Pub Date : 2026-01-16DOI: 10.1016/j.bja.2025.12.020
Clístenes Crístian de Carvalho
High-flow nasal oxygen (HFNO) is increasingly used for preoxygenation, yet the optimal flow rate remains uncertain. Sjöblom and colleagues compared 45, 70, and 95 L min-1 and found no significant differences in safe apnoea time when HFNO was stopped at apnoea onset and the airway left open to atmosphere. This commentary reflects on why, under their study design, higher flows might not be expected to extend safe apnoea time and shows that clinically relevant differences (≈2-3 min) cannot be excluded from the summary data. It places the findings within their physiological context and discusses why results may differ if HFNO is continued through apnoea, if patient positioning varies, or when patient-level factors are taken into account. It also emphasises that the absence of a statistically significant difference does not constitute evidence of equivalence and proposes a pragmatic approach to preoxygenation.
高流量鼻氧（HFNO）越来越多地用于预充氧，但最佳流量仍不确定。Sjöblom和同事比较了45、70和95 L min-1，发现在呼吸暂停开始时停止HFNO和气道对大气开放时，安全呼吸暂停时间没有显著差异。这篇评论反映了为什么在他们的研究设计下，高流量可能不会延长安全呼吸暂停时间，并表明临床相关差异（≈2-3分钟）不能从总结数据中排除。它将研究结果置于其生理背景下，并讨论了如果在呼吸暂停期间继续进行高强度no，如果患者体位不同，或者考虑到患者层面的因素，结果可能会有所不同的原因。它还强调，没有统计上显著的差异并不构成等效的证据，并提出了一种实用的预充氧方法。
{"title":"Preoxygenation with high-flow nasal oxygen: the role of flow rate in safe apnoea time.","authors":"Clístenes Crístian de Carvalho","doi":"10.1016/j.bja.2025.12.020","DOIUrl":"https://doi.org/10.1016/j.bja.2025.12.020","url":null,"abstract":"High-flow nasal oxygen (HFNO) is increasingly used for preoxygenation, yet the optimal flow rate remains uncertain. Sjöblom and colleagues compared 45, 70, and 95 L min-1 and found no significant differences in safe apnoea time when HFNO was stopped at apnoea onset and the airway left open to atmosphere. This commentary reflects on why, under their study design, higher flows might not be expected to extend safe apnoea time and shows that clinically relevant differences (≈2-3 min) cannot be excluded from the summary data. It places the findings within their physiological context and discusses why results may differ if HFNO is continued through apnoea, if patient positioning varies, or when patient-level factors are taken into account. It also emphasises that the absence of a statistically significant difference does not constitute evidence of equivalence and proposes a pragmatic approach to preoxygenation.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"270 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993039","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}
{"title":"Bupivacaine pharmacokinetics in the absence or presence of perineural dexamethasone in axillary blockade.","authors":"Daniela Bravo,Germán Aguilera,Ady Giordano,Sebastián Layera,Hans Erpel,Diego Mora,Carla Ramírez,Álvaro Jara,Julián Aliste","doi":"10.1016/j.bja.2025.12.009","DOIUrl":"https://doi.org/10.1016/j.bja.2025.12.009","url":null,"abstract":"NCT05359731.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"36 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993080","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 : 2026-01-16DOI: 10.1016/j.bja.2025.12.024
Katherine McKee,James Turnbull,Anil Patel,Archie I J Brain
{"title":"Laryngeal mask airway sizes: evaluation of the use of the size 6 LMA.","authors":"Katherine McKee,James Turnbull,Anil Patel,Archie I J Brain","doi":"10.1016/j.bja.2025.12.024","DOIUrl":"https://doi.org/10.1016/j.bja.2025.12.024","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"269 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993082","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 : 2026-01-13DOI: 10.1016/j.bja.2025.12.011
Ge Li
{"title":"Intraoperative electroencephalogram-derived measures and their association with postoperative delirium: anaesthetic and surgical heterogeneity in EEG–delirium research. Comment on Br J Anaesth 2025; 135: 1684–1703","authors":"Ge Li","doi":"10.1016/j.bja.2025.12.011","DOIUrl":"https://doi.org/10.1016/j.bja.2025.12.011","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"32 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961649","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 : 2026-01-13DOI: 10.1016/j.bja.2025.12.014
David Ferreira, Francis Berthier
{"title":"Association of intraoperative end-tidal CO2 levels with postoperative outcomes. Comment on Br J Anaesth 2025; 135: 1761–9","authors":"David Ferreira, Francis Berthier","doi":"10.1016/j.bja.2025.12.014","DOIUrl":"https://doi.org/10.1016/j.bja.2025.12.014","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"142 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145962451","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 : 2026-01-09DOI: 10.1016/j.bja.2025.11.055
Peter J Schuller,Jan P G Pretorius
{"title":"qNOX index for quantification of intraoperative nociception and analgesia: the problem of neuromuscular block. Comment on Br J Anaesth 2025; 134: 736-45.","authors":"Peter J Schuller,Jan P G Pretorius","doi":"10.1016/j.bja.2025.11.055","DOIUrl":"https://doi.org/10.1016/j.bja.2025.11.055","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"9 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947426","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 : 2026-01-09DOI: 10.1016/j.bja.2025.12.006
Harriet E Taylor,Joseph C Salf,Charlotte R Roper-Marchand,Dhaneesha N S Senaratne,Blair H Smith,Lesley A Colvin,Jacob George
{"title":"Are adults with chronic pain more likely to develop hypertension than adults without chronic pain? Response to Br J Anaesth 2026; 136: 429-31.","authors":"Harriet E Taylor,Joseph C Salf,Charlotte R Roper-Marchand,Dhaneesha N S Senaratne,Blair H Smith,Lesley A Colvin,Jacob George","doi":"10.1016/j.bja.2025.12.006","DOIUrl":"https://doi.org/10.1016/j.bja.2025.12.006","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"29 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947461","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 : 2026-01-08DOI: 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":"https://doi.org/10.1016/j.bja.2025.12.005","url":null,"abstract":"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.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"6 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-08","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}
BACKGROUNDThe multicentre STOP-or-NOT trial has shown that continuation of renin-angiotensin-aldosterone inhibitors (RAASis) before major noncardiac surgery did not increase the rate of postoperative complications, but led to a higher incidence of intraoperative hypotension. However, the risk of intraoperative hypotension could vary significantly between patients. We evaluated whether there is heterogeneity in the risk of intraoperative hypotension among patients who continue vs those who discontinue RAASi therapy before major surgery.METHODSWe conducted a secondary analysis of the STOP-or-NOT trial. The primary outcome was intraoperative hypotension (defined as a mean arterial pressure <60 mm Hg) requiring vasopressor administration. We assessed for the presence of significant heterogeneity of treatment effect (HTE). When HTE was statistically significant, we estimated the conditional average treatment effect (CATE) using a machine learning approach. On the basis of CATE estimates, patients were stratified into three risk groups: high-risk (top 20%), low-risk (bottom 5%), and medium-risk (remaining 75%).RESULTSAmong 2007 patients, there was a statistically significant HTE for the risk of hypotension. Compared with the low-risk group, patients in the high-risk group (CATE risk difference, 0.172 [0.161-0.179]) were younger (62 vs 69 yr; P<0.001) and had a higher BMI (34 vs 27k m-2; P<0.001), lower baseline systolic blood pressure (133 vs 138 mm Hg; P<0.001), higher baseline haemoglobin (14.9 vs 12.2 g dl-1; P<0.001), and lower serum creatinine (76 vs 82 μM; P=0.003).CONCLUSIONSOur analysis supports the existence of significant heterogeneity in the risk of intraoperative hypotension associated with the continuation of RAASi therapy before major noncardiac surgery.CLINICAL TRIAL REGISTRATIONNCT03374449.
多中心停止或不停止试验表明，在重大非心脏手术前继续使用肾素-血管紧张素-醛酮抑制剂（RAASis）不会增加术后并发症的发生率，但会导致术中低血压的发生率升高。然而，术中低血压的风险在患者之间可能存在显著差异。我们评估了在大手术前继续和停止RAASi治疗的患者中术中低血压的风险是否存在异质性。方法我们对停止或不停止试验进行了二次分析。主要结局是术中低血压（定义为平均动脉压<60 mm Hg），需要使用血管加压剂。我们评估了治疗效果（HTE）是否存在显著异质性。当HTE具有统计学意义时，我们使用机器学习方法估计条件平均治疗效果（CATE）。在CATE估计的基础上，将患者分为三个风险组：高风险（前20%）、低风险（后5%）和中风险（其余75%）。结果在2007例患者中，HTE对低血压的风险有统计学意义。与低危组相比，高危组患者（CATE风险差为0.172[0.161-0.179]）更年轻（62岁vs 69岁，P<0.001）， BMI更高（34岁vs 27k m-2， P<0.001），基线收缩压更低（133 vs 138 mm Hg， P<0.001），基线血红蛋白更高（14.9 vs 12.2 g dl-1， P<0.001），血清肌酐更低（76 vs 82 μM， P=0.003）。结论：我们的分析支持在重大非心脏手术前继续RAASi治疗相关的术中低血压风险存在显著异质性。临床试验注册编号：nct03374449。
{"title":"Impact of continuing renin-angiotensin-aldosterone system inhibitors before surgery on intraoperative hypotensive events: a secondary analysis of the STOP-or-NOT Trial.","authors":"Romain Pirracchio,Bernard Cholley,Jeremy Falcone,Hélène Charbonneau,Amélie Delaporte,Adrien Lemoine,Alexandre Joosten,Etienne Gayat,Matthieu Legrand, ","doi":"10.1016/j.bja.2025.11.049","DOIUrl":"https://doi.org/10.1016/j.bja.2025.11.049","url":null,"abstract":"BACKGROUNDThe multicentre STOP-or-NOT trial has shown that continuation of renin-angiotensin-aldosterone inhibitors (RAASis) before major noncardiac surgery did not increase the rate of postoperative complications, but led to a higher incidence of intraoperative hypotension. However, the risk of intraoperative hypotension could vary significantly between patients. We evaluated whether there is heterogeneity in the risk of intraoperative hypotension among patients who continue vs those who discontinue RAASi therapy before major surgery.METHODSWe conducted a secondary analysis of the STOP-or-NOT trial. The primary outcome was intraoperative hypotension (defined as a mean arterial pressure <60 mm Hg) requiring vasopressor administration. We assessed for the presence of significant heterogeneity of treatment effect (HTE). When HTE was statistically significant, we estimated the conditional average treatment effect (CATE) using a machine learning approach. On the basis of CATE estimates, patients were stratified into three risk groups: high-risk (top 20%), low-risk (bottom 5%), and medium-risk (remaining 75%).RESULTSAmong 2007 patients, there was a statistically significant HTE for the risk of hypotension. Compared with the low-risk group, patients in the high-risk group (CATE risk difference, 0.172 [0.161-0.179]) were younger (62 vs 69 yr; P<0.001) and had a higher BMI (34 vs 27k m-2; P<0.001), lower baseline systolic blood pressure (133 vs 138 mm Hg; P<0.001), higher baseline haemoglobin (14.9 vs 12.2 g dl-1; P<0.001), and lower serum creatinine (76 vs 82 μM; P=0.003).CONCLUSIONSOur analysis supports the existence of significant heterogeneity in the risk of intraoperative hypotension associated with the continuation of RAASi therapy before major noncardiac surgery.CLINICAL TRIAL REGISTRATIONNCT03374449.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"23 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937879","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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