Pub Date : 2024-08-29DOI: 10.1016/j.bja.2024.06.046
{"title":"Tracheal intubation of neonates and infants: advocating rapid adoption of routine videolaryngoscopy in teaching operating theatres","authors":"","doi":"10.1016/j.bja.2024.06.046","DOIUrl":"10.1016/j.bja.2024.06.046","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104510","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}
Pub Date : 2024-08-28DOI: 10.1016/j.bja.2024.06.047
{"title":"Perioperative intravenous lidocaine infusion for chronic pain after breast cancer surgery: a trial sequential analysis of the original meta-analysis. Comment on Br J Anaesth 2024; 132: 575–87","authors":"","doi":"10.1016/j.bja.2024.06.047","DOIUrl":"10.1016/j.bja.2024.06.047","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142092331","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}
Pub Date : 2024-08-28DOI: 10.1016/j.bja.2024.07.019
The issue of potentially harmful effects of neurotoxicity or anaesthesia management on children undergoing general anaesthesia is still not resolved. Studies have so far been limited by methodological problems. In a retrospective cohort study, a new noninvasive method was used to demonstrate visual processing changes in children with a single previous exposure to anaesthesia. We need new noninvasive methods that can be used before and after exposure to anaesthesia and surgery to detemine possible effects on long-term neurodevelopment.
{"title":"New methods needed to investigate the potential adverse effects of anaesthesia on neurological development in childhood","authors":"","doi":"10.1016/j.bja.2024.07.019","DOIUrl":"10.1016/j.bja.2024.07.019","url":null,"abstract":"<div><div>The issue of potentially harmful effects of neurotoxicity or anaesthesia management on children undergoing general anaesthesia is still not resolved. Studies have so far been limited by methodological problems. In a retrospective cohort study, a new noninvasive method was used to demonstrate visual processing changes in children with a single previous exposure to anaesthesia. We need new noninvasive methods that can be used before and after exposure to anaesthesia and surgery to detemine possible effects on long-term neurodevelopment.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142092330","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}
Pub Date : 2024-08-23DOI: 10.1016/j.bja.2024.06.041
Background
The Eleveld pharmacokinetic–pharmacodynamic model for propofol predicts bispectral index (BIS) processed electroencephalogram values from estimated effect-site concentrations. We investigated agreement between measured and predicted BIS values during total intravenous anaesthesia (TIVA).
Methods
Forty participants undergoing lower limb surgery received TIVA using remifentanil target-controlled infusions and propofol by manually controlled, target-guided infusions based upon the Eleveld model and directed by two pharmacokinetic computer simulation applications: PKPD Tools and StelSim. We evaluated the predictive performance of the Eleveld model by calculating median prediction errors (BIS units) and by Bland–Altman analyses. We also performed |Bland-Altman analysis of supplementary data provided by the authors of the Eleveld model.
Results
Whereas median prediction errors were small (MDPE –1.9, MDAPE 10), the ranges were wide (–18.5 to 24.3 and 1.7 to 24.3). The proportion of MDAPE >10 BIS units was 47.8%. Bland–Altman analysis showed a small mean bias (–0.52 BIS units) with wide limits of agreement (–27.7 to 26.2). Each participant's limits of agreement did not meet the requirements for declaring interchangeability between the two measurements. The measurement differences depended on the BIS values, as indicated by the positive slopes of the differences vs BIS values. Bland–Altman analysis of the Eleveld model supplementary data revealed similar results.
Conclusion
BIS predictions by the Eleveld model should be interpreted with caution. In spite of the acceptable MDPE and MDAPE, there are unacceptable degrees of both within-subject and between-subject variation during propofol target-controlled infusions. This limits the use of adjusting targeted concentrations to achieve desired simulated BIS values with confidence.
背景：Eleveld异丙酚药代动力学-药效学模型可根据估计的效应部位浓度预测双频谱指数（BIS）处理后的脑电图值。我们研究了全静脉麻醉（TIVA）期间测量值和预测值之间的一致性：方法：40 位接受下肢手术的参与者在接受 TIVA 时使用瑞芬太尼靶控输注，并根据 Eleveld 模型和两个药代动力学计算机模拟应用程序的指导，通过手动控制的靶向输注使用异丙酚：PKPD Tools 和 StelSim。我们通过计算中位预测误差（BIS 单位）和布兰-阿尔特曼分析评估了 Eleveld 模型的预测性能。我们还对 Eleveld 模型作者提供的补充数据进行了布兰-阿尔特曼分析：结果：虽然预测误差的中位数很小（MDPE -1.9, MDAPE 10），但范围却很大（-18.5 至 24.3 和 1.7 至 24.3）。MDAPE >10 BIS 单位的比例为 47.8%。Bland-Altman 分析显示平均偏差较小（-0.52 BIS 单位），一致性范围较宽（-27.7 至 26.2）。每位受试者的一致性范围都不符合宣布两种测量结果可互换的要求。测量结果的差异取决于 BIS 值，差异与 BIS 值的正斜率表明了这一点。对 Eleveld 模型补充数据的 Bland-Altman 分析也显示了类似的结果：结论：应谨慎解释 Eleveld 模型的 BIS 预测值。尽管 MDPE 和 MDAPE 可以接受，但在异丙酚靶控输注过程中，受试者内和受试者间的变化程度都是不可接受的。这就限制了通过调整目标浓度来达到预期模拟 BIS 值的可信度。
{"title":"Predictive pharmacodynamic performance of the Eleveld pharmacokinetic–pharmacodynamic model for propofol: comparison of predicted and measured bispectral index","authors":"","doi":"10.1016/j.bja.2024.06.041","DOIUrl":"10.1016/j.bja.2024.06.041","url":null,"abstract":"<div><h3>Background</h3><p>The Eleveld pharmacokinetic–pharmacodynamic model for propofol predicts bispectral index (BIS) processed electroencephalogram values from estimated effect-site concentrations. We investigated agreement between measured and predicted BIS values during total intravenous anaesthesia (TIVA).</p></div><div><h3>Methods</h3><p>Forty participants undergoing lower limb surgery received TIVA using remifentanil target-controlled infusions and propofol by manually controlled, target-guided infusions based upon the Eleveld model and directed by two pharmacokinetic computer simulation applications: PKPD Tools and StelSim. We evaluated the predictive performance of the Eleveld model by calculating median prediction errors (BIS units) and by Bland–Altman analyses. We also performed |Bland-Altman analysis of supplementary data provided by the authors of the Eleveld model.</p></div><div><h3>Results</h3><p>Whereas median prediction errors were small (MDPE –1.9, MDAPE 10), the ranges were wide (–18.5 to 24.3 and 1.7 to 24.3). The proportion of MDAPE >10 BIS units was 47.8%. Bland–Altman analysis showed a small mean bias (–0.52 BIS units) with wide limits of agreement (–27.7 to 26.2). Each participant's limits of agreement did not meet the requirements for declaring interchangeability between the two measurements. The measurement differences depended on the BIS values, as indicated by the positive slopes of the differences <em>vs</em> BIS values. Bland–Altman analysis of the Eleveld model supplementary data revealed similar results.</p></div><div><h3>Conclusion</h3><p>BIS predictions by the Eleveld model should be interpreted with caution. In spite of the acceptable MDPE and MDAPE, there are unacceptable degrees of both within-subject and between-subject variation during propofol target-controlled infusions. This limits the use of adjusting targeted concentrations to achieve desired simulated BIS values with confidence.</p></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0007091224004240/pdfft?md5=1eb6ab777184fff2dcbb7020cfab1ba1&pid=1-s2.0-S0007091224004240-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046361","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}
Pub Date : 2024-08-23DOI: 10.1016/j.bja.2024.06.045
{"title":"Morphine-specific IgE testing in the diagnosis of neuromuscular blocking agent allergy: proper use and interpretation","authors":"","doi":"10.1016/j.bja.2024.06.045","DOIUrl":"10.1016/j.bja.2024.06.045","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046360","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}
Pub Date : 2024-08-23DOI: 10.1016/j.bja.2024.07.016
{"title":"The radial trinity block of the upper extremity: combined block of the radial, median and lateral cutaneous nerves of the forearm for radius fracture","authors":"","doi":"10.1016/j.bja.2024.07.016","DOIUrl":"10.1016/j.bja.2024.07.016","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054963","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}
Pub Date : 2024-08-13DOI: 10.1016/j.bja.2024.05.047
Background
Repeated exposure to sevoflurane during early developmental stages is a risk factor for social behavioural disorders, but the underlying neuropathological mechanisms remain unclear. As the hippocampal cornu ammonis area 2 subregion (CA2) is a critical centre for social cognitive functions, we hypothesised that sevoflurane exposure can lead to social behavioural disorders by disrupting neuronal activity in the CA2.
Methods
Neonatal mice were anaesthetised with sevoflurane 3 vol% for 2 h on postnatal day (PND) 6, 8, and 10. Bulk RNA sequencing of CA2 tissue was conducted on PND 12. Social cognitive function was assessed by behavioural experiments, and in vivo CA2 neuronal activity was recorded by multi-channel electrodes on PND 60–65.
Results
Repeated postnatal exposure to sevoflurane impaired social novelty recognition in adulthood. It also caused a decrease in the synchronisation of neuronal spiking, gamma oscillation power, and spike phase-locking between GABAergic spiking and gamma oscillations in the CA2 during social interaction. After sevoflurane exposure, we observed a reduction in the density and dendritic complexity of CA2 GABAergic neurones, and decreased expression of transcription factors critical for GABAergic neuronal development after.
Conclusions
Repeated postnatal exposure to sevoflurane disturbed the development of CA2 GABAergic neurones through downregulation of essential transcription factors. This resulted in impaired electrophysiological function in adult GABAergic neurones, leading to social recognition deficits. These findings reveal a potential electrophysiological mechanism underlying the long-term social recognition deficits induced by sevoflurane and highlight the crucial role of CA2 GABAergic neurones in social interactions.
{"title":"Repeated postnatal sevoflurane exposure impairs social recognition in mice by disrupting GABAergic neuronal activity and development in hippocampus","authors":"","doi":"10.1016/j.bja.2024.05.047","DOIUrl":"10.1016/j.bja.2024.05.047","url":null,"abstract":"<div><h3>Background</h3><p>Repeated exposure to sevoflurane during early developmental stages is a risk factor for social behavioural disorders, but the underlying neuropathological mechanisms remain unclear. As the hippocampal cornu ammonis area 2 subregion (CA2) is a critical centre for social cognitive functions, we hypothesised that sevoflurane exposure can lead to social behavioural disorders by disrupting neuronal activity in the CA2.</p></div><div><h3>Methods</h3><p>Neonatal mice were anaesthetised with sevoflurane 3 vol% for 2 h on postnatal day (PND) 6, 8, and 10. Bulk RNA sequencing of CA2 tissue was conducted on PND 12. Social cognitive function was assessed by behavioural experiments, and <em>in vivo</em> CA2 neuronal activity was recorded by multi-channel electrodes on PND 60–65.</p></div><div><h3>Results</h3><p>Repeated postnatal exposure to sevoflurane impaired social novelty recognition in adulthood. It also caused a decrease in the synchronisation of neuronal spiking, gamma oscillation power, and spike phase-locking between GABAergic spiking and gamma oscillations in the CA2 during social interaction. After sevoflurane exposure, we observed a reduction in the density and dendritic complexity of CA2 GABAergic neurones, and decreased expression of transcription factors critical for GABAergic neuronal development after.</p></div><div><h3>Conclusions</h3><p>Repeated postnatal exposure to sevoflurane disturbed the development of CA2 GABAergic neurones through downregulation of essential transcription factors. This resulted in impaired electrophysiological function in adult GABAergic neurones, leading to social recognition deficits. These findings reveal a potential electrophysiological mechanism underlying the long-term social recognition deficits induced by sevoflurane and highlight the crucial role of CA2 GABAergic neurones in social interactions.</p></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981769","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}
Pub Date : 2024-08-09DOI: 10.1016/j.bja.2024.06.043
{"title":"Preoperative multidisciplinary team meetings for high-risk noncardiac surgical patients: a Dutch nationwide survey","authors":"","doi":"10.1016/j.bja.2024.06.043","DOIUrl":"10.1016/j.bja.2024.06.043","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911848","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}
Pub Date : 2024-08-09DOI: 10.1016/j.bja.2024.06.044
{"title":"Comparison between cold and sharp modalities for testing sensory block in neuraxial labour analgesia: a prospective observational trial","authors":"","doi":"10.1016/j.bja.2024.06.044","DOIUrl":"10.1016/j.bja.2024.06.044","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911847","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}
Pub Date : 2024-08-08DOI: 10.1016/j.bja.2024.06.015
{"title":"Implementation of a prevention care bundle reduces the incidence of atrial fibrillation after cardiac surgery: a single-centre study result","authors":"","doi":"10.1016/j.bja.2024.06.015","DOIUrl":"10.1016/j.bja.2024.06.015","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141952959","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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