William M Hare, Martha Belete, Adam B Brayne, Harriet Daykin, Matthew Everson, Anna Ratcliffe, Katie Samuel, Lexy Sorrell, Mark Rockett
Background: In the UK, approximately 70% of surgical procedures are undertaken as day-cases. Little information exists about recovery from day-case surgery, yet international data highlights patients are at risk of developing significant longer-term health problems including chronic post-surgical pain and persistent postoperative opioid use. The Patient-reported Outcomes, Postoperative Pain and pain relief after daY case surgery (POPPY) study was a national prospective multicentre observational study, measuring short- and longer-term patient-reported outcomes, postoperative pain and pain relief after day-case surgery.
Methods: This was a collaborative project led by resident anaesthetists under the Research and Audit Federation of Trainees umbrella. Adult day-case surgical patients were recruited on the day of surgery. Baseline data including patient characteristics; procedure details; pre-operative analgesic use; pre-existing pain; and quality of life scores were recorded. Patients were followed up through automated short message service messages. Short-term (postoperative days 1, 3 and 7) outcomes included: quality of recovery; pain severity; impact of pain on function; and analgesic use. Longer-term outcomes (postoperative day 97) included: quality of life; analgesic use; incidence of chronic post-surgical pain; and incidence persistent postoperative opioid use. Additional outcomes were completed by those patients with chronic post-surgical pain and persistent postoperative opioid use, with 30 patients recruited to a qualitative semi-structured interview study exploring postoperative expectations, recovery, postoperative pain and opioid use.
Results: An embedded pilot study at four sites recruited 129 patients. Responses to the automated short message service were gained from 129 patients (100%) at day 1; 116 (89.9%) at day 3; 108 (83.7%) at day 7; and 77 (59.7%) at day 97 postoperatively. The pilot enabled refinement of the methods and processes before the national roll out.
Conclusion: This paper outlines the methods for the POPPY study, the largest UK multicentre prospective observational study considering short- and longer-term outcomes following day-case surgery.
{"title":"Patient-reported outcomes, postoperative pain and pain relief after day case surgery (POPPY): methodology for a prospective, multicentre observational study.","authors":"William M Hare, Martha Belete, Adam B Brayne, Harriet Daykin, Matthew Everson, Anna Ratcliffe, Katie Samuel, Lexy Sorrell, Mark Rockett","doi":"10.1111/anae.16460","DOIUrl":"https://doi.org/10.1111/anae.16460","url":null,"abstract":"<p><strong>Background: </strong>In the UK, approximately 70% of surgical procedures are undertaken as day-cases. Little information exists about recovery from day-case surgery, yet international data highlights patients are at risk of developing significant longer-term health problems including chronic post-surgical pain and persistent postoperative opioid use. The Patient-reported Outcomes, Postoperative Pain and pain relief after daY case surgery (POPPY) study was a national prospective multicentre observational study, measuring short- and longer-term patient-reported outcomes, postoperative pain and pain relief after day-case surgery.</p><p><strong>Methods: </strong>This was a collaborative project led by resident anaesthetists under the Research and Audit Federation of Trainees umbrella. Adult day-case surgical patients were recruited on the day of surgery. Baseline data including patient characteristics; procedure details; pre-operative analgesic use; pre-existing pain; and quality of life scores were recorded. Patients were followed up through automated short message service messages. Short-term (postoperative days 1, 3 and 7) outcomes included: quality of recovery; pain severity; impact of pain on function; and analgesic use. Longer-term outcomes (postoperative day 97) included: quality of life; analgesic use; incidence of chronic post-surgical pain; and incidence persistent postoperative opioid use. Additional outcomes were completed by those patients with chronic post-surgical pain and persistent postoperative opioid use, with 30 patients recruited to a qualitative semi-structured interview study exploring postoperative expectations, recovery, postoperative pain and opioid use.</p><p><strong>Results: </strong>An embedded pilot study at four sites recruited 129 patients. Responses to the automated short message service were gained from 129 patients (100%) at day 1; 116 (89.9%) at day 3; 108 (83.7%) at day 7; and 77 (59.7%) at day 97 postoperatively. The pilot enabled refinement of the methods and processes before the national roll out.</p><p><strong>Conclusion: </strong>This paper outlines the methods for the POPPY study, the largest UK multicentre prospective observational study considering short- and longer-term outcomes following day-case surgery.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520746","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, Neel Desai, Jordan B Jones, Sally Elghazali, Imran Ahmad, J Robert Sneyd
Background: Different sedation regimens have been used to facilitate awake tracheal intubation, but the evidence has not been synthesised robustly, particularly with respect to clinically important outcomes. We conducted a systematic review and network meta-analysis to determine the sedation techniques most likely to be associated with successful tracheal intubation, a shorter time to successful intubation and a lower risk of arterial oxygen desaturation.
Methods: We searched for randomised controlled trials of patients undergoing awake tracheal intubation for any indication and reporting: overall tracheal intubation success rate; tracheal intubation time; incidence of arterial oxygen desaturation; and other related outcomes. We performed a frequentist network meta-analysis for these outcomes if two or more sedation regimens were compared between included trials. We also performed a sensitivity analysis excluding trials with a high risk of bias.
Results: In total, 48 studies with 2837 patients comparing 33 different regimens were included. Comparing overall awake tracheal intubation success rates (38 studies, 2139 patients), there was no evidence suggesting that any individual sedation regimen was superior. Comparing times to successful tracheal intubation (1745 patients, 24 studies), any sedation strategy was superior to placebo. When we excluded trials with a high risk of bias, we found no evidence of a difference between any interventions for time to successful tracheal intubation. Thirty-one studies (1753 patients) suggested that dexmedetomidine and magnesium sulphate were associated with a reduced risk of arterial oxygen desaturation compared with other interventions, but excluding trials with a high risk of bias suggested no relevant differences between interventions. The quality of evidence for each of our outcomes was low.
Conclusions: To maximise effective and safe awake tracheal intubation, optimising oxygenation, topical airway anaesthesia and procedural performance may have more impact than any given sedation regimen.
{"title":"Sedation for awake tracheal intubation: A systematic review and network meta-analysis.","authors":"Kariem El-Boghdadly, Neel Desai, Jordan B Jones, Sally Elghazali, Imran Ahmad, J Robert Sneyd","doi":"10.1111/anae.16452","DOIUrl":"https://doi.org/10.1111/anae.16452","url":null,"abstract":"<p><strong>Background: </strong>Different sedation regimens have been used to facilitate awake tracheal intubation, but the evidence has not been synthesised robustly, particularly with respect to clinically important outcomes. We conducted a systematic review and network meta-analysis to determine the sedation techniques most likely to be associated with successful tracheal intubation, a shorter time to successful intubation and a lower risk of arterial oxygen desaturation.</p><p><strong>Methods: </strong>We searched for randomised controlled trials of patients undergoing awake tracheal intubation for any indication and reporting: overall tracheal intubation success rate; tracheal intubation time; incidence of arterial oxygen desaturation; and other related outcomes. We performed a frequentist network meta-analysis for these outcomes if two or more sedation regimens were compared between included trials. We also performed a sensitivity analysis excluding trials with a high risk of bias.</p><p><strong>Results: </strong>In total, 48 studies with 2837 patients comparing 33 different regimens were included. Comparing overall awake tracheal intubation success rates (38 studies, 2139 patients), there was no evidence suggesting that any individual sedation regimen was superior. Comparing times to successful tracheal intubation (1745 patients, 24 studies), any sedation strategy was superior to placebo. When we excluded trials with a high risk of bias, we found no evidence of a difference between any interventions for time to successful tracheal intubation. Thirty-one studies (1753 patients) suggested that dexmedetomidine and magnesium sulphate were associated with a reduced risk of arterial oxygen desaturation compared with other interventions, but excluding trials with a high risk of bias suggested no relevant differences between interventions. The quality of evidence for each of our outcomes was low.</p><p><strong>Conclusions: </strong>To maximise effective and safe awake tracheal intubation, optimising oxygenation, topical airway anaesthesia and procedural performance may have more impact than any given sedation regimen.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520747","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}
Sarah F. Bell, Hazel Taylor, Philip Pallmann, Peter Collins
<p>Fibrinogen is essential for haemostasis and can fall to critically low levels in acute haemorrhage [<span>1</span>]. The long turnaround time for laboratory Clauss fibrinogen has led to interest in point-of-care viscoelastic haemostatic assays to identify hypofibrinogenemia. The ROTEM® Delta and Sigma devices (Werfen, Warrington, UK) offer the FIBTEM assay to assess fibrinogen contribution to clot strength in whole blood. FIBTEM A5, the amplitude 5 min after the clotting time, is used as a surrogate for the Clauss fibrinogen in management algorithms [<span>2, 3</span>]. The original FIBTEM assay used Cytochalasin D to inhibit platelets although inhibition was found to be partially influenced by the platelet count [<span>4</span>]. Tirofiban, a glycoprotein 2b/3a receptor antagonist, was added to reduce the influence of platelets and the dual platelet-inhibited assay received regulatory approval in 2022 [<span>5</span>].</p> <p>Guidelines recommend that fibrinogen levels should be maintained > 2 g.l<sup>-1</sup> [<span>6, 7</span>] in obstetric haemorrhage. Since 2017, management of postpartum haemorrhage in Wales has followed the OBS Cymru ROTEM® algorithm [<span>3</span>] with a FIBTEM A5 > 11 mm corresponding to a Clauss fibrinogen of approximately 2 g.l<sup>-1</sup>. In April 2023, Sigma cartridges with the dual platelet-inhibited FIBTEM assay were distributed in the UK. Clinicians at our institution became aware of this change in July 2024 following anecdotal observations of an altered relationship between FIBTEM A5 and Clauss fibrinogen, and discussions with the manufacturer.</p> <p>Following local service evaluation registration, anonymised data were collected retrospectively from five obstetric units in Wales using the dual platelet-inhibited FIBTEM assay. In total, 212 paired FIBTEM and Clauss fibrinogen results were available for analysis with some patients having more than one sample during a single postpartum haemorrhage episode. Four samples from a patient with severe liver impairment were excluded. The utility of the dual platelet-inhibited FIBTEM A5 to distinguish Clauss fibrinogen ≤ 2 g.l<sup>-1</sup> was analysed. Fibrinogen ≤ 2 g.l<sup>-1</sup> is uncommon during postpartum haemorrhage and to obtain sufficient data around this level, purposive data collection was necessary (Fig. 1). Comparison was made with data from a previous study which used single platelet-inhibited Sigma FIBTEM assays [<span>1</span>].</p> <figure><picture> <source media="(min-width: 1650px)" srcset="/cms/asset/b3c8d0d8-c121-4ecc-baeb-e603a38654ee/anae16455-fig-0001-m.jpg"/><img alt="Details are in the caption following the image" data-lg-src="/cms/asset/b3c8d0d8-c121-4ecc-baeb-e603a38654ee/anae16455-fig-0001-m.jpg" loading="lazy" src="/cms/asset/852836a0-dd89-4a1c-916f-d1373b00217f/anae16455-fig-0001-m.png" title="Details are in the caption following the image"/></picture><figcaption> <div><strong>Figure 1<span style="font-weight:normal"></span></s
{"title":"Relationship between the dual platelet-inhibited ROTEM® Sigma FIBTEM assay and Clauss fibrinogen during postpartum haemorrhage","authors":"Sarah F. Bell, Hazel Taylor, Philip Pallmann, Peter Collins","doi":"10.1111/anae.16455","DOIUrl":"https://doi.org/10.1111/anae.16455","url":null,"abstract":"<p>Fibrinogen is essential for haemostasis and can fall to critically low levels in acute haemorrhage [<span>1</span>]. The long turnaround time for laboratory Clauss fibrinogen has led to interest in point-of-care viscoelastic haemostatic assays to identify hypofibrinogenemia. The ROTEM® Delta and Sigma devices (Werfen, Warrington, UK) offer the FIBTEM assay to assess fibrinogen contribution to clot strength in whole blood. FIBTEM A5, the amplitude 5 min after the clotting time, is used as a surrogate for the Clauss fibrinogen in management algorithms [<span>2, 3</span>]. The original FIBTEM assay used Cytochalasin D to inhibit platelets although inhibition was found to be partially influenced by the platelet count [<span>4</span>]. Tirofiban, a glycoprotein 2b/3a receptor antagonist, was added to reduce the influence of platelets and the dual platelet-inhibited assay received regulatory approval in 2022 [<span>5</span>].</p>\u0000<p>Guidelines recommend that fibrinogen levels should be maintained > 2 g.l<sup>-1</sup> [<span>6, 7</span>] in obstetric haemorrhage. Since 2017, management of postpartum haemorrhage in Wales has followed the OBS Cymru ROTEM® algorithm [<span>3</span>] with a FIBTEM A5 > 11 mm corresponding to a Clauss fibrinogen of approximately 2 g.l<sup>-1</sup>. In April 2023, Sigma cartridges with the dual platelet-inhibited FIBTEM assay were distributed in the UK. Clinicians at our institution became aware of this change in July 2024 following anecdotal observations of an altered relationship between FIBTEM A5 and Clauss fibrinogen, and discussions with the manufacturer.</p>\u0000<p>Following local service evaluation registration, anonymised data were collected retrospectively from five obstetric units in Wales using the dual platelet-inhibited FIBTEM assay. In total, 212 paired FIBTEM and Clauss fibrinogen results were available for analysis with some patients having more than one sample during a single postpartum haemorrhage episode. Four samples from a patient with severe liver impairment were excluded. The utility of the dual platelet-inhibited FIBTEM A5 to distinguish Clauss fibrinogen ≤ 2 g.l<sup>-1</sup> was analysed. Fibrinogen ≤ 2 g.l<sup>-1</sup> is uncommon during postpartum haemorrhage and to obtain sufficient data around this level, purposive data collection was necessary (Fig. 1). Comparison was made with data from a previous study which used single platelet-inhibited Sigma FIBTEM assays [<span>1</span>].</p>\u0000<figure><picture>\u0000<source media=\"(min-width: 1650px)\" srcset=\"/cms/asset/b3c8d0d8-c121-4ecc-baeb-e603a38654ee/anae16455-fig-0001-m.jpg\"/><img alt=\"Details are in the caption following the image\" data-lg-src=\"/cms/asset/b3c8d0d8-c121-4ecc-baeb-e603a38654ee/anae16455-fig-0001-m.jpg\" loading=\"lazy\" src=\"/cms/asset/852836a0-dd89-4a1c-916f-d1373b00217f/anae16455-fig-0001-m.png\" title=\"Details are in the caption following the image\"/></picture><figcaption>\u0000<div><strong>Figure 1<span style=\"font-weight:normal\"></span></s","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"11 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490163","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}
Rafael S. F. Nersessian, Leopoldo M. da Silva, Marco Aurélio S. Carvalho, Saullo Q. Silveira, Arthur C. V. Abib, Fernando N. Bellicieri, Helidea O. Lima, Anthony M.-H. Ho, Gabriel S. Anjos, Glenio B. Mizubuti
Background
Semaglutide is a long-acting glucagon-like peptide-1 receptor agonist known to delay gastric emptying. Despite a growing body of evidence, its peri-operative safety profile remains uncertain, particularly with regard to the risk of increased residual gastric content and aspiration of gastric contents during anaesthesia. We hypothesised that semaglutide interruption of ≤ 10 days before elective surgical procedures is insufficient to reduce or normalise the residual gastric content, despite fasting intervals that comply with current guidelines.
Methods
In this prospective observational study, we recruited patients who received pre-operative once-weekly subcutaneous semaglutide within 10 days of the procedure (semaglutide group) and control patients who had not been exposed to semaglutide (non-semaglutide group). On the day of surgery, all patients underwent pre-operative point-of-care gastric ultrasound to evaluate their residual gastric content. Increased residual gastric content was defined as any solid content or > 1.5 ml.kg-1 of clear fluids as assessed by gastric ultrasound.
Results
We recruited 220 patients, 107 in the semaglutide group and 113 in the non-semaglutide group. Increased residual gastric content was found in 43/107 patients (40%) in the semaglutide group and 3/113 (3%) in the non-semaglutide group (p < 0.001). In propensity-weighted analysis, semaglutide use (OR 36.97, 95%CI 16.54–99.32), age (OR 0.95, 95%CI 0.93–0.98) and male sex (OR 2.28, 95%CI 1.29–4.06) were significantly associated with increased residual gastric content. There were no cases of pulmonary aspiration of gastric contents.
Conclusion
Pre-operative semaglutide use within 10 days of elective surgical procedures was independently associated with increased risk of residual gastric content on pre-operative gastric ultrasound assessment.
{"title":"Relationship between residual gastric content and peri-operative semaglutide use assessed by gastric ultrasound: a prospective observational study","authors":"Rafael S. F. Nersessian, Leopoldo M. da Silva, Marco Aurélio S. Carvalho, Saullo Q. Silveira, Arthur C. V. Abib, Fernando N. Bellicieri, Helidea O. Lima, Anthony M.-H. Ho, Gabriel S. Anjos, Glenio B. Mizubuti","doi":"10.1111/anae.16454","DOIUrl":"10.1111/anae.16454","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Semaglutide is a long-acting glucagon-like peptide-1 receptor agonist known to delay gastric emptying. Despite a growing body of evidence, its peri-operative safety profile remains uncertain, particularly with regard to the risk of increased residual gastric content and aspiration of gastric contents during anaesthesia. We hypothesised that semaglutide interruption of ≤ 10 days before elective surgical procedures is insufficient to reduce or normalise the residual gastric content, despite fasting intervals that comply with current guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective observational study, we recruited patients who received pre-operative once-weekly subcutaneous semaglutide within 10 days of the procedure (semaglutide group) and control patients who had not been exposed to semaglutide (non-semaglutide group). On the day of surgery, all patients underwent pre-operative point-of-care gastric ultrasound to evaluate their residual gastric content. Increased residual gastric content was defined as any solid content or > 1.5 ml.kg<sup>-1</sup> of clear fluids as assessed by gastric ultrasound.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We recruited 220 patients, 107 in the semaglutide group and 113 in the non-semaglutide group. Increased residual gastric content was found in 43/107 patients (40%) in the semaglutide group and 3/113 (3%) in the non-semaglutide group (p < 0.001). In propensity-weighted analysis, semaglutide use (OR 36.97, 95%CI 16.54–99.32), age (OR 0.95, 95%CI 0.93–0.98) and male sex (OR 2.28, 95%CI 1.29–4.06) were significantly associated with increased residual gastric content. There were no cases of pulmonary aspiration of gastric contents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pre-operative semaglutide use within 10 days of elective surgical procedures was independently associated with increased risk of residual gastric content on pre-operative gastric ultrasound assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"79 12","pages":"1317-1324"},"PeriodicalIF":7.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16454","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Opioid use in the bleeding obstetric patient: a clarification regarding NAP7.","authors":"Tim M Cook, D N Lucas, Jasmeet Soar","doi":"10.1111/anae.16459","DOIUrl":"10.1111/anae.16459","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456175","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}
Clístenes C de Carvalho, Idrys H L Guedes, Anna L S Holanda, Yuri S C Costa
{"title":"Safety of anaesthesia techniques in patients undergoing carotid endarterectomy: a systematic review with meta-analysis of randomised clinical trials.","authors":"Clístenes C de Carvalho, Idrys H L Guedes, Anna L S Holanda, Yuri S C Costa","doi":"10.1111/anae.16456","DOIUrl":"10.1111/anae.16456","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456177","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":"The impact of out-of-hours elective surgery: is it worth the risk?","authors":"Emer Scanlon, Hilary Leeson, Nikki Higgins","doi":"10.1111/anae.16458","DOIUrl":"10.1111/anae.16458","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456178","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}
Clístenes C. de Carvalho, Idrys H. L. Guedes, Maria V. M. Dantas, Kariem El-Boghdadly
<p>There is compelling evidence to support the superiority of videolaryngoscopes over direct laryngoscopes for several adult tracheal intubation outcomes [<span>1-3</span>]. However, questions remain regarding this superiority in certain scenarios [<span>4</span>], including whether the results apply to experienced anaesthetists. We aimed to establish whether videolaryngoscopy increases the likelihood of a successful first tracheal intubation attempt and/or reduces the risk of oesophageal intubation and hypoxia when tracheal intubation is attempted by experienced anaesthetists, where high levels of competence with direct laryngoscopes might reduce the advantages of videolaryngoscopes.</p><p>This analysis was based on data from a systematic review, whose protocol was registered prospectively. We included randomised clinical trials that enrolled patients aged ≥ 16 y having elective surgery with tracheal intubation using either videolaryngoscopy or direct laryngoscopy performed by anaesthetists. Studies that involved anaesthesia trainees, anaesthesia associates and medical students were not included. Our primary outcome was rate of first attempt tracheal intubation success. We also assessed rates of oesophageal intubation and hypoxia. A trial sequential analysis was conducted to assess the risk of random error from subsequent meta-analyses for our main outcome.</p><p>In total, we included 120 studies comprising 12,954 patients. The overall risk of bias was generally categorised as either ‘some concerns’ or ‘high’, due primarily to outcome measurement or incomplete reporting (online Supporting Information Figure S1).</p><p>For tracheal intubation first-pass success, we included 117 studies evaluating 12,804 patients. There were varying levels of experience with devices across the studies. Videolaryngoscopy increased the likelihood of success during the first tracheal intubation attempt significantly (relative risk (95%CI) 1.05 (1.02–1.08), p < 0.001, Table 1). The rate of success during a first tracheal intubation attempt was estimated at 90.1% (95%CI 87.7–92.1%) with direct laryngoscopy and 95.3% (93.6–96.6%) with videolaryngoscopy. Further information can be found in the online Supporting Information Figure S2. Publication bias was assessed using the small sample bias approach (online Supporting Information Figure S3), and Egger's test showed a significant asymmetry (p < 0.001). The overall quality of evidence was judged low due to risk of publication bias and inconsistency. Trial sequential analysis indicated that the available data cannot exclude a type 1 error, and thus more information may still be required (Fig. 1).</p><p>For oesophageal intubation, we included 10 studies, with videolaryngoscopy reducing the risk of oesophageal intubation significantly (relative risk (95%CI) 0.33 (0.14–0.76), p = 0.015, Table 1). The quality of the evidence was considered moderate due to imprecision. For hypoxia, we included 10 studies. We did not detect
{"title":"Videolaryngoscopy vs. direct laryngoscopy for tracheal intubation by experienced anaesthetists: a meta-analysis and trial sequential analysis of randomised controlled trials","authors":"Clístenes C. de Carvalho, Idrys H. L. Guedes, Maria V. M. Dantas, Kariem El-Boghdadly","doi":"10.1111/anae.16448","DOIUrl":"10.1111/anae.16448","url":null,"abstract":"<p>There is compelling evidence to support the superiority of videolaryngoscopes over direct laryngoscopes for several adult tracheal intubation outcomes [<span>1-3</span>]. However, questions remain regarding this superiority in certain scenarios [<span>4</span>], including whether the results apply to experienced anaesthetists. We aimed to establish whether videolaryngoscopy increases the likelihood of a successful first tracheal intubation attempt and/or reduces the risk of oesophageal intubation and hypoxia when tracheal intubation is attempted by experienced anaesthetists, where high levels of competence with direct laryngoscopes might reduce the advantages of videolaryngoscopes.</p><p>This analysis was based on data from a systematic review, whose protocol was registered prospectively. We included randomised clinical trials that enrolled patients aged ≥ 16 y having elective surgery with tracheal intubation using either videolaryngoscopy or direct laryngoscopy performed by anaesthetists. Studies that involved anaesthesia trainees, anaesthesia associates and medical students were not included. Our primary outcome was rate of first attempt tracheal intubation success. We also assessed rates of oesophageal intubation and hypoxia. A trial sequential analysis was conducted to assess the risk of random error from subsequent meta-analyses for our main outcome.</p><p>In total, we included 120 studies comprising 12,954 patients. The overall risk of bias was generally categorised as either ‘some concerns’ or ‘high’, due primarily to outcome measurement or incomplete reporting (online Supporting Information Figure S1).</p><p>For tracheal intubation first-pass success, we included 117 studies evaluating 12,804 patients. There were varying levels of experience with devices across the studies. Videolaryngoscopy increased the likelihood of success during the first tracheal intubation attempt significantly (relative risk (95%CI) 1.05 (1.02–1.08), p < 0.001, Table 1). The rate of success during a first tracheal intubation attempt was estimated at 90.1% (95%CI 87.7–92.1%) with direct laryngoscopy and 95.3% (93.6–96.6%) with videolaryngoscopy. Further information can be found in the online Supporting Information Figure S2. Publication bias was assessed using the small sample bias approach (online Supporting Information Figure S3), and Egger's test showed a significant asymmetry (p < 0.001). The overall quality of evidence was judged low due to risk of publication bias and inconsistency. Trial sequential analysis indicated that the available data cannot exclude a type 1 error, and thus more information may still be required (Fig. 1).</p><p>For oesophageal intubation, we included 10 studies, with videolaryngoscopy reducing the risk of oesophageal intubation significantly (relative risk (95%CI) 0.33 (0.14–0.76), p = 0.015, Table 1). The quality of the evidence was considered moderate due to imprecision. For hypoxia, we included 10 studies. We did not detect","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"79 12","pages":"1371-1373"},"PeriodicalIF":7.5,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16448","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clístenes C de Carvalho,Idrys H L Guedes,Maria V M Dantas,Kariem El-Boghdadly
{"title":"Videolaryngoscopy vs. direct laryngoscopy for tracheal intubation by experienced anaesthetists: a meta-analysis and trial sequential analysis of randomised controlled trials.","authors":"Clístenes C de Carvalho,Idrys H L Guedes,Maria V M Dantas,Kariem El-Boghdadly","doi":"10.1111/anae.16448","DOIUrl":"https://doi.org/10.1111/anae.16448","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"75 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486351","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}
Sharon Orbach-Zinger, Michael Heesen, Yair Binyamin
We commend Griffiths et al. [1] for their work on managing intrathecal catheters after inadvertent dural puncture in obstetric patients. These evidence-based recommendations complement and enhance previous guidelines published in Anaesthesia [2]. The recommendation for early removal of intrathecal catheters is particularly noteworthy, as it corresponds with recent findings in the field. We previously recommended leaving the intrathecal catheter for 24 h, but subsequent research has indeed shown no benefit in prolonged catheterisation. In a recent study of 550 cases of accidental dural puncture, we found no advantage in leaving the intrathecal catheter in for 24 h postpartum (postdural puncture headache, adjusted odds ratio (aOR) (95%CI) 1.01 (1.00–1.02), p = 0.015; epidural blood patch, aOR (95%CI) 1.00 (0.99–1.01), p = 0.40) [3]. This aligns well with the Obstetric Anaesthetists' Association current recommendation and supports the trend towards earlier catheter removal. Injecting intrathecal saline through the catheter was associated with decreased odds of developing postdural puncture headache (aOR (95%CI) 0.85 (0.73–0.99), p = 0.04) and reduced need for epidural blood patch (aOR (95%CI) 0.75 (0.64–0.87), p < 0.001) [3]. Moreover, there is some evidence suggesting that a combined approach, such as prophylactic cosyntropin administration with intrathecal 0.9% saline injection, may offer additional benefits in managing postdural puncture headache [4]. This area warrants further investigation and consideration in future updates.
We agree with the authors on the importance of long-term follow-up. However, we suggest extending the follow-up period and explicitly including screening for chronic pain and postpartum depression. Recent studies have shown that women who experience accidental dural puncture are at increased risk of both these complications [5].
We hope that ongoing research in intrathecal 0.9% saline injection, prophylactic treatments and the importance of extended follow-up with screening for chronic pain and postpartum depression can further optimise care for these patients.
{"title":"Optimising management strategies for intrathecal catheters after accidental dural puncture","authors":"Sharon Orbach-Zinger, Michael Heesen, Yair Binyamin","doi":"10.1111/anae.16457","DOIUrl":"https://doi.org/10.1111/anae.16457","url":null,"abstract":"<p>We commend Griffiths et al. [<span>1</span>] for their work on managing intrathecal catheters after inadvertent dural puncture in obstetric patients. These evidence-based recommendations complement and enhance previous guidelines published in <i>Anaesthesia</i> [<span>2</span>]. The recommendation for early removal of intrathecal catheters is particularly noteworthy, as it corresponds with recent findings in the field. We previously recommended leaving the intrathecal catheter for 24 h, but subsequent research has indeed shown no benefit in prolonged catheterisation. In a recent study of 550 cases of accidental dural puncture, we found no advantage in leaving the intrathecal catheter in for 24 h postpartum (postdural puncture headache, adjusted odds ratio (aOR) (95%CI) 1.01 (1.00–1.02), p = 0.015; epidural blood patch, aOR (95%CI) 1.00 (0.99–1.01), p = 0.40) [<span>3</span>]. This aligns well with the Obstetric Anaesthetists' Association current recommendation and supports the trend towards earlier catheter removal. Injecting intrathecal saline through the catheter was associated with decreased odds of developing postdural puncture headache (aOR (95%CI) 0.85 (0.73–0.99), p = 0.04) and reduced need for epidural blood patch (aOR (95%CI) 0.75 (0.64–0.87), p < 0.001) [<span>3</span>]. Moreover, there is some evidence suggesting that a combined approach, such as prophylactic cosyntropin administration with intrathecal 0.9% saline injection, may offer additional benefits in managing postdural puncture headache [<span>4</span>]. This area warrants further investigation and consideration in future updates.</p>\u0000<p>We agree with the authors on the importance of long-term follow-up. However, we suggest extending the follow-up period and explicitly including screening for chronic pain and postpartum depression. Recent studies have shown that women who experience accidental dural puncture are at increased risk of both these complications [<span>5</span>].</p>\u0000<p>We hope that ongoing research in intrathecal 0.9% saline injection, prophylactic treatments and the importance of extended follow-up with screening for chronic pain and postpartum depression can further optimise care for these patients.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"29 Suppl 9 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451915","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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