BJA open最新文献

英文中文

Review of starvation times for paediatric patients requiring magnetic resonance imaging under general anaesthesia 在全身麻醉下需要核磁共振成像的儿科病人的饥饿时间回顾

BJA open

Pub Date : 2025-08-21 DOI: 10.1016/j.bjao.2025.100435

Natasha Parrott, Emily Saffer

引用次数: 0

DrEaM big: investigating barriers to postoperative DrEaMing after major colorectal surgery 大梦：调查大肠癌手术后做梦的障碍

BJA open

Pub Date : 2025-08-21 DOI: 10.1016/j.bjao.2025.100428

Rose Smith, Anna Merlini, Salma Miah, Gloria Ashiru, Mona Behravesh, Emamoke Oteri

引用次数: 0

Addressing preoperative hypoglycaemia: a nurse-driven protocol to enhance patient safety and workflow efficiency 解决术前低血糖：一个护士驱动的方案，以提高患者的安全和工作流程效率

BJA open

Pub Date : 2025-08-21 DOI: 10.1016/j.bjao.2025.100432

Ammar M. Lakda , Samantha Graham , Ray Pickett , Mary Beth Modic , Keren Zhou , Pratibha P.R. Rao , Ursula Galway

引用次数: 0

Improving preoperative assessment investigations in elective surgery 改进择期手术术前评估调查

BJA open

Pub Date : 2025-08-21 DOI: 10.1016/j.bjao.2025.100467

R. Rodgers, M. Harty, S. Millen, J. McKenna, E. McQuillan, M.J. Duffy

引用次数: 0

Innovative technologies in regional anaesthesia education: a scoping review. 区域麻醉教育中的创新技术：范围综述。

BJA open

Pub Date : 2025-08-06 eCollection Date: 2025-09-01 DOI: 10.1016/j.bjao.2025.100473

Samuel Chequer

Background: Regional anaesthesia has experienced a global resurgence over recent decades alongside increasing demand for anaesthetists to be competent in its delivery. This was reflected in a recent UK anaesthetic curriculum update, which mandates a wide range of specific regional anaesthesia competencies. Despite this, regional anaesthesia education remains ad hoc and inconsistent. Innovative technologies (artificial intelligence, virtual reality, and augmented reality) are increasingly integrated within medical education, and have the potential to transform training practices. This scoping review aimed to explore the ways in which innovative technologies are currently used in regional anaesthesia, and to consider their role in education and training.

Methods: This review was conducted using established frameworks for scoping reviews, and included searches of three major databases, alongside targeted citation searching. Data were analysed numerically, followed by reflexive thematic analysis.

Results: In total, 855 citations were identified. After removal of duplicates and abstract eligibility screening, 106 full-text articles were assessed and 38 met the criteria for inclusion. The majority of studies were published in the last 2 yr and a lack of high-quality evidence, particularly focussing on educational outcomes, was noted. A wide range of applications for innovative technologies in regional anaesthesia education were described including roles in anatomy education, accelerated skill acquisition, simulation-based medical education, and assessment.

Conclusions: Innovative technologies were associated with benefits such as provision of reliable learning experiences, reduced supervisory requirements, and enhanced educational outcomes. Future educators should consider their utility and provide structured evaluation. Significant heterogeneity was noted in the literature base and further research is recommended, specifically studying primary educational outcomes.

背景：近几十年来，随着对麻醉师的需求不断增加，区域麻醉在全球范围内复苏。这反映在最近的英国麻醉学课程更新中，该课程要求广泛的特定区域麻醉能力。尽管如此，区域麻醉教育仍然是临时的和不一致的。创新技术（人工智能、虚拟现实和增强现实）越来越多地融入医学教育，并有可能改变培训实践。本次范围审查旨在探讨创新技术目前在区域麻醉中的应用方式，并考虑其在教育和培训中的作用。方法：本综述使用已建立的范围综述框架进行，包括三个主要数据库的检索，以及目标引文检索。对数据进行数值分析，然后进行反身性专题分析。结果：共鉴定出855篇引文。在去除重复和摘要筛选后，106篇全文文章被评估，38篇符合纳入标准。大多数研究发表于过去两年，缺乏高质量的证据，特别是关注教育成果的证据。介绍了创新技术在区域麻醉教育中的广泛应用，包括在解剖学教育、加速技能习得、基于模拟的医学教育和评估中的作用。结论：创新技术带来的好处包括提供可靠的学习经验、减少监管要求和提高教育成果。未来的教育工作者应该考虑他们的效用，并提供结构化的评估。在文献基础上发现了显著的异质性，建议进一步研究，特别是对小学教育成果的研究。

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引用次数: 0

Socioeconomic deprivation and postoperative mortality: a retrospective analysis of prospectively collected data 社会经济剥夺与术后死亡率：前瞻性收集数据的回顾性分析

BJA open

Pub Date : 2025-07-28 DOI: 10.1016/j.bjao.2025.100479

Ross Lilley , Jason Woodier , Jennifer Summers , Patrice Forget

Background

Deprivation and inequality are globally increasing. This study aims to explore the relationship between deprivation and postoperative mortality.

Methods

A retrospective analysis was conducted using prospectively collected data from all Aberdeen Royal Infirmary surgical patients from 2011 to 2019. Trends in Scottish Index of Multiple Deprivation (SIMD), sex, ethnicity, and speciality of care over the period were described. A Cox regression model was used to determine the effect of SIMD quintiles on 90-day postoperative mortality.

Results

No trends were observed in sex and SIMD, but proportions of certain specialities and ethnicities changed over time. A total of 2609 of 79 708 participants died within 90 days of their operation (crude mortality of 3.3%). There were significant differences in sex, age, ethnicity, and speciality across SIMD quintiles. Cox regression, adjusted for these variables, revealed that a greater level of deprivation was associated with greater mortality at 90 days (hazard ratio 1.594, 95% confidence interval 1.335–1.905 for SIMD 1 compared with SIMD 5 reference).

Conclusions

Deprivation is associated with 90-day postoperative mortality. The level of deprivation may be considered when planning perioperative care.

在全球范围内，贫困和不平等现象正在加剧。本研究旨在探讨剥夺与术后死亡率之间的关系。方法回顾性分析2011年至2019年阿伯丁皇家医院外科手术患者的前瞻性数据。描述了这一时期苏格兰多重剥夺指数（SIMD）、性别、种族和护理专业的趋势。采用Cox回归模型确定SIMD五分位数对术后90天死亡率的影响。结果在性别和SIMD方面没有观察到趋势，但某些专业和种族的比例随时间而变化。79708名参与者中有2609人在手术后90天内死亡（粗死亡率为3.3%）。在SIMD五分位数中，性别、年龄、种族和专业存在显著差异。对这些变量进行校正后的Cox回归显示，剥夺程度越高，90天死亡率越高（与参考SIMD 5相比，SIMD 1的风险比为1.594,95%置信区间为1.335-1.905）。结论剥夺与术后90天死亡率相关。在规划围手术期护理时可考虑剥夺程度。

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引用次数: 0

Peripartum takotsubo cardiomyopathy after an emergency Caesarean delivery—diagnosis and specialist management 紧急剖宫产后围生期takotsubo心肌病的诊断和专科治疗

BJA open

Pub Date : 2025-07-25 DOI: 10.1016/j.bjao.2025.100478

Cathriona Murphy , Deirdre Edgeworth , Gerard Giblin , Rosemarie Kearsley

We report the case of a 32-yr-old primiparous patient who underwent an emergency Caesarean delivery and subsequently developed peripartum takotsubo cardiomyopathy necessitating transfer to a tertiary referral critical care unit and the heart failure service. Takotsubo cardiomyopathy, also called stress cardiomyopathy, is a form of left ventricular dysfunction with distinct wall motion abnormalities in the absence of coronary artery disease. It is considered extremely rare in the peripartum period, most commonly presenting in postmenopausal women with increased myocardial sensitivity to excess circulating catecholamines as a potential role in the pathogenesis. In the peripartum period, the physiological cardiovascular adaptations of pregnancy superimposed on psychosocial stressors is the assumed pathogenesis. Unexplained dyspnoea in the peripartum period should prompt early transthoracic echocardiography and specialist critical care and heart failure team input, where appropriate. This case highlights the need to consider rare cardiac causes of acute dyspnoea and demonstrates the value of point-of-care transthoracic ultrasound for prompt bedside assessment, aiding diagnosis and management. Clinical, echocardiographic, and radiological features can aid differentiating takotsubo cardiomyopathy from other differential diagnoses. Specialist multidisciplinary teams comprised of obstetricians, anaesthetists, intensivists, cardiologists, and specialist services, such as lactation and psychology services, should be available to care for these patients and a holistic approach needs to be adopted to counsel and address the psychological sequelae after such a diagnosis and appropriately plan for future pregnancies.

我们报告一例32岁的初产妇，她接受了紧急剖腹产，随后发展为围产期takotsubo心肌病，需要转到三级转诊重症监护病房和心力衰竭服务。Takotsubo心肌病，也称为应激性心肌病，是一种左心室功能障碍，在没有冠状动脉疾病的情况下，伴有明显的壁运动异常。它被认为在围产期极为罕见，最常见于绝经后妇女，心肌对过量循环儿茶酚胺的敏感性增加，这是发病机制的潜在作用。在围产期，生理心血管适应妊娠叠加社会心理压力是假定的发病机制。围产期不明原因的呼吸困难应尽早进行经胸超声心动图检查，并在适当情况下投入专科重症监护和心力衰竭小组。本病例强调了考虑急性呼吸困难的罕见心脏原因的必要性，并证明了即时经胸超声对及时床边评估、辅助诊断和治疗的价值。临床、超声心动图和放射学特征可以帮助鉴别takotsubo型心肌病与其他鉴别诊断。由产科医生、麻醉师、重症监护医师、心脏病专家和专科服务（如哺乳和心理服务）组成的多学科专家团队应该可用于护理这些患者，并需要采用整体方法来咨询和解决此类诊断后的心理后遗症，并适当地规划未来的怀孕。

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引用次数: 0

Equity of participants in clinical trials in critical care and perioperative medicine research: a systematic review 重症监护和围手术期医学研究临床试验参与者的公平性：一项系统综述

BJA open

Pub Date : 2025-07-24 DOI: 10.1016/j.bjao.2025.100425

Joanna Kae Ling Wong , Caroline Thomas , Hannah Gravett , Kavi Thobhani , Ayah Mekhaimar , Jan Man Wong , Yize Isalina Wan

Background

Underrepresentation in critical care and perioperative randomised controlled trials (RCTs) limit generalisability and drive health inequity. This systematic review of large, high-quality RCTs analysed representation and reporting trends of equity data over 10 yr.

Methods

We searched MEDLINE, Embase, and Clinicaltrials.gov between 01 January 2013 and 11 May 2023 for RCTs recruiting adults (age ≥18 yr) receiving a critical care/perioperative intervention. We examined study characteristics, completeness of participant characteristic reporting, considerations accounting for participant characteristics, differential missing data rates, participant representativeness, and considerations to improve equitable recruitment. Participant characteristics were defined using the PROGRESS framework: Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital. We assessed risk of bias using the Cochrane Risk of Bias 2 tool.

Results

We included 60 trials (52 critical care, eight perioperative medicine) involving 155 036 participants. Mean (sd) age was 62.9 (4.1) yr. Gender/sex (n=59, 98.3%), race/ethnicity (n=10, 16.7%), place of residence (n=1, 1.7%), and social capital (n=1, 1.7%) were reported in trials. Statistical considerations were made for gender/sex in nine (15.0%) trials. Gender/sex data were missing in two trials with 5.0% and 0.3% missingness. Race/ethnicity data were missing in seven trials, with 7.39% (inter-quartile range 0.4–19.2%) missingness. Trials underrepresented female and non-White participants compared with baseline populations. No trial explicitly stated efforts to improve equitable recruitment.

Conclusions

Large, high-quality critical care and perioperative RCTs inconsistently collect and report equity data. Female and non-White participants are underrepresented. These findings potentially limit generalisability of research findings. Further work is required to promote equitable study designs.

Systematic review protocol

PROSPERO (CRD42023401126)

背景：危重病护理和围手术期随机对照试验（RCTs）的代表性不足限制了普遍性，并导致健康不公平。本系统综述对大型、高质量的随机对照试验进行了分析，分析了10年来公平数据的代表性和报告趋势。方法我们在2013年1月1日至2023年5月11日期间检索MEDLINE、Embase和Clinicaltrials.gov，检索招募接受重症监护/围手术期干预的成人（年龄≥18岁）的随机对照试验。我们检查了研究特征、参与者特征报告的完整性、对参与者特征的考虑、差异缺失数据率、参与者代表性以及改善公平招募的考虑。使用PROGRESS框架定义参与者特征：居住地、种族/民族/文化/语言、职业、性别/性别、宗教、教育、社会经济地位和社会资本。我们使用Cochrane risk of bias 2工具评估偏倚风险。结果纳入60项试验（52项危重医学试验，8项围手术期医学试验），共纳入155036名受试者。平均（sd）年龄为62.9（4.1）岁。在试验中报告了性别/性别（n=59, 98.3%）、种族/民族（n=10, 16.7%）、居住地（n=1, 1.7%）和社会资本（n=1, 1.7%）。在9项（15.0%）试验中对性别/性别进行了统计考虑。两项试验缺少性别/性别数据，缺失率分别为5.0%和0.3%。7项试验缺少种族/族裔数据，缺失率为7.39%（四分位数间距为0.4-19.2%）。与基线人群相比，试验中女性和非白人参与者的代表性不足。没有一项试验明确说明了改善公平招聘的努力。结论：大型、高质量的危重病护理和围手术期随机对照试验收集和报告的公平数据不一致。女性和非白人参与者的人数不足。这些发现可能会限制研究结果的普遍性。需要进一步的工作来促进公平的研究设计。系统评价协议prospero （CRD42023401126）

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引用次数: 0

Reply to Walker and Nott 回复沃克和诺特

BJA open

Pub Date : 2025-07-24 DOI: 10.1016/j.bjao.2025.100423

Anton Utas , Stefanie Seifert , Knut Taxbro

引用次数: 0

Ethical decision making in airway management: a difficult Airway Society position statement on good practice 气道管理中的道德决策：气道协会关于良好实践的艰难立场声明

BJA open

Pub Date : 2025-06-19 DOI: 10.1016/j.bjao.2025.100416

Barry McGuire , Simon Crawley , Nicki Dill , Paul Greig , Rehana Iqbal , Mathew Patteril , Kate Rivett , Anika Sud , Anne-Marie Slowther

Practitioners involved in airway management must balance ethical issues in their practice. Ethical tensions exist because clinicians must maintain clinical standards while maximising skill development, exploring advances in airway practice, and incorporating new learning to benefit future patients. Balancing the benefits and risks to the patient and choosing the right techniques in the right situations and with the right level of patient understanding and respect for patient autonomy can be challenging.

These challenges are shared by airway practitioners from many professional backgrounds; however, this document has been developed specifically to support anaesthetists in their airway management decisions, and for simplicity, the term ‘anaesthetists’ will be used throughout the document. However, the ethical considerations will have relevance to all airway practitioners.

Practice combined with training is central to professional development. Most patients are aware that training is entwined with care and trust anaesthetists to deliver this safely. Trainers should use airway teaching methods appropriate to the trainee's needs and skills.

Informed consent is required for airway management, and the level of detail should be proportionate to the risks involved. Patients have individual preferences and appreciation of risks, so these conversations must be individualised.

Anaesthetists should support the development of new airway devices and techniques. New methods must be assessed within governance structures, and it may be appropriate to collect data or feedback as part of the introduction to practice.

Ethical practice requires doing what is best, doing it openly, honestly, and in patients' interests. The modern ethical and legal landscape has emphasised patient information, discussion, and documentation. We hope this position statement provides guidance, structure, and clarity for the benefit of our patients and our specialty.

参与气道管理的从业人员必须在实践中平衡道德问题。伦理上的紧张关系之所以存在，是因为临床医生必须保持临床标准，同时最大限度地提高技能发展，探索气道实践的进步，并将新的学习纳入未来的患者。平衡对患者的益处和风险，在正确的情况下选择正确的技术，以及患者对患者自主权的适当理解和尊重，可能是一项挑战。这些挑战是来自许多专业背景的气道从业人员共同面临的；然而，本文件是专门为支持麻醉师气道管理决策而制定的，为简单起见，“麻醉师”一词将在整个文件中使用。然而，道德方面的考虑将与所有气道从业人员相关。实践与培训相结合是专业发展的核心。大多数患者都意识到，培训与护理和信任麻醉师安全交付麻醉是密不可分的。培训师应使用适合学员需要和技能的气道教学方法。气道管理需要知情同意，详细程度应与所涉及的风险成比例。病人有个人的偏好和对风险的理解，所以这些谈话必须是个体化的。麻醉师应该支持新的气道设备和技术的发展。新方法必须在治理结构中进行评估，收集数据或反馈作为实践介绍的一部分可能是合适的。道德实践要求做最好的事情，公开、诚实地做，并为病人的利益服务。现代伦理和法律环境强调患者信息、讨论和记录。我们希望这份立场声明能为我们的患者和我们的专业提供指导、结构和清晰。

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