Abstract:
Background:Identification of statistically reliable outcomes for comparison among anaesthetists is challenging. Time-weighted intraoperative mean arterial pressure <65 mm Hg (AUC 65 ) is associated with increased odds for myocardial damage. We explored retrospectively whether such hypotension before incision was statistically reliable for peer comparison. Methods:We retrieved electronic data between 2006 and 2015 at a tertiary care, academic hospital in the USA for patients at risk for myocardial damage (inpatient after surgery, ASA physical status ≥III, ≥50 yr of age, and case duration ≥60 min). We determined the percentage of anaesthetists comparable based on caseload and case-mix. The AUC 65 was compared amongst anaesthetists supervising ≥100 cases involving at-risk patients during the last 12 months. Results:Only 14.1% [95% confidence interval (CI) 13.6-14.5%] of cases involved patients who were 'at risk' during the 10 yr study period. A yearly average of 49 ( sd 6) anaesthetists supervised ≥100 cases of any type, of whom only 52% (95% CI 47.1-56.0%) supervised ≥100 cases involving at-risk patients. Thus, nearly half the anaesthetists would have been excluded from peer comparison. During the last 12 months, there were two outliers among 34 evaluable anaesthetists ( P <0.05, controlling for false discovery). However, their contribution to total hypotension amongst cases for all patients was small, because hypotension was widely distributed (e.g. 80% of hypotension attributable to 61.8% of anaesthetists, 95% CI 59.8-63.7%). There was no relationship between the AUC 65 and propofol induction dose. Conclusions:The AUC 65 of time-weighted pre-incision hypotension is not a suitable metric for comparing anaesthetists. There were few at-risk patients, half the anaesthetists were not evaluable because of their case-mix and caseload, and hypotension was widely distributed.
journal_name
Br J Anaesthjournal_title
British journal of anaesthesiaauthors
Epstein RH,Dexter F,Schwenk ESdoi
10.1093/bja/aex153subject
Has Abstractpub_date
2017-07-01 00:00:00pages
106-114issue
1eissn
0007-0912issn
1471-6771pii
S0007-0912(17)33744-3journal_volume
119pub_type
杂志文章abstract::We studied 60 patients undergoing operation on the kidney with combined general and epidural anaesthesia, in a double-blind, randomized, controlled study. Patients were allocated to receive a preoperative bolus dose of ketamine 10 mg i.v., followed by an i.v. infusion of ketamine 10 mg h-1 for 48 h after operation, or...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/81.5.707
更新日期:1998-11-01 00:00:00
abstract::The effects of laudanosine, a metabolite of atracurium, on the behaviour of conscious mice, rats and dogs, and on cardiovascular function in conscious and anaesthetized dogs have been evaluated: EEG studies were performed in anaesthetized dogs. In mice and rats, i.v. bolus doses of laudanosine 10-20 mg kg-1, caused co...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/59.2.218
更新日期:1987-02-01 00:00:00
abstract::Continuous intercostal nerve blockade was used to provide analgesia after cholecystectomy. The blockade was maintained by the insertion of a single extradural catheter into an appropriate intercostal space and by "topping-up" with local anaesthetic on demand. Of the patients studied, 92%, and 76%, required no addition...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/55.6.521
更新日期:1983-06-01 00:00:00
abstract::The relative sensitivity of sympathetic preganglionic and postganglionic axons, B and C fibres, respectively, to two structurally dissimilar local anaesthetics was examined. The concentration of amethocaine (ester-linked tertiary amine) or prilocaine (amide-linked secondary amine) required to reduce the B fibre compou...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/47.11.1135
更新日期:1975-11-01 00:00:00
abstract::A mathematical model of a subject breathing from a circle system has been used to follow the course of anaesthetic uptake during the simulated administration of 60% nitrous oxide, 2% halothane and 2% methoxyflurane, under non-rebreathing conditions and with fresh gas flows to the circle system of between 8 and 0.25 li...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/58.10.1167
更新日期:1986-10-01 00:00:00
abstract::A patient with a tracheostomy and an iatrogenic tracheo-oesophageal fistula presented for diagnostic bronchoscopy and right upper lobectomy. The anaesthetic management is discussed with reference to the options available and, in particular, the use of a Brompton Pallister single lumen endobronchial tube. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/74.4.461
更新日期:1995-04-01 00:00:00
abstract::A 38-yr-old woman with an atrial septum defect and Eisenmenger syndrome was scheduled for a lung biopsy via thoracoscopy during one-lung ventilation. Fluids were given to increase central venous pressure to 8 mm Hg, an epidural catheter was inserted at the sixth thoracic intervertebral space and ropivacaine 0.3%, 6 ml...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeh104
更新日期:2004-04-01 00:00:00
abstract::A computer-controlled infusion of propofol designed to achieve a target blood concentration of propofol 3 microgram ml-1 was used to investigate the possibility of an interaction between propofol and fentanyl in 32 patients undergoing body surface surgery. In 16 patients who were not receiving a neuromuscular blocker ...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/64.2.142
更新日期:1990-02-01 00:00:00
abstract::The effect of the i.v. administration of methylene blue dye on haemoglobin oxygen saturation, measured by a pulse oximeter was investigated. The absorption spectra of various concentrations of haemoglobin, oxyhaemoglobin and methylene blue were compared. The amount of 660-nm light absorbed by methylene blue was suffic...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/60.4.439
更新日期:1988-03-01 00:00:00
abstract::Protein kinase C (PKC) is a key regulatory enzyme that has been implicated as a molecular target for the action of general anaesthetics. We have determined the effects of halothane on the translocation and down-regulation of conventional PKC (cPKC) by analysing the subcellular distribution of PKC activity, [3H]phorbol...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/78.2.189
更新日期:1997-02-01 00:00:00
abstract::Spinal anaesthesia is the preferred anaesthetic technique for elective Caesarean deliveries. Hypotension is the most common side-effect and has both maternal and neonatal consequences. Different strategies have been attempted to prevent spinal-induced hypotension, including the use of low-dose bupivacaine. We conducte...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,meta分析,评审
doi:10.1093/bja/aer200
更新日期:2011-09-01 00:00:00
abstract:Background:Checklists can reduce medical errors. However, the effectiveness of checklists is hampered by lack of acceptance and compliance. Recently, a new type of checklist with dynamic properties has been created to provide more specific checklist items for each individual patient. Our purpose in this simulation-base...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aex129
更新日期:2017-08-01 00:00:00
abstract::The analgesic efficacy of a 150-mg meptazinol suppository was compared with that of morphine 10 mg i.m. in the treatment of moderate postoperative pain. Two groups of 15 female patients took part in a 4-h, randomized double-blind, double-dummy study on the first day after elective abdominal hysterectomy. Meptazinol di...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/60.5.542
更新日期:1988-04-01 00:00:00
abstract:BACKGROUND:With the increasing prevalence of children who are overweight and with obesity, anaesthesiologists must determine the optimal dosing of medications given the altered pharmacokinetics and pharmacodynamics in this population. We therefore determined the single dose of dexmedetomidine that provided sufficient s...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1016/j.bja.2020.11.037
更新日期:2021-01-22 00:00:00
abstract::The gliding characteristics were evaluated of 10-ml plastic syringes used to identify the extradural space by "loss of resistance" techniques. This was undertaken quantitatively, by measuring the force necessary to depress syringe plungers, and qualitatively, by examining travel characteristics in terms of the force a...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/61.6.776
更新日期:1988-12-01 00:00:00
abstract::The ventilatory effects of single i.v. doses of morphine 0.1 mg kg-1, pethidine 0.67 mg kg-1 and methadone 0.1 mg kg-1 were compared after ophthalmic surgery in an open, randomized study in 30 children aged 3-8 yr. Ventilatory changes after each drug had distinctive profiles, with appreciable individual variation. Acu...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/70.4.414
更新日期:1993-04-01 00:00:00
abstract::The processed electroencephalogram (pEEG) was monitored in eight patients undergoing gynaecological laparotomy under combined extradural and nitrous oxide-isoflurane anaesthesia. Pre-incisional mean spectral edge frequency 95 percentile (SEF95) and median frequency (MF) were 11.67 (SD 1.63) Hz and 3.74 (0.24) Hz, resp...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章
doi:10.1093/bja/78.6.751
更新日期:1997-06-01 00:00:00
abstract::A randomized, double-blind study of 40 women was performed to compare patient controlled anaesthesia (PCA) morphine requirements after spinal anaesthesia for elective Caesarean section. The women received 0.2 mg of either morphine or diamorphine mixed with 0.5% bupivacaine in 8% dextrose. There were no significant dif...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/81.2.135
更新日期:1998-08-01 00:00:00
abstract::The isolated rat hepatocyte model has been used to assess the hepatotoxicity of a number of i.v. anaesthetic induction agents. Ketamine, Althesin and CCI 12923 (minaxolone) all inhibited gluconeogenesis and urea formation from alanine. There was also a decrease in the cell ATP concentration, and a dose-related increas...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/51.8.733
更新日期:1979-08-01 00:00:00
abstract::The pupils in brainstem-dead patients are classically fixed and dilated. We present a case of a brainstem-dead patient whose pupils displayed persistent asynchronous pupillary constriction and dilatation independent of external physical stimuli. Central causes for the phenomenon were excluded leaving an unexplained pe...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/86.5.717
更新日期:2001-05-01 00:00:00
abstract:BACKGROUND:The observation that patients presenting for bariatric surgery had a high incidence of neuromuscular blocking agent (NMBA) anaphylaxis prompted this restricted case-control study to test the hypothesis that obesity is a risk factor for NMBA anaphylaxis, independent of differences in pholcodine consumption. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1016/j.bja.2020.12.018
更新日期:2021-01-13 00:00:00
abstract::Blood concentrations of nitrous oxide were measured in anaesthetists, surgeons and theatre nurses. Comparison of anaesthetists and surgeons working in the same theatre showed that in ENT surgeons concentrations were greater (P < 0.01), while in general surgeons they were smaller (P < 0.003). Blood concentrations of ni...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/52.11.1143
更新日期:1980-11-01 00:00:00
abstract::This report describes the anaesthetic management of a ventricular arrhythmia-prone patient with a prolonged Q-T interval for closed reduction and wiring of a mandibular fracture. The patient was premedicated with propranolol and anaesthetized with isoflurane (inhalation). Documentation of heart rate v. Q-T interval re...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/55.4.361
更新日期:1983-04-01 00:00:00
abstract:BACKGROUND:We explored whether a previously successful initiative to improve first-case on-time starts succeeded because (i) preoperative steps started earlier (but the process did not necessarily improve) or (ii) the process was brought into better control. METHODS:We analysed 35 months of data comprising 28 882 firs...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1016/j.bja.2018.05.043
更新日期:2018-11-01 00:00:00
abstract::We have examined the effects of morphine in auricular myocardium from non-failing and failing human hearts. In both preparations morphine induced inhibition. These responses were not antagonized by naloxone. Comparison of mean IC30 values obtained in non-failing (3.9 (SEM 0.2) x 10(-8) mol litre-1) and failing (5010 (...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/76.1.106
更新日期:1996-01-01 00:00:00
abstract::Neurone specific enolase (NSE) and S-100 beta protein have been used as markers of brain damage. We hypothesized that blood concentrations of NSE and S-100 beta protein reflect cognitive dysfunction after abdominal surgery. We studied 65 elderly patients in whom neuropsychological testing was performed before abdomina...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/oxfordjournals.bja.a013410
更新日期:2000-02-01 00:00:00
abstract:BACKGROUND:The low and moderate doses of dexmedetomidine reduce arterial pressure and heart rate (HR), suggesting attenuation of sympathetic activity and dominance of cardiac-vagal activity. These autonomic responses under dexmedetomidine sedation may attenuate cardiovascular reflex responses to temporal reduction in a...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aep210
更新日期:2009-10-01 00:00:00
abstract::Effects of ageing were studied on the neural blockade and the pharmacokinetics after subarachnoid administration of 0.5% bupivacaine 3 ml in 8% glucose in two groups of 15 male patients, between 20 and 55 yr and older than 55 yr, respectively. The blockade was performed with the patient in the sitting position. Two mi...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/60.2.187
更新日期:1988-02-01 00:00:00
abstract:BACKGROUND:Tetrodotoxin (TTX) is a powerful sodium channel blocker extracted from the puffer fish. The analgesic effects of TTX were investigated in different animal pain models. METHODS:Wistar rats were submitted to the formalin test and to partial ligation of the sciatic nerve (Seltzer's model). Swiss Webster mice w...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/ael096
更新日期:2006-06-01 00:00:00
abstract:BACKGROUND:Lidocaine is frequently used as an agent to treat ventricular arrhythmias associated with acute myocardial ischaemia. Lidocaine is a potent blocker not only of sodium channels, but also of ATP-sensitive potassium channels. The opening of these channels is a key mechanism of ischaemic preconditioning. We inve...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeh262
更新日期:2004-11-01 00:00:00