Frontiers in Anesthesiology最新文献

{"title":"Long-term sensorimotor changes after a sciatic nerve block with bupivacaine and liposomal bupivacaine in a high-fat diet/low-dose streptozotocin rodent model of diabetes","authors":"Susanna C. Byram, Krista M. Lotesto, Michael Volyanyuk, Jacob E. Exline, Elizabeth A. Sager, Eileen M. Foecking","doi":"10.3389/fanes.2024.1422353","DOIUrl":"https://doi.org/10.3389/fanes.2024.1422353","url":null,"abstract":"It is unclear whether patients with diabetes are more susceptible to nerve toxicity of local anesthetics or whether nerve blocks can accelerate the progression of diabetic peripheral neuropathy. Bupivacaine is one of the most widely used local anesthetics for regional anesthesia despite many pre-clinical studies demonstrating neurotoxicity. Herein, we report the long-term functional consequences of sciatic nerve block with bupivacaine and liposomal bupivacaine (Exparel®) in an animal model of diabetes.Male Sprague Dawley rats were subject to standard chow/vehicle or high-fat diet/low-dose streptozotocin to induce a diabetic phenotype. Animals were then subdivided into groups that received repeated sciatic nerve blocks of saline, bupivacaine, or liposomal bupivacaine. Mechanical allodynia and thermal hyperalgesia were assessed prior to and 12 weeks following nerve blocks utilizing the von Frey and Hargreaves tests, respectively. Exploratory and locomotor activity were assessed with open field testing, and nerve conduction velocity testing was conducted prior to the termination of the study at 28 weeks.Animals in the diabetic group developed sustained hyperglycemia >200 mg/dl and signs of peripheral neuropathy six weeks after treatment with streptozotocin, which persisted until the end of the study. Twelve weeks after a repeated sciatic nerve block with saline, bupivacaine, or liposomal bupivacaine, results indicate significant interaction effects of the disease group (control vs. diabetic) and local anesthetic treatment. Overall, diabetic status resulted in worse sensorimotor function compared to control animals. Treatment with perineural bupivacaine resulted in worse sensorimotor functions in both control and diabetic animals. Furthermore, bupivacaine treatment in diabetic animals with pre-existing neuropathy exacerbated sensorimotor function in some measures. In contrast, liposomal bupivacaine did not appear to cause any negative effects on functional outcomes for control or diabetic animals.Our data indicate that bupivacaine, and not liposomal bupivacaine, causes long-term changes in tactile allodynia, thermal hyperalgesia, locomotor behaviors, and nerve conduction velocity in control as well as a high-fat diet/low-dose streptozotocin rodent model of diabetes. These results highlight the necessity to investigate safe peripheral nerve block strategies to preserve long-term functional independence in patients with or at risk for diabetic peripheral neuropathy.","PeriodicalId":502300,"journal":{"name":"Frontiers in Anesthesiology","volume":"30 31","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141378451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesia-mediated neuroinflammatory sequelae in post operative cognitive dysfunction: mechanisms and therapeutic implications","authors":"Gregory T. Smith, Tytus J. Chen, Neha M. Shah, Brett Agrest, Janet Grotticelli","doi":"10.3389/fanes.2024.1281034","DOIUrl":"https://doi.org/10.3389/fanes.2024.1281034","url":null,"abstract":"Post-operative cognitive dysfunction (POCD) is an iatrogenic cognitive decline with unclear etiology. While current hypotheses include surgical and pharmacological-induced neuroinflammatory mechanisms, the growing prevalence, especially amongst the geriatric population, emphasizes the ambiguity of the dysfunction. Recent studies have highlighted the potential role of general and regional anesthesia in the pathogenesis of POCD; these pharmacological effects have been demonstrated to disrupt blood-brain barrier integrity, influence microglial polarization, and have been linked to worsening prognoses in cognitive decline. Moreover, mechanical stress from surgical intervention and reperfusion injury may exacerbate the generation of reactive oxygen species (ROS), thereby increasing oxidative stress to the brain synergistically with blood-brain barrier disruptions. In previous studies, factors for the variable incidence and various risk factors have been explored. In this review, we examine the pharmacological effects of local, regional, and general anesthesia on molecular and cellular glial response, along with its intercellular interactions and previously reported clinical outcomes.","PeriodicalId":502300,"journal":{"name":"Frontiers in Anesthesiology","volume":"51 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140425307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: The management of hemorrhagic shock of different origins by target-controlled coagulation and extracorporeal organ support (continuous renal replacement therapy)","authors":"Ákos Pertich, András Lovas","doi":"10.3389/fanes.2023.1323180","DOIUrl":"https://doi.org/10.3389/fanes.2023.1323180","url":null,"abstract":"Trauma-related severe bleeding and peripartum hemorrhage complicated by shock state is challenging for acute care physicians. Management steps relating to each other include damage control surgery, maintenance of optimal clotting preconditions, point-of-care and targeted supplementation of coagulation factors, control of hyperfibrinolysis, and supplementation of thrombocytes. Extensive tissue damage and surgical management of bleeding activate the proinflammatory process, leading to a dysregulated immune response. The originating systemic inflammation produces further damage, harmfully altering clot formation through the activation of immunothrombosis.The case report presents one obstetric, massive bleeding patient and one politraumatized patient with severe hemorrhage. Both underwent extended surgery regarding bleeding control intervention.Elimination of coagulation disorder was driven by point-of-care viscoelastometry and targeted clotting factor supplementation. Continuous renal replacement therapy and the hemadsorption technique augmented the well-established, up-to-date recommendations-guided care throughout the treatment line. The patients could leave the intensive care unit 4 and 8 days following the initial injury.Prompt administration of extracorporeal organ support enhanced the recovery from hemorrhagic shock.","PeriodicalId":502300,"journal":{"name":"Frontiers in Anesthesiology","volume":"106 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139615526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Pre-emptive intra-aortic balloon counterpulsation in patients with aortic regurgitation initiated after cross-clamping during cardiopulmonary bypass","authors":"David Hirschl, Lennart Muras, Simon Schemke, Maximilian Vondran, Matthias Heringlake","doi":"10.3389/fanes.2023.1275379","DOIUrl":"https://doi.org/10.3389/fanes.2023.1275379","url":null,"abstract":"Preoperative implantation of an intra-aortic balloon pump has been shown to reduce mortality in high-risk cardiac surgery cases. However, one main contraindication for its use is severe aortic regurgitation. We describe a case of safe and beneficial use in a patient presenting with moderate to severe aortic regurgitation and highly reduced ejection fraction undergoing aortic valve replacement.","PeriodicalId":502300,"journal":{"name":"Frontiers in Anesthesiology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139202521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of continuous popliteal nerve blocks using lidocaine vs. bupivacaine infusions for ambulatory foot surgery: a randomized, double-blind, noninferiority trial","authors":"Ghislaine C. Echevarria, Fernando R. Altermatt, P. Miranda, A. Araneda, Marcia Corvetto, René de la Fuente, J. C. De la Cuadra","doi":"10.3389/fanes.2023.1266270","DOIUrl":"https://doi.org/10.3389/fanes.2023.1266270","url":null,"abstract":"Continuous sciatic popliteal nerve block effectively manages pain after ankle and foot surgery. Most studies on continuous infusion of local anesthetics by perineural catheters have been made with bupivacaine, levobupivacaine, and ropivacaine, but lidocaine has not been used. The main objective of this study was to compare the quality of analgesia, motor function, and side effects between lidocaine and bupivacaine infusions in bilateral continuous popliteal nerve blocks for foot surgery.This was a prospective, double-blind, randomized, parallel-group, noninferiority study. We enrolled 70 patients undergoing bilateral foot or ankle surgery that could be performed under general anesthesia and continuous regional analgesia using sciatic popliteal nerve blocks. During their postoperative care, they were randomized into 2 groups: group lidocaine (lidocaine 0.5%, 5 ml/h) or group bupivacaine (bupivacaine 0.1%, 5 ml/h), administered through elastomeric pumps. The primary outcome was pain at 24 h after surgery, assessed by a verbal numeric rating scale (ranging from 0 to 10). A pre-specified non-inferiority margin of 1.5 was defined. Secondary outcomes were the degree of motor and sensitive block, total opioid use, and difficulties with pump or catheter management.The mean postoperative pain at 24 h of surgery was 2.06 (95% bootstrap confidence interval bCI 1.29, 2.83) and 1.82 (95% bCI 1.02, 2.62) in the lidocaine and bupivacaine group, respectively. The upper limit of the 95% bCI for the mean difference between lidocaine and bupivacaine was 0.82, declaring non-inferiority. No differences in the postoperative rescue analgesia use and satisfaction with care were found. No differences in postoperative NRS, sensory block and motor block were seen between groups.Lidocaine 0.5% and bupivacaine 0.1% provide similar postoperative analgesia through a sciatic popliteal catheter in ambulatory bilateral foot surgery patients.https://clinicaltrials.gov/, identifier: NCT02121119","PeriodicalId":502300,"journal":{"name":"Frontiers in Anesthesiology","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139213593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}