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Associate Editorial Board and cover image caption
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-03-19 DOI: 10.1016/S0007-0912(25)00119-9
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引用次数: 0
The radial trinity block of the upper extremity: combined block of the radial, median, and lateral cutaneous nerves of the forearm for radial fracture. Response to Br J Anaesth 2024; 134: 243-4.
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-03-14 DOI: 10.1016/j.bja.2025.01.040
Amjad Maniar, Rammurthy Kulkarni
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引用次数: 0
Advancing surgical outcomes through cardiovascular biomarker sub-phenotyping.
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-03-14 DOI: 10.1016/j.bja.2025.02.009
Bruno Garcia, Ashish K Khanna, Matthieu Legrand

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.

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引用次数: 0
Preoperative GLP-1 agonist use is not associated with perioperative aspiration or pneumonia: an observational study using US national data.
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-03-14 DOI: 10.1016/j.bja.2025.01.038
Jashvant Poeran, Yhan Colon Iban, Haoyan Zhong, Alex Illescas, Crispiana Cozowicz, Lisa Reisinger, Jiabin Liu, Stavros Memtsoudis
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引用次数: 0
Beyond the numbers: obstetric anaesthesia and maternal deaths.
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-03-14 DOI: 10.1016/j.bja.2025.02.008
James H Bamber, Felicity Plaat

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.

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引用次数: 0
Technical and regulatory challenges in artificial intelligence-based pulse oximetry: a proposed development pipeline.
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-03-14 DOI: 10.1016/j.bja.2025.02.014
Ana M Cabanas, Pilar Martín-Escudero, Josué Pagán, Domingo Mery

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.

脉搏血氧仪虽然在理想条件下普遍有效,但在复杂的临床场景中,尤其是在饱和度较低和皮肤色素较深的患者中,要准确估计外周血氧饱和度(SpO2)却面临挑战。人工智能(AI)通过实现更准确、公平和便捷的估算,为改善SpO2监测提供了可能。我们强调了开发人工智能增强型脉搏血氧仪所面临的主要挑战,包括需要多样化和具有代表性的数据集、解决算法偏差等伦理问题的完善验证协议、扩大 SpO2 测量范围(包括低氧血症水平)以及增强模型的可解释性。我们强调从主观肤色评估过渡到定量方法的重要性,以确保公平并减少偏差。最后,我们提出了一个开发管道,并讨论了基于人工智能的稳健、公平的 SpO2 监测策略,包括根据全球监管框架进行验证和促进跨学科合作。这些进步将提高脉搏血氧仪的可靠性和公平性,最终有助于加强全球患者护理。
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引用次数: 0
A core outcome set of measurement instruments for assessing effectiveness and efficacy of perioperative pain management: results of the international IMI-PainCare PROMPT Delphi consensus process.
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-03-14 DOI: 10.1016/j.bja.2025.01.029
Esther M Pogatzki-Zahn, Sarah De Lucia, Claudia Weinmann, Hauke Heitkamp, Lone Hummelshoj, Hiltrud Liedgens, Winfried Meissner, Katy Vincent, Jan Vollert, Peter Zahn, Ulrike Kaiser, Daniela C Rosenberger

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.

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引用次数: 0
Chronic postsurgical pain in the ICD-11: implications for anaesthesiology and pain medicine.
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-03-14 DOI: 10.1016/j.bja.2025.02.005
Ulrike M Stamer, Patricia Lavand'homme, Debora M Hofer, Antonia Barke, Beatrice Korwisi

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.

慢性手术后疼痛(CPSP)与健康相关的生活质量下降和残疾有关。在某些患者中,即使是小手术后也会导致长期使用阿片类药物。流行病学研究报告的 CPSP 发生率差异很大,这主要是因为研究人员使用了不同的定义和自行定义的疼痛评分临界值。随着世界卫生组织《国际疾病和相关健康问题分类》(ICD-11)第 11 次修订版的推出,慢性疼痛现在被认为是一个独立的实体,其生物心理社会性质得到了强调,其定义也得到了标准化。与 ICD-11 的定义相比,以往的研究可能高估了 CPSP 的患病率。ICD-11 对疼痛严重程度进行了多因素评估,包括疼痛强度、疼痛相关干扰和疼痛相关困扰,涵盖了慢性疼痛的生物心理社会方面。这三个评分可作为扩展代码添加到任何疼痛诊断中。在 ICD-11 的不同编码级别中统一 CPSP 标准可能会提高 CPSP 与其他非手术引起的慢性疼痛病症的区分度。虽然神经病理性 CPSP 会增加疼痛的严重程度,并需要采用疼痛性疼痛的替代治疗方法,但目前还没有区分神经病理性和非神经病理性 CPSP 的特定代码。在临床实践和研究中,一般应使用以证据为基础的 ICD-11 定义,该定义提供了明确的诊断标准,而不应仅仅使用疼痛评分。这将提高数据的可比性,为未来的诊断和治疗方法奠定基础,并促进交流。
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引用次数: 0
Etomidate and its derivatives: time to say goodbye? Br J Anaesth 2024; 134: 11-13.
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-03-14 DOI: 10.1016/j.bja.2025.02.011
Andrew Bowdle, Evan D Kharasch
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引用次数: 0
Pulmonary complications associated with sugammadex or neostigmine in patients recovering from advanced diagnostic or interventional bronchoscopy: a retrospective two-centre analysis.
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2025-03-14 DOI: 10.1016/j.bja.2025.01.039
Ehab Farag, Karan Shah, Maged Argalious, Basem Abdelmalak, Thomas Gildea, John Seif, Shuyi Li, Edward J Mascha, Daniel I Sessler

Background: Many diagnostic and interventional procedures are performed in bronchoscopy suites in high-risk patients. Minor impairment in respiratory muscle function caused by incomplete reversal of neuromuscular block can contribute to postoperative pulmonary complications (PPCs). We assessed whether there are fewer serious PPCs after diagnostic or therapeutic bronchoscopy when neuromuscular block is reversed with sugammadex rather than neostigmine.

Methods: This is a retrospective cohort study for bronchoscopy under general anaesthesia with the use of neuromuscular blockers between July 2016 and June 2022. The primary outcome was a composite of PPCs. The secondary outcome was hypoxaemia. We used inverse probability of treatment weighting (IPTW) to adjust for confounding, fitting weighted outcome regression models to evaluate the association between the treatment and outcomes.

Results: We analysed 8557 bronchoscopies across 6123 patients for the primary analysis. Adequate balance was achieved on all potential confounders after IPTW. The unweighted PPC incidence was 85/3830 (2.2%) for sugammadex and 93/4727 (2.0%) for neostigmine. The weighted PPC incidence was 2.7% for sugammadex and 1.9% for neostigmine. Sugammadex was associated with higher odds of experiencing the primary outcome of PPCs (odds ratio [OR]: 1.44; 95% confidence interval [CI]: 1.02-2.05; P=0.038), but not the secondary outcome of hypoxaemia (OR: 0.98; 95% CI: 0.81-1.20; P=0.878).

Conclusions: Sugammadex was associated with a higher risk of PPCs than neostigmine. However, the absolute difference observed (0.8%) might not be clinically meaningful. Randomised trials are needed to more accurately determine the effect of neuromuscular block reversal agent selection on respiratory complications.

{"title":"Pulmonary complications associated with sugammadex or neostigmine in patients recovering from advanced diagnostic or interventional bronchoscopy: a retrospective two-centre analysis.","authors":"Ehab Farag, Karan Shah, Maged Argalious, Basem Abdelmalak, Thomas Gildea, John Seif, Shuyi Li, Edward J Mascha, Daniel I Sessler","doi":"10.1016/j.bja.2025.01.039","DOIUrl":"https://doi.org/10.1016/j.bja.2025.01.039","url":null,"abstract":"<p><strong>Background: </strong>Many diagnostic and interventional procedures are performed in bronchoscopy suites in high-risk patients. Minor impairment in respiratory muscle function caused by incomplete reversal of neuromuscular block can contribute to postoperative pulmonary complications (PPCs). We assessed whether there are fewer serious PPCs after diagnostic or therapeutic bronchoscopy when neuromuscular block is reversed with sugammadex rather than neostigmine.</p><p><strong>Methods: </strong>This is a retrospective cohort study for bronchoscopy under general anaesthesia with the use of neuromuscular blockers between July 2016 and June 2022. The primary outcome was a composite of PPCs. The secondary outcome was hypoxaemia. We used inverse probability of treatment weighting (IPTW) to adjust for confounding, fitting weighted outcome regression models to evaluate the association between the treatment and outcomes.</p><p><strong>Results: </strong>We analysed 8557 bronchoscopies across 6123 patients for the primary analysis. Adequate balance was achieved on all potential confounders after IPTW. The unweighted PPC incidence was 85/3830 (2.2%) for sugammadex and 93/4727 (2.0%) for neostigmine. The weighted PPC incidence was 2.7% for sugammadex and 1.9% for neostigmine. Sugammadex was associated with higher odds of experiencing the primary outcome of PPCs (odds ratio [OR]: 1.44; 95% confidence interval [CI]: 1.02-2.05; P=0.038), but not the secondary outcome of hypoxaemia (OR: 0.98; 95% CI: 0.81-1.20; P=0.878).</p><p><strong>Conclusions: </strong>Sugammadex was associated with a higher risk of PPCs than neostigmine. However, the absolute difference observed (0.8%) might not be clinically meaningful. Randomised trials are needed to more accurately determine the effect of neuromuscular block reversal agent selection on respiratory complications.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633686","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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British journal of anaesthesia
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