Pub Date : 2025-11-25DOI: 10.1213/ane.0000000000007829
Awani Gadre,Julien Cobert,Priya Ramaswamy
{"title":"Silent Contaminants: The Unseen Threat of Microplastics in the Perioperative Period.","authors":"Awani Gadre,Julien Cobert,Priya Ramaswamy","doi":"10.1213/ane.0000000000007829","DOIUrl":"https://doi.org/10.1213/ane.0000000000007829","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1213/ane.0000000000007878
Philip S Susser,Ashok Chhetry,Valentin Fauveau,Cynthia Mercedes,Yun Soung Kim,Matthew A Levin
{"title":"Evaluation of a Novel Wireless Bluetooth Nanoelectrode Electrocardiogram in the Operating Room: A Pilot Study.","authors":"Philip S Susser,Ashok Chhetry,Valentin Fauveau,Cynthia Mercedes,Yun Soung Kim,Matthew A Levin","doi":"10.1213/ane.0000000000007878","DOIUrl":"https://doi.org/10.1213/ane.0000000000007878","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1213/ane.0000000000007828
Victor F A Almeida,Berk B Ozmen,Travis Tsai,John Y Ha,Manoela Dantas,Glaudir Donato,Piyush Mathur
{"title":"Artificial Intelligence in Anesthesiology: Regulatory Pathways and Analysis of FDA-Approved Devices.","authors":"Victor F A Almeida,Berk B Ozmen,Travis Tsai,John Y Ha,Manoela Dantas,Glaudir Donato,Piyush Mathur","doi":"10.1213/ane.0000000000007828","DOIUrl":"https://doi.org/10.1213/ane.0000000000007828","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDDiabetic peripheral neuropathy (DPN) is a debilitating diabetic complication with progressive nerve damage and chronic pain. The limited efficacy of current treatments reflects the incomplete understanding of its underlying mechanisms, particularly the role of neutrophil extracellular traps (NETs) in neuroinflammation.METHODSUsing a streptozotocin (STZ)-induced DPN mouse model, we conducted quantitative proteomic analysis with functional validation. Pharmacological inhibition of protein-arginine deiminase type-4 (PAD4)-mediated NETs formation was achieved using Cl-amidine. Protein interaction networks were constructed via STRING and experimentally validated for key inflammatory pathways.RESULTSProteomic analysis revealed a significant upregulation of myeloperoxidase (MPO) in DPN mice (45.0 ± 1.41 vs 28.3 ± 3.47; P = .002), with enrichment analysis indicating a strong association with the NETs pathway (fold enrichment = 5.03; P = .021). Functional assays showed that Cl-amidine significantly attenuated pain hypersensitivity over time, with repeated measures analysis of variance (ANOVA) confirming a significant group × time interaction (P < .001). Post hoc analysis demonstrated increased paw withdrawal threshold (PWT: 0.450 ± 0.170 g vs 0.230 ± 0.170 g, P = .011) and hot withdrawal latency (HWT: 16.5 ± 3.76 seconds vs 11.4 ± 3.76 seconds; P = .002) at week 3. Cl-amidine also markedly reduced the expression of NETs-related proteins and proinflammatory cytokines. Protein-protein interaction (PPI) analysis detected MPO-NLR family pyrin domain containing 3 (NLRP3) association (textmining: 0.465) with ancillary co-expression support (0.042), consistent with their shared roles in inflammatory pathways. Notably, Cl-amidine treatment significantly decreased NLRP3-related proteins along with interleukin (IL)-1β and IL-18 levels.CONCLUSIONSThis study is the first to reveal that the MPO/NLRP3 axis mediates NETs-driven neuroinflammation in DPN. The findings provide molecular insights into DPN pathogenesis and suggest combined NETs clearance with inflammasome inhibition as a potential therapeutic strategy.
背景：糖尿病周围神经病变（DPN）是一种伴有进行性神经损伤和慢性疼痛的糖尿病并发症。目前治疗的有限疗效反映了对其潜在机制的不完全理解，特别是中性粒细胞胞外陷阱（NETs）在神经炎症中的作用。方法采用链脲佐菌素（STZ）诱导的DPN小鼠模型，进行定量蛋白质组学分析，并进行功能验证。用cl -脒实现了蛋白精氨酸脱亚胺酶4型（PAD4）介导的NETs形成的药理学抑制。通过STRING构建蛋白相互作用网络，并在关键炎症通路中进行实验验证。结果蛋白质组学分析显示DPN小鼠髓过氧化物酶（MPO）显著上调（45.0±1.41 vs 28.3±3.47;P = 0.002），富集分析显示与NETs通路密切相关（富集倍数= 5.03;P = 0.021）。功能分析显示，随着时间的推移，氯脒显著减轻了疼痛超敏反应，重复测量方差分析（ANOVA）证实了显著的组×时间相互作用（P < 0.001）。事后分析显示，在第3周时，爪子戒断阈值（PWT: 0.450±0.170 g vs 0.230±0.170 g, P = 0.011）和热戒断潜伏期（HWT: 16.5±3.76秒vs 11.4±3.76秒，P = 0.002）增加。cl -脒还显著降低nets相关蛋白和促炎细胞因子的表达。蛋白-蛋白相互作用（PPI）分析检测到MPO-NLR家族pyrin结构域含有3 （NLRP3）关联（文本挖掘：0.465）和辅助共表达支持（0.042），这与它们在炎症通路中的共同作用一致。值得注意的是，cl -脒治疗显著降低nlrp3相关蛋白以及白细胞介素(IL)-1β和IL-18水平。结论本研究首次揭示MPO/NLRP3轴在DPN中介导nets驱动的神经炎症。这些发现为DPN的发病机制提供了分子视角，并建议将NETs清除与炎症小体抑制结合起来作为潜在的治疗策略。
{"title":"Influence of MPO/NLRP3 Axis-Mediated Neutrophil Extracellular Traps on Diabetic Neuropathic Pain in a Mouse Model.","authors":"Yuyan Pan,Yan Cao,Xiangnan Chen,Xin Chen,Simin Lu,Jiaxin Zhuang,Xiong Song,Yan Yan,Qiang Li,Weian Zeng,Dongtai Chen","doi":"10.1213/ane.0000000000007814","DOIUrl":"https://doi.org/10.1213/ane.0000000000007814","url":null,"abstract":"BACKGROUNDDiabetic peripheral neuropathy (DPN) is a debilitating diabetic complication with progressive nerve damage and chronic pain. The limited efficacy of current treatments reflects the incomplete understanding of its underlying mechanisms, particularly the role of neutrophil extracellular traps (NETs) in neuroinflammation.METHODSUsing a streptozotocin (STZ)-induced DPN mouse model, we conducted quantitative proteomic analysis with functional validation. Pharmacological inhibition of protein-arginine deiminase type-4 (PAD4)-mediated NETs formation was achieved using Cl-amidine. Protein interaction networks were constructed via STRING and experimentally validated for key inflammatory pathways.RESULTSProteomic analysis revealed a significant upregulation of myeloperoxidase (MPO) in DPN mice (45.0 ± 1.41 vs 28.3 ± 3.47; P = .002), with enrichment analysis indicating a strong association with the NETs pathway (fold enrichment = 5.03; P = .021). Functional assays showed that Cl-amidine significantly attenuated pain hypersensitivity over time, with repeated measures analysis of variance (ANOVA) confirming a significant group × time interaction (P < .001). Post hoc analysis demonstrated increased paw withdrawal threshold (PWT: 0.450 ± 0.170 g vs 0.230 ± 0.170 g, P = .011) and hot withdrawal latency (HWT: 16.5 ± 3.76 seconds vs 11.4 ± 3.76 seconds; P = .002) at week 3. Cl-amidine also markedly reduced the expression of NETs-related proteins and proinflammatory cytokines. Protein-protein interaction (PPI) analysis detected MPO-NLR family pyrin domain containing 3 (NLRP3) association (textmining: 0.465) with ancillary co-expression support (0.042), consistent with their shared roles in inflammatory pathways. Notably, Cl-amidine treatment significantly decreased NLRP3-related proteins along with interleukin (IL)-1β and IL-18 levels.CONCLUSIONSThis study is the first to reveal that the MPO/NLRP3 axis mediates NETs-driven neuroinflammation in DPN. The findings provide molecular insights into DPN pathogenesis and suggest combined NETs clearance with inflammasome inhibition as a potential therapeutic strategy.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1213/ane.0000000000007818
DongGeon Lee,Hayoung Lee,Cheolhyeong Lee,Cheol Lee
BACKGROUNDDrug-induced dreams during intravenous sedation vary by pharmacological agent and influence patient experiences, yet the role of preoperative positive suggestions in modulating these dreams is unclear. This study aimed to investigate the impact of preoperative positive suggestions on drug-induced dream recall (DIDR) frequency, dream content, and subjective perceptions during sedation with propofol or ketamine.METHODSThis prospective, randomized, controlled, double-blinded trial with a 2 × 2 factorial design was conducted at a single tertiary university hospital in South Korea from September 2024 to January 2025. A total of 188 adults (American Society of Anesthesiologists [ASA] physical status I-III), aged 20 to 65, undergoing elective upper extremity surgery with sedation via brachial plexus block were enrolled, excluding those with cognitive or psychiatric disorders or recent sedative use. Patients were randomly assigned to 4 groups: propofol with suggestions (P-S; n = 47), propofol without suggestions (P-NS; n = 47), ketamine with suggestions (K-S; n = 47), and ketamine without suggestions (K-NS; n = 47). The suggestion intervention involved providing 8 pleasant dream scenarios preoperatively. The primary outcome was DIDR frequency (binary: yes/no). Secondary outcomes included dream content, subjective dream perceptions, and predictors of DIDR.RESULTSIn the intention-to-treat analysis (n = 188), DIDR frequencies were 21.3% (P-NS), 25.5% (P-S), 36.2% (K-NS), and 44.7% (K-S), with a significant difference between K-S and P-NS (P = .010). Factorial analysis showed a significant main effect of drug type (ketamine versus propofol: odds ratio [OR] = 2.14, 95% confidence interval [CI], 1.23-3.72; P = .007), but no main effect of suggestions (OR = 1.16, 95% CI, 0.67-2.01; P =.598) or interaction (P = .818). DIDR frequencies were 23.4% (propofol groups: P-NS and P-S) vs 40.4% (ketamine groups: K-NS and K-S) (P = .002), and 35.1% (suggestion groups: P-S and K-S) vs 28.7% (no-suggestion groups: P-NS and K-NS) (P = .308). A significant difference was noted between K-S and P-NS (44.7% vs 21.3%; P = .010). Ketamine increased emotional intensity (P = .0071 versus P-NS; P = .003 vs P-S) and dream strangeness (P = .0071 versus P-NS; P = .0071 versus P-S) versus propofol. Suggestions enhanced dream pleasantness in both drug groups (P = .002 versus P-NS; P = .001 versus K-NS; P = .0071 versus K-S).CONCLUSIONSPreoperative suggestions did not increase DIDR frequency or alter dream content but improved dream pleasantness, indicating potential psychological benefits during sedation.
背景：静脉镇静期间药物引起的梦因药物而异，并影响患者的经历，但术前积极提示在调节这些梦中的作用尚不清楚。本研究旨在探讨术前积极提示对异丙酚或氯胺酮镇静期间药物诱导梦回忆（DIDR）频率、梦内容和主观知觉的影响。方法该前瞻性、随机、对照、双盲试验采用2 × 2因子设计，于2024年9月至2025年1月在韩国一家三级大学医院进行。共有188名成年人（美国麻醉医师协会[ASA]身体状况I-III），年龄20至65岁，接受选择性上肢手术并通过臂丛神经阻滞镇静，排除认知或精神障碍或近期使用镇静剂的患者。将患者随机分为4组：异丙酚伴提示组（P-S, n = 47）、异丙酚无提示组（P-NS, n = 47）、氯胺酮伴提示组（K-S, n = 47）、氯胺酮无提示组（K-NS, n = 47）。建议干预包括术前提供8个愉快的梦境场景。主要结局是DIDR频率（二元：是/否）。次要结局包括梦境内容、主观梦境知觉和DIDR的预测因子。结果意向治疗分析（n = 188）中，DIDR频次分别为21.3% （P- ns）、25.5% （P- ns）、36.2% （K-NS）和44.7% (K-NS)， K-NS与P- ns差异有统计学意义（P = 0.010）。析因分析显示，药物类型（氯胺酮vs丙泊酚：优势比[OR] = 2.14, 95%可信区间[CI]， 1.23-3.72; P =. 007）是主要影响因素，但建议（OR = 1.16, 95% CI, 0.67-2.01; P =.598）和相互作用（P =. 818）无主要影响。DIDR频率分别为23.4%（异丙酚组：P- ns和P- s） vs 40.4%（氯胺酮组：K-NS和K-S） （P = 0.002）， 35.1%（暗示组：P- s和K-S） vs 28.7%（无暗示组：P- ns和K-NS） （P = 0.308）。K-S和P- ns之间存在显著差异（44.7% vs 21.3%; P = 0.010）。与异丙酚相比，氯胺酮增加了情绪强度（P = 0.0071 vs P- ns; P = 0.003 vs P- s）和梦境陌生感（P = 0.0071 vs P- ns; P = 0.0071 vs P- s）。两种药物组的提示均增强了梦境愉悦性（P = 0.002 vs P- ns; P = 0.001 vs K-NS; P = 0.0071 vs K-S）。结论术前建议并未增加DIDR频率或改变梦的内容，但改善了梦的愉悦度，提示镇静期间可能存在心理益处。
{"title":"The Impact of Preoperative Positive Suggestions on Dreaming With Intravenous Sedation: A Randomized Controlled, Blinded Trial.","authors":"DongGeon Lee,Hayoung Lee,Cheolhyeong Lee,Cheol Lee","doi":"10.1213/ane.0000000000007818","DOIUrl":"https://doi.org/10.1213/ane.0000000000007818","url":null,"abstract":"BACKGROUNDDrug-induced dreams during intravenous sedation vary by pharmacological agent and influence patient experiences, yet the role of preoperative positive suggestions in modulating these dreams is unclear. This study aimed to investigate the impact of preoperative positive suggestions on drug-induced dream recall (DIDR) frequency, dream content, and subjective perceptions during sedation with propofol or ketamine.METHODSThis prospective, randomized, controlled, double-blinded trial with a 2 × 2 factorial design was conducted at a single tertiary university hospital in South Korea from September 2024 to January 2025. A total of 188 adults (American Society of Anesthesiologists [ASA] physical status I-III), aged 20 to 65, undergoing elective upper extremity surgery with sedation via brachial plexus block were enrolled, excluding those with cognitive or psychiatric disorders or recent sedative use. Patients were randomly assigned to 4 groups: propofol with suggestions (P-S; n = 47), propofol without suggestions (P-NS; n = 47), ketamine with suggestions (K-S; n = 47), and ketamine without suggestions (K-NS; n = 47). The suggestion intervention involved providing 8 pleasant dream scenarios preoperatively. The primary outcome was DIDR frequency (binary: yes/no). Secondary outcomes included dream content, subjective dream perceptions, and predictors of DIDR.RESULTSIn the intention-to-treat analysis (n = 188), DIDR frequencies were 21.3% (P-NS), 25.5% (P-S), 36.2% (K-NS), and 44.7% (K-S), with a significant difference between K-S and P-NS (P = .010). Factorial analysis showed a significant main effect of drug type (ketamine versus propofol: odds ratio [OR] = 2.14, 95% confidence interval [CI], 1.23-3.72; P = .007), but no main effect of suggestions (OR = 1.16, 95% CI, 0.67-2.01; P =.598) or interaction (P = .818). DIDR frequencies were 23.4% (propofol groups: P-NS and P-S) vs 40.4% (ketamine groups: K-NS and K-S) (P = .002), and 35.1% (suggestion groups: P-S and K-S) vs 28.7% (no-suggestion groups: P-NS and K-NS) (P = .308). A significant difference was noted between K-S and P-NS (44.7% vs 21.3%; P = .010). Ketamine increased emotional intensity (P = .0071 versus P-NS; P = .003 vs P-S) and dream strangeness (P = .0071 versus P-NS; P = .0071 versus P-S) versus propofol. Suggestions enhanced dream pleasantness in both drug groups (P = .002 versus P-NS; P = .001 versus K-NS; P = .0071 versus K-S).CONCLUSIONSPreoperative suggestions did not increase DIDR frequency or alter dream content but improved dream pleasantness, indicating potential psychological benefits during sedation.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1213/ane.0000000000007803
Arthur W Bracey
{"title":"Patient Blood Management in Cardiac Surgery: Opportunities in Cardiac Surgery-2024 Sazama Award Lecture, Society for the Advancement of Blood Management.","authors":"Arthur W Bracey","doi":"10.1213/ane.0000000000007803","DOIUrl":"https://doi.org/10.1213/ane.0000000000007803","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145664137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDWhile ropivacaine-dexmedetomidine coadministration is widely used in surgical anesthesia, its pharmacokinetic effects in lumbar plexus blocks (LPB) remain uncharacterized. We therefore conducted a prospective randomized trial to evaluate dexmedetomidine's modulation of ropivacaine's pharmacokinetics and pharmacodynamics during unilateral lower limb surgery. Additionally, this study seeks to establish a dosing regimen for ropivacaine in combination with dexmedetomidine for LPB.METHODSPatients undergoing unilateral lower limb surgery were randomly allocated to 1 of 3 groups using a random-number table. The study included a control group receiving only ropivacaine, and 2 experimental groups receiving ropivacaine combined with either 0.25 or 0.5 µg·kg-1 of dexmedetomidine, all administered perineurally. Clinical efficacy data were gathered and analyzed using statistical software to assess the pharmacodynamics of the three treatment regimens. Furthermore, data from all patients were used to develop a population pharmacokinetics model for ropivacaine, and pharmacokinetic parameters were determined. Using Bayesian estimation, we simulated ropivacaine dosing across body weights of 56 to 76 kg to identify doses where plasma concentrations exceed the toxicity threshold (4.3 ± 0.6 µg·mL-1, mean ± standard deviation).RESULTSA total of 46 patients were enrolled in the study. Ropivacaine pharmacokinetics were best described by a 2-compartment model, with body weight and dexmedetomidine coadministration as significant covariates. Simulations indicated that for LPB, the modeled toxic dose decreased from 4.9 to 3.0 mg·kg-1 (with 0.5 µg·kg-1 dexmedetomidine) and from 3.3 to 2.1 mg·kg-1 (without dexmedetomidine) as body weight increased from 56 to 76 kg. The inclusion of 0.5 µg·kg-1 dexmedetomidine significantly reduced the maximum concentration of ropivacaine (mean difference, 0.8 µg·mL-1; 95% confidence interval [CI], 0.5-1.2 µg·mL-1; P < .0001), increased the apparent volume of distribution (33.1 L; 95% CI, 13.4-52.8 L; P = .013), prolonged the time to maximum concentration (5 minutes; 95% CI, 1-9; P = .011), and reduced the onset time of sensory blockade (5 minutes; 95% CI, 2-6; P < .0001), while also extending the duration of sensory blockade (175 minutes; 95% CI, 55-294; P = .005). The addition of 0.25 µg·kg-1 dexmedetomidine to ropivacaine did not change outcomes compared to ropivacaine alone.CONCLUSIONSOur research demonstrated that dexmedetomidine significantly influences the pharmacokinetics and pharmacodynamics of ropivacaine in LPB. When combining dexmedetomidine 0.5 µg·kg-1 with ropivacaine for LPB in a 66 kg adult, the maximum ropivacaine dose should not exceed 3.7 mg·kg-1.
{"title":"The Influence of Dexmedetomidine Added to Ropivacaine on Its Pharmacokinetic and Pharmacodynamic Effects During Lumbar Plexus Block.","authors":"Zeyuan He,Haiming Huang,Ying Wang,Yuqing Chen,Hua Zhu,Chen Ye,Jiebin Ou,Junyan Wu,Xiaoxia Yu","doi":"10.1213/ane.0000000000007871","DOIUrl":"https://doi.org/10.1213/ane.0000000000007871","url":null,"abstract":"BACKGROUNDWhile ropivacaine-dexmedetomidine coadministration is widely used in surgical anesthesia, its pharmacokinetic effects in lumbar plexus blocks (LPB) remain uncharacterized. We therefore conducted a prospective randomized trial to evaluate dexmedetomidine's modulation of ropivacaine's pharmacokinetics and pharmacodynamics during unilateral lower limb surgery. Additionally, this study seeks to establish a dosing regimen for ropivacaine in combination with dexmedetomidine for LPB.METHODSPatients undergoing unilateral lower limb surgery were randomly allocated to 1 of 3 groups using a random-number table. The study included a control group receiving only ropivacaine, and 2 experimental groups receiving ropivacaine combined with either 0.25 or 0.5 µg·kg-1 of dexmedetomidine, all administered perineurally. Clinical efficacy data were gathered and analyzed using statistical software to assess the pharmacodynamics of the three treatment regimens. Furthermore, data from all patients were used to develop a population pharmacokinetics model for ropivacaine, and pharmacokinetic parameters were determined. Using Bayesian estimation, we simulated ropivacaine dosing across body weights of 56 to 76 kg to identify doses where plasma concentrations exceed the toxicity threshold (4.3 ± 0.6 µg·mL-1, mean ± standard deviation).RESULTSA total of 46 patients were enrolled in the study. Ropivacaine pharmacokinetics were best described by a 2-compartment model, with body weight and dexmedetomidine coadministration as significant covariates. Simulations indicated that for LPB, the modeled toxic dose decreased from 4.9 to 3.0 mg·kg-1 (with 0.5 µg·kg-1 dexmedetomidine) and from 3.3 to 2.1 mg·kg-1 (without dexmedetomidine) as body weight increased from 56 to 76 kg. The inclusion of 0.5 µg·kg-1 dexmedetomidine significantly reduced the maximum concentration of ropivacaine (mean difference, 0.8 µg·mL-1; 95% confidence interval [CI], 0.5-1.2 µg·mL-1; P < .0001), increased the apparent volume of distribution (33.1 L; 95% CI, 13.4-52.8 L; P = .013), prolonged the time to maximum concentration (5 minutes; 95% CI, 1-9; P = .011), and reduced the onset time of sensory blockade (5 minutes; 95% CI, 2-6; P < .0001), while also extending the duration of sensory blockade (175 minutes; 95% CI, 55-294; P = .005). The addition of 0.25 µg·kg-1 dexmedetomidine to ropivacaine did not change outcomes compared to ropivacaine alone.CONCLUSIONSOur research demonstrated that dexmedetomidine significantly influences the pharmacokinetics and pharmacodynamics of ropivacaine in LPB. When combining dexmedetomidine 0.5 µg·kg-1 with ropivacaine for LPB in a 66 kg adult, the maximum ropivacaine dose should not exceed 3.7 mg·kg-1.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145664240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1213/ane.0000000000007791
Nina Zech,Anna Bauer,Ernil Hansen
BACKGROUNDThe preoperative anesthesia consultation and risk disclosure required for informed consent can lead to negative patient expectations about their surgery, with resulting nocebo effects. Negative consequences are closely linked to patient anxiety, which further contributes to poor outcomes. Therefore, instruction in specific communication skills is essential for reducing preoperative anxiety.METHODSPatient anxiety levels were measured before and after the preoperative anesthesia consultation using the State-Trait Anxiety Inventory (STAI-S), a numeric rating scale (NRS), and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in a single institution study. Following an initial data collection period for the control group, a single 1-hour education session on specific communication skills was offered to the Anaesthesiology Department. Patients seen by anesthesiologists who underwent this training constituted the intervention group. Central to the education was an emphasis on positive aspects, such as treatment benefit, prophylaxis, monitoring, and treatability of adverse reactions, alongside risk information.RESULTSThe preoperative consultation resulted in an anesthesia-related anxiety reduction in 85% of all patients (573 out of 673 patients). Anxiety reduction was more pronounced in the intervention group, where anesthesiologists had received the risk communication training (274 out of 306 ≈ 89.5%) compared to the control group (299 out of 367 = 81.5%), p = 0.003. Anxiety scores decreased by approximately 6% in the control and 7.5% in the intervention group. The most significant change was observed in anesthesia-related anxiety (decrease from 3.5 ± 1.6 to 3.1 ± 1.3 ≈ -11%, p = 0.016). Initial surgery-related anxiety was higher (5.0 ± 2.2) than anesthesia-related anxiety with a similar decrease post-consultation. Decrease in preoperative anxiety was most pronounced in patients with high preexisting anxiety (a drop by 4.9 in the STAI-S vs. 3.3 in the control, p = 0.033).CONCLUSIONA single session of risk communication training for anesthesiologists can significantly enhance the reduction of anesthesia-related anxiety in patients. This finding shows that evidence-based educational interventions on risk communication are feasible and effective when transferred from the study setting to clinical practice.
{"title":"Communication Training for the Preoperative Anesthesia Consultation Reduces Anxiety: A Prospective, Patient-Blinded Pre-Post Intervention Study.","authors":"Nina Zech,Anna Bauer,Ernil Hansen","doi":"10.1213/ane.0000000000007791","DOIUrl":"https://doi.org/10.1213/ane.0000000000007791","url":null,"abstract":"BACKGROUNDThe preoperative anesthesia consultation and risk disclosure required for informed consent can lead to negative patient expectations about their surgery, with resulting nocebo effects. Negative consequences are closely linked to patient anxiety, which further contributes to poor outcomes. Therefore, instruction in specific communication skills is essential for reducing preoperative anxiety.METHODSPatient anxiety levels were measured before and after the preoperative anesthesia consultation using the State-Trait Anxiety Inventory (STAI-S), a numeric rating scale (NRS), and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in a single institution study. Following an initial data collection period for the control group, a single 1-hour education session on specific communication skills was offered to the Anaesthesiology Department. Patients seen by anesthesiologists who underwent this training constituted the intervention group. Central to the education was an emphasis on positive aspects, such as treatment benefit, prophylaxis, monitoring, and treatability of adverse reactions, alongside risk information.RESULTSThe preoperative consultation resulted in an anesthesia-related anxiety reduction in 85% of all patients (573 out of 673 patients). Anxiety reduction was more pronounced in the intervention group, where anesthesiologists had received the risk communication training (274 out of 306 ≈ 89.5%) compared to the control group (299 out of 367 = 81.5%), p = 0.003. Anxiety scores decreased by approximately 6% in the control and 7.5% in the intervention group. The most significant change was observed in anesthesia-related anxiety (decrease from 3.5 ± 1.6 to 3.1 ± 1.3 ≈ -11%, p = 0.016). Initial surgery-related anxiety was higher (5.0 ± 2.2) than anesthesia-related anxiety with a similar decrease post-consultation. Decrease in preoperative anxiety was most pronounced in patients with high preexisting anxiety (a drop by 4.9 in the STAI-S vs. 3.3 in the control, p = 0.033).CONCLUSIONA single session of risk communication training for anesthesiologists can significantly enhance the reduction of anesthesia-related anxiety in patients. This finding shows that evidence-based educational interventions on risk communication are feasible and effective when transferred from the study setting to clinical practice.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145664241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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