Anesthesiology and Perioperative Science最新文献

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.

Purpose

Congenitally corrected transposition of the great arteries (ccTGA) is a rare disease that is complicated by a variety of tachyarrhythmias or atrioventricular blocks and cardiac malformations. Anesthesia management is a challenge, especially in ccTGA patients with complications. Herein, we reported a case of ccTGA.

Methods

Multimodal general anesthesia combined with transversus thoracic muscle plane block (TTMPB), use of low-dose opioids and adjuvant medications, lung protective ventilation, use of vasoactive drugs and close perioperative monitoring were employed for the peri-operative management of this patient.

Results

The patient was safely returned to the ward and did not develop serious complications. Fourteen days after surgery, the patient recovered well and was discharged.

Conclusions

For patients undergoing a secondary cardiac surgery for ccTGA, preoperative evaluation of etiology of ccTGA is very important. Anesthesia management based on the surgical method and intraoperative vital signs and the postoperative real-time monitoring are also crucial for the post-operative recovery of these patients.

Effective management of pediatric perioperative pain is typically goal-directed and multimodal, requiring various imperfect agents in combination to provide analgesia and support recovery. Gabapentinoids are one such class of agents often used in pediatric analgesic and enhanced recovery pathways. In adults, gabapentinoids have been associated with a modest reduction in pain scores but are often avoided due to undesired side effects. Children may be less susceptible to these unwanted effects, and the reduction in pain, agitation, and post-operative nausea and vomiting seen with these medications may confer significant benefit. While further studies are needed, to date there is no evidence to suggest a significantly increased risk of adverse effects in generally healthy children treated with gabapentinoids in the perioperative period. Although current evidence does not support their indiscriminate use, there appears to be a subset of pediatric surgical patients who stand to benefit from perioperative gabapentinoids. Pediatric use should not be abandoned, but rather further investigated to support thoughtful goal-directed application.

Graphical Abstract

Purpose

To present a review of insights gained from investigating the question as to whether red haired individuals have altered sensitivity to pain.

Methods

A narrative review of the literature.

Results

Anecdotal observations from anaesthesiologists have suggested that individuals with red hair require more analgesia on average than members of the general population. This observation has been confirmed and the redheaded phenotype is associated with an altered sensitivity to pain across a wide range of different pain types. Through the use of mouse models, a central mechanism for this altered pain sensitivity has been proposed involving both the melanocortin and opioid receptor systems, despite the causative mutation for this phenotype occurring in melanocortin 1 receptors (MC1Rs) on peripheral melanocytes.

Conclusions

Understanding the endocrine imbalance caused by this loss of function mutation helps us to further explore the mechanisms behind pain sensitivity. It also facilitates a discussion about how pharmacogenomics can be exploited to personalise and subsequently optimise treatment.

Graphical Abstract

Purpose

We developed EmergenCSim™, a serious game (SG) with an embedded assessment, to teach and assess performing general anesthesia for cesarean delivery. We hypothesized that first-year anesthesiology trainees (CA-1) playing EmergenCSim™ would yield superior knowledge scores versus controls, and EmergenCSim™ and high-fidelity simulation (HFS) assessments would correlate.

Methods

This was a single-blinded, longitudinal randomized experiment. Following a lecture (week 3), trainees took a multiple-choice question (MCQ) test (week 4) and were randomized to play EmergenCSim™ (N = 26) or a non-content specific SG (N = 23). Participants repeated the MCQ test (week 8). Between month 3 and 12, all repeated the MCQ test, played EmergenCSim™ and participated in HFS of an identical scenario. HFS performance was rated using a behavior checklist.

Results

There was no significant change in mean MCQ scores over time between groups F (2, 94) = 0.870, p = 0.42, and no main effect on MCQ scores, F (1, 47) = 1.110, p = 0.20. There was significant three-way interaction between time, gender and group, F (2, 90) = 3.042, p = 0.053, and significant two-way interaction between gender and time on MCQ scores, F (2, 94) = 107.77, p = 0.036; outcomes improved over time among males. There was no group difference in HFS checklist and SG scores. Both instruments demonstrated good internal consistency reliability but non-significant score correlation.

Conclusions

Playing EmergenCSim™ once did not improve MCQ scores; nonetheless scores slightly improved among males over time, suggesting gender may impact learning outcomes with SGs.

Bilateral superficial cervical plexus block (BSCPB) is widely used in thyroid surgery. However, its ability to reduce patients’ perioperative pain remains controversial. Therefore, this study aimed to investigate the value of using BSCPB perioperatively for thyroid surgery by conducting a systematic review and meta-analysis of relevant clinical studies. In this systematic review and meta-analysis, we conducted comprehensive searches in the PubMed, Embase, and Cochrane Library databases to collect all randomized controlled trials (RCTs) that used BSCPB for thyroid surgery. The included studies were then analyzed for heterogeneity using the chi-square test, and studies with large heterogeneity were subjected to subgroup or sensitivity analyses. Treatment effects were measured using odds ratio (OR) or weighted mean difference (WMD) and 95% confidence interval (CI). A total of 19 RCTs with 1,365 patients who underwent thyroid surgery (713 and 652 patients in the BSCPB and control groups, respectively) were included in this systematic review. Most of the studies reported that cervical plexus blocks were used preoperatively, and the main drugs used were 0.25–0.75% ropivacaine or bupivacaine. The BSCPB procedure could significantly reduce visual analog scale scores in the immediate (WMD: −1.12, 95% CI: −1.51 to −0.73, P < 0.00001), 6-h (WMD: −1.06, 95% CI: −1.60 to −0.53, P = 0.0001) and 24-h (WMD: −0.87, 95% CI: −1.29 to −0.45, P < 0.0001) postoperative period and also reduce opioid requirements for patients in the post-anesthesia care unit (50.99% vs 72.92%, OR: 0.3, 95% CI: 0.17 to 0.52, P < 0.0001) and in the wards (39.80% vs 59.79%, OR: 0.27, 95% CI: 0.12 to 0.59, P = 0.001). Additionally, BSCPB reduced the incidence of postoperative nausea and vomiting (OR: 0.50, 95% CI: 0.29 to 0.87, P = 0.01). Due to the large heterogeneity, the results only suggest decrease use of intraoperative fentanyl and postoperative morphine in the BSCPB group. The use of BSCPB alleviates of postoperative pain, opioid requirement, and reduces incidence of postoperative nausea and vomiting in patients who have undergone thyroid surgery. More clinical studies are needed for further conclusions.