British journal of anaesthesia最新文献

{"title":"Combined approach to the young infant airway","authors":"Karen Wouters , Benjamin J. Blaise","doi":"10.1016/j.bja.2024.09.012","DOIUrl":"10.1016/j.bja.2024.09.012","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1335-1337"},"PeriodicalIF":9.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449328","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 spinal versus general anaesthesia on perioperative obstructive sleep apnoea severity in patients undergoing hip arthroplasty. Comment on Br J Anaesth 2024; 133: 416–423","authors":"Zhongpeng Sun, Dong Yang","doi":"10.1016/j.bja.2024.09.018","DOIUrl":"10.1016/j.bja.2024.09.018","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Page 1332"},"PeriodicalIF":9.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449329","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 perioperative blood transfusion on preoperative haemoglobin levels as a risk factor for long-term outcomes in patients undergoing major noncardiac surgery: a prospective multicentre observational study","authors":"Fraser J.D. Morris ,&nbsp;Rasmus Åhman ,&nbsp;Alison Craswell ,&nbsp;Helén Didriksson ,&nbsp;Carina Jonsson ,&nbsp;Manda Gisselgård ,&nbsp;Henrik A. Andersson ,&nbsp;Yoke-Lin Fung ,&nbsp;Michelle S. Chew","doi":"10.1016/j.bja.2024.09.007","DOIUrl":"10.1016/j.bja.2024.09.007","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative anaemia and red blood cell (RBC) transfusions are associated with poorer clinical outcomes. It is unknown whether perioperative RBC transfusions mediate the relationship between preoperative haemoglobin levels and postoperative outcomes.</div></div><div><h3>Methods</h3><div>This was a prospective observational study among patients aged ≥50 yr undergoing elective major noncardiac surgery from four Swedish hospitals. The co-primary outcomes were 1-yr major adverse cardiovascular and cerebrovascular events (MACCEs) and all-cause mortality. The secondary outcome was a composite of 30-day mortality, MACCEs, acute kidney injury (AKI), pulmonary embolism, anastomotic leak, and postoperative infection. Mediation analyses were conducted with preoperative haemoglobin as the exposure and RBC transfusion as a mediator.</div></div><div><h3>Results</h3><div>Among 1060 patients (mean age 70 [SD 9] yr; 472 [45%] women), 171 patients (16.1%) developed 1-yr MACCEs, and 105 patients (9.9%) died within 1 yr. Preoperative haemoglobin levels were significantly associated with both 1-yr MACCEs (<em>b</em>=–0.015, <em>P</em>=0.041) and all-cause mortality (<em>b</em>=–0.028, <em>P</em>&lt;0.001). Volume of RBC transfusion was not directly associated with the outcomes and did not mediate the relationship between preoperative haemoglobin levels and 1-yr MACCEs (<em>b=</em>–0.001<em>, P=</em>0.451) or all-cause mortality (<em>b</em>=–0.002, <em>P</em>=0.293). For the secondary outcome, RBC transfusions had a significant mediating effect between preoperative haemoglobin and the composite 30-day outcome; however, no direct association was observed (<em>b</em>=0.006, <em>P</em>=0.554).</div></div><div><h3>Conclusions</h3><div>Preoperative haemoglobin levels were significantly associated with 1-yr MACCEs and all-cause mortality. This effect was not mediated by perioperative RBC transfusions. Further research is needed to confirm these findings.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1183-1191"},"PeriodicalIF":9.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449326","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":"Choice of supraglottic airway devices: a network meta-analysis of randomised controlled trials","authors":"Muthuraj Kanakaraj ,&nbsp;Adithya D. Bhat ,&nbsp;Narinder P. Singh ,&nbsp;Sennaraj Balasubramanian ,&nbsp;Abhay Tyagi ,&nbsp;Rohan Aathreya ,&nbsp;Preet M. Singh","doi":"10.1016/j.bja.2024.09.001","DOIUrl":"10.1016/j.bja.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><div>Over the last two decades, significant research interest has led to the development of a wide variety of supraglottic airways (SGAs) for anaesthesia providers to choose from.</div></div><div><h3>Methods</h3><div>In this network meta-analysis, we analysed 111 studies, enrolling 12 045 patients undergoing airway management with 29 SGAs. We targeted outcomes that contribute to clinicians' choice of one SGA over another. The primary outcome was the incidence of postoperative sore throat (POST). Secondary outcomes were first-attempt insertion success, bleeding complications, and oropharyngeal leak pressure (OLP). Based on credible intervals, we created a ‘rank order’ to guide decision-making for clinicians.</div></div><div><h3>Results</h3><div>The highest-ranking devices based on credible intervals for POST, bleeding complications, first-attempt insertion success, and OLP were LMA Ambu, Jcerity Endoscoper, LMA Blockbuster, and LMA Baska Mask, respectively. Air-Q and i-gel ranked favourably across multiple outcomes, with i-gel being the only device to rank within the top six SGAs for POST, bleeding, and first-attempt success despite ranking poorly for OLP.</div></div><div><h3>Conclusions</h3><div>Our data support the use of LMA-Ambu, Jcerity-Endoscoper, Air-Q, and i-gel when considering patient-centred outcomes. Clinician familiarity with these devices and their continued expansion into anaesthetic practice will have important implications on the perioperative patient experience.</div></div><div><h3>Systematic review protocol</h3><div>PROSPERO (CRD42022383136).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1284-1306"},"PeriodicalIF":9.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443691","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":"Sugammadex hypersensitivity: a multicentre retrospective analysis of a large Australian cohort.","authors":"Danielle Crimmins,Helen Crilly,Christian van Nieuwenhuysen,Kate Ziser,Syeda Zahir,Gemma Todd,Leanne Ryan,David Heyworth-Smith,Liam Balkin,Annabelle Harrocks,Anton W G Booth","doi":"10.1016/j.bja.2024.07.042","DOIUrl":"https://doi.org/10.1016/j.bja.2024.07.042","url":null,"abstract":"BACKGROUNDSugammadex hypersensitivity is an emerging safety concern. We aimed to describe the clinical and diagnostic features of perioperative hypersensitivity to sugammadex, and secondarily to provide an estimate of perioperative sugammadex hypersensitivity incidence in Australia.METHODSWe retrospectively analysed cases of hypersensitivity to sugammadex diagnosed by positive intradermal or skin prick testing at six perioperative allergy clinics in Australia. We included all grades of hypersensitivity and compared life-threatening with non-life-threatening presentations. Incidence of hypersensitivity events was estimated relative to the estimated number of sugammadex administrations across two health services between January 1, 2010 and June 30, 2023.RESULTSThirty cases were included (15 life-threatening and 15 non-life-threatening). The most common clinical signs were hypotension (n=25, 83.3%) and flushing/erythema (n=21, 70%). The median time to recognition of hypersensitivity was 5 (interquartile range 2-7.5) min. Five cases were recognised 10-30 min after administration. Serum tryptase was measured in 28 (93.3%) patients. Tryptase was positive in 15 (100%) life-threatening cases and nine (69.2%) non-life-threatening cases. The estimated incidence of sugammadex hypersensitivity was 0.004% (95% confidence interval 0.002-0.008%).CONCLUSIONSSugammadex hypersensitivity presents similarly to other causes of perioperative hypersensitivity, however recognition can be delayed. The combination of positive serum tryptase and positive skin tests suggests an IgE-mediated mechanism of hypersensitivity. The estimated incidence of sugammadex hypersensitivity in Australia is lower than earlier reports.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"104 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443693","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":"Associate Editorial Board","authors":"","doi":"10.1016/S0007-0912(24)00581-6","DOIUrl":"10.1016/S0007-0912(24)00581-6","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 5","pages":"Page ii"},"PeriodicalIF":9.1,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418761","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":"Human dorsal root ganglia are either preserved or completely lost after deafferentation by brachial plexus injury","authors":"Annemarie Sodmann ,&nbsp;Johannes Degenbeck ,&nbsp;Annemarie Aue ,&nbsp;Magnus Schindehütte ,&nbsp;Felicitas Schlott ,&nbsp;Panagiota Arampatzi ,&nbsp;Thorsten Bischler ,&nbsp;Max Schneider ,&nbsp;Alexander Brack ,&nbsp;Camelia M. Monoranu ,&nbsp;Tom Gräfenhan ,&nbsp;Michael Bohnert ,&nbsp;Mirko Pham ,&nbsp;Gregor Antoniadis ,&nbsp;Robert Blum ,&nbsp;Heike L. Rittner","doi":"10.1016/j.bja.2024.09.004","DOIUrl":"10.1016/j.bja.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Plexus injury results in lifelong suffering from flaccid paralysis, sensory loss, and intractable pain. For this clinical problem, regenerative medicine concepts set high expectations. However, it is largely unknown how dorsal root ganglia (DRG) are affected by accidental deafferentation.</div></div><div><h3>Methods</h3><div>Here, we phenotyped DRG of a clinically and MRI-characterised cohort of 13 patients with plexus injury. Avulsed DRG were collected during reconstructive nerve surgery. For control, we used DRG from forensic autopsy. The cellular composition of the DRG was analysed in histopathological slices with multicolour high-resolution immunohistochemistry, tile microscopy, and deep-learning-based bioimage analysis. We then sequenced the bulk RNA of corresponding DRG slices.</div></div><div><h3>Results</h3><div>In about half of the patients we found loss of the typical DRG units consisting of neurones and satellite glial cells. The DRG cells were replaced by mesodermal/connective tissue. In the remaining patients, the cellular units were well preserved. Preoperative plexus MRI neurography was not able to distinguish the two types. Patients with ‘neuronal preservation’ had less maximum pain than patients with ‘neuronal loss’. Arm function improved after nerve reconstruction, but severe pain persisted. Transcriptome analysis of preserved DRGs revealed expression of subtype-specific sensory neurone marker genes, but downregulation of neuronal attributes. Furthermore, they showed signs of ongoing inflammation and connective tissue remodelling.</div></div><div><h3>Conclusions</h3><div>Patients with plexus injury separate into two groups with either neuronal preservation or neuronal loss. The former could benefit from anti-inflammatory therapy. For the latter, studies should explore mechanisms of neuronal loss especially for regenerative approaches.</div></div><div><h3>Clinical trial registration</h3><div>DRKS00017266.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1250-1262"},"PeriodicalIF":9.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406148","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":"Evaluating the role of ChatGPT in perioperative pain management versus procedure-specific postoperative pain management (PROSPECT) recommendations","authors":"Dan Mija ,&nbsp;Henrik Kehlet ,&nbsp;Eric B. Rosero ,&nbsp;Girish P. Joshi","doi":"10.1016/j.bja.2024.09.010","DOIUrl":"10.1016/j.bja.2024.09.010","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1318-1320"},"PeriodicalIF":9.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406147","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":"Nitrous Oxide Manifold and Other Reduction of Emissions (NoMoreGas): a multicentre observational study evaluating pre-utilisation loss of nitrous oxide","authors":"Megan A.F. Thomas ,&nbsp;Christopher J. Ward ,&nbsp;Matthew E. Sinnott ,&nbsp;Thomas W. Davies ,&nbsp;Jan M. Wong ,&nbsp;Joanna K.L. Wong ,&nbsp;Gudrun Kunst ,&nbsp;Sibtain Anwar","doi":"10.1016/j.bja.2024.08.027","DOIUrl":"10.1016/j.bja.2024.08.027","url":null,"abstract":"<div><h3>Background</h3><div>Nitrous oxide (N₂O) is a potent greenhouse gas that contributes significantly to the healthcare sector's carbon footprint. Pre-utilisation losses of N₂O are up to 95%. Decommissioning manifolds can reduce these losses.</div></div><div><h3>Methods</h3><div>Hospitals in our Greater London research network with at least one active N₂O manifold were included in the Nitrous Oxide Manifold and Other Reduction of Emissions (NoMoreGas) study. N₂O utilisation data were collected continuously over 5 days and extrapolated over a year, in addition to collecting procurement records from the preceding financial year. The primary outcome was the discrepancy between clinically utilised N₂O and the quantity procured by hospitals, referred to as the ‘N₂O gap’. Secondary outcomes included anaesthetists' self-reported utilisation of N₂O and their opinions on manifold decommissioning.</div></div><div><h3>Results</h3><div>Eighteen of 53 hospitals were included. In total, 6 487 200 L of N₂O were procured with a median (IQR) of 304 200 (183 600–473 400) L per site. During the 5-day data collection period, sites utilised a median (IQR) of 501 (42–1409) L of N₂O. Extrapolating over a year resulted in a median (IQR) annual utilisation of 36 573 (3066–102 857) L per site and a total of 1 175 348 L. This represented an estimated 18% of the N₂O procured, suggesting pre-utilisation losses of 5 311 852 L. Among surveyed anaesthetists, 70% (<em>n</em>=309) reported using N₂O within the previous year, with one-third (<em>n</em>=97) using it once a week or more. There was widespread support for decommissioning manifolds.</div></div><div><h3>Conclusions</h3><div>Consistent with other reports, the data demonstrate a substantial discrepancy between the quantities of N₂O procured and utilised clinically, indicative of significant pre-utilisation losses. Our findings support the decommissioning of N₂O manifolds for environmental and economic benefits.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1427-1434"},"PeriodicalIF":9.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399375","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":"Postoperative pain and neurocognitive outcomes after noncardiac surgery: a systematic review and dose-response meta-analysis.","authors":"Maram Khaled, Denise Sabac, Matthew Fuda, Chantal Koubaesh, Joseph Gallab, Marianna Qu, Giuliana Lo Bianco, Harsha Shanthanna, James Paul, Lehana Thabane, Maura Marcucci","doi":"10.1016/j.bja.2024.08.032","DOIUrl":"10.1016/j.bja.2024.08.032","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common after noncardiac surgery. Postsurgical pain is frequent and can persist as chronic postsurgical pain (CPSP). The association between postsurgical pain and POD or POCD is biologically plausible. We conducted this systematic review to evaluate the association between acute postsurgical pain or CPSP and POD or POCD in adults undergoing noncardiac surgery.</p><p><strong>Methods: </strong>We followed Preferred Reporting Items for Systematic Review and Meta-Analyses. We searched MEDLINE, EMBASE, Cochrane, CINAHL and PSYCHINFO up to May 2023. We included cohort, case-control, and cross-sectional studies of any language. Pairs of reviewers independently screened studies, extracted data and assessed the risk of bias using the CLARITY tool and the Joanna Briggs Institute checklist. We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. Where possible, we conducted random-effects meta-analyses to summarise our findings.</p><p><strong>Results: </strong>We analysed 30 studies (>9000 participants) that assessed the association between acute postoperative pain and POD/POCD. Dose-response meta-analyses found that postoperative pain intensity was associated with occurrence of POD (adjusted relative risk [aRR]/unit of pain intensity: 1.26; 95% confidence interval [CI]: 1.17-1.35; low certainty of evidence) and risk of developing POD (aRR/unit of pain intensity: 1.18; 95% CI: 1.08-1.30; low certainty of evidence). There was very low certainty of evidence regarding the association between postoperative pain and POCD. No studies assessed the association between CPSP and POCD. Residual confounding and substantial methodological variability between studies prevented pooling data from many of the included studies and lowered certainty of evidence.</p><p><strong>Conclusions: </strong>Dose-response meta-analyses found that postoperative pain intensity was associated with occurrence of and risk of developing POD.</p><p><strong>Systematic review protocol: </strong>PROSPERO-CRD42021192105.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406149","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}