British journal of anaesthesia最新文献

{"title":"Preoperative predictors of acute postoperative anxiety and depression using ecological momentary assessments: a secondary analysis of a single-centre prospective observational study.","authors":"Eli Aminpour, Katherine J Holzer, Madelyn Frumkin, Thomas L Rodebaugh, Caroline Jones, Simon Haroutounian, Bradley A Fritz","doi":"10.1016/j.bja.2024.08.035","DOIUrl":"https://doi.org/10.1016/j.bja.2024.08.035","url":null,"abstract":"<p><strong>Background: </strong>Postoperative anxiety and depression can negatively affect surgical outcomes and patient wellbeing. This study aimed to quantify the incidence of postoperative worsening anxiety and depression symptoms and to identify preoperative predictors of these conditions.</p><p><strong>Methods: </strong>This prospective, observational cohort study included 1168 patients undergoing surgery lasting >1 h with overnight admission at a university-affiliated quaternary referral centre. Postoperative anxiety and depression symptoms were measured using standardised, thrice-daily ecological momentary assessments (EMAs) for 30 days. Co-primary outcomes were worsening anxiety and depression symptoms, each defined as a slope >0 when EMA was modelled as a linear function of time. Multivariable logistic regression was performed to identify independent preoperative predictors of each outcome.</p><p><strong>Results: </strong>Postoperative worsening anxiety occurred in 60 patients (5%), and postoperative worsening depression occurred in 86 patients (7%). Predictors of postoperative worsening of anxiety symptoms included preoperative Patient-Reported Outcome Measurement Information System (PROMIS) anxiety symptoms (adjusted odds ratio [aOR] 2.48, 95% credible interval [CI] 1.29-4.79, for mild symptoms; aOR 2.22, 95% CI 1.10-4.51, for moderate to severe symptoms), and preoperative pain (aOR 3.46, 95% CI 1.32-9.12). Predictors of postoperative worsening depression symptoms included preoperative PROMIS depression symptoms (aOR 2.26, 95% CI 1.24-4.14, for mild symptoms; aOR 3.79, 95% CI 2.10-6.81, for moderate to severe symptoms). Self-reported history of anxiety or depression did not independently predict either outcome.</p><p><strong>Conclusions: </strong>Postoperative worsening anxiety and depression appear to be associated more closely with preoperative active mental health or pain symptoms rather than self-reported history of these conditions. Preoperative identification of at-risk patients will require screening for symptoms rather than simple history taking.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495478","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":"Gastric emptying in pregnancy and its clinical implications: a narrative review.","authors":"Jacob Lawson,Ryan Howle,Petar Popivanov,Jas Sidhu,Camilla Gordon,Maria Leong,Desire Onwochei,Neel Desai","doi":"10.1016/j.bja.2024.09.005","DOIUrl":"https://doi.org/10.1016/j.bja.2024.09.005","url":null,"abstract":"Delayed gastric emptying increases the risk of pulmonary aspiration during anaesthesia for Caesarean delivery. Our aim in conducting this narrative review was to consider the effect of pregnancy on gastric emptying. The indices of gastric emptying after liquids, solids, or both and when fasted in the various trimesters of pregnancy, at the time of Caesarean delivery, in labour, and the postpartum period were assessed. We considered 32 observational studies, one nonrandomised controlled study, and 22 randomised controlled trials. The evidence indicates that, compared with the nonpregnant state, gastric emptying is decreased in the first but not the second and third trimesters. Before elective Caesarean delivery, carbohydrate drink or tea with milk leads to no difference in gastric cross-sectional area at 2 h relative to fasting or water. Following a standard fast for elective Caesarean delivery, patients may still have high-risk gastric contents. Compared with the nonpregnant state and third trimester, gastric emptying is delayed in labour, although the choice of analgesia has modifying effects. Systemic opioids delay gastric emptying. Epidural analgesia increases gastric emptying, but not back to baseline. Intrathecal analgesia delays gastric emptying relative to epidural analgesia. Women in labour who have eaten solids in the last 8 h still have high-risk gastric contents present in the stomach. The evidence with respect to the postpartum period is conflicting. In conclusion, inconsistencies in the literature reflect the unpredictability of gastric emptying in pregnancy and underline the potential value of gastric ultrasound in women who are pregnant.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"97 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489416","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":"Residual neuromuscular block in the postanaesthesia care unit: a single-centre prospective observational study and systematic review.","authors":"Veerle Bijkerk,Piet Krijtenburg,Tessa Verweijen,Jörgen Bruhn,Gert Jan Scheffer,Christiaan Keijzer,Michiel C Warlé","doi":"10.1016/j.bja.2024.07.043","DOIUrl":"https://doi.org/10.1016/j.bja.2024.07.043","url":null,"abstract":"BACKGROUNDConcerns regarding residual neuromuscular block (RNMB) have persisted since the introduction of neuromuscular blocking agents, with reported incidences in the 21st century up to 50%. Advances in neuromuscular transmission (NMT) monitoring and the introduction of sugammadex have addressed this issue, but the impact of these developments remains unclear.METHODSThis prospective observational study evaluated RNMB in 500 surgical patients in a large Dutch teaching hospital with readily available quantitative NMT monitoring and reversal agents. The anaesthetic technique and intraoperative NMT monitoring were independently chosen by the attending anaesthesiologist. Acceleromyography was performed upon arrival in the PACU for patients who received nondepolarising neuromuscular blocking agents. RNMB was defined as a train-of-four ratio (TOFR) <0.9. A systematic review was conducted to analyse trends in RNMB in contemporary practice.RESULTSOut of 500 patients, 11 (2.2%) had a TOFR <0.9. Intraoperative NMT monitoring was performed in 77.6% of patients, and sugammadex was administered to 38% of patients. No patient received neostigmine. The only difference was an automatically recorded TOFR ≥0.9 at the end of surgery in 61.1% in the non-RNMB group compared with 18.2% in the RNMB group (P=0.009). Our systematic review identified incidences ranging from 3.5% to 53.3% since 2000, with a decreasing trend in Europe and North America.CONCLUSIONSThe incidence of residual neuromuscular block in the PACU was 2.2%. This suggests significant improvement in the prevention of residual neuromuscular block and stresses the importance of rigorous neuromuscular transmission monitoring and adequate use of reversal agents.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"22 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489625","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 adverse childhood experiences on analgesia-related outcomes: a systematic review.","authors":"Dhaneesha N S Senaratne,Mia Koponen,Karen N Barnett,Blair H Smith,Tim G Hales,Louise Marryat,Lesley A Colvin","doi":"10.1016/j.bja.2024.09.015","DOIUrl":"https://doi.org/10.1016/j.bja.2024.09.015","url":null,"abstract":"BACKGROUNDThere is well-established evidence linking adverse childhood experiences (ACEs) and chronic pain in adulthood. It is less clear how ACE exposure might influence the response to chronic pain treatment. In this systematic review, we synthesise the literature assessing the impact of ACE exposure on outcomes relating to the use, benefits, and harms of analgesic medications (analgesia-related outcomes).METHODSWe searched seven databases from inception to September 26, 2023, for studies investigating adverse events in childhood (<18 yr) and any analgesia-related outcome during adulthood (≥18 yr). Title/abstract screening, full-text review, data extraction, and risk of bias assessment were performed independently by two authors. Given the high degree of study heterogeneity, a narrative synthesis was performed.RESULTSFrom 7531 records, 66 studies met inclusion criteria, involving 137 395 participants. Analgesia-related outcomes were classed into six categories: use of analgesics (n=12), analgesic side-effects (n=4), substance misuse (n=45), lifetime drug overdose (n=2), endogenous pain signalling (n=4), and other outcomes (n=2). No studies assessed the effect of ACE exposure on the potential benefits of analgesics. ACE exposure was associated with greater use of analgesic medication, higher incidence of analgesic medication side-effects, greater risk and severity of substance misuse, greater risk of drug overdose, and greater risk of attempted suicide in opioid dependency.CONCLUSIONSAdverse childhood experience exposure is associated with poor analgesia-related outcomes, so individual assessment adverse childhood experiences is important when considering the treatment of chronic pain. However, significant gaps in the literature remain, especially relating to the use and harms of non opioid analgesics.SYSTEMATIC REVIEW PROTOCOLCRD42023389870 (PROSPERO).","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"89 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488290","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 two-person verbal check to confirm tracheal intubation: evaluation of practice changes to prevent unrecognised oesophageal intubation","authors":"Thomas Cloke ,&nbsp;Catherine Ross ,&nbsp;Paula Joy ,&nbsp;Anthony Carver ,&nbsp;Thomas E. Potter ,&nbsp;Dani Padman ,&nbsp;Kate Kanga ,&nbsp;Imran Ahmad ,&nbsp;Kariem El-Boghdadly ,&nbsp;Fiona E. Kelly ,&nbsp;Timothy M. Cook","doi":"10.1016/j.bja.2024.09.006","DOIUrl":"10.1016/j.bja.2024.09.006","url":null,"abstract":"<div><h3>Background</h3><div>Deaths from unrecognised oesophageal intubation continue despite national campaigns emphasising the importance of capnography to confirm tracheal intubation. A two-person verbal intubation check is recommended in consensus guidelines intended to prevent such deaths. This check can be performed by the intubator with their assistant, either as a one-step process (identification of sustained exhaled carbon dioxide) or as a two-step process (adding identification of the tracheal tube passing through the vocal cords during videolaryngoscopy).</div></div><div><h3>Methods</h3><div>In two hospitals we introduced two-person checking of tracheal intubation. In one hospital this involved the one-step process and in the other the two-step process. We used anonymous online questionnaires before, during, and after these changes to collect opinions from anaesthetists and their assistants regarding the feasibility and acceptability of these changes.</div></div><div><h3>Results</h3><div>Most intubators (116/149, 78%) and intubators' assistants (70/72, 97%) reported that the two-person verbal intubation check would reduce the likelihood of unrecognised oesophageal intubation. Benefits and lack of negative aspects were reported for both one-step and two-step two-person intubation checks in both centres. Intubators judged that the checks improved communication and teamwork (118/149, 79%); intubators' assistants reported feeling more empowered to voice concerns if needed (69/72, 96%), a flattened team hierarchy (53/72, 74%), and feeling more valued as team members (64/72, 89%). Most intubators (122/149, 82%) and intubators' assistants (68/72, 94%) planned to continue using the two-person intubation check for all future intubations.</div></div><div><h3>Conclusions</h3><div>Our results suggest that a two-person verbal intubation check is feasible and acceptable to all members of the intubating team.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1307-1317"},"PeriodicalIF":9.1,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451874","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":"Informed consent: do we have an obligation to double check?","authors":"Sarah Morton,&nbsp;Michael Janula,&nbsp;Cesare Quarto,&nbsp;Sarah Trenfield","doi":"10.1016/j.bja.2024.09.013","DOIUrl":"10.1016/j.bja.2024.09.013","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1350-1351"},"PeriodicalIF":9.1,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451864","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":"Use of coagulation factor concentrates and blood transfusion in cardiac surgery: a retrospective cohort study of adults with hereditary and acquired bleeding disorders","authors":"Kenichi A. Tanaka ,&nbsp;Hisako Okada ,&nbsp;Amir L. Butt ,&nbsp;Kofi B. Vandyck ,&nbsp;Srikiran Ramarapu ,&nbsp;Cheryl L. Maier ,&nbsp;Roman M. Sniecinski ,&nbsp;Kenneth E. Stewart","doi":"10.1016/j.bja.2024.07.041","DOIUrl":"10.1016/j.bja.2024.07.041","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac surgery poses a significant risk of perioperative bleeding and allogeneic blood transfusions, particularly in patients with bleeding disorders. Increasingly frequent use of coagulation factor concentrates could impact haemorrhagic risks, thromboembolic events, and costs. We describe the use of coagulation factor concentrates and allogeneic blood products in cardiac surgical patients with hereditary and acquired bleeding disorders to assess pertinent outcomes, including perioperative haemorrhage, thromboembolism, and hospital costs.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the Premier Health Database, including adult cardiac surgical patients diagnosed with hereditary or acquired bleeding disorders compared with those without bleeding disorders.</div></div><div><h3>Results</h3><div>Patients with acquired bleeding disorders required more extensive use of coagulation factor concentrates and blood products compared with those with hereditary bleeding disorders or without bleeding disorders. The highest exposures to coagulation factor concentrates were found in the acquired bleeding disorders group, with 24% receiving factor VIIa and 11.7% receiving prothrombin complex concentrate. This group also experienced significantly higher rates of complications, including a 15.8% rate of haemorrhage and a 19.2% rate of thromboembolic events. The acquired bleeding disorders group had longer intensive care and hospital stays, and the highest mortality rate (19.2%). The increased use of perioperative replacement of factor VIII and factor IX in the hereditary bleeding disorders group led to increased pharmacy costs but did not significantly impact blood bank charges.</div></div><div><h3>Conclusions</h3><div>Acquired bleeding disorders in cardiac surgery patients are associated with increased use of haemostatic interventions, postoperative complications, and increased healthcare costs. Improved management of perioperative haemostasis and thromboprophylaxis strategies are essential for optimising patient outcomes and reducing expenses.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1150-1158"},"PeriodicalIF":9.1,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451865","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":"Desorption of volatile anaesthetics from CONTRAfluran™ during total intravenous anaesthesia with a high fresh gas flow","authors":"Alain F. Kalmar ,&nbsp;Hugo Vereecke ,&nbsp;Steffen Rex","doi":"10.1016/j.bja.2024.09.017","DOIUrl":"10.1016/j.bja.2024.09.017","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1528-1529"},"PeriodicalIF":9.1,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451859","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":"Changes in circulating extracellular vesicle cargo are associated with cognitive decline after major surgery: an observational case-control study.","authors":"Souren Mkrtchian,Maria Eldh,Anette Ebberyd,Susanne Gabrielsson,Ákos Végvári,Sven-Erik Ricksten,Mattias Danielson,Jonatan Oras,Andreas Wiklund,Lars I Eriksson,Marta Gómez-Galán","doi":"10.1016/j.bja.2024.07.040","DOIUrl":"https://doi.org/10.1016/j.bja.2024.07.040","url":null,"abstract":"BACKGROUNDPostoperative neurocognitive decline is a frequent complication triggered by unclear signalling mechanisms. This observational case-control study investigated the effects of hip or knee replacement surgery on the composition of circulating extracellular vesicles (EVs), potential periphery-to-brain messengers, and their association with neurocognitive outcomes.METHODSWe mapped the microRNAome and proteome of plasma-derived EVs from 12 patients (six with good and six with poor neurocognitive outcomes at 3 months after surgery) at preoperative and postoperative timepoints (4, 8, 24, and 48 h). Complement C3-EV association was confirmed by flow cytometry in plasma- and cerebrospinal fluid (CSF)-derived EVs, with total plasma and CSF C3 and C3a concentrations determined using enzyme-linked immunosorbent assay.RESULTSDifferential expression analysis found eight dysregulated EV microRNAs (miRNAs) exclusively in the poor neurocognitive outcomes group. Pathway analysis suggested potential downregulation of proliferative pathways and activation of extracellular matrix and inflammatory response pathways in EV target tissues. Proteome analysis revealed a time-dependent increase in immune-related EV proteins, including complement system proteins, notably EV surface-associated C3. Such upward kinetics was detected earlier in the poor neurocognitive outcomes group. Interestingly, CSF-derived EVs from the same group showed a drastic drop of C3 at 48 h with unchanged concentrations in the good neurocognitive outcomes group. Functionally, the complement system was activated in both patient groups in plasma, but only in the poor neurocognitive outcomes group in CSF.CONCLUSIONSOur findings highlight the impact of surgery on plasma- and CSF-derived EVs, particularly in patients with poor neurocognitive outcomes, indicating a potential role for EVs. The small sample size necessitates verification with a larger patient cohort.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"26 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451862","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":"Effect of a comfort scale compared with a pain numerical rate scale on opioids consumption in postanaesthesia care unit: the COMFORT study. Comment on Br J Anaesth 2024; 133: 839–45","authors":"Guanyu Yang","doi":"10.1016/j.bja.2024.09.019","DOIUrl":"10.1016/j.bja.2024.09.019","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Page 1321"},"PeriodicalIF":9.1,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449327","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}