Pub Date : 2026-03-03DOI: 10.1016/j.bja.2026.02.002
Yuan Li,Bingxing Shuai,Han Huang
BACKGROUNDWhether neuraxial analgesia during labour influences offspring neurodevelopment remains controversial, largely because of reliance on observational evidence susceptible to residual confounding. We aimed to re-evaluate this association through an updated and methodologically rigorous systematic review and meta-analysis, with particular emphasis on family-based designs that better account for shared familial factors.METHODSPubMed, Embase, Web of Science, and the Cochrane Library were searched to September 16, 2025. Eligible studies assessed epidural, caudal, or combined spinal-epidural anaesthesia during labour and reported clinically defined neurodevelopmental outcomes. Random-effects meta-analyses with restricted maximum likelihood estimation were performed, with prespecified sibling-matched analyses.RESULTSNineteen studies were included. In sibling-matched cohorts, which provide stronger control for shared genetic and familial confounding, neuraxial labour analgesia was not associated with autism spectrum disorder (ASD) (adjusted hazard ratio 1.06; 95% confidence interval 0.98-1.14) or attention-deficit/hyperactivity disorder. Population-based analyses showed a small increase in ASD risk after adjustment (adjusted hazard ratio 1.10; 95% confidence interval 1.08-1.13), but effect estimates attenuated with increasing control for familial confounding. No clinically meaningful associations were observed for other neurodevelopmental outcomes.CONCLUSIONSAcross population-based and family-based observational evidence, this updated systematic review and meta-analysis showed that there is no convincing evidence that neuraxial labour analgesia is associated with an increased risk of ASD, attention-deficit/hyperactivity disorder or other neurodevelopmental disorders in offspring.SYSTEMATIC REVIEW PROTOCOLPROSPERO (CRD420251148665).
分娩过程中神经轴镇痛是否会影响后代的神经发育仍然存在争议，主要是因为依赖于观察证据，容易产生残留的混淆。我们的目的是通过更新和方法上严格的系统回顾和荟萃分析来重新评估这种关联，特别强调基于家庭的设计，以更好地解释共同的家庭因素。方法检索spubmed、Embase、Web of Science、Cochrane Library至2025年9月16日。符合条件的研究评估了分娩期间的硬膜外、尾侧或脊髓-硬膜外联合麻醉，并报告了临床定义的神经发育结果。采用限制最大似然估计进行随机效应荟萃分析，并进行预先指定的兄弟姐妹匹配分析。结果共纳入19项研究。在对共同遗传和家族混淆提供更强控制的兄弟姐妹配对队列中，神经轴分娩镇痛与自闭症谱系障碍（ASD）（校正风险比1.06；95%可信区间0.98-1.14）或注意缺陷/多动障碍无关。基于人群的分析显示，调整后的ASD风险略有增加（调整后的风险比为1.10；95%置信区间为1.08-1.13），但随着对家族混杂因素控制的增加，效果估计减弱。其他神经发育结果未观察到有临床意义的关联。结论：通过基于人群和家庭的观察性证据，这一更新的系统回顾和荟萃分析显示，没有令人信服的证据表明神经轴分娩镇痛与后代患ASD、注意力缺陷/多动障碍或其他神经发育障碍的风险增加有关。系统评价协议prospero （crd420251148665）。
{"title":"The impact of neuraxial labour analgesia on neurodevelopmental disorders in offspring: a systematic review and meta-analysis.","authors":"Yuan Li,Bingxing Shuai,Han Huang","doi":"10.1016/j.bja.2026.02.002","DOIUrl":"https://doi.org/10.1016/j.bja.2026.02.002","url":null,"abstract":"BACKGROUNDWhether neuraxial analgesia during labour influences offspring neurodevelopment remains controversial, largely because of reliance on observational evidence susceptible to residual confounding. We aimed to re-evaluate this association through an updated and methodologically rigorous systematic review and meta-analysis, with particular emphasis on family-based designs that better account for shared familial factors.METHODSPubMed, Embase, Web of Science, and the Cochrane Library were searched to September 16, 2025. Eligible studies assessed epidural, caudal, or combined spinal-epidural anaesthesia during labour and reported clinically defined neurodevelopmental outcomes. Random-effects meta-analyses with restricted maximum likelihood estimation were performed, with prespecified sibling-matched analyses.RESULTSNineteen studies were included. In sibling-matched cohorts, which provide stronger control for shared genetic and familial confounding, neuraxial labour analgesia was not associated with autism spectrum disorder (ASD) (adjusted hazard ratio 1.06; 95% confidence interval 0.98-1.14) or attention-deficit/hyperactivity disorder. Population-based analyses showed a small increase in ASD risk after adjustment (adjusted hazard ratio 1.10; 95% confidence interval 1.08-1.13), but effect estimates attenuated with increasing control for familial confounding. No clinically meaningful associations were observed for other neurodevelopmental outcomes.CONCLUSIONSAcross population-based and family-based observational evidence, this updated systematic review and meta-analysis showed that there is no convincing evidence that neuraxial labour analgesia is associated with an increased risk of ASD, attention-deficit/hyperactivity disorder or other neurodevelopmental disorders in offspring.SYSTEMATIC REVIEW PROTOCOLPROSPERO (CRD420251148665).","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"15 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350360","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 : 2026-03-01Epub Date: 2026-01-08DOI: 10.1016/j.bja.2025.12.005
Matthew J. Rowland , Amod Sawardekar , Narasimhan Jagannathan
Paediatric 1-h clear liquid fasting is now supported by multiple international guidelines. A systematic review together with EUROFAST strengthen the evidence for its safety. Despite this, clinical practice is still lagging, with inconsistent encouragement of clear liquids and unclear communication during delays. We highlight this evidence–practice gap to emphasise the need for simple systems and quality improvement measures that ensure 1-h fasting becomes routine for children undergoing anaesthesia.
{"title":"Sip, don’t skip: implementing 1-hour fasting in paediatric anaesthesia","authors":"Matthew J. Rowland , Amod Sawardekar , Narasimhan Jagannathan","doi":"10.1016/j.bja.2025.12.005","DOIUrl":"10.1016/j.bja.2025.12.005","url":null,"abstract":"<div><div>Paediatric 1-h clear liquid fasting is now supported by multiple international guidelines. A systematic review together with EUROFAST strengthen the evidence for its safety. Despite this, clinical practice is still lagging, with inconsistent encouragement of clear liquids and unclear communication during delays. We highlight this evidence–practice gap to emphasise the need for simple systems and quality improvement measures that ensure 1-h fasting becomes routine for children undergoing anaesthesia.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"136 3","pages":"Pages 812-815"},"PeriodicalIF":9.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937878","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 : 2026-03-01Epub Date: 2026-01-19DOI: 10.1016/j.bja.2025.12.037
Hao Kong , Mo Li , Zhong-Yuan Zhang
{"title":"Effect of perioperative dexmedetomidine on acute kidney injury after partial nephrectomy. Response to Br J Anaesth 2026; 136: 796-7","authors":"Hao Kong , Mo Li , Zhong-Yuan Zhang","doi":"10.1016/j.bja.2025.12.037","DOIUrl":"10.1016/j.bja.2025.12.037","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"136 3","pages":"Pages 1007-1008"},"PeriodicalIF":9.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000589","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 : 2026-03-01Epub Date: 2026-01-23DOI: 10.1016/j.bja.2025.12.035
Xinyan Cao , E Wang , Haoyu Tan , Shenghui Yang
{"title":"Knotted epidural catheter removal using a modified tissue dilator-assisted technique","authors":"Xinyan Cao , E Wang , Haoyu Tan , Shenghui Yang","doi":"10.1016/j.bja.2025.12.035","DOIUrl":"10.1016/j.bja.2025.12.035","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"136 3","pages":"Pages 1087-1089"},"PeriodicalIF":9.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032854","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 : 2026-03-01Epub Date: 2025-11-14DOI: 10.1016/j.bja.2025.09.038
Yi Feng , Junjun Xu , Hong Ma , E Wang , Jinjun Bian , Xiangming Fang , Le Shen , Tao Zhu , Kexuan Liu , Lai Jiang , Jianjun Yang , Xiangdong Chen , Yan Luo , Ailin Luo , Yunshui Peng , Hailong Dong , Changhong Miao , Ke Wei , Tianlong Wang , Weifeng Yu , Ke Wei
Total intravenous anaesthesia (TIVA) has been widely used for general anaesthesia in clinical practice. In order to further promote the standardised application of TIVA in China, the Chinese Society of Anesthesiology of the Chinese Medical Association organised experts to formulate these clinical practice guidelines for TIVA. After collection and selection of clinical questions, the working group conducted rigorous searches of the literature, formulated recommendations, and reached a consensus. A total of 22 recommendations were made on 12 clinical issues, including the indications, contraindications, and advantages of TIVA, use of depth of anaesthesia monitoring during implementation, pharmacological characteristics of available i.v. anaesthetic drugs, selection and use of drugs in target- and nontarget-controlled infusion modes, and precautions for application of TIVA in special populations, thus providing guidance for anaesthetists to standardise implementation of TIVA.
{"title":"Chinese clinical practice guidelines for total intravenous anaesthesia: a systematic review and expert consensus-based recommendations☆","authors":"Yi Feng , Junjun Xu , Hong Ma , E Wang , Jinjun Bian , Xiangming Fang , Le Shen , Tao Zhu , Kexuan Liu , Lai Jiang , Jianjun Yang , Xiangdong Chen , Yan Luo , Ailin Luo , Yunshui Peng , Hailong Dong , Changhong Miao , Ke Wei , Tianlong Wang , Weifeng Yu , Ke Wei","doi":"10.1016/j.bja.2025.09.038","DOIUrl":"10.1016/j.bja.2025.09.038","url":null,"abstract":"<div><div>Total intravenous anaesthesia (TIVA) has been widely used for general anaesthesia in clinical practice. In order to further promote the standardised application of TIVA in China, the Chinese Society of Anesthesiology of the Chinese Medical Association organised experts to formulate these clinical practice guidelines for TIVA. After collection and selection of clinical questions, the working group conducted rigorous searches of the literature, formulated recommendations, and reached a consensus. A total of 22 recommendations were made on 12 clinical issues, including the indications, contraindications, and advantages of TIVA, use of depth of anaesthesia monitoring during implementation, pharmacological characteristics of available i.v. anaesthetic drugs, selection and use of drugs in target- and nontarget-controlled infusion modes, and precautions for application of TIVA in special populations, thus providing guidance for anaesthetists to standardise implementation of TIVA.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"136 3","pages":"Pages 876-896"},"PeriodicalIF":9.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516222","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 : 2026-03-01Epub Date: 2025-12-30DOI: 10.1016/j.bja.2025.11.038
David Thalmann , Johan Ræder
{"title":"Warning on dexmedetomidine for ICU sedation in younger patients: weighing the evidence","authors":"David Thalmann , Johan Ræder","doi":"10.1016/j.bja.2025.11.038","DOIUrl":"10.1016/j.bja.2025.11.038","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"136 3","pages":"Pages 1005-1006"},"PeriodicalIF":9.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877823","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 : 2026-03-01Epub Date: 2026-01-06DOI: 10.1016/j.bja.2025.11.044
Jimmy J. Arevalo , Monique van Velzen , Albert Dahan , Marieke Niesters , Elise Sarton , Rutger van der Schrier
{"title":"Esketamine effect on remifentanil-induced depression of the acute hypoxic ventilatory response: a volunteer study","authors":"Jimmy J. Arevalo , Monique van Velzen , Albert Dahan , Marieke Niesters , Elise Sarton , Rutger van der Schrier","doi":"10.1016/j.bja.2025.11.044","DOIUrl":"10.1016/j.bja.2025.11.044","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"136 3","pages":"Pages 1019-1021"},"PeriodicalIF":9.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145916965","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 : 2026-03-01Epub Date: 2026-01-16DOI: 10.1016/j.bja.2025.12.019
Irma L.A. Geenen , René Willems , Leonie J.P. Slegers , Tijs J. van den Berg , Anna L.M.J. van der Knijff-van Dortmont , Oscar F.C. van den Bosch
{"title":"Development and implementation of a ready-to-use intrathecal mixture of hyperbaric bupivacaine and morphine for Caesarean delivery","authors":"Irma L.A. Geenen , René Willems , Leonie J.P. Slegers , Tijs J. van den Berg , Anna L.M.J. van der Knijff-van Dortmont , Oscar F.C. van den Bosch","doi":"10.1016/j.bja.2025.12.019","DOIUrl":"10.1016/j.bja.2025.12.019","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"136 3","pages":"Pages 1068-1070"},"PeriodicalIF":9.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993038","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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