British journal of anaesthesia
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Editorial Comment
The 'long shadow' of perioperative complications: association with increased risk of death up to 1 year after surgery.
Thirty-day mortality is widely used in medical and surgical outcomes research as a quality indicator, and as an endpoint in perioperative clinical trials. However, the validity of this metric has recently been questioned. In this issue of the British Journal of Anaesthesia, Fowler and colleagues quantify, update, and put into perspective the looming suspicion that perioperative adverse events cast a 'long shadow' of increased mortality, far beyond the 30-day time frame. Their work not only raises important questions on how we should think about, analyse, and report 'perioperative' complications and mortality, but also stresses anaesthesiologist and surgeon roles as key stakeholders in patient long-term survival.
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Hypoxaemia during general anaesthesia can cause harm. Apnoeic oxygenation extends safe apnoea time, reducing risk during airway management. We hypothesised that low-flow nasal oxygenation (LFNO) would extend safe apnoea time similarly to high-flow nasal oxygenation (HFNO), whilst allowing face-mask preoxygenation and rescue. ⋯ There is likely to be clinical benefit to using LFNO, given that LFNO and HFNO extend safe apnoea time similarly, particularly when BMI ≥40 kg m-2. Additional benefits to LFNO include the facilitation of rescue face-mask ventilation and ability to monitor FE'O2 during preoxygenation.
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General anaesthesia in the neonatal period has detrimental effects on the developing mammalian brain. The impact of underlying inflammation on anaesthesia-induced developmental neurotoxicity remains largely unknown. ⋯ Systemic inflammation promotes developmental neurotoxicity by worsening anaesthesia-induced neuronal damage with sex-specific behavioural outcomes. This highlights the importance of studying anaesthesia-induced neurotoxicity in more clinically relevant settings.