British journal of anaesthesia最新文献_第7页

Tracheal intubation in a UK emergency department: a single-centre observational study following adoption of routine videolaryngoscopy. 气管插管在英国急诊科：单中心观察研究采用常规视频喉镜检查。

IF 9.8 1区医学

British journal of anaesthesia Pub Date : 2026-04-21 DOI: 10.1016/j.bja.2026.02.039

Charles A Flanders,John Cafferkey,Philippa Serebriakoff,Nicola Di Rollo,Scott Clarke,Alistair F McNarry,Patrick A Ward

引用次数: 0

Modulating effect of peripheral nerve stimulation on peripheral nerve blocks: technique and preliminary block profile. 周围神经刺激对周围神经阻滞的调节作用：技术和初步阻滞剖面。

IF 9.8 1区医学

British journal of anaesthesia Pub Date : 2026-04-20 DOI: 10.1016/j.bja.2026.02.042

Claudia F Denoue,Rakesh Sondekoppam,Seth Klapman,Seokha Yoo,Chi-Ho Ban Tsui,Jean-Louis Horn

引用次数: 0

Defining estimands in anaesthesia clinical trials: a scoping review and framework. 麻醉临床试验评估的定义：范围审查和框架。

IF 9.8 1区医学

British journal of anaesthesia Pub Date : 2026-04-20 DOI: 10.1016/j.bja.2026.03.026

Gethmini A Siriwardena,Sarah Luu,Rukshala K Gunaratne,Julie A Simpson,Kate Leslie,Sabine Braat,Anurika P De Silva

{"title":"Defining estimands in anaesthesia clinical trials: a scoping review and framework.","authors":"Gethmini A Siriwardena,Sarah Luu,Rukshala K Gunaratne,Julie A Simpson,Kate Leslie,Sabine Braat,Anurika P De Silva","doi":"10.1016/j.bja.2026.03.026","DOIUrl":"https://doi.org/10.1016/j.bja.2026.03.026","url":null,"abstract":"BACKGROUNDIntercurrent events, such as treatment switching and rescue medication, commonly occur in anaesthesia trials, and can affect the occurrence or interpretation of primary outcomes. The estimand framework provides strategies for handling these events, aligning trial objectives with outcomes.METHODSWe conducted a scoping review of RCTs with ≥100 participants published from January 2020 to June 2024 in ten high-impact journals, including patients receiving anaesthesia before surgery. We examined whether estimands were reported and identified intercurrent events. A structured framework was developed by mapping intercurrent events to intervention-outcome combinations investigated across all included anaesthesia trials.RESULTSAmong 139 included trials, none explicitly used the estimand framework, and an estimand could be inferred in only 27 (19%). The primary outcome was defined in all trials, while other attributes were often not inferable: target population (44 [32%]), treatment condition (21 [15%]), summary measure (22 [16%]) and intercurrent event handling (84 [60%]). The most common intercurrent events were not receiving the randomised intervention (64 [46%]), treatment discontinuation (38 [27%]), and treatment switching (27 [19%]). Anaesthesia-related intercurrent events included surgery cancellation (37 [27%]) and non-protocolised anaesthesia management (17 [12%]). Findings informed the development of a structured, interactive web-based tool linking intercurrent events to intervention-outcome combinations, refined by expert review.CONCLUSIONSUse of estimands in anaesthesia trials is limited. Our tool supports structured identification and handling of intercurrent events in anaesthesia trials. Greater collaboration between statisticians and clinicians, with consistent application of the estimand framework, is needed to improve clarity and interpretability of future anaesthesia research.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"127 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731422","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}

引用次数: 0

Astrocytic α2A-adrenergic signalling in the hypothalamic paraventricular nucleus contributes to dexmedetomidine-induced sedation in mice. 下丘脑室旁核星形细胞α 2a -肾上腺素能信号参与右美托咪定诱导小鼠镇静。

IF 9.8 1区医学

British journal of anaesthesia Pub Date : 2026-04-20 DOI: 10.1016/j.bja.2026.01.049

Rong Luo,Xiaojun Hu,Yuncheng Luo,Ping Liao,Fan Zhang,Yu Shen,Hao-Di Tang,Qingran Li,Yunqing Yu,Limei Yi,Yunxia Zuo,Ruotian Jiang

{"title":"Astrocytic α2A-adrenergic signalling in the hypothalamic paraventricular nucleus contributes to dexmedetomidine-induced sedation in mice.","authors":"Rong Luo,Xiaojun Hu,Yuncheng Luo,Ping Liao,Fan Zhang,Yu Shen,Hao-Di Tang,Qingran Li,Yunqing Yu,Limei Yi,Yunxia Zuo,Ruotian Jiang","doi":"10.1016/j.bja.2026.01.049","DOIUrl":"https://doi.org/10.1016/j.bja.2026.01.049","url":null,"abstract":"BACKGROUNDDexmedetomidine (Dex) is a selective α2-adrenergic receptor (α2-AR) agonist widely used for sedation, but its underlying mechanisms remain incompletely understood. We aimed to identify novel brain regions and cellular pathways mediating Dex-induced sedation in mice.METHODSBrain-wide α2A-ARs expression was mapped in adult male C57BL/6 mice using RNAscope in situ hybridisation with immunofluorescence. Functional expression was confirmed by intracellular Ca2+ imaging in astrocytes. Sedation was assessed by rotarod, open-field tests, and electroencephalography (EEG). Astrocyte-specific gene knockdown, chemogenetics, and electrophysiology were used to explore underlying mechanisms.RESULTSExpression of α2A-ARs was enriched in hypothalamic paraventricular nucleus (PVH) astrocytes, where Dex triggered α2A-AR-dependent Ca2+ elevations. Knockdown of astrocyte α2A-ARs reduced Dex-induced sedation, evidenced by increased rotarod fall latency (mean [standard deviation] 228 [52] vs 166 [62] s, P=0.026), increased open-field distance (3640 [950] vs 2680 [850] cm, P=0.029) and decreased EEG delta power (54.2 [11.0] vs 62.0 [5.9]%, P=0.024). Inhibition of astrocyte Ca2+ signalling produced similar effects. Mechanistically, Dex enhanced tonic gamma-aminobutyric acid (GABA) currents in local Vglut2+ neurones (15.5 [9.6] vs 7.8 [6.6] pA, P=0.035) and suppressed neuronal firing (0.5 [0.5] vs 1.8 [1.3] Hz, P<0.001); both effects were attenuated by inhibition of astrocyte Ca2+ levels. Furthermore, knockdown of the Ca2+-activated anion channel bestrophin-1 (BEST1) in PVH astrocytes reduced tonic GABA currents (3.5 [3.4] vs 7.5 [7.2] pA, P=0.024) and diminished sedation.CONCLUSIONSAn astrocytic α2A-AR-Ca2+-BEST1 pathway in hypothalamic paraventricular nucleus neurones mediates Dex-induced sedation, which identifies a critical role for astrocytes in pharmacologically induced sedation.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"263 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731421","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}

引用次数: 0

Intraoperative electroencephalographic burst suppression: a narrative review and clinical framework for interpretation and management. 术中脑电图爆发抑制：叙述回顾和临床框架的解释和管理。

IF 9.8 1区医学

British journal of anaesthesia Pub Date : 2026-04-20 DOI: 10.1016/j.bja.2026.03.003

Benjamin F Gruenbaum,Seyed A Safavynia,Federico Bilotta

{"title":"Intraoperative electroencephalographic burst suppression: a narrative review and clinical framework for interpretation and management.","authors":"Benjamin F Gruenbaum,Seyed A Safavynia,Federico Bilotta","doi":"10.1016/j.bja.2026.03.003","DOIUrl":"https://doi.org/10.1016/j.bja.2026.03.003","url":null,"abstract":"Burst suppression is common during general anaesthesia yet remains one of the most confusing electroencephalography (EEG) patterns for practicing anaesthetists. The literature alternately frames burst suppression as neuroprotective, harmful, or clinically neutral, leaving clinicians uncertain about how to interpret its appearance and respond in real time. This narrative review reframes burst suppression as a context-dependent biomarker of cortical energy balance rather than a uniformly protective or purely iatrogenic phenomenon. From a mechanistic perspective, physiologic burst suppression reflects activity-dependent neuronal downregulation, whereas pathologic burst suppression is increasingly linked to neuronal energy failure and blood-brain barrier disruption, raising concern that burst suppression might exacerbate perioperative neuronal stress instead of preventing it in susceptible brains. Despite the importance of burst suppression, anaesthetists often rely on processed EEG indices that can underestimate burst suppression or misclassify artifact. In contrast, direct visualisation of the raw EEG provides more reliable detection and interpretation of burst suppression. We synthesise the mechanisms, clinical associations, and vulnerable EEG phenotypes into a clinically actionable framework that links raw EEG interpretation to real-time anaesthetic and physiologic decision-making when burst suppression arises. This approach will help clinicians recognise and respond to burst suppression promptly to support brain health.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"13 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731424","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}

引用次数: 0

Difficult Airway Society 2025 guidelines for management of unanticipated difficult tracheal intubation in adults: human factors and ergonomics. Comment on Br J Anaesth 2026; 136: 283-307. 困难气道学会2025成人意外气管插管困难管理指南：人为因素和人体工程学。[J]中国生物医学工程学报（英文版）；136: 283 - 307。

IF 9.8 1区医学

British journal of anaesthesia Pub Date : 2026-04-20 DOI: 10.1016/j.bja.2026.02.040

Amol Lotlikar

引用次数: 0

Suicidal behaviour after surgery 术后自杀行为

IF 9.8 1区医学

British journal of anaesthesia Pub Date : 2026-04-20 DOI: 10.1016/j.bja.2026.03.001

Peter Nagele, Max Bell

引用次数: 0

Monitoring intraoperative EEG: importance of monitor settings for individualised anaesthesia. 术中脑电图监测：个体化麻醉监测设置的重要性。

IF 9.8 1区医学

British journal of anaesthesia Pub Date : 2026-04-20 DOI: 10.1016/j.bja.2026.02.041

Antoine Premachandra,Sylvain Diop,Morgan Le Guen

引用次数: 0

Association between preoperative anaemia, transfusion, and outcomes in children undergoing noncardiac surgery. Comment on Br J Anaesth 2025; 135: 375–81 非心脏手术儿童术前贫血、输血与预后的关系Br [J][研究][2025]；135: 375 - 81

IF 9.8 1区医学

British journal of anaesthesia Pub Date : 2026-04-20 DOI: 10.1016/j.bja.2026.02.043

Dilek Ucak

引用次数: 0

Continuous posterior extrathoracic fascial plane block versus continuous paravertebral block for pain management in patients with multiple rib fractures: possible influence of fracture location on analgesic efficacy. Comment on Br J Anaesth 2025; 136:677-86. 连续胸后筋膜平面阻滞与连续椎旁阻滞治疗多发性肋骨骨折患者疼痛：骨折位置对镇痛效果的可能影响Br [J][研究][2025]；136:677 - 86。

IF 9.8 1区医学

British journal of anaesthesia Pub Date : 2026-04-20 DOI: 10.1016/j.bja.2026.02.034

Boyi Zhang,Xinru Xie,Yifan Ai

引用次数: 0