Journal of Clinical Anesthesia最新文献

{"title":"Functional MRI-based machine learning strategy for prediction of postoperative delirium in cardiac surgery patients: A secondary analysis of a prospective observational study","authors":"Mei-Yan Zhou ,&nbsp;Yi-Bing Shi ,&nbsp;Sheng-Jie Bai ,&nbsp;Yao Lu ,&nbsp;Yan Zhang ,&nbsp;Wei Zhang ,&nbsp;Wei Wang ,&nbsp;Yang-Zi Zhu ,&nbsp;Jun-Li Cao ,&nbsp;Li-Wei Wang","doi":"10.1016/j.jclinane.2025.111771","DOIUrl":"10.1016/j.jclinane.2025.111771","url":null,"abstract":"<div><h3>Study objective</h3><div>Delirium is a common complication after cardiac surgery and is associated with poor prognosis. An effective delirium prediction model could identify high-risk patients who might benefit from targeted prevention strategies. We introduce machine learning models that employ resting-state functional MRI datasets obtained before surgery to predict postoperative delirium.</div></div><div><h3>Design</h3><div>A secondary analysis of a prospective observational study.</div></div><div><h3>Setting</h3><div>The study was conducted at one tertiary hospital in China.</div></div><div><h3>Patients</h3><div>The study involved 103 patients who underwent preoperative functional MRI scan and cardiac valve replacement.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements</h3><div>Delirium was assessed twice daily for the first seven postoperative days using the Confusion Assessment Method. We used three whole-brain functional connectivity (FC) measures (parcel-wise connectivity matrix, mean FC and degree of FC) and trained three machine models, namely, random forest, logistic regression, and linear support vector machine, to distinguish delirium patients from patients without delirium. The top performing model was selected for further training with functional MRI datasets and clinical variables.</div></div><div><h3>Main results</h3><div>This study included 103 participants. A total of 29 participants (28.2 %) met postoperative delirium criteria. Based solely on functional MRI datasets, the random forest model trained using the degree of FC achieved the highest accuracy (0.864), precision (0.887), specificity (0.894), F1 score (0.859) and area under the curve (0.924), and this model was further optimized for accuracy (0.879), sensitivity (0.909), F1 score (0.882) and area under the curve (0.928) by fusing clinical variables. The most discriminative nodes for predicting postoperative delirium were located in the default, cingulo-opercular, and frontoparietal networks.</div></div><div><h3>Conclusions</h3><div>This study found that the random forest model using preoperative functional MRI data and clinical variables was accurate in identifying patients at high risk of developing delirium after cardiac surgery.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111771"},"PeriodicalIF":5.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative glucagon-like peptide-1 receptor agonist use and retained gastric contents: A retrospective analysis of patients undergoing elective upper endoscopy","authors":"Jacqueline A. Quinn M.D ,&nbsp;Kevin M. Welch M.D ,&nbsp;Erina Fujino B.S ,&nbsp;Carlos A. Jimenez Rosado M.D ,&nbsp;Xinming An Ph.D ,&nbsp;Jay W. Schoenherr M.D ,&nbsp;Lindsey N. Gouker M.D., M.H.A","doi":"10.1016/j.jclinane.2025.111776","DOIUrl":"10.1016/j.jclinane.2025.111776","url":null,"abstract":"<div><h3>Introduction</h3><div>Glucagon-like peptide-1 receptor (GLP-1R) agonists have been increasingly prescribed for weight loss and glycemic control. The potential side effect of slowed gastric emptying may increase risk of regurgitation and aspiration. Our primary aim was to investigate the incidence of retained gastric contents (RGCs) among appropriately fasted patients taking a GLP-1R agonist compared to those not taking a GLP-1R agonist presenting for upper gastrointestinal endoscopy (UE).</div></div><div><h3>Methods</h3><div>A retrospective chart review of patients undergoing UE was conducted. For the GLP-1R group, included were patients aged 18 years or older who had documentation of taking a GLP-1R agonist within 30 days prior to the procedure, adhered to standard fasting guidelines, and had clear documentation in the electronic medical record of gastric findings during endoscopy. This group was compared to a group of agematched controls. The primary outcome was the incidence of RGCs. Secondary outcome included a propensity-weighted analysis of the odds ratio of taking a GLP-1R and having RGCs.</div></div><div><h3>Results</h3><div>Included were 940 patients who presented for UE between July 2022 and December 2023 (470 GLP-1R and 470 controls). RGCs were found in 59/470 (12.6 %) of GLP-1R patients compared to 26/470 (5.5 %) of controls (<em>P</em> &lt; 0.001). Propensity-weighted analysis found a significant association between the use of GLP-1R and retained gastric contents [OR = 1.92, 95 % CI (1.04, 3.53)].</div></div><div><h3>Conclusions</h3><div>A higher incidence of RGCs was found in appropriately fasted patients on a GLP-1R agonist who presented for UE. After controlling for the differences between the two study groups, RGC's were correlated to GLP-1R agonist use. Anesthesiologists should remain vigilant regarding a potential increased risk of RGCs in appropriately fasted patients taking a GLP-1R agonist who present for surgery.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111776"},"PeriodicalIF":5.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional lung ventilation during supraglottic and subglottic jet ventilation: A randomized cross-over trial","authors":"Marita Windpassinger MD ,&nbsp;Michal Prusak MD ,&nbsp;Jana Gemeiner MD ,&nbsp;Maximilian Edlinger-Stanger MD ,&nbsp;Imme Roesner MD ,&nbsp;Doris-Maria Denk-Linnert MD ,&nbsp;Olga Plattner MD ,&nbsp;Ahmed Khattab MSc ,&nbsp;Eugenijus Kaniusas Dr. DI ,&nbsp;Lu Wang MS ,&nbsp;Daniel I. Sessler MD","doi":"10.1016/j.jclinane.2025.111773","DOIUrl":"10.1016/j.jclinane.2025.111773","url":null,"abstract":"<div><h3>Objective</h3><div>Test the hypothesis that the center of ventilation, a measure of ventro-dorsal atelectasis, is posterior during supraglottic ventilation indicating better dependent-lung ventilation. Secondarily, we tested the hypothesis that supraglottic ventilation improves oxygenation and carbon dioxide elimination.</div></div><div><h3>Background</h3><div>Supraglottic and subglottic jet ventilation are both used during laryngotracheal surgery. Supraglottic jet ventilation may better prevent atelectasis and provide superior ventilation.</div></div><div><h3>Design</h3><div>Randomized, cross-over trial.</div></div><div><h3>Setting</h3><div>Operating rooms.</div></div><div><h3>Patients</h3><div>Patients having elective micro-laryngotracheal surgery.</div></div><div><h3>Interventions</h3><div>Patients were sequentially ventilated for 5 min with one randomly selected type of jet ventilation before being switched to the alternative method.</div></div><div><h3>Measurements</h3><div>Regional ventilation distribution was estimated using electrical impedance tomography, with arterial oxygenation and carbon dioxide partial pressures being simultaneously evaluated.</div></div><div><h3>Results</h3><div>Thirty patients completed the study. There were no statistically significant or clinically meaningful differences in the center of ventilation with supraglottic and subglottic ventilation. However, ventilation with the supraglottic approach was about 4 % higher in the ventromedial lung region and about 4 % lower in the dorsal lung. Surprisingly, arterial blood oxygenation was considerably worse with supraglottic (173 [156, 199] mmHg) than subglottic ventilation (293 [244, 340] mmHg). Arterial carbon dioxide partial pressure was near 40 mmHg with each approach, although slightly lower with supraglottic jet ventilation.</div></div><div><h3>Conclusion</h3><div>The center of ventilation distribution, a measure of atelectasis, was similar with supraglottic and subglottic jet ventilation. Subglottic jet ventilation improved the dorsal-dependent lung region and provided superior arterial oxygenation. Both techniques effectively eliminated carbon dioxide, with the supraglottic approach demonstrating slightly superior efficacy.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111773"},"PeriodicalIF":5.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143376937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of Neurokinin-1 receptor antagonists on postoperative pain: A meta-analysis of randomized controlled trials","authors":"Filippo D'Amico MD ,&nbsp;Eoin Kelleher MD ,&nbsp;Jacopo D'Andria Ursoleo MD ,&nbsp;Andrey G. Yavorovskiy MD ,&nbsp;Stefano Turi MD ,&nbsp;Sara Zaffaroni MD ,&nbsp;Viviana Teresa Agosta MD ,&nbsp;Silvia Ajello MD ,&nbsp;Giovanni Landoni MD","doi":"10.1016/j.jclinane.2025.111772","DOIUrl":"10.1016/j.jclinane.2025.111772","url":null,"abstract":"<div><h3>Study objective</h3><div>Substance P is a neuropeptide with a pivotal role in pain transmission and modulation. Preclinical studies suggest that targeting substance P and inhibiting its receptor, neurokinin 1 (NK−1), is a potential avenue for pain relief. When translated into clinical settings, these preliminary findings yielded mixed results. This meta-analysis of randomized controlled trials (RCTs) aims to investigate whether a preemptive administration of NK-1 antagonists may reduce postoperative pain.</div></div><div><h3>Design</h3><div>We searched PubMed, Cochrane and EMBASE from inception to January 3, 2025, for studies comparing NK-1 antagonists versus placebo or standard care that reported data on postoperative pain. The primary outcome was pain at two hours after surgery measured through a 0–10 numeric scale. Secondary outcomes were postoperative pain at 24 and at 48 h and postoperative morphine equivalent consumption.</div></div><div><h3>Setting</h3><div>Hospitals.</div></div><div><h3>Main results</h3><div>The search strategies identified 13 RCTs with a total of 1959 patients. All studies reported a single preoperative administration of NK-1 antagonists. NK-1 antagonists reduced postoperative pain two hours (<em>n</em> = 8; MD -0.62; 95 % CI: −0.91, −0.32; <em>P</em> &lt; 0.001; I2 = 0 %) and at 24 h (<em>n</em> = 9; MD -0.65; 95 % CI: −1.22, −0.09; <em>P</em> = 0.02; I2 = 86 %) but not 48 h after surgery. Morphine equivalent consumption was similar in the two groups.</div></div><div><h3>Conclusions</h3><div>Preoperative single-administration of NK-1 antagonists reduces postoperative pain. The observed pain reduction pattern is consistent with the pharmacokinetics (half-life 9–12 h) of these inhibitors and with data from preclinical studies.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111772"},"PeriodicalIF":5.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National practice patterns for the use of regional anesthesia for pediatric cardiac surgery: An analysis of the Society of Thoracic Surgeons congenital heart surgery database","authors":"Lisa M. Einhorn ,&nbsp;Benjamin Y. Andrew ,&nbsp;Kevin D. Hill ,&nbsp;Levi N. Bonnell ,&nbsp;Robert H. Habib ,&nbsp;Marshall L. Jacobs ,&nbsp;Jeffrey P. Jacobs ,&nbsp;David F. Vener ,&nbsp;Warwick A. Ames","doi":"10.1016/j.jclinane.2025.111774","DOIUrl":"10.1016/j.jclinane.2025.111774","url":null,"abstract":"<div><h3>Background</h3><div>Complications associated with suboptimal pain management after pediatric cardiac surgery have increased interest in regional anesthesia (RA). We sought to evaluate national trends and explore the association of RA with postoperative outcomes following pediatric cardiac surgery.</div></div><div><h3>Methods</h3><div>Patients &lt;18 years in the Society of Thoracic Surgeons Congenital Cardiac Anesthesia Society Database from 01/2016–05/2023 were analyzed. Non-OR operations and records with missing data on RA were excluded. Data on patients, centers, operations, year, and RA type and medication were collected, and trends over the 8-year study period were analyzed. The association of RA with outcomes was analyzed with multivariable modeling in a subpopulation of children without preoperative risk factors who underwent index atrial and ventricular septal defect (ASD/VSD) repairs and Fontan procedures.</div></div><div><h3>Results</h3><div>The cohort included 95,514 operations from 62 U.S. centers. RA was used in 8.4 % (<em>N</em> = 7997) and increased annually from 6.1 % in 2016 to 12.5 % in 2023. Prevalence was highest in cases performed in children 1–11 years, characterized as low risk, and conducted low volume centers. There were statistically significant increases (<em>p</em> &lt; 0.001) in RA use across all age groups and surgical risk categories during the study period. While the number of neuraxial techniques remained constant year-to-year, the number of non-neuraxial techniques (i.e., fascial plane blocks) increased sixfold during the study period. In the sub-analysis cohort (<em>N</em> = 7931), patients with RA for septal defect repairs and Fontan procedures were more likely to be extubated in the OR compared to non-RA patients (<em>p</em> &lt; 0.001). ASD and VSD patients with RA were also more likely to have a short length of stay compared to those without RA (p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>RA use is increasing in pediatric cardiac surgery in the U.S. and may be associated with surgery-specific outcome improvements.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111774"},"PeriodicalIF":5.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesia-induced electroencephalogram oscillations and perioperative outcomes in older adults undergoing cardiac surgery","authors":"Isaac G. Freedman ,&nbsp;Gonzalo Boncompte ,&nbsp;Jason Z. Qu ,&nbsp;Zain Q. Khawaja ,&nbsp;Isabella Turco ,&nbsp;Ariel Mueller ,&nbsp;Kwame Wiredu ,&nbsp;Tina B. McKay ,&nbsp;M. Brandon Westover ,&nbsp;Juan C. Pedemonte ,&nbsp;Oluwaseun Akeju","doi":"10.1016/j.jclinane.2025.111770","DOIUrl":"10.1016/j.jclinane.2025.111770","url":null,"abstract":"<div><h3>Background</h3><div>Electroencephalogram oscillations during general anesthesia may change as a function of cognitive and physical health. This study aimed to characterize associations between anesthesia-induced oscillations and postoperative outcomes in cardiac surgery patients over 60 years.</div></div><div><h3>Methods</h3><div>This was a prespecified secondary data analysis from the Minimizing Intensive Care Unit Dysfunction with Dexmedetomidine-induced Sleep (MINDDS) study. Participants were admitted from home for elective cardiac surgery with cardiopulmonary bypass. The primary outcome was postoperative delirium obtained using the Confusion Assessment Method. Secondary outcomes were non-home discharge and 30-day readmission. The exposure of interest was alpha power measured during the maintenance phase of isoflurane-general anesthesia. Confounding cognitive and physical health variables were collected.</div></div><div><h3>Results</h3><div>Of 394 participants in the MINDDS study, 302 had analyzable electroencephalograms. The incidence of postoperative delirium was 11.1 %. Odds of postoperative delirium decreased by 14 % for every decibel increase in alpha power (OR 0.86, 95 % CI: 0.78 to 0.95; <em>P</em> = 0.004). This finding was not significant in adjusted analysis (OR_adj 0.92, 95 % CI: 0.81 to 1.03; <em>P</em> = 0.154). Non-home discharge setting findings were not associated with alpha power. The odds of 30-day readmission decreased by 20 % for every decibel increase in alpha power (OR_adj 0.80, 95 % CI: 0.71 to 0.91; <em>P</em> &lt; 0.001). Findings were conserved in exploratory and sensitivity analyses.</div></div><div><h3>Conclusions</h3><div>In this study anesthesia-induced oscillations were associated with postoperative outcomes; however, these were not independently associated with delirium or discharge disposition after considering preoperative cognitive and physical health. These oscillations were robustly associated with 30-day readmission however, which may help anesthesiologists identify high-risk patients, offering benefits beyond the operating room.</div><div><strong>Clinical trial registration:</strong> Registration Number: <span><span>NCT02856594</span><svg><path></path></svg></span></div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111770"},"PeriodicalIF":5.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the letter regarding manuscript “Aspirin is associated with improved outcomes in patients with sepsis-induced myocardial injury: An analysis of the MIMIC-IV database”","authors":"Yiming Dong ,&nbsp;Shujian Wei","doi":"10.1016/j.jclinane.2025.111769","DOIUrl":"10.1016/j.jclinane.2025.111769","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111769"},"PeriodicalIF":5.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143093866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New postoperative atrial fibrillation after in OR extubation after cardiac surgery – A response to a letter to the editor","authors":"Ragini G. Gupta,&nbsp;Jennie Y. Ngai","doi":"10.1016/j.jclinane.2024.111716","DOIUrl":"10.1016/j.jclinane.2024.111716","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111716"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing neuromuscular block monitoring and reversal: A large-scale quality improvement initiative in a diverse healthcare setting","authors":"Pavel Goriacko ,&nbsp;Jerry Chao ,&nbsp;Philipp Fassbender ,&nbsp;Maíra I. Rudolph ,&nbsp;Paul Beechner ,&nbsp;Harshal Shukla ,&nbsp;Vicken Yaghdjian ,&nbsp;Curtis Choice ,&nbsp;Frank Aroh ,&nbsp;Mark Sinnett ,&nbsp;Ibraheem M. Karaye ,&nbsp;Matthias Eikermann","doi":"10.1016/j.jclinane.2024.111709","DOIUrl":"10.1016/j.jclinane.2024.111709","url":null,"abstract":"<div><h3>Background</h3><div>Residual neuromuscular block (NMB) after anesthesia poses significant risk to patients, which can be reduced by adhering to evidence-based practices for the dosing, monitoring, and reversal of NMB. Incorporation of best practices into routine clinical care remains uneven across providers and institutions, prompting the need for effective implementation strategies.</div></div><div><h3>Methods</h3><div>An interdisciplinary quality improvement initiative aimed to optimize NMB reversal practices across a large multi-campus urban medical center. Using the Institute for Healthcare Improvement (IHI) framework, interventions were designed to increase Train-of-Four (TOF) monitoring and promote evidence-based and cost-effective use of the NMB reversal agents. Process and outcome measures were tracked through Plan-Do-Study-Act (PDSA) cycles. Qualitative interviews provided insights into clinician perspectives.</div></div><div><h3>Results</h3><div>The study encompassed 35,198 surgical cases utilizing NMB agents. The interventions led to a sustained increase in TOF monitoring from 42 % to 83 %. Significant increases were also observed in TOF ratio documentation and utilization of sugammadex. Postoperative respiratory complication rates decreased by 41 % (RR 0.59, 95 % CI 0.32–0.96) over the course of the initiative. The most pronounced increases in TOF monitoring were associated with financial incentives for the achievement of department-wide target monitoring rate.</div></div><div><h3>Conclusion</h3><div>This initiative demonstrates successful large-scale integration of quantitative TOF monitoring and evidence based NMB management across a diverse medical center, while highlighting important barriers in implementation. These findings contribute to the broader discussion on translating evidence into practice, offering insights for improving patient care and safety through tailored implementation strategies.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111709"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proposing Bromo-epi-androsterone (BEA) for perioperative neurocognitive disorders with Interleukin-6 as a druggable target","authors":"Coad Thomas Dow ,&nbsp;Zade Kidess","doi":"10.1016/j.jclinane.2024.111736","DOIUrl":"10.1016/j.jclinane.2024.111736","url":null,"abstract":"<div><div>Cognitive impairment following surgery is a significant complication, affecting multiple neurocognitive domains. The term “perioperative neurocognitive disorders” (PND) is recommended to encompass this entity. Individuals who develop PND are typically older and have increases in serum and brain pro-inflammatory cytokines notwithstanding the type of surgery undergone. Surgical trauma induces production of small biomolecules, damage-associated molecular patterns (DAMP), particularly the DAMP known as high molecular group box 1 protein (HMGB1). Mechanistically, peripheral surgical trauma promotes pro-inflammatory cytokines that stimulate central nervous system (CNS) inflammation by disrupting the blood-brain barrier (BBB) causing functional neuronal disruption that leads to PND. PND is strongly linked to elevations in serum and CNS pro-inflammatory cytokines interleukin-1 beta (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFα); these cytokines cause further release of HMGB1 creating a positive feedback loop that amplifies the inflammatory response. The cytokine IL-6 is necessary and sufficient for PND. Dehydroepiandrosterone (DHEA) is a principal component of the steroid metabolome and is involved in immune homeostasis. DHEA has been shown to suppress expression of several pro-inflammatory cytokines by regulation of the NF-kB pathway. Bromo-epi-androsterone (BEA) is a potent synthetic analog of DHEA; unlike DHEA, it is non-androgenic, non-anabolic and is an effective modulator of immune dysregulation. In a randomized, placebo-controlled clinical trial, BEA effected significant and sustained decreases in IL-1β, TNFα and IL-6. This article presents BEA as a potential candidate for clinical trials targeting PND and further suggests the use of BEA in elective total hip arthroplasty as a well-documented surgical entity relevant to the management of PND.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111736"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}