Anesthesiology最新文献

{"title":"A Randomized Controlled Trial of Intraoperative Ketamine for Acute Postsurgical Pain after Breast Cancer Surgery: The Moderating Effect of Baseline Temporal Summation of Pain.","authors":"Jenna M Wilson,Sheila Gokul,Angelina R Franqueiro,Emily Rosado,Richard J Yong,Robert R Edwards,Kristin L Schreiber","doi":"10.1097/aln.0000000000005649","DOIUrl":"https://doi.org/10.1097/aln.0000000000005649","url":null,"abstract":"BACKGROUNDActivation of nociceptive pathways by surgical trauma can induce central sensitization, which is associated with greater pain severity and persistence. The NMDA-receptor antagonist ketamine blocks central sensitization, but has a variable track-record for preventing postsurgical pain. Patient-level factors contribute to variability in pain and may serve as markers of differential efficacy of preventive effect.METHODSThis prospective, longitudinal randomized controlled trial investigated the effectiveness of intraoperatively administered ketamine to decrease postoperative pain after breast surgery. Before surgery, patients reported demographic and medical information and completed validated pain and psychosocial questionnaires. A subset of patients also underwent quantitative sensory testing to assess baseline temporal summation of pain (central sensitization tendency). Analyses of Covariance, controlling for relevant pre- and peri-operative factors, examined treatment group (ketamine vs. saline) differences in 2-week postoperative pain outcomes. Exploratory moderation analysis explored whether the efficacy of ketamine differed based on patients' baseline temporal summation of pain.RESULTSOf the sample of 225 patients, 113 received ketamine and 112 received placebo. The majority of patients underwent lumpectomy (53%), with 16% undergoing mastectomy and 30% mastectomy with reconstruction. There were no significant treatment group differences in pain severity or impact reported two weeks after surgery. However, moderation analysis revealed that among patients with higher baseline temporal summation of pain, ketamine was associated with lower pain severity and impact scores.CONCLUSIONSKetamine was not associated with an analgesic benefit over placebo in the acute postoperative period, as measured using a variety of pain assessments. However, exploratory moderation analysis suggested that patients with evidence of a greater central sensitization at baseline may derive an analgesic effect of ketamine. These findings support future collection of baseline phenotypic patient characteristics related to relevant mechanisms in trials, to identify which patients may derive a larger benefit from analgesic interventions.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"14 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639745","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":"Cerebral Blood Flow Under Pressure: Investigating Cerebrovascular Compliance with Phase Contrast Magnetic Resonance Imaging During Induced Hypertension.","authors":"Jonas Österlind,Johan Birnefeld,Anders Eklund,Magnus Hultin,Anders Wåhlin,Petter Holmlund,Laleh Zarrinkoob","doi":"10.1097/aln.0000000000005651","DOIUrl":"https://doi.org/10.1097/aln.0000000000005651","url":null,"abstract":"BACKGROUNDInduced hypertension is used clinically to increase cerebral blood flow (CBF) in conditions such as vasospasm after subarachnoid hemorrhage. However, increased blood pressure also raises pulsatile force. Cerebrovascular compliance plays a key role in buffering flow dynamics and protecting the microcirculation, but whether it adapts to elevated pressure remains unclear. This study assessed the response of compliant cerebral arteries to induced hypertension in healthy adults using phase-contrast magnetic resonance imaging (PCMRI) and two compliance models: a two-element Windkessel (CWK) and a simplified model (CVP), representing the extremes of pulsatility transmission at the capillary level.METHODSEighteen healthy adults (median age: 34 years; 9 females) underwent PCMRI at baseline and after increasing mean arterial pressure by 20% using norepinephrine (NE) infusion. PCMRI quantified CBF and cardiac output, while cerebrovascular resistance and systemic vascular resistance were derived. Flow waveforms were combined with blood pressure to assess CWK and CVP in CBF, ascending/descending aorta, and external carotid arteries, while corresponding regions of interest were used to calculate cross-sectional flow areas. Data are reported as median (interquartile range).RESULTSNE increased cerebrovascular compliance significantly; CWK by 110% (56% to 163%; P=0.001) and CVP by 11% (-2% to 26%; P=0.018). CWK increased in the external carotid artery by 12% (1% to 32%; P=0.037) but did not change in the ascending or descending aorta. CVP decreased in the descending aorta by 5% (-11% to 2%; P=0.028), with no changes in the ascending aorta or external carotid artery. Cross-sectional area of cerebral arteries contributing to CBF decreased by 5% (-17% to -3%; P=0.033), while the ascending and descending aorta areas increased by 7% (4% to 11%; P=0.012) and 8% (6% to 11%; P<0.001), respectively.CONCLUSIONCerebral arteries enhanced their compliance during NE-induced hypertension, unlike systemic arteries, regardless of the assumed degree of pulsatility transmission.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"6 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611494","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 Comprehensive Update on Intraoperative Methadone Use.","authors":"James Xie,Stephanie J Pan,T Anthony Anderson","doi":"10.1097/aln.0000000000005550","DOIUrl":"https://doi.org/10.1097/aln.0000000000005550","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"22 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603983","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":"Recovery of the acute hypoxic ventilatory response after reversal of a minimal neuromuscular block. A randomized, controlled trial in healthy, non-obese volunteers.","authors":"Merel A J Snoek,Maarten A van Lemmen,Rutger van der Schrier,Monique van Velzen,Albert Dahan,Martijn Boon","doi":"10.1097/aln.0000000000005650","DOIUrl":"https://doi.org/10.1097/aln.0000000000005650","url":null,"abstract":"BACKGROUNDNeuromuscular blocking agents inhibit the peripheral chemoreflex. We examined the effect of sugammadex 2 mg/kg and 4 mg/kg compared to spontaneous recovery of neuromuscular block (NMB) on the recovery of the acute hypoxic ventilatory response (AHVR).METHODSThis was a 2-experiment, randomized, controlled trial in healthy volunteers. Participants received a continuous infusion of rocuronium, to achieve stable symptoms of neuromuscular block in the head and neck region (symptomatic NMB). Thereafter, NMB was allowed to recover spontaneously in the first experiment, while in experiment 2, volunteers were randomized to receive sugammadex 2 mg/kg or 4 mg/kg for reversal. The depth of neuromuscular block was assessed with electromyography at the adductor pollicis muscle. AHVR was measured at baseline; during stable NMB; and at 0-, 20-, and 40-minutes post-recovery.RESULTSThirty-seven volunteers were enrolled; data from 27 volunteers were eligible for analysis. AHVR was reduced by 32% (mean difference versus baseline (MD) -0.22 L.%-1.min-1, 95% CI -0.32 to -0.12) during symptomatic NMB (mean train of four ratio 0.42 ± 0.22;). At the disappearance of all symptoms, AHVR remained on average depressed by 23% (MD -0.16 L.%-1.min-1, 95% CI -0.28 to -0.04). In 57% of volunteers following spontaneous recovery versus 28% following sugammadex reversal, AHVR did not return to baseline values during the measurement period. In addition, the magnitude of residual AHVR depression was greater following spontaneous recovery compared to reversal with sugammadex. However, on average AHVR was not significantly different from baseline at 20 and 40 minutes post-recovery in any group.CONCLUSIONSThe AHVR after reversal of a minimal NMB with sugammadex did not significantly differ with spontaneous recovery of NMB. However, fewer patients had residual depression of AHVR when sugammadex was used. In all groups, a considerable proportion of patients had residual depression of the AHVR 40 minutes after recovery.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"696 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611500","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":"Anesthesia Management of a Patient with a Giant Dilated Pulmonary Artery.","authors":"Ryo Wakabayashi,Ayako Hirai,Gaku Kawamura,Kanji Uchida","doi":"10.1097/aln.0000000000005588","DOIUrl":"https://doi.org/10.1097/aln.0000000000005588","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"19 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144594108","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 Last Time.","authors":"Sophia Zhao","doi":"10.1097/ALN.0000000000005556","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005556","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599181","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":"Potential Benefits of Medical Nutrition Therapy for Timely Ventilator Weaning in the Critically Ill.","authors":"Silvia De Rosa,Michela Rauseo,Michele Umbrello,Sergio Lassola,Denise Battaglini","doi":"10.1097/aln.0000000000005557","DOIUrl":"https://doi.org/10.1097/aln.0000000000005557","url":null,"abstract":"Nutritional support and metabolic assessment are crucial in weaning from invasive mechanical ventilation. This review explores strategies for metabolic assessment and tailored nutritional interventions and their impact on weaning outcomes, highlighting individualized nutritional interventions. While indirect calorimetry provides direct metabolic data, diaphragm ultrasound can complement metabolic monitoring by assessing respiratory muscle function and detecting early signs of muscle wasting. Protein intake in critically ill patients remains controversial, as early high protein administration (greater than 1.2 g/kg each day) has not demonstrated clear benefits and may even be detrimental to successful ventilator weaning, supporting the adoption of a moderate, individualized nutritional strategy. Vitamin D deficiency is common in critically ill patients, and targeted supplementation may reduce mechanical ventilation duration. High-fat and ketogenic diets have shown limited benefit and are not currently recommended. Some nutritional supplements (e.g., creatine, branched-chain amino acids, β-hydroxy-β-methylbutyrate) are under investigation, but current evidence does not support their routine use. A personalized approach integrating metabolic assessment, tailored protein intake, and vitamin D optimization may improve weaning success, functional recovery, and post-intensive care unit outcomes. Further research is needed to refine evidence-based guidelines.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"694 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144594218","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":"Ephedrine and the Brain: Bridging Hemodynamics, Neuromodulation, and Potential Neuroprotection in Perioperative Medicine.","authors":"Lingzhong Meng,Mads Rasmussen","doi":"10.1097/aln.0000000000005532","DOIUrl":"https://doi.org/10.1097/aln.0000000000005532","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"12 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144594222","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":"Three Years On: The Impact of the Dobbs Decision on Anesthesia Practice.","authors":"David R Gambling,Tracey M Vogel,John C Markley,Andrea J Traynor,Jennifer H Cohn,Christy L Morgan","doi":"10.1097/aln.0000000000005512","DOIUrl":"https://doi.org/10.1097/aln.0000000000005512","url":null,"abstract":"Many individuals seeking abortion care since the Dobbs decision present at later gestations and with comorbidities. This article discusses its impact on patients and anesthesia providers and suggests opportunities to improve health outcomes.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"12 1","pages":"261-265"},"PeriodicalIF":8.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578722","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":"Anesthetic Amnesia: The Forgotten Importance of Forgetting?","authors":"Kane O Pryor,Yandong Jiang,Jamie W Sleigh","doi":"10.1097/aln.0000000000005544","DOIUrl":"https://doi.org/10.1097/aln.0000000000005544","url":null,"abstract":"There is increasing evidence that the impairment of consciousness by anesthetic drugs does not always lead to its complete absence and that the loss of subjective experience with anesthesia may at times be an illusion created by amnesia. However, the study of how anesthetic drugs cause amnesia, and importantly how they fail, has received less attention than the other cardinal properties of anesthesia. There is no reliable biomarker to determine the adequacy of pharmacologic amnesia in real time. Anesthetic drugs can influence all stages of memory formation and recall, and their amnestic effects are dissociable from their hypnotic effects; for example, propofol has potent specific amnestic potential, whereas dexmedetomidine is a pure hypnotic. Post-traumatic stress disorder cluster symptoms, which constitute a disorder of amygdala-centered memory systems, are commonly related to surgical memories under both general anesthesia and procedural sedation and need to be better understood and managed.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"109 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578763","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}