British journal of anaesthesia最新文献

{"title":"Neural correlates of systemic lidocaine administration in healthy adults measured by functional MRI: a single arm open label study.","authors":"Keith M Vogt, Alex C Burlew, Marcus A Simmons, Sujatha N Reddy, Courtney N Kozdron, James W Ibinson","doi":"10.1016/j.bja.2024.07.039","DOIUrl":"https://doi.org/10.1016/j.bja.2024.07.039","url":null,"abstract":"<p><strong>Introduction: </strong>Intravenous lidocaine is increasingly used as a nonopioid analgesic, but how it acts in the brain is incompletely understood. We conducted a functional MRI study of pain response, resting connectivity, and cognitive task performance in volunteers to elucidate the effects of lidocaine at the brain-systems level.</p><p><strong>Methods: </strong>We enrolled 27 adults (age 22-55 yr) in this single-arm, open-label study. Pain response task and resting-state functional MRI scans at 3 T were obtained at baseline and then with a constant effect-site concentration of lidocaine. Electric nerve stimulation, titrated in advance to 7/10 intensity, was used for the pain task (five times every 10 s). Group-level differences in pain task-evoked responses (primary outcome, focused on the insula) and in resting connectivity were compared between baseline and lidocaine conditions, using adjusted P<0.05 to account for multiple comparisons. Pain ratings and performance on a brief battery of computer-based tasks were also recorded.</p><p><strong>Results: </strong>Lidocaine infusion was associated with decreased pain-evoked responses in the insula (left: Z=3.6, P<0.001, right: Z=3.6, P=0.004) and other brain areas including the cingulate gyrus, thalamus, and primary sensory cortex. Resting-state connectivity showed significant diffuse reductions in both region-to-region and global connectivity measures with lidocaine. Small decreases in pain intensity and unpleasantness and worse memory performance were also seen with lidocaine.</p><p><strong>Conclusions: </strong>Lidocaine was associated with broad reductions in functional MRI response to acute pain and modulated whole-brain functional connectivity, predominantly decreasing long-range connectivity. This was accompanied by small but significant decreases in pain perception and memory performance.</p><p><strong>Clinical trial registration: </strong>NCT05501600.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495476","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":"Heart failure diagnostic accuracy, intraoperative fluid management, and postoperative acute kidney injury: a single-centre prospective observational study.","authors":"Michael R Mathis, Kamrouz Ghadimi, Andrew Benner, Elizabeth S Jewell, Allison M Janda, Hyeon Joo, Michael D Maile, Jessica R Golbus, Keith D Aaronson, Milo C Engoren","doi":"10.1016/j.bja.2024.08.020","DOIUrl":"10.1016/j.bja.2024.08.020","url":null,"abstract":"<p><strong>Background: </strong>The accurate diagnosis of heart failure (HF) before major noncardiac surgery is frequently challenging. The impact of diagnostic accuracy for HF on intraoperative practice patterns and clinical outcomes remains unknown.</p><p><strong>Methods: </strong>We performed an observational study of adult patients undergoing major noncardiac surgery at an academic hospital from 2015 to 2019. A preoperative clinical diagnosis of HF was defined by keywords in the preoperative assessment or a diagnosis code. Medical records of patients with and without HF clinical diagnoses were reviewed by a multispecialty panel of physician experts to develop an adjudicated HF reference standard. The exposure of interest was an adjudicated diagnosis of heart failure. The primary outcome was volume of intraoperative fluid administered. The secondary outcome was postoperative acute kidney injury (AKI).</p><p><strong>Results: </strong>From 40 659 surgeries, a stratified subsample of 1018 patients were reviewed by a physician panel. Among patients with adjudicated diagnoses of HF, those without a clinical diagnosis (false negatives) more commonly had preserved left ventricular ejection fractions and fewer comorbidities. Compared with false negatives, an accurate diagnosis of HF (true positives) was associated with 470 ml (95% confidence interval: 120-830; P=0.009) lower intraoperative fluid administration and lower risk of AKI (adjusted odds ratio:0.39, 95% confidence interval 0.18-0.89). For patients without adjudicated diagnoses of HF, non-HF was not associated with differences in either fluids administered or AKI.</p><p><strong>Conclusions: </strong>An accurate preoperative diagnosis of heart failure before noncardiac surgery is associated with reduced intraoperative fluid administration and less acute kidney injury. Targeted efforts to improve preoperative diagnostic accuracy for heart failure may improve perioperative outcomes.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399374","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":"Adverse outcomes after surgery after a cerebrovascular accident or acute coronary syndrome: a retrospective observational cohort study.","authors":"Matthew S Luney, Christos V Chalitsios, William Lindsay, Robert D Sanders, Tricia M McKeever, Iain K Moppett","doi":"10.1016/j.bja.2024.08.029","DOIUrl":"https://doi.org/10.1016/j.bja.2024.08.029","url":null,"abstract":"<p><strong>Background: </strong>Delaying surgery after a major cardiovascular event might reduce adverse postoperative outcomes. The time interval represents a potentially modifiable risk factor but is not well studied.</p><p><strong>Methods: </strong>This was a longitudinal retrospective population-based cohort study, linking data from Hospital Episode Statistics for NHS England and the Myocardial Ischaemia National Audit Project. Adults undergoing noncardiac, non-neurologic surgery in 2007-2018 were included. The time interval between a preoperative cardiovascular event and surgery was the main exposure. The outcomes of interest were acute coronary syndrome (ACS), acute myocardial infarction (AMI), cerebrovascular accident (CVA) within 1 year of surgery, unplanned readmission (at 30 days and 1 year), and prolonged length of stay. Multivariable logistic regression models with restricted cubic splines were used to estimate adjusted odds ratios (aORs; age, sex, socioeconomic deprivation, and comorbidities).</p><p><strong>Results: </strong>In total, 877 430 people had a previous cardiovascular event and 20 582 717 were without an event. CVA, ACS, and AMI in the year after elective surgery were more frequent after prior cardiovascular events (adjusted hazard ratio 2.12, 95% confidence interval [CI] 2.08-2.16). Prolonged hospital stay (aOR 1.36, 95% CI 1.35-1.38) and 30-day (aOR 1.28, 95% CI 1.25-1.30) and 1-yr (aOR 1.60, 95% CI 1.58-1.62) unplanned readmission were more common after major operations in those with a prior cardiovascular event. After adjusting for the time interval between preoperative events until surgery, elective operations within 37 months were associated with an increased risk of postoperative ACS or AMI. The risk of postoperative stroke plateaued after a 20-month interval until surgery, irrespective of surgical urgency.</p><p><strong>Conclusions: </strong>These observational data suggest increased adverse outcomes after a recent cardiovascular event can occur for up to 37 months after a major cardiovascular event.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388224","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":"Authorship misconduct: professional misconduct in editorial handling of authorship","authors":"Britta S. von Ungern-Sternberg ,&nbsp;Adrian Regli ,&nbsp;Bojana Stepanovic ,&nbsp;Karin Becke-Jakob","doi":"10.1016/j.bja.2024.08.015","DOIUrl":"10.1016/j.bja.2024.08.015","url":null,"abstract":"<div><div>Authorship provides academic recognition for substantial intellectual contributions to scholarly articles. Beyond recognition, authorship has become a form of currency within the academic community, acting as an indicator of academic output and thus influencing standing within an institution and the general medical community. It might further impact salary as well as job and research grant funding opportunities. Unfortunately, this emphasis on authorship has also been linked to instances of misconduct. We discuss our personal experience with editorial misconduct hoping to highlight the issue and thereby increase awareness and peer-to-peer control to reduce future authorship misconduct and to encourage others to speak up.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1134-1136"},"PeriodicalIF":9.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647089","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":"Towards sustainability of volatile anaesthetics: capture and beyond","authors":"Lukas M. Müller-Wirtz ,&nbsp;Thomas Volk ,&nbsp;Andreas Meiser","doi":"10.1016/j.bja.2024.08.022","DOIUrl":"10.1016/j.bja.2024.08.022","url":null,"abstract":"<div><div>The first measures to reduce the environmental harm from volatile anaesthetics are implementation of minimal fresh gas flow strategies and avoidance of desflurane. Although anaesthetic waste gas capture systems generally exert high capturing efficiencies, only about half of volatile anaesthetics used in the operating room are accessible for capture. Industry-sponsored reports promise a reduction of the global warming potential by both incineration and recycling of captured volatile anaesthetics. However, independent high-quality peer-reviewed studies are needed to confirm these findings.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1363-1366"},"PeriodicalIF":9.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647108","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":"Characterisation of older patients that require, but do not undergo, emergency laparotomy: a multicentre cohort study","authors":"Angeline Price ,&nbsp;Elizabeth McLennan ,&nbsp;Stephen R. Knight ,&nbsp;Nicola Reeves ,&nbsp;Susan Chandler ,&nbsp;Jemma Boyle ,&nbsp;Lyndsay Pearce ,&nbsp;Susan J. Moug","doi":"10.1016/j.bja.2024.07.009","DOIUrl":"10.1016/j.bja.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Older adults (≥65 yr) account for the majority of emergency laparotomies in the UK and are well characterised with reported outcomes. In contrast, there is limited knowledge on those patients that require emergency laparotomy but do not undergo surgery (NoLaps).</div></div><div><h3>Methods</h3><div>A multicentre cohort study (<em>n</em>=64 UK surgical centres) recruited 750 consecutive NoLap patients (February 15th - November 15th 2021, inclusive of a 90-day follow up period). Each patient was admitted to hospital with a surgical condition treatable by an emergency laparotomy (defined by The National Emergency Laparotomy Audit (NELA) criteria), but a decision was made not to undergo surgery (NoLap).</div></div><div><h3>Results</h3><div>NoLap patients were predominately female (452 patients, 60%), of advanced age (median age 83.0 yr, interquartile range 77.0–88.8), frail (523 patients, 70%), and had severe comorbidity (750 patients, 100%); 99% underwent CT scanning. The commonest diagnoses were perforation (26%), small bowel obstruction (17%), and ischaemic bowel (13%). The 90-day mortality was 79% and influencing factors were &gt;80 yr, underweight BMI, elevated serum lactate or creatinine concentration. The majority of patients died in hospital (77%), with those with ischaemic bowel dying early. For the 21% of NoLap patients that survived to 90 days, 77% returned home with increased care requirements.</div></div><div><h3>Conclusions</h3><div>This study reports that the NoLap patient population present significant medical challenges because of their extreme levels of comorbidity, frailty, and physiology. Despite these complexities a fifth remained alive at 90 days. Further work is underway to explore this high-risk decision-making process.</div></div><div><h3>Clinical trial registration</h3><div>ISRCTN14556210.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 5","pages":"Pages 973-982"},"PeriodicalIF":9.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375093","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":"Talk before they sleep: strategies for patient-centred communication in anaesthesiology","authors":"Jacopo D'Andria Ursoleo ,&nbsp;Alice Bottussi ,&nbsp;Fabrizio Monaco","doi":"10.1016/j.bja.2024.08.013","DOIUrl":"10.1016/j.bja.2024.08.013","url":null,"abstract":"<div><div>Patient–physician communication is an integral part of daily anaesthetic practice. Although it is an undeniably powerful means of building a solid therapeutic alliance, several of its fundamental aspects are often overlooked, which can hinder successful communication in the preoperative period. We outline these underexploited elements by analysing the various phases of preoperative patient–physician interactions to provide the practising anaesthesiologist with a useful framework for achieving thoughtful and patient-centred communication.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 5","pages":"Pages 934-939"},"PeriodicalIF":9.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418775","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":"Efficacy of nonopioid analgesics and adjuvants in multimodal analgesia for reducing postoperative opioid consumption and complications in obesity: a systematic review and network meta-analysis","authors":"Michele Carron ,&nbsp;Enrico Tamburini ,&nbsp;Federico Linassi ,&nbsp;Tommaso Pettenuzzo ,&nbsp;Annalisa Boscolo ,&nbsp;Paolo Navalesi","doi":"10.1016/j.bja.2024.08.009","DOIUrl":"10.1016/j.bja.2024.08.009","url":null,"abstract":"<div><h3>Background</h3><div>Managing postoperative pain in patients with obesity is challenging. Although multimodal analgesia has proved effective for pain relief, the specific impacts of different nonopioid i.v. analgesics and adjuvants on these patients are not well-defined. This study aims to assess the effectiveness of nonsteroidal antiinflammatory drugs, paracetamol, ketamine, α-2 adrenergic receptor agonists, lidocaine, magnesium, and oral gabapentinoids in reducing perioperative opioid consumption and, secondarily, in mitigating the occurrence of general and postoperative pulmonary complications (POPCs), nausea, vomiting, PACU length of stay (LOS), and hospital LOS among surgical patients with obesity.</div></div><div><h3>Methods</h3><div>A systematic review and network meta-analysis was performed. PubMed, Scopus, Web of Science, CINAHL, and EMBASE were searched. Only English-language RCTs investigating the use of nonopioid analgesics and adjuvants in adult surgical patients with obesity were included. The quality of evidence and certainty were assessed using the RoB 2 tool and GRADE framework, respectively.</div></div><div><h3>Results</h3><div>In total, 37 RCTs involving 3602 patients were included in the quantitative analysis. Compared with placebo/no intervention or a comparator, dexmedetomidine, ketamine, lidocaine, magnesium, and gabapentin significantly reduced postoperative opioid consumption after surgery. Ketamine/esketamine also significantly reduced POPCs. Ibuprofen, dexmedetomidine, and lidocaine significantly reduced postoperative nausea, whereas dexmedetomidine, either alone or combined with pregabalin, and lidocaine reduced postoperative vomiting. Dexmedetomidine significantly reduced PACU LOS, whereas both paracetamol and lidocaine reduced hospital LOS.</div></div><div><h3>Conclusions</h3><div>Intravenous nonopioid analgesics and adjuvants are crucial in multimodal anaesthesia, reducing opioid consumption and enhancing postoperative care in adult surgical patients with obesity.</div></div><div><h3>Systematic review protocol</h3><div>CRD42023399373 (PROSPERO).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1234-1249"},"PeriodicalIF":9.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375094","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":"Impact of a serious game on anaesthesia resident performance in operating theatre equipment check procedures: a randomised controlled study","authors":"Jean Selim ,&nbsp;Maxime Henry ,&nbsp;Julien Kallout ,&nbsp;Antoine Lefevre-Scelles ,&nbsp;Thomas Clavier ,&nbsp;Emmanuel Besnier ,&nbsp;Vincent Compère","doi":"10.1016/j.bja.2024.09.002","DOIUrl":"10.1016/j.bja.2024.09.002","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1347-1349"},"PeriodicalIF":9.1,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364460","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":"Effectiveness of pain medication tapering in chronic pain patients: a systematic review and meta-analysis","authors":"Elke Wuyts ,&nbsp;Lisa Goudman ,&nbsp;Cleo L. Crunelle ,&nbsp;Maria Merlano Gomez ,&nbsp;Koen Putman ,&nbsp;Frenn Bultinck ,&nbsp;Julie G. Pilitsis ,&nbsp;Maarten Moens","doi":"10.1016/j.bja.2024.07.025","DOIUrl":"10.1016/j.bja.2024.07.025","url":null,"abstract":"<div><h3>Background</h3><div>This systematic review and meta-analysis aimed to inventory all outcome measures that are affected by tapering in chronic noncancer pain and to investigate the effectiveness of tapering.</div></div><div><h3>Methods</h3><div>A literature search was conducted from inception to April 2024 in MEDLINE via PubMed, Web of Science, SCOPUS, EMBASE, and PsycINFO.</div></div><div><h3>Results</h3><div>The initial database search identified 3969 articles, which were screened by two independent reviewers. Studies evaluating pain medication tapering in adults with chronic noncancer pain were eligible for inclusion. In total, 57 and 34 articles were included in the systematic review and meta-analysis, respectively. Risk of bias assessment demonstrated poor, fair, and good quality in 30, 24, and three studies, respectively. Pain intensity was the most reported outcome measure, as reported in 28 studies. Furthermore, a random-effect three-level meta-analysis was performed. An overall effect size of 0.917 (95% confidence interval 0.61–1.22; <em>P</em>&lt;0.001) was found, indicating a beneficial effect of tapering. In addition, a statistically significant improvement was demonstrated after tapering for pain intensity, headache disability, the number of headache days per month, anxiety, depression, the number of pills consumed per month, the number of days with medication intake per month, pain catastrophising, and pain interference. No statistically significant effect was observed for physical functioning, mental health-related quality of life, opioid use, pain self-efficacy, and physical health-related quality of life.</div></div><div><h3>Conclusions</h3><div>This systematic review revealed a broad range of outcome measures affected by tapering. Owing to the high risk of bias of the included articles, the results of this meta-analysis must be interpreted with caution.</div></div><div><h3>Systematic review protocol</h3><div>CRD42023416343 (PROSPERO).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 5","pages":"Pages 998-1020"},"PeriodicalIF":9.1,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364459","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}