Anesthesiology最新文献

{"title":"Increased global and regional connectivity in propofol-induced unconsciousness: human intracranial electroencephalography study.","authors":"Mikyung Choe, Yunhee Choi, Jii Kwon, Hee-Pyoung Park, Seung-Hyun Jin, June Sic Kim, Seokhyun Lee, Chun Kee Chung","doi":"10.1097/ALN.0000000000005479","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005479","url":null,"abstract":"<p><strong>Background: </strong>The conscious state is maintained through intact communication between brain regions. However, studies on global and regional connectivity changes in unconscious state have been inconsistent. These inconsistencies could arise from unclear definition of unconsciousness, spatial and temporal limitations of neuroimaging modalities, and estimating only single connectivity measure. Here, we investigated global and regional changes in amplitude and phase based functional connectivity in propofol-induced unconsciousness, which is widely recognized as unconsciousness.</p><p><strong>Methods: </strong>We calculated amplitude and phase based functional connectivity using amplitude envelope correlation (AEC), weighted phase lag index (wPLI), and magnitude squared coherence (MSC) from intracranial electroencephalography data of 73 patients. Global changes in connectivity, complexity, and network efficiency were estimated. Regional connectivity changes between Brodmann areas, between 7 cortical lobes, and between resting state networks were assessed across all frequency bands. Additionally, we employed machine learning analysis to identify specific regions in classifying conscious and unconscious states.</p><p><strong>Results: </strong>In the unconscious state, global connectivity increased across all frequency bands, while global complexity and efficiency decreased, accompanied by increased delta and decreased high gamma power spectral density. Regional connectivity increased between entire cortical regions across all frequency bands. Machine learning analysis revealed that posterior connectivity was the most influential in classifying consciousness. Amplitude-based connectivity predominantly increased in the delta and theta bands, while phase-based connectivity predominantly increased from the beta to high gamma bands.</p><p><strong>Conclusions: </strong>Propofol anesthesia suppresses cortical activity and induces oscillatory changes characterized by increased delta power and decreased high gamma power. These changes are accompanied by increased functional connectivity and reduced network complexity and efficiency. These changes limit the brain's ability to generate a diverse repertoire of activity, ultimately leading to unconsciousness. Posterior connectivity, which showed high accuracy in predicting conscious states, would be crucial for sustaining consciousness.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778758","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.0000000000005436","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005436","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 4","pages":"A3-A6"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603587","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":"Influence of Remifentanil on the Pharmacokinetics and Pharmacodynamics of Remimazolam in Healthy Volunteers.","authors":"Remco Vellinga, Jeroen V Koomen, Douglas J Eleveld, Thomas Stöhr, Marija Pesic, Michel M R F Struys, Pieter J Colin","doi":"10.1097/ALN.0000000000005348","DOIUrl":"10.1097/ALN.0000000000005348","url":null,"abstract":"<p><strong>Background: </strong>Synergistic effects between opioids and remimazolam on Bispectral Index (BIS) and Modified Observer's Assessment of Alertness and Sedation (MOAAS) score were previously described. This study aimed to characterize the influence of remifentanil on the sedative properties of remimazolam as measured by MOAAS, BIS, and tolerance to laryngoscopy or tetanic stimulation (TOL or TOTS) and to determine target concentrations that maximize MOAAS 2 or 3.</p><p><strong>Methods: </strong>A three-period, crossover, dose-ranging clinical trial was performed in 24 healthy volunteers. In all periods, remimazolam was administered using a step-up and step-down target controlled infusion protocol (50 to 2,000 ng/ml). Stable remifentanil target concentrations of 0.5 ng/ml and 0.1 to 4.0 ng/ml were maintained in periods 2 and 3, respectively. Remifentanil, remimazolam, and CNS7054 (metabolite) concentrations and MOAAS, BIS, TOL, and TOTS were collected in each step of the target controlled infusion protocol. Data were analyzed using nonlinear mixed-effects models, where P ≤ 0.01 was considered significant.</p><p><strong>Results: </strong>Remifentanil reduced the apparent clearance of CNS7054 with a half-maximum inhibition at 8.0 ng/ml (95% CI, 5.5 to 13.4 ng/ml). A pharmacodynamic interaction was detected on all endpoints. Simulations indicate that the probability of observing a MOAAS 2 or 3 is highest at remimazolam target concentration of 275, 250, or 200 ng/ml combined with 0, 0.1, or 0.5 ng/ml remifentanil resulting in probabilities of 45%, 45%, and 44%, respectively. Additionally, simulations indicate that the highest probability of observing TOTS and TOL was 93.3% and 85.5%, respectively, at the highest studied target concentrations.</p><p><strong>Conclusions: </strong>A pharmacokinetic and pharmacodynamic drug-drug interaction between remimazolam and remifentanil was quantified in this clinical trial. Appropriate target concentrations for MOAAS and BIS could be estimated, but for TOL and TOTS, the trial design did not allow to fully characterize the exposure-response relationship.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 4","pages":"666-679"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603596","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":"Protein Alterations in Patients with Delirium after Cardiac Surgery: An Exploratory Case-Control Substudy 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":"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, a case-control substudy was conducted using the Vascular Events in Surgery Patients Cohort Evaluation (VISION) Cardiac Surgery Biobank. The objective was to identify candidate biomarkers to investigate in future studies.</p><p><strong>Methods: </strong>The study gathered a convenience sample of 30 patients with delirium on postoperative day 1 matched to 30 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 units (log 2 fold scale). Protein expression was compared between cases and controls using a paired t test and identified significantly different biomarkers based on a false discovery rate-adjusted P value of less than 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 a false discovery rate of less than 0.05. Pathway analysis identified calcium-release channel activity ( Padj = 0.02) and 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 interleukin-8 (CXCL8; mean difference = 2.36; P = 3.6 × 10- 4 ) was also associated with delirium.</p><p><strong>Conclusions: </strong>The study identified 26 biomarkers significantly associated with delirium; all are novel except for interleukin-8. An association between delirium and recognized neuroinflammatory proteins or markers of brain injury was not identifed, which supports using biomarkers to differentiate between delirium and other neurologic conditions. While exploratory, the study's 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":"716-725"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","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":"Airway Injury during Double-lumen Endotracheal Intubation.","authors":"Elisa C Walsh, Paul H Alfille, Xiaodong Bao","doi":"10.1097/ALN.0000000000005357","DOIUrl":"10.1097/ALN.0000000000005357","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"738-739"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370239","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":"Preoperative Electroencephalography Biomarkers to Identify Children at Risk for Emergence Delirium.","authors":"Xuan Li, Dezhao Liu, Niannian Chen, Zheng Li, Xiaoli Li, Tianyi Zhou","doi":"10.1097/ALN.0000000000005334","DOIUrl":"10.1097/ALN.0000000000005334","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"758-760"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397767","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":"Pupillometry: Keeping an Eye on Anesthesia.","authors":"","doi":"10.1097/ALN.0000000000005415","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005415","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 4","pages":"715"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603601","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":"With.","authors":"Grace S Kao","doi":"10.1097/ALN.0000000000005319","DOIUrl":"10.1097/ALN.0000000000005319","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"753-754"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389705","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":"Advanced Hemodynamic Monitoring: Are We Asking the Right Questions?","authors":"Daniel I McIsaac, Michael R Mathis, Martin J London","doi":"10.1097/ALN.0000000000005373","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005373","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 4","pages":"593-596"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603578","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":"Hemodynamic Management Guided by the Hypotension Prediction Index in Abdominal Surgery: A Multicenter Randomized Clinical Trial.","authors":"Javier Ripollés-Melchor, José L Tomé-Roca, Andrés Zorrilla-Vaca, César Aldecoa, María J Colomina, Eva Bassas-Parga, Juan V Lorente, Alicia Ruiz-Escobar, Laura Carrasco-Sánchez, Marc Sadurni-Sarda, Eva Rivas, Jaume Puig, Elizabeth Agudelo-Montoya, Sabela Del Rio-Fernández, Daniel García-López, Ana B Adell-Pérez, Antonio Guillen, Rocío Venturoli-Ojeda, Bartolomé Fernández-Torres, Ane Abad-Motos, Irene Mojarro, José L Garrido-Calmaestra, Jesús Fernanz-Antón, Ana Pedregosa-Sanz, Luisa Cueva-Castro, Miren A Echevarria-Correas, Montserrat Mallol, María M Olvera-García, Rosalía Navarro-Pérez, Paula Fernández-Valdés-Bango, Javier García-Fernández, Ángel V Espinosa, Hussein Abu Khudair, Ángel Becerra-Bolaños, Yolanda Díez-Remesal, María A Fuentes-Pradera, Miguel A Valbuena-Bueno, Begoña Quintana-Villamandos, Jordi Llorca-García, Ignacio Fernández-López, Álvaro Ocón-Moreno, Sandra L Martín-Infantes, Javier M Valiente-Lourtau, Marta Amelburu-Egoscozabal, Hugo Rivera-Ramos, Alfredo Abad-Gurumeta, Manuel I Monge-García","doi":"10.1097/ALN.0000000000005355","DOIUrl":"10.1097/ALN.0000000000005355","url":null,"abstract":"<p><strong>Background: </strong>Postoperative acute kidney injury (AKI) after major abdominal surgery leads to poor outcomes. The Hypotension Prediction Index (HPI; Edwards Lifesciences, USA) may aid in managing intraoperative hemodynamic instability. This study assessed whether HPI-guided therapy reduces moderate-to-severe AKI incidence in moderate- to high-risk elective abdominal surgery patients.</p><p><strong>Methods: </strong>This multicenter randomized trial was conducted from October 2022 to February 2024 across 28 hospitals evaluating HPI-guided management compared to a wide range of real-world hemodynamic approaches. A total of 917 patients (65 yr or older or older than 18 yr with American Society of Anesthesiologists Physical Status greater than II) undergoing moderate- to high-risk elective abdominal surgery were included in the intention-to-treat analysis. HPI-guided management triggered interventions when the HPI exceeded 80, using fluids and/or vasopressors/inotropes based on hemodynamic data. The primary outcome was the incidence of moderate-to-severe AKI within the first 7 days after surgery. Secondary outcomes included overall complications, the need for renal replacement therapy, duration of hospital stay, and 30-day mortality.</p><p><strong>Results: </strong>Median age was 71 yr (interquartile range, 65 to 77) in the HPI group and 70 yr (interquartile range, 63 to 76) in standard care group. American Society of Anesthesiologists Physical Status III/IV was 58.3% (268 of 459) in the HPI group and 57.9% (263 of 458) in standard care group. The incidence of moderate-to-severe AKI was 6.1% (28 of 459) in the HPI group and 7.0% (32 of 458) in the standard care group (risk ratio, 0.89; 95% CI, 0.54 to 1.49; P = 0.66). Overall complications occurred in 31.9% (146 of 459) of the HPI group and 29.7% (136 of 458) of the standard care group (risk ratio, 1.08; 95% CI, 0.85 to 1.37; P = 0.52). The incidence of renal replacement therapy did not differ between groups. Median length of hospital stay was 6 days (interquartile range, 4 to 10) in both groups. The 30-day mortality was 1.1% (5 of 459) in the HPI group versus 0.9% (4 of 458) in standard care group (risk ratio, 1.35; 95% CI, 0.36 to 5.10; P = 0.66).</p><p><strong>Conclusions: </strong>HPI-guided hemodynamic therapy did not reduce the incidence of postoperative AKI or overall complications compared to standard care.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"639-654"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920708","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}