Anesthesia & Analgesia最新文献

{"title":"Pharmacokinetics and Pharmacodynamics of Analgesic and Anesthetic Drugs in Patients During Cardiac Surgery With Cardiopulmonary Bypass: A Narrative Review.","authors":"Anne Beukers,Jennifer Breel,Charissa van den Brom,Aryen Saatpoor,Jolanda Kluin,Douglas Eleveld,Markus Hollmann,Henning Hermanns,Susanne Eberl","doi":"10.1213/ane.0000000000007564","DOIUrl":"https://doi.org/10.1213/ane.0000000000007564","url":null,"abstract":"Cardiopulmonary bypass (CPB) impacts pharmacokinetics and -dynamics of drugs used during cardiac surgery. These alterations can lead to changes in drug efficacy resulting in under- or overdosing. This review summarizes current knowledge on the effects of CPB on commonly used intraoperative and continuously administered anesthetics and analgesics. Out of 197 articles initially identified, 22 were included in the final review. The breakdown of studies by main topic was as follows: propofol (9 articles), sevoflurane (4), remifentanil (3), isoflurane (2), fentanyl (2), and sufentanil (2), and alfentanil (1). The initiation of CPB typically results in hemodilution and hypothermia, leading to a decrease in total plasma concentration combined with an increase in unbound plasma concentrations. This phenomenon has varying implications for different drugs: For propofol and sevoflurane, lower doses may be required during CPB to achieve the same anesthetic effect. Fentanyl and sufentanil plasma concentrations decrease by 25% on average at CPB initiation due to an increased volume of distribution, followed by an increase during CPB, with sufentanil, showing an almost 50% increase post-CPB. This implies that an additional bolus before CPB initiation should be considered, followed by a reduction of the maintenance dose to prevent prolonged sedation. Remifentanil plasma concentration decreases at CPB initiation, which implies that higher initial- or adjusted maintenance dose should be considered in normothermic patients. However, under hypothermic conditions, infusion rates should be decreased by 30% for every 5°C decrease in temperature. Alfentanils, total plasma concentration decreases during CPB, while its free fraction remains unaltered, indicating that no further adjustments are necessary. Target-controlled infusion (TCI) models for propofol (Schnider, Marsh, and PGIMER [Postgraduate Institute of Medical Education and Research]) and remifentanil (Minto) were found to be inaccurate in the context of CPB. Based on the included studies, the use of these pharmacokinetic models is not recommended. In conclusion, dosing inaccuracies resulting in adverse events in on-pump cardiac surgery underscore the importance of understanding the pharmacokinetics and -dynamics of anesthetic and analgesic drugs during CPB. The clinical implication of the altered drug responses after CPB remains challenging in this high-risk population. Key takeaways include the necessity of considering patient-specific factors, utilizing objective monitoring tools, and recognizing potential drug alterations due to CPB.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"122 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066853","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 Sevoflurane Postconditioning on Hypoxic-Ischemic Brain Injury via Nrf2-Regulated Ferroptosis in Neonatal Rats.","authors":"Chang Li,Ziyi Wu,Hang Xue,Qiushi Gao,Shihui Kuai,Ping Zhao","doi":"10.1213/ane.0000000000007547","DOIUrl":"https://doi.org/10.1213/ane.0000000000007547","url":null,"abstract":"BACKGROUNDThe mechanisms by which sevoflurane protects the brain from hypoxic-ischemic brain injury (HIBI) are unknown. Ferroptosis occurs during HIBI and is regulated by the nuclear factor erythroid 2-related factor 2 (Nrf2). This study investigated the roles of Nrf2-regulated ferroptosis in sevoflurane postconditioning (SPC)-mediated neuroprotection during HIBI.METHODSHIBI was induced in 7-day-old rats. SPC (2.5%, 30 minutes) was performed immediately after HIBI, and some rats were injected with ML385 (an Nrf2-inhibitor) 30 minutes before HIBI. Ferroptosis was evaluated by measuring glutathione peroxidase 4 (GPx4), solute carrier family 7 member 11 (SLC7A11, also known as xCT), glutathione (GSH), cysteine, iron, malondialdehyde (MDA) levels, and mitochondrial morphology. Nrf2 and heme oxygenase-1 (HO-1) expression were determined to explore the signaling pathways involved in SPC-mediated neuroprotection. Brain morphology, left/right hemisphere weight ratios, and Nissl staining were measured to assess brain damage. The Morris water maze was conducted to assess long-term learning and memory abilities.RESULTSSPC alleviated HIBI-induced cysteine depletion-induced (HIBI versus SPC, xCT/β-tubulin ratio: -0.435 [95% CI, -0.727 to -0.143], P = .003; Cysteine (% of Sham): -29.8 [95% CI, -39.4 to -20.2], P < .001; GSH (% of Sham): -46.5 [95% CI, -54.6 to -38.4], P < .001) and GPx4 inhibition-induced ferroptosis (HIBI versus SPC, GPx4/β-tubulin ratio: -0.287 [95% CI, -0.514 to -0.0603], P = .01). Compared with the HIBI group, the SPC group showed improved learning and memory abilities (HIBI versus SPC, platform crossings: -4 times [95% CI, -7 to -1], P = .002; escape latency: 46 seconds [95% CI, 24 to 68], P < .001), reduced brain damage (HIBI versus SPC, weight ratio of left/right cerebral hemispheres: -13.1 [95% CI, -15.7 to -10.4], P < .001; neuronal density ratio: -0.450 [-0.620 to -0.280], P < .001), and increased Nrf2 and HO-1 protein levels (HIBI versus SPC, Nrf2/β-tubulin ratio: -1.89 [95% CI, -2.82 to -0.970], P < .001; HO-1/β-tubulin ratio: -1.08 [95% CI, -1.73 to -0.442], P < .001). Inhibiting Nrf2 via ML385 partly reversed SPC-mediated neuroprotection (SPC versus SPC+ML385, weight ratio of left/right cerebral hemispheres: 12.4 [95% CI, 9.73-15.1], P < .001; neuronal density ratio: 0.412 [95% CI, 0.242-0.582], P < .001), accompanied by decreased HO-1 expression (SPC versus SPC+ML385, HO-1/β-tubulin ratio: 1.70 [95% CI, 1.05-2.34], P < .001).CONCLUSIONSSPC inhibits both cysteine depletion- and GPx4 inhibition-induced ferroptosis by regulating Nrf2/HO-1 signaling to protect against HIBI.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144067172","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 Effect of Acute Normovolemic Hemodilution on Coagulation During Cardiac Surgery Using Sonorheometric Clot Analysis (Quantra QPlus): A Retrospective Pilot Study.","authors":"Anil Tiwari,Gagan Mathur,Dolly Modha,Jesse Qiao","doi":"10.1213/ane.0000000000007551","DOIUrl":"https://doi.org/10.1213/ane.0000000000007551","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066846","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":"Optimizing Flow-Controlled Ventilation: Impact of I:E Ratios and Oxygen Concentration in a Porcine Model of Total Airway Obstruction.","authors":"Tomas Karlsson,Jenny Gustavsson,Katrin Wellfelt,Mattias Günther","doi":"10.1213/ane.0000000000007583","DOIUrl":"https://doi.org/10.1213/ane.0000000000007583","url":null,"abstract":"BACKGROUNDPrehospital airway obstruction is a medical emergency requiring immediate intervention. When the insertion of a larger bore tube over an airway catheter is hindered by obstruction, flow-controlled ventilation (FCV) with expiratory ventilation assistance (EVA) may offer a solution by allowing for ventilation through the airway catheter. This method uses a continuous bidirectional flow, necessitating a high-pressure gas source, typically 100% oxygen. However, in prehospital or military settings, oxygen supplies and exact manual control may be limited. Therefore, evaluating FCV/EVA without 100% oxygen, and with variable inspiratory-to-expiratory (I:E) control is essential to ensure its feasibility in such environments. We hypothesized that arterial oxygenation with 21% oxygen would be feasible and would vary between different I:E ratios.METHODSIn this randomized crossover trial, FCV/EVA with different I:E ratios and fraction of inspired oxygen were compared in total airway obstruction. 15 crossbred male specific pathogen-free swine, mean (standard deviation [SD]) weight 56.6 (2.1) kg were divided into groups; method A (n = 9) and method B (n = 6), anesthetized, muscle relaxed and desaturated <80%. FCV/EVA was performed for 15 minutes through an airway catheter in the obstructed airway.RESULTSIn I:E 1:1 vs 1:2 with 21% oxygen, the mean difference of Sao2 was 33.8% (95% confidence interval [CI], 16.3-51.4, P =.0020) and Pao2 was 4.7 kPa (95% CI, 1.3-8.1, P =.0127). Paco2 decreased more in 1:1 than 1:1 with a pause and 1:2. Paco2 remained <5 kPa with small variability in 1:1 with 21% oxygen.CONCLUSIONSFCV/EVA with 21% oxygen was feasible and maintained oxygenation and ventilation for 15 minutes. An I:E ratio of 1:1 was superior to 1:2. This approach may offer a viable alternative in a totally obstructed airway in resource-limited settings where higher oxygen concentrations are unavailable.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144067173","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":"Unique Perioperative Medicine Education Programs Designed to Fill Gaps in Postgraduate Medical Education.","authors":"Angela F Edwards,Sarah L Kittner,Macrae C Robertson,Aidan D Keleghan,Jeanna D Blitz","doi":"10.1213/ane.0000000000007509","DOIUrl":"https://doi.org/10.1213/ane.0000000000007509","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144066795","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":"Intrathecal Morphine Dose Matters: When Sample Size Is Measured in Micrograms.","authors":"Fabricio Andres Lasso Andrade","doi":"10.1213/ane.0000000000007575","DOIUrl":"https://doi.org/10.1213/ane.0000000000007575","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932492","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":"Signal, Not Noise: Aperiodic Dynamics in the Electroencephalogram Under Anesthesia.","authors":"Christopher W Connor","doi":"10.1213/ane.0000000000007577","DOIUrl":"https://doi.org/10.1213/ane.0000000000007577","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932388","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":"Postoperative Nausea and Vomiting Prevention After Intrathecal Morphine-Pondering the Permutations.","authors":"Anisha Pauline Paul,Aruna Parameswari","doi":"10.1213/ane.0000000000007574","DOIUrl":"https://doi.org/10.1213/ane.0000000000007574","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932491","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":"Efficacy of Remimazolam in Anesthetic Induction: Population Characteristic Concerns.","authors":"Dengfeng Liu,Chunwei Lian,Li Pan","doi":"10.1213/ane.0000000000007543","DOIUrl":"https://doi.org/10.1213/ane.0000000000007543","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"229 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932495","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":"Office-Based Anesthesia: The Focus on Communication, Competency, Connectivity, and Collaboration.","authors":"Steven B Greenberg","doi":"10.1213/ane.0000000000007576","DOIUrl":"https://doi.org/10.1213/ane.0000000000007576","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926479","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}