Anesthesiology and Perioperative Science最新文献

Purpose

To compare hemodynamic stability during anesthesia induction period between routine anesthesia tracheal intubation and modified-delayed sequence intubation (mDSI) in elderly patients (≥ 65 years) undergoing noncardiac surgery.

Methods

A single-center retrospective study was conducted involving patients aged ≥ 65 years undergoing noncardiac surgical procedures. Hemodynamic outcomes during anesthesia induction encompassed duration of hypotensive episodes, mean rate-pressure product (RPP), mean arterial pressure, and administration patterns of vasoactive agents. Propensity score matching (PSM) was implemented to balance covariates and mitigate potential confounding effects.

Results

The study cohort comprised 9,828 elderly patients, including 8,770 cases of routine anesthesia tracheal intubation and 1,058 cases of mDSI. Following PSM, comparative analysis revealed significantly reduced hypotension duration in the mDSI group compared to the routine anesthesia tracheal intubation group: 6.5 (6.0–7.5) vs. 1.0 (0–3.0) minutes, respectively (p < 0.001). Hemodynamic assessment showed significantly higher RPP values in the routine anesthesia tracheal intubation cohort [12,432 (8,142–15,480) mmHg·bpm] versus the mDSI group [9,993 (8,362–11,243) mmHg·bpm, p < 0.001]. Pharmacological analysis indicated reduced vasoactive agent requirements in the mDSI group, including lower cumulative dosages of phenylephrine, esmolol, and urapidil.

Conclusion

The mDSI demonstrates efficacy in maintaining the circulatory stability during anesthesia induction, facilitating a smooth induction process for elderly surgical patients.

Acute pain management remains a core challenge in the field of emergency medicine. Traditional opioids have limited clinical application due to respiratory depression, addiction risks, and other adverse effects. As the dextrorotatory isomer of ketamine, esketamine relies on its unique N-methyl-D-aspartate (NMDA) receptor antagonism to exhibit rapid analgesic, anti-inflammatory, and antidepressant effects while maintaining hemodynamic stability, thus providing a novel alternative for emergency care. This study systematically explored the application value and controversies of esketamine in critical emergency scenarios such as combat trauma, burns, obstetric emergencies, and difficult airway management through literature review, clinical case analysis, and multidisciplinary expert consultation. Our findings revealed that in combat trauma care, intranasal or intravenous administration of esketamine achieves rapid analgesia, reduces the risk of respiratory depression, and its sympathomimetic effects help stabilize the hemodynamics of shock patients. In the management of clinical emergencies, the combination of esketamine with propofol reduces opioid consumption by more than 20% and improves the safety of endoscopic procedures, burn debridement, and obstetric anesthesia. However, controversies persist regarding psychiatric symptoms induced by esketamine at doses > 0.5 mg/kg, potential neurotoxicity with long-term use, and safety issues in special populations such as pregnant women and psychiatric patients. In conclusion, esketamine demonstrates prominent advantages in emergency settings and is expected to transform from a "controversial alternative" to a core drug for analgesic and sedative treatment in emergency medicine.

Postoperative nausea and vomiting (PONV) remains a common complication, with persistently high failure rates even in high-risk patients receiving standard combination regimens such as ondansetron and dexamethasone. This finding highlights the limitations of current therapies in terms of the duration of action, particularly for delayed PONV, and receptor coverage. Fosaprepitant, an intravenous neurokinin-1 receptor antagonist, represents a novel strategy to overcome this challenge. Its long duration of action (half-life of 9–13 h) and potent blockade of substance P, a key component of the pathway involved in vomiting, provide a new approach to managing this complication. A systematic search of major databases (PubMed, Web of Science, and Cochrane Library) was conducted to identify clinical studies published between January 2000 and June 30, 2025, investigating intravenous fosaprepitant for the prevention of postoperative nausea and vomiting. Keywords included fosaprepitant, neuropeptide-1 receptor antagonist, postoperative nausea and vomiting, drug interactions, and intravenous administration. The relevant literature was screened based on clinical relevance and the study design. The findings of this review indicate that compared with conventional agents, fosaprepitant demonstrates superior or equivalent efficacy in preventing vomiting, particularly across multiple surgical procedures involving opioid use or high-risk patients, and is suitable as the cornerstone of multimodal protocols. However, its interactions with CYP3A4-metabolized drugs and the associated hypotension risk remain challenges that require careful consideration before its integration into routine perioperative management. Thus, fosaprepitant, with its unique mechanism and pharmacokinetic advantages, represents a significant option for optimizing PONV prevention and advancing personalized therapy. Future research should focus on developing standardized strategies for managing drug interactions to fully realize its clinical potential.

With continuous advancements in medical technology and the steady improvement of the healthcare system, the future of day surgery in China holds immense potential for growth. This review explores recent advances and challenges in day surgery in China, focusing on policy, technological innovation, and implementation gaps. While these advancements present exciting opportunities, challenges remain, necessitating collaborative efforts to ensure the sustainable expansion of day surgery in China.

Purpose

Stroke can cause severe cognitive impairment in patients. Recently, neurogenesis has been proposed as a potential approach to improve cognitive abilities after stroke. However, no effective treatment strategy currently exists for stimulating hippocampal neurogenesis to promote cognitive recovery. Therefore, this study investigated the mechanisms underlying the increase in hippocampal neurogenesis induced by mitochondrial biogenesis.

Methods

To achieve the objective, mice subjected to the global cerebral ischaemia (GCI) model via bilateral common carotid artery occlusion were used to investigate mitochondrial biogenesis in vivo through western blotting, transmission electron microscopy, and immunofluorescence staining. Hippocampal neurogenesis was assessed using immunofluorescence staining. Cognitive functions were evaluated using the open field test, novel object recognition, fear conditioning, and Morris water maze. In addition, an in vitro oxygen–glucose deprivation model served as a stroke analogue. Neurite outgrowth in primary neurons was quantified using immunofluorescence staining, while mitochondrial function parameters, including adenosine triphosphate, mitochondrial membrane potential, and reactive oxygen species, were measured using specific assay kits. Lentiviruses were used to manipulate mitochondrial biogenesis both in vivo and in vitro.

Results

We observed that the time course of mitochondrial biogenesis matched that of neurogenesis in the hippocampal dentate gyrus (DG) following GCI. Promoting mitochondrial biogenesis enhanced neurogenesis in the DG, lengthened neurites, and improved mitochondrial function, collectively alleviating cognitive deficits following stroke. Conversely, inhibition of mitochondrial biogenesis had the opposite effect. In addition, ubiquinol-cytochrome c reductase core protein 1 (UQCRC1) was identified as a crucial component of mitochondrial biogenesis. UQCRC1 knockdown impaired neurogenesis and cognitive abilities in mice.

Conclusion

This study highlights that mitochondrial biogenesis plays a pivotal role in neurogenesis within the hippocampal DG and may represent a promising strategy for treating cognitive impairment associated with ischaemic stroke.

Graphical Abstract

Early prediction of the major perioperative adverse events is of great significance for reducing mortality, morbidity and medical costs. Machine learning (ML) leverages the capacity for predicting the probability of perioperative adverse events, revealing the promise to facilitate risk stratification, tailored prevention, and individualized perioperative management. However, significant heterogeneity has been demonstrated in the model’s performance of discrimination, calibration, interpretability, and transparency among studies, which raises concerns over their clinical efficacy and usability. A lack of guidance for non-expert medical professionals and stakeholders hinders rigorously conducting research with standard procedure, appropriate methodology, consistent measures, and complete reports. We established a multidisciplinary team consisting of clinicians, data scientists, computer scientists. Multiple libraries including Medline, PubMed, Web of Science, Embase, and CINAHL were searched. We comprehensively summarized critical issues within the entire workflow of ML-based model study, including scenarios and problems, task definition, data collecting and processing, feature representation, model development and validation, clinical implementation and evaluation, aiming to provide guidance and insights for this topic. This review provides a practical checklist of the ML workflow tailored for perioperative teams, bridging technical innovations with clinical translation.

Purpose

Using Mendelian Randomization (MR) analysis, this study aimed to assess any causal effect of educational attainment on the risk of delirium and to determine whether smoking mediates this association.

Methods

We obtained genome-wide association study (GWAS) summary-level statistics for educational attainment (n = 765,283), age of smoking initiation (n = 341,427), cigarettes per day (n = 337,334) and delirium (4,381 cases, 469,981 controls) from GWAS repositories. The inverse variance weighted approach served as the main analytical strategy for causal estimation. Multiple sensitivity tests were used to assess the robustness of MR analyses. We evaluated the causal effect of educational attainment on delirium, the effect of educational attainment on smoking-related traits and the effect of smoking-related traits on delirium. We then performed mediation analysis to evaluate the mediating effect of smoking traits on the association between educational attainment and delirium. In addition, we performed linkage disequilibrium score regression (LDSC) to evaluate genetic correlations between traits.

Results

Higher educational attainment was significantly associated with a lower delirium risk (OR = 0.767, 95% CI: 0.637–0.922, P = 0.005). Age of smoking initiation was positively associated with educational attainment (β = 0.289, P = 8.89 × 10^-133) and inversely associated with delirium risk (OR = 0.553, P = 0.014), whereas cigarettes per day was inversely associated with educational attainment (β = –0.315, P = 1.70 × 10^-32) and positively associated with delirium risk (OR = 1.238, P = 0.022). Sensitivity analyses indicated that the MR results were not affected by heterogeneity or horizontal pleiotropy. Mediation analysis indicated that the age of smoking initiation and cigarettes per day mediated 64.4% (P = 0.014) and 25.3% (P = 0.024) of the total effect, respectively. LDSC analysis revealed a significant negative genetic correlation between educational attainment and delirium, and between age of smoking initiation and delirium. Educational attainment also showed strong correlations with smoking traits, positively with age of initiation and negatively with cigarettes per day.

Conclusion

The findings of this MR study support the notion that higher educational attainment may reduce the risk of delirium by promoting a later age of smoking initiation and decreasing the number of cigarettes smoked per day.

Modern anesthesiology has expanded beyond intraoperative care. It now integrates pain management, critical care, and emergency resuscitation. However, it still faces challenges like biological variability in drug responses, unpredictable intraoperative crises, and complex perioperative complications. Artificial intelligence (AI) emerges as a transformative force, can effectively enhance clinical quality and operational efficiency by extracting critical insights from vast amounts of healthcare data including electronic health records, vital sign waveforms, and imaging databases. AI applications in clinical anesthesia span the entire perioperative period, encompassing preoperative risk assessment, intraoperative physiological monitoring with adverse event prediction and visualized procedural guidance, as well as postoperative outcome forecasting and dynamic adaptive individualized treatment to enhance recovery after surgery. Beyond direct patient care, AI enhances operating room efficiency and revolutionizes anesthesia education. Despite progress, challenges persist in algorithm generalizability, data interoperability, and clinical validation. This review synthesizes the transformative role of AI across anesthesiology subspecialties, analyzes the barriers to implementation, and proposes strategic directions to bridge technological innovation with clinical optimization.