Anesthesiology最新文献

{"title":"Impaired Macroscopic Cerebrospinal Fluid Flow by Sevoflurane in Humans during and after Anesthesia.","authors":"Juliana Zimmermann, Christian Sorg, Leander Müller, Franziska Zistler, Viktor Neumaier, Moritz Bonhoeffer, Andreas Ranft, Daniel Golkowski, Josef Priller, Claus Zimmer, Rüdiger Ilg, Christine Preibisch, Gerhard Schneider, Rachel Nuttall, Benedikt Zott","doi":"10.1097/ALN.0000000000005360","DOIUrl":"10.1097/ALN.0000000000005360","url":null,"abstract":"<p><strong>Background: </strong>According to the model of the glymphatic system, the directed flow of cerebrospinal fluid (CSF) is a driver of waste clearance from the brain. In sleep, glymphatic transport is enhanced, but it is unclear how it is affected by anesthesia. Animal research indicates partially opposing effects of distinct anesthetics, but corresponding results in humans are lacking. Thus, this study aims to investigate the effect of sevoflurane anesthesia on CSF flow in humans, both during and after anesthesia.</p><p><strong>Methods: </strong>Using data from a functional magnetic resonance imaging experiment in 16 healthy human subjects before, during, and 45 min after sevoflurane monoanesthesia of 2 volume percent (vol%), the authors related gray matter blood oxygenation level-dependent signals to CSF flow, indexed by functional magnetic resonance imaging signal fluctuations, across the basal cisternae. Specifically, CSF flow was measured by CSF functional magnetic resonance imaging signal amplitudes, global gray matter functional connectivity by the median of interregional gray matter functional magnetic resonance imaging Spearman rank correlations, and global gray matter-CSF basal cisternae coupling by Spearman rank correlations of functional magnetic resonance imaging signals.</p><p><strong>Results: </strong>Anesthesia decreased cisternal CSF peak-to-trough amplitude (median difference, 1.00; 95% CI, 0.17 to 1.83; P = .013) and disrupted the global cortical blood oxygenation level-dependent and functional magnetic resonance imaging-based connectivity (median difference, 1.5; 95% CI, 0.67 to 2.33; P < 0.001) and global gray matter-CSF coupling (median difference, 1.19; 95% CI, 0.36 to 2.02; P = 0.002). Remarkably, the impairments of global connectivity (median difference, 0.94; 95% CI, 0.11 to 1.77; P = 0.022) and global gray matter-CSF coupling (median difference, 1.06; 95% CI, 0.23 to 1.89; P = 0.008) persisted after re-emergence from anesthesia.</p><p><strong>Conclusions: </strong>Collectively, the authors' data show that sevoflurane impairs macroscopic CSF flow via a disruption of coherent global gray matter activity. This effect persists, at least for a short time, after regaining consciousness. Future studies need to elucidate whether this contributes to the emergence of postoperative neurocognitive symptoms, especially in older patients or those with dementia.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"692-703"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942939","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":"Dr. Benjamin Rush: The Founding Father Who Healed a Wounded Nation.","authors":"Kathryn E McGoldrick","doi":"10.1097/ALN.0000000000005317","DOIUrl":"10.1097/ALN.0000000000005317","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"770-772"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397672","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":"Biventricular Response to Positive End-expiratory Pressure in Swine: Assessment Based on Beat-to-beat Pressure Waveform Analysis.","authors":"Joaquin Araos, Felix Glocker, Clark G Owyang, Felipe Teran, Jiwon Kim, Gary Nieman, Paul M Heerdt","doi":"10.1097/ALN.0000000000005363","DOIUrl":"10.1097/ALN.0000000000005363","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"767-769"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413000","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":"B6 or Be Sick? Pyridoxine to Prevent Postoperative Nausea and Vomiting.","authors":"Kate Leslie, Jai N Darvall","doi":"10.1097/ALN.0000000000005380","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005380","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 4","pages":"597-598"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603591","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":"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. The authors sought to develop and validate preliminary computer vision-based approaches for nociception detection in hospitalized patients.</p><p><strong>Methods: </strong>This was a prospective observational cohort study using red-green-blue camera detection of perioperative patients. Adults (18 yr or older) admitted for surgical procedures to the San Francisco Veterans Affairs Medical Center (San Francisco, California) were included across two study phases: (1) the algorithm development phase and (2) the internal validation phase. Continuous recordings occurred perioperatively across any postoperative setting. The authors inputted facial images into convolutional neural networks using a pretrained backbone to classify (1) the Critical Care Pain Observation Tool (CPOT) and (2) the numeric rating scale. Outcomes were binary pain/no pain. We performed external validation for CPOT and numerical rating scale classification on data from the University of Northern British Columbia (Prince George, Canada)-McMaster University (Hamilton, Canada) and the Delaware Pain Database. Perturbation models were used for explainability.</p><p><strong>Results: </strong>The study included 130 patients for development, 77 patients for the validation cohort, and 25 patients from University of Northern British Columbia-McMaster University and 229 patients from Delaware datasets for external validation. Model areas under the curve of the receiver operating characteristic for CPOT models were 0.71 (95% CI, 0.70 to 0.74) on the development cohort, 0.91 (95% CI, 0.90 to 0.92) on the San Francisco Veterans Affairs Medical Center validation cohort, 0.91 (95% CI, 0.89 to 0.93) on University of Northern British Columbia-McMaster University, and 0.80 (95% CI, 0.75 to 0.85) on Delaware. The numeric rating scale model had lower performance (area under the receiver operating characteristics curve, 0.58 [95% CI, 0.55 to 0.61]). Brier scores improved after calibration across multiple different techniques. Perturbation models for CPOT models revealed eyebrows, nose, lips, and forehead 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 the 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":"726-737"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","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":"A Quantitative Analysis on Depictions of Chronic Pain Generated via DALL-E 3, a Text-to-Image Artificial Intelligence Tool.","authors":"Morgan King, Serena Zahra, Ethan Patterson","doi":"10.1097/ALN.0000000000005364","DOIUrl":"10.1097/ALN.0000000000005364","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"764-766"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397669","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.0000000000005422","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005422","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 4","pages":"A7-A9"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603585","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":"Science, Medicine, and the Anesthesiologist.","authors":"","doi":"10.1097/ALN.0000000000005419","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005419","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"142 4","pages":"A13-A15"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603603","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 Men.","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":"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 (11 mg [low-dose], then 19 mg [high-dose]) or placebo, under remifentanil infusion, on two occasions separated by a 36-h or longer washout period. Remifentanil infusion was titrated under isohypercapnic conditions to achieve an approximately 30 to 40% decrease in minute ventilation (from approximately 20 to approximately 14 l/min) before danavorexton/placebo administration. Assessments included safety, ventilation measurements, sedation, and pain tolerance.</p><p><strong>Results: </strong>A total of four (30.8%) danavorexton-treated participants and one (8.3%) placebo-treated participant experienced treatment-emergent adverse events (all mild in severity). Insomnia, lasting 1 day, occurred in one participant, and was considered related to danavorexton. Compared with placebo, low- and high-dose danavorexton significantly increased ventilation variables (observed mean [95% CI] change, sensitivity analysis model-based P values) including minute volume (8.2 [95% CI, 5.0 to 11.4] and 13.0 [95% CI, 9.4 to 16.5] l/min), tidal volume (312 [95% CI, 180 to 443] and 483 [95% CI, 309 to 657] ml), and respiratory rate (3.8 [95% CI, 1.9 to 5.7] and 5.2 [95% CI, 2.7 to 7.7] breaths/min; all P < 0.001). High-dose danavorexton significantly decreased sedation on a visual analog scale (-29.7 [95% CI, -54.1 to -5.3] mm; P < 0.001) and the Richmond Agitation Sedation Scale (0.4 [95% CI, 0.0 to 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 (approximately 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":"628-638"},"PeriodicalIF":9.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892998/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hippocampal Neural Dynamics and Postoperative Delirium-Like Behavior in Aged Mice.","authors":"Shiqi Guo, Liuyue Yang, Weihua Ding, Tewodros Mulugeta Dagnew, Yuting Gao, Wei Wang, Pei Wang, Song Huang, Chongzhao Ran, Changning Wang, Le Shen, Qian Chen, Oluwaseun Akeju, Shiqian Shen","doi":"10.1097/ALN.0000000000005478","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005478","url":null,"abstract":"<p><strong>Background: </strong>Post-operative delirium (POD) is a common and serious clinical condition that occurs following anesthesia/surgery. While its clinical impact is well recognized, the underlying electrophysiological mechanisms remain largely unknown, posing challenges for effective treatment. This study aims to investigate hippocampal neural dynamics before and after anesthesia/surgery in aged mice, which have a tendency of developing POD.</p><p><strong>Methods: </strong>This study included adult and aged mice with a POD model. POD-like behavior was assessed in N = 10 mice at baseline (the day before surgery), as well as at 9 hours and 24 hours post-anesthesia/surgery. A behavioral battery, including the open field test, Y-maze, buried food test, and novel object recognition, was used for assessment. In vivo chronic brain recordings were performed on awake, restrained mice using a high-density silicon probe (HSP) during the same time intervals. To further investigate hippocampal neural dynamics, in vivo two-photon calcium imaging was also conducted. Additionally, aged mice were pre-treated with indole 3-propionic acid (IPA), and its effects on POD-like behavior and neural activity were evaluated using electrophysiology and calcium imaging.</p><p><strong>Results: </strong>We first observed that aged mice exhibited significant POD-like behavior, as measured by z-scores, compared to adult mice following anesthesia/surgery. Our analysis revealed significant age-related differences in hippocampal neuronal activities. At 9 hours post-surgery, aged mice exhibited a marked increase in pyramidal cell activity and a reduction in interneuron activity compared to adult mice. These changes in neuronal dynamics were associated with the onset of POD-like symptoms in aged mice. By 24 hours post-surgery, both pyramidal cell and interneuron activity in aged mice had returned to pre-surgery levels, which coincided with an improvement in POD-like behavior. Additionally, IPA pre-treatment modulated neuronal activity in aged mice, attenuating pyramidal cell hyperactivity and partially ameliorating interneuron dysfunction, changes associated with mitigated POD-like behavior.</p><p><strong>Conclusion: </strong>Alterations in hippocampal neural activity may significantly contribute to brain dysfunction and POD-like behavior. IPA pre-treatment may modulate neural circuit imbalances in aged mice, potentially mitigating POD incidence.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735578","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}