To present a review of insights gained from investigating the question as to whether red haired individuals have altered sensitivity to pain.
A narrative review of the literature.
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.
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.
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.
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.
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.
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.
The erector spinae plane block remains a divisive regional technique which has split the regional anesthesia community into believers and non-believers. Its main mechanism of action remains controversial and this has been pivotal in the controversy. We explore our current understanding of fascial plane blocks and erector spinae blocks as well as explore the gaps in knowledge. This opinion paper is meant to give a balanced view of the current state of this block in regard to guidelines, research and future. The viewpoint of the authors may not necessarily align with current ideas, however, hopefully will guide subsequent trials to more robust evidence.
To characterize the fragility index (FI) of statistically significant results reported in randomized controlled trials (RCTs) investigating the incidence of hemidiaphragmatic paralysis (HDP) after brachial plexus blocks. A systematic review of RCTs retrieved from the PubMed-Medline, Embase, and Web of Science electronic databases was conducted. All alternative RCTs published between January 2012 and October 2022 were identified. Only RCTs with two parallel arms designs, and reporting HDP as the primary outcome, statistical significance, and superiority results were selected. The FI was calculated according to Fisher’s exact test using previously described methods. In addition, the risk of bias was evaluated using the Cochrane Risk-of-Bias tool for randomized trials. The 23 RCTs that fulfilled the inclusion criteria had a median FI of 4 (interquartile range [IQR]2–8) and a median Fragility Quotient of 0.077 (IQR 0.038- 0.129). However, in 13 (56.5%) trials, the calculated FI value was ≤ 4. In 3/23 (13.0%) trials, the number of patients who dropped-out exceeded the FI value. Most trials (91.3%) had an overall low risk of bias. This systematic review revealed that the statistical results of RCTs investing HDP after brachial plexus blocks have tended to be fragile in the past decade. The FI should be an important aid in the interpretation of clinical results in combination with the P-value, particularly when statistically significant results are dependent on a small number of events. Future RCTs with larger sample sizes are needed to obtain more robust results in this field.
Exogenous catecholamines may have pronounced side effects and affect physiological cascades. The aim of this study was to investigate the effect of vasopressors on mortality of critically ill patients with coronavirus disease 2019 (COVID-19). A systematic search of PubMed, Scopus, and ClinicalTrials.gov was conducted for relevant articles until December 2022. Eligibility criteria were randomized controlled and non-randomized trials. The primary outcome was in-hospital and 30-day mortality. The quality of studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool, while paired meta-analysis was used to estimate the pooled risk ratios (RR) along with their 95% Confidence Interval (95% CI). Analyses of 22 studies (n = 8034) revealed that vasopressor use is associated with mortality compared to no vasopressor therapy [RR (95%CI): 4.30 (3.21, 5.75); p < 0.001]. In-hospital and 30-day mortality are significantly higher in patients who receive vasopressors [RR (95%CI): 4.60 (2.47, 8.55); p < 0.001 and RR (95%CI): 2.97 (1.72, 5.14); p < 0.001, respectively]. Also, analyses of data from 10 studies (n = 3519) revealed that vasopressor use is associated with acute kidney injury [RR (95%CI): 3.17 (2.21, 4.54); p < 0.001]. In conclusion, current use of vasopressors in critically ill patients with COVID-19 may be associated with higher in-hospital mortality, 30-day mortality, and incidence rate of acute kidney injury. Further research is required to estimate the correlation of specific vasopressor characteristics (type, timing, dose, combination) with adverse effects and mortality in this population.
The development of acute kidney injury after surgery is associated with significant mortality and morbidity and with worse short and long-term outcomes. Patients who develop acute kidney injury are at an increased risk of developing long-term renal dysfunction, which leads to lower quality of life and greater financial burden on the healthcare system. Although there are various systems to classify the severity of acute kidney injury, most systems only measure components that deteriorate after significant renal damage, such as urine output and serum creatinine. Surgical trauma and stress trigger acute kidney injury development, in addition to multiple co-morbidities, cardiovascular disease, and postoperative factors. The pathophysiology of acute kidney injury is complex, and this is reflected in the heterogenous population that is affected. Treatment is largely supportive and focuses on ensuring adequate renal perfusion, correcting electrolyte abnormalities and avoiding further renal injury. Current research focuses on novel biomarkers that detect decreased renal function earlier and that the deteriorating renal function can be treated before long-lasting damage occurs. This review discusses the epidemiology, aetiology, risk factors, and short and long-term surgical outcomes of acute kidney injury. Treatment, prevention, and recent developments in future research are also discussed.
SARS-CoV-2 have become widespread worldwide since the outbreak. Respiratory function deteriorates rapidly in critically ill patients infected with SARS-CoV-2. Endotracheal intubation is an indispensable therapeutic measure during the development of the disease. This study was intended to describe the experience of endotracheal intubation from front-line anesthesiologists and clinical prognosis of patients infected with Coronavirus disease-19 (COVID-19).
Fourteen critical patients infected with COVID-19 who underwent endotracheal intubation were included in this study. We collate and analyze the blood gas results before and after tracheal intubation of patients and clinical prognostic indicators such as length of stay and. mortality. The experience of anesthesiologists who intubated patients has also been recorded in detail.
Patients had a mean time of 10.6 days from initial symptoms to endotracheal intubation. Most intubated patients had one or more underlying conditions: hypertension (8, 57.14%), diabetes (5, 35.71%), and cardiovascular and cerebrovascular diseases (2, 14.29%). The oxygenation index increased significantly after intubation compared with before intubation (148.80 ± 42.25 vs 284.43 ± 60.17 p < 0.001). 85.72% of patients required extra-corporeal membrane oxygenation (ECMO) due to inability to maintain oxygen saturation with standard therapeutic measures. Two patients underwent lung transplantation because their lungs were essentially nonfunctional, and they recovered well after surgery. As of this writing, all patients were discharged after satisfactory recovery.
Reasonable selection of intubation timing is particularly important. It is crucial to increase the patient's oxygen supply and reduce oxygen consumption as much as possible during endotracheal intubation. In addition, the personal protective measures of medical personnel participating in treatment should be scientific and standardized.
Homer1, an immediate early gene, is related to sleep deprivation (SD), and its protein products are involved in synaptic plasticity affecting the cognitive process. This study aimed to identify the SD-associated key Homer1 gene in the brain and explore the value of Homer1 proteins acting on synaptic plasticity in SD.
GSE9441 was extracted from Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) between SD and Control samples were achieved by R software and were analyzed by the Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway, and gene set enrichment analysis (GSEA). Protein–protein interactions (PPI) network was built by the GeneMANIA databases. In animal experiments, male C57BL/6 J mice (aged 12–13 weeks) were sleep deprived for 6 h, followed by independent behavioral tests and in vitro assays. Morris water maze (MWM) was used to evaluate learning and memory function. The expression of hippocampal Homer1 proteins was detected by Western blot analysis and its distribution in CA1 by immunohistochemistry and immunofluorescence staining. Synaptic plasticity was assessed by Golgi staining and long-term potentiation (LTP) testing in the hippocampal CA1 region.
Homer1 was the hub gene most associated with SD, and its protein products specifically acted on the regulation of synaptic plasticity in bioinformatics. SD mice exhibited spatial memory impairment accompanied by increased Homer1a expression in hippocampal tissue and CA1 region. SD did not induce Homer1b/c overexpression of mice in the hippocampus. SD impaired the hippocampal synaptic plasticity of mice by reducing the density of dendritic spines and inhibiting LTP in the hippocampal CA1 region, which may involve the overexpression of Homer1a in the hippocampus.
Homer1 gene is a core brain molecule associated with acute SD, and its protein product Homer1a is involved in the changes in cognitive brain function following short-term SD, especially the impact on hippocampal synaptic plasticity.
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