<p>Murphy's letter opposing the call for mandatory training for rare anaesthetic events [<span>1</span>] challenges issues inferred, but not contained, in the editorial by Nathanson et al. [<span>2</span>]. For example, Nathanson et al. did not suggest that training would make individual humans less error prone. They proposed that we should be training staff to work in multidisciplinary teams, as teamwork can help us identify and correct the inevitable errors of our colleagues and can help them identify and correct ours. While the concepts of teamwork can, and should, be learned through lectures and reading existing literature, developing and refining the non-technical skills required for good teamwork requires training and deliberate practice, with targeted positive feedback. Simulation is the ideal learning environment for this, allowing non-technical skills to be observed, practised and improved. Murphy also seemed particularly concerned about the possibility of sanctions for failing to meet standards, but sanctions do not have a role in simulation training, and they were not mentioned by Nathanson et al.</p> <p>In response to Murphy's philosophical position that we should view this issue through a utilitarian lens, we believe that a Kantian perspective would be much more appropriate. Utilitarianism can be summarised as the greatest good for the greatest number of people; it is important to recognise that this is based on consequentialism, meaning that, when we act, we are trying to predict how much good the act will produce, as opposed to whether the act is good [<span>3</span>]. The Kantian approach is deontological in nature. This means our actions are judged as objectively good or bad based on ethical values and principles, rather than predicted consequences [<span>4</span>]. According to Kant, what matters is the ethical or moral value of an action. While outcomes are important, it is vital to recognise that, instead of trying to anticipate the optimal outcomes for all parties involved, we have a duty to act in the most ethically correct way for our patients. This includes supporting all measures to ensure that we, as doctors, are appropriately trained to deal with serious rare events that we know cause death and disability. This, therefore, includes supporting the call by Nathanson et al. for mandatory training [<span>2</span>].</p> <p>The second relevant element of Kantian ethics is found within his categorical imperative, which boils down to the principle of universalisation [<span>5</span>]: “<i>if I act in a certain way, I should be content with everyone else also acting in this way</i>”. This mirrors the question posed by Nathanson et al.: “<i>would we be happy if a member of our family were under the care of an anaesthetist who was unable to demonstrate they could safely manage inadvertent oesophageal intubation or acute anaphylaxis to a neuromuscular blocking drug?</i>” [<span>2</span>]. We believe anaesthetists would answer this
{"title":"Mandatory training for rare anaesthetic events – a philosophical view","authors":"Christopher Frerk, Genevieve Evans","doi":"10.1111/anae.16552","DOIUrl":"https://doi.org/10.1111/anae.16552","url":null,"abstract":"<p>Murphy's letter opposing the call for mandatory training for rare anaesthetic events [<span>1</span>] challenges issues inferred, but not contained, in the editorial by Nathanson et al. [<span>2</span>]. For example, Nathanson et al. did not suggest that training would make individual humans less error prone. They proposed that we should be training staff to work in multidisciplinary teams, as teamwork can help us identify and correct the inevitable errors of our colleagues and can help them identify and correct ours. While the concepts of teamwork can, and should, be learned through lectures and reading existing literature, developing and refining the non-technical skills required for good teamwork requires training and deliberate practice, with targeted positive feedback. Simulation is the ideal learning environment for this, allowing non-technical skills to be observed, practised and improved. Murphy also seemed particularly concerned about the possibility of sanctions for failing to meet standards, but sanctions do not have a role in simulation training, and they were not mentioned by Nathanson et al.</p>\u0000<p>In response to Murphy's philosophical position that we should view this issue through a utilitarian lens, we believe that a Kantian perspective would be much more appropriate. Utilitarianism can be summarised as the greatest good for the greatest number of people; it is important to recognise that this is based on consequentialism, meaning that, when we act, we are trying to predict how much good the act will produce, as opposed to whether the act is good [<span>3</span>]. The Kantian approach is deontological in nature. This means our actions are judged as objectively good or bad based on ethical values and principles, rather than predicted consequences [<span>4</span>]. According to Kant, what matters is the ethical or moral value of an action. While outcomes are important, it is vital to recognise that, instead of trying to anticipate the optimal outcomes for all parties involved, we have a duty to act in the most ethically correct way for our patients. This includes supporting all measures to ensure that we, as doctors, are appropriately trained to deal with serious rare events that we know cause death and disability. This, therefore, includes supporting the call by Nathanson et al. for mandatory training [<span>2</span>].</p>\u0000<p>The second relevant element of Kantian ethics is found within his categorical imperative, which boils down to the principle of universalisation [<span>5</span>]: “<i>if I act in a certain way, I should be content with everyone else also acting in this way</i>”. This mirrors the question posed by Nathanson et al.: “<i>would we be happy if a member of our family were under the care of an anaesthetist who was unable to demonstrate they could safely manage inadvertent oesophageal intubation or acute anaphylaxis to a neuromuscular blocking drug?</i>” [<span>2</span>]. We believe anaesthetists would answer this ","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"74 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>We read the correspondence from Margiotta and Plaat with interest [<span>1</span>]. There could be much gained by comparing major obstetric and traumatic haemorrhage. Three areas that we believe are particularly relevant are identification of hypovolaemia and coagulopathy, and the impact of human factors.</p> <p>The 7th National Audit Project (NAP7) authors identified that hypovolaemia was under-recognised and inadequately treated in obstetric patients who had a cardiac arrest [<span>2</span>]. Trauma research suggests multimodal assessments of volume status are important, as individual parameters and scoring systems lack sensitivity and specificity. In addition to heart rate and blood pressure, capillary refill, pulse pressure, base deficit and lactate, coagulopathy and estimated blood loss may be most useful and should be used in combination. Shock index can be a predictor of the severity of shock in trauma, but not in the obstetric population.</p> <p>The NAP7 authors recommended the use of fluid resuscitation and vasopressor use in obstetric haemorrhage [<span>2</span>]. In the major trauma setting, acidaemia, hypothermia, hyperkalaemia, hypocalcaemia and coagulopathy are associated with worse outcomes. Consequently, early transfusion of blood products and management of metabolic disturbance are of the upmost importance. Viscoelastic haemostatic assay-driven therapy represents the ‘gold standard’ in trauma care and is recommended by international guidelines [<span>3</span>]. The importance of targeted therapy was emphasised by CRYOSTAT-2, showing no advantage to empirical cryoprecipitate use in major trauma and worse outcomes if given before depletion of fibrinogen [<span>4</span>]. Pregnancy is accompanied by significant changes in the coagulation and fibrinolytic systems including increased fibrinogen concentrations (3.5–6.5 g.l<sup>-1</sup>) [<span>5</span>]. Hypofibrinogenaemia is associated with poor outcomes and, as a result, a higher fibrinogen target of 2 g.l<sup>-1</sup> is recommended.</p> <p>We must also consider fetal wellbeing. To preserve uterine blood flow, maternal systemic blood pressure should be maintained near normal before delivery. As such, hypotensive resuscitation, which can be an advantageous approach in damage control resuscitation in trauma [<span>3</span>], is not the mainstay in obstetrics.</p> <p>Multidisciplinary teamwork, effective communication and human factors are key in managing both obstetric and traumatic major haemorrhage, with failure of these recognised as a contributor to maternal morbidity and mortality by MBRRACE-UK [<span>6</span>]. Non-technical skills including situational awareness, appropriate role allocation and performance under pressure in stressful situations are important.</p> <p>Comparing obstetric and traumatic haemorrhage highlights that not all bleeding is the same, as they differ significantly in physiological response and risk of coagulopathy. These differences are influenced by a
{"title":"Similarities and differences between maternal and major traumatic haemorrhage – what can we learn?","authors":"Benjamin Stretch, Paola Eiben, James O'Carroll","doi":"10.1111/anae.16544","DOIUrl":"https://doi.org/10.1111/anae.16544","url":null,"abstract":"<p>We read the correspondence from Margiotta and Plaat with interest [<span>1</span>]. There could be much gained by comparing major obstetric and traumatic haemorrhage. Three areas that we believe are particularly relevant are identification of hypovolaemia and coagulopathy, and the impact of human factors.</p>\u0000<p>The 7th National Audit Project (NAP7) authors identified that hypovolaemia was under-recognised and inadequately treated in obstetric patients who had a cardiac arrest [<span>2</span>]. Trauma research suggests multimodal assessments of volume status are important, as individual parameters and scoring systems lack sensitivity and specificity. In addition to heart rate and blood pressure, capillary refill, pulse pressure, base deficit and lactate, coagulopathy and estimated blood loss may be most useful and should be used in combination. Shock index can be a predictor of the severity of shock in trauma, but not in the obstetric population.</p>\u0000<p>The NAP7 authors recommended the use of fluid resuscitation and vasopressor use in obstetric haemorrhage [<span>2</span>]. In the major trauma setting, acidaemia, hypothermia, hyperkalaemia, hypocalcaemia and coagulopathy are associated with worse outcomes. Consequently, early transfusion of blood products and management of metabolic disturbance are of the upmost importance. Viscoelastic haemostatic assay-driven therapy represents the ‘gold standard’ in trauma care and is recommended by international guidelines [<span>3</span>]. The importance of targeted therapy was emphasised by CRYOSTAT-2, showing no advantage to empirical cryoprecipitate use in major trauma and worse outcomes if given before depletion of fibrinogen [<span>4</span>]. Pregnancy is accompanied by significant changes in the coagulation and fibrinolytic systems including increased fibrinogen concentrations (3.5–6.5 g.l<sup>-1</sup>) [<span>5</span>]. Hypofibrinogenaemia is associated with poor outcomes and, as a result, a higher fibrinogen target of 2 g.l<sup>-1</sup> is recommended.</p>\u0000<p>We must also consider fetal wellbeing. To preserve uterine blood flow, maternal systemic blood pressure should be maintained near normal before delivery. As such, hypotensive resuscitation, which can be an advantageous approach in damage control resuscitation in trauma [<span>3</span>], is not the mainstay in obstetrics.</p>\u0000<p>Multidisciplinary teamwork, effective communication and human factors are key in managing both obstetric and traumatic major haemorrhage, with failure of these recognised as a contributor to maternal morbidity and mortality by MBRRACE-UK [<span>6</span>]. Non-technical skills including situational awareness, appropriate role allocation and performance under pressure in stressful situations are important.</p>\u0000<p>Comparing obstetric and traumatic haemorrhage highlights that not all bleeding is the same, as they differ significantly in physiological response and risk of coagulopathy. These differences are influenced by a ","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"82 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Assessment of functional capacity is an essential part of peri-operative risk stratification. Subjective functional capacity is easier to examine than objective tests of patient fitness. However, the association between subjective functional capacity and postoperative outcomes has not been established.
{"title":"Pre-operative subjective functional capacity and postoperative outcomes in adult non-cardiac surgery: a systematic review and meta-analysis","authors":"Kyosuke Takahashi, Kyoko Chiba, Ayano Honda, Yusuke Iizuka, Koichi Yoshinaga, Alka Sachin Deo, Tokujiro Uchida","doi":"10.1111/anae.16543","DOIUrl":"https://doi.org/10.1111/anae.16543","url":null,"abstract":"Assessment of functional capacity is an essential part of peri-operative risk stratification. Subjective functional capacity is easier to examine than objective tests of patient fitness. However, the association between subjective functional capacity and postoperative outcomes has not been established.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"1 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ting Li, Jun Li, Chenchen Jiang, Liyong Yuan, Jinze Wu, Ali Mazaheri, Mingcang Wang, Shengwei Jin, Paul S. Myles, Yinguang Yao, Jimin Wu, Junping Chen, Fang G. Smith
Data regarding the incidence of 12-month postoperative cognitive decline following regional or general anaesthesia in older patients undergoing hip fracture surgery remain observational. Compared with general anaesthesia, we hypothesised that regional anaesthesia would decrease the incidence of 12-month postoperative cognitive decline.
{"title":"Incidence of 12-month postoperative cognitive decline following regional vs. general anaesthesia in older patients undergoing hip fracture surgery: follow-up of the RAGA trial","authors":"Ting Li, Jun Li, Chenchen Jiang, Liyong Yuan, Jinze Wu, Ali Mazaheri, Mingcang Wang, Shengwei Jin, Paul S. Myles, Yinguang Yao, Jimin Wu, Junping Chen, Fang G. Smith","doi":"10.1111/anae.16545","DOIUrl":"https://doi.org/10.1111/anae.16545","url":null,"abstract":"Data regarding the incidence of 12-month postoperative cognitive decline following regional or general anaesthesia in older patients undergoing hip fracture surgery remain observational. Compared with general anaesthesia, we hypothesised that regional anaesthesia would decrease the incidence of 12-month postoperative cognitive decline.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"49 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Instrumental variable analyses – an alternative to regression?","authors":"Siu‐Wai Choi","doi":"10.1111/anae.16549","DOIUrl":"https://doi.org/10.1111/anae.16549","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"157 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Gastric point-of-care ultrasound in the GLP-1 receptor agonist era: clinical impact and competency","authors":"Dáire N. Kelly, Sai Pentyala, Stephen C. Haskins","doi":"10.1111/anae.16548","DOIUrl":"https://doi.org/10.1111/anae.16548","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"18 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"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","authors":"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, , , ","doi":"10.1111/anae.16537","DOIUrl":"https://doi.org/10.1111/anae.16537","url":null,"abstract":"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.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"26 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142975240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Issue Information – Editorial Board","authors":"","doi":"10.1111/anae.16330","DOIUrl":"https://doi.org/10.1111/anae.16330","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"204 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142968356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"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","authors":"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","doi":"10.1111/anae.16541","DOIUrl":"https://doi.org/10.1111/anae.16541","url":null,"abstract":"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.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"132 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Peri‐operative identification and management of patients with unhealthy alcohol intake","authors":"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","doi":"10.1111/anae.16530","DOIUrl":"https://doi.org/10.1111/anae.16530","url":null,"abstract":"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.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"23 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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