British journal of anaesthesia最新文献

{"title":"Role of recruitment manoeuvres in reducing postoperative pulmonary complications during driving pressure-guided ventilation: a meta-analysis and sequential analysis","authors":"Enrico Tamburini , Honoria Ocagli , Michele Carron","doi":"10.1016/j.bja.2025.01.017","DOIUrl":"10.1016/j.bja.2025.01.017","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 1232-1234"},"PeriodicalIF":9.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398291","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":"Connectome harmonic decomposition tracks the presence of disconnected consciousness during ketamine-induced unresponsiveness","authors":"Milan Van Maldegem ,&nbsp;Jakub Vohryzek ,&nbsp;Selen Atasoy ,&nbsp;Naji Alnagger ,&nbsp;Paolo Cardone ,&nbsp;Vincent Bonhomme ,&nbsp;Audrey Vanhaudenhuyse ,&nbsp;Athena Demertzi ,&nbsp;Oceane Jaquet ,&nbsp;Mohamed Ali Bahri ,&nbsp;Pablo Nunez ,&nbsp;Morten L. Kringelbach ,&nbsp;Emmanuel A. Stamatakis ,&nbsp;Andrea I. Luppi","doi":"10.1016/j.bja.2024.12.036","DOIUrl":"10.1016/j.bja.2024.12.036","url":null,"abstract":"<div><h3>Background</h3><div>Ketamine, in doses suitable to induce anaesthesia in humans, gives rise to a unique state of unresponsiveness accompanied by vivid experiences and sensations, making it possible to disentangle the correlated but distinct concepts of conscious awareness and behavioural responsiveness. This distinction is often overlooked in the study of consciousness.</div></div><div><h3>Methods</h3><div>The mathematical framework of connectome harmonic decomposition (CHD) was used to view functional magnetic resonance imaging (fMRI) signals during ketamine-induced unresponsiveness as distributed patterns across spatial scales. The connectome harmonic signature of this particular state was mapped onto signatures of other states of consciousness for comparison.</div></div><div><h3>Results</h3><div>An increased prevalence of fine-grained connectome harmonics was found in fMRI signals obtained during ketamine-induced unresponsiveness, indicating higher granularity. After statistical assessment, the ketamine sedation harmonic signature showed alignment with signatures of LSD-induced (fixed effect =0.0113 [0.0099, 0.0127], <em>P</em>&lt;0.001) or ketamine-induced (fixed effect =0.0087 [0.0071, 0.0103], <em>P</em>&lt;0.001) psychedelic states, and misalignment with signatures seen in unconscious individuals owing to propofol sedation (fixed effect =–0.0213 [–0.0245, –0.0181], <em>P</em>&lt;0.001) or brain injury (fixed effect =–0.0205 [–0.0234, –0.0178], <em>P</em>&lt;0.001).</div></div><div><h3>Conclusions</h3><div>The CHD framework, which only requires resting-state fMRI data and can be applied retrospectively, has the ability to track alterations in conscious awareness in the absence of behavioural responsiveness on a group level. This is possible because of ketamine's unique property of decoupling these two facets, and is important for consciousness and anaesthesia research.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 1088-1104"},"PeriodicalIF":9.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398289","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":"William Fitch (1937–2024): seventh editor of the British Journal of Anaesthesia, 1983–7","authors":"Jennifer M. Hunter","doi":"10.1016/j.bja.2025.01.020","DOIUrl":"10.1016/j.bja.2025.01.020","url":null,"abstract":"<div><div>The academic contributions of William Fitch, the seventh editor of the <em>BJA</em> from 1983 to 1987 who died recently, are considered. His anaesthetic career was mainly based at the University of Glasgow, with research appointments during his training with Professor D. Gordon McDowall at the University of Leeds. Professor Fitch, known to his friends and colleagues as Bill, was a neuroanaesthetist with a specific interest in the effects of general anaesthesia on the cerebral circulation. His participation in the <em>BJA</em> spanned more than 50 years, and the <em>BJA</em> Board very much value his longstanding contribution.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 914-916"},"PeriodicalIF":9.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643785","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":"Handheld ultrasound versus palpation technique for radial artery cannulation in conscious patients before noncardiac surgery: an open-label randomised controlled study","authors":"Timothy C. Egan ,&nbsp;Tom E.F. Abbott ,&nbsp;Gareth L. Ackland ,&nbsp;for the Arterial Cannulation with Ultrasound investigators","doi":"10.1016/j.bja.2025.01.016","DOIUrl":"10.1016/j.bja.2025.01.016","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 1208-1210"},"PeriodicalIF":9.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373696","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":"Optiflow Switch™: a clinical evaluation case series in general anaesthesia for Caesarean delivery. Comment on Br J Anaesth 2024; 132: 207–9","authors":"Balaji Vaithialingam","doi":"10.1016/j.bja.2025.01.013","DOIUrl":"10.1016/j.bja.2025.01.013","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 1230-1231"},"PeriodicalIF":9.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373787","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 comparison of large language model-generated and published perioperative neurocognitive disorder recommendations: a cross-sectional web-based analysis.","authors":"Sarah Saxena, Odmara L Barreto Chang, Melanie Suppan, Basak Ceyda Meco, Susana Vacas, Finn Radtke, Idit Matot, Arnout Devos, Mervyn Maze, Mia Gisselbaek, Joana Berger-Estilita","doi":"10.1016/j.bja.2025.01.001","DOIUrl":"10.1016/j.bja.2025.01.001","url":null,"abstract":"<p><strong>Background: </strong>Perioperative neurocognitive disorders (PNDs) are common complications after surgery and anaesthesia, particularly in older adults, leading to increased morbidity, mortality, and healthcare costs. Therefore, major medical societies have developed recommendations for the prevention and treatment of PNDs. Our study evaluated the reliability of large language models, specifically ChatGPT-4 and Gemini, in generating recommendations for PND management and comparing them with published guidelines.</p><p><strong>Methods: </strong>We conducted an online cross-sectional web-based analysis over 48 h in June 2024. Artificial intelligence (AI)-generated recommendations were produced in six different locations across five countries (Switzerland, Belgium, Turkey, Canada, and the East and West Coasts of the USA). The English prompt 'a table of a bundle of care for perioperative neurocognitive disorders' was entered into ChatGPT-4 and Gemini, generating tables evaluated by independent reviewers. The primary outcomes were the Total Disagreement Score (TDS) and Quality Assessment of Medical Artificial Intelligence (QAMAI), which compared AI-generated recommendations with published guidelines.</p><p><strong>Results: </strong>The study generated 14 tables, with TDS and QAMAI scores showing similar results for ChatGPT-4 and Gemini (2 [1-3] vs 2 [2-3], P=0.636 and 4 [4-4] vs 4 [3-4], P=0.424, respectively). AI-generated recommendations aligned well with published guidelines, with the highest alignment observed in ChatGPT-4-generated recommendations. No complete agreement with guidelines was achieved, and lack of cited sources was a noted limitation.</p><p><strong>Conclusions: </strong>Large language models can generate perioperative neurocognitive disorder recommendations that align closely with published guidelines. However, further validation and integration of clinician feedback are required before clinical application.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373649","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":"Seizure after flumazenil reversal for total intravenous anaesthesia with remimazolam versus propofol: a matched retrospective cohort analysis of a large Japanese nationwide inpatient database","authors":"Shuichiro Komatsu ,&nbsp;Toshiaki Isogai ,&nbsp;Kanako Makito ,&nbsp;Hiroki Matsui ,&nbsp;Kiyohide Fushimi ,&nbsp;Hideo Yasunaga","doi":"10.1016/j.bja.2024.11.046","DOIUrl":"10.1016/j.bja.2024.11.046","url":null,"abstract":"<div><h3>Background</h3><div>Remimazolam is a novel anaesthetic and sedative agent that offers several advantages, including minimal adverse haemodynamic effects and availability of a specific antidote, flumazenil. Flumazenil can induce seizures as an adverse effect; however, the incidence of seizures after flumazenil reversal after total intravenous anaesthesia with remimazolam (remimazolam-flumazenil) remains unknown. We compared the risk of seizures between total i.v. anaesthesia with remimazolam-flumazenil or propofol.</div></div><div><h3>Methods</h3><div>We retrospectively identified patients who underwent elective surgery (excluding brain surgery) with total i.v. anaesthesia in Japan between April 2020 and March 2022 using the Japanese Diagnosis Procedure Combination database. Patients were divided into remimazolam-flumazenil and propofol groups. Patients in the remimazolam-flumazenil group were matched to those in the propofol group at a variable ratio of 1:3 (maximum) based on age, sex, hospital, and type of surgery. We conducted conditional logistic regression analyses to assess the association between total i.v. anaesthesia with remimazolam-flumazenil and the incidence of perioperative seizures.</div></div><div><h3>Results</h3><div>We identified 12 033 patients who underwent total i.v. anaesthesia with remimazolam-flumazenil and 432 275 patients with propofol, creating a matched cohort of 19 105. The crude incidence of seizures was 0.66% (95% confidence interval, 0.63–0.68%). There was no significant difference in seizures between the two groups (adjusted odds ratio, 1.08; 95% confidence interval, 0.49–2.37).</div></div><div><h3>Conclusions</h3><div>We observed no significant differences in perioperative seizures between remimazolam-flumazenil and propofol in patients undergoing non-neurological surgery. This suggests that remimazolam-flumazenil is a possible alternative to total i.v. anaesthesia with propofol.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 1050-1057"},"PeriodicalIF":9.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370474","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":"Sex impacts on mismatch negativity under low-dose ketamine","authors":"Jordan J. Wehrman ,&nbsp;Robert D. Sanders","doi":"10.1016/j.bja.2025.01.005","DOIUrl":"10.1016/j.bja.2025.01.005","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 1249-1250"},"PeriodicalIF":9.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370493","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":"Role of brain-derived neurotrophic factor in dysfunction of short-term to long-term memory transformation after surgery and anaesthesia in older mice","authors":"Qiang Liu ,&nbsp;Hai-Bi Wang ,&nbsp;Jia-Tao Lin ,&nbsp;Xin-Hao Jiao ,&nbsp;Yan-Ping Liu ,&nbsp;Tian-Zuo Li ,&nbsp;Zhongcong Xie ,&nbsp;Cheng-Hua Zhou ,&nbsp;Yu-Qing Wu ,&nbsp;Hui-Hui Miao","doi":"10.1016/j.bja.2024.11.045","DOIUrl":"10.1016/j.bja.2024.11.045","url":null,"abstract":"<div><h3>Background</h3><div>Memory decline is one of the main manifestations in perioperative neurocognitive disorder. Short-term memory (STM) to long-term memory (LTM) transformation is one aspect of memory consolidation. Early-phase long-term potentiation (E-LTP) to late-phase long-term potentiation (L-LTP) is the molecular correlate of STM to LTM transformation. We examined whether the STM to LTM transformation was impaired after anaesthesia and surgery in older mice.</div></div><div><h3>Methods</h3><div>Optogenetics and chemogenetics were used to confirm the role of Vglut1+ glutamatergic neurones in the STM to LTM transformation in older mice. Synaptosomes were isolated to analyse expression of brain-derived neurotrophic factor (BDNF). Golgi-Cox staining and hippocampal field potential recordings were also used to measure synaptic plasticity.</div></div><div><h3>Results</h3><div>We found that the STM to LTM and E-LTP to L-LTP transformations were impaired after anaesthesia and surgery in older mice, and Vglut1+ excitatory neurone activity in the hippocampal CA1 region was reduced. BDNF expression decreased in the postsynaptic fraction, especially in Vglut1+ neurones, whereas cell-type specific overexpression of BDNF in Vglut1+ neurones reversed postoperative STM to LTM transformation dysfunction in older mice.</div></div><div><h3>Conclusions</h3><div>Reduced BDNF expression was involved in anaesthesia and surgery-induced impairment of the STM to LTM transition involving glutamatergic neurones in the hippocampal CA1 region of older mice. This provides a potential target that might be helpful for understanding and developing treatments for postoperative neurocognitive dysfunction.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 1134-1145"},"PeriodicalIF":9.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254885","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":"Evaluating the role of ChatGPT in perioperative pain management: importance of version and prompt sensitivity. Comment on Br J Anaesth 2024; 133: 1318–20","authors":"Michel Abdel Malek,&nbsp;Nadia du Fosse,&nbsp;Martijn Boon","doi":"10.1016/j.bja.2024.12.034","DOIUrl":"10.1016/j.bja.2024.12.034","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 1241-1243"},"PeriodicalIF":9.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254879","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}