British journal of anaesthesia最新文献

{"title":"Individualised positive end-expiratory pressure to minimise driving pressure and postoperative pulmonary complications in minimally invasive thoracic and abdominal surgery a systematic review and meta-analysis.","authors":"Megan Abbott,Richard Ma,Hawwa Chakera,Teruko Kishibe,Martin Girard,Alexis F Turgeon,Ary Serpa Neto,Michael C Sklar,Ashwin Sankar","doi":"10.1016/j.bja.2026.02.036","DOIUrl":"https://doi.org/10.1016/j.bja.2026.02.036","url":null,"abstract":"BACKGROUNDMechanical ventilation during minimally invasive surgery is associated with postoperative pulmonary complications. Limiting driving pressure appears to reduce pulmonary complications with lung-protective ventilation strategies. Whether individualising PEEP minimises driving pressure to reduce pulmonary complications is unknown. In this systematic review, we assessed whether individualised PEEP strategies during minimally invasive surgery reduce postoperative pulmonary outcomes and driving pressures or both.METHODSWe searched Medline, Central, LILACS, Embase, and Scopus for studies comparing individualised PEEP to lung-protective ventilation in minimally invasive thoracic and abdominal surgery (PROSPERO CRD42023495377). The primary outcome was postoperative pulmonary complication. Random-effects models generated risk ratios (RRs) with 95% confidence intervals (95% CIs) for binary outcomes. We conducted prespecified subgroup analyses by surgery type and post hoc subgroup analyses by individualised PEEP strategy and patient factors. We compared driving pressure differences between individualised PEEP and lung-protective strategies. Statistical heterogeneity was assessed using the I2 index and the risk of bias with Cochrane (RoB2) and ROBINS-I.RESULTSThirty studies were included (n=3295 participants). Individualised PEEP was associated with reduced risk of postoperative pulmonary complications, compared with lung-protective ventilation (RR=0.67, 95% CI=0.56-0.79, I2=0.4%). This association was consistent in abdominal and thoracic surgery, and in subgroup analyses. Individualised PEEP was associated with lower driving pressures (mean difference= -3.17, 95% CI= -3.84 to -2.50); I2=86.6%). The certainty of evidence for PPCs was moderate, with a low risk of bias.CONCLUSIONIndividualised PEEP was associated with fewer postoperative pulmonary complications and lower driving pressures during minimally invasive surgery; showing causality requires further research.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"20 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663828","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":"Difficult Airway Society 2025 guidelines for management of unanticipated difficult tracheal intubation in adults. Response to Br J Anaesth 2026; 136: 761-2.","authors":"Kariem El-Boghdadly,Imran Ahmad, ","doi":"10.1016/j.bja.2026.02.017","DOIUrl":"https://doi.org/10.1016/j.bja.2026.02.017","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"33 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147649005","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":"Personalised care and subgroup evidence: anticipated effects, exploratory models, and evidentiary standards.","authors":"Carsten Külls,Niloufar Dadashpour,Majid Golestanieraghi","doi":"10.1016/j.bja.2026.02.026","DOIUrl":"https://doi.org/10.1016/j.bja.2026.02.026","url":null,"abstract":"Personalised treatment strategies are increasingly promoted in perioperative and critical care medicine, yet the evidentiary basis for their routine clinical adoption remains heterogeneous. Some approaches reflect anticipated, biologically coherent subgroup effects along established risk gradients, while others propose individualised treatment selection based on exploratory, data-driven models derived from high-dimensional analyses. We argue that personalisation is not a binary concept but exists along a continuum of evidentiary credibility, and should be evaluated according to subgroup plausibility, reproducibility, and transportability rather than novelty alone. A proportionate, evidence-first framework is proposed to clarify when stratified care is robust and when exploratory personalisation requires substantially higher evidentiary support.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"123 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147648975","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":"Association of peripheral nerve blocks with increased postoperative pain and opioid use in orthopaedic surgery: are postoperative outcomes linked to rebound pain occurrence? Comment on Br J Anaesth 2025; 135: 1286-96.","authors":"Nassim Touil,Patricia Lavand'homme","doi":"10.1016/j.bja.2026.02.033","DOIUrl":"https://doi.org/10.1016/j.bja.2026.02.033","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"15 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147648974","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 Difficult Airway Society 2025 Guidelines Education Package: bridging the translational gap.","authors":"Mary Madden,Gunjeet Dua,Imran Ahmad","doi":"10.1016/j.bja.2026.03.013","DOIUrl":"https://doi.org/10.1016/j.bja.2026.03.013","url":null,"abstract":"We discuss the rationale, structure, and intended functions of the Difficult Airway Society 2025 Education Package, developed as one of the first coordinated educational supplements to accompany the dissemination of airway management guidelines. The initiative integrates knowledge acquisition, cognitive rehearsal, and simulation within a multimodal framework designed to strengthen shared mental models and multiprofessional practice. Attention is given to standardisation and scalability, informed by human factors, implementation science, and behavioural principles, to support consistent guideline application across varied clinical environments. The Education Package offers a feasible and practical route through which recommendations can become embedded in everyday clinical care.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"2 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641615","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":"Fatigue is not a virtue: social-media celebrations and patient safety in the operating theatre.","authors":"Fang Li,Liqun Zhang","doi":"10.1016/j.bja.2026.02.022","DOIUrl":"https://doi.org/10.1016/j.bja.2026.02.022","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"32 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147636011","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":"Ketamine versus alternate agents to prevent postinduction haemodynamic instability during tracheal intubation of critically ill adults: a systematic review and meta-analysis.","authors":"Daniel Loughnan,Humphrey G M Walker,Nicholas Woodland,Samuel Finlayson,Helen Wilding,Ary Serpa Neto,Adam M Deane,Matthew W Semler,Alastair Brown","doi":"10.1016/j.bja.2026.02.023","DOIUrl":"https://doi.org/10.1016/j.bja.2026.02.023","url":null,"abstract":"BACKGROUNDPostinduction haemodynamic instability is common in critically ill adults undergoing emergency tracheal intubation. Ketamine is frequently used for induction of anaesthesia in patients perceived to be at high risk of haemodynamic instability; however, its haemodynamic effects relative to other induction agents remain uncertain. We sought to evaluate the effect of ketamine compared with alternative induction agents on postinduction haemodynamic instability and other clinically important outcomes during emergency tracheal intubation.METHODSWe conducted a systematic review and meta-analysis according to a prospectively registered International Prospective Register of Systematic Reviews protocol (CRD42024618433) and Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Randomised controlled trials enrolling adults undergoing tracheal intubation in the emergency department or intensive care unit were included. Searches of six databases and three trial registries were performed to November 5, 2025, supplemented by pre-publication access to the RSI trial. The primary outcome was postinduction haemodynamic instability harmonised across trials. A random-effects model with Hartung-Knapp adjustment was used.RESULTSTen trials (n=4673) met inclusion criteria, of which nine used etomidate as the comparator, and one used a regimen of midazolam and sufentanil. There was a significantly greater risk of postinduction haemodynamic instability (risk ratio 1.28 [1.13-1.45]) with ketamine compared with etomidate. However, when compared with the alternative comparator, ketamine appeared superior (risk ratio 0.51 [0.29-0.89]). No differences in mortality, ventilator-free days, or ICU-free days were shown.CONCLUSIONSKetamine appears associated with less haemodynamic stability than etomidate during the peri-intubation period but might perform more favourably than other agents, with no effect on longer-term outcomes.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"15 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147636001","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":"Difficult Airway Society 2025 guidelines for management of unanticipated difficult tracheal intubation in adults: the importance of anatomical endpoints and minimal complexity in eFONA. Response to Br J Anaesth 2026; 136: 1040–1","authors":"Kariem El-Boghdadly, Imran Ahmad","doi":"10.1016/j.bja.2026.02.018","DOIUrl":"https://doi.org/10.1016/j.bja.2026.02.018","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"14 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597973","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":"Incidence of hiccups with remimazolam compared to propofol: a systematic review and meta-analysis with trial sequential analysis","authors":"Kanako Sasaki, Chikako Ishikawa, Yuriko Kondo, Takahisa Goto, Takahiro Mihara","doi":"10.1016/j.bja.2026.02.028","DOIUrl":"https://doi.org/10.1016/j.bja.2026.02.028","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"64 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597972","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":"Continuous posterior extrathoracic fascial plane block versus continuous paravertebral block for pain management in patients with multiple rib fractures. Response to Br J Anaesth 2026; 136: 1074–5","authors":"Xavier Capdevila, Matthias Herteleer, Olivier Choquet","doi":"10.1016/j.bja.2026.02.029","DOIUrl":"https://doi.org/10.1016/j.bja.2026.02.029","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"49 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597971","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}