British journal of anaesthesia最新文献

{"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}

{"title":"Home-based prehabilitation: a systematic review and meta-analysis of randomised trials","authors":"Filippo D'Amico ,&nbsp;Sara Dormio ,&nbsp;Giulia Veronesi ,&nbsp;Fabio Guarracino ,&nbsp;Katia Donadello ,&nbsp;Gilda Cinnella ,&nbsp;Riccardo Rosati ,&nbsp;Nicolò Pecorelli ,&nbsp;Gabriele Baldini ,&nbsp;Marina Pieri ,&nbsp;Giovanni Landoni ,&nbsp;Stefano Turi","doi":"10.1016/j.bja.2025.01.010","DOIUrl":"10.1016/j.bja.2025.01.010","url":null,"abstract":"<div><h3>Background</h3><div>Prehabilitation aims to enhance preoperative functional capacity through exercise, nutrition, and psychological programs. Home-based prehabilitation represents an alternative to hospital prehabilitation, with the advantage of not utilising hospital resources. This review aims to evaluate adherence and clinical effectiveness of home-based prehabilitation.</div></div><div><h3>Methods</h3><div>We searched PubMed, Cochrane, and Embase up to October 1, 2024 for randomised controlled trials comparing home-based prehabilitation with standard care. The primary outcome was the proportion of patients with postoperative complications. Secondary outcomes included protocol adherence, and 6-min walking test. We used risk ratios (RR) and mean differences to summarise the results. The risk of bias was assessed using RoB 2 tool.</div></div><div><h3>Results</h3><div>We included 29 randomised trials for a total of 3508 patients. Median adherence to home-based prehabilitation programs was 82%. Home-based prehabilitation reduced the proportion of patients with postoperative complications (508/1322 [38.4%] <em>vs</em> 578/1335 [43.3%], risk ratio 0.84, 95% confidence interval [CI] 0.72–0.98, <em>P</em>=0.02, <em>I</em>²=44%, low certainty). After home-based prehabilitation, 6-min walking test performance was better compared with control (MD 28.2 m (95% CI 9.5–46.9; <em>P</em>&lt;0.01, <em>I</em>²=48). Preoperative depression (MD −0.65, 95% CI −0.87 to −0.43; <em>P</em>&lt;0.001, <em>I</em>²=0%), postoperative anxiety (MD −0.50, 95% CI −0.75 to −0.25; <em>P</em>&lt;0.001, <em>I</em>²=0%, low certainty) and length of hospital stays (MD −0.32 days, 95% CI −0.61 to −0.03; <em>P</em>=0.03, <em>I</em>²=45%, low certainty) were lower with home-based prehabilitation.</div></div><div><h3>Conclusions</h3><div>Home-based prehabilitation reduced the proportion of patients with postoperative complications, but with low certainty of evidence. It also improved preoperative functional capacity, reduced hospital stays, depression and anxiety scores, with good adherence to the intervention.</div></div><div><h3>Systematic review protocol</h3><div>PROSPERO (CRD42024591208).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 1018-1028"},"PeriodicalIF":9.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370462","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 age on the reliability of GE Entropy™ module indices for guidance of maintenance of anaesthesia in adult patients: a single-centre retrospective analysis","authors":"Max Ebensperger ,&nbsp;Matthias Kreuzer ,&nbsp;Stephan Kratzer ,&nbsp;Gerhard Schneider ,&nbsp;Stefan Schwerin","doi":"10.1016/j.bja.2024.11.050","DOIUrl":"10.1016/j.bja.2024.11.050","url":null,"abstract":"<div><h3>Background</h3><div>The GE Entropy™ module uses frontal EEG to compute the processed indices state entropy (SE), response entropy (RE), and burst suppression ratio (BSR) to guide maintenance of anaesthesia by supposedly minimising overly ‘<em>deep</em>’ or ‘<em>light</em>’ anaesthesia. It remains unclear whether the manufacturer-recommended index ranges accurately reflect anaesthesia levels or prevent complications such as burst suppression or arousal reactions.</div></div><div><h3>Methods</h3><div>We retrospectively analysed 15 608 patient records, evaluating 14 770 adult patients (18–90 yr old) undergoing general anaesthesia. Age-dependent effects on processed index values were assessed using linear regression and Spearman's correlation coefficients (rho).</div></div><div><h3>Results</h3><div>During steady-state anaesthesia (BSR=0), only 38.4% (32.5–42.4%) of SE values were within the recommended range, with most values below the target. Age was positively associated with an increase in age-adjusted minimal alveolar concentration for volatile anaesthetics (adjusted [adj.] <em>R</em>²=0.18, <em>P</em>&lt;0.001, rho=0.47 [0.20–0.70]). Despite this, SE paradoxically increased with age (adj. <em>R</em>²=0.45, <em>P</em>&lt;0.001, rho=0.67 [0.51–0.79]). This trend persisted even during periods with positive BSR despite supposedly adequate SE values (adj. <em>R</em>²=0.73, <em>P</em>&lt;0.001, rho=0.90 [0.80–0.95]). Maintaining anaesthesia within the recommended index range did not prevent positive BSR. Additionally, both frequency (adj. <em>R</em>²=0.70, <em>P</em>&lt;0.001, rho=0.92 [0.85–0.95]) and duration (adj. <em>R</em>²=0.73, <em>P</em>&lt;0.001, rho=0.89 [0.82–0.93]) of ΔRE-SE≥10, indicating arousal, increased with age.</div></div><div><h3>Conclusions</h3><div>Despite their intuitive appeal, the processed EEG index values SE, RE, ΔRE-SE, and BSR showed limited reliability in guiding maintenance of anaesthesia, especially in older patients. Anaesthesiologists should not rely exclusively on the recommended index value range, as it is often unattainable and does not prevent burst suppression or arousal indicators.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 1077-1087"},"PeriodicalIF":9.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254882","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":"Striatal neurones expressing D1 dopamine receptors modulate consciousness in sevoflurane but not propofol anaesthesia in mice","authors":"Kang Zhou ,&nbsp;Zi-Jun Hou ,&nbsp;Xu-Liang Jiang ,&nbsp;Yu-Jie Xiao ,&nbsp;Lin-Chen Zhang ,&nbsp;Wei Xu ,&nbsp;Bo Xiong ,&nbsp;Wei-Min Qu ,&nbsp;Yu-Guang Huang ,&nbsp;Zhi-Li Huang ,&nbsp;Lu Wang","doi":"10.1016/j.bja.2024.10.049","DOIUrl":"10.1016/j.bja.2024.10.049","url":null,"abstract":"<div><h3>Background</h3><div>Sevoflurane and propofol are the most widely used inhaled and i.v. general anaesthetics, respectively. The mechanisms by which sevoflurane and propofol induce loss of consciousness (LOC) remain unclear. Recent studies implicate the brain dopaminergic circuit in anaesthetic-induced LOC and the cortical–striatal–thalamic–cortical loop in decoding consciousness. We investigated the contribution of the dorsal striatum, which is a critical interface between the dopaminergic circuit and the cortical–striatal–thalamic–cortical loop, in sevoflurane and propofol anaesthesia.</div></div><div><h3>Methods</h3><div>Electroencephalography and electromyography recordings and righting reflex tests were used to determine LOC and recovery of consciousness (ROC). The activity of D1 dopamine receptor (D1R)-expressing neurones in the dorsal striatum was monitored using fibre photometry, and regulated using optogenetic and chemogenetic methods in D1R-Cre mice.</div></div><div><h3>Results</h3><div>Population activities of striatal D1R neurones began to decrease before LOC and gradually returned after ROC. During sevoflurane anaesthesia, optogenetic activation of striatal D1R neurones induced ROC at cortical and behavioural levels in steady-state anaesthesia and promoted cortical activation in deep burst suppression anaesthesia. Chemogenetic inhibition of striatal D1R neurones accelerated induction (from 242.0 [46.1] to 194.0 [26.9] s; <em>P</em>=0.010) and delayed emergence (from 93.5 [21.2] to 133.5 [33.9] s; <em>P</em>=0.005), whereas chemogenetic activation of these neurones accelerated emergence (from 107 [23.7] to 81.3 [16.1] s; <em>P</em>=0.011). However, neither optogenetic nor chemogenetic manipulation of striatal D1R neurones had any effects on propofol anaesthesia.</div></div><div><h3>Conclusions</h3><div>Striatal D1R neurones modulate the state of consciousness in sevoflurane anaesthesia, but not in propofol anaesthesia.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"134 4","pages":"Pages 1105-1121"},"PeriodicalIF":9.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363661","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":"Chronic postsurgical inguinal pain: incidence and diagnostic biomarkers from a large German national claims database.","authors":"Eva Herrmann, Magnus Schindehütte, Gudrun Kindl, Ann-Kristin Reinhold, Felix Aulbach, Norman Rose, Johannes Dreiling, Daniel Schwarzkopf, Michael Meir, Yuying Jin, Karolin Teichmüller, Anna Widder, Robert Blum, Abdelrahman Sawalma, Nadine Cebulla, Michael Sendtner, Winfried Meissner, Alexander Brack, Mirko Pham, Claudia Sommer, Nicolas Schlegel, Heike L Rittner","doi":"10.1016/j.bja.2024.11.048","DOIUrl":"https://doi.org/10.1016/j.bja.2024.11.048","url":null,"abstract":"<p><strong>Background: </strong>Chronic postsurgical inguinal pain (CPIP) is the most common complication of groin hernia surgery. The characteristics of patients, their medical care, and choice of diagnostic tools remain to be defined to optimise preventive and therapeutic interventions.</p><p><strong>Methods: </strong>Claims data from 2018 and a 1-yr follow-up were analysed for incidence and medical care. A separate cohort (141 healthy controls and 17 CPIP patients) was examined by deep phenotyping. This included sensory testing, blood and skin biopsies, MRI of the dorsal root ganglion (DRG), and patient-reported outcomes.</p><p><strong>Results: </strong>Of 11,221 patients with hernia surgery in 2018 identified, 8.5% had pain before that was relieved by surgery, but a similar percentage had novel pain in this region. Deep phenotyping of 141 healthy controls provided a map of the inguinal sensory system. The following analysis of patients with CPIP revealed that they suffered from moderate pain with neuropathic features, individual sensory abnormalities, and unilateral L1 DRG atrophy. In the blood, levels of C-C-motif chemokine ligand (CCL2) and brain-derived neurotrophic factor (BDNF) were upregulated, whereas apolipoprotein A1 (ApoA1) concentration was reduced. A cluster of DRG atrophy, BDNF, ApoA1, and anxiety correlated best with the diagnosis. CPIP patients with novel pain had significantly more DRG atrophy (-24% ipsilateral vs contralateral volume).</p><p><strong>Conclusions: </strong>CPIP is often newly acquired after surgery. A combination of DRG imaging, serum markers, and anxiety screening can support the diagnosis. In the future, this could guide clinicians towards more personalised therapies (e.g. targeting anxiety or lipid profiles) and possible altered surgical techniques.</p><p><strong>Clinical trial registration: </strong>German Trial Registry DRKS00024588 and DRKS00016790.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254875","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}