Shared decision-making in anaesthesia is widely endorsed yet delivered inconsistently. This mixed methods systematic review aimed to identify primary activation targets for enhancing shared decision-making in peri-operative anaesthesia practice.
{"title":"Key targets for activating anaesthesia shared decision-making: a mixed methods systematic review","authors":"Adam Madhani, Nicolas Suarez, Katherine A. Finlay","doi":"10.1111/anae.70164","DOIUrl":"https://doi.org/10.1111/anae.70164","url":null,"abstract":"Shared decision-making in anaesthesia is widely endorsed yet delivered inconsistently. This mixed methods systematic review aimed to identify primary activation targets for enhancing shared decision-making in peri-operative anaesthesia practice.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"10 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146222879","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":"Target controlled infusions for rapid sequence induction: a national survey of practice","authors":"Morgan Back, William Musselbrook","doi":"10.1111/anae.70169","DOIUrl":"https://doi.org/10.1111/anae.70169","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"96 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146222853","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}
Aditya Krishnan, Katie Booth, Louise Hiller, Joyce Yeung, Stephen Berry
{"title":"Carbon emissions from total intravenous vs. volatile anaesthesia for elective cholecystectomy: a pilot observational study","authors":"Aditya Krishnan, Katie Booth, Louise Hiller, Joyce Yeung, Stephen Berry","doi":"10.1111/anae.70167","DOIUrl":"https://doi.org/10.1111/anae.70167","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"13 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146222852","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}
Elena Ahrens, Luca J. Wachtendorf, Theresa Tenge, Sophia Riesemann, Lars Kaiser, Guanqing Chen, Sara E. Neves, Mark J. Robitaille, Xiaohan Xu, Rae M. Allain, Haobo Ma, Maximilian S. Schaefer
Dexmedetomidine can attenuate delirium in patients who are critically ill, but evidence with regards to its preventive effect on postoperative delirium remains equivocal. We hypothesised that the risk of delirium after intra-operative dexmedetomidine administration varies depending on the dose administered and aimed to identify the optimum dose to mitigate delirium.
{"title":"Dose-dependent relationship between intra-operative dexmedetomidine and delirium after non-cardiac surgery: a retrospective cohort study*","authors":"Elena Ahrens, Luca J. Wachtendorf, Theresa Tenge, Sophia Riesemann, Lars Kaiser, Guanqing Chen, Sara E. Neves, Mark J. Robitaille, Xiaohan Xu, Rae M. Allain, Haobo Ma, Maximilian S. Schaefer","doi":"10.1111/anae.70163","DOIUrl":"https://doi.org/10.1111/anae.70163","url":null,"abstract":"Dexmedetomidine can attenuate delirium in patients who are critically ill, but evidence with regards to its preventive effect on postoperative delirium remains equivocal. We hypothesised that the risk of delirium after intra-operative dexmedetomidine administration varies depending on the dose administered and aimed to identify the optimum dose to mitigate delirium.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"122 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146222877","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 of day of cardiac surgery and postoperative outcomes: exploratory findings require caution.","authors":"Eryl Davies, Lajos Szentgyorgyi","doi":"10.1111/anae.70175","DOIUrl":"https://doi.org/10.1111/anae.70175","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146211886","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":"Balancing analgesia and function with patient preference and readiness","authors":"Clístenes C. de Carvalho, Kariem El‐Boghdadly","doi":"10.1111/anae.70173","DOIUrl":"https://doi.org/10.1111/anae.70173","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"24 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146198813","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 Intra‐operative hypotension is common during caesarean section and may result in adverse maternal effects, such as nausea and vomiting. While oscillometric blood pressure and continuous non‐invasive arterial pressure monitoring enable reactive treatment, the hypotension prediction index offers a machine learning‐based approach that may allow proactive haemodynamic intervention. This study investigated whether hypotension prediction index‐guided management could reduce the incidence of intra‐operative hypotension compared with oscillometric and continuous non‐invasive arterial pressure monitoring. Methods Patients scheduled for elective caesarean section under spinal anaesthesia were allocated randomly to one of three haemodynamic monitoring strategies: oscillometric blood pressure; continuous non‐invasive arterial pressure; or hypotension prediction index‐guided monitoring. Hypotension and hypertension were defined as mean arterial pressure < 65 mmHg and ≥ 100 mmHg, respectively. Hypotension was treated using intermittent intravenous boluses of noradrenaline. The primary outcome was the time‐weighted average of hypotension. Secondary outcomes included time‐weighted average hypertension and maternal adverse effects, including bradycardia, nausea and vomiting. Results Data from 171 patients were analysed. Median time‐weighted average hypotension was significantly higher in patients allocated to the oscillometric and continuous non‐invasive arterial pressure groups compared with the hypotension prediction index group (0.89 mmHg and 0.30 mmHg vs. 0.08 mmHg, respectively, p < 0.001). Patients allocated to the oscillometric group had a higher incidence of maternal nausea and vomiting compared with those allocated to the continuous non‐invasive arterial pressure and hypotension prediction index groups (nausea: 43/59 vs. 29/55 and 30/57, respectively, p = 0.038; and vomiting: 13/59 vs. 6/55 and 3/57, respectively, p = 0.023). Discussion Hypotension prediction index‐guided management during caesarean section significantly reduced intra‐operative hypotension without increasing the risk of hypertension. This approach provides a proactive strategy for haemodynamic optimisation in obstetric anaesthesia.
剖宫产术中低血压是常见的，可导致产妇恶心、呕吐等不良反应。虽然示波血压和连续无创动脉压监测可以进行反应性治疗，但低血压预测指数提供了一种基于机器学习的方法，可以进行主动血流动力学干预。本研究探讨了与振荡和连续无创动脉压监测相比，以低血压预测指数为指导的管理是否能降低术中低血压的发生率。方法脊髓麻醉下择期剖宫产的患者随机分配到三种血流动力学监测策略中的一种：振荡血压；连续无创动脉压；或低血压预测指数引导监测。低血压和高血压的定义分别为平均动脉压65mmhg和≥100mmhg。低血压治疗采用间歇性静脉注射去甲肾上腺素。主要终点是低血压的时间加权平均值。次要结局包括时间加权平均高血压和产妇不良反应，包括心动过缓、恶心和呕吐。结果对171例患者资料进行分析。与低血压预测指数组相比，分配到振荡测量组和持续无创动脉压组的患者中位时间加权平均低血压明显更高（分别为0.89 mmHg和0.30 mmHg vs. 0.08 mmHg, p < 0.001）。与连续无创动脉压和低血压预测指数组相比，振荡测量组的产妇恶心和呕吐发生率更高（恶心：分别为43/59比29/55和30/57，p = 0.038；呕吐：分别为13/59比6/55和3/57，p = 0.023）。剖宫产术中低血压预测指数指导下的处理可显著降低术中低血压，且不增加高血压的风险。这种方法为产科麻醉中的血流动力学优化提供了一种积极主动的策略。
{"title":"Proactive haemodynamic management using the hypotension prediction index during caesarean section: a randomised controlled study","authors":"Po‐Yuan Shih, Tzu‐Jung Wei, Chen‐Tse Lee, Jessica Kang, Ming‐Chieh Shih, Ying‐Hsi Chen, Yow‐Shan Lee, Hsin‐Ting Chen, Chun‐Yu Wu","doi":"10.1111/anae.70161","DOIUrl":"https://doi.org/10.1111/anae.70161","url":null,"abstract":"Summary Introduction Intra‐operative hypotension is common during caesarean section and may result in adverse maternal effects, such as nausea and vomiting. While oscillometric blood pressure and continuous non‐invasive arterial pressure monitoring enable reactive treatment, the hypotension prediction index offers a machine learning‐based approach that may allow proactive haemodynamic intervention. This study investigated whether hypotension prediction index‐guided management could reduce the incidence of intra‐operative hypotension compared with oscillometric and continuous non‐invasive arterial pressure monitoring. Methods Patients scheduled for elective caesarean section under spinal anaesthesia were allocated randomly to one of three haemodynamic monitoring strategies: oscillometric blood pressure; continuous non‐invasive arterial pressure; or hypotension prediction index‐guided monitoring. Hypotension and hypertension were defined as mean arterial pressure < 65 mmHg and ≥ 100 mmHg, respectively. Hypotension was treated using intermittent intravenous boluses of noradrenaline. The primary outcome was the time‐weighted average of hypotension. Secondary outcomes included time‐weighted average hypertension and maternal adverse effects, including bradycardia, nausea and vomiting. Results Data from 171 patients were analysed. Median time‐weighted average hypotension was significantly higher in patients allocated to the oscillometric and continuous non‐invasive arterial pressure groups compared with the hypotension prediction index group (0.89 mmHg and 0.30 mmHg vs. 0.08 mmHg, respectively, p < 0.001). Patients allocated to the oscillometric group had a higher incidence of maternal nausea and vomiting compared with those allocated to the continuous non‐invasive arterial pressure and hypotension prediction index groups (nausea: 43/59 vs. 29/55 and 30/57, respectively, p = 0.038; and vomiting: 13/59 vs. 6/55 and 3/57, respectively, p = 0.023). Discussion Hypotension prediction index‐guided management during caesarean section significantly reduced intra‐operative hypotension without increasing the risk of hypertension. This approach provides a proactive strategy for haemodynamic optimisation in obstetric anaesthesia.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"30 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146198400","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 of day of cardiac surgery and postoperative outcomes: a reply","authors":"Gareth Kitchen","doi":"10.1111/anae.70174","DOIUrl":"https://doi.org/10.1111/anae.70174","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"13 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146198815","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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