John F. Pearson, Calvin S. Riss, Douglas A. Colquhoun, Yue Zhang, Matthew J. Strickland
{"title":"The effect of hospital‐level fine particulate matter exposure on surgical complications","authors":"John F. Pearson, Calvin S. Riss, Douglas A. Colquhoun, Yue Zhang, Matthew J. Strickland","doi":"10.1111/anae.70207","DOIUrl":"https://doi.org/10.1111/anae.70207","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"58 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478125","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":"Recommendations on antihypertensives in the peri‐operative period","authors":"Claire Frank","doi":"10.1111/anae.70210","DOIUrl":"https://doi.org/10.1111/anae.70210","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"17 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478127","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}
Summary Introduction Phenylephrine infusion is widely endorsed by guidelines as the preferred prophylactic drug for spinal hypotension in patients undergoing caesarean delivery; however, clinical practice continues to show marked variability in the selection of vasopressor drugs. To address this, we aimed to synthesise current evidence from randomised controlled trials comparing vasopressor infusions for various feto‐maternal outcomes in normotensive adult patients undergoing caesarean delivery. Methods Randomised controlled trials evaluating maternal and fetal outcomes associated with prophylactic vasopressor infusion were identified through comprehensive database searches. Primary outcomes were the incidence of maternal hypotension and umbilical artery base excess. Secondary outcomes comprised maternal and fetal parameters including: umbilical artery and vein pH; umbilical vein base excess; Apgar scores at 1 min and 5 min; and incidence of maternal intra‐operative nausea and vomiting, bradycardia, tachycardia and hypertension. Results Fifty‐five trials involving 5487 patients undergoing caesarean delivery under spinal or combined spinal and epidural anaesthesia using a variety of vasopressor infusions were included in the final analysis. Four drugs—metaraminol, noradrenaline, phenylephrine and adrenaline—were judged to be ‘definitely superior’ to control (no active vasopressor infusion) for the prevention of hypotension. Umbilical vessel analyses indicated that mephentermine and metaraminol provided superior preservation of both umbilical arterial and venous acid–base balance. Discussion Current evidence suggests that continuous infusions of α‐agonists with mild β‐activity (e.g. noradrenaline, metaraminol) are preferable to mixed adrenergic agonists such as ephedrine for preventing maternal hypotension. While these findings reinforce existing recommendations for maternal haemodynamic management, the evidence base for fetal outcomes remains limited.
{"title":"Efficacy and safety of different vasopressor infusions on feto‐maternal outcomes in normotensive patients undergoing caesarean delivery: a systematic review and network meta‐analysis of randomised controlled trials","authors":"Narinder Pal Singh, Jeetinder Kaur Makkar, Bisman Jeet Kaur Khurana, Anuradha Borle, Preet Mohinder Singh","doi":"10.1111/anae.70204","DOIUrl":"https://doi.org/10.1111/anae.70204","url":null,"abstract":"Summary Introduction Phenylephrine infusion is widely endorsed by guidelines as the preferred prophylactic drug for spinal hypotension in patients undergoing caesarean delivery; however, clinical practice continues to show marked variability in the selection of vasopressor drugs. To address this, we aimed to synthesise current evidence from randomised controlled trials comparing vasopressor infusions for various feto‐maternal outcomes in normotensive adult patients undergoing caesarean delivery. Methods Randomised controlled trials evaluating maternal and fetal outcomes associated with prophylactic vasopressor infusion were identified through comprehensive database searches. Primary outcomes were the incidence of maternal hypotension and umbilical artery base excess. Secondary outcomes comprised maternal and fetal parameters including: umbilical artery and vein pH; umbilical vein base excess; Apgar scores at 1 min and 5 min; and incidence of maternal intra‐operative nausea and vomiting, bradycardia, tachycardia and hypertension. Results Fifty‐five trials involving 5487 patients undergoing caesarean delivery under spinal or combined spinal and epidural anaesthesia using a variety of vasopressor infusions were included in the final analysis. Four drugs—metaraminol, noradrenaline, phenylephrine and adrenaline—were judged to be ‘definitely superior’ to control (no active vasopressor infusion) for the prevention of hypotension. Umbilical vessel analyses indicated that mephentermine and metaraminol provided superior preservation of both umbilical arterial and venous acid–base balance. Discussion Current evidence suggests that continuous infusions of α‐agonists with mild β‐activity (e.g. noradrenaline, metaraminol) are preferable to mixed adrenergic agonists such as ephedrine for preventing maternal hypotension. While these findings reinforce existing recommendations for maternal haemodynamic management, the evidence base for fetal outcomes remains limited.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"27 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478128","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}
Anne Rüggeberg, Alexander Nagrebetsky, Kariem El‐Boghdadly
{"title":"Peri‐operative fasting in adults and assumed milk composition: a reply","authors":"Anne Rüggeberg, Alexander Nagrebetsky, Kariem El‐Boghdadly","doi":"10.1111/anae.70209","DOIUrl":"https://doi.org/10.1111/anae.70209","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"197 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478124","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":"Time to explain and not just describe disparities","authors":"D. N. Lucas, Harry Bamber, Lisa Hinton","doi":"10.1111/anae.70208","DOIUrl":"https://doi.org/10.1111/anae.70208","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"94 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478126","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}
Jonghae Kim, Sang Gyu Kwak, Eugene Kim, Hyung‐Chul Lee, Hyun‐Lim Yang, Yun Jin Kim, Ji‐Yoon Kim, Jeong Min Sung, Soo Min Lee
Summary Introduction Previous studies comparing the effects of general and regional anaesthesia on postoperative opioid use have focused primarily on the immediate postoperative period, with limited investigations into long‐term outcomes. Methods This retrospective cohort study included 558,944 patients aged ≥ 18 y who underwent one of nine surgical procedures (thoracotomy; total hip arthroplasty; total knee arthroplasty; shoulder arthroplasty; transurethral resection of the prostate; inguinal hernia repair; knee arthroscopy; varicose vein surgery; and caesarean section) that required regional anaesthesia, general anaesthesia or combined general/regional anaesthesia. The primary outcome was the incidence of persistent postoperative opioid utilisation, which was defined as having filled ≥ 10 prescriptions or a supply of > 120 days between postoperative days 91 and 365. Age, sex, medical comorbidities, pre‐operative medications and surgery type were balanced among regional anaesthesia, general anaesthesia and combined general/regional anaesthesia using pairwise propensity score matching. Results General anaesthesia had significantly higher odds than regional anaesthesia for the development of persistent postoperative opioid utilisation (odds ratio 2.13, 95%CI 1.50–3.01, p < 0.001). The odds ratio of general anaesthesia vs. combined general/regional anaesthesia was significant in patients undergoing thoracotomy (odds ratio 1.47, 95%CI 1.25–1.74, p < 0.001). In the overall population, the regional anaesthesia group consumed fewer opioids than the other groups. Among the patients undergoing thoracotomy, the combined general/regional anaesthesia group consumed fewer opioids than the general anaesthesia group. Discussion This study found that regional anaesthesia was associated with a reduction in persistent postoperative opioid utilisation, particularly in patients undergoing thoracotomy.
先前比较全身麻醉和区域麻醉对术后阿片类药物使用影响的研究主要集中在术后即刻，对长期结果的调查有限。方法：本回顾性队列研究纳入558,944例年龄≥18岁的患者，他们接受了需要区域麻醉、全身麻醉或全身/区域联合麻醉的9种外科手术（开胸手术、全髋关节置换术、全膝关节置换术、肩关节置换术、经尿道前列腺切除术、腹股沟疝修补术、膝关节镜检查、静脉曲张手术和剖宫产术）中的一种。主要终点是术后持续阿片类药物使用的发生率，其定义为在术后91天至365天期间服用≥10张处方或供应120天。年龄、性别、医疗合并症、术前用药和手术类型在区域麻醉、全身麻醉和全身/区域联合麻醉中使用两两倾向评分匹配进行平衡。结果全麻患者术后持续使用阿片类药物的几率明显高于区域麻醉（优势比2.13,95%CI 1.50-3.01, p < 0.001）。在接受开胸手术的患者中，全麻与全麻/局部联合麻醉的优势比显著（优势比1.47,95%CI 1.25-1.74, p < 0.001）。在总体人群中，区域麻醉组比其他组消耗更少的阿片类药物。在开胸患者中，全身/区域联合麻醉组比全身麻醉组消耗的阿片类药物更少。本研究发现，区域麻醉与术后持续阿片类药物使用的减少有关，特别是在开胸患者中。
{"title":"Effects of anaesthesia type on development of persistent postoperative opioid utilisation: a South Korean nationwide cohort study","authors":"Jonghae Kim, Sang Gyu Kwak, Eugene Kim, Hyung‐Chul Lee, Hyun‐Lim Yang, Yun Jin Kim, Ji‐Yoon Kim, Jeong Min Sung, Soo Min Lee","doi":"10.1111/anae.70184","DOIUrl":"https://doi.org/10.1111/anae.70184","url":null,"abstract":"Summary Introduction Previous studies comparing the effects of general and regional anaesthesia on postoperative opioid use have focused primarily on the immediate postoperative period, with limited investigations into long‐term outcomes. Methods This retrospective cohort study included 558,944 patients aged ≥ 18 y who underwent one of nine surgical procedures (thoracotomy; total hip arthroplasty; total knee arthroplasty; shoulder arthroplasty; transurethral resection of the prostate; inguinal hernia repair; knee arthroscopy; varicose vein surgery; and caesarean section) that required regional anaesthesia, general anaesthesia or combined general/regional anaesthesia. The primary outcome was the incidence of persistent postoperative opioid utilisation, which was defined as having filled ≥ 10 prescriptions or a supply of > 120 days between postoperative days 91 and 365. Age, sex, medical comorbidities, pre‐operative medications and surgery type were balanced among regional anaesthesia, general anaesthesia and combined general/regional anaesthesia using pairwise propensity score matching. Results General anaesthesia had significantly higher odds than regional anaesthesia for the development of persistent postoperative opioid utilisation (odds ratio 2.13, 95%CI 1.50–3.01, p < 0.001). The odds ratio of general anaesthesia vs. combined general/regional anaesthesia was significant in patients undergoing thoracotomy (odds ratio 1.47, 95%CI 1.25–1.74, p < 0.001). In the overall population, the regional anaesthesia group consumed fewer opioids than the other groups. Among the patients undergoing thoracotomy, the combined general/regional anaesthesia group consumed fewer opioids than the general anaesthesia group. Discussion This study found that regional anaesthesia was associated with a reduction in persistent postoperative opioid utilisation, particularly in patients undergoing thoracotomy.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"96 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478132","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}
Sana Asif,Hsing-Fen Tu,Richard A White,Birgitta Birgisdottir,Miklos Lipcsey,Martin F Bjurström,Alkistis Skalkidou
INTRODUCTIONLabour epidural analgesia is the most effective method for intrapartum pain relief and is associated with improved maternal outcomes. However, concerns have been raised regarding potential associations between labour epidural analgesia and adverse psycho-emotional outcomes in children. Evidence from large epidemiological studies is inconsistent and potential biological mechanisms remain unclear. Maternal immune activation during pregnancy may play a role. We aimed to investigate behavioural and psycho-emotional outcomes in children of mothers who received epidural analgesia during labour, accounting for perinatal mental health, sociodemographic characteristics and cytokine profiles.METHODSSingleton vaginal births from the Biology, Affect, Stress, Imaging and Cognition study were included. Child behavioural outcomes were assessed by Child Behavioural Checklist scores at 18 months, 6 years and 11 years postpartum in the U-BIRTH follow-up cohort, with higher scores indicating more behavioural difficulties. The main exposure was maternal use of labour epidural analgesia. Maternal data were collected from questionnaires and medical records.RESULTSAmong 1962 mother-child dyads, 726 (37%) received labour epidural analgesia. Younger maternal age; lower resilience; inflammatory diseases; primiparity; antenatal depression; fear of childbirth; and longer duration of labour were associated with higher Child Behavioural Checklist scores at 18 months postpartum. In crude analysis, labour epidural analgesia correlated with higher Child Behavioural Checklist scores at 18 months postpartum; however, this association was not significant after adjusting for confounders. Among those with lower expression of TNFSF14 and CXCL6 cytokines, labour epidural analgesia use was associated with higher Child Behavioural Checklist scores.DISCUSSIONUse of epidural analgesia during labour was not found to be independently associated with adverse child behavioural outcomes. Variations in maternal cytokine profiles among those choosing labour epidural analgesia or not may influence susceptibility to early behavioural differences. Replication in larger cohorts and further exploration of additional immune biomarker dynamics during pregnancy are warranted.
{"title":"Labour epidural analgesia and early childhood behavioural outcomes: the moderating role of maternal mental health and pro-inflammatory cytokines.","authors":"Sana Asif,Hsing-Fen Tu,Richard A White,Birgitta Birgisdottir,Miklos Lipcsey,Martin F Bjurström,Alkistis Skalkidou","doi":"10.1111/anae.70203","DOIUrl":"https://doi.org/10.1111/anae.70203","url":null,"abstract":"INTRODUCTIONLabour epidural analgesia is the most effective method for intrapartum pain relief and is associated with improved maternal outcomes. However, concerns have been raised regarding potential associations between labour epidural analgesia and adverse psycho-emotional outcomes in children. Evidence from large epidemiological studies is inconsistent and potential biological mechanisms remain unclear. Maternal immune activation during pregnancy may play a role. We aimed to investigate behavioural and psycho-emotional outcomes in children of mothers who received epidural analgesia during labour, accounting for perinatal mental health, sociodemographic characteristics and cytokine profiles.METHODSSingleton vaginal births from the Biology, Affect, Stress, Imaging and Cognition study were included. Child behavioural outcomes were assessed by Child Behavioural Checklist scores at 18 months, 6 years and 11 years postpartum in the U-BIRTH follow-up cohort, with higher scores indicating more behavioural difficulties. The main exposure was maternal use of labour epidural analgesia. Maternal data were collected from questionnaires and medical records.RESULTSAmong 1962 mother-child dyads, 726 (37%) received labour epidural analgesia. Younger maternal age; lower resilience; inflammatory diseases; primiparity; antenatal depression; fear of childbirth; and longer duration of labour were associated with higher Child Behavioural Checklist scores at 18 months postpartum. In crude analysis, labour epidural analgesia correlated with higher Child Behavioural Checklist scores at 18 months postpartum; however, this association was not significant after adjusting for confounders. Among those with lower expression of TNFSF14 and CXCL6 cytokines, labour epidural analgesia use was associated with higher Child Behavioural Checklist scores.DISCUSSIONUse of epidural analgesia during labour was not found to be independently associated with adverse child behavioural outcomes. Variations in maternal cytokine profiles among those choosing labour epidural analgesia or not may influence susceptibility to early behavioural differences. Replication in larger cohorts and further exploration of additional immune biomarker dynamics during pregnancy are warranted.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"91 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147461756","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}
Wei Wang,Kun Liu,Chengya Huang,Qiliang Jiang,Yi Ge,Daniel I Sessler,Jingxiang Wu
INTRODUCTIONPostoperative pulmonary complications are common after lung cancer surgery in older adults. Individualised positive end-expiratory pressure may optimise intra-operative lung mechanics, but its effect on postoperative pulmonary complications is uncertain. We hypothesised that individualised positive end-expiratory pressure would reduce the incidence of postoperative pulmonary complications compared with a fixed positive end-expiratory pressure in older patients (age ≥ 60 years) undergoing lung cancer surgery.METHODSIn total, 400 patients were allocated randomly to individualised positive end-expiratory pressure (PEEPIND group) or a fixed positive end-expiratory pressure of 5 cmH2O (PEEP5 group). The primary outcome was the incidence of postoperative pulmonary complications. Secondary outcomes included duration of postoperative hospital stay; extrapulmonary complications; 30-day postoperative complications; driving pressure; and oxygenation index.RESULTSMedian (IQR [range]) individualised positive end-expiratory pressure was 11 (9-11 [3-13]) cmH2O during one-lung and 9 (7-9 [3-13]) cmH2O during two-lung ventilation. Patients allocated to the PEEPIND group had lower driving pressures during one-lung (12 (11-14 [4-23]) vs. 15 (13-18 [7-24]) cmH2O, p < 0.001) and two-lung ventilation (9 (7-13 [4-26]) vs. 12 (10-14 [5-26]) cmH2O, p < 0.001) and a higher oxygenation index during one-lung ventilation (26.7 (20.3-34.4 [6.7-55.9]) vs. 22.7 (16.0-29.3 [8.8-58.9]) kPa, p < 0.001) compared with those allocated to the PEEP5 group. Despite this, the incidence of postoperative pulmonary complications was similar between groups (PEEPIND group 54/195 (28%) vs. PEEP5 group 50/197 (25%), risk ratio 1.09, 95%CI 0.79-1.52, p = 0.60).DISCUSSIONElectrical impedance tomography-guided individualised positive end-expiratory pressure reduced driving pressures and improved intra-operative oxygenation but did not decrease the incidence of postoperative pulmonary complications in older adults undergoing lung cancer surgery.
老年人肺癌手术后肺部并发症是常见的。个体化呼气末正压可优化术中肺力学，但其对术后肺并发症的影响尚不确定。我们假设，与固定呼气末正压相比，个体化呼气末正压可减少老年肺癌手术患者（年龄≥60岁）术后肺部并发症的发生率。方法400例患者随机分为个体化呼气末正压组（PEEPIND组）和固定呼气末正压5 cmH2O组（PEEP5组）。主要观察指标是术后肺部并发症的发生率。次要结局包括术后住院时间；肺外并发症;术后30天并发症；开车压力;氧合指数。结果单肺通气时个体化呼气末正压中位数（IQR[范围]）为11 (9-11 [3-13])cmH2O，双肺通气时为9 (7-9 [3-13])cmH2O。PEEPIND组患者单肺通气（12（11-14[4-23]）比15 (13-18 [7-24])cmH2O, p < 0.001）和双肺通气（9（7-13[4-26]）比12 (10-14 [5-26])cmH2O, p < 0.001）时驱动压较低，单肺通气时氧合指数较高（26.7（20.3-34.4[6.7-55.9]）比22.7 (16.0-29.3 [8.8-58.9])kPa, p < 0.001）。尽管如此，两组术后肺部并发症的发生率相似(PEEPIND组54/195 （28%)vs. PEEP5组50/197(25%)，风险比1.09,95%CI 0.79-1.52, p = 0.60）。电阻抗断层扫描引导个体化呼气末正压降低了驱动压，改善了术中氧合，但没有降低老年人肺癌手术后肺部并发症的发生率。
{"title":"Pulmonary complications with individualised vs. fixed positive end-expiratory pressure in older patients recovering from lung cancer surgery: a randomised trial.","authors":"Wei Wang,Kun Liu,Chengya Huang,Qiliang Jiang,Yi Ge,Daniel I Sessler,Jingxiang Wu","doi":"10.1111/anae.70165","DOIUrl":"https://doi.org/10.1111/anae.70165","url":null,"abstract":"INTRODUCTIONPostoperative pulmonary complications are common after lung cancer surgery in older adults. Individualised positive end-expiratory pressure may optimise intra-operative lung mechanics, but its effect on postoperative pulmonary complications is uncertain. We hypothesised that individualised positive end-expiratory pressure would reduce the incidence of postoperative pulmonary complications compared with a fixed positive end-expiratory pressure in older patients (age ≥ 60 years) undergoing lung cancer surgery.METHODSIn total, 400 patients were allocated randomly to individualised positive end-expiratory pressure (PEEPIND group) or a fixed positive end-expiratory pressure of 5 cmH2O (PEEP5 group). The primary outcome was the incidence of postoperative pulmonary complications. Secondary outcomes included duration of postoperative hospital stay; extrapulmonary complications; 30-day postoperative complications; driving pressure; and oxygenation index.RESULTSMedian (IQR [range]) individualised positive end-expiratory pressure was 11 (9-11 [3-13]) cmH2O during one-lung and 9 (7-9 [3-13]) cmH2O during two-lung ventilation. Patients allocated to the PEEPIND group had lower driving pressures during one-lung (12 (11-14 [4-23]) vs. 15 (13-18 [7-24]) cmH2O, p < 0.001) and two-lung ventilation (9 (7-13 [4-26]) vs. 12 (10-14 [5-26]) cmH2O, p < 0.001) and a higher oxygenation index during one-lung ventilation (26.7 (20.3-34.4 [6.7-55.9]) vs. 22.7 (16.0-29.3 [8.8-58.9]) kPa, p < 0.001) compared with those allocated to the PEEP5 group. Despite this, the incidence of postoperative pulmonary complications was similar between groups (PEEPIND group 54/195 (28%) vs. PEEP5 group 50/197 (25%), risk ratio 1.09, 95%CI 0.79-1.52, p = 0.60).DISCUSSIONElectrical impedance tomography-guided individualised positive end-expiratory pressure reduced driving pressures and improved intra-operative oxygenation but did not decrease the incidence of postoperative pulmonary complications in older adults undergoing lung cancer surgery.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"75 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147393862","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}
L Amaki Sogbodjor, Cyrus Razavi, Karen Williams, Andrew Selman, Snehal M Pinto Pereira, Mark Davenport, S Ramani Moonesinghe
Introduction: Appendicitis is one of the most common emergency surgical pathologies in childhood. This study used data from the Children's Acute Surgical Abdomen Programme study to describe compliance with published standards of care and the relationship between care delivery and 30-day postoperative morbidity for children aged 1-16 y undergoing appendicectomy.
Methods: Data were collected from 80 hospitals and this included the type of care delivered, the setting in which care was provided and patient level factors. Bivariable and multivariable analysis was undertaken to identify associations between care delivery and outcome.
Results: Data collected from 2799 children highlighted variation in care provision related to the use of pre-operative imaging, multimodal analgesia and the proportion of children undergoing surgery within 24 h of presentation; compliance with these standards was 42.6%, 70.8% and 72.8%, respectively. Children managed in specialist paediatric centres were younger, with a higher burden of chronic disease and higher rates of complicated appendicitis. They were also less likely to have a negative appendicectomy but more likely to experience postoperative complications.
Discussion: Despite a high compliance with published recommendations for several aspects of care, deficiencies were identified. A focused effort is needed to improve diagnostic accuracy, optimise analgesia management and reduce the duration of time for which children are waiting for surgery. Similarly, further work is required to better understand the increased rates of postoperative morbidity seen in specialist paediatric centres. Addressing these factors may lead to discernible improvements in experience and outcomes for children with suspected appendicitis.
{"title":"Quality of care received by children with suspected appendicitis in the UK National Health Service.","authors":"L Amaki Sogbodjor, Cyrus Razavi, Karen Williams, Andrew Selman, Snehal M Pinto Pereira, Mark Davenport, S Ramani Moonesinghe","doi":"10.1111/anae.70183","DOIUrl":"https://doi.org/10.1111/anae.70183","url":null,"abstract":"<p><strong>Introduction: </strong>Appendicitis is one of the most common emergency surgical pathologies in childhood. This study used data from the Children's Acute Surgical Abdomen Programme study to describe compliance with published standards of care and the relationship between care delivery and 30-day postoperative morbidity for children aged 1-16 y undergoing appendicectomy.</p><p><strong>Methods: </strong>Data were collected from 80 hospitals and this included the type of care delivered, the setting in which care was provided and patient level factors. Bivariable and multivariable analysis was undertaken to identify associations between care delivery and outcome.</p><p><strong>Results: </strong>Data collected from 2799 children highlighted variation in care provision related to the use of pre-operative imaging, multimodal analgesia and the proportion of children undergoing surgery within 24 h of presentation; compliance with these standards was 42.6%, 70.8% and 72.8%, respectively. Children managed in specialist paediatric centres were younger, with a higher burden of chronic disease and higher rates of complicated appendicitis. They were also less likely to have a negative appendicectomy but more likely to experience postoperative complications.</p><p><strong>Discussion: </strong>Despite a high compliance with published recommendations for several aspects of care, deficiencies were identified. A focused effort is needed to improve diagnostic accuracy, optimise analgesia management and reduce the duration of time for which children are waiting for surgery. Similarly, further work is required to better understand the increased rates of postoperative morbidity seen in specialist paediatric centres. Addressing these factors may lead to discernible improvements in experience and outcomes for children with suspected appendicitis.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430327","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：