Abstract:
INTRODUCTION:Compared with term neonates, preterm babies are more likely to die from sepsis. However, the combined effects of sepsis and prematurity on neonatal postoperative mortality are largely unknown. Our objective was to quantify the proportion of neonatal postoperative mortality that is attributable to the synergistic effects of preoperative sepsis and prematurity. METHODS:We performed a multicentre, propensity-score-weighted, retrospective, cohort study of neonates who underwent inpatient surgery across hospitals participating in the United States National Surgical Quality Improvement Program-Pediatric (2012-2017). We assessed the proportion of the observed hazard ratio of mortality and complications that is attributable to the synergistic effect of prematurity and sepsis by estimating the attributable proportion (AP) and its 95% confidence interval (CI). RESULTS:We identified 19 312 neonates who realised a total of 321 321 person-days of postsurgical observations, during which 683 died (mortality rate: 2.1 per 1000 person-days). The proportion of mortality risk that is attributable to the synergistic effect of prematurity and sepsis was 50.5% (AP=50.5%; 95% CI, 28.8-72.3%; P < 0.001). About half of mortality events among preterm neonates with sepsis occurred within 24 h after surgery. Just over 45% of postoperative complications were attributable to the synergistic effect of prematurity and sepsis when both conditions were present (AP=45.8; 95% CI, 13.4-78.1%; P<0.001). CONCLUSION:Approximately half of postsurgical mortality and complications were attributable to the combined effect of sepsis and prematurity among neonates with both exposures. These neonates typically died within a few days after surgery, indicating a very narrow window of opportunity to predict and prevent mortality. CLINICAL TRIAL NUMBER AND REGISTRY:Not applicable.
journal_name
Br J Anaesthjournal_title
British journal of anaesthesiaauthors
Mpody C,Shepherd EG,Thakkar RK,Dairo OO,Tobias JD,Nafiu OOdoi
10.1016/j.bja.2020.07.026subject
Has Abstractpub_date
2020-12-01 00:00:00pages
1056-1063issue
6eissn
0007-0912issn
1471-6771pii
S0007-0912(20)30616-4journal_volume
125pub_type
杂志文章,多中心研究abstract:BACKGROUND:Perioperative warming is recommended for surgery under anaesthesia, however its role during Caesarean delivery remains unclear. This meta-analysis aimed to determine the efficacy of active warming on outcomes after elective Caesarean delivery. METHODS:We searched databases for randomized controlled trials u...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,meta分析,评审
doi:10.1093/bja/aev325
更新日期:2015-10-01 00:00:00
abstract::All 484 candidates for the 1988 Fellowship in Anaesthesia (Part Three) were surveyed to investigate any differences between successful and unsuccessful candidates in study techniques, work and domestic factors, and examination history that might lead to better guidance to those preparing for the examination and an imp...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/64.6.752
更新日期:1990-06-01 00:00:00
abstract:BACKGROUND:The ProSeal laryngeal mask airway (PLMA) is a new laryngeal mask device with a modified cuff and a drainage tube. METHODS:We assessed the PLMA in 300 anaesthetized adults either paralysed or breathing spontaneously. We assessed insertion characteristics, airway seal pressures, haemodynamic response to inser...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/88.4.534
更新日期:2002-04-01 00:00:00
abstract::In vitro experiments on the rat phrenic nerve-hemidiaphragm preparation, stimulated directly or indirectly with supramaximal impulses at 0.1 Hz revealed that pethidine in concentrations greater than 5 micrograms ml-1 caused a rapid increase of the twitch. This was maximal (60% increase during direct and 70% increase d...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/56.2.195
更新日期:1984-02-01 00:00:00
abstract::As constant hypoxaemia itself may trigger development of apnoea and periodic breathing, we have studied the effect of oxygen therapy on the occurrence of late postoperative episodic hypoxaemia. Thirty-five patients without cardiopulmonary disease and undergoing elective total hip replacement were monitored with a puls...
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/68.1.18
更新日期:1992-01-01 00:00:00
abstract:BACKGROUND:The Alaris AEP monitor(TM) (Alaris, UK, version 1.4) is the first commercially available auditory evoked potential (AEP) monitor designed to estimate the depth of anaesthesia. It generates an "Alaris AEP index" (AAI), which is a dimensionless number scaled from 100 (awake) to 0. This study was designed to co...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeg189
更新日期:2003-09-01 00:00:00
abstract::We have measured plasma concentrations of bupivacaine after ilioinguinal block in children of different sizes. We studied 14 children with weights 10-15 kg and 17 children with weights 15-30 kg. Each child received 0.5% bupivacaine 0.25 ml kg-1 (1.25 mg kg-1) (Carbostesin, Astra, Germany). Venous blood was obtained be...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/76.3.452
更新日期:1996-03-01 00:00:00
abstract::Thirty patients for elective lower segment Caesarean section were randomly divided into two groups. One group received 50 mulitre/kg of Althesin for induction of anaesthesia and the other, 100 mulitre/kg. The two maternal groups were similar. There was no significant difference in the clinical or biochemical status of...
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/47.11.1213
更新日期:1975-11-01 00:00:00
abstract::Summary While complex physiological mechanisms exist to regulate and optimize tissue oxygenation under various conditions, clinical and experimental evidence indicates that anaemia, unchecked, is associated with organ injury and unfavourable outcomes. More data (especially from human studies) are needed to answer ques...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
doi:10.1093/bja/aer350
更新日期:2011-12-01 00:00:00
abstract::We have assessed neuromuscular block electromyographically at the gastrocnemius muscle and compared it with that at the abductor digiti minimi muscle in 60 adult patients undergoing cervical spine surgery under general anaesthesia. All patients were in the prone position. After vecuronium 0.2 mg kg-1, times to onset o...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,收录出版
doi:10.1093/bja/82.3.329
更新日期:1999-03-01 00:00:00
abstract::Changes in intragastric pressure after the administration of suxamethonium 1.5 mg kg-1 i.v. were studied in 32 children (mean age 6.9 yr) pretreated with either physiological saline or alfentanil 50 micrograms kg-1. Anaesthesia was induced with thiopentone 5 mg kg-1. The incidence and intensity of muscle fasciculation...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/60.2.176
更新日期:1988-02-01 00:00:00
abstract::Forty patients (age range 60-79 yr) undergoing transurethral surgery were allocated randomly to receive 0.5% plain bupivacaine 4 ml at the L2-3 (n = 20) or L4-5 (n = 20) space. The solution was injected over 30 s with the patient in the sitting position. The patient was kept sitting for 2 min, then placed supine and, ...
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/64.2.170
更新日期:1990-02-01 00:00:00
abstract:Background:Experimental studies suggest that mechanical cell washing to remove pro-inflammatory components that accumulate in the supernatant of stored donor red blood cells (RBCs) might reduce inflammation and organ injury in transfused patients. Methods:Cardiac surgery patients at increased risk of large-volume RBC ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1093/bja/aex083
更新日期:2017-05-01 00:00:00
abstract::Plain bupivacaine 0.5% or 0.75% was injected intrathecally in four groups of 10 patients. Group A received 0.75% bupivacaine 2.7 ml at L3/4, group B 0.5% bupivacaine 4 ml at L3/4, group C 0.75% bupivacaine 2.7 ml at L2/3 and group D 0.75% bupivacaine 2 ml at L3/4. A very wide range of height of block was found in each...
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/58.3.292
更新日期:1986-03-01 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::We describe the anaesthetic management of a patient who underwent transthoracic endoscopic vagotomy. One-lung ventilation was necessary to provide adequate surgical access. Potential intraoperative problems involved arterial oxygen saturation during one-lung ventilation, unequal intrathoracic pressures causing mediast...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/68.3.318
更新日期:1992-03-01 00:00:00
abstract:BACKGROUND:Clonidine is an alpha 2 adrenergic agonist with analgesic properties. This study aimed to see if the addition of clonidine to morphine when given by patient-controlled analgesia (PCA) would improve analgesia beyond the first 12 h after surgery. METHODS:Sixty patients undergoing lower abdominal surgery were ...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:2002-09-01 00:00:00
abstract::We have studied the tone of the lower oesophageal sphincter (LOS) in 40 adults undergoing routine body surface surgery and allocated randomly to receive anaesthesia either by face mask and Guedel airway or by laryngeal mask airway. In the laryngeal mask group there was a mean (SEM) decrease in barrier pressure (LOS mi...
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/69.4.346
更新日期:1992-10-01 00:00:00
abstract::The induction dose requirements of propofol were compared in three age groups in 300 unpremedicated healthy Chinese children: group A, younger than 2 yr (n = 48); group B, 2-5 yr (n = 117); group C, 6-12 yr (n = 135). Patients in each group were allocated randomly to receive one of eight doses of propofol (1.2, 1.4, 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/68.1.64
更新日期:1992-01-01 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:BACKGROUND:Intraneural injection of local anaesthetic agents carries a risk of neurological complications. Early detection of intraneural needle-tip position is very important in the initial phase of injection. Ultrasound (US) characteristics for real-time detection of intraneural injections have been described, but on...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aes208
更新日期:2012-09-01 00:00:00
abstract::One hundred and forty male rats received a cryoinjury to a segment of the exposed sciatic nerve. A variety of temperatures and freeze patterns was used and the recovery of function was monitored. Where obvious nerve freezing occurred, the cryoinjury caused complete loss of function in the limb. The return of motor act...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/53.11.1121
更新日期:1981-11-01 00:00:00
abstract:BACKGROUND:Chronic pain is no longer an effective warning system, but a syndrome with co-morbidities and many causes, needing a careful evaluation. Questions remain about the pain behaviour of chronic pain patients compared with patients with acute pain, or healthy subjects that we investigated. METHODS:We compared th...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章
doi:10.1016/j.bja.2018.04.042
更新日期:2018-09-01 00:00:00
abstract::Mean venous pressures were measured in 20 patients in whom a catheter, inserted via the external jugular vein, failed to pass centrally. The catheter used had a rounded end and two side holes. Pressures were measured with the patient's head in three different positions. The pressures were compared with the central ven...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/58.12.1384
更新日期:1986-12-01 00:00:00
abstract::In order to evaluate the use of the post-tetanic count (PTC) method during repetitive administration of vecuronium, we studied 20 patients allocated randomly to one of two groups: 10 patients received droperidol-fentanyl anaesthesia (control group); 10 other patients were given droperidol-fentanyl anaesthesia modified...
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/65.4.487
更新日期:1990-10-01 00:00:00
abstract:BACKGROUND:Ischaemia is one of the causative mechanisms of peripheral nerve injury, a documented complication of regional anaesthesia. Local anaesthetics per se and/or vasopressor adjuvants may account for changes in peripheral nerve blood flow. The aim of this study was to test the effects of levobupivacaine and ropiv...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aei242
更新日期:2005-11-01 00:00:00
abstract:BACKGROUND:The Laryngeal Tube (LT) performs similarly to the classic laryngeal mask airway during controlled ventilation but with an improved airway seal. We compared the laryngeal tube with the ProSeal laryngeal mask airway (PLMA) throughout anaesthesia. METHODS:Thirty-two patients were studied using a randomized cro...
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/aeg239
更新日期:2003-11-01 00:00:00
abstract:BACKGROUND:Low bispectral index values frequently reflect EEG suppression and have been associated with postoperative mortality. This study investigated whether intraoperative EEG suppression was an independent predictor of 90 day postoperative mortality and explored risk factors for EEG suppression. METHODS:This obse...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1093/bja/aeu105
更新日期:2014-12-01 00:00:00
abstract:BACKGROUND:Muscle relaxants facilitate tracheal intubation, but they are often not used for short peripheral surgical procedures. The consequences of this practice on the upper airway are still a matter of controversy. We therefore compared the incidence of post-intubation symptoms in a randomized study comparing patie...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aem147
更新日期:2007-08-01 00:00:00
abstract::We have studied the relationship between gas exchange and mechanical frequency response during high frequency jet ventilation (HFJV) at 0.5-5.0 Hz in anaesthetized pigs. The mechanical gain curve showed a minimal "anti-resonant" response at 0.8 Hz (f1) and a maximal "resonant" response at 5.0 Hz (f2). This finding may...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/64.4.453
更新日期:1990-04-01 00:00:00