Clinical Anesthesia Research Articles

Stuck: How Vaccine Rumors Start—and Why They Won’t Go Away

Stuck: How Vaccine Rumors Start—and Why They Won’t Go Away

Breviscapine restores sevoflurane-induced cognitive dysfunction by activating the PI3K/Akt pathway and inhibiting NF-κB

Postoperative cognitive dysfunction (POCD) is featured by cognitive impairments in patients with high morbidity and mortality. Sevoflurane (SEV) is one of the main drugs used to maintain clinical general anesthesia and has been found to cause cognitive dysfunction. Breviscapine has various pharmacological effects. However, the effects of breviscapine on sevoflurane-induced cognitive dysfunction is unclear. The sevoflurane-induced cognitive dysfunction rat model was established. Morris water maze task was conducted to detect time in target quadrant, number of platform crossings, and the distance covered in the quadrant. Hematoxylin and eosin (H&E) staining was used to examine cell morphology. Cell apoptosis was analyzed through terminal deoxynucleotidyl transferase (TdT)-mediated dUTP Nick-End Labeling (TUNEL) staining. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) detected the messenger RNA (mRNA) levels. Western blot assay was conducted to measure the protein level. Enzyme-linked immunosorbent serologic assay examined tumor necrosis factor-α, interleukin (IL)-6, IL-1β, malondialdehyde, superoxide dismutase, plasma glutathione peroxidase, and catalase levels. Breviscapine improved sevoflurane-induced cognitive dysfunctioning in rats. Breviscapine could play a suppressive role in apoptosis in the brain tissues of sevoflurane-induced rats. Further functional analysis showed that sevoflurane increased inflammation and oxidative stress in the brain tissues of sevoflurane-induced rats whereas breviscapine exerted apposite effects on sevoflurane-induced inflammation and oxidative stress. Additionally, we demonstrated that breviscapine promoted sevoflurane-induced phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) (PI3K/Akt) pathway and inhibited sevoflurane-induced nuclear factor kappa B (NF-κB) pathway in the brain tissues of rats. These results indicate that breviscapine could improve sevoflurane-induced cognitive dysfunction through activating the PI3K/Akt pathway and suppressing NF-κB pathway, which provides a therapeutic method for patients with sevoflurane-induced cognitive dysfunction.

Efficacy of three different cervical dislocation methods for on-farm killing of layer chicks

Unfit chicks with low viability are often euthanized in the layer industry. An effective euthanasia protocol is characterized by rapid, irreversible insensibility, followed by prompt death. This study was conducted to evaluate the efficacy of three cervical dislocation methods for killing layer chicks (2-3-day-old, avg BW ± SD; 44 ± 3 g, n=40): manual cervical dislocation (CD), assisted manual cervical dislocation (ACD; the bird's ventral neck is placed on a blunt table edge and the back of the neck pressed firmly), and mechanical cervical dislocation by Koechner Euthanizing Device (KED-model-S). All three killing methods were assessed on anesthetized chicks (intramuscular injections of medetomidine [0.3 mg/kg BW] and ketamine [30 mg/kg BW] were used to induce clinical anesthesia). CD and ACD were also evaluated using conscious chicks to compare the killing methods and to determine the effect of anesthesia on response variables. There were no differences in time to loss of pupillary light reflex, cessation of heartbeat, or duration of gasping between conscious chicks killed with CD and ACD, but these values were all longer for conscious compared to anesthetized chicks. KED resulted in longer latencies to loss of pupillary light reflex, cessation of heartbeat, and duration of gasping. Radiographs revealed that both CD and ACD resulted in cervical luxation, mainly below the C4 vertebra, whereas KED did not cause luxation in any of the 8 chicks tested. Chicks killed by CD and ACD presented more subdural hemorrhage (SDH) at the site of cervical dislocation than those killed by KED. None of the killing methods resulted in brain trauma. Compared to CD and ACD, KED resulted in longer latency to brain death and less anatomical pathology indicating a lower efficacy of KED as an on-farm killing method.

Anesthesiology education: A discussion on the current reform for training in the hypoxic environment of the highlands of China

HighlightsAnesthesiology education in Tibet is lagging behind, and clinical anesthesia needs to be improved.To improve the overall quality of anesthesiology teachers in Tibet is beneficial to the development of local anesthesiology.Improving the teaching ability of anesthesiologists not only promotes the improvement of the independent learning ability of young doctors, but also lays a solid foundation for the smooth development of clinical work.

Women Authorship Trends in the Highest-Impact Anesthesiology Journals from 2005 to 2021.

Background: Although women and men have matriculated into medical schools in similar proportions since the 1980s, recent data indicate that anesthesiology is lagging in gender equity, especially in academic leadership roles.1,2 As promotion in academic medicine is strongly influenced by publications, understanding whether a lack of women authorship is contributing to this gender gap is crucial.3,4 This article aims to assess how woman authorship trends have changed in the last 16 years, including during the COVID-19 pandemic. Materials and Methods: The five highest impact journals in anesthesia were identified as Journal of Clinical Anesthesia, British Journal of Anaesthesia, Anesthesiology, PAIN, and Regional Anesthesia & Pain Medicine. Number of total authors, including women, men, and unknown gender authors as well as incidence of woman first and/or last author, was documented from articles published in 2005, 2010, 2015, 2020, and 2021. Results: This analysis shows that women are gaining representation in anesthesia publications. Overall, there was a statistically significant increase in the total number of women authors and women first and last authorship. However, as of 2021, women still only represented ∼40% of total and first authors and ∼24% of last authors. In addition, increase in first/last woman authorship was not present in all journals when stratified. Conclusion: These journal differences may suggest the editorial evaluation process as a potential source of gender bias. There was a statistically significant relationship between women senior authors and articles with 50% or more women authors, indicating that woman mentorship is contributing to closing equity gap. These data present a starting point for further investigations into gender disparities within anesthesia to continue the forward progression for women in academic medicine.

We Are All Perfectly Fine: A Memoir of Love, Medicine and Healing

We Are All Perfectly Fine: A Memoir of Love, Medicine and Healing

Responsiveness variability during anaesthesia relates to inherent differences in brain structure and function of the frontoparietal networks.

Anaesthesia combined with functional neuroimaging provides a powerful approach for understanding the brain mechanisms of consciousness. Although propofol is used ubiquitously in clinical interventions that reversibly suppress consciousness, it shows large inter-individual variability, and the brain bases of this variability remain poorly understood. We asked whether three networks key to conscious cognition-the dorsal attention (DAN), executive control (ECN), and default mode (DMN)-underlie responsiveness variability under anaesthesia. Healthy participants (N= 17) were moderately anaesthetized during narrative understanding and resting-state conditions inside the Magnetic Resonance Imaging scanner. A target detection task measured behavioural responsiveness. An independent behavioural study (N= 25) qualified the attention demands of narrative understanding. Then, 30% of participants were unaffected in their response times, thus thwarting a key aim of anaesthesia-the suppression of behavioural responsiveness. Individuals with stronger functional connectivity within the DAN and ECN, between them, and to the DMN, and with larger grey matter volume in frontal regions were more resilient to anaesthesia. For the first time, we show that responsiveness variability during propofol anaesthesia relates to inherent differences in brain structure and function of the frontoparietal networks, which can be predicted prior to sedation. Results highlight novel markers for improving awareness monitoring during clinical anaesthesia.

Esketamine-based opioid-free anaesthesia alleviates postoperative nausea and vomiting in patients who underwent laparoscopic surgery: study protocol for a randomized, double-blinded, multicentre trial

BackgroundAlthough opioids are commonly prescribed in clinical anaesthesia, the significant side effects attributed to their overuse are raising increasing concerns. One way to reduce perioperative opioid consumption is to apply opioid-reduced anaesthesia (ORA) and even opioid-free anaesthesia (OFA), which involves regional techniques, neuraxial anaesthesia, nonopioid analgesics or combined use. The aim of this study was to investigate whether the application of OFA by using esketamine in intraoperative analgesia could minimize the side effects of postoperative nausea and vomiting (PONV), as well as other short-term side effects related to anaesthesia.Methods/designThe study was designed as a prospective, randomized, controlled, multicentre trial. A total of 278 patients were enrolled; participants were nonsmoking female patients aged 18–50 years and scheduled for laparoscopic appendectomy or cholecystectomy, ASA at I–III, with no serious physical or mental diseases. Both groups received usual perioperative care except for the analgesic medication of either esketamine or sufentanil. The primary outcome was the incidence of PONV 3 days after surgery. Secondary outcomes included recovery status, pain, sedation level and overall recovery, delirium and cognition, anxiety and depression and total consumption of analgesic agents.DiscussionThis trial may show that the synergy of esketamine and propofol anaesthesia reduces PONV as well as other short-term adverse events, thereby providing a better safety and satisfaction profile of ERAS for laparoscopic appendectomy and cholecystectomy.Trial registrationChinese Clinical Trial Registry ChiCTR2100047169. Registered on June 9, 2021

A review of neuroprotective mechanisms of dexmedetomidine

Dexmedetomidine (DEX) is a highly specific and effective α2-adrenergic receptor agonist. Due to its high protein binding rate, intravenous pumping can play a good role in sedation and hypnosis, analgesia, anti-anxiety, reducing inflammation, and so on, so it has been widely used in clinical anesthesia and basic research. In recent years, with the further study of dexmedetomidine, it has been found that it has a certain protective effect on nerve injury caused by various causes.

A Clinical Trial to Determine the Efficacy of Abhaya Nagara Churna in the Management of Tamaka Swasa~Bronchial Asthma

Introduction: In the 19th century, surgery underwent a transformative moment with the discovery of the first anesthetic. Ayurvedic pioneers like Susrutha and Caraka described surgical techniques devoid of anesthetics, relying on substances such as wine. Recognizing the limited effectiveness of herbal local anesthetics like Akarakarabha and Giri Ardraka, researchers began exploring Aparajitha (Clitorea ternatea) as a potential potent local anesthetic.Methods: To assess Aparajitha as a local anesthetic, water and alcohol extracts were obtained from finely powdered white Clitoria ternatea leaves. These extracts underwent testing at different concentrations using anesthesia methods like the frog’s web, frog pouch, and guinea pig’s wheel.Results: The alcohol extract of Aparajitha acted as an effective anesthetic, with onset from the 7th to the 20th minute, waning by the 35th minute. Both water and alcohol extracts were employed for a comprehensive assessment based on compound solubility. In frog pouch experiments, the test substance induced anesthesia in 10 minutes, while the standard took 3 minutes. Concentrations of 0.2%, 0.4%, and 0.8% had no significant impact, but concentrations of 0.8%, 1%, and 2% showed noticeable anesthesia effects. The 2% alcohol extract achieved the desired effect within 10 applications, matching the standard’s performance, although the standard surpassed the test samples in guinea pig infiltration anesthesia.Discussion: The study indicates that Aparajitha possesses local anesthetic properties, despite limited literature references. Further evaluation, including toxicity studies and clinical trials, is needed to assess its viability as a clinical anesthetic. This research serves as an initial exploration of Ayurvedic anesthesia potential contributions to modern surgery.

Ciprofol: A Novel Alternative to Propofol in Clinical Intravenous Anesthesia?

Ciprofol is a novel compound that was independently developed in China. According to the Chinese product instructions approved by the China National Medical Products Administration and the information of official website, indications for ciprofol include sedation and anesthesia during the surgical/procedure of nontracheal intubation, induction and maintenance of general anesthesia, and sedation during intensive care. Ciprofol is a short-acting intravenous sedative based on the structural modification of propofol. Ciprofol has high efficacy, good selectivity, and fewer adverse reactions, indicating good clinical application potential. A series of clinical studies have been conducted to evaluate the sedative effect of ciprofol in various procedures and settings, including gastroscopy and colonoscopy, fiber-optic bronchoscopy, general anesthesia in elective surgeries, and mechanical ventilation in intensive care units. This review summarizes the chemical structure, pharmacodynamics, and pharmacokinetic properties of ciprofol. We also assessed the efficacy and safety of ciprofol by synthesizing the relevant clinical trial data.

Progress of Brain Network Studies on Anesthesia and Consciousness: Framework and Clinical Applications

Although the relationship between anesthesia and consciousness has been investigated for decades, our understanding of the underlying neural mechanisms of anesthesia and consciousness remains rudimentary, which limits the development of systems for anesthesia monitoring and consciousness evaluation. Moreover, the current practices for anesthesia monitoring are mainly based on methods that do not provide adequate information and may present obstacles to the precise application of anesthesia. Most recently, there has been a growing trend to utilize brain network analysis to reveal the mechanisms of anesthesia, with the aim of providing novel insights to promote practical application. This review summarizes recent research on brain network studies of anesthesia, and compares the underlying neural mechanisms of consciousness and anesthesia along with the neural signs and measures of the distinct aspects of neural activity. Using the theory of cortical fragmentation as a starting point, we introduce important methods and research involving connectivity and network analysis. We demonstrate that whole-brain multimodal network data can provide important supplementary clinical information. More importantly, this review posits that brain network methods, if simplified, will likely play an important role in improving the current clinical anesthesia monitoring systems.

Environmental sustainability in the operating room

BACKGROUND The healthcare industry carbon footprint is 5.2% of total CO2 equivalent emissions worldwide. The operating rooms are the most resource demanding areas in hospital care and the higher energy demands, lack of effective waste management, and inhaled anaesthetic use, lead to a high carbon footprint. There is wide variation in the carbon footprint of inhaled gases, with desflurane ranking 40 times higher than sevoflurane. Other inhaled agents, including N2O and isoflurane, have additional ozone-depleting properties. OBJECTIVE To describe what factors influence the implementation of sustainable anaesthetic strategies. DESIGN An international survey. SETTING Anaesthesia clinicians worldwide between April 2021 and April 2022. PARTICIPANTS One thousand two hundred and thirty-seven anaesthesia clinicians from 75 countries. MAIN OUTCOME MEASURES The primary outcome was a determination of the most used anaesthetic plans among anaesthesia practitioners. Secondary outcomes included an assessment of the influence of various socioeconomic variables on anaesthetic decision-making, and on the level of the practitioners’ awareness of peri-operative environmental sustainability. RESULTS Sixty-four percent of respondents use inhaled anaesthetics on a daily basis, with 83% preferring sevoflurane, and only 5% using N2O regularly. Forty-five percent do not know which halogen gas has the highest carbon footprint. Fifty-one percent do not use low flow anaesthesia regimes (<1.0 l min-1) due to concerns about CO2 rebreathing (30%), hypoxia (25%), compound A related renal failure (12%) or CO generation (10%). Only 15% use minimal flow anaesthesia (<0.5 l min-1). There is a correlation between higher income countries and implementation of more sustainable strategies, probably due to better access to updated technology and sustainability education programmes. Desflurane is used in 6 to 12% of the cases regardless of the GDP index. CONCLUSIONS Halogen gases are the most frequently used anaesthetic drugs worldwide. The majority of respondents are unaware of their global warming impact, or are not influenced in their anaesthetic choices by environmental concerns. More sustainable alternatives of anaesthesia are under-implemented, and vary significantly among countries depending on their GDP index. Further education and training in sustainability is needed.

Anesthesiology Resident Knowledge of Transfusion Medicine: Results From the Anesthesiology Transfusion Education Study.

Transfusion of blood products is a common practice in anesthesiology. Inadequate transfusion medicine knowledge may lead to inappropriate transfusion practices and patient risk. Using a validated assessment tool modified for anesthesiology, we conducted a survey of anesthesiology residents in the United States to assess transfusion medicine knowledge. A validated transfusion medicine examination and accompanying survey were forwarded by program directors to residents for anonymous completion on May 5 and closed on June 30, 2021. The outcome of interest was the mean examination score. Secondary areas of interest were performance by year of training and previous educational experience in transfusion reported by the trainees. Rasch analysis was performed on the examination quality and individual question performance. Kruskal-Wallis H tests were used to identify differences between mean scores. Post hoc comparisons were used to assess specific pairwise differences between mean test scores by survey variable. Four hundred twenty-three anesthesiology residents in 37 programs completed the examination. The mean score was 45.5% ± 12.6%. There was a significant difference in mean cumulative examination scores between different resident training levels ( P < 0.001). There was a significant difference in scores between clinical anesthesia (CA)-1 and CA-2 residents ( P = 0.011) and CA-1 and CA-3 residents ( P = 0.012). No significant difference in examination scores was observed between CA-2 and CA-3 residents ( P = 0.95). All these subgroups scored below 50% on the examination. Significant differences between the residency training programs and cumulative scores were identified ( P < 0.001). This examination highlights gaps in transfusion medicine knowledge within US anesthesiology residents. Targeted education may improve knowledge in this area and patient care.

Age-dependent Electroencephalogram Characteristics During Different Levels of Anesthetic Depth.

Objective The monitoring of anesthetic depth based on electroencephalogram derivation is not currently adjusted for age. Here we analyze the influence of age factors on electroencephalogram characteristics. Methods Frontal electroencephalogram recordings were obtained from 80 adults during routine clinical anesthesia. The characteristics of electroencephalogram with age and anesthesia were observed during four kinds of anesthesia. Results The slow wave power, δ power, Bispectral Index (BIS) and approximate entropy can be used to distinguish different states of anesthesia (P < 0.05). In the deep and very deep anesthesia states, δ power decreased with age (P < 0.0001). In the very deep anesthesia state, θ power decreased with age (P < 0.05). In the deep and very deep anesthesia states, α power decreased with age (P = 0.0002). In the light and deep anesthesia states, β power decreased with age (P = 0.003). In the deep anesthesia state, γ power decreased with age (P = 0.002). In the very deep anesthesia state, permutation entropy increased significantly with age (P = 0.0001). In the very deep anesthesia state, BIS value increased with age (P = 0.006). The slow wave power, approximate entropy, and sample entropy did not show age-dependent changes. Conclusions The influence of age should be considered when using BIS and δ power to monitor the depth of anesthesia, while the influence of age should not be considered when using slow wave power and approximate entropy to monitor the depth of anesthesia.

Propofol maintains Th17/Treg cell balance in elderly patients undergoing lung cancer surgery through GABAA receptor

Propofol is widely used in clinical anesthesia due to its advantages of rapid onset and less adverse reactions. This study focused on the role of propofol in the balance of Th17/Treg in elderly patients with lung cancer during perioperative period. Patients undergoing lung cancer surgery were anesthetized by propofol or sevoflurane. Veinal blood was collected at different time points to evaluate the changes of Th17/Treg cell. Propofol better maintained the balance of Th17/Treg in vivo. The peripheral blood of patients with lung cancer was collected in vitro before surgery. Cluster of differentiation (CD)4+ T cells were obtained and then treated with propofol at different concentrations and γ-aminobutyric acid A (GABAA) receptor antagonists. Propofol affected Th17/Treg cell balance by increasing Th17 cells, decreasing Treg cells, thus elevating Th17/Treg ratio, and inhibited invasion and migration of lung cancer cells through GABAA receptor, which was counteracted by GABAA receptor inhibitors. Subsequently, tumor in situ model of lung cancer in aged mice was established. Propofol anesthetized mice had lower change of Th17/Treg ratio, higher survival rate and less metastasis. In brief, propofol regulated balance of Th17/Treg in elderly patients undergoing lung cancer surgery through GABAA receptor. Additionally, propofol could inhibit metastasis of lung cancer.

Update on Developmental Anesthesia Neurotoxicity

(Curr Opin Anaesthesiol. 2017;30:337–342. doi: 10.1097/ACO.0000000000000461) For more than 60 years, the controversial association between anesthesia exposure in early postnatal life and behavioral or neurocognitive deficiency have been studied. Despite past and ongoing studies, there is no definitive answer as to whether general anesthesia impairs brain development and, if it does, to what extent. While research is still required, a few important recent studies have appeared. This paper aimed to review clinical and experimental developmental anesthesia neurotoxicity findings over the past 2 years.

The Desperate Hours: One Hospital’s Fight to Save a City on the Pandemic’s Front Lines

The Desperate Hours: One Hospital’s Fight to Save a City on the Pandemic’s Front Lines

Cerebrospinal fluid contacting nucleus and its 5-HT: A new insight into the regulation mechanism of general intravenous anesthesia

General anesthesia is one of the most common clinical anesthesia methods. Many studies have suggested that 5-HT plays an important role in the mechanism of general anesthesia, but its basic principle is still unclear. The cerebrospinal fluid (CSF)-contacting nucleus, which we identified 30 years ago, contains a large number of 5-HT neurons. In the brain, many of the nuclei involved in regulating the effects of general anesthesia send projections to the CSF-contacting nucleus.Does the CSF-contacting nucleus and its 5-HT neurons participate in regulating the effect of general anesthesia? This is a new and interesting scientific question.To answer this question, rats underwent general anesthesia by intravenous injection of propofol. During the maintenance of and recovery from general anesthesia, the protein expression of c-Fos in the CSF-contacting nucleus was significantly increased. “Knockout” of this nucleus significantly increased the of number of low-frequency δ waves, which are indicative of deep anesthesia, during general anesthesia maintenance; however, the number of high-frequency β waves, which indicate consciousness, was significantly decreased. During recovery from general anesthesia, the recovery of the righting reflex (RORR) time of rats with CSF-contacting nucleus ablation was significantly prolonged; activation of 5-HT neurons in the CSF-contacting nucleus promoted recovery from general anesthesia, while inhibition of 5-HT neurons in the CSF-contacting nucleus delayed recovery from general anesthesia.The above results suggest that the CSF-contacting nucleus and its 5-HT neurons play a key role in regulating the effect of intravenous anesthesia, especially during recovery from general anesthesia.

Modulating operating room music volume with the CanaryBox: A quality improvement initiative to improve anesthesia clinicians’ response times to alarms to improve quality of anesthetic care

Music is commonly played in the operating rooms and contributes to overall noise level. High noise levels in the operating room, often surpassing the National Institute for Occupational Safety and Health recommendations, affect clinician communication and vigilance. This study's primary aim was to reduce anesthesia provider response time to alarms to improve quality of care to patients undergoing general anesthesia. The aim of this quality improvement project was to reduce anesthesia provider response time to vital sign alarms with the tested intervention of the CanaryBox device to modulate music volume in the OR by August of 2021. Utilizing improvement science methods including the Model of Improvement and tested interventions via the Plan-Do-Study-Act cycles, we utilized the CanaryBox in the pediatric orthopedic operating rooms at Monroe Carell Jr. Children's Hospital at Vanderbilt. This device modulates music volume according to the severity of patient vital sign deviations. Timestamps of onset and response to patient vital sign alarms, recorded by the Philips IntelliVue Information Center system, were collected for 12 control (pre-intervention) and 58 intervention (with the CanaryBox) cases. Median and average response times were calculated for pre- and post-intervention cases. There was an associated decrease (improvement) in average anesthesia provider alarm response times from 30.2 seconds in pre-intervention cases to 23.6 seconds with CanaryBox intervention cases. Improved anesthesia provider response times with implementation of the CanaryBox imply less distraction due to unnecessary noise levels at critical periods. This improved vigilance and decreased response time indicate anesthesia providers deliver higher levels of patient care when the CanaryBox is modulating music volume.