British journal of anaesthesia最新文献

{"title":"Preoperative preparation of children with upper respiratory tract infection: a focussed narrative review","authors":"Bojana Stepanovic ,&nbsp;Adrian Regli ,&nbsp;Karin Becke-Jakob ,&nbsp;Britta S. von Ungern-Sternberg","doi":"10.1016/j.bja.2024.07.035","DOIUrl":"10.1016/j.bja.2024.07.035","url":null,"abstract":"<div><div>This review summarises the current evidence for the perioperative preparation in children with upper respiratory tract infections (URTI), including COVID-19 infection. URTI, including COVID-19 infection, are common and frequent in children who present for elective surgery. Children with URTI are at increased risk of perioperative respiratory adverse events. Perioperative respiratory adverse events are among the most serious and impactful consequences of paediatric anaesthesia, including cardiorespiratory arrest, and therefore present a significant challenge for the paediatric anaesthetist. This review addresses the pathophysiology and time course of URTI, including COVID-19. The evidence-based patient, anaesthetic, and surgical risk factors for perioperative respiratory adverse events are summarised. These risk factors work synergistically to determine individual patient risk and allow for risk stratification both clinically and with validated scoring systems. Evidence-based optimisation of modifiable respiratory risk factors can reduce the risk of perioperative bronchospasm. The evidence for the anaesthesia management options, including the timing and setting of surgery, experience of the paediatric anaesthetist, premedication, choice of airway device, choice of agent for induction and maintenance of anaesthesia, and deep <em>vs</em> awake tracheal extubation techniques along with a risk stratification framework are discussed.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1212-1221"},"PeriodicalIF":9.1,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364461","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":"The need for rigour in consensus statements and guidelines","authors":"Simon J. Howell","doi":"10.1016/j.bja.2024.08.012","DOIUrl":"10.1016/j.bja.2024.08.012","url":null,"abstract":"<div><div>Clinical guidelines and consensus statements are an essential aid to clinical practice. However, they bring with them risks. Amongst these are the exclusion of key stakeholders, the creation of mutual self-citation networks, and a lack of rigour in implementing and documenting the consensus process. This editorial explores the challenges of producing robust consensus statements and guidelines that have impact, and identifies current frameworks for addressing these. It is important to conduct clinical consensus exercises using recognised and accepted methodologies.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1123-1125"},"PeriodicalIF":9.1,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647106","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":"Educational outcomes of simulation-based training in regional anaesthesia: a scoping review.","authors":"Balakrishnan Ashokka, Lawrence Siu-Chun Law, Archana Areti, David Burckett-St Laurent, Roman Oliver Zuercher, Ki-Jinn Chin, Reva Ramlogan","doi":"10.1016/j.bja.2024.07.037","DOIUrl":"https://doi.org/10.1016/j.bja.2024.07.037","url":null,"abstract":"<p><strong>Background: </strong>Structured training in regional anaesthesia includes pretraining on simulation-based educational platforms to establish a safe and controlled learning environment before learners are provided clinical exposure in an apprenticeship model. This scoping review was designed to appraise the educational outcomes of current simulation-based educational modalities in regional anaesthesia.</p><p><strong>Methods: </strong>This review conformed to PRISMA-ScR guidelines. Relevant articles were searched in PubMed, Scopus, Google Scholar, Web of Science, and EMBASE with no date restrictions, until November 2023. Studies included randomised controlled trials, pre-post intervention, time series, case control, case series, and longitudinal studies, with no restrictions to settings, language or ethnic groups. The Kirkpatrick framework was applied for extraction of educational outcomes.</p><p><strong>Results: </strong>We included 28 studies, ranging from 2009 to 2023, of which 46.4% were randomised controlled trials. The majority of the target population was identified as trainees or residents (46.4%). Higher order educational outcomes that appraised translation to real clinical contexts (Kirkpatrick 3 and above) were reported in 12 studies (42.9%). Two studies demonstrated translational patient outcomes (Level 4) with reduced incidence of paraesthesia and clinical complications. The majority of studies appraised Level 3 outcomes of performance improvements in either laboratory simulation contexts (42.9%) or demonstration of clinical performance improvements in regional anaesthesia (39.3%).</p><p><strong>Conclusions: </strong>There was significant heterogeneity in the types of simulation modalities used, teaching interventions applied, study methodologies, assessment tools, and outcome measures studied. When improvisations were made to regional anaesthesia simulation platforms (hybrid simulation), there were sustained educational improvements beyond 6 months. Newer technology-enhanced innovations such as virtual, augmented, and mixed reality simulations are evolving, with early reports of educational effectiveness.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364458","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 fluid management: evidence-based consensus recommendations from the international multidisciplinary PeriOperative Quality Initiative","authors":"Marlies Ostermann ,&nbsp;Georg Auzinger ,&nbsp;Michael Grocott ,&nbsp;Victoria Morton-Bailey ,&nbsp;Jacob Raphael ,&nbsp;Andrew D. Shaw ,&nbsp;Alexander Zarbock","doi":"10.1016/j.bja.2024.07.038","DOIUrl":"10.1016/j.bja.2024.07.038","url":null,"abstract":"<div><div>Fluid therapy is an integral component of perioperative management. In light of emerging evidence in this area, the Perioperative Quality Initiative (POQI) convened an international multiprofessional expert meeting to generate evidence-based consensus recommendations for fluid management in patients undergoing surgery. This article provides a summary of the recommendations for perioperative fluid management of surgical patients from the preoperative period until hospital discharge and for all types of elective and emergency surgery, apart from burn injuries and head and neck surgery. Where evidence was lacking, recommendations for future research were generated. Specific recommendations are made for fluid management in elective major noncardiac surgery, cardiopulmonary bypass, thoracic surgery, neurosurgery, minor noncardiac surgery under general anaesthesia, and critical illness. There are ongoing gaps in knowledge resulting in variation in practice and some disagreement with our consensus recommendations. Perioperative fluid management should be individualised, taking into account the type of surgery and important patient factors, including intravascular volume status and acute and chronic comorbidities. Recommendations are made for further research in perioperative fluid management to address important gaps.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1263-1275"},"PeriodicalIF":9.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142341994","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 intravenous iron supplementation in reducing transfusion risk following cardiac surgery: an updated meta-analysis of randomised controlled trials","authors":"Kuo-Chuan Hung ,&nbsp;Li-Chen Chang ,&nbsp;Chun-Ning Ho ,&nbsp;Chih-Wei Hsu ,&nbsp;Chia-Hung Yu ,&nbsp;Jheng-Yan Wu ,&nbsp;Chien-Ming Lin ,&nbsp;I-Wen Chen","doi":"10.1016/j.bja.2024.08.030","DOIUrl":"10.1016/j.bja.2024.08.030","url":null,"abstract":"<div><h3>Background</h3><div>Previous meta-analyses of intravenous iron supplementation for reducing red blood cell (RBC) transfusion risk after cardiac surgery were inconclusive because of limited data. This updated meta-analysis incorporates recent evidence.</div></div><div><h3>Methods</h3><div>Major databases were searched on May 2, 2024 for randomised controlled trials comparing the incidence of RBC transfusion between adult patients receiving <em>intravenous iron supplementation</em> and those receiving controls (i.e. oral iron or placebo) after cardiac surgery. The secondary outcomes included the number of RBC units transfused, postoperative haemoglobin levels, iron status, complications, and length of hospital stay. Trial sequential analysis was conducted to examine the robustness of evidence.</div></div><div><h3>Results</h3><div>Fourteen randomised controlled trials including 2043 subjects were identified. Intravenous iron supplementation was found to reduce the RBC transfusion risk compared with controls (relative risk 0.77, 95% confidence interval [CI] 0.65–0.91, <em>P</em>=0.002, <em>n</em>=1955, <em>I</em>²=61%, certainty of evidence: moderate). The trial sequential analysis supported the robustness of the evidence. Furthermore, haemoglobin levels were higher in the intravenous iron supplementation group on postoperative days 4–10 (mean difference 0.17 g dl⁻¹, 95% CI 0.06–0.29, <em>n</em>=1989) and &gt;21 days (mean difference 0.66 g/dl⁻¹, 95% CI 0.36–0.95, <em>n</em>=1008). Postoperative iron status also improved with Intravenous iron supplementation, particularly on postoperative days 4–10. There were no significant differences in other outcomes, including mortality.</div></div><div><h3>Conclusions</h3><div>Intravenous iron supplementation can reduce RBC transfusion risk and improve postoperative haemoglobin level and iron status after cardiac surgery, supporting the implementation of Intravenous iron supplementation in perioperative blood management strategies.</div></div><div><h3>Systematic review protocol</h3><div>CRD42024542206 (PROSPERO).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1137-1149"},"PeriodicalIF":9.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142329259","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":"From pain level to pain experience: redefining acute pain assessment to enhance understanding of chronic postsurgical pain","authors":"Axel Maurice-Szamburski ,&nbsp;Sophie Bringuier ,&nbsp;Pascal Auquier ,&nbsp;Xavier Capdevila","doi":"10.1016/j.bja.2024.08.003","DOIUrl":"10.1016/j.bja.2024.08.003","url":null,"abstract":"<div><h3>Background</h3><div>Chronic postsurgical pain (CPSP) significantly impairs quality of life and poses a substantial healthcare burden, affecting up to a quarter of patients undergoing surgery. Although acute pain is recognised as a predictor for CPSP development, the role of patient experience remains underexplored. This study examines the predictive value of patient experience alongside traditional risk factors for CPSP after orthopaedic surgery.</div></div><div><h3>Methods</h3><div>An exploratory analysis was conducted on 294 patients from a multicentre randomised clinical trial comparing continuous perineural analgesia and single-injection nerve block in ambulatory orthopaedic surgeries. Patient experience was assessed using the Evaluation du Vecu de l’Anesthésie Générale (EVAN-G) validated questionnaire. Factors associated with CPSP at 90 days after surgery were identified through univariate and multivariate analyses, incorporating patient-reported outcomes and classical variables.</div></div><div><h3>Results</h3><div>Out of 219 patients with complete data, 63 (29%) developed CPSP at day 90. Multivariate analysis revealed a poor pain experience, as assessed by the pain dimension of EVAN-G on postoperative day 2, as an independent predictor of CPSP (odds ratio 6.45, 95% confidence interval 1.65–25.26, <em>P</em>&lt;0.01). Poor pain experience was associated with an augmented risk of CPSP.</div></div><div><h3>Conclusions</h3><div>This study underscores the role of patient-reported outcomes, specifically the pain experience dimension captured by the EVAN-G scale, in prediction of CPSP 90 days after surgery. It suggests a shift from conventional assessments of pain intensity to a comprehensive understanding of pain experience, advocating for tailored pain management approaches that could reduce chronic pain, thereby improving patient quality of life and functional recovery.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 5","pages":"Pages 1021-1027"},"PeriodicalIF":9.1,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142329258","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":"Procedural sedation competencies: a review and multidisciplinary international consensus statement on knowledge, skills, training, and credentialing.","authors":"Piet L Leroy,Baruch S Krauss,Luciane R Costa,Egidio Barbi,Michael G Irwin,Douglas W Carlson,Anthony Absalom,Gary Andolfatto,Mark G Roback,Franz E Babl,Keira P Mason,James Roelofse,Paulo S Costa,Steven M Green,","doi":"10.1016/j.bja.2024.07.036","DOIUrl":"https://doi.org/10.1016/j.bja.2024.07.036","url":null,"abstract":"Procedural sedation is practised by a heterogeneous group of practitioners working in a wide array of settings. However, there are currently no accepted standards for the competencies a sedation practitioner should have, the content of sedation training programmes, and guidelines for credentialing. The multidisciplinary International Committee for the Advancement of Procedural Sedation sought to develop a consensus statement on the following: which competencies should medical or dental practitioners have for procedural sedation and how are they obtained, assessed, maintained, and privileged. Using the framework of Competency-Based Medical Education, the practice of procedural sedation was defined as a complex professional task requiring demonstrable integration of different competencies. For each question, the results of a literature review were synthetised into preliminary statements. Following an iterative Delphi review method, final consensus was reached. Using multispeciality consensus, we defined procedural sedation competence by identifying a set of core competencies in the domains of knowledge, skills, and attitudes across physical safety, effectiveness, psychological safety, and deliberate practice. In addition, we present a standardised framework for competency-based training and credentialing of procedural sedation practitioners.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"19 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328679","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":"Feasibility of ultrasound-guided nerve blocks in simulated microgravity: a proof-of-concept study for regional anaesthesia during deep space missions","authors":"Mathew B. Kiberd,&nbsp;Regan Brownbridge,&nbsp;Matthew Mackin,&nbsp;Daniel Werry,&nbsp;Sally Bird,&nbsp;Garrett Barry,&nbsp;Jonathan G. Bailey","doi":"10.1016/j.bja.2024.07.034","DOIUrl":"10.1016/j.bja.2024.07.034","url":null,"abstract":"<div><h3>Background</h3><div>With crewed deep space exploration on the horizon, preparation for potential astronaut health crises in space missions has become vital. Administration of anaesthesia and analgesia presents many challenges owing to constraints specific to space (physiologic and ergonomic challenges associated with microgravity) and nonspecific factors (isolation and lack of supplies). Regional anaesthesia can be the safest option; however, we hypothesised that the ergonomics of microgravity would compromise ease and accuracy of nerve blocks.</div></div><div><h3>Methods</h3><div>We evaluated the feasibility of regional anaesthesia in a simulated microgravity environment (free-floating underwater conditions) using a meat (bovine muscle) model. Forty meat models were randomised for injection under simulated microgravity or normal gravity conditions. Success rates were determined by blinded assessors after injection. Parameters assessed included time to block, ease of image acquisition, and ease of needle placement.</div></div><div><h3>Results</h3><div>The median time to block in normal gravity was 27 (interquartile range 21–69) s <em>vs</em> 35 (interquartile range 22–48) s in simulated microgravity (<em>P</em>=0.751). Ease of image acquisition was similar in both conditions, as was ease of needle placement. There was no significant difference in the rate of accidental intraneural injections (5% <em>vs</em> 5%), with block success rates comparable in both scenarios (80% normal gravity <em>vs</em> 85% microgravity, <em>P</em>&gt;0.999).</div></div><div><h3>Conclusions</h3><div>Regional anaesthesia appears feasible for experts in simulated microgravity despite the ergonomic challenges. Although our model has limitations and might not fully capture the complexities of actual space conditions, it provides a foundation for future research into anaesthesia and analgesia during deep space missions.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1276-1283"},"PeriodicalIF":9.1,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328768","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":"Hospital action plan for mitigating anaesthetic nitrous oxide emissions","authors":"Alifia Chakera ,&nbsp;Anna Fuhrmann","doi":"10.1016/j.bja.2024.08.021","DOIUrl":"10.1016/j.bja.2024.08.021","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1514-1517"},"PeriodicalIF":9.1,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328850","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":"Standardisation of training in anaesthesiology in Europe: a survey on the impact of the 2022 European Training Requirements in Anaesthesiology","authors":"Alessandro Scudellari ,&nbsp;Federico Bilotta","doi":"10.1016/j.bja.2024.07.029","DOIUrl":"10.1016/j.bja.2024.07.029","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 5","pages":"Pages 1104-1107"},"PeriodicalIF":9.1,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328678","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}