Abstract:
BACKGROUND:The debate on lung-protective ventilation strategies for surgical patients is ongoing. Evidence suggests that the use of low tidal volume VT improves clinical outcomes. However, the optimal levels of PEEP and recruitment manoeuvre (RM) strategies incorporated into low VT ventilation remain unclear. METHODS:Several electronic databases were searched to identify RCTs that focused on comparison between low VT strategy and conventional mechanical ventilation (CMV), or between two different low VT strategies in surgical patients. The primary outcome was postoperative pulmonary complications (PPCs). The secondary outcomes were atelectasis, pneumonia, acute respiratory distress syndrome, and short-term mortality. Bayesian network meta-analyses were performed using WinBUGS. The odds ratios (ORs) and corresponding 95% credible intervals (CrIs) were estimated. RESULTS:Compared with CMV, low VT ventilation with moderate-to-high PEEP reduced the risk of PPCs (moderate PEEP [5-8 cm H2O]: OR 0.50 [95% CrI: 0.28, 0.89]; moderate PEEP+RMs: 0.39 [0.19, 0.78]; and high PEEP [≥9 cm H2O]+RMs: 0.34 [0.14, 0.79]). Low VT ventilation with moderate-to-high PEEP and RMs also specifically reduced the risk of atelectasis compared with CMV (moderate PEEP+RMs: OR 0.36 [95% CrI: 0.16, 0.87]; and high PEEP+RMs: 0.41 [0.15, 0.97]), whilst low VT ventilation with moderate PEEP was superior to CMV in reducing the risk of pneumonia (OR 0.46 [95% CrI: 0.15, 0.94]). CONCLUSIONS:The combination of low VT ventilation and moderate-to-high PEEP (≥5 cm H2O) seems to confer lung protection in surgical patients undergoing general anaesthesia. CLINICAL TRIAL REGISTRATION:PROSPERO (CRD42019144561).
journal_name
Br J Anaesthjournal_title
British journal of anaesthesiaauthors
Deng QW,Tan WC,Zhao BC,Wen SH,Shen JT,Xu Mdoi
10.1016/j.bja.2019.10.024subject
Has Abstractpub_date
2020-03-01 00:00:00pages
324-335issue
3eissn
0007-0912issn
1471-6771pii
S0007-0912(19)30967-5journal_volume
124pub_type
杂志文章,meta分析abstract:BACKGROUND:High-dose glucocorticoid may reduce postsurgical pain and improve recovery. We hypothesized that 125 mg methylprednisolone (MP) would reduce time to meet functional discharge criteria after total hip arthroplasty (THA). METHODS:Forty-eight patients undergoing unilateral THA under spinal anaesthesia were con...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aes345
更新日期:2013-01-01 00:00:00
abstract:Background:There is growing evidence that beta-blockade may reduce mortality in selected patients with sepsis. However, it is unclear if a pre-existing, chronic oral beta-blocker therapy should be continued or discontinued during the acute phase of severe sepsis and septic shock. Methods:The present secondary analysis...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aex231
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND:Prediction models to identify parturients who experience protracted pain, prolonged opioid use, and delayed self-assessed functional recovery are currently inadequate. METHODS:For this study, 213 nulliparous women who planned vaginal delivery were enrolled and assessed daily until they completed three outco...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1016/j.bja.2018.04.033
更新日期:2018-08-01 00:00:00
abstract::The performance of a fuzzy controller for atracurium-induced neuromuscular block was assessed. Ten ASA I or II patients undergoing surgery anticipated to last at least 120 min were studied. A Datex Relaxograph was used to monitor neuromuscular block. Initially the T1 set point was set at 10% of baseline for at least 3...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/76.3.396
更新日期:1996-03-01 00:00:00
abstract::Twenty consecutive patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) were allocated at random to group 1 (n = 10, high inspired oxygen fraction (FIO2) after CPB), or group 2 (n = 10, moderate FIO2 after CPB). The effects of each FIO2 on arterial and mixed venous concentrations of endothelin-1 (ET-1...
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/84.5.565
更新日期:2000-05-01 00:00:00
abstract::A total of 1442 patients who had major gynaecological surgery were recruited into three multicentre studies using a standard general anaesthetic technique in order to assess the efficacy of various doses of orally administered ondansetron in the prevention of postoperative nausea and vomiting. A total of 1257 patients...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,meta分析,多中心研究,随机对照试验
doi:10.1093/bja/71.4.517
更新日期:1993-10-01 00:00:00
abstract::One explanation for diminished opioid analgesic efficacy is opioid-induced hyperalgesia (OIH). We report a case of OIH in an infant with gastroschisis, requiring multiple surgical interventions and prolonged sedation for ventilation. This is the first report of OIH in an infant. On day 41 of life after nine separate s...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aer332
更新日期:2012-01-01 00:00:00
abstract::The Myotest is a new nerve stimulator which can give train-of-four, single twitch (1 and 10 s) and tetanic stimuli. Power is supplied by standard batteries, which allow 200 h effective use. The impulse is unipolar constant current, and the amplitude can be adjusted between 0 and 40 mA. These factors, plus the electron...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/52.5.547
更新日期:1980-05-01 00:00:00
abstract::In the dog, pancuronium 0.2 mg/kg increased left ventricular systolic pressure and systemic arterial pressure, but did not change central venous pressure. Repeated doses produced diminishing responses and eventually no change in arterial pressure. After tachyphylaxis was established, a pressor response to pancuronium ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/48.12.1143
更新日期:1976-12-01 00:00:00
abstract::Six male patients were studied on the morning following upper abdominal surgery for highly selective vagotomy. Nalbuphine hydrochloride was infused i.v. at different rates that increased progressively in each hour over a 4-h period. In the last 15 min of each hour, the plasma nalbuphine concentrations were almost stea...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/59.11.1356
更新日期:1987-11-01 00:00:00
abstract::The kinetics of morphine were studied during balanced anaesthesia in 10 patients undergoing lower abdominal or body surface surgery, and compared with those obtained in nine awake patients receiving morphine i.v. for the relief of chronic non-cancer pain. All patients received morphine sulfphate pentahydrate 10 mg i.v...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/62.1.22
更新日期:1989-01-01 00:00:00
abstract:BACKGROUND:Evidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes. METHODS:The International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) systematic review, including randomised controlled and ob...
journal_title:British journal of anaesthesia
pub_type: 共识发展会议,杂志文章,meta分析
doi:10.1016/j.bja.2019.05.042
更新日期:2019-09-01 00:00:00
abstract::We determined in 51 healthy patients undergoing body surface surgery the dose requirements for propofol, as part of a total i.v. anaesthesia technique with an alfentanil infusion. After premedication with temazepam, patients received alfentanil 50 micrograms kg-1 followed by an infusion of 50 micrograms kg-1 h-1. Pati...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章
doi:10.1093/bja/65.2.157
更新日期:1990-08-01 00:00:00
abstract::The insufflation of oxygen at 1 litre kg-1 min-1 via two endobronchial catheters (called continuous flow ventilation (CFV)) maintained a normal PaCO2 and a constant PaO2 in anaesthetized paralysed dogs and in five out of seven cats. In two cats with a high carbon dioxide production, CFV failed to maintain carbon dioxi...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/58.5.544
更新日期:1986-05-01 00:00:00
abstract:BACKGROUND:Descriptions of the pharmacokinetics and metabolism of morphine and its metabolites in young children are scant. Previous studies have not differentiated the effects of size from those related to age during infancy. METHODS:Postoperative children 0-3 yr old were given an intravenous loading dose of morphine...
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/aeh042
更新日期:2004-02-01 00:00:00
abstract::We have studied in eight rabbits the cardiovascular effects of midazolam, propofol and alfentanil with graded hypoxia. Central blood volume was reduced progressively by gradual inflation of a thoracic vena cava cuff so that cardiac index (CI) decreased at a constant rate. Under control conditions the haemodynamic resp...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/75.5.610
更新日期:1995-11-01 00:00:00
abstract::Cardiac rate and rhythm were compared in 60 patients having dental extractions under conventional general anaesthesia using halothane, enflurane or isoflurane to supplement nitrous oxide in oxygen. The incidence of arrhythmia was higher in the halothane group when compared with both the enflurane (P less than 0.05) an...
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/57.5.476
更新日期:1985-05-01 00:00:00
abstract:BACKGROUND:Emotional information has the ability to alter the formation and strength of a memory ('memory modulation'). Memory modulation by negative emotion is mediated by the amygdala. It is not known how gamma aminobutyric acid (GABA)ergic drugs affect the processes involved in memory modulation. This study investig...
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/aeh211
更新日期:2004-09-01 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::We have studied post-tetanic count (PTC) and single twitch height at the onset of reflex movement to carinal stimulation after administration of vecuronium with five different types of anaesthesia. Seventy-five adult patients were allocated randomly to five groups of 15 patients each, to receive one of the following a...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验,收录出版
doi:10.1093/bja/72.6.688
更新日期:1994-06-01 00:00:00
abstract::The protein binding of four non-depolarizing neuromuscular blocking drugs-tubocurarine, fazadinium, pancuronium and Org NC45-was measured, in serum from normal patients and from patients with cirrhosis of the liver, by an ultracentrifugation method. The fraction bound to serum protein in normal patients was 56% for tu...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/54.5.513
更新日期:1982-05-01 00:00:00
abstract::Moderate to severe arterial oxygen desaturation (SaO2 75-88%) occurred in three of four patients who were given sedation during regional conduction block without the administration of oxygen. No desaturation occurred in six patients given oxygen 2 litre min-1 via a nasal catheter during similar procedures. It is concl...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章
doi:10.1093/bja/62.2.206
更新日期:1989-02-01 00:00:00
abstract::One hundred and six former or current flexible trainees in anaesthesia responded to a questionnaire evaluating their part-time training (a response rate of 71%). They were compared with a group of 32 flexible trainees in obstetrics and gynaecology. Anaesthetists were more satisfied than obstetricians and gynaecologist...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/81.2.268
更新日期:1998-08-01 00:00:00
abstract::A high degree of safety from fires and explosions exists in operating theatres in the U.K. and this is reflected in the extremely low number of fatal and non-fatal accidents which occur. This has been achieved by safety precautions which in some respects have been over-careful and overexpensive. Antistatic precautions...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/50.7.659
更新日期:1978-07-01 00:00:00
abstract::The effect of the topical application of a lignocaine-prilocaine cream (EMLA) on the pain of venous cannulation was tested in a double-blind manner. Sixty boys and girls between the ages of 4 and 10 yr who were to undergo surgery participated in the study. No analgesic premedication was given and the venous cannulatio...
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/58.11.1242
更新日期:1986-11-01 00:00:00
abstract::As the route of breathing and use of airway apparatus such as mask, mouthpiece and noseclip can alter breathing pattern, this study has used the helium dilution method to estimate the effects of mouthpiece and mask breathing on functional residual capacity (FRC) in the supine position, and the change in FRC that occur...
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/76.4.560
更新日期:1996-04-01 00:00:00
abstract::Ketamine, as the sole anaesthetic agent, was assessed in a double-blind study of 135 female patients who underwent laparoscopic sterilization. The patients were allocated randomly to one of four groups according to the type (pentobarbitone or droperidol) and route (i.v. or i.m.) of premedication. In addition all the p...
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/49.11.1159
更新日期:1977-11-01 00:00:00
abstract::Five-year survival following cardiac transplantation approaches 50% and such patients occasionally present for non-cardiac surgery. The application of a simple general anaesthetic technique is described in a patient undergoing minor surgery, and the problems involved in managing heart transplant recipients are discuss...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/57.6.634
更新日期:1985-06-01 00:00:00
abstract:BACKGROUND:Restrictive transfusion triggers are safe for most critically ill patients, but doubts exist for patients with ischaemic heart disease (IHD). We investigated the prevalence of reported IHD at admission to the intensive care unit (ICU) and investigated how this influenced red cell transfusion triggers. We als...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,多中心研究
doi:10.1093/bja/aei073
更新日期:2005-04-01 00:00:00
abstract::In this study, we have compared two different doses of clonidine (bolus of 25 micrograms and infusion of 19 micrograms h-1; bolus of 50 micrograms and infusion of 37 micrograms h-1, both added to 0.03% bupivacaine) with a control group of 0.03% bupivacaine alone. The study was performed in a randomized, double-blind m...
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/83.2.257
更新日期:1999-08-01 00:00:00