European Journal of Anaesthesiology最新文献

Background: Apnoeic oxygenation using high-flow nasal oxygen is becoming a commonly used technique in adult patients undergoing laryngotracheal surgery. Despite widespread adoption, there are no best practice guidelines governing its safe delivery.

Objective: To develop a checklist for use during laryngotracheal surgery to guide the safe delivery of apnoeic oxygenation using high-flow nasal oxygen.

Design: Recognised experts in the field of apnoeic oxygenation were invited to participate in a Delphi process to establish essential items for inclusion in the safety checklist. An online Delphi survey platform was used to facilitate this process.

Setting: A panel of 36 experts was assembled from 11 countries. They participated voluntarily in an 8-week Delphi process that included one preliminary round, two electronic voting rounds and a final virtual roundtable discussion. A small steering group was responsible for leading the Delphi process, collating the electronic voting responses, analysing the results and compiling the final checklist.

Main outcome measures: The consensus threshold for inclusion/exclusion of items in the safety checklist was set at at least 80% for the first and second electronic voting rounds. The consensus threshold was set at 70% for the final roundtable discussion.

Results: The final checklist comprises 19 items, sub-divided into pre-procedure, peri-procedure and post-procedure aspects of patient care. The Delphi process was well attended, with an expert attrition rate of only 6%. A number of items reached more than 90% consensus, including the requirement to establish patients' suitability for the technique in advance of surgery and preparedness for the immediate implementation of an agreed individualised rescue oxygenation strategy.

Conclusion: A Delphi process involving international experts has formulated a 19-item checklist for guiding the safe delivery of apnoeic oxygenation using high-flow nasal oxygen in adult patients undergoing laryngotracheal surgery. Further studies are required to assess the effects of this checklist on patient safety and outcomes.

Background: Optimising a mother's quality of recovery following caesarean delivery is of paramount importance as it facilitates maternal care of the newborn and affects physical, psychological and emotional well being. Intrathecal morphine (ITM) reduces postoperative pain and may improve quality of recovery: however its widespread use is limited.

Objective: To assess the effects of implementing ITM for caesarean delivery on postoperative quality of recovery.

Study design: Single-centre observational before-after study.

Setting: Tertiary university hospital, the Netherlands, January 2023 until April 2024.

Study population: Patients who underwent caesarean delivery under spinal anaesthesia.

Intervention: Patients recruited before implementation of ITM (n = 55) received patient-controlled intravenous analgesia with morphine or continuation of epidural analgesia previously used for labour ('pre-ITM group'). Patients recruited after implementation of ITM (n = 47) received ITM 100 μg and oral morphine tablets 10 mg as needed ('ITM group').

Main study parameters/endpoints: Primary outcome was the score on the Obstetric Quality of Recovery (ObsQoR-10-Dutch) questionnaire (0 to 100). Secondary outcomes included ObsQoR-10 subscores, length of stay, opioid consumption and self-reported general health score (0 to 100).

Results: Protocol adherence for ITM was 98%. Quality of recovery improved significantly [ObsQoR-10 scores pre-ITM 65 ± 16 vs. ITM 74 ± 13 points, mean difference 9.0 (95% CI, 3.1 to 15] points, P = 0.002], with improvement in pain scores, physical comfort, independence and psychological wellbeing. In multivariate analysis, the improvement was 6.3 (95% CI, 0.37 to 12.2] points, which was statistically significant but did not reach the predefined threshold for clinical relevance. There was, however, an improvement in self-reported general health score (57 ± 18 vs. 68 ± 17, P = 0.002), median [IQR] length of hospital stay (41 [36 to 51] vs. 37 [32 to 49] hours, P = 0.032) and median [IQR] opioid consumption (52 [35 to 73] vs. 0 [0 to 0] mg, P < 0.001).

Conclusions: Implementing ITM for caesarean delivery resulted in moderate improvements in obstetric recovery and reduced opioid consumption. Cautious interpretation is warranted given the nonrandomised design of this implementation study. Our findings support the use of ITM in a multimodal analgesia strategy for patients undergoing caesarean delivery.