British journal of anaesthesia最新文献

{"title":"Videolaryngoscopy versus direct laryngoscopy for teaching direct laryngoscopy skills: a systematic review and meta-analysis.","authors":"Samuel G S Gunning,David Urwin,Tim M Cook,Jan Hansel","doi":"10.1016/j.bja.2025.05.034","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.034","url":null,"abstract":"BACKGROUNDIt is established that videolaryngoscopy improves intubation success rates and views compared with direct laryngoscopy. However, concerns regarding default adoption of videolaryngoscopy include a negative impact on skill acquisition for direct laryngoscopy. This study aimed to assess the utility of Macintosh videolaryngoscopy for teaching direct laryngoscopy.METHODSWe systematically searched MEDLINE and Embase databases for relevant randomised controlled trials, crossover, and observational studies. Two authors screened abstracts and full-text manuscripts for inclusion before extracting and cross-checking data. Critical outcomes included first-attempt success, overall success, and time to intubation, with trainee confidence and ease of guidance assessed as secondary outcomes. Meta-analysis was performed using random-effects models. Risk of bias was assessed using the Cochrane RoB-2 tool.RESULTSWe identified 21 relevant studies, 10 of which assessed Macintosh videolaryngoscopy for teaching direct laryngoscopy. For first-attempt success, videolaryngoscopy outperformed direct laryngoscopy with a risk ratio (RR) of 1.16 ([95% confidence interval 1.07-1.25]; five studies; I2= 17%). Overall intubation success did not differ significantly between videolaryngoscopy and direct laryngoscopy training (RR 1.05 [0.99-1.12]; seven studies; I2=27%) and neither did time to successful intubation (mean difference -7.4 s [-15.8 s to 0.9 s]; seven studies; I2=73%). All but two studies raised concern for risk of bias in at least one domain. Limitations included small sample sizes and heterogeneous data presentation. Sensitivity analyses favoured videolaryngoscopy.CONCLUSIONSVideolaryngoscopy appears to be an effective tool for teaching direct laryngoscopy. Its role as a preferred teaching tool should be considered.SYSTEMATIC REVIEW PROTOCOLPROSPERO (CRD42023493366).","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"34 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144594221","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":"Hydroxocobalamin for vasoplegia in cardiac surgery: a retrospective cohort analysis.","authors":"Luai Zakaria,Karan Shah,Dongsheng Yang,Marta Kelava,Haytham Elgharably,Ashish K Khanna,Sanchit Ahuja,Benjamin Hohlfelder,Andrej Alfirevic,Andra E Duncan,Nikolaos J Skubas,Daniel I Sessler","doi":"10.1016/j.bja.2025.05.026","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.026","url":null,"abstract":"BACKGROUNDVasoplegia during cardiac surgery is common and associated with perioperative mortality. Hydroxocobalamin is a catecholamine-sparing approach for treating vasoplegia. However, there is currently limited evidence to inform its use.METHODSWe conducted a single-centre retrospective propensity-matched cohort study of patients who developed vasoplegia after cardiopulmonary bypass. Our primary outcome was vasopressor requirement, expressed as norepinephrine equivalents (NEE), at 1, 4, 24, and 48 h after treatment. Our secondary outcome was a collapsed composite of in-hospital complications comprising stroke, sternal wound infection, mesenteric ischaemia, renal failure, and death.RESULTSWe identified 2727 (11%) patients with vasoplegia from 2018 to 2024. The final analysis cohort included 229 matched pairs. Hydroxocobalamin administration was associated with a significant reduction in median NEE infusion rates of -0.04 (95% confidence interval [CI]: -0.07 to -0.02; P=0.008) μg kg-1 min-1 at 1 h, -0.05 (95% CI: -0.07 to -0.02; P<0.001) μg kg-1 min-1 at 4 h, and -0.04 (95% CI: -0.06 to -0.02; P=0.004) μg kg-1 min-1 at 24 h, but not at 48 h, -0.02 (95% CI: -0.05 to 0.0; P=0.220) μg kg-1 min-1. Over the initial 24 h, hydroxocobalamin reduced NEE by 14% compared with the reference group. The risk of in-hospital complications was similar in each group (odds ratio: 1.06; 95% CI: 0.74-1.54; P=0.745).CONCLUSIONSHydroxocobalamin administration was associated with reduced vasopressor requirement over 24 h, but not thereafter. Robust trials are needed to determine whether this relationship is causal, and whether a reduction in vasopressor use improves substantive clinical outcomes.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"4 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144594220","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":"Orexinergic projections to substantia innominata mediate arousal and analgesia.","authors":"Xuaner Xiang, Fei Wang, Chao Chen, Zhonghui Guan, Wei Zhou","doi":"10.1016/j.bja.2025.05.021","DOIUrl":"10.1016/j.bja.2025.05.021","url":null,"abstract":"<p><strong>Background: </strong>Understanding neural circuits involved in anaesthesia is crucial for improving its safety and efficacy. Lateral hypothalamic area orexinergic neurones (LHA^OX), projecting broadly, are essential in regulating arousal and pain. However, the precise targets remain unclear. Here we investigated the orexin projections to the substantia innominata (SI).</p><p><strong>Methods: </strong>Combining optogenetics, fibre photometry, electroencephalography, and electromyography allowed us to manipulate orexin activities while simultaneously recording local ligand release and global cortical activities during isoflurane anaesthesia. Brain slice electrophysiology revealed the synaptic connections in SI, while RNAscope was used to examine the distribution of orexin receptors and downstream neuronal types.</p><p><strong>Results: </strong>Presynaptic vesicles were identified in the orexin-releasing axon terminals in SI, where 49.2% of cells expressed orexin receptor-2 (OX2R) and 6.8% expressed orexin receptor-1 (OX1R). Orexin release in SI was reversibly suppressed by isoflurane. Optogenetic activation of the LHA^OX→SI circuit increased orexin release and promoted arousal from various anaesthesia stages, including during isoflurane 0.75 vol% (P<0.0001), prolongation of isoflurane 3 vol% induction (P=0.0033), and acceleration of emergence from isoflurane 2 vol% (P<0.0001). Furthermore, activating this circuit induced analgesia to both thermal (P<0.0001) and inflammatory (P<0.0001) pain. Patch-clamp recordings revealed that optogenetic activation of orexin terminals in SI elicited excitatory postsynaptic currents, which were blocked by an OX2R antagonist. The SI contains more GABAergic (28.2%) and glutamatergic (12.0%) neurones than cholinergic neurones (4.1%), all of which expressed OX2R.</p><p><strong>Conclusions: </strong>Hypothalamic area orexinergic neurones innervate substantia innominata neurones to regulate both arousal and pain predominantly through orexin receptor-2.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599498","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":"Analysis of four rapid infusion systems for heating fluids at high flow rates: an in vitro study.","authors":"Michael Eichinger,Alexander Pichler,Michael Eichlseder,Sonja Oehner,Nikolaus Schreiber,Hani Essber,David West,Lioba Heuschneider,Philipp Zoidl,Thomas Wagner","doi":"10.1016/j.bja.2025.05.045","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.045","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"109 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586674","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":"Differential reasoning and chain-of-thought processes in Deepseek-R1 and Open AI o3-mini-high for determining American Society of Anesthesiologists physical status.","authors":"Yu He Ke,Yun Hao Leong,Liyuan Jin,Kabilan Elangovan,Hairil Rizal Abdullah,Alex Tiong Heng Sia,Jasmine Chiat Ling Ong,Nigam H Shah,Tien Yin Wong,Daniel Shu Wei Ting","doi":"10.1016/j.bja.2025.05.044","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.044","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"3 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586675","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 misunderstood P-value: why statistical significance is not enough in clinical practice. Comment on Br J Anaesth 2025; 134: 909-13.","authors":"Alice Bottussi,Samuele Bugo,Jacopo D'Andria Ursoleo,Viviana Teresa Agosta,Fabrizio Monaco","doi":"10.1016/j.bja.2025.06.009","DOIUrl":"https://doi.org/10.1016/j.bja.2025.06.009","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"37 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586673","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":"Effects of ketamine on postoperative cognition: a scoping review.","authors":"Connor T A Brenna,Xuan W He,Daheng Liu,Lilia Kaustov,Stephen Choi,Beverley A Orser","doi":"10.1016/j.bja.2025.05.035","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.035","url":null,"abstract":"Postoperative delirium and other forms of perioperative neurocognitive deficits occur commonly in older adult patients. Ketamine, administered either before or during general anaesthesia, may have cognitive-sparing properties owing to its ability to reduce neuroinflammation, increase neurotrophin levels, or allow reductions in the doses of other general anaesthetic drugs. However, the efficacy of ketamine in preventing perioperative neurocognitive disorders remains highly controversial. This scoping review summarises clinical studies that examined the cognitive-sparing properties of ketamine in adult surgical patients. Clinical trials and retrospective cohort analyses that assessed cognition in adult patients after treatment with racemic (R,S) ketamine, esketamine, or arketamine were identified through a systematic search of the Embase and Embase Classic databases (from 1947 to 2025). Overall, we identified 58 studies involving 6830 patients. Most studies (n=31) evaluated postoperative delirium and, of these, most used a derivative of the Confusion Assessment Method as the primary measurement tool (81%). Thirty-nine studies evaluated other types of perioperative neurocognitive disorders; of these, 24 (62%) used the Mini Mental State Examination and six (15%) used the Montreal Cognitive Assessment. Ketamine produced no cognitive benefits in 35 of the 58 studies (60%), whereas 23 studies (40%) reported a reduced incidence or duration of perioperative neurocognitive disorders, or both. There were no clear trends in terms of the doses, enantiomeric formulations, or timing of ketamine administration associated with favourable cognitive outcomes. However, ketamine studies that evaluated cognition at only early postoperative timepoints were more likely to report no cognitive benefit. Most trials were underpowered to detect changes in cognitive endpoints, and study populations and methods were too heterogeneous to support meaningful meta-analyses. Although the current results summarised in this extensive review are inconsistent, the data nevertheless support the need for larger, well-designed trials to determine whether subgroups of patients that undergo specific types of surgeries might benefit from ketamine. Recommendations regarding the direction of future research are proposed.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"21 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586462","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":"Training and assessment of skills in neuraxial space access: a scoping review of educational approaches to lumbar puncture, epidural anaesthesia, and spinal anaesthesia.","authors":"Martine Siw Nielsen,Frederik Veitland Ilkjær,Anders Morten Grejs,Anders Bo Nielsen,Lars Konge,Anne Craveiro Brøchner","doi":"10.1016/j.bja.2025.06.008","DOIUrl":"https://doi.org/10.1016/j.bja.2025.06.008","url":null,"abstract":"BACKGROUNDNeuraxial space access, including lumbar puncture, spinal anaesthesia, and epidural anaesthesia, is important in clinical practise for diagnostics and anaesthesia. Despite frequent use, standardised educational recommendations for training and assessing proficiency in these procedures are not well-integrated. The following research question was formulated: what is known from published literature to guide future educational recommendations for training and skills assessment of neuraxial space access with and without the use of ultrasound?METHODSOn May 7, 2024, searches were performed in the Cochrane Library, MEDLINE (Ovid), Scopus, PubMed, CINAHL (EBSCO), and EMBASE (Ovid). Studies were eligible if they involved physicians, medical students, or nurses and focused on training or assessment of neuraxial space access skills. No comparator was required, and all study designs were included if outcomes could be assessed using Kirkpatrick framework. There were no restrictions on language or publication date. Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).RESULTSThe review included 99 studies, and overall, 28 (28%) of the included studies were of low quality with a MERSQI score <9, whereas 22 (22%) were of high quality with a MERSQI score of ≥14. The designs were primarily cohort studies (68%) and RCTs (24%). Specialities represented were mainly anaesthesia (22%) and paediatrics (17%), but many were not reported (30%). Training modalities varied, predominantly using low-fidelity manikins (55%). Simulation-based methods enhanced procedural confidence and technical skills.CONCLUSIONSStudies on education in neuraxial space access show substantial variation in educational approaches and assessment. Consistent findings indicate that simulation-based training enhances outcomes across multiple Kirkpatrick levels, although the studies generally have low methodological quality. Further high-quality research is needed, especially linking training and assessment to patient outcomes.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"33 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586692","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":"EhabFaragLoranMounir-SolimanBrown’s Atlas of Regional Anesthesia(editors), 7th edn2024Published by Elsevier361 pp. Price $186.99. ISBN 9780443112218","authors":"Shelby Badani, Tiffany Tedore","doi":"10.1016/j.bja.2025.06.007","DOIUrl":"https://doi.org/10.1016/j.bja.2025.06.007","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"23 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621797","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":"Quality of patient-centred recovery trajectories after different types of surgery: a prospective cohort study","authors":"Paul S. Myles, Belinda Phillips, Sarah Robertshaw, Hazel Haughney, Timothy T. Houle, Rebecca Rowland, Damian Johnson, Sophie Wallace","doi":"10.1016/j.bja.2025.05.032","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.032","url":null,"abstract":"We sought to measure patient recovery trajectory up to 90 days after surgery using both the 15-item quality of recovery score (QoR-15) (range 0–150) and the number of days alive and at home up to 30 days after surgery (DAH<ce:inf loc=\"post\">30</ce:inf>).","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"16 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565682","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}