BJA open最新文献

英文中文

Adequacy of intraoperative patient handover 术中患者交接的充分性

BJA open

Pub Date : 2023-06-01 DOI: 10.1016/j.bjao.2023.100160

Ahmed Bilal Akhtar, Almas Iqbal, Huma Saleem, Zahra Waheed, Asma Ashraf

引用次数: 0

Reducing ethyl chloride usage with innovative cool sticks 使用创新的冷却棒减少氯乙烷的使用

BJA open

Pub Date : 2023-06-01 DOI: 10.1016/j.bjao.2023.100153

M.N. Arsanious, H. Nugent, D. Rafia, C. Papoutsos, C. McCabe

引用次数: 0

Patient experience and satisfaction with telephone consultations in maternity POAC—a service evaluation at Musgrove Park Hospital Taunton 产妇POAC的患者体验和电话咨询满意度——汤顿Musgrove Park医院的服务评估

BJA open

Pub Date : 2023-06-01 DOI: 10.1016/j.bjao.2023.100192

Anna Perham , Madhavi Keskar

引用次数: 0

Measurement of tracheal tube cuff pressure and the incidence of postoperative sore throat 测量气管管袖口压力与术后喉咙痛的发生率

BJA open

Pub Date : 2023-06-01 DOI: 10.1016/j.bjao.2023.100186

Michael Nesbitt, Shivan Kanani, Gautam Modak, Amr Ali

引用次数: 0

Intraoperative hypotension when using hypotension prediction index software during major noncardiac surgery: a European multicentre prospective observational registry (EU HYPROTECT) 在重大非心脏手术中使用低血压预测指数软件时的术中低血压:欧洲多中心前瞻性观察登记(EU HYPROTECT)

BJA open

Pub Date : 2023-06-01 DOI: 10.1016/j.bjao.2023.100140

Karim Kouz , Manuel Ignacio Monge García , Elisabetta Cerutti , Ivana Lisanti , Gaetano Draisci , Luciano Frassanito , Michael Sander , Amir Ali Akbari , Ulrich H. Frey , Carla Davina Grundmann , Simon James Davies , Abele Donati , Javier Ripolles-Melchor , Daniel García-López , Benjamin Vojnar , Étienne Gayat , Eric Noll , Peter Bramlage , Bernd Saugel

Background

Intraoperative hypotension is associated with organ injury. Current intraoperative arterial pressure management is mainly reactive. Predictive haemodynamic monitoring may help clinicians reduce intraoperative hypotension. The Acumen™ Hypotension Prediction Index software (HPI-software) (Edwards Lifesciences, Irvine, CA, USA) was developed to predict hypotension. We built up the European multicentre, prospective, observational EU HYPROTECT Registry to describe the incidence, duration, and severity of intraoperative hypotension when using HPI-software monitoring in patients having noncardiac surgery.

Methods

We enrolled 749 patients having elective major noncardiac surgery in 12 medical centres in five European countries. Patients were monitored using the HPI-software. We quantified hypotension using the time-weighted average MAP <65 mm Hg (primary endpoint), the proportion of patients with at least one ≥1 min episode of a MAP <65 mm Hg, the number of ≥1 min episodes of a MAP <65 mm Hg, and duration patients spent below a MAP of 65 mm Hg.

Results

We included 702 patients in the final analysis. The median time-weighted average MAP <65 mm Hg was 0.03 (0.00–0.20) mm Hg. In addition, 285 patients (41%) had no ≥1 min episode of a MAP <65 mm Hg; 417 patients (59%) had at least one. The median number of ≥1 min episodes of a MAP <65 mm Hg was 1 (0–3). Patients spent a median of 2 (0–9) min below a MAP of 65 mm Hg.

Conclusions

The median time-weighted average MAP <65 mm Hg was very low in patients in this registry. This suggests that using HPI-software monitoring may help reduce the duration and severity of intraoperative hypotension in patients having noncardiac surgery.

背景:术中低血压与器官损伤有关。目前术中动脉压管理主要是反应性的。预测血流动力学监测可以帮助临床医生减少术中低血压。Acumen™低血压预测指数软件(HPI-software) (Edwards Lifesciences, Irvine, CA, USA)被开发用来预测低血压。我们建立了欧洲多中心、前瞻性、观察性的EU HYPROTECT注册表，以描述在非心脏手术患者中使用hpi软件监测时术中低血压的发生率、持续时间和严重程度。方法:我们在欧洲5个国家的12个医疗中心招募了749例选择性非心脏大手术患者。采用hpi软件对患者进行监测。我们使用时间加权平均MAP <65毫米汞柱(主要终点)、至少一次MAP <65毫米汞柱≥1分钟发作的患者比例、MAP <65毫米汞柱≥1分钟发作的次数以及患者在MAP <65毫米汞柱低于65毫米汞柱的持续时间来量化低血压。结果最终分析纳入702例患者。MAP <65 mm Hg的中位时间加权平均值为0.03 (0.00-0.20)mm Hg。此外，285名患者(41%)没有≥1分钟的MAP <65 mm Hg发作;417例患者(59%)至少有一种。MAP <65 mm Hg≥1分钟发作的中位数为1(0-3)。患者MAP低于65 mm Hg的中位时间为2(0-9)分钟。结论在该登记的患者中位时间加权平均MAP <65 mm Hg非常低。这表明使用hpi软件监测可能有助于减少非心脏手术患者术中低血压的持续时间和严重程度。

{"title":"Intraoperative hypotension when using hypotension prediction index software during major noncardiac surgery: a European multicentre prospective observational registry (EU HYPROTECT)","authors":"Karim Kouz , Manuel Ignacio Monge García , Elisabetta Cerutti , Ivana Lisanti , Gaetano Draisci , Luciano Frassanito , Michael Sander , Amir Ali Akbari , Ulrich H. Frey , Carla Davina Grundmann , Simon James Davies , Abele Donati , Javier Ripolles-Melchor , Daniel García-López , Benjamin Vojnar , Étienne Gayat , Eric Noll , Peter Bramlage , Bernd Saugel","doi":"10.1016/j.bjao.2023.100140","DOIUrl":"10.1016/j.bjao.2023.100140","url":null,"abstract":"<div><h3>Background</h3><p>Intraoperative hypotension is associated with organ injury. Current intraoperative arterial pressure management is mainly reactive. Predictive haemodynamic monitoring may help clinicians reduce intraoperative hypotension. The Acumen™ Hypotension Prediction Index software (HPI-software) (Edwards Lifesciences, Irvine, CA, USA) was developed to predict hypotension. We built up the European multicentre, prospective, observational EU HYPROTECT Registry to describe the incidence, duration, and severity of intraoperative hypotension when using HPI-software monitoring in patients having noncardiac surgery.</p></div><div><h3>Methods</h3><p>We enrolled 749 patients having elective major noncardiac surgery in 12 medical centres in five European countries. Patients were monitored using the HPI-software. We quantified hypotension using the time-weighted average MAP <65 mm Hg (primary endpoint), the proportion of patients with at least one ≥1 min episode of a MAP <65 mm Hg, the number of ≥1 min episodes of a MAP <65 mm Hg, and duration patients spent below a MAP of 65 mm Hg.</p></div><div><h3>Results</h3><p>We included 702 patients in the final analysis. The median time-weighted average MAP <65 mm Hg was 0.03 (0.00–0.20) mm Hg. In addition, 285 patients (41%) had no ≥1 min episode of a MAP <65 mm Hg; 417 patients (59%) had at least one. The median number of ≥1 min episodes of a MAP <65 mm Hg was 1 (0–3). Patients spent a median of 2 (0–9) min below a MAP of 65 mm Hg.</p></div><div><h3>Conclusions</h3><p>The median time-weighted average MAP <65 mm Hg was very low in patients in this registry. This suggests that using HPI-software monitoring may help reduce the duration and severity of intraoperative hypotension in patients having noncardiac surgery.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8d/f6/main.PMC10430826.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10019606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Keep calm and stay warm: a QI project to optimise perioperative temperature control in paediatric anaesthetics at the Evelina London Children’s Hospital 保持冷静和温暖：伦敦Evelina儿童医院优化儿科麻醉师围手术期温度控制的QI项目

BJA open

Pub Date : 2023-06-01 DOI: 10.1016/j.bjao.2023.100169

Alokya Balagamage , Angela Huang , Christy Vougioulki , Aman Patel , Katy Nicholson

引用次数: 0

Improving the recognition and management of inadvertent perioperative hypothermia 提高对围手术期意外低体温的认识和处理

BJA open

Pub Date : 2023-06-01 DOI: 10.1016/j.bjao.2023.100155

Claire Pollington

引用次数: 0

Improving handover in recovery 改善复原工作的移交

BJA open

Pub Date : 2023-06-01 DOI: 10.1016/j.bjao.2023.100151

L. Litvack, A. Wakefield, R. Martin, J. Hearl, L. Chee

引用次数: 0

Preoperative hip fracture analgesia: the case for nerve blocks—a retrospective audit and quality improvement project 髋部骨折术前镇痛：神经阻滞病例——一项回顾性审计和质量改进项目

BJA open

Pub Date : 2023-06-01 DOI: 10.1016/j.bjao.2023.100156

Alexander Churton, Michael Nesbitt, Tom Webster, Gautam Modak, Katie Wood, Su Kyi Ng, Emily Riby, Stephanie Pike, Aravindan Kathirgamanathan, Deepak Subramani

引用次数: 0

Hyperoxia-induced deterioration of diastolic function in anaesthetised patients with coronary artery disease – Randomised crossover trial 冠状动脉疾病麻醉患者高氧诱导舒张功能恶化——随机交叉试验

BJA open

Pub Date : 2023-06-01 DOI: 10.1016/j.bjao.2023.100135

Jan O. Friess , Jan Mikasi , Rico Baumann , Rajevan Ranjan , Kady Fischer , Anja Levis , Sandra Terbeck , Trevor Hirschi , Daniel Gerber , Gabor Erdoes , Florian S. Schoenhoff , Thierry P. Carrel , Raouf Madhkour , Balthasar Eberle , Dominik P. Guensch

Background

There are no current recommendations for oxygen titration in patients with stable coronary artery disease. This study investigates the effect of iatrogenic hyperoxia on cardiac function in patients with coronary artery disease undergoing general anaesthesia.

Methods

Patients scheduled for elective coronary artery bypass graft surgery were prospectively recruited into this randomised crossover clinical trial. All patients were exposed to inspired oxygen fractions of 0.3 (normoxaemia) and 0.8 (hyperoxia) in randomised order. A transoesophageal echocardiographic imaging protocol was performed during each exposure. Primary analysis investigated changes in 3D peak strain, whereas secondary analyses investigated other systolic and diastolic responses.

Results

There was no statistical difference in systolic function between normoxaemia and hyperoxia. However, the response in systolic function to hyperoxia was dependent on ventricular function at normoxaemia. Patients with a normoxaemic left ventricular (LV) global longitudinal strain (GLS) poorer than the derived cut-off (>–15.4%) improved with hyperoxia (P<0.01), whereas in patients with normoxaemic LV-GLS <–15.4%, LV-GLS worsened with transition to hyperoxia (P<0.01). The same was seen for right ventricular GLS with a cut-off at –24.1%. Diastolic function worsened during hyperoxia indicated by a significant increase of averaged E/e′ (8.6 [2.6]. vs 8.2 [2.4], P=0.01) and E/A ratio (1.4 (0.4) vs 1.3 (0.4), P=0.01).

Conclusions

Although the response of biventricular systolic variables is dependent on systolic function at normoxaemia, diastolic function consistently worsens under hyperoxia. In coronary artery disease, intraoperative strain analysis may offer guidance for oxygen titration.

Clinical trial registration

NCT04424433.

背景目前尚无对稳定型冠状动脉疾病患者进行氧气滴定的建议。本研究探讨了医源性高氧对全麻冠状动脉疾病患者心功能的影响。方法前瞻性地将计划进行选择性冠状动脉搭桥术的患者纳入这项随机交叉临床试验。所有患者均随机暴露于0.3（正常氧血症）和0.8（高氧血症）的吸入氧分。在每次暴露期间进行经食道超声心动图成像方案。主要分析调查了三维峰值应变的变化，而次要分析调查了其他收缩和舒张反应。结果正常氧血症和高氧血症患者的收缩功能无统计学差异。然而，高氧对收缩功能的反应取决于正常氧血症时的心室功能。正常氧血症左心室（LV）整体纵向应变（GLS）低于衍生临界值（>；-15.4%）的患者在高氧状态下得到改善（P<；0.01），而在正常氧血症LV-GLS<；-15.4%，LV-GLS随着向高氧过渡而恶化（P<；0.01）。右心室GLS也是如此，截止值为-24.1%。高氧期间舒张功能恶化，平均E/E′（8.6[2.6]vs 8.2[2.4]，P=0.01）和E/a比（1.4（0.4）vs 1.3（0.4）显著增加，P＝0.01）。结论尽管正常氧血症时双心室收缩变量的反应依赖于收缩功能，但高氧状态下舒张功能持续恶化。在冠状动脉疾病中，术中应变分析可以为氧气滴定提供指导。临床试验注册NCT04424433。

{"title":"Hyperoxia-induced deterioration of diastolic function in anaesthetised patients with coronary artery disease – Randomised crossover trial","authors":"Jan O. Friess , Jan Mikasi , Rico Baumann , Rajevan Ranjan , Kady Fischer , Anja Levis , Sandra Terbeck , Trevor Hirschi , Daniel Gerber , Gabor Erdoes , Florian S. Schoenhoff , Thierry P. Carrel , Raouf Madhkour , Balthasar Eberle , Dominik P. Guensch","doi":"10.1016/j.bjao.2023.100135","DOIUrl":"10.1016/j.bjao.2023.100135","url":null,"abstract":"<div><h3>Background</h3><p>There are no current recommendations for oxygen titration in patients with stable coronary artery disease. This study investigates the effect of iatrogenic hyperoxia on cardiac function in patients with coronary artery disease undergoing general anaesthesia.</p></div><div><h3>Methods</h3><p>Patients scheduled for elective coronary artery bypass graft surgery were prospectively recruited into this randomised crossover clinical trial. All patients were exposed to inspired oxygen fractions of 0.3 (normoxaemia) and 0.8 (hyperoxia) in randomised order. A transoesophageal echocardiographic imaging protocol was performed during each exposure. Primary analysis investigated changes in 3D peak strain, whereas secondary analyses investigated other systolic and diastolic responses.</p></div><div><h3>Results</h3><p>There was no statistical difference in systolic function between normoxaemia and hyperoxia. However, the response in systolic function to hyperoxia was dependent on ventricular function at normoxaemia. Patients with a normoxaemic left ventricular (LV) global longitudinal strain (GLS) poorer than the derived cut-off (>–15.4%) improved with hyperoxia (<em>P</em><0.01), whereas in patients with normoxaemic LV-GLS <–15.4%, LV-GLS worsened with transition to hyperoxia (<em>P</em><0.01). The same was seen for right ventricular GLS with a cut-off at –24.1%. Diastolic function worsened during hyperoxia indicated by a significant increase of averaged <em>E</em>/<em>e</em>′ (8.6 [2.6]. <em>vs</em> 8.2 [2.4], <em>P</em>=0.01) and <em>E</em>/<em>A</em> ratio (1.4 (0.4) <em>vs</em> 1.3 (0.4), <em>P</em>=0.01).</p></div><div><h3>Conclusions</h3><p>Although the response of biventricular systolic variables is dependent on systolic function at normoxaemia, diastolic function consistently worsens under hyperoxia. In coronary artery disease, intraoperative strain analysis may offer guidance for oxygen titration.</p></div><div><h3>Clinical trial registration</h3><p>NCT04424433.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10430862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10019608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

首页上一页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

BJA open

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀