57 results found
Baskozos G, Themistocleous AC, Hebert HL, et al., 2022, Classification of painful or painless diabetic peripheral neuropathy and identification of the most powerful predictors using machine learning models in large cross-sectional cohorts, BMC MEDICAL INFORMATICS AND DECISION MAKING, Vol: 22
Casely E, Laycock H, 2022, Opioids in pain medicine, Anaesthesia and Intensive Care Medicine, ISSN: 1472-0299
Opioids represent one of the most important classes of analgesic medication and are effective in acute and cancer pain management. Concerns exist regarding their utility in chronic non-cancer pain due to consequences of long-term use and lack of efficacy. Opioids bind to G protein-coupled receptors leading to a variety of physiological effects, including analgesia. Individual drug pharmacokinetics and pharmacodynamics, actions across different physiological systems, side-effect profiles, routes of administration and patient factors that impact on drug efficacy, all need to be considered when choosing the appropriate opioid and preparation for individual patients.
Agarwal S, El-Boghdadly K, Bailey CR, et al., 2022, Position statement from the Editors of Anaesthesia on equity, diversity and inclusion, Anaesthesia, ISSN: 0003-2409
There is a need to prioritise equity, diversity and inclusion within anaesthesia and medicine as a whole. This position statement outlines the Anaesthesia Editors' current policies and practices aiming to achieve equity, represent the diversity of our specialty and actively include people engaged with this journal and beyond. We will define, promote and embed principles of equity, diversity and inclusion across all our work. We will monitor and report author and editor characteristics and ensure recruitment practices are transparent and adhere to our principles on equity, diversity and inclusion. We will attempt to remove systemic barriers restricting those from under-represented groups from progressing into leadership roles within anaesthesia. We will respond to threats and barriers to the principles and practices we set. With these principles and specific actions we undertake, we aim to be pro-active rather than reactive. We commit to embracing and embedding equity, diversity and inclusion in all our practices and regularly reviewing, improving and updating our policies and practices.
Granovsky Y, Topaz LS, Laycock H, et al., 2021, Conditioned pain modulation is more efficient in painful than in non-painful diabetic polyneuropathy patients., Pain, Vol: 00, ISSN: 0304-3959
ABSTRACT: Endogenous pain modulation, as tested by the conditioned pain modulation (CPM) protocol, is typically less efficient in chronic pain patients compared to healthy controls. We aimed to assess whether CPM is less efficient in painful compared to non-painful diabetic polyneuropathy (DPN) patients. Characterization of the differences in central pain processing between these two groups might provide a central nervous system explanation to the presence or absence of pain in diabetic neuropathy in addition to the peripheral one.271 patients with DPN underwent CPM testing and clinical assessment, including quantitative sensory testing. Two modalities of the test stimuli (heat and pressure) conditioned to cold noxious water were assessed and compared between painful and non-painful DPN patients. No significant difference was found between the groups for pressure pain CPM, however painful DPN patients demonstrated unexpectedly more efficient CPMHEAT ( -7.4±1.0 vs. -2.3±1.6; p=0.008). Efficient CPMHEAT was associated with higher clinical pain experienced in the 24 hours prior to testing (r=-0.15; P=0.029) and greater loss of mechanical sensation (r=-0.135; P=0.042). Moreover, patients who had mechanical hypoesthesia demonstrated more efficient CPMHEAT (p=0.005). More efficient CPM among painful patients might result from central changes in pain modulation, but also from altered sensory messages coming from tested affected body sites. This calls for the use of intact sites for proper assessment of pain modulation in neuropathy patients.
Laycock HC, Harrop-Griffiths W, 2021, Assessing pain: how and why?, ANAESTHESIA, Vol: 76, Pages: 559-562, ISSN: 0003-2409
Laycock HC, Mullins E, 2021, The role of anaesthetists in women's health, Anaesthesia, Vol: 76, Pages: 3-5, ISSN: 0003-2409
Odor PM, Bampoe S, Lucas DN, et al., 2021, Incidence of accidental awareness during general anaesthesia in obstetrics: a multicentre, prospective cohort study, ANAESTHESIA, Vol: 76, Pages: 759-776, ISSN: 0003-2409
Odor PM, Bampoe S, Moonesinghe SR, et al., 2020, General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multicentre observational study, ANAESTHESIA, Vol: 76, Pages: 460-471, ISSN: 0003-2409
Small C, Laycock H, 2020, Are we near to making virtual reality the new reality in pain medicine?, ANAESTHESIA, Vol: 76, Pages: 590-593, ISSN: 0003-2409
Agarwal S, Laycock HC, 2020, The debate ROTEMs on - the utility of point-of-care testing and fibrinogen concentrate in postpartum haemorrhage, ANAESTHESIA, Vol: 75, Pages: 1247-1251, ISSN: 0003-2409
Casely EM, Laycock HC, 2020, Infusion Therapy for Pain, Headache and Related Conditions, ANESTHESIA AND ANALGESIA, Vol: 130, Pages: E167-E168, ISSN: 0003-2999
Odor PM, Bampoe S, Lucas DN, et al., 2020, Protocol for direct reporting of awareness in maternity patients (DREAMY): a prospective, multicentre cohort study of accidental awareness during general anaesthesia, INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA, Vol: 42, Pages: 47-56, ISSN: 0959-289X
Thomas SE, Laycock H, 2020, The use of high dose topical capsaicin in the management of peripheral neuropathy: narrative review and local experience, BRITISH JOURNAL OF PAIN, Vol: 14, Pages: 133-140, ISSN: 2049-4637
Friston D, Junttila S, Borges Paes Lemes J, et al., 2020, Leptin and fractalkine: novel subcutaneous cytokines in burn injury, Disease Models and Mechanisms, Vol: 13, ISSN: 1754-8403
Burn injury is a pathology underpinned by progressive and aberrant inflammation. It is a major clinical challenge to survival and quality of life. While burn injury’s complex local and disseminating pathological processes ultimately stem from local tissue damage, to date relatively few studies have attempted to characterise the local inflammatory mediator profile. Here, cytokine content and associated transcriptional changes were measured in rat skin for three hours immediately following induction of a scald-type (60oC, 2 minutes) burn injury model. Leptin (p = 0.0002) and fractalkine (p = 0.0478) concentrations were significantly elevated post-burn above pre-burn and control site values, coinciding with the development of burn site oedema and differential expression of leptin mRNA (p = 0.0004). Further, gene sequencing enrichment analysis indicated cytokine-cytokine receptor interaction (p = 1.45x10-6). Subsequent behavioural studies demonstrated that, following subcutaneous injection into the dorsum of the paw, both leptin and fractalkine induced mechanical allodynia, heat hyperalgesia and the recruitment of macrophages. This is the first report of leptin’s elevation specifically at the burn site and the first report of fractalkine’s elevation in any tissue post-burn which, together with the functional findings, calls for exploration of the influence of these cytokines on pain, inflammation and burn wound progression. Additionally targeting these signalling molecules represents a therapeutic potential as early formative mediators of these pathological processes.
Laycock H, Bailey CR, 2020, The influence of first author sex on acceptance rates of submissions to Anaesthesia Cases: a reply, ANAESTHESIA, Vol: 75, Pages: 420-420, ISSN: 0003-2409
Friston D, Junttila S, Lemes JBP, et al., 2020, Leptin and fractalkine: Novel subcutaneous cytokines in burn injury., Dis Model Mech
Burn injury is a pathology underpinned by progressive and aberrant inflammation. It is a major clinical challenge to survival and quality of life. While burn injury's complex local and disseminating pathological processes ultimately stem from local tissue damage, to date relatively few studies have attempted to characterise the local inflammatory mediator profile. Here, cytokine content and associated transcriptional changes were measured in rat skin for three hours immediately following induction of a scald-type (60°C, 2 minutes) burn injury model. Leptin (p=0.0002) and fractalkine (p=0.0478) concentrations were significantly elevated post-burn above pre-burn and control site values, coinciding with the development of burn site oedema and differential expression of leptin mRNA (p=0.0004). Further, gene sequencing enrichment analysis indicated cytokine-cytokine receptor interaction (p=1.45x10-6). Subsequent behavioural studies demonstrated that, following subcutaneous injection into the dorsum of the paw, both leptin and fractalkine induced mechanical allodynia, heat hyperalgesia and the recruitment of macrophages. This is the first report of leptin's elevation specifically at the burn site and the first report of fractalkine's elevation in any tissue post-burn which, together with the functional findings, calls for exploration of the influence of these cytokines on pain, inflammation and burn wound progression. Additionally targeting these signalling molecules represents a therapeutic potential as early formative mediators of these pathological processes.
Small C, Laycock H, 2020, Acute postoperative pain management, BRITISH JOURNAL OF SURGERY, Vol: 107, Pages: E70-E80, ISSN: 0007-1323
Brinkler R, Edwards Z, Abid S, et al., 2019, A survey of antenatal and peripartum provision of information on analgesia and anaesthesia, ANAESTHESIA, Vol: 74, Pages: 1101-1111, ISSN: 0003-2409
Laycock H, Bailey CR, 2019, The influence of first author sex on acceptance rates of submissions to Anaesthesia Cases, ANAESTHESIA, Vol: 74, Pages: 1432-1438, ISSN: 0003-2409
Laycock H, Bantel C, 2019, Opioid mechanisms and opioid drugs, ANAESTHESIA AND INTENSIVE CARE MEDICINE, Vol: 20, Pages: 450-455, ISSN: 1472-0299
Kemp HI, Laycock H, Costello A, et al., 2019, Chronic pain in critical care survivors: a narrative review, British Journal of Anaesthesia, Vol: 123, Pages: e372-e384, ISSN: 1471-6771
Chronic pain is an important problem after critical care admission. Estimates of the prevalence of chronic pain in the year after discharge range from 14% to 77% depending on the type of cohort, the tool used to measure pain, and the time point when pain was assessed. The majority of data available come from studies using health-related quality of life tools, although some have included pain-specific tools. Nociceptive, neuropathic, and nociplastic pain can occur in critical care survivors, but limited information about the aetiology, body site, and temporal trajectory of pain is currently available. Older age, pre-existing pain, and medical co-morbidity have been associated with pain after critical care admission. No trials were identified of interventions to target chronic pain in survivors specifically. Larger studies, using pain-specific tools, over an extended follow-up period are required to confirm the prevalence, identify risk factors, explore any association between acute and chronic pain in this setting, determine the underlying pathological mechanisms, and inform the development of future analgesic interventions.
Friston D, Laycock H, Nagy I, et al., 2019, Microdialysis workflow for metabotyping superficial pathologies: application to burn injury, Analytical Chemistry, Vol: 91, Pages: 6541-6548, ISSN: 0003-2700
Burn injury can be a devastating traumatic injury, with long-term personal and social implications for the patient. The many complex local and disseminating pathological processes underlying burn injury's clinical challenges are orchestrated from the site of injury and develop over time, yet few studies of the molecular basis of these mechanisms specifically explore the local signaling environment. Those that do are typically destructive in nature and preclude the collection of longitudinal temporal data. Burn injury therefore exemplifies a superficial temporally dynamic pathology for which experimental sampling typically prioritizes either specificity to the local burn site or continuous collection from circulation. Here, we present an exploratory approach to the targeted elucidation of complex, local, acutely temporally dynamic interstitia through its application to burn injury. Subcutaneous microdialysis is coupled with ultraperformance liquid chromatography-mass spectrometry (UPLC-MS) analysis, permitting the application of high-throughput metabolomic profiling to samples collected both continuously and specifically from the burn site. We demonstrate this workflow's high yield of burn-altered metabolites including the complete structural elucidation of niacinamide and uric acid, two compounds potentially involved in the pathology of burn injury. Further understanding the metabolic changes induced by burn injury will help to guide therapeutic intervention in the future. This approach is equally applicable to the analysis of other tissues and pathological conditions, so it may further improve our understanding of the metabolic changes underlying a wide variety of pathological processes.
Kemp H, Laycock H, Costello A, et al., 2019, Chronic pain in critical care survivors, BJA: British Journal of Anaesthesia, ISSN: 1471-6771
Chronic pain is an important problem following critical care admission. Estimates of prevalence of chronic pain in the year following discharge range from 14-77% depending on the type of cohort, the tool used to measure pain and the time point when pain was assessed. The majority of data available comefrom studies using health-related quality of life tools,although some have included pain-specific tools. Nociceptive, neuropathic and nociplastic pain can occur in critical caresurvivors butlimited information about aetiology, body site and temporal trajectory of pain is currently available. Older age, pre-existing pain andmedicalco-morbidity have been associated with pain after critical careadmission. No trials were identified of interventions to target chronic pain in survivors specifically. Larger studies, using pain-specific tools, over an extended follow up period are required to confirm prevalence, identify risk factors, explore anyassociation between acute and chronic pain in this setting, determine underlying pathological mechanisms and inform the development of future analgesic interventions.
Stamenkovic DM, Laycock H, Karanikolas M, et al., 2019, Chronic pain and chronic opioid use after intensive care discharge - Is it time to change practice?, Frontiers in Pharmacology, Vol: 10, ISSN: 1663-9812
Almost half of patients treated on intensive care unit (ICU) experience moderate to severe pain. Managing pain in the critically ill patient is challenging, as their pain is complex with multiple causes. Pharmacological treatment often focuses on opioids, and over a prolonged admission this can represent high cumulative doses which risk opioid dependence at discharge. Despite analgesia the incidence of chronic pain after treatment on ICU is high ranging from 33–73%. Measures need to be taken to prevent the transition from acute to chronic pain, whilst avoiding opioid overuse. This narrative review discusses preventive measures for the development of chronic pain in ICU patients. It considers a number of strategies that can be employed including non-opioid analgesics, regional analgesia, and non-pharmacological methods. We reason that individualized pain management plans should become the cornerstone for critically ill patients to facilitate physical and psychological well being after discharge from critical care and hospital.
Laycock H, Crawford V, Rice ASC, et al., 2019, Lessons learnt from establishing a high dose opioid review clinic for people living with HIV, Pain Management, Vol: 9, ISSN: 1758-1869
People living with HIV represent a unique aging population, living with a chronic condition associated with significant pain. A number take high dose, long-term opioids to manage moderate to severe chronic pain, presenting specific risks. This article highlights the size and impact of this problem and outlines the service objectives and set up of a specialist clinic to manage people living with HIV on high dose opioids, alongside its successes and learning points.
Watson X, Chereshneva M, Odor PM, et al., 2018, Adoption of lung protective ventilation IN patients undergoing emergency laparotomy: the ALPINE study. A prospective multicentre observational study, British Journal of Anaesthesia, Vol: 121, Pages: 909-917, ISSN: 0007-0912
BackgroundEmergency abdominal surgery is associated with a high risk of postoperative pulmonary complications (PPCs). The primary aim of this study was to determine whether patients undergoing emergency laparotomy are ventilated using a lung-protective ventilation strategy employing tidal volume ≤8 ml kg−1 ideal body weight−1, PEEP >5 cm H2O, and recruitment manoeuvres. The secondary aim was to investigate the association between ventilation factors (lung-protective ventilation strategy, intraoperative FiO2, and peak inspiratory pressure) and the occurrence of PPCs.MethodsData were collected prospectively in 28 hospitals across London as part of routine National Emergency Laparotomy Audit (NELA). Patients were followed for 7 days. Complications were defined according to the European Perioperative Clinical Outcome definition.ResultsData were collected from 568 patients. The median [inter-quartile range (IQR)] tidal volume observed was 500 ml (450–540 ml), corresponding to a median tidal volume of 8 ml kg−1 ideal body weight−1 (IQR: 7.2–9.1 ml). A lung-protective ventilation strategy was employed in 4.9% (28/568) of patients, and was not protective against the occurrence of PPCs in the multivariable analysis (hazard ratio=1.06; P=0.69). Peak inspiratory pressure of <30 cm H2O was protective against development of PPCs (hazard ratio=0.46; confidence interval: 0.30–0.72; P=0.001). Median FiO2 was 0.5 (IQR: 0.44–0.53), and an increase in FiO2 by 5% increased the risk of developing a PPC by 8% (2.6–14.1%; P=0.008).ConclusionsBoth intraoperative peak inspiratory pressure and FiO2 are independent factors significantly associated with development of a postoperative pulmonary complication in emergency laparotomy patients. Further studies are required to identify causality and to demonstrate if their manipulation could lead to better clinical outcomes.
Wong DJN, Harris SK, Moonesinghe SR, 2018, Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals, British Journal of Anaesthesia, Vol: 121, Pages: 730-738, ISSN: 0007-0912
Morkane CM, McKenna H, Cumpstey AF, et al., 2018, Intraoperative oxygenation in adult patients undergoing surgery (iOPS): a retrospective observational study across 29 UK hospitals, Perioperative Medicine, Vol: 7, ISSN: 2047-0525
BackgroundConsiderable controversy remains about how much oxygen patients should receive during surgery. The 2016 World Health Organization (WHO) guidelines recommend that intubated patients receive a fractional inspired oxygen concentration (FIO2) of 0.8 throughout abdominal surgery to reduce the risk of surgical site infection. However, this recommendation has been widely criticised by anaesthetists and evidence from other clinical contexts has suggested that giving a high concentration of oxygen might worsen patient outcomes. This retrospective multi-centre observational study aimed to ascertain intraoperative oxygen administration practice by anaesthetists across parts of the UK.MethodsPatients undergoing general anaesthesia with an arterial catheter in situ across hospitals affiliated with two anaesthetic trainee audit networks (PLAN, SPARC) were eligible for inclusion unless undergoing cardiopulmonary bypass. Demographic and intraoperative oxygenation data, haemoglobin saturation and positive end-expiratory pressure were retrieved from anaesthetic charts and arterial blood gases (ABGs) over five consecutive weekdays in April and May 2017.ResultsThree hundred seventy-eight patients from 29 hospitals were included. Median age was 66 years, 205 (54.2%) were male and median ASA grade was 3. One hundred eight (28.6%) were emergency cases. An anticipated difficult airway or raised BMI was documented preoperatively in 31 (8.2%) and 45 (11.9%) respectively. Respiratory or cardiac comorbidity was documented in 103 (27%) and 83 (22%) respectively. SpO2 < 96% was documented in 83 (22%) patients, with 7 (1.9%) patients desaturating < 88% at any point intraoperatively. The intraoperative FIO2 ranged from 0.25 to 1.0, and median PaO2/FIO2 ratios for the first four arterial blood gases taken in each case were 24.6/0.5, 23.4/0.49, 25.7/0.46 and 25.4/0.47 respectively.ConclusionsIntraoperative oxygenation currently varies widely. An intraoperative FIO2 of 0
Bantel C, Laycock HC, 2017, Between evidence and commerce - the case of sufentanil sublingual tablet systems, Anaesthesia, Vol: 73, Pages: 143-147, ISSN: 0003-2409
Kemp H, Bantel C, Gordon F, et al., 2017, Pain Assessment in INTensive care (PAINT): an observational study of physician-documented pain assessment in 45 intensive care units in the United Kingdom, Anaesthesia, Vol: 72, Pages: 737-748, ISSN: 1365-2044
Pain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environ-ment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTen-sive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect topublished guidelines. This observational service evaluation considered all pain and analgesia-related entries inpatients’records over a 24-h period, in 45 adult intensive care units (ICUs) in London and the South-East ofEngland. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two-thirds ofpatients (n=475, 64.5 95% CI 60.9–67.8%) received no physician-documented pain assessment during the 24-hstudy period. Just under one-third (n=215, 28.6 95% CI 25.5–32.0%) received no nursing-documented pain assess-ment, and over one-fifth (n=159, 21.2 95% CI 19.2–23.4)% received neither a doctor nor a nursing pain assessment.Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician painassessment was affected by the following factors: the number of nursing assessments performed; whether the patientwas admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU.Physician-documented pain assessments in the majority of participating ICUs were infrequent and did not utiliserecommended behavioural pain assessment tools. Further research to identify factors influencing physician painassessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed.
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