Anesthesiology最新文献

{"title":"In Vitro Performance of a Charcoal-capturing Device with Desflurane.","authors":"Maurits Hoffmann, Jennifer Jouwena, Andre M De Wolf, Rik Carette, Rinaldo S H Lauwers, Jan F A Hendrickx","doi":"10.1097/ALN.0000000000005445","DOIUrl":"10.1097/ALN.0000000000005445","url":null,"abstract":"<p><strong>Background: </strong>The use of capturing devices may become required for the continued use desflurane. This study tested the percentage of desflurane captured by a charcoal filter (CONTRAfluran; Zeosys GmbH, Germany)-workstation (Aisys; GE Healthcare, USA) combination in vitro .</p><p><strong>Methods: </strong>Desflurane in oxygen/air was administered via an Aisys workstation into a 2-l test lung that was insufflated with carbon dioxide (160 ml/min). First, to confirm that all vaporized desflurane reached the capturing device, the amount of desflurane collected in a Douglas bag attached to the machine exhaust was compared to the vaporized amount during 15-min runs with the following fresh gas flow and vaporizer setting combinations: 0.3 l/min and 8%, 0.5 l/min and 8%, 1 l/min and 6%, 2 l/min and 6%, 3 l/min and 6%, 4 l/min and 6%, 5 l/min and 6%, and 6 l/min and 6%. Next, to determine the effect of carbon dioxide, the capturing device weight gain was measured with the same fresh gas flow run for longer than 1 h but without desflurane. Finally, the ratio of the capturing device weight gain/vaporizer weight loss (which equals the performance, expressed as a percentage) was determined for the same 15-min runs with the desflurane vaporizer settings described above. All experiments were arbitrarily repeated five times.</p><p><strong>Results: </strong>The amount of vaporized desflurane did not differ from the amount collected in the Douglas bag. When carbon dioxide, oxygen, and air were delivered without desflurane, the capturing device lost a relatively small amount of weight (less than 5 g), especially with fresh gas flow less than or equal to 1 l/min. Finally, performance with 0.3, 0.5 to 2, and 3 to 6 l/min fresh gas flow was 103, 100, and 95 to 93%, respectively.</p><p><strong>Conclusions: </strong>CONTRAfluran charcoal filter in vitro performance for desflurane in oxygen/air combined with the Aisys workstation ranged from 93 to 103% with fresh gas flow of 0.3 to 6 l/min with vaporizer settings that reflect clinical conditions. Defining the place of charcoal filters in clinical practice requires full life-cycle analysis of both the charcoal and inhaled agent.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1038-1046"},"PeriodicalIF":9.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"This Month in Anesthesiology.","authors":"","doi":"10.1097/ALN.0000000000005526","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005526","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 6","pages":"A1-A2"},"PeriodicalIF":9.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Lung Expansion on Global and Regional Pulmonary Blood Volume in a Sheep Model of Acute Lung Injury.","authors":"Mingyang Zang, Congli Zeng, David Lagier, Nan Leng, Kira Grogg, Gabriel Motta-Ribeiro, Andrew F Laine, Tilo Winkler, Marcos F Vidal Melo","doi":"10.1097/ALN.0000000000005412","DOIUrl":"10.1097/ALN.0000000000005412","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary capillary blood volume is a major determinant of lung gas transport efficiency and also potentially related to ventilator-induced lung injury. However, knowledge on how lung expansion influences pulmonary blood volume in injured lungs is scant. The hypothesis was that lung expansion produced by positive end-expiratory pressure (PEEP) modulates the global and regional spatial distribution of pulmonary blood volume.</p><p><strong>Methods: </strong>In a lung injury model exposed to distinct lung expansion within clinical range (PEEP of 5 to 20 cm H 2 O), this study aimed to determine whole-lung and regional blood volume, their dynamic changes, and association with gas volume changes. Seven healthy sheep were subjected to 3 h of low-lung volume mechanical ventilation at a PEEP of 0 cm H 2 O and systemic endotoxemia. PEEP values of 5 (low), 20 (high), and 12 (intermediate) cm H 2 O were applied to produce distinct lung expansion. Respiratory-gated positron emission tomography with 11 C-labeled carbon monoxide and four-dimensional computed tomography were obtained to quantify blood volume and aeration.</p><p><strong>Results: </strong>Transpulmonary pressures were lowest at a PEEP of 12 cm H 2 O. Changes in whole-lung blood volume correlated with gas volume changes between PEEP of 5 and 12 cm H 2 O at end expiration ( P < 0.001) and end inspiration ( P < 0.001) but not between 12 and 20 cm H 2 O. Tissue-normalized blood volume ( ) was heterogeneously distributed, with mean values in nondependent regions ( = 0.116 ± 0.055) approximately seven times smaller than those in mid-dependent regions ( = 0.832 ± 0.132). A positive end-expiratory pressure of 12 cm H 2 O resulted in the most homogeneous distribution, with the largest means in mid-dependent regions and inspiratory 10th percentile, a measure of lowest values, throughout the lung. increased with inspiration at PEEP of 5 and 12 cm H 2 O but decreased with a PEEP of 20 cm H 2 O in mid-nondependent regions.</p><p><strong>Conclusions: </strong>During low-volume mechanical ventilation and systemic endotoxemia, lung blood volume is markedly heterogeneously distributed, and modulated by PEEP. Nondependent regions are susceptible to low blood volume and capillary closure. Recruitment of pulmonary vascular blood volume with gas volume is nonlinear, limited at an intermediate PEEP, indicating its advantage to spatial distribution of blood volume.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1071-1084"},"PeriodicalIF":9.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12074886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wake Up.","authors":"Ming-Hui Hung","doi":"10.1097/ALN.0000000000005429","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005429","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 6","pages":"1169-1170"},"PeriodicalIF":9.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesiology.","authors":"","doi":"10.1097/ALN.0000000000005527","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005527","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 6","pages":"A7-A9"},"PeriodicalIF":9.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Trends in Analgesic Opioid Use in Pregnancy: A Retrospective Cohort Study.","authors":"Jonathan Brett, Carolyn E Cesta, Malcolm B Gillies, Brian T Bateman, Adrienne Y L Chan, Michael C-Y Cheng, Yongtai Cho, Eunyoung Choi, Jacqueline M Cohen, Sarah Donald, Kari Furu, Mika Gissler, Tara Gomes, Alice Havard, Sonya Hernandez-Diaz, Miyuki H C Hsieh, Krista F Huybrechts, Par Karlsson, Erin Kelty, Edward C C Lai, Shaleesa Ledlie, Tianru Wang, Maarit K Leinonen, Lianne Parkin, Johan Reutfors, Jo-Young Shin, Chris T T Su, Bianca Varney, Ian C K Wong, Kenneth K C Man, Helga Zoega","doi":"10.1097/ALN.0000000000005418","DOIUrl":"10.1097/ALN.0000000000005418","url":null,"abstract":"<p><strong>Background: </strong>Pain is common during pregnancy, yet there are few contemporary studies of opioid use in pregnancy. This study aimed to describe prescription analgesic opioid use during pregnancy across four regions: Oceania (New South Wales, Australia, and New Zealand), North America (Ontario, Canada, and United States), Northern Europe (Denmark, Finland, Iceland, Norway, Sweden, and United Kingdom), and East Asia (Hong Kong, South Korea, and Taiwan).</p><p><strong>Methods: </strong>A common protocol was applied to population-based data to measure analgesic opioid dispensing or prescriptions during pregnancy before birth in 2000 to 2020. The populations captured included those with public and private insurance in the United States, a sample of primary care practices in the United Kingdom, and whole-of-population cohorts in the remainder of the locations. This study examined prevalence of use, defined as at least one dispensing or prescribing and estimated trends over time. Use by sociodemographic and pregnancy characteristics is described.</p><p><strong>Results: </strong>Among a total of 20,306,228 pregnancies, 1,115,853 (55 per 1,000) had at least one analgesic opioid dispensing or prescription, ranging from 4 per 1,000 in the United Kingdom to 191 per 1,000 in the U.S. publicly insured population. The greatest relative decrease in prevalence was observed in Hong Kong (prevalence ratio, 0.2; 95% CI, 0.1 to 0.2 between 2005 and 2020), and the greatest increase was in Iceland (prevalence ratio, 4.4; 95% CI, 3.7 to 5.2 between 2004 and 2017). Codeine and tramadol were among the three most prevalent opioids in most populations. In a sensitivity analysis defining opioid use as two or more opioid -dispensing or -prescribing events, the prevalence of opioid use across populations was 17 per 1,000.</p><p><strong>Conclusions: </strong>In this large multinational study, wide global variation in the prevalence of analgesic opioid use in pregnancy was observed, yet patterns of use by sociodemographic and pregnancy characteristics were relatively consistent. Analgesic opioid use remained stable or downward trending over time in most, but not all, countries.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1100-1113"},"PeriodicalIF":9.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuromuscular Blockade and Antagonism in Patients with Renal Impairment: A Multicenter Retrospective Cross-sectional Study.","authors":"Rania Elkhateb, Davis L Campbell, Xinyi Zhao, Graciela Mentz, Nadir El Sharawi, Sathish Kumar, Jill M Mhyre, Sachin Kheterpal, Douglas A Colquhoun","doi":"10.1097/ALN.0000000000005411","DOIUrl":"10.1097/ALN.0000000000005411","url":null,"abstract":"<p><strong>Background: </strong>Current practice guidelines do not address the use of neuromuscular blocking and antagonism agents in patients with renal impairment. The U.S. Food and Drug Administration (Silver Spring, Maryland) label for sugammadex advises against use in patients with severe renal impairment (estimated glomerular filtration rate [eGFR] less than 30 ml/min). Using a multicenter electronic health record registry, the authors sought to understand the modern use of neuromuscular blockade and antagonism agents in patients with significant renal impairment (eGFR less than 60 ml/min).</p><p><strong>Methods: </strong>Data were obtained from the Multicenter Perioperative Outcomes Group (MPOG) registry for adult patients (older than 18 yr) with an eGFR less than 60 ml/min, based on most recent serum creatinine, receiving general anesthesia for a nonrenal transplant procedure with an endotracheal tube between January 1, 2016, and July 31, 2022. Patients were classified into three mutually exclusive blockade and reversal strategies: rocuronium-sugammadex, cisatracurium-neostigmine, and rocuronium-neostigmine. Adjusted incidence of each blockade reversal strategy was established by a multinomial mixed effects model. The contribution of institution, anesthesiologist, and patient or case factors to variation in strategy choice was assessed by multilevel mixed effects models.</p><p><strong>Results: </strong>In 243,944 cases across 5,133 anesthesiologists and 48 institutions, adjusted use of rocuronium-sugammadex increased from 4.4 to 95.2%, rocuronium-neostigmine decreased from 84.7 to 4.3%, and cisatracurium-neostigmine decreased from 10.9 to 0.5%. In patients with an eGFR less than 15 ml/min, rocuronium-sugammadex use increased from 0.5 to 86.9%. Of the variation in choice of rocuronium-sugammadex versus cisatracurium-neostigmine, 30.1% was attributed to the institution, 22.7% to the attending anesthesiologist, and 47.2% to patient/case factors or was unexplained. The adjusted median odds ratio for this choice was 2.5 for clinicians and 3.1 for institutions.</p><p><strong>Conclusion: </strong>Rocuronium-sugammadex is the primary neuromuscular blockade-antagonism strategy for patients with moderate and severe renal impairment. Variation in choice is significantly impacted by the institution and attending anesthesiologist providing care.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1009-1024"},"PeriodicalIF":9.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12074883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinct Effects of Sevoflurane and Propofol on Vascular Permeability In Vitro and in a Mouse Model.","authors":"Ru Li, Yujie Huang, Kevin Lin, Xuri Li, James P Dilger, Jun Lin","doi":"10.1097/ALN.0000000000005434","DOIUrl":"10.1097/ALN.0000000000005434","url":null,"abstract":"<p><strong>Background: </strong>General anesthetics may substantially influence endothelium function, potentially affecting outcomes of surgical patients, but their effects are unclear. Here, the authors studied a commonly used inhaled anesthetic, sevoflurane, and an intravenous anesthetic, propofol, on vascular endothelial permeability using multiple in vitro assays and a mouse model.</p><p><strong>Methods: </strong>Human umbilical vein endothelial cells and mouse pulmonary endothelial cells (MPECs) were used for in vitro models to test the effect of anesthetics on endothelial permeability. The effect of anesthetics on pulmonary vascular leakage was analyzed using AngioSense 750 (PerkinElmer, USA) fluorescent tracer and rhodamine-labeled 3-kD dextran in a mouse model. Downstream targets were identified using RNA sequencing and confirmed by quantitative real-time polymerase chain reaction and Western blot.</p><p><strong>Results: </strong>Sevoflurane at clinically relevant concentrations disrupted the endothelial monolayer formed by human umbilical vein endothelial cells and MPECs in transwell permeability models. Sevoflurane, but not propofol, induced a 1.8-fold increase of AngioSense dye accumulation in mouse lung over control, indicating pulmonary vascular leakage in the sevoflurane group. RNA sequencing analysis, quantitative real-time polymerase chain reaction, and Western blot analysis revealed that sevoflurane induced the expression and activation of hypoxia-inducible factor 1α (HIF-1α) in vitro and in vivo . The activation of HIF-1α led to the increased expression of its downstream vascular endothelial growth factor (VEGF). The knockdown of HIF-1α restored the change of endothelial permeability and abolished the increase of VEGF induced by sevoflurane in MPECs.</p><p><strong>Conclusions: </strong>The authors' results demonstrate that sevoflurane increased endothelial and pulmonary vascular permeability via HIF-1α and VEGF. Propofol had no significant effect on the permeability of endothelium.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"1058-1070"},"PeriodicalIF":9.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Instructions for Obtaining Anesthesiology Continuing Medical Education (CME) Credit.","authors":"","doi":"10.1097/ALN.0000000000005517","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005517","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 6","pages":"A11"},"PeriodicalIF":9.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Science, Medicine, and the Anesthesiologist.","authors":"","doi":"10.1097/ALN.0000000000005521","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005521","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 6","pages":"A13-A15"},"PeriodicalIF":9.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}