British journal of anaesthesia最新文献

{"title":"Risk of perioperative discontinuation of SGLT2 inhibitors. Comment on Br J Anaesth 2024; 133: 239-40.","authors":"Sarah Pearcey, Andrew Morris, Roger Knaggs","doi":"10.1016/j.bja.2025.01.011","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.011","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":"143613461","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":"Performance analysis of an artificial intelligence algorithm for detection and localisation of tracheal tube position by chest radiography.","authors":"Alex Novak, Sarim Ather, Abdala T Espinosa Morgado, Akshay Shah, James S Bowness, Giles Maskell, Gordon W Cowell, Douglas Black, Jason L Oke, Hilal Johnson, Claire Bloomfield, Mark Beggs, Fergus Gleeson","doi":"10.1016/j.bja.2025.01.030","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.030","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":"143613459","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":"Shame must change sides: fostering fairness and respect in medicine.","authors":"Mia Gisselbaek, Idit Matot, Joana Berger-Estilita, Sarah Saxena","doi":"10.1016/j.bja.2025.01.036","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.036","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":"143613463","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 analgesic effects of novel fascial plane blocks compared with intrathecal morphine after Caesarean delivery: a systematic review and meta-analysis.","authors":"Nasir Hussain, Richard Brull, Lauren Thaete, Samantha Fuller, Ryan S D'Souza, Yasmeen Mankinen-Abdallah, Michael K Essandoh, Tristan E Weaver, Faraj W Abdallah","doi":"10.1016/j.bja.2025.01.032","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.032","url":null,"abstract":"<p><strong>Background: </strong>Intrathecal morphine is the mainstay for post-Caesarean multimodal analgesia but is associated with important side-effects. Novel ultrasound-guided abdominal wall fascial plane blocks are proposed as intrathecal morphine alternatives, but evidence of effectiveness is conflicting. We compared the analgesic effects of fascial plane blocks with those of intrathecal morphine after Caesarean delivery.</p><p><strong>Methods: </strong>We sought trials comparing the analgesic effects of intrathecal morphine with quadratus lumborum (QL), transversus abdominus plane (TAP), or erector spinae plane (ESP) blocks after Caesarean delivery. The primary outcome was rest pain intensity at 6 h on a visual analogue scale (VAS) ranging from 0 to 10 cm, with 10 cm indicating severe pain. Secondary outcomes included pain at 12 and 24 h; cumulative 24-h opioid consumption in milligrams of oral morphine; times to first analgesic request, ambulation, and breast feeding in hours; lengths of recovery room and hospital stay in hours; incidence of opioid-related side-effects; and block-related complications.</p><p><strong>Results: </strong>Eighteen trials (1525 subjects) were included. TAP block was evaluated in 11 studies, QL block in five, and ESP block in two. Intrathecal morphine was superior to TAP block for pain at 6 and 12 h, with mean differences (Hartung-Knapp-Sidik-Jonkman [HKSJ] 95% confidence interval [CI]) of 1.21 cm (0.42-2.00) (P=0.01, I²=80%) and 1.03 cm (0.05-2.01) (P=0.04, I²=86%), respectively. There were no differences in pain at 6 or 12 h between QL or ESP block compared with intrathecal morphine. Both TAP block and QL block reduced the odds of nausea and vomiting by 0.41 (0.21-0.79) (P=0.01) and 0.33 (0.23-0.48) (P=0.002), respectively, compared with intrathecal morphine. There were no differences in other outcomes. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) certainty of evidence was low across these pooled outcomes.</p><p><strong>Conclusions: </strong>Quadratus lumborum block, rather than erector spinae or transversus abdominus plane blocks, may be a better intrathecal morphine alternative owing to similar post-Caesarean analgesic effects and reduced opioid-related side-effects.</p><p><strong>Systematic review protocol: </strong>CRD42024543371.</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":"143613464","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":"Automated structured data extraction from intraoperative echocardiography reports using large language models.","authors":"Emily J MacKay, Shir Goldfinger, Trevor J Chan, Rachel H Grasfield, Vikram J Eswar, Kelly Li, Quy Cao, Alison M Pouch","doi":"10.1016/j.bja.2025.01.028","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.028","url":null,"abstract":"<p><strong>Background: </strong>Consensus-based large language model (LLM) ensembles might provide an automated solution for extracting structured data from unstructured text in echocardiography reports.</p><p><strong>Methods: </strong>This cross-sectional study utilised 600 intraoperative transoesophageal reports (100 for prompt engineering; 500 for testing) randomly sampled from 7106 adult patients undergoing cardiac surgery at two hospitals within the University of Pennsylvania Healthcare System. Three echocardiographic parameters (left ventricular ejection fraction, right ventricular systolic function, and tricuspid regurgitation) were extracted from both the presurgical and postsurgical sections of the reports. LLM ensembles were generated using five open-source LLMs and four voting strategies: (1) unanimous (five out of five in agreement); (2) supermajority (four or more of five in agreement); (3) majority (three or more of five in agreement); and (4) plurality (two or more of five in agreement). Returned LLM ensemble responses were compared with the reference standard dataset to calculate raw accuracy, consensus accuracy, error rate, and yield.</p><p><strong>Results: </strong>Of the four LLM ensembles, the unanimous LLM ensemble achieved the highest consensus accuracies (99.4% presurgical; 97.9% postsurgical) and the lowest error rates (0.6% presurgical; 2.1% postsurgical) but had the lowest data extraction yields (81.7% presurgical; 80.5% postsurgical) and the lowest raw accuracies (81.2% presurgical; 78.9% postsurgical). In contrast, the plurality LLM ensemble achieved the highest raw accuracies (96.1% presurgical; 93.7% postsurgical) and the highest data extraction yields (99.4% presurgical; 98.9% postsurgical) but had the lowest consensus accuracies (96.7% presurgical; 94.7% postsurgical) and highest error rates (3.3% presurgical; 5.3% postsurgical).</p><p><strong>Conclusions: </strong>A consensus-based LLM ensemble successfully generated structured data from unstructured text contained in intraoperative transoesophageal reports.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555940","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":"Regulation of cerebrovascular resistance below the lower limit of cerebral autoregulation during induced hypotension: an observational study","authors":"Eline Kho ,&nbsp;Rokus E.C. van den Dool ,&nbsp;Sandjiv S. Mahes ,&nbsp;Oskar T. Corsmit ,&nbsp;Alexander P.J. Vlaar ,&nbsp;Dave R. Koolbergen ,&nbsp;Denise P. Veelo ,&nbsp;Nicholaas H. Sperna Weiland ,&nbsp;Rogier V. Immink","doi":"10.1016/j.bja.2024.12.037","DOIUrl":"10.1016/j.bja.2024.12.037","url":null,"abstract":"<div><h3>Background</h3><div>To maintain adequate perfusion, cerebral blood flow (CBF) is preserved by changes in cerebrovascular resistance (CVR) inversely related to fluctuations in mean arterial blood pressure (MAP). It has been hypothesised that during progressive hypotension, a lower limit of cerebral autoregulation (LLCA) is reached beyond which cerebrovascular dilation becomes exhausted and CBF starts to decrease together with BP. We tested this hypothesis by assessing CVR above and below the LLCA.</div></div><div><h3>Methods</h3><div>Radial arterial pressure, thermodilution cardiac output (CO), and mean middle cerebral artery blood velocity (MCAV_mean) were recorded during sustained intraoperative hypotension clinically needed for off-pump aortic root aneurysm surgery. For each participant, the individual LLCA was determined. Systemic vascular resistance (SVR) and CVR were calculated, and changes below and above the LLCA were assessed with a generalised linear effect models.</div></div><div><h3>Results</h3><div>For 50 participants undergoing aortic root surgery who met inclusion criteria, LLCA was located at 58 (12) mm Hg, with a corresponding MCAV_mean of 32 (8) cm s⁻¹ and CO of 5.1 (1.2) L min⁻¹. Above the LLCA, the decline in CVR and SVR were similar, both with 19% per 10 mm Hg decrease in MAP (<em>P</em>&lt;0.001). Below the LLCA, CVR declined at a lower rate (7% per 10 mm Hg), whereas the decrease in SVR was 13% per 10 mm Hg decrease in MAP (both <em>P</em>&lt;0.001).</div></div><div><h3>Conclusions</h3><div>The continuing decline of CVR below the LLCA indicated that brain vasculature is still able to react on changing BP. This implies that LLCA should not be regarded as a fixed point but rather a transitional zone between exhausted and normally functioning autoregulation.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 1009-1017"},"PeriodicalIF":9.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536633","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":"The treat while you wait initiative: a pilot project on turning surgical waiting lists into preparation lists","authors":"Miriam Stephens ,&nbsp;Rachel Mansley ,&nbsp;Megan Crawford ,&nbsp;Emma Murphy","doi":"10.1016/j.bja.2025.01.024","DOIUrl":"10.1016/j.bja.2025.01.024","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 1268-1270"},"PeriodicalIF":9.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531159","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 AI-based nerve segmentation on ultrasound: relevance of standard metrics in the clinical setting.","authors":"Bernard V Delvaux, Olivier Maupain, Thomas Giral, James S Bowness, Luc Mercadal","doi":"10.1016/j.bja.2024.12.040","DOIUrl":"https://doi.org/10.1016/j.bja.2024.12.040","url":null,"abstract":"<p><strong>Background: </strong>In artificial intelligence for ultrasound-guided regional anaesthesia, accurate nerve identification is essential. The technology community typically favours objective metrics of pixel overlap on still-frame images, whereas clinical assessments often use subjective evaluation of cine loops by physician experts. No clinically acceptable threshold of pixel overlap has been defined for nerve segmentation. We investigated the relationship between these approaches and identify thresholds for objective pixel-based metrics when clinical evaluations identify high-quality nerve segmentation.</p><p><strong>Methods: </strong>cNerve™ is a deep learning segmentation tool on GE Healthcare's Venue™ ultrasound systems. It highlights nerves of the interscalene-supraclavicular-level brachial plexus, femoral, and popliteal-level sciatic block regions. Expert anaesthesiologists subjectively rated overall segmentation quality of cNerve™ on ultrasound cine loop sequences using a 1-5 Likert scale (1 = poor; 5 = excellent). Objective assessments of nerve segmentation, using the Intersection over Union and Dice similarity coefficient metrics, were applied to frames from sequences rated 5.</p><p><strong>Results: </strong>A total of 173 still image frames were analysed. The median Intersection over Union for nerves was 0.49, and the median Dice similarity coefficient was 0.65, indicating variable performance based on objective metrics, despite subjective clinical evaluations rating the artificial intelligence-generated nerve segmentation as excellent.</p><p><strong>Conclusions: </strong>Variable objective segmentation metric scores correspond to excellent performance on clinically oriented assessment and lack the context provided by subjective expert evaluations. Further work is needed to establish standardised evaluation criteria that incorporate both objective pixel-based and subjective clinical assessments. Collaboration between clinicians and technologists is needed to develop these evaluation methods for improved clinical applicability.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522594","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":"What's old is new again: opioid and benzodiazepine actions on ventilation, a reminder of the importance of knowing one's drugs","authors":"Konrad Meissner ,&nbsp;Evan D. Kharasch","doi":"10.1016/j.bja.2025.01.014","DOIUrl":"10.1016/j.bja.2025.01.014","url":null,"abstract":"<div><div>Co-administering opioids and benzodiazepines can have deleterious effects on ventilation. However, little is known about the underlying mechanisms leading to hypoventilation. A recent article in the <em>British Journal of Anaesthesia</em> is not just another reminder of the hazards of combining opioids with benzodiazepines or other sedatives, but also applies mechanistic understanding to guide informed practice and future pharmaceutical development.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 903-905"},"PeriodicalIF":9.1,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643784","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 fires during use of high-flow nasal oxygen: a cause for concern","authors":"Craig Lyons ,&nbsp;Malin Jonsson Fagerlund","doi":"10.1016/j.bja.2024.12.021","DOIUrl":"10.1016/j.bja.2024.12.021","url":null,"abstract":"<div><div>The value of high-flow nasal oxygen (HFNO) in anaesthetic practice is well recognised. Its roles are diverse, with the potential to oxygenate patients whether they are breathing or apnoeic, and whether they are awake, sedated, or anaesthetised. HFNO is administered without incident to thousands of patients worldwide on a daily basis. Major complications associated with its use are rare. However, a number of fires have now been reported with laser or diathermy use within or adjacent to the airways of patients receiving HFNO.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 893-897"},"PeriodicalIF":9.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643782","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}