British journal of anaesthesia最新文献

{"title":"Machine learning-augmented interventions in perioperative care: a systematic review and meta-analysis","authors":"Divya Mehta ,&nbsp;Xiomara T. Gonzalez ,&nbsp;Grace Huang ,&nbsp;Joanna Abraham","doi":"10.1016/j.bja.2024.08.007","DOIUrl":"10.1016/j.bja.2024.08.007","url":null,"abstract":"<div><h3>Background</h3><div>We lack evidence on the cumulative effectiveness of machine learning (ML)-driven interventions in perioperative settings. Therefore, we conducted a systematic review to appraise the evidence on the impact of ML-driven interventions on perioperative outcomes.</div></div><div><h3>Methods</h3><div>Ovid MEDLINE, CINAHL, Embase, Scopus, PubMed, and ClinicalTrials.gov were searched to identify randomised controlled trials (RCTs) evaluating the effectiveness of ML-driven interventions in surgical inpatient populations. The review was registered with PROSPERO (CRD42023433163) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Meta-analysis was conducted for outcomes with two or more studies using a random-effects model, and vote counting was conducted for other outcomes.</div></div><div><h3>Results</h3><div>Among 13 included RCTs, three types of ML-driven interventions were evaluated: Hypotension Prediction Index (HPI) (<em>n</em>=5), Nociception Level Index (NoL) (<em>n</em>=7), and a scheduling system (<em>n</em>=1). Compared with the standard care, HPI led to a significant decrease in absolute hypotension (<em>n</em>=421, <em>P</em>=0.003, I²=75%) and relative hypotension (<em>n</em>=208, <em>P</em>&lt;0.0001, I²=0%); NoL led to significantly lower mean pain scores in the post-anaesthesia care unit (PACU) (<em>n</em>=191, <em>P</em>=0.004, I²=19%). NoL showed no significant impact on intraoperative opioid consumption (<em>n</em>=339, <em>P</em>=0.31, I²=92%) or PACU opioid consumption (<em>n</em>=339, <em>P</em>=0.11, I²=0%). No significant difference in hospital length of stay (<em>n</em>=361, <em>P</em>=0.81, I²=0%) and PACU stay (<em>n</em>=267, <em>P</em>=0.44, I²=0) was found between HPI and NoL.</div></div><div><h3>Conclusions</h3><div>HPI decreased the duration of intraoperative hypotension, and NoL decreased postoperative pain scores, but no significant impact on other clinical outcomes was found. We highlight the need to address both methodological and clinical practice gaps to ensure the successful future implementation of ML-driven interventions.</div></div><div><h3>Systematic review protocol</h3><div>CRD42023433163 (PROSPERO).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1159-1172"},"PeriodicalIF":9.1,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324950","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":"Sodium leak channels in the central amygdala modulate the analgesic potency of volatile anaesthetics in mice","authors":"Yaoxin Yang ,&nbsp;Jingxuan Qiu ,&nbsp;Jin Liu ,&nbsp;Donghang Zhang ,&nbsp;Mengchan Ou ,&nbsp;Han Huang ,&nbsp;Peng Liang ,&nbsp;Tao Zhu ,&nbsp;Cheng Zhou","doi":"10.1016/j.bja.2024.06.049","DOIUrl":"10.1016/j.bja.2024.06.049","url":null,"abstract":"<div><h3>Background</h3><div>Analgesia is an important effect of volatile anaesthetics, for which the spinal cord is a critical neural target. However, how supraspinal mechanisms modulate analgesic potency of volatile anaesthetics is not clear. We investigated the contribution of the central amygdala (CeA) to the analgesic effects of isoflurane and sevoflurane.</div></div><div><h3>Methods</h3><div>Analgesic potencies of volatile anaesthetics were tested during optogenetic and chemogenetic inhibition of CeA neurones. <em>In vivo</em> calcium imaging was used to measure neuronal activities of CeA neuronal subtypes under volatile anaesthesia. Contributions of the sodium leak channel (NALCN) in GABAergic CeA (CeA^GABA) neurones to analgesic effects of volatile anaesthetics were explored by specific NALCN knockdown. Electrophysiological recordings on acute brain slices were applied to measure volatile anaesthetic modulation of CeA neuronal activity by NALCN.</div></div><div><h3>Results</h3><div>Optogenetic or chemogenetic silencing CeA neurones reduced the analgesic effects of isoflurane or sevoflurane <em>in vivo</em>. The calcium signals of CeA^GABA neurones increased during exposure to isoflurane or sevoflurane at analgesic concentrations. Knockdown of NALCN in CeA^GABA neurones attenuated antinociceptive effects of isoflurane, sevoflurane, or both. For example, mean concentrations of isoflurane, sevoflurane, or both that induced immobility to tail-flick stimuli were significantly increased (isoflurane: 1.17 [0.05] vol% <em>vs</em> 1.24 [0.04] vol%, <em>P=</em>0.01; sevoflurane: 2.65 [0.07] vol% <em>vs</em> 2.81 [0.07] vol%; <em>P&lt;</em>0.001). In brain slices, isoflurane, sevoflurane, or both at clinical concentrations increased NALCN-mediated holding currents and conductance in CeA^GABA neurones, which increased excitability of CeA^GABA neurones in an NALCN-dependent manner.</div></div><div><h3>Conclusions</h3><div>The analgesic potencies of volatile anaesthetics are partially mediated by modulation of NALCN in CeA^GABA neurones.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 5","pages":"Pages 983-997"},"PeriodicalIF":9.1,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324949","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":"Mitigating the systemic loss of nitrous oxide: a narrative review and data-driven practice analysis","authors":"Brian B. Chesebro ,&nbsp;Seema Gandhi","doi":"10.1016/j.bja.2024.08.028","DOIUrl":"10.1016/j.bja.2024.08.028","url":null,"abstract":"<div><div>Given the negative health impacts of climate change, clinicians have a fundamental responsibility to take an active role in mitigating the environmental impact of their practices. Inhaled anaesthetics are potent greenhouse gases, including nitrous oxide (N₂O), with their long atmospheric lifetime, high global warming potential, and ozone-depleting properties. However, few clinicians realise that losses from central N₂O supply systems account for the vast majority of overall N₂O consumption in healthcare. Central N₂O supply systems are standard in most facilities, compounding the impact of these under-recognised, unnecessary greenhouse gas emissions. We review the environmental impact of N₂O in healthcare, offer N₂O utilisation data from 47 hospitals in the USA, and provide clinician-targeted guidance for mitigating these widespread N₂O emissions. Consistent with findings from the UK and Australia, data from two large US healthcare systems reveal significant nonclinical N₂O losses of 47.2–99.8% of total procured N₂O. As illustrated in one quaternary medical centre, the transition from central to portable supply systems reduced overall N₂O consumption by 97.6%. To date, this mitigation initiative has been successfully implemented at over 25 hospitals in our system. Raising awareness of this considerable source of healthcare-specific N₂O emissions empowers clinicians to spearhead facility-level engagement and action. As healthcare leaders, clinicians should advocate for decarbonisation of clinical practices and systems while ensuring high-quality patient care.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1413-1418"},"PeriodicalIF":9.1,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324955","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":"Classification system for failed peripheral nerve blocks","authors":"Vasyl Katerenchuk","doi":"10.1016/j.bja.2024.08.031","DOIUrl":"10.1016/j.bja.2024.08.031","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1324-1325"},"PeriodicalIF":9.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321094","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 analgesic effectiveness of perioperative lidocaine infusions for acute and chronic persistent postsurgical pain in patients undergoing breast cancer surgery. Comment on Br J Anaesth 2024; 132: 575–87","authors":"Hongmei Liu,&nbsp;Xiaohong Lei","doi":"10.1016/j.bja.2024.06.036","DOIUrl":"10.1016/j.bja.2024.06.036","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 5","pages":"Pages 1111-1112"},"PeriodicalIF":9.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321033","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":"Ultrasound-guided suprainguinal fascia iliaca compartment block and early postoperative analgesia after total hip arthroplasty. Comment on Br J Anaesth 2024; 133: 146–51","authors":"Michele Carella ,&nbsp;Florian Beck ,&nbsp;Kris Vermeylen","doi":"10.1016/j.bja.2024.08.024","DOIUrl":"10.1016/j.bja.2024.08.024","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1326-1327"},"PeriodicalIF":9.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142341995","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":"Helping clinicians debrief themselves: a simple how-to guide","authors":"Michaela Kolbe ,&nbsp;Benjamin Symon","doi":"10.1016/j.bja.2024.08.014","DOIUrl":"10.1016/j.bja.2024.08.014","url":null,"abstract":"<div><div>The operating theatre is a dynamic and challenging environment where effective teamwork is essential. Routine clinical debriefings, which involve brief reflections on collaboration to identify successes and areas for improvement, have proved to enhance teamwork, particularly in the operating theatre. However, barriers such as time constraints, conflicting priorities, and a lack of standardised debriefing processes hinder their regular use. Implementation of TALK©, a voluntary self-debriefing method, showed significant improvements in debriefing performance and integration of debriefing into routine practice, although long-term consistency remains a challenge.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1129-1133"},"PeriodicalIF":9.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275245","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":"Optimal McGRATH® MAC videolaryngoscope blade size for small children","authors":"Asuka Fujishiro,&nbsp;Takashi Asai","doi":"10.1016/j.bja.2024.08.026","DOIUrl":"10.1016/j.bja.2024.08.026","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1333-1334"},"PeriodicalIF":9.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275228","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":"Interventions to optimise preoperative fasting in paediatrics: a scoping review","authors":"Erika Dulay ,&nbsp;Bronwyn Griffin ,&nbsp;James Brannigan ,&nbsp;Craig McBride ,&nbsp;Adrienne Hudson ,&nbsp;Amanda Ullman","doi":"10.1016/j.bja.2024.08.010","DOIUrl":"10.1016/j.bja.2024.08.010","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative fasting is the standard of care for patients undergoing a procedure under general anaesthesia. Despite the increased leniency of fasting guideline recommendations, prolonged preoperative fasting periods continue to disproportionally affect paediatric patients. This review maps existing interventions optimising paediatric fasting practices, to explore strategies that can be best applied in clinical practice.</div></div><div><h3>Methods</h3><div>A search strategy applied to PubMed, CINAHL, Embase, Scopus, and the Cochrane Database involved four key concepts: (1) fasting, (2) preoperative, (3) paediatric, and (4) quality improvement intervention. The Preferred Reporting Items of Systematic Reviews and Meta-analyses extension for Scoping Reviews was utilised in this review.</div></div><div><h3>Results</h3><div>Thirteen heterogeneous studies, involving approximately 31 000 children across five continents, were included. Each intervention studied fell into at least one of the following six themes: (1) change in facility protocol, (2) technology-based intervention, (3) individualised fasting programs, (4) processes to improve communication between clinicians, (5) processes to improve communication to parents and families, and (6) staff education.</div></div><div><h3>Conclusions</h3><div>A variety of interventions have been studied to optimise paediatric preoperative fasting duration. These interventions show potential in reducing preoperative fasting duration.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1201-1211"},"PeriodicalIF":9.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275246","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":"Lived experience of burnout and fatigue in perioperative healthcare professionals in Rwanda: a qualitative study","authors":"M. Dylan Bould ,&nbsp;Eugene Tuyishime ,&nbsp;Charles Nkurunziza ,&nbsp;Christophe Mpirimbanyi ,&nbsp;Gedeon Mutabezi ,&nbsp;Logan Wiwchar ,&nbsp;Lydia Yilma ,&nbsp;Christopher Charles ,&nbsp;Christian Rangel","doi":"10.1016/j.bja.2024.07.018","DOIUrl":"10.1016/j.bja.2024.07.018","url":null,"abstract":"<div><h3>Background</h3><div>There is a lack of qualitative data on the negative effects of workplace stressors on the well-being of healthcare professionals in hospitals in Africa. It is unclear how well research methods developed for high-income country contexts apply to different cultural, social, and economic contexts in the global south.</div></div><div><h3>Methods</h3><div>We conducted a qualitative interview-based study including 64 perioperative healthcare professionals across all provinces of Rwanda. We used an iterative thematic analysis and aimed to explore the lived experience of Rwandan healthcare professionals and to consider to what extent the Maslach model aligns with these experiences.</div></div><div><h3>Results</h3><div>We found mixed responses of the effects on individuals, including the denial of burnout and fatigue to the points of physical exhaustion. Responses aligned with Maslach's three-factor model of emotional exhaustion, decreased personal accomplishment, and depersonalisation, with downstream effects on the healthcare system. Other factors included strongly patriotic culture, goals framed by narratives of Rwanda's recovery after the genocide, and personal and collective investment in developing the Rwandan healthcare system.</div></div><div><h3>Conclusions</h3><div>The Rwandan healthcare system presents many challenges which can become profoundly stressful for the workforce. Consideration of reduced personal and collective accomplishment, of moral injury, and its diverse downstream effects on the whole healthcare system may better represent the costs of burnout Rwanda. It is likely that improving the causes of work-based stress will require a significant investment in improving staffing and working conditions.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 5","pages":"Pages 1051-1061"},"PeriodicalIF":9.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275224","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}