Anaesthesia最新文献

英文中文

Erector spinae plane block vs. rectus sheath block. 脊束肌平面阻滞与直肌鞘阻滞。

IF 7.5 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-02-01 Epub Date: 2024-11-04 DOI: 10.1111/anae.16466

Guanyu Yang

引用次数: 0

Mandatory training for rare anaesthetic events or mandatory safety preparedness - the beatings will continue until morale improves, or is it time for a carrot and not a stick? 针对罕见麻醉事件的强制性培训或强制性安全准备--在士气提高之前，殴打会一直持续下去，还是到了胡萝卜加大棒的时候了？

IF 7.5 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-02-01 Epub Date: 2024-11-18 DOI: 10.1111/anae.16480

Tim Murphy

引用次数: 0

The impact of out-of-hours elective surgery: is it worth the risk? 非工作时间择期手术的影响：值得冒险吗？

IF 7.5 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-02-01 Epub Date: 2024-10-22 DOI: 10.1111/anae.16458

Emer Scanlon, Hilary Leeson, Nikki Higgins

引用次数: 0

Gastric ultrasound performance time and difficulty: a prospective observational study. 胃部超声波检查时间和难度：一项前瞻性观察研究。

IF 7.5 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-02-01 Epub Date: 2024-11-15 DOI: 10.1111/anae.16472

Mark G Filipovic, Sascha J Baettig, Monika Hebeisen, Roman Meierhans, Michael T Ganter

Introduction: Point-of-care gastric ultrasound is an emerging tool in peri-operative practice. However, data on the technical challenges of gastric ultrasound, which are essential for optimised training, remain scarce. We analysed gastric ultrasound examinations performed after basic training to identify factors associated with difficulty.

Methods: This was an analysis of data from a prospective observational study evaluating the potential impact of routine pre-operative gastric ultrasound on peri-operative management in adult patients undergoing elective or emergency surgery at a single centre. Before initiation, physicians received extensive structured training with at least 30 supervised gastric sonograms before independent practice. We then used regression models to identify factors associated with deviation from a predefined sonography algorithm, performance time and scan difficulty.

Results: Seventy-three trained physicians performed 2003 ultrasound scans. Median (IQR [range]) performance time was 5 (4-6 [1-20]) min, which was achieved after 20-27 scans following structured training. Patient characteristics associated with more difficult and longer duration scans were: increase in BMI per 5 kg.m^-2 (odds ratio (95%CI) 1.57 (1.35-1.83), p < 0.001 for difficulty and percentage change coefficient (95%CI) 1.03 (1.02-1.05), p < 0.001 for duration); and male sex (odds ratio (95%CI) 3.31 (2.28-4.88), p < 0.001 for difficulty and percentage change coefficient (95%CI) 1.08 (1.04-1.12), p < 0.001, for duration). Trauma surgery (odds ratio (95%CI) 3.26 (1.88-5.68), p < 0.001), ASA physical status of 3 or 4 (odds ratio (95%CI) 1.86 (1.21-2.88), p = 0.0049) and emergency surgery (odds ratio (95%CI) 1.86 (1.20-2.89), p = 0.006) were associated with deviation from the predefined sonography algorithm.

Discussion: Approximately 50 scans are required to achieve a baseline performance of 5 min per gastric ultrasound. Future training programmes should focus on patients with obesity, male sex, higher ASA physical status and trauma.

简介护理点胃部超声是围手术期实践中的一种新兴工具。然而，有关胃部超声技术挑战的数据仍然很少，而这些数据对于优化培训至关重要。我们对基础培训后进行的胃部超声检查进行了分析，以确定与困难相关的因素：这是一项前瞻性观察研究的数据分析，该研究评估了常规术前胃部超声波检查对在一个中心接受择期手术或急诊手术的成年患者围手术期管理的潜在影响。在开始实施前，医生们接受了广泛的结构化培训，在独立实践前至少进行了 30 次有指导的胃超声检查。然后，我们使用回归模型确定了与偏离预先定义的超声造影算法、操作时间和扫描难度相关的因素：73名经过培训的医生进行了2003次超声扫描。中位（IQR [范围]）操作时间为 5（4-6 [1-20]）分钟，这是在经过结构化培训后进行 20-27 次扫描后达到的。与扫描难度增加和持续时间延长相关的患者特征有：体重指数每增加 5 kg.m-2 （几率比（95%CI）为 1.57 (1.35-1.83)，p 讨论：大约需要 50 次扫描才能达到每次胃部超声检查 5 分钟的基准性能。未来的培训计划应侧重于肥胖、男性、ASA 身体状况较好和外伤患者。

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引用次数: 0

Instrumental variable analyses – an alternative to regression?

IF 10.7 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-01-17 DOI: 10.1111/anae.16549

Siu‐Wai Choi

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引用次数: 0

Gastric point-of-care ultrasound in the GLP-1 receptor agonist era: clinical impact and competency

IF 10.7 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-01-15 DOI: 10.1111/anae.16548

Dáire N. Kelly, Sai Pentyala, Stephen C. Haskins

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引用次数: 0

Association of ventilation volumes, pressures and rates with the mechanical power of ventilation in patients without acute respiratory distress syndrome: exploring the impact of rate reduction

IF 10.7 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-01-13 DOI: 10.1111/anae.16537

Laura A. Buiteman-Kruizinga, David M. P. van Meenen, Ary Serpa Neto, Guido Mazzinari, Lieuwe D. J. Bos, Pim L. J. van der Heiden, Frederique Paulus, Marcus J. Schultz, , ,

High mechanical power is associated with mortality in patients who are critically ill and require invasive ventilation. It remains uncertain which components of mechanical power – volume, pressure or rate – increase mechanical power the most.

引用次数: 0

Issue Information – Editorial Board

IF 10.7 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-01-13 DOI: 10.1111/anae.16330

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引用次数: 0

Elective peri‐operative management of adults taking glucagon‐like peptide‐1 receptor agonists, glucose‐dependent insulinotropic peptide agonists and sodium‐glucose cotransporter‐2 inhibitors: a multidisciplinary consensus statement

IF 10.7 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-01-09 DOI: 10.1111/anae.16541

Kariem El‐Boghdadly, Jugdeep Dhesi, Philippa Fabb, Nicholas Levy, Dileep N. Lobo, Andrew McKechnie, Omar Mustafa, Philip Newland‐Jones, Anil Patel, Dimitri J. Pournaras, Ken Clare, Ketan Dhatariya

SummaryIntroductionGlucagon‐like peptide‐1 receptor agonists, dual glucose‐dependent insulinotropic peptide receptor agonists and sodium‐glucose cotransporter‐2 inhibitors are used increasingly in patients receiving peri‐operative care. These drugs may be associated with risks of peri‐operative pulmonary aspiration or euglycaemic ketoacidosis. We produced a consensus statement for the peri‐operative management of adults taking these drugs.MethodsThis multidisciplinary consensus statement included surgeons, anaesthetists, physicians, pharmacists and people with lived experience relevant to these guidelines. Following the directed literature review, a three‐round modified Delphi process was conducted to generate and ratify recommendations.ResultsPatients taking glucagon‐like peptide‐1 receptor agonists and dual glucose‐dependent insulinotropic peptide receptor agonists should: continue these drugs before surgery; have full risk assessment and stratification; and receive peri‐operative techniques that may mitigate risk of pulmonary aspiration before, during and after sedation or general anaesthesia. Patients taking sodium‐glucose cotransporter‐2 inhibitors should omit them the day before and the day of a procedure. All patients should have risks and mitigation strategies discussed with a shared decision‐making approach.DiscussionUntil more evidence becomes available, this pragmatic, multidisciplinary consensus statement aims to support shared decision‐making and improve safety for patients taking glucagon‐like peptide‐1 receptor agonists, dual glucose‐dependent insulinotropic peptide receptor agonists and sodium‐glucose cotransporter‐2 inhibitors during the peri‐operative period.

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引用次数: 0

Peri‐operative identification and management of patients with unhealthy alcohol intake

IF 10.7 1区医学 Q1 ANESTHESIOLOGY

Anaesthesia

Pub Date : 2025-01-09 DOI: 10.1111/anae.16530

Matthew J. A. Jenkins, Stephen M. Kinsella, Matthew D. Wiles, Brijesh Srivastava, Catherine Griffiths, Jacquelyn Lewin, Stephen Usher, Gautam Mehta, Abi Berger, Dereck Gondongwe, Isra Hassan

SummaryIntroductionThis consensus statement gives practical advice for the safe management of patients with harmful alcohol intake undergoing elective and emergency surgery. The wide spectrum of alcohol‐related organ dysfunction observed in this cohort of patients may have a profound impact on care, and the additional effects of alcohol withdrawal may further exacerbate postoperative morbidity and mortality.MethodsA working party was assembled based on clinical and/or academic expertise in the area. Recommendations were formulated using a modified Delphi process. An initial list of recommendations was produced following targeted literature reviews for all relevant phases of patient care throughout the peri‐operative pathway. These recommendations were distributed among the authors who rated each as ‘include’, ‘exclude’; or ‘revise’. Recommendations with ≥ 75% inclusion decision were included.ResultsThe working party produced a list of 10 key peri‐operative management recommendations. These include recommendations on how to screen effectively for excessive alcohol usage in the surgical population. To achieve this, a validated point‐of‐care tool is used with additional weighting provided by considering surgical urgency. This is combined with the use of scoring systems to facilitate decisions regarding peri‐operative care including postoperative location. This document also provides clear explanation of the physiological and pharmacological issues relating to alcohol excess, highlighting the direct effects of alcohol and its secondary effects on organ systems.DiscussionThis consensus statement offers strategies and solutions to minimise the impact of harmful alcohol intake on the safe conduct of anaesthesia.

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