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":"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, the authors explored the hypothesis that somatostatin interneurons in the medial prefrontal cortex enhance the effects of sevoflurane anesthesia by increasing γ-aminobutyric acid (GABA) transmission to pyramidal neurons.</p><p><strong>Methods: </strong>Electroencephalography 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 vs. sevoflurane: 26.4 ± 6.5% vs. 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 (baseline vs . pre-loss of the righting reflex: 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 leads to a significant reduction in calcium signals within local pyramidal neurons (baseline vs . 20 Hz stimulation: from -0.14 ± 0.52% to -10.08 ± 4.44%; P = 0.002; n = 10 mice). Additionally,GABA input on pyramidal neurons increased (baseline vs . 20 Hz stimulation: 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":"844-862"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","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":"Instructions for Obtaining Anesthesiology Continuing Medical Education (CME) Credit.","authors":"","doi":"10.1097/ALN.0000000000005458","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005458","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"A13"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802356","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":"Surgical Antibiotic Prophylaxis Dosing in Adult Patients with Obesity: A Comprehensive Review of Pharmacokinetic and Pharmacodynamic Data.","authors":"Stefanie Nothofer, Michael Haselbeck-Koebler, Markus Zeitlinger, Christoph Dorn, David Petroff, Hermann Wrigge, Christian Dumps, Axel R Heller, Philipp Simon","doi":"10.1097/ALN.0000000000005410","DOIUrl":"10.1097/ALN.0000000000005410","url":null,"abstract":"<p><p>Surgical antibiotic prophylaxis is an important measure to prevent postoperative surgical site infections. Current guideline recommendations do not treat obesity specifically, although it can affect pharmacokinetics and pharmacodynamics. The objective of this review was to synthesize current evidence on the need for obesity-related dosing adjustments in surgical antibiotic prophylaxis. MEDLINE and Cochrane Library were searched for studies investigating antibiotic prophylaxis dosing in surgical patients with obesity. Outcomes of interest were pharmacokinetic parameters such as plasma and interstitial fluid concentrations, area under the concentration time curve in plasma and in interstitial fluid, and other pharmacokinetic measures. Thirty studies investigating cefazolin, cefoxitin, cefuroxime, piperacillin/tazobactam, meropenem, ertapenem, metronidazole, vancomycin, ciprofloxacin, and gentamicin were included in this analysis. Except for metronidazole, cefoxitin, and gentamicin, there is currently no evidence suggesting the need for dosing adjustments.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 5","pages":"929-948"},"PeriodicalIF":9.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802365","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":"Breath Analysis of Propofol and Associated Metabolic Signatures: A Pilot Study Using Secondary Electrospray Ionization High-Resolution Mass Spectrometry.","authors":"Jiafa Zeng,Nikola Stankovic,Kapil Dev Singh,Regula Steiner,Urs Frey,Thomas Erb,Pablo Sinues","doi":"10.1097/aln.0000000000005531","DOIUrl":"https://doi.org/10.1097/aln.0000000000005531","url":null,"abstract":"BACKGROUNDPropofol is a widely used anesthetic for total intravenous anesthesia (TIVA). Though generally safe, rare but serious complications can occur in vulnerable groups, such as critically ill patients and children. Clinicians often rely on surrogate measures (e.g., predicted effect-site concentrations or bispectral index), yet more direct indicators of anesthetic exposure and metabolic stress would be valuable. We hypothesized that pharmacometabolomics via breath analysis could yield real-time insights into propofol concentrations as well as accompanying metabolic responses to surgery.METHODSIn this pilot, 10 pediatric patients (median age 5.9 years; interquartile range 4.3-6.6) undergoing propofol anesthesia contributed 47 breath samples (10 pre-induction, 37 post-induction) and 37 blood samples. All samples were analyzed by high-resolution mass spectrometry. Linear mixed-effects models examined associations between exhaled compounds and serum propofol concentrations while accounting for repeated measures in individual patients. Volcano plots were used to identify differential changes in metabolites following propofol induction.RESULTSPropofol, its metabolites, and endogenous metabolites were readily detected in exhaled breath, demonstrating strong correlations with serum propofol concentrations (R² ≥ 0.65; adjusted p < 0.001). Differential analysis showed significant upregulation of endogenous fatty aldehydes (log₂[post/pre] ≥ 1; adjusted p ≤ 0.05), suggestive of lipid peroxidation and oxidative stress. Exogenous compounds, including benzene and phenols, were also observed, reflecting propofol metabolism in vivo.CONCLUSIONSThis pilot study highlights a robust breath-serum relationship for propofol and reveals surgery-associated shifts in metabolic pathways, including evidence of oxidative stress. These findings underscore the feasibility of exhaled-breath pharmacometabolomics for individualized anesthetic care. Further validation in larger cohorts is warranted to confirm clinical utility and to determine whether real-time breath analysis could ultimately serve as a useful adjunct for guiding anesthetic management and monitoring perioperative metabolic responses.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"19 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861981","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":"Development and external validation of a novel in-hospital mortality model after pediatric congenital heart surgery-a multicenter retrospective cohort study.","authors":"Chaoyang Tong,Qihang Li,Xinwei Du,Mengqin Shan,Yuxin Zhang,Haixi Wu,Ziyun Shen,Zhuoming Xu,Xiaodong Ge,Shuang Cai,Xin Fu,Kan Zhang,Haibo Zhang,Shoujun Li,Changhong Miao,Jijian Zheng","doi":"10.1097/aln.0000000000005514","DOIUrl":"https://doi.org/10.1097/aln.0000000000005514","url":null,"abstract":"BACKGROUNDThe applicability of four major traditional in-hospital mortality models in the Chinese setting is unclear due to disease spectrum and population heterogeneity. This study aimed to test the performance of these models in the Chinese setting and to construct and externally validate a novel model.METHODS21,855 consecutive pediatric patients who underwent congenital heart surgery from January 2015 to December 2021 in Shanghai Children's Medical Center were enrolled. For external validation, we additionally pooled 5,221 consecutive pediatric patients who underwent this surgical treatment from January 2020 to December 2021 in Beijing Fuwai Hospital. The performance of Aristotle Basis Complexity (ABC) score, Risk Adjustment for Congenital Heart Surgery (RACHS)-1 categories, Society of Thoracic Surgeons (STS)-European Association for Cardiothoracic Surgery (STAT) score, and STAT categories was tested. Independent predictors were used to develop a model. The area under the receiver operating characteristic curves (AUROCs) and Brier score were used to examine the model performance.RESULTSThe AUROCs were 0.778 for ABC score, 0.685 for RACHS-1 categories, 0.808 for STAT score, and 0.784 for STAT categories. When preoperative covariates were added to four models, the AUROCs improved: ABC score (AUROC=0.860), RACHS-1 categories (AUROC=0.844), STAT score (AUROC= 0.856), and STAT categories (AUROC=0.864). The best-performing model incorporated 6 variables, including age, height, oxygen support, previous cardiac operation, emergency surgery, and STAT categories. The AUROCs and Brier score were 0.864 and 0.00977 in the development cohort, and 0.860 and 0.00654 in the external validation cohort.CONCLUSIONSFour major traditional models were only moderately effective in predicting in-hospital mortality after congenital heart surgery in the Chinese setting. The novel model founded on the STAT categories in combination with preoperative covariates can serve as a useful and effective tool for predicting the risk of in-hospital mortality after congenital heart surgery in the Chinese setting.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"90 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846407","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":"Thrombin Generation in Pediatric Cardiac Surgery Patients, a Prospective Single-center Cohort Study.","authors":"Elena Ashikhmina Swan,Brian D Lahr,Ahmad H Al-Huniti","doi":"10.1097/aln.0000000000005502","DOIUrl":"https://doi.org/10.1097/aln.0000000000005502","url":null,"abstract":"BACKGROUNDThe objective of this study was to describe thrombin generation in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Change in the endogenous thrombin potential (ETP) across three measurements before and after CPB (after protamine and at chest closure) was the primary outcome. Secondary analyses explored an association between thrombin generation and transfusion requirements and predictors of the thrombin generation decline.METHODSBlood samples of children (median age 6.3 months; 68.5% weighed <10 kg) were collected intraoperatively three times: before administration of heparin (baseline), shortly after protamine and at sternal closure. Platelet poor plasma obtained after centrifugation of these samples was frozen at -80ºC. Thrombin generation and anti-Xa assays were performed in series on batches of thawed samples to evaluate thrombin generation parameters and functional activity of unfractionated heparin which could have affected thrombin generation assay results.RESULTSBetween August 2022 and May 2024, 162 plasma samples from 54 patients were collected and analyzed. Compared with baseline, mean ETP decreased by 1911 nM (95% CI 1655 to 2168) after administration of protamine, and by 1865 nM (95% CI 1609 to 2122) at sternal closure, P<0.001. Similar changes were observed in secondary thrombin generation parameters. Median unfractionated heparin activity was <0.1 U/ml at all three time points. Secondary analyses showed strong negative correlation between ETP after protamine and volume of transfusion after bypass (ρ =-0.52, P<0.001). Among five examined factors, only total heparin dose was independently associated with ETP decline, with higher dose being predictive of greater ETP decline (P=0.002).CONCLUSIONSIn children undergoing cardiac surgery, we noted a significant and persistent decline in endogenous thrombin potential following cardiopulmonary bypass, despite hemostatic interventions. This reduced thrombin potential correlated with higher volume of transfusions. Additionally, greater intraoperative heparin requirements could be linked to a more pronounced decline in thrombin generation.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"1 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836540","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 Point-of-care allogeneic red blood cell washing on markers of transfusion-related respiratory complications: A phase II randomized clinical trial.","authors":"Daryl J Kor,Matthew A Warner,Philip J Norris,Sarah Armour,Erica D Wittwer,Paula J Santrach,Laurie A Meade,Chelsea M Conn,Phillip J Schulte,Richard S Pendegraft,Clara Di Germanio,Mihai Podgoreanu,Ian J Welsby","doi":"10.1097/aln.0000000000005505","DOIUrl":"https://doi.org/10.1097/aln.0000000000005505","url":null,"abstract":"BACKGROUNDTransfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are leading causes of transfusion-related morbidity and mortality. Soluble factors in red blood cell (RBC) supernatant may increase risk for these complications. We hypothesized that point-of-care allogeneic RBC washing may be an effective intervention to mitigate elevations in soluble factors as well as physiologic responses associated with transfusion-associated respiratory complications in the setting of cardiac surgery.METHODSThis is a two-center, non-blinded, randomized clinical trial evaluating point-of-care washed versus standard-issue allogeneic RBC transfusions administered during or on the day of cardiac surgery. The primary analysis was performed via modified intention-to-treat. The primary outcomes assessed were changes in intermediate markers of lung injury as well as cardiopulmonary physiologic responses to RBC transfusion. Secondary outcomes included the duration of intensive care unit and hospital stay, durations of mechanical ventilation and oxygen supplementation, presence of TRALI or TACO, and mortality.RESULTSAmong 154 analyzed patients (81 washed, 73 standard issue), median age was 66 years and 77 (50.0%) were women. The median (IQR) number of allogeneic RBC units transfused on the day of surgery was 3.0 (2.0 - 5.0) in the washed RBC group and 3.0 (2.0 - 4.0) in the standard issue group (p = 0.13). No between-group differences were identified in any of the assessed recipient lung injury biomarkers (all p-values > adjusted alpha). Durations of intensive care unit stay (median [interquartile range]; 3.0 [2.0-5.0] versus 3.0 [2.0-4.0] days; p = 0.117) and hospital length of stay (12.0 [9.0-17.0] versus 12.0 [9.0-17.0] days; p = 0.801) were similar, as were the number of ventilator-free days at day 28 (27.0 [27.0-27.0] versus 27.0 [26.0-27.0]; p = 0.699) and oxygen free days at day 28 (24.0 [19.0-26.0] versus 24.0 [22.0-26.0]; p = 0.400) . No significant differences were noted in mortality rate nor in incidence rates for TRALI, TACO, and acute kidney injury.CONCLUSIONSAmong patients undergoing cardiovascular surgery with high risk of RBC transfusion, point-of-care washing of allogeneic RBC transfusions did not mitigate changes in intermediate markers of lung injury or cardiopulmonary physiologic responses to RBC transfusion and was not associated with improved clinical outcomes.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"121 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836520","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":"Magnetic Resonance Imaging of Brachial Plexopathy after Prolonged Prone Positioning.","authors":"Ryan M Meral,Douglas H Anderson,Trishul Kapoor,Srinivas Chiravuri","doi":"10.1097/aln.0000000000005430","DOIUrl":"https://doi.org/10.1097/aln.0000000000005430","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"299 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836527","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 Use of the Society for Pediatric Anesthesia's Pedi Crisis 2.0 Mobile Application as an Educational Assessment Tool for Pediatric Anesthesiology Fellows: A Prospective, Randomized, Controlled Multi-Center Study.","authors":"Kim M Strupp,Tessa Mandler,Lucine Papazian,Zhaoxing Pan,Devika Singh,Lenard W Babus,William B Waldrop,Chaitanya Challa,Caroll N Vazquez-Colon,Debnath Chatterjee,Myron Yaster,Sean Schooley,Rebecca Safon,Lawrence Schwartz,Adria Boucharel,","doi":"10.1097/aln.0000000000005499","DOIUrl":"https://doi.org/10.1097/aln.0000000000005499","url":null,"abstract":"BACKGROUNDAnesthesiologists manage life-threatening, critical events in a fast-paced, high-distraction atmosphere, with little time to deliberate about treatment options. The Society for Pediatric Anesthesia developed the Pedi Crisis 2.0 Mobile Application to assist in managing critical pediatric perioperative events. We hypothesized that the application could be used as a formal educational assessment tool in pediatric anesthesiology fellowship training and developed a one-hour classroom examination designed to assess the impact of the application on fellows' knowledge of the management of pediatric critical events. We sought to evaluate whether the just-in-time knowledge provided by the application leads to improved testing outcomes compared with baseline knowledge alone.METHODSPediatric anesthesia fellows participated in a one-hour session with ten pediatric critical event scenarios (stems). Each scenario presented a case with open-ended questions on standard management. Participants were randomized to answer half of the stems using the application (APP) and half of the stems not using the application (NO APP). Instead, they utilized knowledge from routine practice, memory recall, and alternative electronic resources. Two blinded reviewers graded answers, and the average percent of correct answers was calculated.RESULTSFifty-one pediatric anesthesiology fellows from four institutions enrolled in the study. Six fellows were improperly randomized and excluded. The total percent correct scores for stems 1/3/5/7/9 and 2/4/6/8/10 were significantly higher for the APP condition (78.7% vs 45.4%, 59% vs 40%, p<0.0001). The percent correct answers for individual stems varied; the APP condition scores were always statistically higher than the NO APP condition (p < 0.05).CONCLUSIONSPediatric anesthesiology fellows were significantly more successful at describing the management of pediatric critical events when using the Pedi Crisis 2.0 application compared to not using the application. Thus, we believe that cognitive aids, such as Pedi Crisis 2.0, should be an integral component of pediatric anesthesia fellowship training curricula.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"113 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836522","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":"Frailty and Cardiac Complications after Minor and Major Noncardiac Surgery in Older Adults.","authors":"Chan Mi Park,Jessica J Lie,Darae Ko,Xiecheng Chen,Dae Hyun Kim","doi":"10.1097/aln.0000000000005447","DOIUrl":"https://doi.org/10.1097/aln.0000000000005447","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"7 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836528","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}