Pub Date : 2024-09-25DOI: 10.1016/j.bja.2024.07.029
{"title":"Standardisation of training in anaesthesiology in Europe: a survey on the impact of the 2022 European Training Requirements in Anaesthesiology","authors":"","doi":"10.1016/j.bja.2024.07.029","DOIUrl":"10.1016/j.bja.2024.07.029","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328678","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 : 2024-09-24DOI: 10.1016/j.bja.2024.08.007
Divya Mehta,Xiomara T Gonzalez,Grace Huang,Joanna Abraham
BACKGROUNDWe lack evidence on the cumulative effectiveness of machine learning (ML)-driven interventions in perioperative settings. Therefore, we conducted a systematic review to appraise the evidence on the impact of ML-driven interventions on perioperative outcomes.METHODSOvid MEDLINE, CINAHL, Embase, Scopus, PubMed, and ClinicalTrials.gov were searched to identify randomised controlled trials (RCTs) evaluating the effectiveness of ML-driven interventions in surgical inpatient populations. The review was registered with PROSPERO (CRD42023433163) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Meta-analysis was conducted for outcomes with two or more studies using a random-effects model, and vote counting was conducted for other outcomes.RESULTSAmong 13 included RCTs, three types of ML-driven interventions were evaluated: Hypotension Prediction Index (HPI) (n=5), Nociception Level Index (NoL) (n=7), and a scheduling system (n=1). Compared with the standard care, HPI led to a significant decrease in absolute hypotension (n=421, P=0.003, I2=75%) and relative hypotension (n=208, P<0.0001, I2=0%); NoL led to significantly lower mean pain scores in the post-anaesthesia care unit (PACU) (n=191, P=0.004, I2=19%). NoL showed no significant impact on intraoperative opioid consumption (n=339, P=0.31, I2=92%) or PACU opioid consumption (n=339, P=0.11, I2=0%). No significant difference in hospital length of stay (n=361, P=0.81, I2=0%) and PACU stay (n=267, P=0.44, I2=0) was found between HPI and NoL.CONCLUSIONSHPI decreased the duration of intraoperative hypotension, and NoL decreased postoperative pain scores, but no significant impact on other clinical outcomes was found. We highlight the need to address both methodological and clinical practice gaps to ensure the successful future implementation of ML-driven interventions.SYSTEMATIC REVIEW PROTOCOLCRD42023433163 (PROSPERO).
背景我们缺乏有关围手术期机器学习（ML）驱动的干预措施累积效果的证据。因此，我们进行了一项系统性综述，以评估有关 ML 驱动的干预措施对围术期结果的影响的证据。我们检索了 MEDLINE、CINAHL、Embase、Scopus、PubMed 和 ClinicalTrials.gov，以确定评估 ML 驱动的干预措施在外科住院患者中的有效性的随机对照试验 (RCT)。该综述已在 PROSPERO（CRD42023433163）上注册，并按照《系统综述和元分析首选报告项目》（PRISMA）指南进行。采用随机效应模型对有两项或更多研究的结果进行了 Meta 分析，并对其他结果进行了计票。结果在 13 项纳入的 RCT 中，评估了三种 ML 驱动的干预措施：低血压预测指数（HPI）（5 例）、痛觉水平指数（NoL）（7 例）和调度系统（1 例）。与标准护理相比，HPI 显著降低了绝对低血压（421 人，P=0.003，I2=75%）和相对低血压（208 人，P<0.0001，I2=0%）；NoL 显著降低了麻醉后护理病房（PACU）的平均疼痛评分（191 人，P=0.004，I2=19%）。NoL对术中阿片类药物消耗量（n=339，P=0.31，I2=92%）或PACU阿片类药物消耗量（n=339，P=0.11，I2=0%）无明显影响。HPI和NoL的住院时间（n=361，P=0.81，I2=0%）和PACU住院时间（n=267，P=0.44，I2=0）无明显差异。我们强调需要解决方法学和临床实践两方面的差距，以确保未来成功实施 ML 驱动的干预措施。
{"title":"Machine learning-augmented interventions in perioperative care: a systematic review and meta-analysis.","authors":"Divya Mehta,Xiomara T Gonzalez,Grace Huang,Joanna Abraham","doi":"10.1016/j.bja.2024.08.007","DOIUrl":"https://doi.org/10.1016/j.bja.2024.08.007","url":null,"abstract":"BACKGROUNDWe lack evidence on the cumulative effectiveness of machine learning (ML)-driven interventions in perioperative settings. Therefore, we conducted a systematic review to appraise the evidence on the impact of ML-driven interventions on perioperative outcomes.METHODSOvid MEDLINE, CINAHL, Embase, Scopus, PubMed, and ClinicalTrials.gov were searched to identify randomised controlled trials (RCTs) evaluating the effectiveness of ML-driven interventions in surgical inpatient populations. The review was registered with PROSPERO (CRD42023433163) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Meta-analysis was conducted for outcomes with two or more studies using a random-effects model, and vote counting was conducted for other outcomes.RESULTSAmong 13 included RCTs, three types of ML-driven interventions were evaluated: Hypotension Prediction Index (HPI) (n=5), Nociception Level Index (NoL) (n=7), and a scheduling system (n=1). Compared with the standard care, HPI led to a significant decrease in absolute hypotension (n=421, P=0.003, I2=75%) and relative hypotension (n=208, P<0.0001, I2=0%); NoL led to significantly lower mean pain scores in the post-anaesthesia care unit (PACU) (n=191, P=0.004, I2=19%). NoL showed no significant impact on intraoperative opioid consumption (n=339, P=0.31, I2=92%) or PACU opioid consumption (n=339, P=0.11, I2=0%). No significant difference in hospital length of stay (n=361, P=0.81, I2=0%) and PACU stay (n=267, P=0.44, I2=0) was found between HPI and NoL.CONCLUSIONSHPI decreased the duration of intraoperative hypotension, and NoL decreased postoperative pain scores, but no significant impact on other clinical outcomes was found. We highlight the need to address both methodological and clinical practice gaps to ensure the successful future implementation of ML-driven interventions.SYSTEMATIC REVIEW PROTOCOLCRD42023433163 (PROSPERO).","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.8,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324950","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 : 2024-09-24DOI: 10.1016/j.bja.2024.06.049
Background
Analgesia is an important effect of volatile anaesthetics, for which the spinal cord is a critical neural target. However, how supraspinal mechanisms modulate analgesic potency of volatile anaesthetics is not clear. We investigated the contribution of the central amygdala (CeA) to the analgesic effects of isoflurane and sevoflurane.
Methods
Analgesic potencies of volatile anaesthetics were tested during optogenetic and chemogenetic inhibition of CeA neurones. In vivo calcium imaging was used to measure neuronal activities of CeA neuronal subtypes under volatile anaesthesia. Contributions of the sodium leak channel (NALCN) in GABAergic CeA (CeAGABA) neurones to analgesic effects of volatile anaesthetics were explored by specific NALCN knockdown. Electrophysiological recordings on acute brain slices were applied to measure volatile anaesthetic modulation of CeA neuronal activity by NALCN.
Results
Optogenetic or chemogenetic silencing CeA neurones reduced the analgesic effects of isoflurane or sevoflurane in vivo. The calcium signals of CeAGABA neurones increased during exposure to isoflurane or sevoflurane at analgesic concentrations. Knockdown of NALCN in CeAGABA neurones attenuated antinociceptive effects of isoflurane, sevoflurane, or both. For example, mean concentrations of isoflurane, sevoflurane, or both that induced immobility to tail-flick stimuli were significantly increased (isoflurane: 1.17 [0.05] vol% vs 1.24 [0.04] vol%, P=0.01; sevoflurane: 2.65 [0.07] vol% vs 2.81 [0.07] vol%; P<0.001). In brain slices, isoflurane, sevoflurane, or both at clinical concentrations increased NALCN-mediated holding currents and conductance in CeAGABA neurones, which increased excitability of CeAGABA neurones in an NALCN-dependent manner.
Conclusions
The analgesic potencies of volatile anaesthetics are partially mediated by modulation of NALCN in CeAGABA neurones.
背景镇痛是挥发性麻醉剂的一个重要作用，而脊髓是其关键的神经靶点。然而，脊髓上机制如何调节挥发性麻醉剂的镇痛效力尚不清楚。我们研究了中央杏仁核（CeA）对异氟烷和七氟烷镇痛作用的贡献。方法在光遗传和化学遗传抑制 CeA 神经元的过程中测试挥发性麻醉剂的镇痛效力。体内钙成像用于测量挥发性麻醉下 CeA 神经元亚型的神经元活动。通过特定的 NALCN 敲除，探讨了 GABA 能 CeA（CeAGABA）神经元中的钠漏通道（NALCN）对挥发性麻醉剂镇痛效果的贡献。结果光遗传或化学遗传沉默 CeA 神经元降低了异氟醚或七氟烷在体内的镇痛效果。在接触镇痛浓度的异氟烷或七氟烷时，CeAGABA神经元的钙信号增加。敲除 CeAGABA 神经元中的 NALCN 可减弱异氟醚、七氟烷或两者的镇痛作用。例如，异氟醚、七氟醚或二者的平均浓度均显著增加，从而诱发对尾搔刺激的不动（异氟醚：1.17 [0.05] vol% vs 1.24 [0.04] vol%，P=0.01；七氟醚：2.65 [0.07] vol% vs 2.81 [0.07] vol%；P<0.001）。在脑片中，异氟醚、七氟醚或两者的临床浓度都会增加 CeAGABA 神经元中 NALCN 介导的保持电流和电导，从而以 NALCN 依赖性方式增加 CeAGABA 神经元的兴奋性。
{"title":"Sodium leak channels in the central amygdala modulate the analgesic potency of volatile anaesthetics in mice","authors":"","doi":"10.1016/j.bja.2024.06.049","DOIUrl":"10.1016/j.bja.2024.06.049","url":null,"abstract":"<div><h3>Background</h3><div>Analgesia is an important effect of volatile anaesthetics, for which the spinal cord is a critical neural target. However, how supraspinal mechanisms modulate analgesic potency of volatile anaesthetics is not clear. We investigated the contribution of the central amygdala (CeA) to the analgesic effects of isoflurane and sevoflurane.</div></div><div><h3>Methods</h3><div>Analgesic potencies of volatile anaesthetics were tested during optogenetic and chemogenetic inhibition of CeA neurones. <em>In vivo</em> calcium imaging was used to measure neuronal activities of CeA neuronal subtypes under volatile anaesthesia. Contributions of the sodium leak channel (NALCN) in GABAergic CeA (CeA<sup>GABA</sup>) neurones to analgesic effects of volatile anaesthetics were explored by specific NALCN knockdown. Electrophysiological recordings on acute brain slices were applied to measure volatile anaesthetic modulation of CeA neuronal activity by NALCN.</div></div><div><h3>Results</h3><div>Optogenetic or chemogenetic silencing CeA neurones reduced the analgesic effects of isoflurane or sevoflurane <em>in vivo</em>. The calcium signals of CeA<sup>GABA</sup> neurones increased during exposure to isoflurane or sevoflurane at analgesic concentrations. Knockdown of NALCN in CeA<sup>GABA</sup> neurones attenuated antinociceptive effects of isoflurane, sevoflurane, or both. For example, mean concentrations of isoflurane, sevoflurane, or both that induced immobility to tail-flick stimuli were significantly increased (isoflurane: 1.17 [0.05] vol% <em>vs</em> 1.24 [0.04] vol%, <em>P=</em>0.01; sevoflurane: 2.65 [0.07] vol% <em>vs</em> 2.81 [0.07] vol%; <em>P<</em>0.001). In brain slices, isoflurane, sevoflurane, or both at clinical concentrations increased NALCN-mediated holding currents and conductance in CeA<sup>GABA</sup> neurones, which increased excitability of CeA<sup>GABA</sup> neurones in an NALCN-dependent manner.</div></div><div><h3>Conclusions</h3><div>The analgesic potencies of volatile anaesthetics are partially mediated by modulation of NALCN in CeA<sup>GABA</sup> neurones.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324949","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 : 2024-09-24DOI: 10.1016/j.bja.2024.08.028
Brian B Chesebro,Seema Gandhi
Given the negative health impacts of climate change, clinicians have a fundamental responsibility to take an active role in mitigating the environmental impact of their practices. Inhaled anaesthetics are potent greenhouse gases, including nitrous oxide (N2O), with their long atmospheric lifetime, high global warming potential, and ozone-depleting properties. However, few clinicians realise that losses from central N2O supply systems account for the vast majority of overall N2O consumption in healthcare. Central N2O supply systems are standard in most facilities, compounding the impact of these under-recognised, unnecessary greenhouse gas emissions. We review the environmental impact of N2O in healthcare, offer N2O utilisation data from 47 hospitals in the USA, and provide clinician-targeted guidance for mitigating these widespread N2O emissions. Consistent with findings from the UK and Australia, data from two large US healthcare systems reveal significant nonclinical N2O losses of 47.2-99.8% of total procured N2O. As illustrated in one quaternary medical centre, the transition from central to portable supply systems reduced overall N2O consumption by 97.6%. To date, this mitigation initiative has been successfully implemented at over 25 hospitals in our system. Raising awareness of this considerable source of healthcare-specific N2O emissions empowers clinicians to spearhead facility-level engagement and action. As healthcare leaders, clinicians should advocate for decarbonisation of clinical practices and systems while ensuring high-quality patient care.
{"title":"Mitigating the systemic loss of nitrous oxide: a narrative review and data-driven practice analysis.","authors":"Brian B Chesebro,Seema Gandhi","doi":"10.1016/j.bja.2024.08.028","DOIUrl":"https://doi.org/10.1016/j.bja.2024.08.028","url":null,"abstract":"Given the negative health impacts of climate change, clinicians have a fundamental responsibility to take an active role in mitigating the environmental impact of their practices. Inhaled anaesthetics are potent greenhouse gases, including nitrous oxide (N2O), with their long atmospheric lifetime, high global warming potential, and ozone-depleting properties. However, few clinicians realise that losses from central N2O supply systems account for the vast majority of overall N2O consumption in healthcare. Central N2O supply systems are standard in most facilities, compounding the impact of these under-recognised, unnecessary greenhouse gas emissions. We review the environmental impact of N2O in healthcare, offer N2O utilisation data from 47 hospitals in the USA, and provide clinician-targeted guidance for mitigating these widespread N2O emissions. Consistent with findings from the UK and Australia, data from two large US healthcare systems reveal significant nonclinical N2O losses of 47.2-99.8% of total procured N2O. As illustrated in one quaternary medical centre, the transition from central to portable supply systems reduced overall N2O consumption by 97.6%. To date, this mitigation initiative has been successfully implemented at over 25 hospitals in our system. Raising awareness of this considerable source of healthcare-specific N2O emissions empowers clinicians to spearhead facility-level engagement and action. As healthcare leaders, clinicians should advocate for decarbonisation of clinical practices and systems while ensuring high-quality patient care.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.8,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324955","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 : 2024-09-23DOI: 10.1016/j.bja.2024.08.031
Vasyl Katerenchuk
{"title":"Classification system for failed peripheral nerve blocks.","authors":"Vasyl Katerenchuk","doi":"10.1016/j.bja.2024.08.031","DOIUrl":"https://doi.org/10.1016/j.bja.2024.08.031","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.8,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321094","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 : 2024-09-23DOI: 10.1016/j.bja.2024.06.036
{"title":"The analgesic effectiveness of perioperative lidocaine infusions for acute and chronic persistent postsurgical pain in patients undergoing breast cancer surgery. Comment on Br J Anaesth 2024; 132: 575–87","authors":"","doi":"10.1016/j.bja.2024.06.036","DOIUrl":"10.1016/j.bja.2024.06.036","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142321033","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 : 2024-09-23DOI: 10.1016/j.bja.2024.08.024
Michele Carella, Florian Beck, Kris Vermeylen
{"title":"Ultrasound-guided suprainguinal fascia iliaca compartment block and early postoperative analgesia after total hip arthroplasty. Comment on Br J Anaesth 2024; 133: 146-51.","authors":"Michele Carella, Florian Beck, Kris Vermeylen","doi":"10.1016/j.bja.2024.08.024","DOIUrl":"https://doi.org/10.1016/j.bja.2024.08.024","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142341995","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 : 2024-09-20DOI: 10.1016/j.bja.2024.07.018
Background
There is a lack of qualitative data on the negative effects of workplace stressors on the well-being of healthcare professionals in hospitals in Africa. It is unclear how well research methods developed for high-income country contexts apply to different cultural, social, and economic contexts in the global south.
Methods
We conducted a qualitative interview-based study including 64 perioperative healthcare professionals across all provinces of Rwanda. We used an iterative thematic analysis and aimed to explore the lived experience of Rwandan healthcare professionals and to consider to what extent the Maslach model aligns with these experiences.
Results
We found mixed responses of the effects on individuals, including the denial of burnout and fatigue to the points of physical exhaustion. Responses aligned with Maslach's three-factor model of emotional exhaustion, decreased personal accomplishment, and depersonalisation, with downstream effects on the healthcare system. Other factors included strongly patriotic culture, goals framed by narratives of Rwanda's recovery after the genocide, and personal and collective investment in developing the Rwandan healthcare system.
Conclusions
The Rwandan healthcare system presents many challenges which can become profoundly stressful for the workforce. Consideration of reduced personal and collective accomplishment, of moral injury, and its diverse downstream effects on the whole healthcare system may better represent the costs of burnout Rwanda. It is likely that improving the causes of work-based stress will require a significant investment in improving staffing and working conditions.
{"title":"Lived experience of burnout and fatigue in perioperative healthcare professionals in Rwanda: a qualitative study","authors":"","doi":"10.1016/j.bja.2024.07.018","DOIUrl":"10.1016/j.bja.2024.07.018","url":null,"abstract":"<div><h3>Background</h3><div>There is a lack of qualitative data on the negative effects of workplace stressors on the well-being of healthcare professionals in hospitals in Africa. It is unclear how well research methods developed for high-income country contexts apply to different cultural, social, and economic contexts in the global south.</div></div><div><h3>Methods</h3><div>We conducted a qualitative interview-based study including 64 perioperative healthcare professionals across all provinces of Rwanda. We used an iterative thematic analysis and aimed to explore the lived experience of Rwandan healthcare professionals and to consider to what extent the Maslach model aligns with these experiences.</div></div><div><h3>Results</h3><div>We found mixed responses of the effects on individuals, including the denial of burnout and fatigue to the points of physical exhaustion. Responses aligned with Maslach's three-factor model of emotional exhaustion, decreased personal accomplishment, and depersonalisation, with downstream effects on the healthcare system. Other factors included strongly patriotic culture, goals framed by narratives of Rwanda's recovery after the genocide, and personal and collective investment in developing the Rwandan healthcare system.</div></div><div><h3>Conclusions</h3><div>The Rwandan healthcare system presents many challenges which can become profoundly stressful for the workforce. Consideration of reduced personal and collective accomplishment, of moral injury, and its diverse downstream effects on the whole healthcare system may better represent the costs of burnout Rwanda. It is likely that improving the causes of work-based stress will require a significant investment in improving staffing and working conditions.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275224","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 : 2024-09-20DOI: 10.1016/j.bja.2024.08.006
Background
The risk of respiratory complications is highest in the first 72 h post-surgery. Postoperative respiratory events can exacerbate pre-existing respiratory compromise and lead to reintubation of the trachea, particularly in patients with neurologic disorders. This study examined the association between neurologic comorbidities and unanticipated early postoperative reintubation in children.
Methods
This multicentre, 1:1 propensity score-matched study included 420 096 children who underwent inpatient, elective, noncardiac surgery at National Surgical Quality Improvement Program reporting hospitals in 2012–22. The primary outcome was unanticipated early postoperative reintubation within 72 h after surgery. The secondary outcome was prolonged postoperative mechanical ventilation, defined as ventilator use >72 h. We also evaluated 30-day mortality in patients requiring reintubation.
Results
Cerebral palsy was associated with the highest risk of early reintubation (adjusted relative risk [RRadj]: 1.97, 95% confidence interval [CI]: 1.44–2.69; P<0.01), followed by seizure disorders (RRadj: 1.87, 95% CI: 1.50–2.34; P<0.01), neuromuscular disorders (RRadj: 1.76, 95% CI: 1.41–2.19; P<0.01), and structural central nervous system abnormalities (RRadj: 1.35, 95% CI: 1.13–1.61; P<0.01). Unanticipated early postoperative reintubation was associated with an eight-times increased risk of 30-day mortality (adjusted hazard ratio: 8.1, 95% CI: 6.0–11.1; P<0.01). Risk of prolonged postoperative mechanical ventilation was also increased with neurologic comorbidities, particularly seizure disorders (RRadj: 1.73, 95% CI: 1.55–1.93; P<0.01).
Conclusions
Children with neurologic comorbidities have an increased risk of unanticipated early postoperative reintubation and prolonged mechanical ventilation. Given the high mortality risk associated with these outcomes, children with neurologic comorbidities require heightened monitoring and risk assessment.
{"title":"Preoperative neurologic comorbidity and unanticipated early postoperative reintubation: a multicentre cohort study","authors":"","doi":"10.1016/j.bja.2024.08.006","DOIUrl":"10.1016/j.bja.2024.08.006","url":null,"abstract":"<div><h3>Background</h3><div>The risk of respiratory complications is highest in the first 72 h post-surgery. Postoperative respiratory events can exacerbate pre-existing respiratory compromise and lead to reintubation of the trachea, particularly in patients with neurologic disorders. This study examined the association between neurologic comorbidities and unanticipated early postoperative reintubation in children.</div></div><div><h3>Methods</h3><div>This multicentre, 1:1 propensity score-matched study included 420 096 children who underwent inpatient, elective, noncardiac surgery at National Surgical Quality Improvement Program reporting hospitals in 2012–22. The primary outcome was unanticipated early postoperative reintubation within 72 h after surgery. The secondary outcome was prolonged postoperative mechanical ventilation, defined as ventilator use >72 h. We also evaluated 30-day mortality in patients requiring reintubation.</div></div><div><h3>Results</h3><div>Cerebral palsy was associated with the highest risk of early reintubation (adjusted relative risk [RRadj]: 1.97, 95% confidence interval [CI]: 1.44–2.69; <em>P</em><0.01), followed by seizure disorders (RRadj: 1.87, 95% CI: 1.50–2.34; <em>P</em><0.01), neuromuscular disorders (RRadj: 1.76, 95% CI: 1.41–2.19; <em>P</em><0.01), and structural central nervous system abnormalities (RRadj: 1.35, 95% CI: 1.13–1.61; <em>P</em><0.01). Unanticipated early postoperative reintubation was associated with an eight-times increased risk of 30-day mortality (adjusted hazard ratio: 8.1, 95% CI: 6.0–11.1; <em>P</em><0.01). Risk of prolonged postoperative mechanical ventilation was also increased with neurologic comorbidities, particularly seizure disorders (RRadj: 1.73, 95% CI: 1.55–1.93; <em>P</em><0.01).</div></div><div><h3>Conclusions</h3><div>Children with neurologic comorbidities have an increased risk of unanticipated early postoperative reintubation and prolonged mechanical ventilation. Given the high mortality risk associated with these outcomes, children with neurologic comorbidities require heightened monitoring and risk assessment.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275299","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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