Anesthesiology最新文献

{"title":"Increased Plasma Fibroblast Growth Factor 23 Significantly Associates with In-Hospital Acute Kidney Injury after Cardiac Surgery.","authors":"Sreekanth R Cheruku, Javier A Neyra, Hamza Mohammad, Johnny Trinh, Georgina Hernandez, Paul A Nakonezny, Michael E Jessen, Orson W Moe, Amanda A Fox","doi":"10.1097/ALN.0000000000005605","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005605","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) occurs in 20-30% of cardiac surgery patients and is most often classified as mild. A prior study reported that intact fibroblast growth factor 23 (iFGF23) and C-terminal fibroblast growth factor 23 (cFGF23) measured after cardiopulmonary bypass (CPB) were associated with severe AKI after cardiac surgery, but did not analyze the association between iFGF23 and all-stage AKI. The primary aim of our study was to determine whether FGF23 biomarker measurements six hours following CPB were associated with all-stage AKI after cardiac surgery.</p><p><strong>Methods: </strong>This prospective observational study included 173 patients undergoing non-emergent coronary artery bypass graft (CABG) and/or valve surgery on CPB. The primary study outcome was all-stage postoperative in-hospital AKI defined using the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria through postoperative day seven or earlier if hospital stay was less than 7 days. Plasma iFGF23 and cFGF23 were measured six hours after the end of CPB.</p><p><strong>Results: </strong>A total of 32 patients developed in-hospital postoperative AKI (18.5%) by the seventh post-operative day. The incidence of AKI was 18.5% in CABG patients, 14.3% in valve surgery patients, and 41.2% in combined CABG-valve patients. A 2-fold increase in cFGF23 was associated with 1.57 greater predicted odds of developing in-hospital postoperative AKI (OR 1.57; 95% CI: 1.26 - 1.96; p<0.0001). This association remained significant after adjusting for clinical covariates (OR 1.40; 95% CI: 1.10 - 1.77; p=0.006) and after adjusting for preoperative Cleveland Clinic Score (OR 1.54; 95% CI: 1.22 - 1.95; p=0.0003). A 2-fold increase in iFGF23 was associated with 1.59 greater predicted odds of developing in-hospital postoperative AKI (OR 1.59; 95% CI: 1.08 - 2.35; p=0.018).</p><p><strong>Conclusions: </strong>Early postoperative measurements of cFGF23 and iFGF23 are associated with all-stage AKI after cardiac surgery. The utility of these biomarkers for risk-classification in cardiac surgery patients remains to be determined.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257178","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":"Ketamine-induced sustained modulation of GABAA receptor function in mouse hippocampal neurons following anesthesia.","authors":"Dian-Shi Wang, Winston W Li, Daheng Liu, Shahin Khodaei, Yalun Zhang, MeiFeng Yu, Howell Y H Fang, Agnes Crnic, Kirusanthy Kaneshwaran, Connor T A Brenna, Beverley A Orser","doi":"10.1097/ALN.0000000000005595","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005595","url":null,"abstract":"<p><strong>Background: </strong>Excess function of GABAA receptors that generate a tonic inhibitory conductance contributes to postanesthetic cognitive impairment. Ketamine may have postoperative cognition-sparing properties; however, whether it reduces excess GABAA receptor function is unknown. This study investigated whether ketamine prevents a sustained anesthetic-triggered increase in GABAA receptor function in vitro and mitigates postanesthetic memory deficits in vivo.</p><p><strong>Methods: </strong>Murine hippocampal neurons and cortical astrocytes were cocultured and treated for 1 h with an injectable (etomidate) or an inhaled (sevoflurane) anesthetic, with or without ketamine. After 24 h, GABAA receptor-mediated tonic currents were recorded from neurons using whole-cell patch clamp. Expression of BDNF and its receptor TrkB was assessed by biotinylation, Western blotting, ELISA, and qPCR. Immunostaining was used to visualize α5 subunit-containing GABAA receptors in neurons. In vivo, adult mice were anesthetized with sevoflurane for 2 h, with or without ketamine, and recognition and spatial memory were assessed 24 and 48 h later, respectively.</p><p><strong>Results: </strong>Ketamine prevented the sustained increase in GABAA receptor-mediated tonic currents triggered by etomidate and sevoflurane. This effect was independent of NMDA receptor antagonism and instead was mediated by BDNF-TrkB signaling through a GSK-3β-dependent pathway. Interestingly, ketamine did not alter BDNF levels but increased cell-surface expression of TrkB receptors and thereby facilitated BDNF-TrkB signaling. Ketamine also reduced the anesthetic-induced increase in cell-surface expression of α5 subunit containing GABAA receptors. In vivo, ketamine prevented deficits in both recognition and spatial memory that occurred after sevoflurane anesthesia.</p><p><strong>Conclusions: </strong>Ketamine prevents general anesthetic-induced sustained increase in GABAA receptor function by facilitating BDNF-TrkB signaling. This mechanism is associated with a mitigation of postanesthetic memory deficits in mice.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257179","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":"A pharmacist-partnered opioid tapering service before total hip or knee arthroplasty: Qualitative analysis of patient counselling sessions.","authors":"Sophie A Young, Chi Tran, Claire E Ashton-James, Asad E Patanwala, Jennifer Stevens, Justine M Naylor, Furkan Genel, Sam Adie, Bernadette Brady, Kate Luckie, Geraldine Hassett, Gilbert Whitton, Joseph Descallar, Frances Page, Mary Keehan, Cheng Fai Hui, Shaniya Ogul, Anders G Jansson, Amy Archer, Andrew Sefton, Mitchell Fung, Thomas Byrnes, Geoffrey Murphy, Erica Morgan, Emily Mayze, Clare Eastment, Shania Liu, Jonathan Penm","doi":"10.1097/ALN.0000000000005594","DOIUrl":"10.1097/ALN.0000000000005594","url":null,"abstract":"<p><strong>Background: </strong>Currently, no literature on patients' experiences with opioid tapering before elective surgery has been published. Recent evidence indicates tapering opioids before total hip or knee arthroplasty improves post-surgical outcomes. This study qualitatively analyzed consultation sessions of patients receiving a pharmacist-partnered opioid tapering service before total hip or knee replacement surgery to understand their experiences and attitudes.</p><p><strong>Methods: </strong>A qualitative analysis of pharmacist counselling sessions within a randomised controlled trial (RCT) was conducted. Participants were those recruited from seven hospitals between December 2021 and September 2022 who were assigned to the pharmacist-partnered opioid tapering intervention arm of the RCT. Consultations of participants with the pharmacist were audio-recorded and transcribed verbatim. Consultation data underwent inductive thematic analysis.</p><p><strong>Results: </strong>Consultations were available for 20 participants, with a total of 48 audio-recorded consultations. Among these participants, four major themes including motivations to taper, knowledge and beliefs, psychosocial context, and attitudes towards tapering opioids were identified. Of the 20 participants, 70% tapered their opioids ≥50%, with awareness of the surgery date appearing to be a key external motivating factor to taper opioids, regardless of the dose of opioids. Another notable theme was the motivation to improve fitness for participation in social activities, allowing participants to interact more with their kids and grandkids. Additionally, participant's psychosocial context revealed that factors such as stress impacted their ability to taper. Pharmacists played a foundational role in shaping patients' attitudes and optimisation of pain management strategies. Attitudes were identified as 'optimistic', 'hesitant', and 'resistant', with patients displaying an optimistic attitude being more likely to taper.</p><p><strong>Conclusions: </strong>Exploring the experiences of patients with osteoarthritis in a pharmacist-led opioid tapering service before elective surgery revealed that external motivations, such as knowledge of a surgery date, play a crucial role in successful opioid tapering. Patients were more likely to taper if they knew their surgery date. Attitudes towards opioid tapering were identified as a modifiable factor. Tailoring tapering plans and patient education to individual patient contexts may enhance tapering outcomes.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233013","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":"The role of the supramammillary nucleus-medial septum glutamatergic pathway in mediating the effects of isoflurane anesthesia.","authors":"Li-Li Duan, Ping Cai, Zhang-Shu Li, Qian-Qian Wang, Lei Zhang, Zhuo-Li Chen, Mai-Jie Zhang, Cheng-Wei Zhang, Zhi-Peng Xu, Li Chen","doi":"10.1097/ALN.0000000000005584","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005584","url":null,"abstract":"<p><strong>Background: </strong>Glutamatergic neurons in the supramammillary nucleus (SuM) have been recently identified as a key node in arousal system, yet their role in regulating general anesthesia remains unclear. The aim of the current study is to study the role of the glutamatergic supramammillary neurons and their projections to the medial septum in mediating the effects of isoflurane anesthesia.</p><p><strong>Methods: </strong>Fiber photometry recording was used to determine the changes in calcium signals of glutamatergic neurons in the SuM during isoflurane anesthesia. Optogenetic and chemogenetic approaches were employed to manipulate SuM glutamatergic neuron activity, and the effects on cortical activity, behavioral responses, and physiological parameters-including pupil diameter, respiratory rate, and blood pressure-were examined in anesthetized mice. Both male and female mice were used in this study.</p><p><strong>Results: </strong>The activities of SuM glutamatergic neurons decreased during isoflurane anesthesia and recovered after the emergence. Optogenetic activation of these neurons enhanced cortical activity, decreasing electroencephalogram delta power (mean ± SD, Pre-stimulation vs. Stimulation: 51.35 ± 7.26% vs. 32.08 ± 10.48%, n=8, P=0.002) and burst-suppression ratio (81.82 ± 7.83% vs. 44.53 ± 28.62%, n=8, P=0.002). Furthermore, optogenetic activation altered physiological parameters including enlarged pupil diameter (Pre-stim vs Stim: 1.05 ± 0.08% vs 1.95 ± 0.46%, n=8, P<0.001), increased respiratory rate (0.97 ± 0.07% vs 1.57 ± 0.39%, n=10, P<0.001) and elevated blood pressure, and induced behavioral responses including increased arousal scores and accelerated emergence (Light off vs. Light on, 153.80 ± 40.32 s to 59.88 ± 27.18 s, n=8, P=0.007). Moreover, chemogenetic activation produced similar effects, whereas inhibition led to opposite effects. Finally, optogenetically activating SuM glutamatergic terminals projecting to the medial septum mimicked the effects of activating SuM glutamatergic soma, and increased the activity of medial septum glutamatergic neurons.</p><p><strong>Conclusions: </strong>Our study identifies glutamatergic neurons of the supramamillary nucleus as key neural substrates regulating isoflurane anesthesia and facilitating emergence through their projecitons to the medial septum.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207470","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":"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":"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":"144224077","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":"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}