British journal of anaesthesia最新文献

{"title":"Deep learning model to identify and validate hypotension endotypes in surgical and critically ill patients. Comment on Br J Anaesth 2025; 134: 308-16.","authors":"Michaela Hardt,Michael Koeppen","doi":"10.1016/j.bja.2025.03.025","DOIUrl":"https://doi.org/10.1016/j.bja.2025.03.025","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"55 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926482","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":"Comparison of sugammadex or neostigmine for reversal of mild rocuronium paralysis using repetitive 100-Hz tetanic fade.","authors":"Bertrand Debaene,Denis Frasca,Fabien Moreillon,Alain A D'Hollander","doi":"10.1016/j.bja.2025.02.040","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.040","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"24 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926481","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":"Safety of shorter fasting durations in paediatric surgery: a call for more robust evidence.","authors":"Khaled Sarhan,Rana Walaa","doi":"10.1016/j.bja.2025.03.033","DOIUrl":"https://doi.org/10.1016/j.bja.2025.03.033","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"48 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926480","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 versus bolus norepinephrine administration to treat hypotension after induction of general anaesthesia in low-to-moderate risk noncardiac surgery patients: a randomised trial.","authors":"Kristen K Thomsen, Finn Külls, Christina Vokuhl, Linda Krause, Dominik Müller, Max Bossemeyer, Mirja Wegge, Alina Kröker, Alina Bergholz, Christian Zöllner, Daniel I Sessler, Bernd Saugel","doi":"10.1016/j.bja.2025.03.017","DOIUrl":"https://doi.org/10.1016/j.bja.2025.03.017","url":null,"abstract":"<p><strong>Background: </strong>Hypotension after induction of general anaesthesia (postinduction hypotension) is common in patients undergoing noncardiac surgery and frequently requires treatment with vasopressors such as norepinephrine. We tested the hypothesis that giving norepinephrine continuously using a syringe infusion pump, compared with giving it as repeated manual boluses, reduces postinduction hypotension within 15 min after starting induction of general anaesthesia in low-to-moderate risk noncardiac surgery patients.</p><p><strong>Methods: </strong>Patients undergoing elective noncardiac surgery were randomised to either continuous norepinephrine infusion or manual bolus norepinephrine administration intravenously during induction of general anaesthesia. In both groups, norepinephrine was administered through a peripheral venous catheter. Blood pressure was measured by clinicians using intermittent oscillometry. We additionally performed blinded continuous noninvasive blood pressure monitoring to quantify the duration and extent of postinduction hypotension. The primary endpoint was postinduction hypotension, defined as the area under a MAP of 65 mm Hg within 15 min after starting induction of general anaesthesia.</p><p><strong>Results: </strong>From 276 randomised patients, 261 had complete data (median age: 62 yr; 40% female). The median (25th-75th percentile) area under a MAP of 65 mm Hg was 3.6 (0.0-16.6) mm Hg × min in patients assigned to continuous norepinephrine infusion, compared with 5.5 (0.5-24.5) mm Hg × min in patients assigned to manual bolus norepinephrine administration (P=0.070). The median duration of MAP values <65 mm Hg was 1.0 (0.0-2.5) min vs 1.4 (0.2-3.2) min (P=0.052).</p><p><strong>Conclusions: </strong>Continuous administration of norepinephrine, compared with repeated manual bolus doses, did not reduce postinduction hypotension in low-to-moderate risk noncardiac surgery patients who had intermittent oscillometric blood pressure monitoring.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965961","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 intraoperative dexmedetomidine on prognosis in patients with cancer undergoing surgical procedures: a systematic review and meta-analysis.","authors":"Chaojin Zhang,Yifeng Qu,Qiang Cao,Yiyin Tao,Xiaorong Huai,Wei Xuan,Zhiying Pan,Xiaoqiang Wang,Jie Tian","doi":"10.1016/j.bja.2025.02.041","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.041","url":null,"abstract":"BACKGROUNDCancer places a significant burden on patients and healthcare systems. Dexmedetomidine, an α2 adrenergic agonist commonly used in anaesthesia, has potential effects on cancer biology. We systematically reviewed and analysed the impact of intraoperative dexmedetomidine on postoperative survival and tumour recurrence in patients with cancer.METHODSWe conducted a comprehensive search of PubMed, Web of Science, Embase, and the China National Knowledge Infrastructure up to April 2024. Two researchers extracted data including authors, year, country, study design, follow-up, patient characteristics, and hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival and recurrence-free survival. Quality assessment was conducted using the Cochrane tool for randomised controlled trials (RCTs) and the Newcastle-Ottawa Scale for retrospective studies.RESULTSThe review identified 12 studies: six RCTs and six retrospective studies. In the RCTs, intraoperative dexmedetomidine showed no significant effect on overall survival (odds ratio [OR] 0.87, 95% CI 0.67-1.13, P=0.29) but improved recurrence-free survival (OR 0.65, 95% CI 0.47-0.91, P=0.01). Retrospective studies indicated that dexmedetomidine was associated with decreased overall survival (post-matching HR 1.52, 95% CI 1.15-2.00, P=0.003), and had no significant effect on recurrence-free survival (post-matching HR 1.29, 95% CI 0.96-1.72, P=0.09).CONCLUSIONSMeta-analysis reveals inconsistent evidence regarding impact of intraoperative dexmedetomidine on cancer outcomes after surgery. RCTs suggest improved recurrence-free survival, whereas retrospective studies suggest potential reductions in overall survival. The limited and contradictory data highlight the necessity for more high-quality RCTs to clarify the effects of dexmedetomidine on survival and prognosis in this population.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"9 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902940","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":"Development and analysis of a remimazolam pharmacokinetics and pharmacodynamics model with proposed dosing and concentrations for anaesthesia and sedation.","authors":"Douglas J Eleveld,Pieter J Colin,Johannes P Van den Berg,Jeroen V Koomen,Thomas Stoehr,Michel M R F Struys","doi":"10.1016/j.bja.2025.02.038","DOIUrl":"https://doi.org/10.1016/j.bja.2025.02.038","url":null,"abstract":"BACKGROUNDPharmacokinetic-pharmacodynamic (PK-PD) models of remimazolam and their covariate relationships are useful for understanding drug disposition and predicting drug effects. Although clinical studies have shown that remimazolam induction doses decline with advancing age, this property is not reflected in existing models. The purpose of this investigation was to develop a PK-PD model for remimazolam and perform covariate analysis to maximise its utility across broad, diverse populations and to evaluate its consistency with clinical observations of drug dosing.METHODSArterial and venous concentrations of remimazolam and its metabolite, Modified Observer's Assessment of Alertness and Sedation score and bispectral index were determined in 20 studies. Final population models were developed with covariate analysis. Simulations of drug administration for sedation and anaesthesia for this and previously published models were compared with the results of clinical studies.RESULTSModel development proceeded from 933 individuals aged 6-93 yr and weight 21-171 kg. PK data from studies with extracorporeal membrane oxygenation and treatment in ICU were considered in a post hoc analysis. Simulations of target-controlled infusion with the final model targeting sedation (Modified Observer's Assessment of Alertness and Sedation score 2 or 3) or anaesthesia (bispectral index 50) showed drug administration declining with age consistent with clinical observations.CONCLUSIONSA PK-PD model for remimazolam was developed for a broad, diverse population. Dosing and target concentrations are proposed that are clinically useful for anaesthesia and sedation, especially for target-controlled infusion administration.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"36 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902943","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 dexmedetomidine for the prevention of postoperative delirium after cardiac surgery: a systematic review, Bayesian meta-analysis, and Bayesian re-analysis of the DECADE trial","authors":"Tessa Hunt ,&nbsp;Thomas Payne ,&nbsp;James M. Brophy ,&nbsp;Joanne Irons ,&nbsp;Andy Y. Wang ,&nbsp;Charles Cartwright ,&nbsp;Benjamin Moran ,&nbsp;John A. Loadsman ,&nbsp;Robert D. Sanders","doi":"10.1016/j.bja.2025.02.031","DOIUrl":"10.1016/j.bja.2025.02.031","url":null,"abstract":"<div><h3>Background</h3><div>Dexmedetomidine is seen as a promising agent for the prevention of postoperative delirium after cardiac surgery, but the largest study (DECADE) paradoxically suggested an increased risk of delirium.</div></div><div><h3>Methods</h3><div>Studies were selected using inclusion/exclusion criteria after conducting online database searches for randomised controlled trials. The primary outcome was the incidence of postoperative delirium with a minimum clinically important difference (MCID), defined as an odds ratio &gt;1.20 or &lt;0.84. Publication bias was quantified using Bayesian model averaging. A random-effects meta-analysis with weakly informative priors was performed. Bayesian re-analysis of DECADE using several different priors including a prior based on this meta-analysis (excluding DECADE) was also performed.</div></div><div><h3>Results</h3><div>We identified 12 eligible randomised controlled trials (3539 participants). The overall pooled effect showed a mean benefit from dexmedetomidine in delirium prevention (odds ratio 0.67 [95% credible interval 0.45, 0.92]), but any definitive evidence of benefit disappeared after accounting for publication bias (odds ratio 1.15 [95% credible interval 0.93, 2.51]). Bayesian re-analysis of the DECADE trial under a vague prior showed a 1.5% posterior probability of any benefit and only a 0.1% probability of an MCID for benefit. Combining DECADE with the unadjusted meta-analysis-derived prior increased the probability of an MCID for benefit to 17.8%, which decreased to 0.2% using the meta-analysis-derived prior adjusted for publication bias.</div></div><div><h3>Conclusions</h3><div>Pooled evidence suggests dexmedetomidine is associated with reduced incidence of postoperative delirium; however, this is highly sensitive to the possibility of publication bias. Bayesian re-analysis of the recently published DECADE trial showed the effect of dexmedetomidine differs markedly depending on the weight given to previous studies. Hence, any true benefit from the use of dexmedetomidine over standard care in this population cannot be definitively characterised at present.</div></div><div><h3>Systematic review protocol</h3><div>CRD42023401623 (PROSPERO).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 6","pages":"Pages 1671-1682"},"PeriodicalIF":9.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902941","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":"A nationwide approach to reduction in anaesthetic gas use: the Dutch Approach to decarbonising anaesthesia. Comment on Br J Anaesth 2025; 134: 1146-52.","authors":"Peter Kranke,Giovanni Landoni,Laurentiu Marin,Niels Rahe-Meyer,Jan G Jakobsson,Robert L Kleinberg","doi":"10.1016/j.bja.2025.03.023","DOIUrl":"https://doi.org/10.1016/j.bja.2025.03.023","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"23 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902958","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":"Thoracic segmental spinal anaesthesia: expanding applications while keeping it safe.","authors":"Naresh W Paliwal,Imran A Khan","doi":"10.1016/j.bja.2025.03.026","DOIUrl":"https://doi.org/10.1016/j.bja.2025.03.026","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"95 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902942","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 peripheral nerve blocks on chronic opioid use after elective total knee arthroplasty from a large US claims database","authors":"Lisa Reisinger ,&nbsp;Crispiana Cozowicz ,&nbsp;Jashvant Poeran ,&nbsp;Haoyan Zhong ,&nbsp;Alex Illescas ,&nbsp;Periklis Giannakis ,&nbsp;Jiabin Liu ,&nbsp;David H. Kim ,&nbsp;Stavros G. Memtsoudis","doi":"10.1016/j.bja.2025.03.014","DOIUrl":"10.1016/j.bja.2025.03.014","url":null,"abstract":"<div><h3>Background</h3><div>Peripheral nerve blocks (PNBs), either single-shot injection or continuous catheter infusion, are increasingly used in total knee arthroplasties (TKAs). Although recent data show equivalence between both modalities in immediate perioperative analgesia, comparative data on longer-term outcomes such as chronic opioid use are scarce.</div></div><div><h3>Methods</h3><div>Using US Merative MarketScan commercial claims data (2018–22; <em>n</em>=126 860 TKAs), we compared: (1) patients receiving PNB <em>vs</em> those who did not; and (2) single-shot <em>vs</em> continuous catheter infusion PNB. Primary outcomes were: (1) ‘chronic opioid dependence’ (&gt;120 pills of opioids prescribed or &gt;10 prescriptions between postoperative day 90 and 180); and (2) ‘chronic opioid use’ (any opioid refill between postoperative day 90 and 180). Multivariable models measured associations between PNB modalities and outcomes.</div></div><div><h3>Results</h3><div>Incidence of ‘chronic opioid dependence’ was 0.7%, 0.8%, and 0.9% among patients without PNB, with single-shot PNB, and with continuous PNB, respectively. For ‘chronic opioid use’, this was 12.6%, 13.8%, and 14.3%. Multivariable analyses indicated no association between PNB (yes/no and modality) utilisation and ‘chronic opioid dependence’. However, single-shot (OR 1.01, 95% CI 1.01–1.02; <em>P</em>&lt;0.001) and continuous PNB (OR 1.01, 95% CI 1.01–1.02; <em>P</em>&lt;0.001) compared with no PNB use were associated with slightly higher odds of ‘chronic opioid use’.</div></div><div><h3>Discussion</h3><div>Our results did not show any clinically meaningful differences in postoperative chronic opioid use or dependence across patients receiving single-shot PNB or continuous PNB treatment. Future prospective registry data might be indicated to further address this question.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 6","pages":"Pages 1779-1783"},"PeriodicalIF":9.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902957","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}