British journal of anaesthesia最新文献

{"title":"Acute effects of esketamine on hypoxic ventilatory response, haemodynamics, and brain function in healthy volunteers","authors":"Simone C. Jansen ,&nbsp;Monique van Velzen ,&nbsp;Elise Sarton ,&nbsp;Albert Dahan ,&nbsp;Marieke Niesters ,&nbsp;Rutger van der Schrier","doi":"10.1016/j.bja.2024.08.040","DOIUrl":"10.1016/j.bja.2024.08.040","url":null,"abstract":"<div><h3>Background</h3><div>The acute hypoxic ventilatory response is a critical chemoreflex originating at the carotid bodies. This study investigates the impact of low-dose i.v. esketamine on the ventilatory response to 20 min of isocapnic hypoxia to test the hypothesis that esketamine does not affect hypoxic ventilation.</div></div><div><h3>Methods</h3><div>In this open-label study, 18 healthy subjects received a 3-h escalating i.v. infusion of esketamine, totalling 1.0 mg kg⁻¹. Before the esketamine infusion (control condition) and during the last 30 min of infusion, the ventilatory response to 20 min of isocapnic hypoxia (oxygen saturation ∼80%) was measured. We assessed the increase in ventilation from baseline to its peak during the first 5 min of isocapnic hypoxia (hypoxic ventilatory response) and the increase in ventilation from baseline to 20 min of isocapnic hypoxia (sustained hypoxia). Haemodynamics and acute brain function were also measured.</div></div><div><h3>Results</h3><div>Independent of hypoxia, a small excitatory effect of ketamine on isocapnic ventilation was observed: the mean increase in ventilation (95% confidence interval) was 3.1 (2.4–3.7) L min⁻¹ (<em>P</em>&lt;0.0001). Esketamine had no effect on the isocapnic ventilatory response to acute and sustained hypoxia but increased MAP (+10 mm Hg) and heart rate (+10 beats min⁻¹), similarly during normoxia and hypoxia. Esketamine increased anxiety and alertness and affected external perception.</div></div><div><h3>Conclusions</h3><div>I.V. esketamine up to 1 mg kg⁻¹ does not affect the ventilatory response to hypoxia, but affects haemodynamics and acute brain function. Increases in anxiety and alertness could be a cause of the sustained ventilatory response to hypoxia during esketamine infusion.</div></div><div><h3>Clinical trial registration</h3><div>The trial was registered at the ISRCTN registry on June 27, 2023 under identifier ISRCTN 42617929 (<span><span>https://www.isrctn.com/ISRCTN42617929</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 557-563"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615136","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":"Aperiodic component of the electroencephalogram power spectrum reflects the hypnotic level of anaesthesia","authors":"Sandra Widmann ,&nbsp;Julian Ostertag ,&nbsp;Sebastian Zinn ,&nbsp;Stefanie Pilge ,&nbsp;Paul S. García ,&nbsp;Stephan Kratzer ,&nbsp;Gerhard Schneider ,&nbsp;Matthias Kreuzer","doi":"10.1016/j.bja.2024.09.027","DOIUrl":"10.1016/j.bja.2024.09.027","url":null,"abstract":"<div><h3>Background</h3><div>Aperiodic (nonoscillatory) electroencephalogram (EEG) activity can be characterised by its power spectral density, which decays according to an inverse power law. Previous studies reported a shift in the spectral exponent <em>α</em> from consciousness to unconsciousness. We investigated the impact of aperiodic EEG activity on parameters used for anaesthesia monitoring to test the hypothesis that aperiodic EEG activity carries information about the hypnotic component of general anaesthesia.</div></div><div><h3>Methods</h3><div>We used simulated noise with varying inverse power law exponents <em>α</em> and the aperiodic component of EEGs recorded during wakefulness (<em>n</em>=62) and maintenance of general anaesthesia (<em>n</em>=125) in a diverse sample of surgical patients receiving sevoflurane, desflurane, or propofol, extracted using the Fitting Oscillations and One-Over-F algorithm. Four spectral EEG parameters (beta ratio, spectral edge frequency 95, spectral entropy, and alpha-to-delta ratio) and two time-series parameters (approximate [ApEn] and permutation entropy [PeEn]) were calculated from the simulated signals and human EEG data. Performance in distinguishing between consciousness and unconsciousness was evaluated with AUC values.</div></div><div><h3>Results</h3><div>We observed an increase in the spectral exponent from consciousness to unconsciousness (AUC=0.98 (0.94–1)). The spectral parameters exhibited linear or nonlinear responses to changes in <em>α</em>. Using aperiodic EEG activity instead of the entire spectrum for spectral parameter calculation improved the separation between consciousness and unconsciousness for all parameters (AUC_{<em>aperiodic</em>}=0.98 (0.94–1.00) <em>vs</em> AUC_{<em>original</em>}=0.71 (0.62–0.79) to AUC_{<em>original</em>}=0.95 (0.92–0.98)) up to the level of ApEn (AUC=0.96 (0.93–0.98)) and PeEn (AUC=0.94 (0.90–0.97)).</div></div><div><h3>Conclusions</h3><div>Aperiodic EEG activity could improve discrimination between consciousness and unconsciousness using spectral analyses.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 392-401"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750046","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":"A high-fidelity non-animal model for simulation of infant emergency front-of-neck access","authors":"Anita Flynn ,&nbsp;Melody Chen","doi":"10.1016/j.bja.2024.11.013","DOIUrl":"10.1016/j.bja.2024.11.013","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 576-578"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852892","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":"Continuous vital sign monitoring of patients recovering from surgery on general wards: a narrative review","authors":"Ashish K. Khanna ,&nbsp;Moritz Flick ,&nbsp;Bernd Saugel","doi":"10.1016/j.bja.2024.10.045","DOIUrl":"10.1016/j.bja.2024.10.045","url":null,"abstract":"<div><div>Most postoperative deaths occur on general wards, often linked to complications associated with untreated changes in vital signs. Monitoring in these units is typically intermittent checks each shift or maximally every 4–6 h, which misses prolonged periods of subtle changes in physiology that can herald a critical downstream event. Continuous monitoring of vital signs is therefore intuitively necessary for patient safety. The past five decades have seen monitoring systems evolve rapidly, and today entirely wireless, wearable, and portable continuous surveillance of vital signs is possible on general wards. Introduction of this technology has the potential to modify both the sensing (afferent) and response (efferent) limbs of monitoring, and will allow earlier detection of vital signs perturbations. But this comes with challenges, including but not limited to issues with connectivity, data handling, alarm fatigue, information overload, and lack of meaningful clinical interventions. Evidence from before and after studies and retrospective propensity-matched data suggests that continuous ward monitoring decreases the risk of intensive care unit (ICU) admissions, rapid response calls, and in some instances, mortality. This review summarises the history of general ward monitoring and describes future directions, including opportunities to implement these devices using artificial intelligence, pattern detection, and user-friendly interfaces. Pragmatic, well designed and appropriately powered trials, and real-world implementation data are necessary to make continuous monitoring standard practice at every hospital bed.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 501-509"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945018","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":"Risk of intrafascicular spread after deliberate ex vivo intraneural injections of brachial plexus nerve roots","authors":"Xavier Sala-Blanch ,&nbsp;André P. Boezaart ,&nbsp;Graeme A. McLeod ,&nbsp;Miguel A. Reina","doi":"10.1016/j.bja.2024.11.030","DOIUrl":"10.1016/j.bja.2024.11.030","url":null,"abstract":"<div><h3>Background</h3><div>We investigated the intraneural spread of injected fluid in brachial plexus nerve roots, examining the potential for intrafascicular spread and identifying influencing factors.</div></div><div><h3>Methods</h3><div>Twelve deliberate ultrasound-guided intraneural injections were performed at the ventral rami of the brachial plexus nerve roots at their exits from the neuroforamina in six fresh, unembalmed, cryopreserved human cadavers. A 22-G, 30-degree bevel echogenic regional anaesthesia needle was used. Each injection contained 1 ml of heparinised erythrocytes as a marker. Nerve swelling observed on ultrasound images confirmed intraneural injection.</div></div><div><h3>Results</h3><div>Intraneural spread was observed in 12 ventral rami of the six brachial plexi: C5 (1), C6 (3), C7 (5), C8 (2), and T1 (1). Among these, intrafascicular spread was detected in eight cases, six in monofascicular roots and two in bifascicular roots, though none in roots with three or more fascicles. The fascicle diameters in these cases (2.1–3.8 mm) were at least twice the diameter of the needle orifice, measured at 0.9 mm, which was entirely inside the fascicles. In the four cases with intraneural but without intrafascicular spread, the fascicle diameters were about two times the diameter of the needle orifice in three instances, but the entire needle orifice was not always inside a fascicle.</div></div><div><h3>Conclusions</h3><div>In contrast with multifascicular peripheral nerves, intrafascicular spread was possible after deliberate intraneural injections near the neuroforaminal canal exit of the brachial plexus nerve roots in several monofascicular or bifascicular ventral rami if the fascicle diameter was more than twice the needle opening length and the entire opening was inside the fascicle.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 545-556"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969659","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":"An RCT investigating the learning curves of anaesthetists performing hologram-guided thoracic epidural insertion on the Thiel soft-embalmed cadaver","authors":"Graeme McLeod ,&nbsp;Mel McKendrick ,&nbsp;Gary McKendrick ,&nbsp;Rony Portelli ,&nbsp;Gareth James ,&nbsp;Zsolt Husz","doi":"10.1016/j.bja.2024.11.007","DOIUrl":"10.1016/j.bja.2024.11.007","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 617-618"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139313","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 inflammatory subphenotypes predict postoperative pulmonary complications in patients undergoing elective major surgery: a secondary analysis of the Prevention-HARP2 trial","authors":"Adam Glass ,&nbsp;Kiran Reddy ,&nbsp;Nerielle Fundano ,&nbsp;Jon Silversides ,&nbsp;Cecilia O’Kane ,&nbsp;Murali Shyamsundar ,&nbsp;Danny McAuley","doi":"10.1016/j.bja.2024.11.006","DOIUrl":"10.1016/j.bja.2024.11.006","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 616-617"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139314","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":"Multicentre analysis of severe perioperative adverse events in children undergoing surgery who were infected with SARS-CoV-2: a propensity score-adjusted analysis","authors":"Rita Saynhalath ,&nbsp;Ethan L. Sanford ,&nbsp;Meredith A. Kato ,&nbsp;Steven J. Staffa ,&nbsp;David Zurakowski ,&nbsp;Petra M. Meier ,&nbsp;Gijo A. Alex ,&nbsp;Clinton L. Fuller ,&nbsp;Elizabeth N. Rossmann Beel ,&nbsp;Surendrasingh Chhabada ,&nbsp;Kiley F. Poppino ,&nbsp;Peter Szmuk ,&nbsp;Clyde T. Matava ,&nbsp;Proshad N. Efune","doi":"10.1016/j.bja.2024.10.005","DOIUrl":"10.1016/j.bja.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of severe adverse events in children with SARS-CoV-2 undergoing anaesthesia has not been well established. We examined the relationship between SARS-CoV-2 infection and severe perioperative adverse events in children.</div></div><div><h3>Methods</h3><div>This multicentre (21 North American institutions), retrospective cohort study included children &lt;18 years old, with American Society of Anesthesiologists physical status (ASA PS) of 1–4 and non-severe SARS-CoV-2, who underwent general anaesthesia between April 1, 2020, and March 31, 2021. The primary outcome was the incidence of severe perioperative adverse events (admission to the intensive care unit for escalation of respiratory support, acute respiratory distress syndrome, postoperative pneumonia, cardiovascular arrest, extracorporeal life support, and death) within 7 days of the anaesthetic, assessed using multivariable analysis with inverse probability of treatment weighting by the propensity score. A propensity score mixed-effects model included variables selected <em>a priori</em>. Inverse probability of treatment weighting was used to retain all data while balancing exposure groups on measured confounders.</div></div><div><h3>Results</h3><div>We matched 1138 patients with SARS-CoV-2 positive testing within 10 days of the anaesthetic to 3396 non-infected controls. The cohort included 56.6% (2568/4534) male patients, 69.9% (2839/4060) White patients, and 63.5% (2879/4533) ASA PS 1–2 patients. General surgery cases comprised 38.4% (1739/4534) of the cohort, followed by orthopaedic surgery at 12.6% (573/4534) and ear, nose, and throat surgery at 8.2% (371/4534). In the overall sample of 4534 patients, 52 had a severe adverse event (0.01%). Children with SARS-CoV-2 had a higher risk of at least one severe adverse event (25/1138 [2.20%] <em>vs</em> 27/3396 [0.80%] in those non-infected; adjusted odds ratio 2.34; 95% confidence interval 1.25–4.39). None of the children with SARS-CoV-2 had a cardiac arrest, required extracorporeal life support, or died.</div></div><div><h3>Conclusions</h3><div>In the largest cohort to date of paediatric patients undergoing general anaesthesia, SARS-CoV-2 infection was associated with severe perioperative adverse events, but no children in the infected cohort died.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 441-452"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643402","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":"Neuroanatomical and pharmaco-physiological effects of hypoxia and esketamine on breathing, the sympathetic nerve system, and cortical function","authors":"Aiman Suleiman ,&nbsp;Karuna Wongtangman ,&nbsp;Matthias Eikermann ,&nbsp;Astrid G. Stucke","doi":"10.1016/j.bja.2024.11.011","DOIUrl":"10.1016/j.bja.2024.11.011","url":null,"abstract":"<div><div>Acute hypoxic ventilatory response is an important reflex that helps maintain breathing during low oxygen levels, but it is attenuated by most general anaesthetics. Analgesic doses of ketamine and esketamine are known to have respiratory stimulant effects. In their recent study in the <em>British Journal of Anaesthesia</em>, Jansen and colleagues show that low-dose esketamine preserved the acute hypoxic ventilatory response, while increasing breathing rate, systolic blood pressure, and heart rate. Participants also exhibited higher levels of alertness and unpleasant psychotropic effects compared with the control condition. We review the pharmaco-physiological effects of acute hypoxia and its interactions with esketamine. We provide a summary of the effects of hypoxia and esketamine on the neurocircuitry that leads to arousal, activation of the sympathetic nerve system, and increased drive to upper airway dilator and respiratory pump muscles.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 277-280"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852909","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 transauricular nerve stimulation on perioperative pain: a single-blind, analyser-masked, randomised controlled trial. Comment on Br J Anaesth 2023; 130: 468–76","authors":"Jun Zhang ,&nbsp;Qi-hong Shen ,&nbsp;Gang Chen","doi":"10.1016/j.bja.2024.10.035","DOIUrl":"10.1016/j.bja.2024.10.035","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 2","pages":"Pages 579-580"},"PeriodicalIF":9.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791444","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}