Hasil untuk "Anesthesiology"

J. Giovannitti, Sean M Thoms, James J. Crawford

T. Iba, J. Levy, T. Warkentin et al.

1Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan 2Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA 3Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario, Canada 4Department of Haematology, Manchester Royal Infirmary, Manchester, UK 5Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands 6University College London Hospitals NHS Foundation Trust, London, UK

J. Apfelbaum, C. Hagberg, Richard T Connis et al.

Dong Kyu Lee

The previous articles of the Statistical Round in the Korean Journal of Anesthesiology posed a strong enquiry on the issue of null hypothesis significance testing (NHST). P values lie at the core of NHST and are used to classify all treatments into two groups: "has a significant effect" or "does not have a significant effect." NHST is frequently criticized for its misinterpretation of relationships and limitations in assessing practical importance. It has now provoked criticism for its limited use in merely separating treatments that "have a significant effect" from others that do not. Effect sizes and CIs expand the approach to statistical thinking. These attractive estimates facilitate authors and readers to discriminate between a multitude of treatment effects. Through this article, I have illustrated the concept and estimating principles of effect sizes and CIs.

Amit P. Shah, Prashant Nasa, Syed M. Ahmed et al.

The All India Difficult Airway Association developed clinical practice statements utilising the Delphi method among experts for specific interventions in the management of unanticipated difficult airways in adult, obstetric, and paediatric populations, as well as for the management of at-risk extubations, where existing evidence was either weak or absent. A Steering Committee consisting of nine airway experts and a Delphi methodologist convened a panel of 24 experts, from whom anonymous responses were collected via an online Delphi survey. Consensus was defined as at least 75% experts voting for a particular option in multiple-choice statements, and agreement (scores of 5–7) or disagreement (scores of 1–3) on a nominal 7-point Likert scale statement. The stability of responses between consecutive rounds was assessed using the Kruskal–Wallis test or Chi-square test, with a P value of greater than or equal to 0.05 indicating stability. Twenty-three experts completed four Delphi rounds conducted from 27 December 2024 to 25 January 2025. Of the 26 statements considered, 23 (88%) achieved both consensus and stability. Of note, the statement regarding the maximum number of attempts permitted for supraglottic airway insertion in adults to mitigate airway management-related complications did not achieve consensus among experts; however, the Steering Committee voted unanimously for a maximum of three attempts. From the 23 statements that achieved expert consensus and the statement that received the maximum vote during the adjudication process by the Steering Committee, 24 expert clinical statements were drafted. Future research is necessary to evaluate the impact of these clinical practice statements and to address the remaining uncertainties.

Abdulhakim Şengel, Evren Büyükfırat, Selçuk Seçilmiş et al.

<b>Background/Objectives:</b> Laparoscopic appendectomy (LsA) is a standard acute surgical procedure typically performed under general anesthesia (GA). However, GA is associated with side effects such as hemodynamic instability and postoperative nausea/vomiting. Regional anesthesia (RA) has gained attention as an effective alternative in such surgeries, as it reduces surgical stress responses, provides adequate postoperative analgesia, and promotes early mobilization. This study evaluates the effectiveness of the combined use of spinal anesthesia (SA) and transversus abdominis plane block (TAPB) in LsA procedures. <b>Methods:</b> This retrospective observational study included 220 patients who underwent LsA between 2020 and 2023. Patients were divided into two groups: Group 1 (<i>n</i> = 110) received bilateral TAPB, and Group 2 (<i>n</i> = 110) received unilateral TAPB, both under SA. Postoperative pain was assessed using the Visual Analog Scale (VAS), and outcomes such as time to first analgesic requirement, analgesic consumption, and patient satisfaction were recorded. <b>Results:</b> This study evaluated the effects of SA combined with TAPB in LsA. Bilateral TAPB significantly prolonged the time to first analgesic request (13.7 vs. 12.1 h; <i>p</i> = 0.001) and reduced analgesic requirements (<i>p</i> = 0.008) compared to unilateral TAPB. VAS scores were significantly lower in Group 1 at the 9th and 12th hours postoperatively (<i>p</i> = 0.003 and <i>p</i> = 0.039). Although overall satisfaction scores were similar, a higher proportion of patients in Group 1 reported being “very satisfied” or “excellent” (55.5% vs. 42.7%). <b>Conclusions:</b> The combination of spinal anesthesia and bilateral TAPB is a safe and effective anesthetic strategy for LsA. Compared to unilateral TAPB, it offers superior postoperative analgesia and improved patient satisfaction.

Kai Wu, Min Liao, Juan Deng et al.

ObjectiveThe potential of ciprofol in endoscopic anesthesia is receiving increasing attention. Compared to propofol, ciprofol exhibits stronger sedative effects and requires a lower dosage. This study aimed to compare the safety of ciprofol and propofol in Chinese patients undergoing endoscopic retrograde cholangio-pancreatography (ERCP) anesthesia.MethodsA comprehensive literature search was conducted across eight common databases before 1 January 2025, including PubMed, Embase, the Cochrane Library, and Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, WanFang, and SinoMed. After screening the literature according to established standards, the meta-analysis and trial sequential analysis (TSA) were conducted using Review Manager 5.3 and TSA 0.9.5.10 beta, respectively. Finally, publication bias for each outcome was assessed using Harbord regression analysis.ResultsSeven randomized controlled trials (RCTs) with 1,264 participants undergoing ERCP were included, and all included studies were conducted in China, with participants representing the Chinese population. The meta-analysis showed that compared to propofol, ciprofol reduced bradycardia (risk ratio [RR] 0.44, 95% confidence interval [CI] 0.26–0.76, P = 0.003, n = 4), hypotension (RR 0.72, 95% CI 0.55–0.95, P = 0.02, n = 4), respiratory depression (RR 0.25, 95% CI 0.14–0.44, P &lt; 0.00001, n = 5), hypoxemia (RR 0.35, 95% CI 0.21–0.58, P &lt; 0.0001, n = 5), and injection pain (RR 0.17, 95% CI 0.11–0.26, P &lt; 0.00001, n = 7), but had no significant effect on choking cough, involuntary movements, or nausea and vomiting. TSA showed a conclusive benefit for bradycardia, respiratory depression, hypoxemia, and injection pain, whereas the benefit for hypotension needs further validation. Harbord regression analysis showed no publication bias for any of the outcomes, except for hypotension.ConclusionCompared with propofol, ciprofol has been shown to reduce the incidence of bradycardia, respiratory depression, hypoxemia, and injection pain in patients undergoing ERCP; however, its effect on the occurrence of hypotension still requires further investigation. Future studies are warranted to clarify the safety, efficacy, and optimal dosing of ciprofol across various patient populations, particularly those with complex comorbidities. These efforts would facilitate the broader application of ciprofol in ERCP and other surgical procedures, such as gastrointestinal and ophthalmic surgeries.Systematic review registrationwww.crd.york.ac.uk/PROSPERO/view/CRD420251090047, identifer, CRD420251090047

Ethan R. Roy, Qiang Wang, Kexin Huang et al.

Abstract The accumulation of abnormal, non-mutated tau protein is a key pathological hallmark of Alzheimer’s disease (AD). Despite its strong association with disease progression, the mechanisms by which tau drives neurodegeneration in the brain remain poorly understood. Here, we selectively expressed non-mutated or mutated human microtubule-associated protein tau (hMAPT) in neurons across the mouse brain and observed neurodegeneration in the hippocampus, especially associated with non-mutated human tau. Single-nuclei RNA sequencing confirmed a selective loss of hippocampal excitatory neurons by the wild-type tau and revealed the upregulation of neurodegeneration-related pathways in the affected populations. The accumulation of phosphorylated tau was accompanied by cellular stress in neurons and reactive gliosis in multiple brain regions. Notably, the lifelong absence of microglia significantly and differentially influenced the extent of neurodegeneration in the hippocampus and thalamus. Therefore, our study established an AD-relevant tauopathy mouse model, elucidated both neuron-intrinsic and neuron-extrinsic responses, and highlighted critical and complex roles of microglia in modulating tau-driven neurodegeneration.

Yufeng Zhang, Songchao Xu, Haoning Lan et al.

Abstract Anatomical variations in nerves are common and can significantly impact ultrasound-guided regional anesthesia. They directly influence needle trajectory, local anesthetic spread, and block efficacy, contributing to procedural failure or complications. However, the literature specifically addressing the clinical implications of neural variations for regional anesthesia remains limited. This narrative review synthesizes evidence on three key aspects: (1) variations of common peripheral nerves and their clinical significance in regional anesthesia (including the terminal branches of the trigeminal nerve, suprascapular nerve, phrenic nerve, lumbar plexus, saphenous nerve, obturator nerve, and sciatic nerve); (2) variations of major vessels relevant to regional anesthesia and their clinical significance in regional anesthesia (including the Adamkiewicz artery and vertebral artery); (3) variations of the spine and spinal nerve roots and their clinical significance in regional anesthesia. This review systematically synthesizes current evidence on these anatomical variations and introduces practical resources, including regional ultrasound guidance and tables correlating specific variants with technical modifications, to enhance ultrasound recognition and clinical decision-making, thereby serving as a valuable reference for clinicians.

Zhang C, Su Y, Zeng X et al.

Changteng Zhang,1,2,&ast; Ying Su,1,2,&ast; Xianzheng Zeng,3 Xiaoyu Zhu,1,2 Rui Gao,1,2 Wangyang Liu,1,2 Runzi Du,1,2 Chan Chen,1,2 Jin Liu1,2 1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 3Department of Pain Management, West China Hospital, Sichuan University, Chengdu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Chan Chen, Email chenchan@scu.edu.cn; xychenchan@gmail.comBackground: Cognitive impairment (CI) is frequently observed in patients with chronic pain (CP). CP progression increases the risk of dementia and accelerates Alzheimer’s disease pathogenesis. However, risk diagnostic models and biomarkers for CP-related CI remain insufficient. Previous research has highlighted the relationships between several complete blood count parameters for CP or CI-related diseases, such as Alzheimer’s disease, while the specific values of complete blood count parameters in CP-related CI patients remain unclear. This study aimed to explore the correlation between complete blood count parameters and CP-related CI to establish a risk diagnostic model for the early detection of CP-related CI.Methods: This cross-sectional study was conducted at West China Hospital, Sichuan University. The Montreal Cognitive Assessment (MoCA) was used to classify patients into either the CP with CI group or the CP without CI group. Univariate analysis and multivariate logistic regression analysis were used to screen the related factors of CP-related CI for constructing a risk diagnostic model, and the model was evaluated using receiver operating characteristic (ROC) curve analysis.Results: The study ultimately included 163 eligible patients. Based on analysis, age (OR, 1.037 [95% CI, 1.007– 1.070]; P=0.018), duration of pain (OR, 2.546 [95% CI, 1.099– 6.129]; P=0.032), VAS score (OR, 1.724 [95% CI, 0.819– 3.672]; P=0.153), LMR (OR, 0.091 [95% CI, 0.024– 0.275]; P< 0.001), absolute neutrophil value (OR, 0.306 [95% CI, 0.115– 0.767]; P=0.014), and lymphocyte percentage (OR, 6.551 [95% CI, 2.143– 25.039]; P=0.002) were identified as critical factors of CP-related CI. The diagnostic model was evaluated by the ROC curve, demonstrating good diagnostic value with an area under the curve (AUC) of 0.803, a sensitivity of 0.603 and a specificity of 0.871.Conclusion: The risk diagnostic model developed in this study for CP-related CI has significant value and enables clinicians to customize interventions based on each patient’s needs.Keywords: cognitive impairment, chronic pain, diagnostic model, complete blood count parameters, risk factors

Wen Sun, Jianqin Chen, Jingting Li et al.

Background The vitamin D receptor (VDR) has a low level of expression in the keratinocytes of patients with psoriasis and plays a role in the development of the disease. Furthermore, the crosstalk between macrophages and psoriatic keratinocytes-derived exosomes is critical for psoriasis progression. However, the effects of VDR-deficient keratinocytes-derived exosomes (Exos-shVDR) on macrophages and their underlying mechanisms remain largely unknown. Methods VDR-deficient keratinocytes were constructed by infecting HaCaT cells with a VDR-targeting lentivirus, mimicking the VDR-deficient state observed in psoriatic keratinocytes. Exosomes were characterized using transmission electron microscopy, nanoparticle tracking analysis, and Western blot. The effect of Exos-shVDR on macrophage proliferation, apoptosis, and M1/M2 polarization was assessed using cell counting kit-8 assay (CCK-8), flow cytometer, real-time quantitative polymerasechain reaction (RT-qPCR), and enzyme-linked immunosorbent assay (ELISA). The mechanism underlying the effect of Exos-shVDR on macrophage function was elucidated through data mining, bioinformatics, RT-qPCR, and rescue experiments. Results Our results revealed that both Exos-shVDR and Exos-shNC exhibited typical exosome characteristics, including a hemispheroid shape with a concave side and particle size ranging from 50 to 100 nm. The levels of expression of VDR were significantly lower in Exos-shVDR than in Exos-shNC. Functional experiments demonstrated that Exos-shVDR significantly promoted macrophage proliferation and polarization towards the M1 phenotype while inhibiting macrophage apoptosis. Moreover, miR-4505 was highly expressed in the skin tissue of patients with psoriasis. Its overexpression significantly increased macrophage proliferation and polarization towards M1 and inhibited apoptosis. Furthermore, the effects of Exos-shVDR on macrophage function occur through miR-4505. Conclusions Exos-shVDR exacerbates macrophage proliferation, promotes polarization towards the M1 phenotype, and inhibits macrophage apoptosis by increasing the levels of miR-4505. These results indicate that modulation of macrophage function is a potential strategy for developing new drugs for the treatment of psoriasis.

Yuan-Liang Zheng, Ri-Sheng Huang

Abstract Background In recent years, single-incision thoracoscopic surgery (SITS) has been increasingly applied as an optimal treatment option for primary spontaneous pneumothorax (PSP). However, most SITS techniques are used in the fourth to sixth intercostal space between the anterior axillary and mid axillary lines. To find out more concealed incisions, this study performed PSP surgery via the sub-axillary cosmetic incision (SACI) technique. Methods A total of 128 PSP patients were subjected to video-assisted thoracoscopic surgery (VATS) between January 2017 and January 2019 at our institution. These patients were evaluated and assigned into SACI (n = 21) and SITS (n = 57) groups. Propensity score matching (PSM) was performed based on patients’ backgrounds, and the enrolled cohort was divided into 21 pairs. The incision satisfaction was assessed at 2 weeks and 6 months post-surgery. Results The 21 pairs with matching baseline characteristics in the two groups did not exhibit significant differences in their backgrounds and surgical results. However, compared with the SITS group, the operation time was longer in the SACI group (p = 0.013). There were no post-operative complications in both groups. At 2 weeks and 6 months, incision satisfaction scores in the SACI group were significantly lower than those in the SITS group (p = 0.022 and p = 0.039, respectively). There were no recurrences of ipsilateral pneumothorax in both groups. Conclusions SACI is a safe and feasible surgical method for PSP treatment. In addition, incision concealment can be used for patients with incision needs.

Philipp Lirk, Kamen Vlassakov

Mikhail Dziadzko, Axelle Bouteleux, Raphael Minjard et al.

Abstract Background Successful pain management after outpatient surgery requires proper education leading to correct decisions on the analgesics use at home. Despite different strategies adopted, up to ½ of patients receive little or no information about the treatment of postoperative pain, 1/3 of them are not able to follow postoperative analgesia instructions. This leads to higher rates of unmet needs in pain treatment, post-discharge emergency calls, and readmissions. Structured educational interventions using psychological empowering techniques may improve postoperative pain management. We hypothesize that preoperative education on use of an improved pain scale to make correct pain management decisions will improve the quality of post-operative pain management at home and reduce analgesics-related side effects. Methods A total of 414 patients scheduled for an outpatient orthopedic surgery (knee/shoulder arthroscopic interventions) are included in this randomized (1:1) controlled trial. Patients in the control arm receive standard information on post-discharge pain management. Patients in the experimental arm receive structured educational intervention based on the rational perception of postoperative pain and discomfort (anchoring and improved pain scale), and the proper use of analgesics. There is no difference in post-discharge analgesics regimen in both arms. Patients are followed for 30 days post-discharge, with the primary outcome expressed as total pain relief score at 5 days. Secondary outcomes include the incidence of severe pain during 30 days, changes in sleep quality (Pittsburg Sleep Quality Assessment), and patients’ perception of postoperative pain management assessed with the International Pain Outcomes questionnaire at day 30 post-discharge. Discussion The developed intervention, based on an improved pain scale, offers the advantages of being non-surgery-specific, is easily administered in a short amount of time, and can be delivered individually or in-group, by physicians or nurses. Trial registration ClinicalTrials.gov NCT03754699 . Registered on November 27, 2018.

Tolga Berkman, Rotem Naftalovich, Marko Oydanich et al.

Abdominal compartment syndrome (ACS) is defined as sustained intra-abdominal pressure (IAP) exceeding 20 mm Hg, which causes end-organ damage due to impaired tissue perfusion, as with other compartment syndromes [1, 2]. This dysfunction can extend beyond the abdomen to other organs like the heart and lungs. ACS is most commonly caused by trauma or surgery to the abdomen. It is characterised by interstitial oedema, which can be exacerbated by large fluid shifts during massive transfusion of blood products and other fluid resuscitation [3]. Normally, IAP is nearly equal to or slightly above ambient pressure. Intra-abdominal hypertension is typically defined as abdominal pressure greater than or equal to 12 mm Hg [4]. Initially, the abdomen is able to distend to accommodate the increase in pressure caused by oedema; however, IAP becomes highly sensitive to any additional volume once maximum distension is reached. This is a function of abdominal compliance, which plays a key role in the development and progression of intra-abdominal hypertension [5]. Surgical decompression is required in severe cases of organ dysfunction – usually when IAPs are refractory to other treatment options [6]. Excessive abdominal pressure leads to systemic pathophysiological consequences that may warrant admission to a critical care unit. These include hypoventilation secondary to restriction of the deflection of the diaphragm, which results in reduced chest wall compliance. This is accompanied by hypoxaemia, which is exacerbated by a decrease in venous return. Combined, these consequences lead to decreased cardiac output, a V/Q mismatch, and compromised perfusion to intra-abdominal organs, most notably the kidneys [7]. Kidney damage can be prerenal due to renal vein or artery compression, or intrarenal due to glomerular compression [8] – both share decreased urine output as a manifestation. Elevated bladder pressure is also seen from compression due to increased abdominal pressure, and its measurement, via a Foley catheter, is a diagnostic hallmark. Sustained intra-bladder pressures beyond 20 mm Hg with organ dysfunction are indicative of ACS requiring inter­vention [2, 8]. ACS is an important aetiology to consider in the differential diagnosis for signs of organ dysfunction – especially in the perioperative setting – as highlighted in the case below.

Guohua Li, Yu Wang, Fang Cao et al.

Sevoflurane (SEVO) is a highly fluorinated methyl isopropyl ether used as an inhalational anesthetic for general anesthesia. Previous studies have shown that SEVO may induce impaired memory and recognition ability and may be associated with neurodegenerative disease, e.g., Alzheimer’s disease (AD). However, the underlying mechanism remains unknown. Here, we used a mouse AD model, APP/PS1, to study the effects of SEVO on neurodegeneration occurring in AD. We found that SEVO exposure significantly impaired the spatial reference memory, sensorimotor, and cognitive function of the mice. Mechanistically, we found that SEVO induced formation of NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome and its downstream caspase 1-mediated production of IL-1β and IL-18, which subsequently deactivated brain-derived neurotrophic factor (BDNF) to promote neurodegeneration. Together, these data suggest that NLRP3 inflammasome is essential for SEVO-induced AD.

Hongseok Yoo, Jimi Oh, Chul Park

Abstract Background In 2014, an outbreak of adenoviral pneumonia occurred in the Korean military training center. However, there are limited data on the characteristics of the fever and its response to antipyretic therapy in immunocompetent adults with adenovirus-positive community-acquired pneumonia (CAP). Methods The medical records of the patients who were admitted to the Armed Forces Chuncheon Hospital for the treatment of CAP between January 2014 and December 2016 were retrospectively analyzed. The patients were divided into three groups, namely, the adenovirus-positive (Adv) group, the adenovirus-negative (Non-Adv) group and the unknown pathogen group, according to the results of a polymerase chain reaction (PCR) test and sputum culture used to measure adenovirus and other bacteria or viruses in respiratory specimens. We evaluated and compared the demographics, clinicolaboratory findings and radiological findings upon admission between the two groups. Results Out of the 251 military personnel with CAP during the study periods, 67 were classified into the Adv group, while 134 were classified into the Non-Adv group and 50 were classified into the unknown pathogen group. The patients in the Adv group had a longer duration of fever after admission (3.2 ± 1.6 vs. 1.9 ± 1.2 vs. 2.2 ± 1.5 days, P = 0.018) and symptom onset (5.8 ± 2.2 vs. 3.9 ± 2.5 vs. 3.7 ± 2.0 days, P = 0.006) than patients in the Non-Adv and unknown pathogen groups, respectively. The patients in the Adv group had a higher mean temperature at admission (37.8 ± 0.3 vs. 37.3 ± 0.3 vs. 37.3 ± 0.3, P = 0.005), and more patients were observed over 40 and 39 to 40(14.9% vs. 2.2% vs. 4.0%, 35.8% vs. 3.7% vs. 6.0%, P <  0.001) than those in the Non-Adv and unknown pathogen groups, respectively. The Adv group more commonly had no response or exhibited adverse events after antipyretic treatment compared to the Non-Adv group (17.9% vs. 1.5%, 35.0% vs. 4.3%, P <  0.001, P = 0.05, respectively). In addition, the time from admission to overall clinical stabilization was significantly longer in the patients in the Adv group than in those in the Non-Adv group (4.3 ± 2.8 vs. 2.9 ± 1.8 days, P = 0.034, respectively). Furthermore, no significant difference in the length of hospital stay was observed between the two groups, and no patient died in either group. Conclusion In this study, Adv-positive CAP in immunocompetent military personnel patients had distinct fever characteristics and responses to antipyretic treatment.

Rong Chen, Rong Chen, Ling-hua Tang et al.

Fentanyl-induced cough (FIC) often occurs after intravenous bolus administration of fentanyl analogs during induction of general anesthesia and analgesia procedure. The cough is generally benign, but sometimes it causes undesirable side effects, including elevated intra-abdominal, intracranial or intraocular pressure. Therefore, understanding the related mechanisms and influencing factors are of great significance to prevent and treat the cough. This paper reviews the molecular mechanism, influencing factors and preventive administration of FIC, focusing on the efficacy and side effects of various drugs in inhibiting FIC to provide some medical reference for anesthesiologists.

Sayandeep Mandal, Suparna M Barman, Anshuman Sarkar et al.