Pub Date : 2024-03-22DOI: 10.1016/j.bjao.2024.100270
Jordan N. Edwards , Madeline A. Whitney , Bradford B. Smith , Megan K. Fah , Skye A. Buckner Petty , Omar Durra , Kristen A. Sell-Dottin , Erica Portner , Erica D. Wittwer , Adam J. Milam
Background
This retrospective study evaluated the efficacy and safety of intraoperative methadone compared with short-acting opioids.
Methods
Patients undergoing cardiac surgery with cardiopulmonary bypass (n=11 967) from 2018 to 2023 from a single health system were categorised into groups based on intraoperative opioid administration: no methadone (Group O), methadone plus other opioids (Group M+O), and methadone only (Group M).
Results
Patients in Groups M and M+O had lower mean pain scores until postoperative day (POD) 7 compared with Group O after adjusting for covariates (P<0.01). Both Groups M and M+O had lower total opioid administered compared with Group O for all days POD0–POD6 (all P<0.001). The median number of hours until initial postoperative opioid after surgery was 2.55 (inter-quartile range [IQR]=1.07–5.12), 6.82 (IQR=3.52–12.98), and 7.0 (IQR=3.82–12.95) for Group O, Group M+O, and Group M, respectively. The incidence of postoperative complications did not differ between groups.
Conclusions
Intraoperative administration of methadone was associated with better pain control without significant side-effects after cardiac surgery.
背景这项回顾性研究评估了术中美沙酮与短效阿片类药物相比的疗效和安全性。方法将2018年至2023年在单一医疗系统接受心肺旁路心脏手术的患者(n=11 967)根据术中阿片类药物给药情况分为几组:无美沙酮组(O组)、美沙酮加其他阿片类药物组(M+O组)和仅有美沙酮组(M组)。结果经协变因素调整后,M 组和 M+O 组患者在术后第 7 天前的平均疼痛评分低于 O 组(P<0.01)。与 O 组相比,M 组和 M+O 组在 POD0-POD6 各天的阿片类药物总用量均较低(均为 P<0.001)。O组、M+O组和M组术后首次使用阿片类药物前的中位小时数分别为2.55(四分位数间距[IQR]=1.07-5.12)、6.82(IQR=3.52-12.98)和7.0(IQR=3.82-12.95)。术后并发症的发生率在各组间无差异。
{"title":"The role of methadone in cardiac surgery for management of postoperative pain","authors":"Jordan N. Edwards , Madeline A. Whitney , Bradford B. Smith , Megan K. Fah , Skye A. Buckner Petty , Omar Durra , Kristen A. Sell-Dottin , Erica Portner , Erica D. Wittwer , Adam J. Milam","doi":"10.1016/j.bjao.2024.100270","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100270","url":null,"abstract":"<div><h3>Background</h3><p>This retrospective study evaluated the efficacy and safety of intraoperative methadone compared with short-acting opioids.</p></div><div><h3>Methods</h3><p>Patients undergoing cardiac surgery with cardiopulmonary bypass (<em>n</em>=11 967) from 2018 to 2023 from a single health system were categorised into groups based on intraoperative opioid administration: no methadone (Group O), methadone plus other opioids (Group M+O), and methadone only (Group M).</p></div><div><h3>Results</h3><p>Patients in Groups M and M+O had lower mean pain scores until postoperative day (POD) 7 compared with Group O after adjusting for covariates (<em>P</em><0.01). Both Groups M and M+O had lower total opioid administered compared with Group O for all days POD0–POD6 (all <em>P</em><0.001). The median number of hours until initial postoperative opioid after surgery was 2.55 (inter-quartile range [IQR]=1.07–5.12), 6.82 (IQR=3.52–12.98), and 7.0 (IQR=3.82–12.95) for Group O, Group M+O, and Group M, respectively. The incidence of postoperative complications did not differ between groups.</p></div><div><h3>Conclusions</h3><p>Intraoperative administration of methadone was associated with better pain control without significant side-effects after cardiac surgery.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000145/pdfft?md5=e5a3c7b90cf6b2662d8e8bf8dfa852d1&pid=1-s2.0-S2772609624000145-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140188029","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}
Pub Date : 2024-03-22DOI: 10.1016/j.bjao.2024.100278
Emily J. MacKay , Charlotte J. Talham , Bo Zhang , Chase R. Brown , Peter W. Groeneveld , Nimesh D. Desai , John G. Augoustides
Background
There is a lack of evidence associating intraoperative transoesophageal echocardiography (TOE) use with improved outcomes among coronary artery bypass graft (CABG) surgery subpopulations.
Methods
This matched retrospective cohort study used a US private claims dataset to compare outcomes among different CABG surgery patient populations with vs without TOE. Statistical analyses involved exact matching on pre-selected subgroups (congestive heart failure, single vessel, and multivessel CABG) and used fine and propensity-score balanced techniques to conduct multiple matched comparisons and sensitivity analyses.
Results
Of 42 249 patients undergoing isolated CABG surgery, 24 919 (59.0%) received and 17 330 (41.0%) did not receive TOE. After matching, intraoperative TOE was significantly associated with a lower, 30-day mortality: 2.63% vs 3.20% (odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.71–0.92; P=0.002). In the subgroup matched comparisons, intraoperative TOE was significantly associated with a lower, 30-day mortality rate among those with congestive heart failure: 4.20% vs 5.26% (OR: 0.78; 95% CI: 0.66–0.94; P=0.007) and among those undergoing multivessel CABG with congestive heart failure: 4.23% vs 5.24% (OR: 0.80; 95% CI: 0.65–0.97; P=0.025), but not among those undergoing multivessel CABG without congestive heart failure: 1.83% vs 2.15% (OR: 0.85; 95% CI: 0.70–1.02; P=0.089, nor any of the remaining three subgroups.
Conclusions
Among US adults undergoing isolated CABG surgery, intraoperative TOE was associated with improved outcomes in patients with congestive heart failure (vs without) and among patients undergoing multivessel (vs single vessel) CABG. These findings support prioritised TOE allocation to these patient populations at centres with limited TOE capabilities.
背景目前缺乏证据表明术中使用经食道超声心动图(TOE)可改善冠状动脉旁路移植术(CABG)手术亚群的预后。统计分析涉及预选亚组(充血性心力衰竭、单血管和多血管 CABG)的精确匹配,并使用精细和倾向分数平衡技术进行多重匹配比较和敏感性分析。结果 在 42 249 例接受孤立 CABG 手术的患者中,24 919 例(59.0%)接受了 TOE,17 330 例(41.0%)未接受 TOE。匹配后,术中 TOE 与较低的 30 天死亡率显著相关:2.63% 对 3.20%(赔率比 [OR]:0.81;95% 置信区间 [CI]:0.71-0.92;P=0.002)。在亚组匹配比较中,术中 TOE 与充血性心力衰竭患者的 30 天死亡率显著相关:4.20% vs 5.26% (OR: 0.78; 95% CI: 0.66-0.94; P=0.007),而在接受多支血管 CABG 且伴有充血性心力衰竭的患者中,术中 TOE 与较低的 30 天死亡率明显相关:但在接受多血管 CABG 手术且无充血性心力衰竭的人群中:1.83% vs 2.15%(OR:0.85;95% CI:0.70-1.02;P=0.089),以及其余三个亚组中的任何一个人群中,该结果均不明显。结论在接受孤立 CABG 手术的美国成年人中,术中 TOE 与充血性心力衰竭患者(vs 无充血性心力衰竭)和接受多血管(vs 单血管)CABG 患者的预后改善相关。这些发现支持在TOE能力有限的中心优先为这些患者分配TOE。
{"title":"Testing clinical selection criteria for intraoperative transoesophageal echocardiography in isolated coronary artery bypass graft surgery","authors":"Emily J. MacKay , Charlotte J. Talham , Bo Zhang , Chase R. Brown , Peter W. Groeneveld , Nimesh D. Desai , John G. Augoustides","doi":"10.1016/j.bjao.2024.100278","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100278","url":null,"abstract":"<div><h3>Background</h3><p>There is a lack of evidence associating intraoperative transoesophageal echocardiography (TOE) use with improved outcomes among coronary artery bypass graft (CABG) surgery subpopulations.</p></div><div><h3>Methods</h3><p>This matched retrospective cohort study used a US private claims dataset to compare outcomes among different CABG surgery patient populations with <em>vs</em> without TOE. Statistical analyses involved exact matching on pre-selected subgroups (congestive heart failure, single vessel, and multivessel CABG) and used fine and propensity-score balanced techniques to conduct multiple matched comparisons and sensitivity analyses.</p></div><div><h3>Results</h3><p>Of 42 249 patients undergoing isolated CABG surgery, 24 919 (59.0%) received and 17 330 (41.0%) did not receive TOE. After matching, intraoperative TOE was significantly associated with a lower, 30-day mortality: 2.63% <em>vs</em> 3.20% (odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.71–0.92; <em>P</em>=0.002). In the subgroup matched comparisons, intraoperative TOE was significantly associated with a lower, 30-day mortality rate among those with congestive heart failure: 4.20% <em>vs</em> 5.26% (OR: 0.78; 95% CI: 0.66–0.94; <em>P</em>=0.007) and among those undergoing multivessel CABG with congestive heart failure: 4.23% <em>vs</em> 5.24% (OR: 0.80; 95% CI: 0.65–0.97; <em>P</em>=0.025), but not among those undergoing multivessel CABG without congestive heart failure: 1.83% <em>vs</em> 2.15% (OR: 0.85; 95% CI: 0.70–1.02; <em>P</em>=0.089, nor any of the remaining three subgroups.</p></div><div><h3>Conclusions</h3><p>Among US adults undergoing isolated CABG surgery, intraoperative TOE was associated with improved outcomes in patients with congestive heart failure (<em>vs</em> without) and among patients undergoing multivessel (<em>vs</em> single vessel) CABG. These findings support prioritised TOE allocation to these patient populations at centres with limited TOE capabilities.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000224/pdfft?md5=6b88fb2de000fa1ac379cc84977ecb1a&pid=1-s2.0-S2772609624000224-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140190789","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}
Pub Date : 2024-03-21DOI: 10.1016/j.bjao.2024.100269
Jennifer Guevara , Carlos Sánchez , Jessica Organista-Montaño , Benjamin W. Domingue , Nan Guo , Pervez Sultan
Background
Spanish is the second most spoken language globally with around 475 million native speakers. We aimed to validate a Spanish version of the Obstetric Quality of Recovery-10 item (ObsQoR-10) patient-reported outcome measure.
Methods
ObsQoR-10-Spanish was developed using EuroQoL methodology. ObsQoR-10-Spanish was assessed in 100 Spanish-speaking patients undergoing elective Caesarean or vaginal delivery. Patients <38 weeks, undergoing an intrapartum Caesarean delivery, intrauterine death, or maternal admission to the intensive care unit (ICU) were excluded. Validity was assessed by evaluating (i) convergent validity—correlation with 24-h EuroQoL and global health visual analogue scale (GHVAS) scores (0–100); (ii) discriminant validity—difference in ObsQoR-10-Spanish score for patients with GHVAS scores >70 vs <70; (iii) hypothesis testing—correlation of ObsQoR score with maternal and neonatal factors; and (iv) cross-cultural validity assessed using differential item functioning analysis. Reliability was assessed by evaluating: (i) internal consistency; (ii) split-half reliability and (iii) test–retest reliability; and (iv) floor and ceiling effects.
Results
One hundred patients were approached, recruited, and completed surveys. Validity: (i) convergent validity: the ObsQoR 24-h score correlated moderately with the 24-h EuroQoL (r=−0.632) and GHVAS scores (r=0.590); (ii) discriminant validity: the ObsQoR-10-Spanish 24-h scores were higher in women who delivered vaginally compared to via Caesarean delivery, (mean [standard deviation] scores were 89 [9] vs 81 [12]; P<0.001). The 24-h ObsQoR-Spanish scores were lower in patients experiencing a poor vs a good recovery (mean [standard deviation] scores were 76 [12.3] vs 87.1 [10.6]; P=0.001); (iii) hypothesis testing: the ObsQoR-10 score correlated negatively with age (r=−0.207) and positively with 5-min (r=0.204) and 10-min (r=0.243) Apgar scores. Remaining correlations were not significant; and (iv) differential item functioning analysis suggested no potential bias among the 10 items. Reliability: (i) internal consistency was good (Cronbach alpha=0.763); (ii) split-half reliability was good (Spearman–Brown prophesy reliability estimate of 0.866); (iii) test–retest reliability was excellent with an intra-class correlation coefficient of 0.90; and (iv) floor and ceiling effects: six patients scored a maximum total ObsQoR-10 score.
Conclusions
The ObsQoR-10-Spanish patient-reported outcome measure is valid, reliable, and clinically feasible, and should be considered for use in Spanish-speaking women to assess quality of inpatient postpartum recovery.
{"title":"Development and validation of a Spanish version of the Obstetric Quality of Recovery-10 item score (ObsQoR-10-Spanish)","authors":"Jennifer Guevara , Carlos Sánchez , Jessica Organista-Montaño , Benjamin W. Domingue , Nan Guo , Pervez Sultan","doi":"10.1016/j.bjao.2024.100269","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100269","url":null,"abstract":"<div><h3>Background</h3><p>Spanish is the second most spoken language globally with around 475 million native speakers. We aimed to validate a Spanish version of the Obstetric Quality of Recovery-10 item (ObsQoR-10) patient-reported outcome measure.</p></div><div><h3>Methods</h3><p>ObsQoR-10-Spanish was developed using EuroQoL methodology. ObsQoR-10-Spanish was assessed in 100 Spanish-speaking patients undergoing elective Caesarean or vaginal delivery. Patients <38 weeks, undergoing an intrapartum Caesarean delivery, intrauterine death, or maternal admission to the intensive care unit (ICU) were excluded. Validity was assessed by evaluating (i) convergent validity—correlation with 24-h EuroQoL and global health visual analogue scale (GHVAS) scores (0–100); (ii) discriminant validity—difference in ObsQoR-10-Spanish score for patients with GHVAS scores >70 <em>vs</em> <70; (iii) hypothesis testing—correlation of ObsQoR score with maternal and neonatal factors; and (iv) cross-cultural validity assessed using differential item functioning analysis. Reliability was assessed by evaluating: (i) internal consistency; (ii) split-half reliability and (iii) test–retest reliability; and (iv) floor and ceiling effects.</p></div><div><h3>Results</h3><p>One hundred patients were approached, recruited, and completed surveys. Validity: (i) convergent validity: the ObsQoR 24-h score correlated moderately with the 24-h EuroQoL (<em>r</em>=−0.632) and GHVAS scores (<em>r</em>=0.590); (ii) discriminant validity: the ObsQoR-10-Spanish 24-h scores were higher in women who delivered vaginally compared to via Caesarean delivery, (mean [standard deviation] scores were 89 [9] <em>vs</em> 81 [12]; <em>P</em><0.001). The 24-h ObsQoR-Spanish scores were lower in patients experiencing a poor <em>vs</em> a good recovery (mean [standard deviation] scores were 76 [12.3] <em>vs</em> 87.1 [10.6]; <em>P</em>=0.001); (iii) hypothesis testing: the ObsQoR-10 score correlated negatively with age (<em>r</em>=−0.207) and positively with 5-min (<em>r</em>=0.204) and 10-min (<em>r</em>=0.243) Apgar scores. Remaining correlations were not significant; and (iv) differential item functioning analysis suggested no potential bias among the 10 items. Reliability: (i) internal consistency was good (Cronbach alpha=0.763); (ii) split-half reliability was good (Spearman–Brown prophesy reliability estimate of 0.866); (iii) test–retest reliability was excellent with an intra-class correlation coefficient of 0.90; and (iv) floor and ceiling effects: six patients scored a maximum total ObsQoR-10 score.</p></div><div><h3>Conclusions</h3><p>The ObsQoR-10-Spanish patient-reported outcome measure is valid, reliable, and clinically feasible, and should be considered for use in Spanish-speaking women to assess quality of inpatient postpartum recovery.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000133/pdfft?md5=ab561d1e65b006327b8fa0c7a786943d&pid=1-s2.0-S2772609624000133-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140188143","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}
Pub Date : 2024-03-20DOI: 10.1016/j.bjao.2024.100277
Joseph Larvin , Mark Edwards , Daniel S. Martin , Martin Feelisch , Michael P.W. Grocott , Andrew F. Cumpstey
Oxygen is the most used drug in anaesthesia. Despite such widespread use, optimal perioperative oxygen administration remains highly controversial because of concerns about the competing harms of both hyperoxia and hypoxia.
Notwithstanding a Cochrane review concluding that routinely administering a fractional inspired oxygen concentration (FiO2) >0.6 intraoperatively might increase postoperative morbidity and mortality, the World Health Organization (WHO) currently recommends all anaesthetised patients receive 0.8 FiO2 during and immediately after surgery to reduce surgical site infections. Results from the largest trial available at the time of these two reviews (suggesting long-term survival may be worse with high FiO2, particularly in patients with malignant disease) were considered ‘biologically implausible’ by the WHO's Guideline Development Group. In addition, the integrity of some perioperative oxygen studies has been challenged. Resolving these controversies is of fundamental importance to all perioperative clinicians.
This narrative review is based on the inaugural BJA William Mapleson lecture delivered by the senior author (AC) at the 2023 annual meeting of the Royal College of Anaesthetists in Birmingham. We present the current evidence for perioperative oxygen administration and contrast this with how oxygen therapy is targeted in other specialties (e.g. intensive care medicine). We will explore whether anaesthetists follow the WHO recommendations and consider how oxygen administration affects the stress response to surgery. We reason that novel clinical trial designs in combination with targeted experimental medicine studies will be required to improve our understanding of how best to optimise individualised perioperative oxygenation—a cornerstone of anaesthesia.
{"title":"Perioperative oxygenation—what's the stress?","authors":"Joseph Larvin , Mark Edwards , Daniel S. Martin , Martin Feelisch , Michael P.W. Grocott , Andrew F. Cumpstey","doi":"10.1016/j.bjao.2024.100277","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100277","url":null,"abstract":"<div><p>Oxygen is the most used drug in anaesthesia. Despite such widespread use, optimal perioperative oxygen administration remains highly controversial because of concerns about the competing harms of both hyperoxia and hypoxia.</p><p>Notwithstanding a Cochrane review concluding that routinely administering a fractional inspired oxygen concentration (FiO<sub>2</sub>) >0.6 intraoperatively might increase postoperative morbidity and mortality, the World Health Organization (WHO) currently recommends all anaesthetised patients receive 0.8 FiO<sub>2</sub> during and immediately after surgery to reduce surgical site infections. Results from the largest trial available at the time of these two reviews (suggesting long-term survival may be worse with high FiO<sub>2</sub>, particularly in patients with malignant disease) were considered ‘biologically implausible’ by the WHO's Guideline Development Group. In addition, the integrity of some perioperative oxygen studies has been challenged. Resolving these controversies is of fundamental importance to all perioperative clinicians.</p><p>This narrative review is based on the inaugural <em>BJA</em> William Mapleson lecture delivered by the senior author (AC) at the 2023 annual meeting of the Royal College of Anaesthetists in Birmingham. We present the current evidence for perioperative oxygen administration and contrast this with how oxygen therapy is targeted in other specialties (e.g. intensive care medicine). We will explore whether anaesthetists follow the WHO recommendations and consider how oxygen administration affects the stress response to surgery. We reason that novel clinical trial designs in combination with targeted experimental medicine studies will be required to improve our understanding of how best to optimise individualised perioperative oxygenation—a cornerstone of anaesthesia.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000212/pdfft?md5=e4c56e0ed1b7f3df5046ca39a5705c4a&pid=1-s2.0-S2772609624000212-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140163198","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}
Pub Date : 2024-03-19DOI: 10.1016/j.bjao.2024.100268
Umeshkumar Athiraman , Tusar Giri
Background
Altered patterns of genetic expression induced by isoflurane preconditioning in mouse brain have not yet been investigated. The aim of our pilot study is to examine the temporal sequence of changes in the transcriptome of mouse brain cortex produced by isoflurane preconditioning.
Methods
Twelve-wk-old wild-type (C57BL/6J) male mice were randomly assigned for the experiments. Mice were exposed to isoflurane 2% in air for 1 h and brains were harvested at the following time points—immediately (0 h), and at 6, 12, 24, 36, 48, and 72 h after isoflurane exposure. A separate cohort of mice were exposed to three doses of isoflurane on days 1, 2, and 3 and brains were harvested after the third exposure. The NanoString mouse neuropathology panel was used to analyse isoflurane-induced gene expression in the cortex. The neuropathology panel included 760 genes covering pathways involved in neurodegeneration and other nervous system diseases, and 10 internal reference genes for data normalisation.
Results
Genes involving several pathways were upregulated and downregulated by isoflurane preconditioning. Interestingly, a biphasic response was noted, meaning, an early expression of genes (until 6 h), followed by a transient pause (until 24 h), and a second wave of genomic response beginning at 36 h of isoflurane exposure was noted.
Conclusions
Isoflurane preconditioning induces significant alterations in the genes involved in neurodegeneration and other nervous system disorders in a temporal sequence. These data could aid in the identification of molecular mechanisms behind isoflurane preconditioning-induced neuroprotection in various central nervous system diseases.
{"title":"Isoflurane preconditioning induced genomic changes in mouse cortex","authors":"Umeshkumar Athiraman , Tusar Giri","doi":"10.1016/j.bjao.2024.100268","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100268","url":null,"abstract":"<div><h3>Background</h3><p>Altered patterns of genetic expression induced by isoflurane preconditioning in mouse brain have not yet been investigated. The aim of our pilot study is to examine the temporal sequence of changes in the transcriptome of mouse brain cortex produced by isoflurane preconditioning.</p></div><div><h3>Methods</h3><p>Twelve-wk-old wild-type (C57BL/6J) male mice were randomly assigned for the experiments. Mice were exposed to isoflurane 2% in air for 1 h and brains were harvested at the following time points—immediately (0 h), and at 6, 12, 24, 36, 48, and 72 h after isoflurane exposure. A separate cohort of mice were exposed to three doses of isoflurane on days 1, 2, and 3 and brains were harvested after the third exposure. The NanoString mouse neuropathology panel was used to analyse isoflurane-induced gene expression in the cortex. The neuropathology panel included 760 genes covering pathways involved in neurodegeneration and other nervous system diseases, and 10 internal reference genes for data normalisation.</p></div><div><h3>Results</h3><p>Genes involving several pathways were upregulated and downregulated by isoflurane preconditioning. Interestingly, a biphasic response was noted, meaning, an early expression of genes (until 6 h), followed by a transient pause (until 24 h), and a second wave of genomic response beginning at 36 h of isoflurane exposure was noted.</p></div><div><h3>Conclusions</h3><p>Isoflurane preconditioning induces significant alterations in the genes involved in neurodegeneration and other nervous system disorders in a temporal sequence. These data could aid in the identification of molecular mechanisms behind isoflurane preconditioning-induced neuroprotection in various central nervous system diseases.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000121/pdfft?md5=27b8ec9fa26d452a60023cf8ab1d7328&pid=1-s2.0-S2772609624000121-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140163199","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}
Pub Date : 2024-03-06DOI: 10.1016/j.bjao.2024.100267
Mwayi Kachapila , Mark Monahan , Adesoji O. Ademuyiwa , Yakubu Momohsani Adinoyi , Bruce M. Biccard , Christina George , Dhruva N. Ghosh , James Glasbey , Dion G. Morton , Osaheni Osayomwanbo , Rupert Pearse , Tracy E. Roberts , Atul Suroy , Saidu Yusuf Yakubu , Raymond Oppong
{"title":"Erratum to ‘Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries’ [BJA Open 7 (2023) 100207]","authors":"Mwayi Kachapila , Mark Monahan , Adesoji O. Ademuyiwa , Yakubu Momohsani Adinoyi , Bruce M. Biccard , Christina George , Dhruva N. Ghosh , James Glasbey , Dion G. Morton , Osaheni Osayomwanbo , Rupert Pearse , Tracy E. Roberts , Atul Suroy , Saidu Yusuf Yakubu , Raymond Oppong","doi":"10.1016/j.bjao.2024.100267","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100267","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277260962400011X/pdfft?md5=d5d100c347dd5a1746503e1589901418&pid=1-s2.0-S277260962400011X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051778","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}
Pub Date : 2024-03-01DOI: 10.1016/j.bjao.2023.100251
Mwayi Kachapila , Mark Monahan , Adesoji O. Ademuyiwa , Yakubu Momohsani Adinoyi , Bruce M. Biccard , Christina George , Dhruva N. Ghosh , James Glasbey , Dion G. Morton , Osaheni Osayomwanbo , Rupert Pearse , Tracy E. Roberts , Atul Suroy , Saidu Yusuf Yakubu , Raymond Oppong , NIHR Global Health Research Unit on Global Surgery Collaborators
{"title":"Erratum to “Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries” [BJA Open 7 (2023) 100207]","authors":"Mwayi Kachapila , Mark Monahan , Adesoji O. Ademuyiwa , Yakubu Momohsani Adinoyi , Bruce M. Biccard , Christina George , Dhruva N. Ghosh , James Glasbey , Dion G. Morton , Osaheni Osayomwanbo , Rupert Pearse , Tracy E. Roberts , Atul Suroy , Saidu Yusuf Yakubu , Raymond Oppong , NIHR Global Health Research Unit on Global Surgery Collaborators","doi":"10.1016/j.bjao.2023.100251","DOIUrl":"https://doi.org/10.1016/j.bjao.2023.100251","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609623001302/pdfft?md5=f4e7edb9ade23a09fbdd429ae1acdc71&pid=1-s2.0-S2772609623001302-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139992383","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}
Pub Date : 2024-03-01DOI: 10.1016/j.bjao.2024.100262
Matthijs Kant , Wilton A. van Klei , Markus W. Hollmann , Denise P. Veelo , Teus H. Kappen
Background
Intraoperative hypotension has been extensively studied for its association with adverse outcomes. However, small sample sizes and methodological issues limit the causal inference that can be drawn.
Methods
In this multicentre, adaptive, randomised controlled trial, we will include 5000 adult inpatients scheduled for elective non-cardiac surgery under general or central neuraxial anaesthesia. Patients will be either randomly allocated to the intervention or care-as-usual group using computer-generated blocks of four, six, or eight, with an allocation ratio of 1:1. In the intervention arm patients will be divided into low-, intermediate-, and high-risk groups based on their likelihood to experience intraoperative hypotension, with resulting mean blood pressure targets of 70, 80, and 90 mm Hg, respectively. Anaesthesia teams will be provided with a clinical guideline on how to keep patients at their target blood pressure. During the first 6 months of the trial the intervention strategy will be evaluated and further revised in adaptation cycles of 3 weeks if necessary, to improve successful impact on the clinical process. The primary outcome is postoperative disability after 6 months measured with the World Health Organization Disability Assessment Score (WHODAS) 2.0 questionnaire.
Ethics and dissemination
This study protocol has been approved by the Medical Ethics Committee of the University Medical Centre Utrecht (20–749) and all protocol amendments will be communicated to the Medical Ethics Committee. The study protocol is in adherence with the Declaration of Helsinki and the guideline of Good Clinical Practice. Dissemination plans include publication in a peer-reviewed journal.
Clinical trial registration
The Dutch Trial Register, NL9391. Registered on 22 March 2021.
{"title":"The effect of proactive versus reactive treatment of hypotension on postoperative disability and outcome in surgical patients under anaesthesia (PRETREAT): clinical trial protocol and considerations","authors":"Matthijs Kant , Wilton A. van Klei , Markus W. Hollmann , Denise P. Veelo , Teus H. Kappen","doi":"10.1016/j.bjao.2024.100262","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100262","url":null,"abstract":"<div><h3>Background</h3><p>Intraoperative hypotension has been extensively studied for its association with adverse outcomes. However, small sample sizes and methodological issues limit the causal inference that can be drawn.</p></div><div><h3>Methods</h3><p>In this multicentre, adaptive, randomised controlled trial, we will include 5000 adult inpatients scheduled for elective non-cardiac surgery under general or central neuraxial anaesthesia. Patients will be either randomly allocated to the intervention or care-as-usual group using computer-generated blocks of four, six, or eight, with an allocation ratio of 1:1. In the intervention arm patients will be divided into low-, intermediate-, and high-risk groups based on their likelihood to experience intraoperative hypotension, with resulting mean blood pressure targets of 70, 80, and 90 mm Hg, respectively. Anaesthesia teams will be provided with a clinical guideline on how to keep patients at their target blood pressure. During the first 6 months of the trial the intervention strategy will be evaluated and further revised in adaptation cycles of 3 weeks if necessary, to improve successful impact on the clinical process. The primary outcome is postoperative disability after 6 months measured with the World Health Organization Disability Assessment Score (WHODAS) 2.0 questionnaire.</p></div><div><h3>Ethics and dissemination</h3><p>This study protocol has been approved by the Medical Ethics Committee of the University Medical Centre Utrecht (20–749) and all protocol amendments will be communicated to the Medical Ethics Committee. The study protocol is in adherence with the Declaration of Helsinki and the guideline of Good Clinical Practice. Dissemination plans include publication in a peer-reviewed journal.</p></div><div><h3>Clinical trial registration</h3><p>The Dutch Trial Register, NL9391. Registered on 22 March 2021.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000066/pdfft?md5=989e6e2df59ac65f6b9e16ae2eb58bd6&pid=1-s2.0-S2772609624000066-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139992382","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}
Pub Date : 2024-03-01DOI: 10.1016/j.bjao.2023.100252
E. Morgan, D. Mayhew, E. Houston
{"title":"Retraction notice to “Development of a perioperative pathway for patients with mucopolysaccharidosis, cardiac disease, and difficult airways using virtual reality and 3D printing” [BJA Open 6 (2023) 100190]","authors":"E. Morgan, D. Mayhew, E. Houston","doi":"10.1016/j.bjao.2023.100252","DOIUrl":"https://doi.org/10.1016/j.bjao.2023.100252","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609623001314/pdfft?md5=909fb1bfa36f661d88283df10febf83e&pid=1-s2.0-S2772609623001314-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140041544","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}
Pub Date : 2024-02-28DOI: 10.1016/j.bjao.2024.100265
Richard H. Epstein , Olivia F. Perez , Ira S. Hofer , J. Ross Renew , Réka Nemes , Sorin J. Brull
{"title":"Validation of a convolutional neural network that reliably identifies electromyographic compound motor action potentials following train-of-four stimulation: an algorithm development experimental study—Reply to: Br J Anaesth Open 2024:100264.","authors":"Richard H. Epstein , Olivia F. Perez , Ira S. Hofer , J. Ross Renew , Réka Nemes , Sorin J. Brull","doi":"10.1016/j.bjao.2024.100265","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100265","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000091/pdfft?md5=0bbfce4065effdf10862d9dd6a0d0e1c&pid=1-s2.0-S2772609624000091-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139986955","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}