British journal of anaesthesia最新文献

Background: A previous large clinical trial demonstrated an increased risk of perioperative stroke with beta blockers initiated just before surgery. This study evaluated the association between long-term beta blocker prescription and ischaemic stroke after noncardiac surgery.

Methods: We conducted a multicentre retrospective study of male and female adults undergoing noncardiac surgery between 2005 and 2021 at two academic healthcare networks in the USA. The primary exposure was long-term beta blocker prescription within 1 yr before surgery. We assessed postoperative ischaemic stroke risk at 30 and 365 days using modified Poisson regression with robust error variances, and conducted effect modification analyses.

Results: Long-term beta blocker prescription was associated with an increased risk of postoperative stroke at 30 days (adjusted relative risk [RRadj] 1.26, 95% confidence interval [CI] 1.17-1.36, P<0.001) and 365 days (RRadj 1.22, 95% CI 1.16-1.28, P<0.001). For stroke within 365 days of surgery, this association was amplified in patients with ASA physical status of 1-2 (RRadj 1.96, 95% CI 1.56-2.45, P<0.001) compared with that in patients with ASA physical status of 3-4 (RRadj 1.20, 95% CI 1.15-1.26, P<0.001; P for interaction <0.001). No significant association was observed in patients with severe heart failure.

Conclusions: Long-term beta blocker prescription was associated with increased risk of ischaemic stroke within 30 days and up to 365 days after surgery. No association of beta blocker use and ischaemic stroke risk was observed in patients with severe heart failure, or a history of stroke.

Background: Chronic postsurgical pain is a significant medical concern, particularly in cancer patients. However, most previous studies overlooked the psychological mechanisms contributing to this risk. The present study aimed to identify baseline predictive factors for chronic postsurgical pain in order to build and validate a predictive algorithm based on somatic and psychological predictors in a highly phenotyped longitudinal cohort of adult patients with breast or lung cancer from two European centres.

Methods: Comprehensive preoperative data, including patient characteristics and clinical, psychological, and social variables, were collected between 2017 and 2018. Four distinct machine learning models were trained and validated. Patients were examined at baseline and re-evaluated in face-to-face interviews 1 yr later.

Results: The sample included 255 patients (mean age 62.3 [range, 28-83] yr, 89.4% female). Chronic postsurgical pain was present in 83 patients (32.5%), of whom 72 (28% of the total sample) had neuropathic pain. We developed a predictive algorithm based on three independent variables: younger age (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.32-0.69), preoperative pain outside of the surgical area (OR, 2.45; 95% CI, 1.46-4.10), and a specific anxiety symptom (overwhelming worries) (OR, 1.81; 95% CI, 1.05-3.13).

Conclusions: This simple algorithm, requiring only three easily accessible inputs, offers a practical tool in routine preoperative settings, supporting timely, targeted interventions to improve pain management in cancer patients at risk of chronic postsurgical pain.

Clinical trial registration: NCT02368275, NCT03124511, NCT02960971.

Background: Quantitative neuromuscular monitoring is crucial to ensure patient safety when using neuromuscular blocking agents. Although historically considered as the research standard for neuromuscular monitoring, currently, no certified mechanomyography device is available for routine clinical use. This study aimed to investigate noninferiority in precision of a newly developed mechanomyography (TOF^3D mechanosensor; MIPM, Mammendorf, Germany) compared with electromyography.

Methods: We conducted a prospective, interventional, single-centre agreement study comparing electromyography and mechanomyography in 33 anaesthetised adult patients. Devices were randomly installed on opposite arms. Train-of-four (TOF) ratios were measured beginning before administration of rocuronium 0.45 mg kg^-1 i.v. until spontaneous recovery and after additional administration of sugammadex 2 mg kg^-1 i.v. The primary endpoint was precision using the repeatability coefficient at baseline and full recovery. Precision of the TOF ratio measurement was assumed noninferior if the repeatability coefficient did not exceed a margin of 0.01.

Results: Mechanomyography had higher repeatability coefficients than electromyography at all measured TOF intervals. Mechanomyography was partially noninferior to electromyography because the 95% confidence interval of the median difference between TOF ratios of both techniques (0.039 [0.007 to 0.042]) covered the acceptable margin during baseline, but not after recovery to TOF ratio >0.9 (0.052 [0.047 to 0.076]).

Conclusions: The TOF^3D mechanosensor was not less precise than electromyography during baseline. Better hand fixation must be achieved to improve precision mechanomyography.

Clinical trial registration: EUDAMED (CIV-23-06-043334); ClinicalTrials.gov (NCT06230653).