Anesthesia & Analgesia最新文献

{"title":"Clonidine Conserves Sleep Spindle Properties and Age-Dependent Electroencephalogram Patterns Mirroring Physiologic Sleep in Infants Under Spinal Anesthesia.","authors":"Andrew L Chen,Mingjian He,Uday Agrawal,Rodrigo G Gutierrez,Johanna M Lee,Alexis Novak,Jack S Elder,Patrick L Purdon,Christian S Guay,Chang Amber Liu","doi":"10.1213/ane.0000000000007763","DOIUrl":"https://doi.org/10.1213/ane.0000000000007763","url":null,"abstract":"BACKGROUNDSpinal anesthesia is an alternative to general anesthesia in infants. A caveat of spinal anesthesia in infants is short block duration. Clonidine is a common adjunct that prolongs spinal anesthesia. The mechanisms by which clonidine prolongs spinal anesthesia are unknown. Infants under spinal anesthesia appear in a sleep-like state. We hypothesized that infants receiving bupivacaine spinal anesthesia with clonidine may exhibit more sleep spindles on the electroencephalogram (EEG).METHODSWe obtained intraoperative frontal EEG recordings in 73 infants under spinal anesthesia. We compared EEG spectral features of bupivacaine and bupivacaine + clonidine spinal anesthesia using nonparametric multitaper spectral analysis. A recently developed switching state-space modeling approach was then applied to extract and compare spindle features in bupivacaine versus bupivacaine + clonidine spinal anesthesia. We then applied the same model to compare younger versus older infants.RESULTSThere was no difference in the power spectra and sleep spindle detection probability between bupivacaine and bupivacaine + clonidine spinal anesthesia (P = .51). We found age-related EEG changes in both bupivacaine and bupivacaine + clonidine spinal anesthesia independent of clonidine. Increasing age was associated with decreased spectral power from 0 to 0.6 Hz (median difference -2.9 dB, 95% CI [-5.3, -0.5,]) and increased power from 2 to 15 Hz (median difference 3.4 dB, 95% CI [1.5, 5.2]). Increasing age was also associated with increased spindle strength (R2 = 0.323, F(2,67) = 15.98, P < 0.001). These EEG findings mirror those found in infants under physiologic sleep.CONCLUSIONSOur findings suggest that low-dose clonidine does not impact sleep spindle properties in the EEG of infants under spinal anesthesia. The EEG of infants under spinal anesthesia demonstrate age-related changes that mirror quiet physiologic sleep. In addition, the presence of intrathecal clonidine has no effect on the age-related changes in the EEG pattern. Clonidine is an adjunct for spinal anesthesia in infants that appears to prolong anesthetic duration without affecting their EEG patterns of physiologic sleep.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071812","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":"Antiretroviral Therapy and Anesthesia: Considerations for Lenacapavir.","authors":"Aaron S Devanathan,Raymond J Van Ham","doi":"10.1213/ane.0000000000007770","DOIUrl":"https://doi.org/10.1213/ane.0000000000007770","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071815","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":"Uncovering the Cortical Code of Anesthesia-Induced Loss of Consciousness.","authors":"Kevin Barber,Peter A Goldstein,Jyun-You Liou","doi":"10.1213/ane.0000000000007760","DOIUrl":"https://doi.org/10.1213/ane.0000000000007760","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071813","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":"Analysis of the Local Opioid System in Human Left Ventricular Myocardial Tissue from Failing Hearts.","authors":"Alexandra Lasch,Kholod Shahin,Mohammed Shaqura,Lukas Dehé,Melih Ö Celik,Shaaban A Mousa,Bettina Heidecker,Christoph Knosalla,Michael Schäfer,Sascha Treskatsch","doi":"10.1213/ane.0000000000007744","DOIUrl":"https://doi.org/10.1213/ane.0000000000007744","url":null,"abstract":"BACKGROUNDThe increasing age of surgical patients is associated with a higher prevalence of chronic pain and cardiovascular comorbidities, including heart failure (HF). Recent studies suggest the existence of an intrinsic cardiac opioid system that may be dynamically regulated during HF. This study investigated left ventricular myocardial tissue from patients with end-stage dilated (DCM) and/or hypertrophic obstructive cardiomyopathy (HOCM) to assess whether the expression of opioid receptors and their endogenous ligand precursor peptides varies with cardiomyopathy type and severity. It was hypothesized that the cardiac opioid system is differentially regulated in DCM and HOCM, reflecting disease-specific remodeling.METHODSLeft ventricular myocardial tissue was obtained from a biobank. Samples had previously been collected from patients with DCM who had undergone heart transplantation or left ventricular assist device implantation, and from HOCM patients who had undergone surgical myectomy. Patients were grouped by cardiomyopathy type and left ventricular ejection fraction (LVEF): DCM with moderate (20%-35%) or severely reduced (<20%) LVEF, and HOCM with preserved LVEF (>55%). Gene and protein expression of the opioid receptors delta (DOR), kappa (KOR), and mu (MOR), as well as their endogenous ligand precursors proenkephalin (PENK), prodynorphin (PDYN), and proopiomelanocortin (POMC), were analyzed by real-time PCR and western blot, respectively. In addition, opioid receptor expression was assessed by immunohistochemistry in postmortem human hearts.RESULTSKOR, PENK, and POMC mRNA were detected by real-time PCR, while DOR, MOR, and PDYN mRNA were below detection in end-stage left ventricular cardiomyopathy. Western blot analysis confirmed protein expression of DOR, KOR, MOR, and PENK. When comparing DCM to HOCM samples, KOR gene expression showed the largest difference (effect size: 0.93), and MOR protein expression showed a moderate difference (effect size: 0.62). However, none of the differences reached statistical significance (P > .05). Immunohistochemistry confirmed the presence of opioid receptors in postmortem human myocardial tissue of the left ventricle.CONCLUSIONSThis study confirms the presence of opioid receptors and opioid peptides in human left ventricular myocardial tissue, supporting the existence of an intrinsic cardiac opioid system. However, no statistically significant differences in gene or protein expression were observed between cardiomyopathy subtypes. These neutral findings suggest a largely uniform expression pattern across cardiomyopathy subtypes or only subtle disease-related changes and warrant further investigation into the potential role of the cardiac opioid system in HF pathophysiology.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059153","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":"Pharmacogenomic-Based Oral Morphine Dose Adjustment: Is It Hard to Swallow?","authors":"Patrick K Henthorn,Thomas K Henthorn","doi":"10.1213/ane.0000000000007735","DOIUrl":"https://doi.org/10.1213/ane.0000000000007735","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025233","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":"Acute Pain After Total Knee Arthroplasty: 2-Arachidonoylglycerol Tone and Endocannabinoid/Eicosanoid Crosstalk.","authors":"Livia Schutz,Chris Gordon,Mariam Hassan,Keith Studholme,Ayesha Khan,Alexa Christophides,Darcy Halper,Samuel Stanley,James Nicholson,Elliott Bennett-Guerrero,David E Komatsu,Martin Kaczocha","doi":"10.1213/ane.0000000000007741","DOIUrl":"https://doi.org/10.1213/ane.0000000000007741","url":null,"abstract":"BACKGROUNDTotal knee arthroplasty (TKA) is a surgical procedure that induces intense acute postoperative pain, but the mechanisms that amplify post-TKA pain remain incompletely understood. Endocannabinoids, such as 2-arachidonoylglycerol (2-AG), are endogenous lipids that can produce antinociceptive effects. However, hydrolysis of 2-AG by monoacylglycerol lipase (MAGL) generates arachidonic acid, the precursor to a host of eicosanoids that enhance pain. The presence of this metabolic pathway suggests that individuals with elevated 2-AG levels may be primed to develop greater postoperative pain.METHODSThe primary goal of this prospective study was to determine if intraoperative 2-AG levels in the synovial fluid (SF) and cerebrospinal fluid (CSF) of TKA patients are associated with the magnitude of acute postoperative pain at rest and with ambulation. The secondary goal was to determine whether 2-AG metabolism contributes to prostaglandin E2 (PGE2) biosynthesis in synovial tissue ex vivo.RESULTSNinety subjects were enrolled in the study. SF 2-AG was positively correlated with pain at rest (r = 0.2644; P = .0157) and with ambulation (r = 0.3856; P = .0005) while CSF 2-AG was associated with pain at rest (r = 0.3312; P = .0017) but not with ambulation (r = 0.1454; P =.1871). Stratification of the results by sex revealed positive correlations between 2-AG and pain in females, which were markedly weaker or not observed in males. Ex vivo analysis demonstrated coexpression of MAGL and cyclooxygenase-2 in synovial membranes, with MAGL inhibition by MJN110 elevating 2-AG levels (median, vehicle: 0.165 nmol/g vs MJN110: 0.325 nmol/g, P = .0269) and concomitantly reducing PGE2 (median, vehicle: 5.645 nmol/g vs MJN110: 3.440 nmol/g, P = .0425).CONCLUSIONSOur findings demonstrate that patients presenting with an elevated 2-AG tone develop greater postoperative pain and position MAGL as an enzymatic node linking 2-AG metabolism with eicosanoid biosynthesis in perioperative human tissue.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025231","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":"Association of Sedation Depth With Detection of Small Serrated Polyps and Serrated Polyp Counts During Colonoscopy: A Registry-Based Cohort Study.","authors":"Aurora N Quaye,William M Hisey,Todd A Mackenzie,Christina M Robinson,Joseph C Anderson,Lynn F Butterly","doi":"10.1213/ane.0000000000007742","DOIUrl":"https://doi.org/10.1213/ane.0000000000007742","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025232","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":"Influence of High-Dose Heparin on CT EXTEM of ROTEM Sigma and ROTEM Delta During Cardiopulmonary Bypass.","authors":"Maite M T van Haeren,Jimmy Schenk,Marcella C A Müller,Susanne Eberl,Alexander P J Vlaar,Henning Hermanns","doi":"10.1213/ane.0000000000007753","DOIUrl":"https://doi.org/10.1213/ane.0000000000007753","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003292","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":"Multivariable Model for Hypoxemia During One-Lung Ventilation: Are They \"True\" Risk Factors?","authors":"Kyosuke Takahashi","doi":"10.1213/ane.0000000000007743","DOIUrl":"https://doi.org/10.1213/ane.0000000000007743","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003204","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":"The Promising Role of Pediatric Pharmacokinetic Simulations in Informing Opioid Dosing Decisions.","authors":"Niloofar Gheshlaghi,Kheireddin Mufti,Jia He Zhang,Erika N Scott,Anil Maharaj,Catrina M Loucks","doi":"10.1213/ane.0000000000007732","DOIUrl":"https://doi.org/10.1213/ane.0000000000007732","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025236","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}