Anesthesiology and Perioperative Science最新文献

Bibliometric analysis is a widely used method to identify and evaluate the trends and characteristics of the scientific publications in a specific research field. A large volume of literature has been published in the field of malignant hyperthermia (MH). However, no bibliometric studies have been conducted to describe the characteristics of highly cited articles on MH. Therefore, this study aims to identify the 100 most frequently cited articles about malignant hyperthermia, describe their characteristics, and investigate research trends. Searches were performed in Web of Science Core Collection, Google Scholar, and Scopus from January 1900 to March 2023, with no language limitation. The 100 most frequently cited articles were selected and analyzed. Characteristics including publication year, journal, impact factor, authors, authors countries, citation number, journal citation indicator, study design, and topics were analyzed. For the 100 most cited articles, the number of times each article was cited ranged from 84 to 1254, with a median of 133. The number of articles published peaked in the decade of 1990s (n = 30). The articles were published in 39 journals, with Anesthesiology leading with 13 publications and then the British Journal of Anaesthesia with 12 publications. The authors were from 21 countries, led by the United States (n = 37). Forty articles focused on genetic susceptibility screening, 27 articles were about MH etiology, and 11 articles were about diagnosis and treatment. The mortality rate of MH and dantrolene availability are known to be uneven worldwide. This may partly be explained by the fact that scientific publications primarily report by authors from developed countries. This bibliometric analysis highlights the characteristics of the most influential research related to malignant hyperthermia, providing a reference for conducting future research.

Purpose

In patients with a radial arterial catheter, underdamping of the pressure signal is common and responsible for an overestimation of systolic arterial pressure (SAP). The maximum rate of the arterial pressure rise during systole (dP/dt_MAX) has been proposed to assess left ventricular systolic function. The impact of underdamping on dP/dt_MAX is likely but has never been quantified.

Methods

We analyzed data from 70 critically ill patients monitored with a radial catheter in whom underdamping of the arterial pressure waveform was confirmed by the Gardner’s method. Invasive SAP and dP/dt_MAX were recorded at baseline and after the correction of underdamping with a resonance filter.

Results

With resonance filtering, SAP decreased from 159 ± 25 to 139 ± 22 mmHg (p < 0.001) and dP/dt_MAX from 2.0 ± 0.6 to 1.1 ± 0.3 mmHg/ms (p < 0.001). The underdamping-induced overestimation of SAP (delta-SAP) ranged from 6 to 41 mmHg (mean 21 ± 9 mmHg or + 15%) and the overestimation of dP/dt_MAX (delta-dP/dt_MAX) ranged from 0.2 to 2.0 mmHg/ms (mean 0.9 ± 0.4 mmHg/ms or + 84%). A significant linear relationship (p < 0.001, r = 0.6) was observed between delta-SAP and delta-dP/dt_MAX such that the higher was delta-SAP, the higher was delta-dP/dt_MAX.

Conclusions

Radial arterial pressure underdamping has a major impact on dP/dt_MAX. In case of underdamping, the overestimation of dP/dt_MAX is > fivefold higher than SAP overestimation. Therefore, caution should be exercised before using radial dP/dt_MAX as a marker of left ventricular systolic function.

Trial registration

Registered at ClinicalTrials.gov on December 22, 2021 (NCT05166993).

Graphical Abstract

Sleep disturbances are risk factors for postoperative delirium (POD), and sleep interventions have been proposed as potential preventive measures. However, the effectiveness of sleep interventions in preventing POD is uncertain. We performed a systematic literature search using the PubMed, Embase, and Cochrane Library databases from inception until December 24, 2022. We included randomized controlled trials on sleep interventions and POD in adult surgery patients. The screening of titles, abstracts, and full texts was performed independently by two reviewers. Another two reviewers independently performed the data extraction and assessed the risk of bias. Pooled-effect estimates were calculated with a random effect model. Our primary outcome was POD, which was assessed with the confusion assessment method (CAM), CAM for the intensive care unit (CAM-ICU), or other delirium assessment tools. We used trial sequential analysis to control for type I and II statistical errors. We also conducted prespecified subgroup analyses, according to the type of intervention, efficacy of the intervention on postoperative sleep, sample size, participant age, delirium assessment tool used, and the type of surgery. Data were obtained from 25 trials, including 4799 participants. Sleep interventions had a statistically significant difference in the incidence of POD (relative risk (RR) = 0.60; 95% confidence interval (CI), 0.46–0.77; I² = 58%). Stratified analyses indicated that the beneficial effects of sleep interventions were evident in trials where the interventions promoted postoperative sleep (RR = 0.51; 95% CI, 0.36–0.71) as compared to trials that did not (RR = 1.01; 95% CI, 0.77–1.31) (p-value for interaction between subgroups = 0.004). Our primary analysis demonstrated that in adult patients following elective surgery, interventions that improved postoperative sleep, as compared to the standard care or placebo groups, were associated with a lower risk of POD. However, such evidences are limited by the heterogeneity among trials and the small sample sizes of some trials.

Graphical Abstract

Inadvertent hypothermia, defined as a body temperature lower than 36 °C, remains to be a critical issue during the perioperative period. Despite of the development of the active warming devices, the incidence of perioperative hypothermia has been reported to varying between 10%–80%. The top five risk factors of perioperative hypothermia include advanced age, low body mass index, duration of anesthesia or surgery, preoperative hypothermia and large amount of fluid or blood product. A prediction scoring system may be helpful in identifying the population with high risk of perioperative hypothermia. Perioperative hypothermia is associated with shivering, postoperative infection, increased amount of intraoperative blood loss and infusion of fluid or blood products, and delayed recovery after anesthesia. The most accepted warming intervention is forced-air warmers, which has been reported to be associated with elevated intraoperative temperature and reduced intraoperative bleeding and postoperative infection. The present review will focus on the mechanism, incidence, risk factor, adverse outcome, monitoring and warming strategies of perioperative hypothermia.

Graphical Abstract

Cognitive training (CT) has been shown to reduce the risk of postoperative cognitive dysfunction (POCD) in surgical patients undergoing general anesthesia, but the evidence is controversial. Additionally, whether different timings of CT have diverse effects and which surgical populations benefit most are unclear. To answer these questions, we searched Medline, Embase, Web of Science and Cochrane Library through July 18, 2022, for randomized controlled trials (RCTs) of CT in surgical patients with general anesthesia reporting cognitive outcomes, and found 13 studies including 989 patients. Pooled analysis showed that CT could significantly reduce the incidence of POCD (k=7, RR=0.52, 95% confidence interval (CI)=[0.34–0.78]), especially for the noncardiac surgery population (k=4, RR=0.43 [0.29–0.63], P<0.01, I² =0%). The pooled RRs for preoperative CT and postoperative CT were both low and statistically significant, while that for perioperative CT was not (k=2, RR=0.42 [0.25–0.70], P<0.01, I²=0% vs k=4, RR=0.43 [0.28–0.67], P<0.01, I²=0% vs k=1, RR=1.44 [0.69–3.01], P=0.34, I²=0%). Small to moderate effects were found for executive function, speed, language and verbal memory, while no statistically significant effects were found for postoperative delirium (POD), global cognition, working memory, and psychosocial functioning, including depressive symptoms and anxiety symptoms. Although RCT evidence remains sparse, current evidence suggests that preoperative and postoperative CT may help reduce the incidence of POCD, particularly in the noncardiac surgery population, and improve specific cognitive domains in surgical patients. This intervention therefore warrants longer-term and larger-scale trials to examine the effects on the risk of POD and application to the cardiac surgery population.

Graphical Abstract

The short acting benzodiazepine remimazolam has been well characterised for use during procedural sedation. Onset of hypnotic effect is swifter than midazolam and recovery is faster with a period of antegrade amnesia. Haemodynamic changes associated with remimazolam sedation are modest and there is no pain on injection. General anaesthesia may be induced and maintained by infusion of remimazolam in combination with a suitable opioid. Hypotension is less frequent than when propofol is used. In addition, remimazolam may be a suitable alternative to propofol or etomidate for inducing anaesthesia in haemodynamically compromised patients prior to maintenance with a volatile agent. A small proportion of patients are slow to recover consciousness after total intravenous anaesthesia (TIVA) with remimazolam/opioid combinations. Preliminary experience suggests that flumazenil may be useful in this group however studies are required to define the appropriate dosage and timing for flumazenil administration. Future developments may include sedation and anaesthesia for infants and children as well as intensive care sedation for all age groups. These indications require demonstration in well designed clinical trials.

Graphical Abstract

Purpose

Glial cells play a crucial role in regulating physiological and pathological functions, such as sensation, infections, acute injuries, and chronic neurodegenerative disorders. Despite the recent understanding of glial subtypes and functional heterogeneity in central nervous system via single-cell/nucleus RNA sequencing, the transcriptomic profiles of glial cells in the adult human dorsal root ganglia (DRG) have not yet been characterized at single-cell resolution.

Methods

We used high-throughput single-nucleus RNA sequencing to map the cellular and molecular heterogeneity of satellite glial cells (SGCs) and Schwann cells (SCs) in the human DRG, and further compared these human findings with those from mice. The expression profiles of classical marker genes of peripheral somatosensory system in glial cells were examined in human and mouse DRG. Additionally, the functional properties of the enriched genes in glial cells and their subtypes were also explored by Gene Ontology (GO) term analysis.

Results

Human DRG cells were initially classified into 11 clusters based on their distinct transcriptional characteristics. SGCs and SCs were identified through their representative marker genes. SGCs were further classified into six subclusters, while SCs were classified into seven subclusters. The comparison with mouse transcriptomic profiles revealed an overall similarity between the two species, while simultaneously highlighting some degree of heterogeneity in specific genes.

Conclusions

This atlas comprehensively profiled glial cell heterogeneity and provides a powerful resource for investigating the cellular basis of physiological and pathological conditions associated with DRG glial cells.

Graphical Abstract

Patients awaiting surgical procedures often experience obvious anxiety due to discomfort and uncertain events, which is one of the most common clinical manifestations in perioperative patients. Numerous studies have confirmed that preoperative anxiety is closely related to the occurrence of postoperative adverse events, such as insomnia, pain, nausea and vomiting and neurocognitive dysfunction. Appropriate intervention or treatment for preoperative anxiety may contribute to reducing the incidence of postoperative adverse events. Although people have long known about the negative effects of preoperative anxiety and have taken certain measures, the underlying mechanism has yet to be fully elucidated. In this paper, we focus on several typical postoperative adverse events that are, particularly concerning to anesthesiologists, review their relationships with preoperative anxiety, describe the intervention strategies and provide a certain summary and outlook.