Anesthesiology最新文献

{"title":"Ultrasound-guided superficial cervical plexus blocks for persistent pain after suboccipital craniotomies: a randomized trial.","authors":"Min Zeng, Maoyao Zheng, Yue Ren, Xueke Yin, Shu Li, Yan Zhao, Dexiang Wang, Liyong Zhang, Xiudong Guan, Deling Li, Daniel I Sessler, Yuming Peng","doi":"10.1097/ALN.0000000000005238","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005238","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of superficial cervical plexus blocks for reducing persistent pain after craniotomies remains unclear. We therefore tested the primary hypothesis that preoperative ultrasound-guided superficial cervical plexus blocks reduce persistent pain 3 months after suboccipital craniotomies.</p><p><strong>Methods: </strong>We conducted a single-center randomized and blinded parallel-group trial. Eligible patients having suboccipital craniotomies were randomly allocated to superficial cervical plexus blocks with 10 ml of 0.5% ropivacaine or a comparable amount of normal saline. Injections were into the superficial layer of prevertebral fascia. The primary outcome was the incidence of persistent pain three months after surgery.</p><p><strong>Results: </strong>From Nov 2021 to August 2023, 292 qualifying patients were randomly allocated to blocks with ropivacaine (n=146) or saline (n=146). The average ± SD age of participating patients was 45±12 years and the duration of surgery was 4.2±1.3 hours. Persistent pain 3 months after surgery was reported by 48 (34%) of patients randomized to ropivacaine versus 73 (51%) in those assigned to saline (relative risk 0.66; 95% CI, 0.50 to 0.88; P = 0.003) in the per-protocol population, and by 53 (36%) of patients randomized to ropivacaine versus 77 (53%) in those assigned to saline (relative risk 0.69, 95% CI, 0.53 to 0.90; P = 0.005) in the intention-to-treat population.</p><p><strong>Conclusion: </strong>Superficial cervical plexus blocks reduce the incidence of persistent incisional pain by about a third in patients recovering from suboccipital craniotomies.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142306983","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":"Changes in Intra- and Cross-Hemispheric Directed Functional Connectivity in the Electroencephalographic Signals during Propofol-Induced Loss of Consciousness.","authors":"Carla Troyas, Julian Ostertag, Gerhard Schneider, Paul S Garcia, Jamie W Sleigh, Matthias Kreuzer","doi":"10.1097/ALN.0000000000005241","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005241","url":null,"abstract":"<p><strong>Background: </strong>Numerous, sometimes conflicting, changes in brain functional connectivity have been associated with the transition from wakefulness to unresponsiveness at induction of general anesthesia. However, relatively few studies have looked at: the detailed time evolution of the transition; for different EEG frequency bands; and in the clinical scenario of surgical patients undergoing general anesthesia.</p><p><strong>Methods: </strong>We investigated the changes in the frontal and fronto-parietal directed and undirected functional connectivity to multichannel EEG data recorded from 29 adult male surgical patients undergoing propofol-induced loss of consciousness during induction of anesthesia. Directed functional connectivity was estimated using bivariate frequency domain Granger causality, and undirected connectivity was assessed using EEG coherence.</p><p><strong>Results: </strong>Around the point of loss of consciousness: local frontal, interhemispheric frontal, and frontoparietal feedback and feedforward Granger causality all decreased between 31% and 51.5% in the delta-band (median [interquartile range] for local frontal: 0.14 [0.08, 0.27] to 0.08 [0.06, 0.12] (p=0.02)). After a lag of a few minutes, Granger Causality markedly increased in the gamma and beta bands for local frontal (0.03 [0.02, 0.07] to 0.09 [0.07, 0.11](p<0.001)) and long-distance cross-hemispheric frontoparietal feedback (0.02 [0.01, 0.04] to 0.07 [0.04, 0.09], p<0.001) and feedforward (0.02 [0.01, 0.04] to 0.03 [0.03, 0.04], p=0.01) coupling; but not for within-hemispheric frontoparietal feedback and feedforward. Frontal interhemispheric EEG coherence significantly decreased in the lower frequencies (f<12Hz) at loss of consciousness, while no significant increase for the beta and gamma bands was observed.</p><p><strong>Conclusions: </strong>Propofol-induced loss of consciousness in surgical patients is associated with a global breakdown in low-frequency directed functional connectivity, coupled with a high-frequency increase between closely located brain regions. At loss of consciousness, Granger causality shows more pronounced changes than coherence.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142306982","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":"Perioperative Care for Spine Surgery: Comment.","authors":"Todd Nelson","doi":"10.1097/aln.0000000000005123","DOIUrl":"https://doi.org/10.1097/aln.0000000000005123","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"7 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245463","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":"Perioperative Care for Spine Surgery: Comment.","authors":"Jairo R Moyano A","doi":"10.1097/aln.0000000000005124","DOIUrl":"https://doi.org/10.1097/aln.0000000000005124","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"331 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245462","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":"Perioperative Care for Spine Surgery: Reply.","authors":"Louanne M Carabini,John F Bebawy","doi":"10.1097/aln.0000000000005125","DOIUrl":"https://doi.org/10.1097/aln.0000000000005125","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"46 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245461","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":"Heart under Pressure: Intrathoracic Impact of Large Hiatal Hernia.","authors":"Youlei Li,Dahyun Kang,Michael Gonzalez,Alexander Doyal","doi":"10.1097/aln.0000000000005154","DOIUrl":"https://doi.org/10.1097/aln.0000000000005154","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"10 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245464","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":"Ex Utero Intrapartum Intubation for Giant Fetal Neck Mass.","authors":"Mengyun Zhao,Lijian Pei,Yulin Jiang,Jingsong Gao","doi":"10.1097/aln.0000000000005162","DOIUrl":"https://doi.org/10.1097/aln.0000000000005162","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"52 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174725","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":"Diagnosis and Treatment of Perioperative Anemia: A Society for Perioperative Assessment and Quality Improvement Collaborative Review.","authors":"Mandeep Kumar,David L Hepner,Erin S Grawe,Maureen Keshock,Maleka Khambaty,Manish S Patel,BobbieJean Sweitzer","doi":"10.1097/aln.0000000000005111","DOIUrl":"https://doi.org/10.1097/aln.0000000000005111","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"36 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174645","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":"Polygenic Score for the Prediction of Postoperative Nausea and Vomiting: A Retrospective Derivation and Validation Cohort Study.","authors":"Nicholas J Douville,Lisa Bastarache,Jing He,Kuan-Han H Wu,Brett Vanderwerff,Emily Bertucci-Richter,Whitney E Hornsby,Adam Lewis,Elizabeth S Jewell,Sachin Kheterpal,Nirav Shah,Michael Mathis,Milo C Engoren,Christopher B Douville,Ida Surakka,Cristen Willer,Miklos D Kertai","doi":"10.1097/aln.0000000000005214","DOIUrl":"https://doi.org/10.1097/aln.0000000000005214","url":null,"abstract":"BACKGROUNDPostoperative nausea and vomiting (PONV) is a key driver of unplanned admission and patient satisfaction following surgery. Because traditional risk factors do not completely explain variability in risk, we hypothesize that genetics may contribute to the overall risk for this complication. The objective of this research is to perform a genome-wide association study of PONV, derive a polygenic risk score for PONV, assess associations between the risk score and PONV in a validation cohort, and compare any genetic contributions to known clinical risks for PONV.METHODSSurgeries with integrated genetic and perioperative data performed under general anesthesia at Michigan Medicine and Vanderbilt University Medical Center were studied. PONV was defined as nausea or emesis occurring and documented in the PACU. In the Discovery Phase, genome-wide association studies were performed on each genetic cohort and the results were meta-analyzed. Next, in the Polygenic Phase, we assessed whether a polygenic score, derived from genome-wide association study in a derivation cohort from Vanderbilt University Medical Center, improved prediction within a validation cohort from Michigan Medicine, as quantified by discrimination (C-statistic) and net reclassification index.RESULTSOf 64,523 total patients, 5,703 developed PONV (8.8%). We identified 46 genetic variants exceeding P<1x10-5 threshold, occurring with minor allele frequency > 1%, and demonstrating concordant effects in both cohorts. Standardized polygenic score was associated with PONV in a basic model, controlling for age and sex, (aOR 1.027 per standard deviation increase in overall genetic risk, 95% CI 1.001-1.053, P=0.044), a model based on known clinical risks (aOR 1.029, 95% CI 1.003-1.055, P=0.030), and a full clinical regression, controlling for 21 demographic, surgical, and anesthetic factors, (aOR 1.029, 95% CI 1.002-1.056, P=0.033). The addition of polygenic score improved overall discrimination in models based on known clinical risk factors (c-statistic: 0.616 compared to 0.613, P=0.028) and improved net reclassification of 4.6% of cases.CONCLUSIONStandardized polygenic risk was associated with PONV in all three of our models, but the genetic influence was smaller than exerted by clinical risk factors. Specifically, a patient with a polygenic risk score > 1 standard deviation above the mean, has 2-3% greater odds of developing PONV when compared to the baseline population, which is at least an order of magnitude smaller than the increase associated with having prior PONV/motion sickness (55%), having a history of migraines (17%), or being female (83%), and is not clinically significant. Furthermore, the use of a polygenic risk score does not meaningfully improve discrimination compared to clinical risk factors and is not clinically useful.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"57 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142165934","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 Required Reconsideration of \"Required Reconsideration\": Pioneering a New Paradigm for Perioperative Management of Patients Presenting with Treatment Limitations.","authors":"Rachel Hadler, Rebecca A Aslakson","doi":"10.1097/ALN.0000000000005116","DOIUrl":"10.1097/ALN.0000000000005116","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"141 3","pages":"440-442"},"PeriodicalIF":9.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970452","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}