Abstract:
BACKGROUND:Preoperative anaemia affects one third of patients undergoing cardiac surgery and is associated with increased mortality and morbidity. Although it is recommended that perioperative teams should identify and treat patients with preoperative anaemia before surgery, introducing new treatment protocols can be challenging in surgical pathways. The aim of this study was to assess the feasibility and effectiveness of introducing a preoperative intravenous iron service as a national initiative in cardiac surgery. METHODS:We performed a multicentre, stepped, observational study using the UK Association of Cardiothoracic Anaesthesia and Critical Care Research Network. The primary feasibility outcome was the ability to set up an anaemia and intravenous iron clinic at each site. The primary efficacy outcome was change in haemoglobin (Hb) concentration between intervention and operation. Secondary outcomes included blood transfusion and hospital stay. Patients with anaemia were compared with non-anaemic patients and with those who received intravenous iron as part of their routine treatment protocol. RESULTS:Seven out of 11 NHS hospitals successfully set up iron clinics over 2 yr, and 228 patients were recruited into this study. Patients with anaemia who received intravenous iron were at higher surgical risk, were more likely to have a known previous history of iron deficiency or anaemia, had a higher rate of chronic kidney disease, and were slightly more anaemic than the non-treated group. Intravenous iron was administered a median (inter-quartile range, IQR [range]) of 33 (15-53 [4-303]) days before surgery. Preoperative intravenous iron increased [Hb] from baseline to pre-surgery; mean (95% confidence interval) change was +8.4 (5.0-11.8) g L-1 (P<0.001). Overall, anaemic compared with non-anaemic patients were more likely to be transfused (49% [59/136] vs 27% (22/92), P=0.001) and stayed longer in hospital (median days [IQR], 9 [7-15] vs 8 [6-11]; P=0.014). The number of days alive and at home was lower in the anaemic group (median days [IQR], 20 [14-22] vs 21 [17-23]; P=0.033). CONCLUSION:The development of an intravenous iron pathway is feasible but appears limited to selected high-risk cardiac patients in routine NHS practise. Although intravenous iron increased [Hb], there is a need for an appropriately powered clinical trial to assess the clinical effect of intravenous iron on patient-centred outcomes.
journal_name
Br J Anaesthjournal_title
British journal of anaesthesiaauthors
Klein AA,Chau M,Yeates JA,Collier T,Evans C,Agarwal S,Richards T,UK Cardiac and Vascular Surgery Interventional Anaemia Response (CAVIAR) study team.doi
10.1016/j.bja.2019.11.023subject
Has Abstractpub_date
2020-03-01 00:00:00pages
243-250issue
3eissn
0007-0912issn
1471-6771pii
S0007-0912(19)30895-5journal_volume
124pub_type
杂志文章,多中心研究abstract::A new prototype of the laryngeal mask airway (LMA), the intubating laryngeal mask airway (ILMA), was used to facilitate tracheal intubation in 100 fasted patients presenting for elective surgery. Alignment of the ILMA with the larynx was assessed fibreoptically before intubation without the investigator performing the...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章
doi:10.1093/bja/79.6.710
更新日期:1997-12-01 00:00:00
abstract::It is known that propofol can have effects on atrioventricular node conduction. We report a case where administration of propofol was associated with termination of supraventricular tachycardia. Although a similar phenomenon has been reported in children, this is the first such case in an adult. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:
更新日期:2002-06-01 00:00:00
abstract:BACKGROUND:To determine the pharmacokinetics (PK) of a new i.v. formulation of paracetamol (Perfalgan) in children ≤15 yr of age. METHODS:After obtaining written informed consent, children under 16 yr of age were recruited to this study. Blood samples were obtained at 0, 15, 30 min, 1, 2, 4, 6, and 8 h after administr...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aes025
更新日期:2012-05-01 00:00:00
abstract:BACKGROUND:Priming during anaesthesia has been hard to replicate and the conditions under which it occurs remain poorly understood. We replicated and extended a recent study to determine whether intraoperative priming during propofol and nitrous oxide anaesthesia is a reliable phenomenon, whether it occurs due to aware...
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/aeh289
更新日期:2005-01-01 00:00:00
abstract::An investigation was carried out into the relationship between the inflation pressures of normally compliant lungs and the airways pressure necessary to produce the insufflation of gas to the stomach. This relationship was examined during manual ventilation with a mask, using a rapid sequence induction technique. In t...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/59.3.315
更新日期:1987-03-01 00:00:00
abstract::We have compared the effects of sevoflurane and halothane on the discharge frequencies of 19 slowly adapting and four rapidly adapting lung receptors in the rabbit by recording from single vagal fibres. Both agents reduced the discharge frequency of slowly adapting receptors during expiration (P < 0.0005), halothane h...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/80.2.257
更新日期:1998-02-01 00:00:00
abstract:BACKGROUND:Medication-related adverse events (MRE) in anaesthesia care are frequent and require a deeper understanding if we are to prevent medication harm. METHODS:We searched for reported MRE from the Spanish Anaesthesia Incident Reporting System (SENSAR) database over a 10-yr period. SENSAR is a cross-national, mul...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,多中心研究
doi:10.1016/j.bja.2019.10.013
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:The significance of IgE antibodies to neuromuscular blocking agent (NMBA)-induced anaphylactic reactions during anaesthesia is unclear. We investigated the relevance of IgE to rocuronium using an in vitro technique. METHODS:Serum samples from 61 patients with anaphylactic reactions during anaesthesia were i...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aer028
更新日期:2011-05-01 00:00:00
abstract::We describe a 25 mg intrathecal morphine overdose during a combined spinal-epidural block for a Caesarean delivery. Naloxone infusion (5.24 mg over 24 h) was started prior to the patient becoming symptomatic and almost immediately after the overdose. Invasive therapeutics such as mechanical ventilation were avoided. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aef286
更新日期:2002-12-01 00:00:00
abstract:BACKGROUND:Handover of anaesthesia patient care during surgery is common; however, its association with patient outcome is unclear. This systematic review aimed to assess the impact of anaesthesia handover during surgery on patient outcome. METHODS:All prospective and retrospective clinical studies specifically invest...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,meta分析
doi:10.1016/j.bja.2020.05.062
更新日期:2020-10-01 00:00:00
abstract::A new type of intra-arterial oxygen electrode was evaluated. In 14 patients, undergoing one-lung ventilation for thoracic surgery, the electrode was inserted into the radial artery and changes in PaO2 were recorded continuously. Methods of improving PaO2 during one-lung ventilation were demonstrated. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/48.10.1005
更新日期:1976-10-01 00:00:00
abstract::The neuromuscular blocking effect of repeated bolus administration of suxamethonium 1 mg/kg was observed in 10 healthy surgical patients under enflurane-nitrous oxide-oxygen anaesthesia. Tachyphylaxis and slow recovery of the thumb twitch occurred in close dose-relationships with transition of Phase I block to Phase I...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/48.2.91
更新日期:1976-02-01 00:00:00
abstract::During resection of a Wilms' tumour in a 10-year-old girl, sudden bradycardia, hypotension and cyanosis developed, leading to cardiac arrest. It was thought that part of the tumour had caused a pulmonary embolus. After prompt resuscitation, cardiopulmonary bypass surgery was started within 20 min. At operation the lef...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/53.8.903
更新日期:1981-08-01 00:00:00
abstract::To determine the influence of renal failure on the pharmacokinetics and neuromuscular blockade of Org NC 45 (Norcuron), a new monoquaternary homologue of pancuronium, 13 patients under halothane and nitrous oxide anesthesia were studied. Org NC 45 was administered by 2-min infusion in doses of 0.28 mg kg-1 (normal ren...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/53.10.1049
更新日期:1981-10-01 00:00:00
abstract:BACKGROUND:Positive end-expiratory pressure (PEEP) is widely used to improve oxygenation and prevent alveolar collapse in mechanically ventilated patients with the acute respiratory distress syndrome (ARDS). Although PEEP improves arterial oxygenation predictably, high-PEEP strategies have demonstrated equivocal improv...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aew314
更新日期:2016-11-01 00:00:00
abstract::We tested the hypothesis that premedication with i.m. midazolam decreases core temperature dose-dependently. We studied six male volunteers, in random order, on 3 days: (1) no midazolam administration (control day), (2) midazolam 0.025 mg kg-1 i.m., (3) midazolam 0.075 mg kg-1 i.m. On the first day, subjects were main...
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/78.4.396
更新日期:1997-04-01 00:00:00
abstract::Use of inhaled nitric oxide for treatment of pulmonary hypertension in adult critical illness is limited by its mode of delivery and high costs, prompting evaluation of alternative therapies. We report the use of oral sildenafil in a patient with severe secondary pulmonary hypertension and right ventricular dysfunctio...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aei114
更新日期:2005-06-01 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::We have evaluated the effect of delivering nitric oxide using a continuous flow system (CFS) or two commercially available proportional gas injection systems (PGIS), Nodomo (Dräger, Lübeck, Germany) and Pulmonox-Mini (Messer Griesheim Austria, Gumpoldskirchen, Austria) on measured and simulated concentrations of nitri...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/81.4.544
更新日期:1998-10-01 00:00:00
abstract::We describe three histaminoid reactions occurring on induction of anaesthesia. The patients were all resuscitated successfully and subsequent skin testing suggested sensitivity to rocuronium. In this hospital, the incidence of such reactions is of the order of 1 in 3000. This may be coincidental but suggests that ther...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/oxfordjournals.bja.a013365
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Near-infrared spectroscopy non-invasively measures regional cerebral oxygen saturation. Intraoperative cerebral desaturations have been associated with worse neurological outcomes. We investigated whether perioperative cerebral desaturations are associated with postoperative delirium in older patients after ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1016/j.bja.2019.09.042
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Early clot amplitudes measured on thromboelastometry (ROTEM®) predict maximum clot firmness (MCF) in adults. In this multicentre, retrospective study, we aimed to confirm the suspected relationship between early ROTEM® variables and MCF, in children undergoing cardiac or non-cardiac surgery. METHODS:4762 RO...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,多中心研究
doi:10.1093/bja/aev369
更新日期:2015-12-01 00:00:00
abstract::Robotic surgery pushes the frontiers of innovation in healthcare technology towards improved clinical outcomes. We discuss the evolution to five generations of robotic surgical platforms including stereotactic, endoscopic, bioinspired, microbots on the millimetre scale, and the future development of autonomous systems...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
doi:10.1093/bja/aex383
更新日期:2017-12-01 00:00:00
abstract::Six patients with airway stenosis were submitted to bronchoscopy under general anaesthesia. Each was ventilated with a gas mixture of 50% oxygen and nitrogen using successively manual jet insufflation (JV) using the Sanders technique at 20 b.p.m., and high frequency jet ventilation (HFJV) at rates of 150, 300 and 500 ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/55.10.969
更新日期:1983-10-01 00:00:00
abstract::Thirty hypertensive patients scheduled for cholecystectomy or hernia repair under general anaesthesia with thiopentone-fentanyl-nitrous oxide-pancuronium were divided into two groups of 15. One group received metoprolol tablets 200 mg in a slow release form, once daily for at least 2 weeks including the morning of sur...
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/58.3.251
更新日期:1986-03-01 00:00:00
abstract:BACKGROUND:In a prospective, randomized, double-blind, placebo-controlled trial, we investigated the effect of adding meperidine 10 mg to intrathecal bupivacaine on the duration of early postoperative analgesia in 40 patients having elective Caesarean section under spinal anaesthesia. METHODS:Patients received intrath...
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/88.3.379
更新日期:2002-03-01 00:00:00
abstract::A simple mathematical model of the chest wall was constructed so that during tidal breathing the relative volume contributions of the rib cage and abdomen/diaphragm could be measured in man, using four mercury-in-rubber strain gauges around the trunk. From the dimensions of the trunk and the change in circumference de...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/51.5.391
更新日期:1979-05-01 00:00:00
abstract::We studied cardiovascular and catecholamine responses for 3 days in three groups of patients undergoing abdominal hysterectomy. The night before surgery and again 2 h before induction of anaesthesia, patients received the ACE inhibitor, ramipril, the beta 1 blocker, metoprolol, or placebo. In the actively treated grou...
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/72.6.633
更新日期:1994-06-01 00:00:00
abstract:BACKGROUND:Patients undergoing non-cardiac, non-vascular surgery are at risk of major cardiovascular complications. In non-cardiac surgery, troponin elevation has previously been shown to be an independent predictor of major adverse cardiac events and postoperative mortality; however, a majority of studies have focused...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,meta分析,评审
doi:10.1093/bja/aew321
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:The pulmonary artery catheter is invasive and may cause serious complications. A safe method of cardiac output (CO) measurement is needed. We have assessed the accuracy and reliability of a recently marketed self-calibrating arterial pulse contour CO monitoring system (FloTrac/Vigileo) in end-stage liver fai...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aen343
更新日期:2009-01-01 00:00:00