale to highlight a 24% incidence of postoperative delirium among patients with both cognitive impairment and frailty, compared to 4% among patients with neither condition. Cognitive impairment emerged as a consistent predictor of delirium across the post-anaesthesia care unit and ward settings, whereas frailty was more closely associated with prolonged hospital length of stay, suggesting the two measures capture complementary dimensions of perioperative vulnerability. Screening for both conditions could provide a practical approach to identify patients most likely to benefit from targeted, multimodal interventions. Further research is needed on cognitive frailty in the perioperative setting.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029747","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}