British journal of anaesthesia最新文献

Background: The optimal single i.v. bolus dose of remimazolam for induction of general anaesthesia in children is not defined. We aimed to determine the 50% (ED50) and 95% (ED95) effective doses of remimazolam for inducing loss of consciousness in children.

Methods: A total of 120 children, aged 1-12 yr, were divided into three groups, with 40 children in each group: toddler (1 to <3 yr), preschool (≥3 to <6 yr), and school-age group (≥6 to <12 yr). Each child received a single i.v. bolus of remimazolam, with doses determined using a biased coin design up-and-down method. The primary outcome was the ED50 and ED95 of remimazolam for inducing loss of consciousness. Secondary outcomes included the incidence of hypotension, respiratory depression, and adverse events.

Results: The ED50 and ED95 of remimazolam were 0.42 mg kg^-1 (95% confidence interval [CI] 0.37-0.44) and 0.57 mg kg^-1 (95% CI 0.48-0.59), respectively, in the toddler group; 0.41 mg kg^-1 (95% CI 0.35-0.47) and 0.57 mg kg^-1 (95% CI 0.50-0.59), respectively, in the preschool group; and 0.30 mg kg^-1 (95% CI 0.28-0.34) and 0.43 mg kg^-1 (95% CI 0.37-0.44), respectively, in the school-age group. No significant cases of hypotension, respiratory depression, bradycardia, or other adverse events occurred in any of the three groups.

Conclusions: A single i.v. bolus of remimazolam at estimated doses of 0.45-0.60 mg kg^-1 for children aged 1-6 yr and 0.35-0.45 mg kg^-1 for those aged 6-12 yr effectively induces loss of consciousness in children.

Clinical trial registration: ClinicalTrials.gov (NCT06061159).

Recent findings from Gutierrez del Arroyo and colleagues identified distinct sub-phenotypes in patients undergoing major noncardiac surgery based on biomarkers such as N terminal pro-brain natriuretic peptide, renin, aldosterone, and angiotensin-converting enzyme 2, which were associated with varying risks of postoperative myocardial injury. Although their findings highlight the potential of sub-phenotyping for advancing perioperative precision medicine, further research is needed to validate these sub-phenotypes and explore their role in tailoring perioperative management strategies.

A recent report on maternal deaths in Japan attributed to anaesthesia highlights the value of a national enquiry process which can review each death to determine the likely cause. It is through national enquiries, such as the UK Confidential Enquiries into Maternal Deaths, that deficiencies in care, including anaesthetic practice, can be identified and improvements made to effect better patient outcomes. The report also underlines that safe anaesthetic practice, particularly in the challenging environment of obstetrics, is best delivered by specialists trained in anaesthesia but who might be in short supply, even in large developed countries such as Japan.

Pulse oximetry, although generally effective under ideal conditions, faces challenges in accurately estimating peripheral oxygen saturation (SpO₂) in complex clinical scenarios, particularly at lower saturation levels and in patients with darker skin pigmentation. Artificial intelligence (AI) offers the potential to improve SpO₂ monitoring by enabling more accurate, equitable, and accessible estimations. We highlight key challenges in developing AI-enhanced pulse oximetry, including the need for diverse and representative datasets, refined validation protocols addressing ethical concerns such as algorithmic bias, expanded SpO₂ measurement ranges encompassing hypoxaemic levels, and enhanced model interpretability. We emphasise the importance of transitioning from subjective skin tone assessments to quantitative methods to ensure equity and mitigate bias. Finally, we propose a development pipeline and discuss strategies for robust, fair AI-based SpO₂ monitoring, including aligning validation with global regulatory frameworks and fostering interdisciplinary collaboration. These advances will improve the reliability and fairness of pulse oximetry, ultimately contributing to enhanced global patient care.

Background: Effective perioperative pain management is crucial to prevent patient suffering, delayed recovery, chronic postsurgical pain, and long-term opioid use. However, the heterogeneous use of outcomes in studies complicates evidence synthesis and might not accurately reflect the experiences of individual patients. We initiated a consensus process to establish a core outcome set (COS) of patient-reported outcome measures (PROMs) in postoperative pain, building upon the earlier consensus on a COS of domains.

Methods: Potential PROMs were identified via systematic literature searches for the domains pain intensity (with subdomains at rest and during activity), physical function, self-efficacy, and adverse events, followed by appraisal of psychometric properties according to the COnsensus-based Standards for the selection of health Measurement INstruments methodology. Then, a consensus meeting was convened, followed by a Delphi process with an international, multiprofessional panel of stakeholders, including those with lived experience. A conclusive consensus meeting approved the final COS of PROMs.

Results: The final COS consists of one unidimensional numerical rating scale for assessing pain intensity on average, worst pain intensity, pain intensity at rest, and procedure-specific pain intensity during activity; one unidimensional scale for pain interfering with activities in bed; one procedure-specific scale for assessing physical function; the IMI-PainCare PROMPT adaptation of the Arthritis Self-Efficacy Scale for assessing self-efficacy; and the IMI-PainCare PROMPT adaptation of the Opioid-Related Symptom Distress Scale for assessing adverse events.

Conclusions: Comprehensive use of a core outcome set will help harmonise outcome assessment, facilitate comparisons between studies, promote patient-centred research, and improve postoperative pain care.

Chronic postsurgical pain (CPSP) is associated with reduced health-related quality of life and disability. In some patients, it can result in long-term opioid use even after minor surgery. Epidemiological studies have reported highly varying rates of CPSP, largely because researchers have used different definitions with self-defined cut-offs for pain scores. With the introduction of the 11th revision of the World Health Organisation International Classification of Diseases and Related Health Problems (ICD-11), chronic pain is now recognised as an entity of its own, its biopsychosocial nature is emphasised, and its definition is standardised. Compared with the ICD-11 definition, the prevalence of CPSP might have been overestimated in previous studies. The ICD-11 provides a multifactorial assessment of pain severity, referring to pain intensity, pain-related interference, and pain-related distress, which cover the biopsychosocial aspects of chronic pain. These three scores can be added as extension codes to any pain diagnosis. Harmonisation of the CPSP criteria within the different coding levels of the ICD-11 might improve discrimination of CPSP from other chronic pain conditions not induced by surgery. Although neuropathic CPSP increases pain severity and requires alternative therapeutic approaches to nociceptive pain, a specific code to differentiate between neuropathic and non-neuropathic CPSP is not available. For clinical practice and research, the evidence-based ICD-11 definition, which provides clear-cut diagnostic criteria, should generally be used instead of pain scores alone. This will improve the comparability of data, form the basis for future diagnostic and therapeutic approaches, and facilitate communication.