Abraham H. Hulst, Jeroen Hermanides, Mark L. van Zuylen
<p>We read with interest the study by Nersessian et al., which explores the relationship between peri-operative semaglutide use and increased residual gastric content as assessed by gastric ultrasound [<span>1</span>]. This prospective study contributes to the emerging literature on GLP-1 receptor agonists (GLP-1 RAs) and delayed gastric emptying, raising important considerations for peri-operative management [<span>2</span>]. However, these findings prompt a need for greater specificity within clinical guidelines, particularly regarding the differing needs of patients using GLP-1 RAs for weight loss and to those prescribed these drugs for type 2 diabetes.</p> <p>Although it is relevant that data are now available on volume of pre-operative gastric contents in patients using GLP-1 RA for weight loss, there are several methodological limitations that hinder the applicability. The study employs a small sample size without formal power calculations, using convenience sampling that undermines the statistical robustness of the findings. In addition, only a small number of baseline variables is presented, making it difficult to assess the validity of comparing the study groups. Factors such as dose of semaglutide, duration of use and the presence of gastrointestinal symptoms are missing. All can significantly influence the risk of increased pre-operative residual gastric contents [<span>3</span>]. Moreover, although BMI is reported, it remains unclear whether the semaglutide group represents patients with formerly higher BMIs, reduced following semaglutide treatment, being compared with a possibly healthier control group with distinct gastric function. Finally, the authors propose using gastric ultrasound as a pre-operative tool to evaluate gastric content. While valuable, the variability inherent in this subjective technique, which is also highlighted by the authors, limits its broad application.</p> <p>Nersessian et al. suggest extending the pre-operative discontinuation period of GLP-1 RAs from 1 to 2–3 weeks. This recommendation, however, is not substantiated by their results, nor by the current literature. There is limited evidence supporting the efficacy of discontinuation in reducing volume of gastric content, which calls into question the proposed cessation periods for peri-operative settings. In addition, recent studies have suggested that GLP-1 RA use does not necessarily correlate with a clinically significant aspiration risk [<span>4</span>]. Furthermore, GLP1 RAs with even longer half-lives than semaglutide are expected, which will be challenging to discontinue promptly and may not prevent delayed gastric emptying effectively even if cessation is attempted.</p> <p>In addition, prolonged discontinuation in patients with type 2 diabetes, who rely on GLP-1 RAs for glycaemic control, could risk peri-operative hyperglycaemia, which itself may contribute to delayed gastric emptying [<span>5</span>], further complicating peri-operative management
{"title":"Residual gastric content and peri-operative semaglutide use assessed by gastric ultrasound","authors":"Abraham H. Hulst, Jeroen Hermanides, Mark L. van Zuylen","doi":"10.1111/anae.16504","DOIUrl":"https://doi.org/10.1111/anae.16504","url":null,"abstract":"<p>We read with interest the study by Nersessian et al., which explores the relationship between peri-operative semaglutide use and increased residual gastric content as assessed by gastric ultrasound [<span>1</span>]. This prospective study contributes to the emerging literature on GLP-1 receptor agonists (GLP-1 RAs) and delayed gastric emptying, raising important considerations for peri-operative management [<span>2</span>]. However, these findings prompt a need for greater specificity within clinical guidelines, particularly regarding the differing needs of patients using GLP-1 RAs for weight loss and to those prescribed these drugs for type 2 diabetes.</p>\u0000<p>Although it is relevant that data are now available on volume of pre-operative gastric contents in patients using GLP-1 RA for weight loss, there are several methodological limitations that hinder the applicability. The study employs a small sample size without formal power calculations, using convenience sampling that undermines the statistical robustness of the findings. In addition, only a small number of baseline variables is presented, making it difficult to assess the validity of comparing the study groups. Factors such as dose of semaglutide, duration of use and the presence of gastrointestinal symptoms are missing. All can significantly influence the risk of increased pre-operative residual gastric contents [<span>3</span>]. Moreover, although BMI is reported, it remains unclear whether the semaglutide group represents patients with formerly higher BMIs, reduced following semaglutide treatment, being compared with a possibly healthier control group with distinct gastric function. Finally, the authors propose using gastric ultrasound as a pre-operative tool to evaluate gastric content. While valuable, the variability inherent in this subjective technique, which is also highlighted by the authors, limits its broad application.</p>\u0000<p>Nersessian et al. suggest extending the pre-operative discontinuation period of GLP-1 RAs from 1 to 2–3 weeks. This recommendation, however, is not substantiated by their results, nor by the current literature. There is limited evidence supporting the efficacy of discontinuation in reducing volume of gastric content, which calls into question the proposed cessation periods for peri-operative settings. In addition, recent studies have suggested that GLP-1 RA use does not necessarily correlate with a clinically significant aspiration risk [<span>4</span>]. Furthermore, GLP1 RAs with even longer half-lives than semaglutide are expected, which will be challenging to discontinue promptly and may not prevent delayed gastric emptying effectively even if cessation is attempted.</p>\u0000<p>In addition, prolonged discontinuation in patients with type 2 diabetes, who rely on GLP-1 RAs for glycaemic control, could risk peri-operative hyperglycaemia, which itself may contribute to delayed gastric emptying [<span>5</span>], further complicating peri-operative management","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"20 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142777397","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}
Annika Eyth, Felix Borngaesser, Osamah M. Zmily, Maíra I. Rudolph, Ling Zhang, Vilma A. Joseph, Oleg V. Evgenov, Jason Oliveira, Nicholas Kolmel, Seena Dehkharghani, Irene Osborn, Michael E. Kiyatkin, Andrew D. Racine, Peter P. Semczuk, Shweta Garg, Karuna Wongtangman, Matthias Eikermann, Ibraheem M. Karaye
Interventional radiology procedures and endoscopies are performed commonly worldwide, often necessitating pharmacological sedation to optimise patient comfort. It is unclear to what extent non-anaesthetists should provide procedural sedation.
{"title":"Association of anaesthesia-directed sedation with unplanned discharge to a nursing home following non-ambulatory interventional radiology and endoscopic procedures: a retrospective cohort study*","authors":"Annika Eyth, Felix Borngaesser, Osamah M. Zmily, Maíra I. Rudolph, Ling Zhang, Vilma A. Joseph, Oleg V. Evgenov, Jason Oliveira, Nicholas Kolmel, Seena Dehkharghani, Irene Osborn, Michael E. Kiyatkin, Andrew D. Racine, Peter P. Semczuk, Shweta Garg, Karuna Wongtangman, Matthias Eikermann, Ibraheem M. Karaye","doi":"10.1111/anae.16497","DOIUrl":"https://doi.org/10.1111/anae.16497","url":null,"abstract":"Interventional radiology procedures and endoscopies are performed commonly worldwide, often necessitating pharmacological sedation to optimise patient comfort. It is unclear to what extent non-anaesthetists should provide procedural sedation.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"226 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782520","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>Sharing data from clinical studies is now recognised to be an important part of the research process [<span>1</span>]. Since many research results cannot be replicated [<span>2, 3</span>], there has been growing interest in making study documents available [<span>4, 5</span>] in order to make reproduction of existing results, detection of false results, and replication of findings and synthesis into larger meta-studies easier. Randomised controlled trials (RCTs) are of particular interest, since they are expensive and time-consuming to run. Post-publication availability of study documents has been investigated previously, but their availability to journals at the point of manuscript submission, where it could be used as part of the review, has not been evaluated.</p> <p>To address this, for a 9-month period (1 June 2023 to 29 February 2024), when an RCT was submitted to <i>Anaesthesia</i> and sent for peer review (i.e. not desk rejected), a member of the editorial team requested, via email, anonymised individual patient data (IPD) and statistical code from the corresponding author. We sent one further request if there was no initial response. I examined the submitted manuscript and any provided IPD and code for each RCT to determine: whether the IPD and code were stated to be available in the submitted manuscript; whether the IPD and code were provided on request to the authors by the journal; the IPD format (if it was provided in multiple formats, the least proprietary format was recorded); whether there was a data dictionary; whether IPD were presented in English; whether (using the manuscript and/or Google Translate) it was clear what the variable names in the IPD represented; whether the results of the manuscript could theoretically be reproduced with the provided documents (I did not actually compare the values); and whether authors changed their submitted manuscript based on the request for IPD. I judged reproducibility was ‘possible’ if code and IPD were available, unless a fully reproducible document was available (e.g. R Markdown). For the proprietary files that could contain code but I was unable to open, I labelled code availability ‘unclear’. The project was approved by the editorial board of <i>Anaesthesia</i>, and the host institution confirmed that ethical approval was not required given that IPD were anonymised by authors before transfer. I performed all data cleaning and analysis in R (R Foundation, Vienna, Austria) and all analysis was exploratory.</p> <p>In the 9-month data collection window 122 RCTs were submitted to <i>Anaesthesia</i>, 44 of which were desk rejected. Of the remaining 78, we missed the opportunity to request IPD for eight before the manuscripts were rejected. Two provided IPD in such a way that we could not access them (one because of concerns about malware, another due to access issues with a website) and so were also excluded. This left a cohort of 68 manuscripts for further analysis. After we requested d
{"title":"Ask, and it shall be given you – individual patient data and code availability for randomised controlled trials submitted for publication","authors":"Paul Bramley","doi":"10.1111/anae.16503","DOIUrl":"https://doi.org/10.1111/anae.16503","url":null,"abstract":"<p>Sharing data from clinical studies is now recognised to be an important part of the research process [<span>1</span>]. Since many research results cannot be replicated [<span>2, 3</span>], there has been growing interest in making study documents available [<span>4, 5</span>] in order to make reproduction of existing results, detection of false results, and replication of findings and synthesis into larger meta-studies easier. Randomised controlled trials (RCTs) are of particular interest, since they are expensive and time-consuming to run. Post-publication availability of study documents has been investigated previously, but their availability to journals at the point of manuscript submission, where it could be used as part of the review, has not been evaluated.</p>\u0000<p>To address this, for a 9-month period (1 June 2023 to 29 February 2024), when an RCT was submitted to <i>Anaesthesia</i> and sent for peer review (i.e. not desk rejected), a member of the editorial team requested, via email, anonymised individual patient data (IPD) and statistical code from the corresponding author. We sent one further request if there was no initial response. I examined the submitted manuscript and any provided IPD and code for each RCT to determine: whether the IPD and code were stated to be available in the submitted manuscript; whether the IPD and code were provided on request to the authors by the journal; the IPD format (if it was provided in multiple formats, the least proprietary format was recorded); whether there was a data dictionary; whether IPD were presented in English; whether (using the manuscript and/or Google Translate) it was clear what the variable names in the IPD represented; whether the results of the manuscript could theoretically be reproduced with the provided documents (I did not actually compare the values); and whether authors changed their submitted manuscript based on the request for IPD. I judged reproducibility was ‘possible’ if code and IPD were available, unless a fully reproducible document was available (e.g. R Markdown). For the proprietary files that could contain code but I was unable to open, I labelled code availability ‘unclear’. The project was approved by the editorial board of <i>Anaesthesia</i>, and the host institution confirmed that ethical approval was not required given that IPD were anonymised by authors before transfer. I performed all data cleaning and analysis in R (R Foundation, Vienna, Austria) and all analysis was exploratory.</p>\u0000<p>In the 9-month data collection window 122 RCTs were submitted to <i>Anaesthesia</i>, 44 of which were desk rejected. Of the remaining 78, we missed the opportunity to request IPD for eight before the manuscripts were rejected. Two provided IPD in such a way that we could not access them (one because of concerns about malware, another due to access issues with a website) and so were also excluded. This left a cohort of 68 manuscripts for further analysis. After we requested d","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"38 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782526","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":"Get remimazolam off the bench and into the game","authors":"Brian J. Anderson, J. Robert Sneyd","doi":"10.1111/anae.16506","DOIUrl":"https://doi.org/10.1111/anae.16506","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"86 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142760765","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}
Shuang‐Qiong Zhou, Jian‐Feng Lian, Yao Zhou, Xiu‐Hong Cao, Xiu Ni, Xiao‐Peng Zhang, Zhen‐Dong Xu, Quan‐Sheng Xiao, Zhi‐Qiang Liu
SummaryIntroductionHigh‐flow nasal oxygenation has been shown to improve oxygenation during induction of anaesthesia in parturients who are not obese. However, data on the efficacy of high‐flow nasal oxygen in parturients living with obesity are lacking. This study investigated the effects of high‐flow nasal oxygenation on pre‐oxygenation and apnoea oxygenation during tracheal intubation in parturients living with obesity.MethodsThis prospective, randomised clinical trial was conducted at two tertiary hospitals and included parturients with BMI > 30 kg.m‐2 undergoing scheduled caesarean delivery under general anaesthesia. Parturients were allocated randomly to standard facemask or high‐flow nasal oxygen groups (oxygen flow rates 10 l.min‐1 and 50 l.min‐1, respectively). The primary outcome measure was arterial partial pressure of oxygen after 3 min of pre‐oxygenation.Results54 patients completed the study. The arterial partial pressure of oxygen after 3 min of pre‐oxygenation was significantly lower in parturients allocated to the standard facemask group compared with those allocated to the high‐flow nasal oxygen group (mean (SD) 40.1 (8.9) kPa vs. 53.8 (9.7) kPa, p < 0.001). End‐tidal oxygen concentration on commencing ventilation was also lower in parturients allocated to the standard facemask group compared with those allocated to the high flow‐nasal oxygen group (mean (SD) 78.3 (5.38)% vs. 86.2 (5.10)%, p < 0.001). The arterial partial pressure of carbon dioxide post tracheal intubation and fetal outcomes were similar in both groups.DiscussionPre‐oxygenation using high‐flow nasal oxygenation provided a higher arterial partial pressure of oxygen and end‐tidal oxygen concentration during general anaesthesia induction than standard facemask oxygenation in parturients living with obesity; however, the differences were not clinically meaningful. High‐flow nasal oxygenation may be considered as an alternative option for pre‐oxygenation during rapid sequence induction in parturients living with obesity.
{"title":"Efficacy of high‐flow nasal oxygenation during induction of general anaesthesia in parturients living with obesity: a two‐centre, prospective, randomised clinical trial","authors":"Shuang‐Qiong Zhou, Jian‐Feng Lian, Yao Zhou, Xiu‐Hong Cao, Xiu Ni, Xiao‐Peng Zhang, Zhen‐Dong Xu, Quan‐Sheng Xiao, Zhi‐Qiang Liu","doi":"10.1111/anae.16492","DOIUrl":"https://doi.org/10.1111/anae.16492","url":null,"abstract":"SummaryIntroductionHigh‐flow nasal oxygenation has been shown to improve oxygenation during induction of anaesthesia in parturients who are not obese. However, data on the efficacy of high‐flow nasal oxygen in parturients living with obesity are lacking. This study investigated the effects of high‐flow nasal oxygenation on pre‐oxygenation and apnoea oxygenation during tracheal intubation in parturients living with obesity.MethodsThis prospective, randomised clinical trial was conducted at two tertiary hospitals and included parturients with BMI > 30 kg.m<jats:sup>‐2</jats:sup> undergoing scheduled caesarean delivery under general anaesthesia. Parturients were allocated randomly to standard facemask or high‐flow nasal oxygen groups (oxygen flow rates 10 l.min<jats:sup>‐1</jats:sup> and 50 l.min<jats:sup>‐1</jats:sup>, respectively). The primary outcome measure was arterial partial pressure of oxygen after 3 min of pre‐oxygenation.Results54 patients completed the study. The arterial partial pressure of oxygen after 3 min of pre‐oxygenation was significantly lower in parturients allocated to the standard facemask group compared with those allocated to the high‐flow nasal oxygen group (mean (SD) 40.1 (8.9) kPa vs. 53.8 (9.7) kPa, p < 0.001). End‐tidal oxygen concentration on commencing ventilation was also lower in parturients allocated to the standard facemask group compared with those allocated to the high flow‐nasal oxygen group (mean (SD) 78.3 (5.38)% vs. 86.2 (5.10)%, p < 0.001). The arterial partial pressure of carbon dioxide post tracheal intubation and fetal outcomes were similar in both groups.DiscussionPre‐oxygenation using high‐flow nasal oxygenation provided a higher arterial partial pressure of oxygen and end‐tidal oxygen concentration during general anaesthesia induction than standard facemask oxygenation in parturients living with obesity; however, the differences were not clinically meaningful. High‐flow nasal oxygenation may be considered as an alternative option for pre‐oxygenation during rapid sequence induction in parturients living with obesity.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"8 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718295","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}
Sascha Ott, Lukas M Müller-Wirtz, Sergio Bustamante, Julian Rössler, Nikolaos J Skubas, Karan Shah, Daniel I Sessler, Alparslan Turan, Kurt Ruetzler
Introduction: The number of tracheal intubation attempts required to reach proficiency in videolaryngoscopy with hyperangulated blades is unknown. Understanding this training requirement might guide training for clinicians who perform laryngoscopy. We therefore performed a planned sub-analysis of a randomised controlled trial comparing tracheal intubation success with videolaryngoscopy vs. direct laryngoscopy to determine the number of tracheal intubations with a hyperangulated videolaryngoscope blade needed to provide an acceptable first-attempt success rate.
Methods: We included clinicians from a randomised controlled trial who were familiar with direct laryngoscopy and Macintosh-blade videolaryngoscopy but inexperienced with hyperangulated videolaryngoscopy. Cumulative sum statistics were used to generate learning curves with acceptable success rates of 85% and unacceptable success rates of 70% for the primary outcome of first-attempt tracheal intubation success.
Results: We included 223 clinicians (25 consultants; 35 certified registered nurse anaesthetists; 36 student registered nurse anaesthetists; 46 fellows; and 81 residents) who attempted tracheal intubation in 4312 procedures. The median (IQR [range]) number of tracheal intubations per clinician was 15 (8-25 [1-77]). First-attempt failure was low, with only 72 failed first attempts overall, and was comparable across clinician groups. In total, 133 (60%) clinicians crossed the acceptable success rate boundary while the remaining 90 (40%) clinicians crossed neither the acceptable nor unacceptable success rate boundaries. Among clinicians who crossed the acceptance boundary, the median (IQR [range]) number of attempts for learning was 12 (12-12 [12-26]).
Discussion: Clinicians experienced in tracheal intubation with direct laryngoscopy but unfamiliar with hyperangulated-blade videolaryngoscopy can achieve proficiency after approximately 12 attempts.
{"title":"Learning tracheal intubation with a hyperangulated videolaryngoscopy blade: sub-analysis of a randomised controlled trial.","authors":"Sascha Ott, Lukas M Müller-Wirtz, Sergio Bustamante, Julian Rössler, Nikolaos J Skubas, Karan Shah, Daniel I Sessler, Alparslan Turan, Kurt Ruetzler","doi":"10.1111/anae.16491","DOIUrl":"https://doi.org/10.1111/anae.16491","url":null,"abstract":"<p><strong>Introduction: </strong>The number of tracheal intubation attempts required to reach proficiency in videolaryngoscopy with hyperangulated blades is unknown. Understanding this training requirement might guide training for clinicians who perform laryngoscopy. We therefore performed a planned sub-analysis of a randomised controlled trial comparing tracheal intubation success with videolaryngoscopy vs. direct laryngoscopy to determine the number of tracheal intubations with a hyperangulated videolaryngoscope blade needed to provide an acceptable first-attempt success rate.</p><p><strong>Methods: </strong>We included clinicians from a randomised controlled trial who were familiar with direct laryngoscopy and Macintosh-blade videolaryngoscopy but inexperienced with hyperangulated videolaryngoscopy. Cumulative sum statistics were used to generate learning curves with acceptable success rates of 85% and unacceptable success rates of 70% for the primary outcome of first-attempt tracheal intubation success.</p><p><strong>Results: </strong>We included 223 clinicians (25 consultants; 35 certified registered nurse anaesthetists; 36 student registered nurse anaesthetists; 46 fellows; and 81 residents) who attempted tracheal intubation in 4312 procedures. The median (IQR [range]) number of tracheal intubations per clinician was 15 (8-25 [1-77]). First-attempt failure was low, with only 72 failed first attempts overall, and was comparable across clinician groups. In total, 133 (60%) clinicians crossed the acceptable success rate boundary while the remaining 90 (40%) clinicians crossed neither the acceptable nor unacceptable success rate boundaries. Among clinicians who crossed the acceptance boundary, the median (IQR [range]) number of attempts for learning was 12 (12-12 [12-26]).</p><p><strong>Discussion: </strong>Clinicians experienced in tracheal intubation with direct laryngoscopy but unfamiliar with hyperangulated-blade videolaryngoscopy can achieve proficiency after approximately 12 attempts.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737983","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}
Soo‐Hyuk Yoon, Yoon Jung Kim, Jeong‐Hwa Seo, Hanbyeol Lim, Ho‐Jin Lee, Cheol Kwak, Won Ho Kim, Hyun‐Kyu Yoon
SummaryIntroductionAcute kidney injury develops frequently after nephrectomy, causing increased hospital duration of stay and mortality. Both propofol and volatile anaesthetic agents are thought to have renoprotective effects. We investigated whether the type of maintenance anaesthetic (propofol or desflurane) affected the incidence of acute kidney injury after nephrectomy.MethodsThis single‐centre, randomised controlled trial enrolled adult patients with renal cell carcinoma undergoing nephrectomy. In patients allocated to the propofol group, anaesthesia was induced and maintained using a target‐controlled infusion of propofol. In patients allocated to the desflurane group, anaesthesia was induced with a bolus of thiopental and maintained with desflurane. Both groups received a target‐controlled infusion of remifentanil during surgery. The primary outcome was the incidence of acute kidney injury within 7 postoperative days based on the serum creatinine component of the Kidney Disease: Improving Global Outcomes criteria.ResultsWe analysed 317 patients (median (IQR [range]) age 62 (52–70 [26–85] y); 221 (70%) men). Postoperative AKI developed in 79 (25%) patients: 43 (27%) in the propofol group and 36 (23%) in the desflurane group (absolute risk difference (95%CI) 4.6 (‐4.9–14.0%), p = 0.347). The severity of kidney injury was stage 1 in 76 patients, stage 2 in two patients and stage 3 in one patient.DiscussionThe type of anaesthetic maintenance drug (propofol vs. desflurane) did not affect the incidence of acute kidney injury after nephrectomy. Future research might be better directed towards investigating other potentially modifiable risk factors for postoperative acute kidney injury in this patient population.
{"title":"Influence of the type of anaesthesia on acute kidney injury after nephrectomy: a randomised controlled trial","authors":"Soo‐Hyuk Yoon, Yoon Jung Kim, Jeong‐Hwa Seo, Hanbyeol Lim, Ho‐Jin Lee, Cheol Kwak, Won Ho Kim, Hyun‐Kyu Yoon","doi":"10.1111/anae.16490","DOIUrl":"https://doi.org/10.1111/anae.16490","url":null,"abstract":"SummaryIntroductionAcute kidney injury develops frequently after nephrectomy, causing increased hospital duration of stay and mortality. Both propofol and volatile anaesthetic agents are thought to have renoprotective effects. We investigated whether the type of maintenance anaesthetic (propofol or desflurane) affected the incidence of acute kidney injury after nephrectomy.MethodsThis single‐centre, randomised controlled trial enrolled adult patients with renal cell carcinoma undergoing nephrectomy. In patients allocated to the propofol group, anaesthesia was induced and maintained using a target‐controlled infusion of propofol. In patients allocated to the desflurane group, anaesthesia was induced with a bolus of thiopental and maintained with desflurane. Both groups received a target‐controlled infusion of remifentanil during surgery. The primary outcome was the incidence of acute kidney injury within 7 postoperative days based on the serum creatinine component of the Kidney Disease: Improving Global Outcomes criteria.ResultsWe analysed 317 patients (median (IQR [range]) age 62 (52–70 [26–85] y); 221 (70%) men). Postoperative AKI developed in 79 (25%) patients: 43 (27%) in the propofol group and 36 (23%) in the desflurane group (absolute risk difference (95%CI) 4.6 (‐4.9–14.0%), p = 0.347). The severity of kidney injury was stage 1 in 76 patients, stage 2 in two patients and stage 3 in one patient.DiscussionThe type of anaesthetic maintenance drug (propofol vs. desflurane) did not affect the incidence of acute kidney injury after nephrectomy. Future research might be better directed towards investigating other potentially modifiable risk factors for postoperative acute kidney injury in this patient population.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"16 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718287","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":"Augmented reality laryngoscopy and ergonomics: a different stance","authors":"Jane L. Orrock, Patrick A. Ward","doi":"10.1111/anae.16479","DOIUrl":"https://doi.org/10.1111/anae.16479","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"25 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718288","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}
Owen Lewis, James Lloyd, Jenny Ferry, Alan J. R. Macfarlane, Jonathan Womack, Kariem El-Boghdadly, Clifford L. Shelton, Olivia Schaff, Tom J. Quick, Andrew F. Smith, Karin Cannons, Annabel Pearson, Leila Heelas, Daniel Rodger, John Marshall, Carol Pellowe, James S. Bowness, Rachel J. Kearns
Regional anaesthesia provides important clinical benefits to patients but is underutilised. A barrier to widespread adoption may be the focus of regional anaesthesia research on novel techniques rather than evaluating and optimising existing approaches. Research priorities in regional anaesthesia identified by anaesthetists have been published, but the views of patients, carers and other healthcare professionals have not been considered previously. Therefore, we launched a multidisciplinary research priority setting partnership that aimed to establish key regional anaesthesia research priorities for the UK.
{"title":"Regional anaesthesia research priorities: a Regional Anaesthesia UK (RA-UK) priority setting partnership involving patients, carers and healthcare professionals","authors":"Owen Lewis, James Lloyd, Jenny Ferry, Alan J. R. Macfarlane, Jonathan Womack, Kariem El-Boghdadly, Clifford L. Shelton, Olivia Schaff, Tom J. Quick, Andrew F. Smith, Karin Cannons, Annabel Pearson, Leila Heelas, Daniel Rodger, John Marshall, Carol Pellowe, James S. Bowness, Rachel J. Kearns","doi":"10.1111/anae.16473","DOIUrl":"https://doi.org/10.1111/anae.16473","url":null,"abstract":"Regional anaesthesia provides important clinical benefits to patients but is underutilised. A barrier to widespread adoption may be the focus of regional anaesthesia research on novel techniques rather than evaluating and optimising existing approaches. Research priorities in regional anaesthesia identified by anaesthetists have been published, but the views of patients, carers and other healthcare professionals have not been considered previously. Therefore, we launched a multidisciplinary research priority setting partnership that aimed to establish key regional anaesthesia research priorities for the UK.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"7 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696812","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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