Best Practice & Research-Clinical Anaesthesiology最新文献_第8页

Neuroprotective strategies in anesthesia-induced neurotoxicity 麻醉诱导神经毒性的神经保护策略

IF 4.8 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-03-01 DOI: 10.1016/j.bpa.2022.11.005

Dean B. Andropoulos (M.D., M.H.C.M., Anesthesiologist in Chief and Chair, Texas Children's Hospital Department of Anesthesiology, Perioperative and Pain Medicine, Professor of Anesthesiology and Pediatrics, Baylor College of Medicine, Houstson, Texas, U.S.A)

{"title":"Neuroprotective strategies in anesthesia-induced neurotoxicity","authors":"Dean B. Andropoulos (M.D., M.H.C.M., Anesthesiologist in Chief and Chair, Texas Children's Hospital Department of Anesthesiology, Perioperative and Pain Medicine, Professor of Anesthesiology and Pediatrics, Baylor College of Medicine, Houstson, Texas, U.S.A)","doi":"10.1016/j.bpa.2022.11.005","DOIUrl":"10.1016/j.bpa.2022.11.005","url":null,"abstract":"<div><p><span>Over the past 20 years, hundreds of preclinical studies of the developing central nervous system have been published concluding that the common γ-aminobutryic acid and N-methyl-</span><span>d</span><span><span>-aspartate binding anesthetic agents cause neuroapoptosis<span> and other forms of neurodegeneration<span>. Some clinical studies, including controlled trials, both prospective and ambidirectional in design, indicate an association between any exposure (single or multiple) to anesthesia and surgery at a young age, generally less than 3–4 years, and later behavioral and neurodevelopmental problems. A consideration of neuroprotective strategies is important, as scientists and clinicians alike ponder methods to potentially improve the neurodevelopmental outcomes of the millions of infants and children who undergo surgery and anesthesia annually around the world. This review will address plausible neuroprotective strategies and include alternative anesthetics, neuroprotective nonanesthetic </span></span></span>drugs<span>, and physiologic neuroprotection.</span></span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 1","pages":"Pages 52-62"},"PeriodicalIF":4.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9629297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Neuraxial analgesia in labour and the foetus 分娩和胎儿的神经轴镇痛

IF 4.8 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-03-01 DOI: 10.1016/j.bpa.2023.02.005

R.J. Kearns Dr , D.N. Lucas Professor

{"title":"Neuraxial analgesia in labour and the foetus","authors":"R.J. Kearns Dr , D.N. Lucas Professor","doi":"10.1016/j.bpa.2023.02.005","DOIUrl":"10.1016/j.bpa.2023.02.005","url":null,"abstract":"<div><p>Providing pain relief during labour is a fundamental human right and can benefit both mother and foetus. Epidural analgesia remains the ‘gold standard’, providing excellent pain relief, as well as the facility to convert to anaesthesia should operative intervention be required. While maternal well-being remains the primary focus, epidural analgesia may also have implications for the foetus. Data from meta-analyses finds that epidural compared with systemic opioids in labour is associated with reduced neonatal respiratory depression. Clinically relevant neonatal outcomes such as Apgar score <7 at 5 min, neonatal resuscitation and need for admission to a neonatal unit are reassuring, with the benefits of epidural analgesia for both mother and neonate outweighing any potential risks. Recent concerns regarding an association of epidural with the development of autism spectrum disorder in childhood appear to be unfounded, with several large observational studies refuting this association. This review discusses the evidence relating to maternal neuraxial analgesia in labour, implications for the foetus <em>in utero</em>, and childhood outcomes both in the immediate peripartum period and longer term.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 1","pages":"Pages 73-86"},"PeriodicalIF":4.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9614009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical investigations on anesthesia-induced developmental neurotoxicity: The knowns, the unknowns and future prospects 麻醉诱导的发育性神经毒性的临床研究：已知、未知和未来展望

IF 4.8 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-03-01 DOI: 10.1016/j.bpa.2023.02.004

Laszlo Vutskits MD, PhD (Professor, Head of Paediatric Anaesthesia) , Andrew Davidson MBBS, MD, FANZCA, FAHMS (Professor, Consultant Anaesthetist, Head of Trial Center)

引用次数: 0

Neurodevelopmental effects of anesthesia on the unborn and the young: Do we still have to worry? 麻醉对未出生和年轻人的神经发育影响：我们还需要担心吗？

IF 4.8 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-03-01 DOI: 10.1016/j.bpa.2023.04.009

Sarah Devroe (Associate Professor of Anaesthesiology), Arvind Palanisamy (Associate Professor of Anesthesiology, Associate Professor of Obstetrics and Gynecology, Division Chief, Obstetric Anesthesiology)

引用次数: 0

Practical and societal implications of the potential anesthesia-induced neurotoxicity: The safetots perspective 潜在麻醉诱导的神经毒性的实际和社会影响：安全专家的观点

IF 4.8 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-03-01 DOI: 10.1016/j.bpa.2023.04.005

Karin Becke-Jakob MD (Head of Department of Anesthesiology, Paediatric Anaesthesiology and Intensive Care) , Nicola Disma MD (Senior Consultant Pediatric Anesthetist, Associate Professor, Department of Anaesthesia, Unit for Research in Anaesthesia) , Tom Giedsing Hansen MD, PhD (Senior Consultant Paediatric Anaesthesiologist and Professor, Department of Anaesthesiology and Intensive Care)

{"title":"Practical and societal implications of the potential anesthesia-induced neurotoxicity: The safetots perspective","authors":"Karin Becke-Jakob MD (Head of Department of Anesthesiology, Paediatric Anaesthesiology and Intensive Care) , Nicola Disma MD (Senior Consultant Pediatric Anesthetist, Associate Professor, Department of Anaesthesia, Unit for Research in Anaesthesia) , Tom Giedsing Hansen MD, PhD (Senior Consultant Paediatric Anaesthesiologist and Professor, Department of Anaesthesiology and Intensive Care)","doi":"10.1016/j.bpa.2023.04.005","DOIUrl":"10.1016/j.bpa.2023.04.005","url":null,"abstract":"<div><p><span><span><span>Key elements for safe and high-quality care in pediatric anesthesia<span> are personal and institutional competence, perioperative maintenance of physiological homeostasis, prevention, prompt recognition, and appropriate </span></span>treatment of critical situations as well as the </span>reassurance of the parents and respecting the children's rights. Training in pediatric anesthesia should take place within the framework of harmonized curricular structures. International quality assessment and improvement projects should be encouraged and supported by collaborations. Healthy communication and providing information in a balanced way to the public and all stakeholders is an important task for pediatric anesthesia societies and individuals. The </span><span>Safetots.org</span><svg><path></path></svg><span> initiative was established to emphasize the role of the conduct of anesthesia to prevent harm, promote quality in the perioperative period, and provide safe and high-quality clinical care. This initiative considers that the prevention of complications and other well-known risk factors of perioperative care, as well as the quality of anesthesia management, have a far more important impact on outcomes following anesthesia and surgery than anesthetic drugs themselves.</span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 1","pages":"Pages 63-72"},"PeriodicalIF":4.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9614020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Controversies in anesthesia-induced developmental neurotoxicity 麻醉诱导发育神经毒性的争议

IF 4.8 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-03-01 DOI: 10.1016/j.bpa.2023.03.004

Nemanja Useinovic (Postdoctoral Fellow) , Vesna Jevtovic-Todorovic (Professor and Chair)

引用次数: 3

Preclinical evidence for anaesthesia-induced neurotoxicity 麻醉引起的神经毒性的临床前证据

IF 4.8 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2023-03-01 DOI: 10.1016/j.bpa.2023.02.001

Tom Bleeser MD, PhD , Arjen Brenders MD , Talia Rose Hubble MD , Marc Van de Velde MD, PhD, Professor , Jan Deprest MD, PhD, Professor , Steffen Rex MD, PhD, Professor , Sarah Devroe MD, PhD, Professor

{"title":"Preclinical evidence for anaesthesia-induced neurotoxicity","authors":"Tom Bleeser MD, PhD , Arjen Brenders MD , Talia Rose Hubble MD , Marc Van de Velde MD, PhD, Professor , Jan Deprest MD, PhD, Professor , Steffen Rex MD, PhD, Professor , Sarah Devroe MD, PhD, Professor","doi":"10.1016/j.bpa.2023.02.001","DOIUrl":"10.1016/j.bpa.2023.02.001","url":null,"abstract":"<div><p>Preclinical research concerning anaesthesia-induced neurotoxicity<span> was initiated in 1999. A decade later, the earliest clinical observational data showed mixed results in neurodevelopmental outcomes following anaesthesia exposure at a young age. Hence to date, preclinical studies remain the cornerstone of research in this field, primarily because of the vulnerability of clinical observational studies to confounding bias. This review summarises current preclinical evidence. Most studies used rodent models, although non-human primates have also been employed. Across all gestational and postnatal ages, there is evidence that all commonly used general anaesthetics induce neuronal injury (e.g. apoptosis) and cause neurobehavioural impairment (e.g. learning and memory deficits). These deficits were more pronounced when animals were subjected to either repeated exposure, prolonged durations of exposure or higher doses of anaesthesia. To interpret these results in the clinical context, the strengths and limitations of each model and experiment should be carefully considered, as these preclinical studies were often biased by supraclinical durations and a lack of control with regard to physiological homeostasis.</span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 1","pages":"Pages 16-27"},"PeriodicalIF":4.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9629296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

The role of fibrinogen in postpartum hemorrhage 纤维蛋白原在产后出血中的作用

IF 4.8 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2022-12-01 DOI: 10.1016/j.bpa.2022.10.002

Tim Vermeulen MD (Anesthesiology Trainee) , Marc Van de Velde MD, PhD, EDRA, FESAIC (Professor)

引用次数: 3

Patient Blood Management programs for post-partum hemorrhage 产后出血患者血液管理方案

IF 4.8 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2022-12-01 DOI: 10.1016/j.bpa.2022.09.001

Carlos Delgado MD (Associate Professor and Associate Director of Obstetric Anesthesia) , Ryu Komatsu MD, MS (Staff Anesthesiologist)

引用次数: 4

Protocol for postpartum haemorrhage including massive transfusion 产后出血的治疗方案包括大量输血

IF 4.8 3区医学

Best Practice & Research-Clinical Anaesthesiology Pub Date : 2022-12-01 DOI: 10.1016/j.bpa.2022.09.003

Ove Karlsson MD, PhD (Consultant Anaesthetist)

引用次数: 1