Anesthesiology最新文献

{"title":"Somatostatin-expressing neurons in the medial prefrontal cortex promote sevoflurane anesthesia in mice.","authors":"Aichen Tang, Mao Xu, Xizu Chen, Juan Liu, Jiamin Wang, Ying Wang, Shuang Cai, Yue Shu, Danxu Zheng, Tian Yu, Yuan Wang, Tianyuan Luo, Shouyang Yu","doi":"10.1097/ALN.0000000000005394","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005394","url":null,"abstract":"<p><strong>Background: </strong>The medial prefrontal cortex plays a crucial role in regulating consciousness. However, the specific functions of its excitatory and inhibitory networks during anesthesia remain uncertain. Here we explored the hypothesis that somatostatin interneurons in the medial prefrontal cortex enhance the effects of sevoflurane anesthesia by increasing GABA transmission to pyramidal neurons.</p><p><strong>Methods: </strong>EEG was utilized to reflect the depth of anesthesia. Immunostaining and fiber photometry were employed to assess neuronal activities and GABA delivery. The regulation of neuronal activity was achieved by chemogenetics and optogenetics.</p><p><strong>Results: </strong>The expression of c-Fos was increased in somatostatin neurons of the medial prefrontal cortex during sevoflurane anesthesia (air versus sevoflurane: 26.4 ± 6.5 % versus 48 ± 6.2 %, P=0.0007, n=5 mice). Chemogenetic inhibition or activation of somatostatin neurons in the medial prefrontal cortex reduced (from 84 ± 24 s to 51 ± 18 s, P=0.008, n=7 mice) or prolonged (from 97 ± 31 s to 140 ± 30 s, P=0.006, n=7 mice) the sevoflurane anesthesia recovery time. Increased GABA input to pyramidal neurons in the medial prefrontal cortex precedes sevoflurane-induced loss of consciousness (ΔF/F: from 0.46 ± 0.57 % to 2.25 ± 1.42 %, P=0.031, n=10 mice). Activation of somatostatin neurons in the medial prefrontal cortex, leading to a significant reduction in calcium signals within local pyramidal neurons (ΔF/F: from -0.14 ± 0.52 % to -10.08 ± 4.44 %, P=0.002, n=10 mice), and GABA input on pyramidal neurons increased (ΔF/F: from -0.001 ± 0.001 % to 0.28 ± 0.03 %, P=0.002, n=7 mice) in a time-locked manner. Chemogenetic inhibition of pyramidal neurons prolonged the recovery from sevoflurane anesthesia in mice (from 101 ± 46 s to 136 ± 54 s, P=0.017, n=19 mice).</p><p><strong>Conclusions: </strong>Cortical somatostatin neurons may inhibit local pyramidal neurons by enhancing GABA transmission, which increases the effectiveness of sevoflurane anesthesia.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051401","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":"Impact of under-assisted ventilation on diaphragm function and structure in a porcine model.","authors":"Mathieu Capdevila, Joris Pensier, Audrey De Jong, Boris Jung, July Beghin, Thomas Laumon, Yassir Aarab, Lucas Deffontis, Thomas Sfara, Ambre Cuny, Julie Carr, Nicolas Molinari, Jean-Yves Le Guennec, Fabrice Raynaud, Stefan Matecki, Laurent Brochard, Alain Lacampagne, Samir Jaber","doi":"10.1097/ALN.0000000000005390","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005390","url":null,"abstract":"<p><strong>Background: </strong>Long-term controlled mechanical ventilation (CMV) in intensive care unit (ICU) induces ventilatory-induced-diaphragm-dysfunction (VIDD). The transition from CMV to assisted mechanical ventilation is a challenge that requires clinicians to balance over-assistance and under-assistance. While the effects of over-assistance on the diaphragm are well known, we aimed to assess the impact of under-assistance on diaphragm function and structure in piglet model with pre-existing VIDD (after long-term CMV) or without VIDD (short-term CMV).</p><p><strong>Methods: </strong>Twenty-two Large-White female piglets were anesthetized, ventilated, and separated into two groups: a VIDD group (n=10) with long-term 72-hour CMV, and a no-VIDD group (n=12) with short-term 2-hour CMV. After sedation reduction at the end of CMV period, each piglet was switched to under-assisted ventilation for 2 hours. Diaphragm function (supramaximal diaphragm pressure-generating capacity assessed by negative tracheal pressure after transvenous phrenic nerve stimulation) and diaphragm structure (mini-invasive in vivo biopsies) were assessed before and after under-assisted ventilation.</p><p><strong>Results: </strong>In VIDD group, supramaximal diaphragm pressure-generating capacity decreased by 22% from 69.9±12.7 to 54.9±19.7 cmH2O (p=0.04) after 72 hours of CMV evidencing VIDD, then dropped by a further 29% from 54.9±19.7 to 38.9±15.5 cmH2O (p<0.01) after 2 hours of under-assisted ventilation. Diaphragm pressure-generating capacity remains stable from 55.3±22.7 to 58.2±24 cmH2O (p=0.24) in no-VIDD group. Diaphragm structure showed sarcomeric injuries increase from 13±10% to 24±19% (p<0.01) and lipid droplets decrease from 14±8% to 11±6% (p=0.03) of the total micrograph area after 2 hours of under-assisted ventilation in the VIDD group. Sarcomeric injuries and lipid droplets accounted respectively for 17±16% and 2±3% of the total micrograph area after under-assisted ventilation in the no-VIDD group.</p><p><strong>Conclusions: </strong>In this porcine model, a short two-hour exposure of under-assisted ventilation induces impairment of diaphragm function with damage to the diaphragm structure in ICU condition with pre-existing VIDD.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031855","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":"Protamine Dosing in Cardiac Surgery: Can One Size Fit All? Erratum.","authors":"Michael Mazzeffi, Jerrold H Levy","doi":"10.1097/ALN.0000000000005356","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005356","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027942","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":"Cytokine Hemoadsorption versus Standard Care in Cardiac Surgery Using the Oxiris® Membrane: the OXICARD single center randomized trial.","authors":"Osama Abou-Arab, Pierre Huette, Azrat Ibrahima, Christophe Beyls, Guillaume Bayart, Mathieu Guilbart, Adrien Coupez, Youssef Bennis, Aurélie Navarre, Gaelle Lenglet, Roman Béal, Gilles Touati, Thierry Caus, Stéphane Bar, Estelle Josse, Maxime Nguyen, Hervé Dupont, Brigitte Gubler, Saïd Kamel, Momar Diouf, Yazine Mahjoub","doi":"10.1097/ALN.0000000000005376","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005376","url":null,"abstract":"<p><strong>Background: </strong>Cardiac surgery can lead to dysregulation with a pro-inflammatory state, resulting in adverse outcomes. Hemadsorption using the AN69 membrane (Oxiris membrane) has the properties to chelate inflammatory cytokines. We hypothesized that in patients at high risk of inflammation, the use of the Oxiris membrane could decrease inflammation, preserve endothelial function, and improve postoperative outcomes.</p><p><strong>Methods: </strong>We conducted a randomized single-center study at Amiens University Hospital. The study population consisted of adult patients admitted for scheduled cardiac surgery with an expected cardiopulmonary bypass (CPB) time over 90 minutes. The patients were allocated to either the standard group or the Oxiris group. The intervention consisted of using the Oxiris membrane on a Prismaflex device at a blood flow rate of 450 ml/min during CPB. The primary outcome was the assessment of microcirculation on day 1 after surgery by measuring sublingual microcirculation using the microvascular flow index (MFI). MFI reflects the microcirculation flow type and is graded from 0 to 3 as follows: 0: no flow; 1: intermittent flow; 2: sluggish flow; 3: continuous flow. The secondary outcome was a composite adverse outcome within 30 days after surgery. Cytokines and endothelial biomarkers were measured in all patients at different time points. An intention-to-treat analysis was performed.</p><p><strong>Results: </strong>From October 2019 to November 2022, we included 70 patients. Two patients were excluded from the Oxiris group: one patient did not undergo surgery and one procedure was performed under deep hypothermia. The MFI did not differ between groups on day 1 from baseline: difference Oxiris-standard at -0.17 [-0.44; 0.10]; P=0.2. The occurrence of a composite adverse outcome did not significantly differ between groups (14 [42%] for the Oxiris group vs 12 [35%] for the standard group; P=0.7). The overall variation in cytokines and angiopoietins did not significantly differ between groups.</p><p><strong>Conclusions: </strong>In patients scheduled for a cardiac surgery with prolonged CPB, we could not demonstrate the benefit on microcirculation and major cardiovascular events.</p><p><strong>Registration: </strong>URL: https://clinicaltrials.gov/study/NCT04201119. Identifier: NCT04201119.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021883","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":"Failed Neuroprotection Trials: An Evaluation of Complexity and Clinical Trial Design.","authors":"W Andrew Kofke,Todd A Miano","doi":"10.1097/aln.0000000000005244","DOIUrl":"https://doi.org/10.1097/aln.0000000000005244","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"7 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988467","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":"Preliminary Development and Validation of Automated Nociception Recognition Using Computer Vision in Perioperative Patients.","authors":"Timothy A Heintz, Anusha Badathala, Avery Wooten, Cassandra W Cu, Alfred Wallace, Benjamin Pham, Arthur W Wallace, Julien Cobert","doi":"10.1097/ALN.0000000000005370","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005370","url":null,"abstract":"<p><strong>Background: </strong>Effective pain recognition and treatment in perioperative environments reduce length of stay and decrease risk of delirium and chronic pain. We sought to develop and validate preliminary computer vision-based approaches for nociception detection in hospitalized patients.</p><p><strong>Methods: </strong>Prospective observational cohort study using red-green-blue camera detection of perioperative patients. Adults (≥18 years) admitted for surgical procedures to the San Francisco Veterans Affairs Medical Center (SFVAMC) were included across 2 study phases: (1) algorithm development phase and (2) internal validation phase. Continuous recordings occurred perioperatively across any postoperative setting. We inputted facial images into convolutional neural networks using a pretrained backbone, to detect (1) critical care pain observation tool (CPOT) and (2) numerical rating scale (NRS). Outcomes were binary pain/no-pain. We performed external validation for CPOT and NRS classification on data from University of Northern British Columbia-McMaster University (UNBC) and Delaware Pain Database. Perturbation models were used for explainability.</p><p><strong>Results: </strong>We included 130 patients for development, 77 patients for validation cohort and 25 patients from UNBC and 229 patients from Delaware datasets for external validation. Model area under the curve of the receiver operating characteristic for CPOT models were 0.71 (95% confidence interval [CI] 0.70, 0.74) on the development cohort, 0.91 (95% CI 0.90, 0.92) on the SFVAMC validation cohort, 0.91 (0.89, 0.93) on UNBC and 0.80 (95% CI 0.75, 0.85) on Delaware. NRS model had lower performance (AUC 0.58 [95% CI 0.55, 0.61]). Brier scores improved following calibration across multiple different techniques. Perturbation models for CPOT models revealed eyebrows, nose, lips, and foreheads were most important for model prediction.</p><p><strong>Conclusions: </strong>Automated nociception detection using computer vision alone is feasible but requires additional testing and validation given small datasets used. Future multicenter observational studies are required to better understand the potential for automated continuous assessments for nociception detection in hospitalized patients.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969481","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":"TAK-925 (danavorexton), an Orexin Receptor 2 Agonist, Reduces Opioid-Induced Respiratory Depression and Sedation Without Affecting Analgesia in Healthy Adult Males.","authors":"Maarten van Lemmen, Albert Dahan, Yaming Hang, Simone C Jansen, Hong Lu, Melissa Naylor, Tina Olsson, Sarah Sheikh, Danielle Sullivan, Max Tolkoff, Rutger van der Schrier, Monique van Velzen, Philipp von Rosenstiel, Rebecca L Wu, Seetha Meyer","doi":"10.1097/ALN.0000000000005375","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005375","url":null,"abstract":"<p><strong>Background: </strong>Orexin neuropeptides help regulate sleep/wake states, respiration, and pain. However, their potential role in regulating breathing, particularly in perioperative settings, is not well understood. TAK-925 (danavorexton), a novel, orexin receptor 2-selective agonist, directly activates neurons associated with respiratory control in the brain and improves respiratory parameters in rodents undergoing fentanyl-induced sedation. This study assessed the safety and effect of danavorexton on ventilation in healthy men in an established remifentanil-induced respiratory depression model.</p><p><strong>Methods: </strong>This single-center, double-blind, placebo-controlled, two-way crossover, phase 1 trial randomized (1:1) 13 healthy men to danavorexton (11mg [low-dose] then 19mg [high-dose]) or placebo, under remifentanil infusion, on two occasions separated by a ≥36-hour washout period. Remifentanil infusion was titrated under isohypercapnic conditions to achieve ~30% to 40% decrease in minute ventilation (from ~20 to ~14 L/minute) before danavorexton/placebo administration. Assessments included safety, ventilation measurements, sedation, and pain tolerance.</p><p><strong>Results: </strong>4 (30.8%) danavorexton-treated participants and 1 (8.3%) placebo-treated participant experienced treatment-emergent adverse events (all mild in severity). Insomnia, lasting 1 day, occurred in 1 participant, and was considered related to danavorexton. Compared with placebo, low- and high-dose danavorexton significantly increased ventilation variables (observed mean [95% confidence interval] change, sensitivity analysis model-based p-values) including minute volume (8.2[5.0, 11.4] and 13.0[9.4, 16.5] L/min), tidal volume (312[180, 443] and 483[309, 657] mL), and respiratory rate (3.8[1.9, 5.7] and 5.2[2.7, 7.7] breaths/min) (all P<0.001). High-dose danavorexton significantly decreased sedation on visual analog scale (-29.7[-54.1, -5.3] mm, P<0.001) and Richmond Agitation Sedation Scale (0.4[0.0, 0.7], P<0.001), compared with placebo. Improvements in respiratory variables continued beyond completion of danavorexton infusion. No significant differences in pain tolerance were observed between danavorexton doses or between danavorexton and placebo (~13% increase from baseline; low-dose:P=0.491; high-dose:P=0.140).</p><p><strong>Conclusions: </strong>Danavorexton has effects on respiration and wakefulness in an opioid-induced respiratory depression setting without reversing opioid analgesia.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142968759","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":"Protein alterations in patients with delirium after cardiac surgery: An exploratory case-control sub-study of the VISION Cardiac Surgery Biobank.","authors":"Jessica Spence, P J Devereaux, Shaheena Bashir, Katheryn Brady, Tao Sun, Matthew T V Chan, Chew Yin Wang, Andre Lamy, Richard P Whitlock, William F McIntyre, Emilie Belley-Côté, Guillaume Paré, Michael Chong","doi":"10.1097/ALN.0000000000005368","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005368","url":null,"abstract":"<p><strong>Background: </strong>Delirium is an acute state of confusion associated with adverse postoperative outcomes. Delirium is diagnosed clinically using screening tools; most cases go undetected. Identifying a delirium biomarker would allow for accurate diagnosis, application of therapies, and insight into causal pathways. To agnostically discover novel biomarkers of delirium, we conducted a case-control sub-study using the VISION-Cardiac Surgery biobank. Our objective was to identify candidate biomarkers to investigate in future studies.</p><p><strong>Methods: </strong>We obtained a convenience sample of 30 patients with delirium on postoperative day 1 matched to 30 matched controls by age, sex, ethnicity, center and cardiopulmonary bypass time. The Olink Explore 3K platform was used to identify blood protein alterations on postoperative day 3. Protein concentrations were expressed as normalized protein expression (NPx) units (log2 fold scale). We compared protein expression between cases and controls using a paired t-test and reported significantly different biomarkers based on a False Discovery Rate (FDR)-adjusted p-value<0.05.</p><p><strong>Results: </strong>Of 2,865 unique serum proteins, 26 (0.9%) were significantly associated with delirium status; all were elevated in cases versus controls at an FDR<0.05. Pathway analysis identified \"calcium-release channel activity\" (Padj=0.02) and \"Guanosine 5' triphosphate (GTP)-binding\" (Padj=0.005) functions as characteristic of proteins associated with delirium. The top three differentially expressed biomarkers were FKBP1B (Padj=0.003), C2CD2L (Padj=0.004), and RAB6B (Padj=0.004). The inflammatory biomarker IL-8 (CXCL8) (mean difference = 2.36; P=3.6x10-4) was also associated with delirium.</p><p><strong>Discussion: </strong>We identified 26 biomarkers significantly associated with delirium; all are novel except for IL-8. We did not identify an association between delirium and recognized neuro-inflammatory proteins and markers of brain injury, which supports using biomarkers to differentiate between delirium and other neurological conditions. While exploratory, our findings support using biomarkers to diagnose postoperative delirium and validate using agnostic screens to identify potential delirium biomarkers.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942942","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":"Developing an EEG-based model to predict awakening after cardiac arrest using partial processing with the BIS Engine.","authors":"Samuel B Snider, Bradley J Molyneaux, Anarghya Murthy, Quinn Rademaker, Hafeez Rajwani, Benjamin M Scirica, Jong Woo Lee, Christopher Connor","doi":"10.1097/ALN.0000000000005369","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005369","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate prognostication in comatose survivors of cardiac arrest is a challenging and high-stakes endeavor. We sought to determine whether internal EEG subparameters extracted by the Bispectral Index (BIS) monitor, a device commonly used to estimate depth-of-anesthesia intraoperatively, could be repurposed to predict recovery of consciousness after cardiac arrest.</p><p><strong>Methods: </strong>In this retrospective cohort study, we trained a 3-layer neural network to predict recovery of consciousness to the point of command following versus not based on 48 hours of continuous EEG recordings in 315 comatose patients admitted to a single US academic medical center after cardiac arrest (Derivation cohort: N=181; Validation cohort: N=134). Continuous EEGs were partially processed into subparameters using virtualized emulation of the BIS Engine (i.e., the internal software of the BIS monitor) applied to signals from the frontotemporal leads of the standard 10-20 EEG montage. Our model was trained on hourly-averaged measurements of these internal subparameters. We compared this model's performance to the modified Westhall qualitative EEG scoring framework.</p><p><strong>Results: </strong>Maximum prognostic accuracy in the Derivation Cohort was achieved using a network trained on only four BIS subparameters (inverse burst suppression ratio, mean spectral power density, gamma power, and theta/delta power). In a held-out sample of 134 patients, our model outperformed current state-of-the-art qualitative EEG assessment techniques at predicting recovery of consciousness (area under the receiver operating characteristic curve: 0.86, accuracy: 0.87, sensitivity: 0.83, specificity: 0.88, positive predictive value: 0.71, negative predictive value: 0.94). Gamma band power has not been previously reported as a correlate of recovery potential after cardiac arrest.</p><p><strong>Conclusions: </strong>In patients comatose after cardiac arrest, four EEG features calculated internally by the BIS Engine were repurposed by a compact neural network to achieve a prognostic accuracy superior to the current clinical qualitative gold-standard, with high sensitivity for recovery. These features hold promise for assessing patients after cardiac arrest.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942906","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":"Does Management of Postoperative Nausea and Vomiting Differ by Patient Demographics? An Evaluation of Perioperative Anesthetic Management - An Observational Study.","authors":"Kareem V Goldson, Emily Brennan, Brittany N Burton, Abimbola O Faloye, Elizabeth B Habermann, Kristine T Hanson, David O Warner, Mohanad R Youssef, Adam J Milam","doi":"10.1097/ALN.0000000000005367","DOIUrl":"10.1097/ALN.0000000000005367","url":null,"abstract":"<p><strong>Background: </strong>Disparities in postoperative nausea and vomiting (PONV) and its prophylaxis may exist based on race, ethnicity, and socioeconomic status (SES). Our objective was to evaluate whether patients from racial and ethnic minority groups and patients from lower SES backgrounds received less appropriate PONV prophylaxis and experienced higher rates of PONV and post-discharge nausea and vomiting (PDNV).</p><p><strong>Methods: </strong>This retrospective cohort study included 23,333 adults who underwent major surgeries (total knee arthroplasty, cholecystectomy, hysterectomy, and prostatectomy) from 2017-2022 in a single, multi-state hospital system. Outcomes included prophylactic antiemetic administration according to consensus guidelines as well as occurrence of PONV and PDNV, with predictors being patient race and ethnicity, payor type, and community-level SES.</p><p><strong>Results: </strong>About 45% (n=10,407) of patients received guideline-recommended PONV prophylaxis. Regression models showed statistically significant differences in appropriate PONV prophylaxis by race and ethnicity as well as community-level SES, with Black (OR=0.76; 95% CI: 0.63, 0.92) and Hispanic (OR=0.82; 95% CI: 0.70, 0.96) patients having lower odds of receiving appropriate antiemetic prophylaxis compared to non-Hispanic White patients. Approximately 11% of patients (n=2522) experienced PONV in the Post-Anesthesia Care Unit (PACU), and about 19.5% of patients (n=4540) experienced PDNV. No significant differences in PONV were observed in the PACU among different groups, however, Black, Hispanic, Other races and ethnicities, and patients with Medicaid had higher odds of PDNV.</p><p><strong>Conclusion: </strong>The study identified differences in appropriate PONV prophylaxis by race and ethnicity as well as community-level SES. There were no differences in PONV by our predictors, but higher odds of PDNV by race and ethnicity and payor. This study underscores the importance of data stratification in quality measures to identify disparities in perioperative care; it can lead to changes in perioperative anesthetic management. Further research should explore these associations in a broader cohort and address potential confounding sources.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942923","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}