British journal of anaesthesia最新文献

{"title":"Online regional anaesthesia resources: comparison between self-directed online educational material and conventional teaching in acquiring ultrasound-guided regional anaesthesia imaging skills by novice performers.","authors":"Hermann Dos Santos Fernandes, Sharon Peacock, Yehoshua Gleicher, Naveed Siddiqui, Shirley Andrade Santos, Zeev Friedman","doi":"10.1016/j.bja.2025.05.003","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.003","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186621","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":"Corrigendum to 'Defining the role of thoracic spinal anaesthesia in the 21st century: a narrative review' [Br J Anaesth 2023; 130: e56-e65].","authors":"Johannes J le Roux, Koji Wakabayashi, Zainub Jooma","doi":"10.1016/j.bja.2025.04.029","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.029","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181143","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":"Preoperative estimated glomerular filtration rate to predict cardiac events in major noncardiac surgery. Comment on Br J Anaesth 2025; 134: 297-307.","authors":"Anna Mases, Sandra Beltrán de Heredia, Sergi Sabaté","doi":"10.1016/j.bja.2025.04.040","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.040","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186622","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":"Incidence of cognitive errors in difficult airway management: an inference human factors study from the Pediatric Difficult Intubation Registry.","authors":"Martina Bordini, Luca Orsini, Simon Y W Li, Julia Olsen, Mary Lyn Stein, Lina A Sarmiento Argüello, Emily B Hesselink, Angela C Lee, Piedad C Echeverry, Lisa K Lee, Elizabeth M O'Brien, Priti G Dalal, Agnes Hunyady, Simon Whyte, Melissa Brooks-Peterson, Annery G Garcia-Marcinkiewicz, Pete Kovatsis, James Peyton, Britta S Von Ungern-Sternberg, John Fiadjoe, Clyde Matava","doi":"10.1016/j.bja.2025.04.033","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.033","url":null,"abstract":"<p><strong>Background: </strong>Cognitive errors are known contributors to poor decision-making in healthcare. However, their incidence and extent of their contribution to negative outcomes during difficult airway management are unknown. We aimed to identify cognitive errors during paediatric difficult airway management using data from the Pediatric Difficult Intubation (PeDI) registry, to determine patient and clinician factors associated with these errors, and their contribution to complications.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the PeDI registry data including cases with at least three intubation attempts. Cognitive error definitions were adapted to airway management, and predefined clinical endpoints were used to identify cognitive errors. A subanalysis was performed for children weighing <5 kg. Our primary outcome was the overall incidence of cognitive errors. Secondary outcomes included the incidence of specific cognitive error subtypes, associations with patient and clinician factors, and the relationship between cognitive errors and complications.</p><p><strong>Results: </strong>Cognitive errors were identified in 17.4% (487/2801) of cases, with fixation errors being the most common (11.5%), followed by omission bias (5.9%) and overconfidence bias (4.5%). Non-anaesthesiologist clinicians had the highest odds of cognitive errors. The presence of at least one cognitive error was independently associated with a higher risk of complications (adjusted odds ratio, 1.86 [95% confidence interval, 1.53-2.27]; P<0.001), and multiple errors increased the likelihood of severe complications (adjusted odds ratio, 2.48 [95% confidence interval, 1.24-4.94]; P=0.01).</p><p><strong>Conclusions: </strong>Cognitive errors occurred in nearly 20% of paediatric difficult airway encounters and were linked to increased complications. Further research should refine error definitions and develop mitigation strategies to improve outcomes.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186619","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":"Perioperative glycaemic variability in patients with diabetes mellitus undergoing vascular surgery: a service evaluation.","authors":"Alice Emma Ismail, Simon James Howell","doi":"10.1016/j.bja.2025.04.036","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.036","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179531","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":"Drug challenge testing in the investigation of neuromuscular blocking agent hypersensitivity. Comment on Br J Anaesth 2025; 134: 641-5.","authors":"Siraj A Misbah, Rachel C Pollard, Joanne Miller","doi":"10.1016/j.bja.2025.04.041","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.041","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181337","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 number of central nervous system-driven symptoms predicts subsequent chronic primary pain. Comment on Br J Anaesth 2025; 134: 772-82.","authors":"Liqiu Kou, Jixuan Wu, Zili Zhang, Lei Zhang","doi":"10.1016/j.bja.2025.04.035","DOIUrl":"https://doi.org/10.1016/j.bja.2025.04.035","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180844","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":"Orexin signalling in the nucleus accumbens promotes arousal from isoflurane anaesthesia and restores communication between the nucleus accumbens and frontal cortex.","authors":"Jia Huo, Huiming Li, Dan Wang, Sa Wang, Xinxin Zhang, Hailong Dong, Jiannan Li","doi":"10.1016/j.bja.2025.03.042","DOIUrl":"https://doi.org/10.1016/j.bja.2025.03.042","url":null,"abstract":"<p><strong>Background: </strong>Orexin can induce arousal from general anaesthesia; however, the underlying mechanisms are not fully understood. Nucleus accumbens (NAc), a downstream target of orexinergic neurones, plays a role in regulating consciousness. We aimed to clarify whether and how the NAc mediates the arousal effects of orexin.</p><p><strong>Methods: </strong>Fibre photometry was used to track changes of orexinergic afferent activity during isoflurane anaesthesia and arousal from anaesthesia. Optogenetics was used to study the effects of orexinergic afferents to the NAc. Neuropharmacology approaches were used to assess receptor mechanisms. Optogenetics and in vivo electrophysiology were used to assess the influence of orexin on NAc neuronal firing and communication between the NAc and the frontal cortex.</p><p><strong>Results: </strong>Orexinergic afferents in the NAc were wake-active during isoflurane anaesthesia and the arousal process. Optogenetic activation of orexinergic terminals in the NAc prolonged the time to induction, shortened time to emergence, and reduced the burst suppression ratio (from 67.4% [2.5%] to 14.5% [1.0%]; n=6, P<0.001) during 1.4 vol% isoflurane anaesthesia. Microinjection of orexin-A into the NAc promoted arousal from isoflurane anaesthesia. Orexin-1 receptors were primarily expressed in NAc D1 receptor-positive (D1R⁺) neurones. Optogenetic activation of orexinergic terminals increased D1R⁺ neuronal firing (from 0.77 [0.54] spikes s^-1 to 2.53 [0.46] spikes s^-1; n=24, P=0.0194) and restored NAc-to-frontal cortex coherence during isoflurane anaesthesia.</p><p><strong>Conclusions: </strong>Orexin restores communication between the NAc and frontal cortex by upregulating the activity of D1R⁺ neurones, thereby promoting arousal from isoflurane anaesthesia.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181266","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":"Directed acyclic graphs to minimise bias and optimise causal inference in SNAP-3: an observational cohort study of frailty, multimorbidity, and delirium in older surgical patients","authors":"Claire J. Swarbrick ,&nbsp;Helen A. Blake ,&nbsp;Peter Martin ,&nbsp;Judith S.L. Partridge ,&nbsp;Iain K. Moppett","doi":"10.1016/j.bja.2025.04.027","DOIUrl":"10.1016/j.bja.2025.04.027","url":null,"abstract":"<div><h3>Background</h3><div>The 3rd Sprint National Anaesthesia Project (SNAP-3) aims to describe the impact of frailty, multimorbidity, and delirium, and their management, on outcomes after surgery within the older surgical population. Causal diagrams, such as directed acyclic graphs (DAGs), are a useful tool for visually representing relationships between variables and for clarifying the causal assumptions underlying a chosen statistical model.</div></div><div><h3>Methods</h3><div>A description of how the SNAP-3 cohort study's DAGs were developed is provided. DAGs have been created for the exposure–outcome relationships between frailty, multimorbidity, and delirium (as an exposure) with postoperative outcomes (length of hospital stay, delirium, morbidity, mortality). DAGs were created following the approach of ‘Evidence synthesis for constructing directed acyclic graphs’, and revised after independent clinical expert input.</div></div><div><h3>Results</h3><div>DAGs provide visual representations of assumptions made, and provide an objective approach to appropriate statistical adjustments. Key nodes within all the DAGs included age, dementia, genetic predisposition, hearing and visual impairment, length of stay, malignancy, operative severity, polypharmacy, postoperative perioperative medicine service, preoperative clinic review, sex, social deprivation, urgency, with delirium, frailty, multimorbidity, interaction, morbidity acting as exposures, or outcomes in certain DAGs.</div></div><div><h3>Conclusions</h3><div>DAGs provide a transparent framework for statistical decision-making in observational research. We provide an overview of DAGs using the SNAP-3 DAGs as examples to explain fundamental concepts for developing and using causal diagrams. This overview acknowledges the complexities of exploring clinical relationships and the assumptions that are necessary, providing an opportunity for critique of the relationships described and refinements for future studies.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"135 1","pages":"Pages 177-187"},"PeriodicalIF":9.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156683","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 outcomes in older patients living with frailty and multimorbidity in the UK: SNAP-3, a snapshot observational study","authors":"Claire J. Swarbrick ,&nbsp;SNAP-3 collaborators ,&nbsp;Karen Williams ,&nbsp;Bob Evans ,&nbsp;Helen A. Blake ,&nbsp;Thomas Poulton ,&nbsp;Samuel Nava ,&nbsp;Akshay Shah ,&nbsp;Peter Martin ,&nbsp;Judith S.L. Partridge ,&nbsp;Iain K. Moppett","doi":"10.1016/j.bja.2025.04.026","DOIUrl":"10.1016/j.bja.2025.04.026","url":null,"abstract":"<div><h3>Background</h3><div>Older surgical patients experience longer hospital stays and a higher risk of morbidity and mortality than their younger counterparts. Frailty (19.6% of cohort) and multimorbidity (63.1% of cohort) increase these risks. The 3^rd Sprint National Anaesthesia Project (SNAP-3) describes the impact of frailty and multimorbidity on postoperative outcomes.</div></div><div><h3>Methods</h3><div>We conducted a prospective observational cohort study over 5 days in 2022 aiming to recruit all UK patients aged ≥60 yr undergoing surgery (excluding minor procedures). Data included patient characteristics, clinical variables, Clinical Frailty Scale (CFS), multimorbidity (<em>two or more comorbidities)</em>, length of stay (LOS), postoperative delirium, morbidity, and mortality. Quantile regression and mixed effects logistic regression were used to analyse relationships.</div></div><div><h3>Results</h3><div>We recruited 7129 patients from 214 hospitals. Increasing frailty was associated with longer LOS, higher odds of delirium, morbidity, and mortality ≥1 yr, with a clear increase noted from CFS of 4 (19.0% of cohort). Amongst those without multimorbidity, individuals with CFS score of 4 had longer admissions than non-frail individuals (median LOS 0.75 days longer, 95% confidence interval [CI] 0.34–1.16), increasing to 2.69 days longer for CFS 5 (95% CI 0.76–4.62). Multimorbidity increased the odds of postoperative morbidity by 46% (adjusted odds ratio 1.46, 95% CI 1.24–1.73), but there was no evidence for multimorbidity impacting LOS, delirium, or mortality.</div></div><div><h3>Conclusions</h3><div>SNAP-3 highlights the impact of frailty on postoperative outcomes. Multimorbidity had less impact, with an effect on postoperative morbidity the only one to have strong statistical evidence. The impact of these conditions must be discussed with older patients considering surgical intervention.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"135 1","pages":"Pages 166-176"},"PeriodicalIF":9.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156641","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}