Anesthesiology最新文献

{"title":"The History of Ultrasound-guided Regional Anesthesia.","authors":"Peter Marhofer,Stephan Kapral","doi":"10.1097/aln.0000000000005548","DOIUrl":"https://doi.org/10.1097/aln.0000000000005548","url":null,"abstract":"Ultrasound-guided Supraclavicular Approach for Regional Anesthesia of the Brachial Plexus. By Kapral S, Krafft P, Eibenberger K, Fitzgerald R, Gosch M, and Weinstabl C. Anesth Analg 1994; 78:507-13. As science keeps evolving, there is a time for revolutionary change. The Classic Paper here revisited, published in Anesthesia & Analgesia in 1994, was the first report to describe an ultrasound-guided technique for regional anesthesia. Its publication met with a response of skepticism, given the inherent claim that here was a novel approach capable of supporting, or indeed replacing, other techniques that had been used for well more than a century. This article recounts both the early history of ultrasound guidance and how this Classic Paper started a paradigm shift in regional anesthesia. Today, ultrasound-guided techniques are being used around the world as the result of 3 decades of devoted research and education. Numerous collaborations have been part of this journey, and the authors look back on years replete with personal memories and some of the more relevant moments.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"27 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533343","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":"Altered Gut Microbiome Composition and Function in Individuals with Complex Regional Pain Syndrome.","authors":"Emmanuel Gonzalez, Tali Sahar, May Haddad, Sylvie Toupin, Ramzi Zioud, Muhammad Zoabi, Lilach Eyal Waldman, Zohar Tal Leshinsky, Maayan Ben Sasson, Vibhu Kumar, Yosefa Marom, Ayelet Midbari, Nicholas J B Brereton, Yoram Shir, Amir Minerbi","doi":"10.1097/ALN.0000000000005435","DOIUrl":"10.1097/ALN.0000000000005435","url":null,"abstract":"<p><strong>Background: </strong>Complex regional pain syndrome is a chronic pain syndrome typically affecting a limb. It is characterized by severe spontaneous and evoked pain, along with vasomotor, autonomic, and motor signs and symptoms. Although dysregulation in several physiologic systems has been suggested in complex regional pain syndrome (CRPS), including aberrant inflammatory and immune responses, vasomotor dysfunction, and nervous system changes, the pathophysiologic mechanisms underlying the syndrome remain elusive. Effective treatment options are also limited. Previous research has highlighted the role of the gut microbiome in chronic pain, prompting us to investigate the composition and function of the gut microbiome in CRPS.</p><p><strong>Methods: </strong>The gut microbiomes of individuals with CRPS to age-, sex-, and ethnicity-matched pain-free control participants were compared using 16S rRNA gene amplification. To minimize environmental confounders, participants were recruited from two geographically independent regions. To explore potential changes in gut bacteria-derived metabolites, targeted metabolomic analysis of feces and plasma was performed. Finally, machine learning algorithms were trained to identify the gut microbiome composition specific to CRPS patients and were tested on a validation cohort.</p><p><strong>Results: </strong>In this study, differential abundance analysis revealed significant differences in several bacterial taxa when comparing 53 CRPS patients to 52 unrelated controls, including alterations in short-chain fatty acid-metabolizing species. Targeted stool and plasma metabolite analysis confirmed differences in fecal and plasma short-chain fatty acid levels between CRPS patients and controls. Notably, the microbiome composition alone allowed accurate classification of patients and controls in a geographically independent test cohort.</p><p><strong>Conclusions: </strong>These findings highlight unique compositional and functional changes in the gut microbiome of individuals with CRPS, thus contributing to the growing body of evidence supporting the role of the gut microbiome in chronic pain syndromes. Furthermore, they pave the way for further studies elucidating the pathophysiology of CRPS and exploring new diagnostic aids and treatment modalities.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"142-155"},"PeriodicalIF":9.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555649","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 Retrospective Single-site Study Comparing Electronic Data Abstraction and International Classification of Diseases, Tenth Revision-Australian Modification Coding Data for Routine Postoperative Nausea and Vomiting Audit.","authors":"Rosannah J Jeavons-Fellows, Matthew Miller, Maria Salazar","doi":"10.1097/ALN.0000000000005467","DOIUrl":"10.1097/ALN.0000000000005467","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 1","pages":"213-216"},"PeriodicalIF":9.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257181","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":"Effects of Preoperative High-intensity Training on Metabolic Flexibility.","authors":"John Whittle, Zachary Healy, Jeroen Molinger, Stratton Barth, Anthony Molina, David MacLeod","doi":"10.1097/ALN.0000000000005487","DOIUrl":"10.1097/ALN.0000000000005487","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 1","pages":"217-220"},"PeriodicalIF":9.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257191","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":"Breath from Salt: A Story of Tenacity.","authors":"Anjan Saha,Teeda Pinyavat","doi":"10.1097/aln.0000000000005567","DOIUrl":"https://doi.org/10.1097/aln.0000000000005567","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"3 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144488214","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":"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":"10.1097/ALN.0000000000005478","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a common and serious clinical condition that occurs after anesthesia/surgery. While its clinical impact is well recognized, the underlying electrophysiologic 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 to develop 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 h and 24 h after 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 during the same time intervals. To further investigate hippocampal neural dynamics, in vivo two-photon calcium imaging was also conducted. Additionally, aged mice were pretreated 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>The first observation was that aged mice exhibited significant POD-like behavior, as measured by Z scores, compared to adult mice after anesthesia/surgery. Analysis revealed significant age-related differences in hippocampal neuronal activities. At 9 h after 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 h after surgery, both pyramidal cell and interneuron activity in aged mice had returned to presurgery levels, which coincided with an improvement in POD-like behavior. Additionally, IPA pretreatment 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>Conclusions: </strong>Alterations in hippocampal neural activity may significantly contribute to brain dysfunction and POD-like behavior. IPA pretreatment may modulate neural circuit imbalances in aged mice, potentially mitigating POD incidence.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-06-26","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}

{"title":"Synergistic effects of commonly used ICU drugs and high temperature on skeletal muscle at the cellular and tissue levels.","authors":"Kei Sugiki,Hironobu Takahashi,Tatsuya Shimizu","doi":"10.1097/aln.0000000000005630","DOIUrl":"https://doi.org/10.1097/aln.0000000000005630","url":null,"abstract":"BACKGROUNDSeveral drugs are commonly administered to patients with high body temperature in intensive care units (ICUs). However, previous in vitro studies have investigated only the independent effects of high temperatures or drugs on various cultured cells. We explored the hypothesis that pharmacological treatment with representative ICU drugs induces lethal effects on cultured skeletal muscle and engineered muscle tissue at high temperatures.METHODSHuman skeletal muscle cultures were treated with the representative drugs propofol, dexmedetomidine, and acetaminophen at 37, 39, and 41 °C for various exposure times. To investigate the effects of the drug treatments, cell viability, lactate dehydrogenase (LDH) activity, caspase activity, and endoplasmic reticulum (ER) stress were analyzed. Conformational changes in myotubes and functional changes in contractile muscle tissue were also assessed. All experiments were repeated at least 3 times.RESULTSDexmedetomidine and acetaminophen had no observable adverse effects at high temperatures, whereas propofol treatment at > 200 µM resulted in increased LDH activity and myotube detachment. Furthermore, this cellular injury was associated with intracellular calcium overload and upregulation of the ER stress-related genes CHOP, GRP78/Bip, and GRP94. Propofol treatment also decreased the contractile ability of muscle tissues at 39 °C (vs. 37 °C propofol, 95% CI, 30.72 to 114.87%; P < 0.001). Additionally, although tauroursodeoxycholic acid (TUDCA), an ER stress inhibitor, alleviated the increase in caspase 3/7 activity at 39 °C (95% CI, 38.10 to 145.22%; P < 0.001) and mitigated myotube detachment, it did not result in notable functional improvement in muscle contraction.CONCLUSIONSThese results demonstrate that propofol had harmful effects on skeletal muscle cells and tissues at high temperatures in vitro. As these synergistic effects were closely associated with ER stress, TUDCA could mitigate propofol-induced apoptosis at high temperatures. These findings could help improve drug treatment for patients, including their functional prognosis in the clinical setting.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"2 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335311","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 association between preoperative depression and length of stay after major surgery: a systematic review and meta-analysis.","authors":"Luka Kremic,Arzina Jaffer,Krisha Patel,Sandra Lee,Yuanxin Xue,Julian F Daza,Jessica Petricca,Maggie Xiao,Bianca Pivetta,Karim S Ladha,Duminda N Wijeysundera,Calvin Diep","doi":"10.1097/aln.0000000000005626","DOIUrl":"https://doi.org/10.1097/aln.0000000000005626","url":null,"abstract":"BACKGROUNDPreoperative depression is common among surgical patients and is associated with undesirable outcomes, such as pain and delirium in the immediate postoperative period. It is unclear whether depression also leads to longer postsurgical hospitalization. This review aimed to evaluate the association between preoperative depression and postoperative length of stay.METHODSWe conducted a systematic review and meta-analysis of studies that reported postsurgical length of stay in adult patients with preoperative depression who underwent inpatient surgery. The study was pre-registered with PROSPERO (ID: CRD42022296532). Medline, Embase, Cochrane Controlled Register of Trials, and PsycINFO databases were searched from inception to June 30, 2023. The primary outcome was the mean difference in postoperative length of stay between patients with and without depression, which was pooled using multi-level random-effects meta-analysis. Secondary outcomes were unadjusted and adjusted odds ratios of extended length of stay in patients with depression, which were also pooled in meta-analyses. GRADE was used to evaluate certainty, and ROBINS-E was used to assess risk of bias.RESULTS57 of the 9869 screened studies were included (n = 27,708,719 participants), of which 26 were prospective and 31 were retrospective. Patients with preoperative depression had a mean postoperative length of stay 0.98 days longer than those without. (95% CI 0.35-1.62). In secondary analyses, the unadjusted and adjusted odds ratios for an extended length of stay for patients with preoperative depression were 1.31 (95% CI 0.94-1.82) and 1.27 (95% CI 1.11-1.46), respectively.CONCLUSIONSThis meta-analysis demonstrated that patients with a history of depression or active depressive symptoms before surgery had longer postoperative hospitalization, though evidence was limited by risk of bias and publication bias. While preoperative screening for depression could potentially identify at-risk patients for targeted interventions, further research is needed to evaluate the efficacy of depression interventions in improving outcomes such as length of stay.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"6 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328583","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":"Associations between SNAP-25 gene polymorphism, autonomic nervous system activity and recovery of consciousness from propofol anesthesia.","authors":"Guanqi Ma,Yueyuan Wang,Jinping Guan,Cui Li,Tengfei Ma,Xuzhu Gao,Junlong Zhang","doi":"10.1097/aln.0000000000005627","DOIUrl":"https://doi.org/10.1097/aln.0000000000005627","url":null,"abstract":"BACKGROUNDThe release of synaptic neurotransmitters and function of pre-synaptic proteins are essential for maintaining nervous system excitation. General anesthesia is a reversible state characterized by the loss of consciousness and reduced responsiveness. This study hypothesized that polymorphisms in one or more genes encoding the three pre-synaptic proteins comprising the SNARE complex affect consciousness and autonomic nerve function during propofol anesthesia.METHODOne hundred thirty preoperative patients volunteered to undergo a simulated anesthesia procedure. The participants were genotyped for candidate single-nucleotide polymorphisms using the Sanger method. Changes in verbal commands, eyelash reflexes, and the ability to hold a weighted object during anesthesia induction and recovery were recorded. Further, other anesthesia endpoints such as effector compartment concentrations (Ce), bispectral index BIS, heart rate variability (HRV), and peripheral perfusion index (PPI) were explored, based on the polymorphic site of significant differences in consciousness.RESULTSThe results show that the recovery time of verbal commands of the synaptosome-associated protein 25 (SNAP-25) rs6039822 G/G genotype (G/G vs. A/A, 319 (259-378) vs. 379 (318-466) s, P=0.048) were shorter. Logistic regression analysis showed that SNAP-25 rs6039822 and sex were independent factors influencing the recovery of verbal commands (χ2 = 11.916, P=0.008). Other consciousness indices, Ce, HRV and PPI, support the resistance of the SNAP-25 rs6039822 variant to anesthetic during recovery.CONCLUSIONSGenetic variation in SNAP-25 gene is associated with the recovery of consciousness and autonomic nervous system activity during propofol anesthesia. This finding supports that the pre-synaptic proteins may be related to the mechanism of action of propofol.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"8 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328635","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":"Erector spinae plane block versus intercostal nerve blocks in uniportal videoscopic assisted thoracic surgery: a multicenter, double-blind, prospective randomized placebo controlled trial.","authors":"S Coppens,D F Hoogma,G Dewinter,A Neyrinck,P Van Loon,B Stessel,J Hassanin,J Vandenbrande,B Du Pont,Y Jansen,S Fieuws,S Rex","doi":"10.1097/aln.0000000000005625","DOIUrl":"https://doi.org/10.1097/aln.0000000000005625","url":null,"abstract":"BACKGROUNDAlthough, intercostal nerve blocks are sometimes approached with caution due to concerns about potentially high local anesthetic uptake, they remain a valuable tool in specific clinical situations. On the other hand, the erector spinae plane block is nowadays often favored for its broader coverage and versatility. We hypothesized that the intercostal nerve block, applied directly by surgeons under direct vision in patients undergoing uniportal video-assisted thoracoscopic surgery, might offer superior analgesia and fewer complications compared to the erector spinae plane block.METHODSIn this multi-center, double-blind placebo controlled, randomized trial, 100 patients undergoing uniportal thoracoscopic surgery (wedge excision or lobectomy) within an enhanced recovery program received either a surgical intercostal nerve block under thoracoscopic guidance or an ultrasound-guided erector spinae plane block, followed by 30 ml of ropivacaine 0.5% (n=50) or saline (n=50). Primary outcome measured was 12-hour morphine consumption post-extubation. Secondary outcomes included 24-hour morphine use, pain severity, rescue analgesia need, postoperative complications, and length of stay. Plasma levels of local anesthetics were also assessed.RESULTSThe intercostal nerve block group had significantly lower mean 12-hour morphine consumption compared to the erector spinae plane block group (10.9 mg vs. 17.6 mg, p=0.0015), as well as lower mean 24-hour consumption (18.7 mg vs. 26.7 mg, p=0.018). Intercostal blocks also led to lower pain scores in the first two hours postoperatively and a reduced need for rescue analgesia (16% vs. 40%, p=0.0033). No differences were found in patient satisfaction, complications, or length of stay. Notably, the erector spinae plane block group showed higher systemic absorption of local anesthetics.CONCLUSIONFor uniportal thoracoscopic surgery, intercostal nerve block significantly reduces morphine consumption and systemic anesthetic absorption compared to erector spinae plane block.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"41 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328826","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}