Anesthesiology Research and Practice最新文献

Despite considerable advancements in therapeutic approaches, neuropathic pain remains a globally prevalent and challenging source of chronic suffering, underscoring the urgent demand for innovative treatment strategies. Here, we investigated the role of macrophage migration inhibitory factor (MIF) in neuropathic pain using a rodent model of chronic constriction injury (CCI) to the sciatic nerve, approved by the Ethical Committee of Animal Use and Care. Mechanical thresholds (von Frey hairs) and thermal latencies (hot plate) were measured, alongside spinal MIF expression, pyroptosis markers (e.g., GSDMD-N), and inflammatory cytokines (IL-1β, IL-6, and TNF-α). Our results showed that spinal MIF levels surged post-CCI, peaking on day 14 (p < 0.001), and drove microglial M1 polarization and inflammatory cytokine release (all p < 0.01). Notably, MIF activated the NLRP3 inflammasome, exacerbating neuronal pyroptosis (p < 0.01). These effects were mitigated by MIF inhibitor ISO-1 or NF-κB inhibitor PDTC, which reduced neuroinflammation and pain hypersensitivity. Collectively, this study reveals that MIF promotes NLRP3 inflammasome-mediated neuronal pyroptosis and microglial polarization via the NF-κB pathway, providing novel mechanistic insights into neuropathic pain alleviation through MIF inhibition.

Objective: Compare the clinical efficacy of CT-guided blunt versus sharp needles for dorsal root ganglion-pulsed radiofrequency (DRG-PRF) in treating zoster-associated pain (ZAP).

Method: This retrospective study analyzed 70 ZAP patients receiving CT-guided DRG-PRF between January 2021 and December 2024. Participants were divided into the blunt needle group (BNG, n = 30) and the sharp needle group (SNG, n = 40). Evaluated endpoints encompassed SF-MPQ scores, postoperative analgesia use, intraprocedural trajectory pain (NRS), operative time, number of CT scan slices, and incidence of complications.

Result: The BN group showed lower puncture NRS scores, shorter operative time, and fewer CT scan layers than the SN group (p < 0.05). SF-MPQ scores (PRI, VAS, and PPI) decreased in both groups postoperatively (p < 0.05), with lower PRI and PPI in the BN group at Day 1, Week 1, and Months 1 and 3 (p < 0.05). Pregabalin use was lower in the BN group at Months 3 and 6, and tramadol use was lower at Week 1 and Month 1 (p < 0.05).

Conclusion: CT-guided DRG-PRF demonstrates good analgesic efficacy in the treatment of ZAP. Compared with sharp needles, blunt needles show superior performance in terms of intraoperative puncture pain, procedure duration, radiation exposure, and postoperative medication use. As an optimized puncture instrument for DRG-PRF, the blunt needle holds promise for broader clinical application and warrants further promotion.

Trial registration: Chinese Clinical Trial Registry: ChiCTR2500102560.

Background: This study aimed to compare general anesthesia (GA) and sedoanalgesia (SA) with dexmedetomidine in terms of anesthetic and surgical outcomes in dacryocystorhinostomy (DCR) under bispectral index (BIS) monitoring.

Methods: In this prospective randomized controlled study, 44 adult patients (≥ 18 y) were divided into two groups. Standard GA was induced in the GA group (n = 22), and dexmedetomidine-based SA in the SA group (n = 22). BIS monitoring was performed in all patients. Hemodynamic parameters, amount of intraoperative bleeding, duration of anesthesia and surgery, postoperative pain scores, complications, and patient and surgeon satisfaction were recorded.

Results: The hemodynamic parameters, amount of intraoperative bleeding, duration of anesthesia and surgery, postoperative pain score, complications, and patient and surgeon satisfaction were similar between the two groups. Patient satisfaction was significantly higher in the SA group (p = 0.033).

Conclusions: This study suggests that SA with dexmedetomidine accompanied by BIS monitoring can be an alternative to GA in selected patients undergoing external DCR surgery, because the anesthetic and surgical processes are similar to those of GA, and patient satisfaction is higher than that with GA.

Trial registration: ClinicalTrials.gov identifier: NCT05397301.

Context: Cause of "emergence delirium" (ED) after general anesthesia with volatile anesthetics in adults remains unclear. While low "fresh gas flow" (FGF) is integral to current anesthesia practice, there is limited literature about FGF's role in ED.

Aims: To compare ED in patients receiving high or low FGF during anesthesia with sevoflurane while undergoing laparoscopic cholecystectomy for gallstone disease.

Settings and design: Prospective randomized double-blind study.

Methods and materials: One hundred American Society of Anesthesiologists (ASA) I and II patients, aged 18-50 years, were randomized to a low FGF or high FGF group of 50 patients each. After preoxygenation with 100% oxygen for 3 min, patients were induced. The low FGF group received 4 L for 5 min, followed by 1 L till the end, while the high FGF group received 4 L throughout. Sevoflurane, nitrous oxide, and oxygen (N₂O : O₂ = 1 : 1) were used to maintain minimum alveolar concentration (MAC) value of ≥ 1.2. A blind independent observer assessed ED by Richmond agitation-sedation scale (RASS).

Statistical analysis used: Student's T-test, chi-square test, and Mann-Whitney U test.

Results: Postoperative lactate was significantly higher in the low FGF group compared with the high FGF group (1.49 ± 0.69 vs. 1.05 ± 0.54 mmol/L, p ≤ 0.001). RASS scores were also higher with low FGF both immediately after PACU admission (median 1 [IQR 1-1] vs. -1 [IQR -2-0], p < 0.001) and at 10 min (median 0 [IQR 0-1] vs. 0 [IQR -1-0], p < 0.001), while scores at 20 and 30 min were comparable.

Conclusions: ED and lactate levels were significantly higher in patients receiving low FGF compared to high FGF during anesthesia.

Background: Obese patients undergoing general anesthesia are at heightened risk for postoperative pulmonary complications (PPCs) due to impaired respiratory mechanics. While lung-protective ventilation strategies are widely adopted, the role of intraoperative inspiratory oxygen fraction (FiO₂) in this population remains controversial.

Methods: We conducted a prospective, randomized controlled trial comparing low (FiO₂ 40%) versus high (FiO₂ 80%) intraoperative oxygen concentration in 113 obese patients undergoing elective laparoscopic bariatric surgery. All patients received standardized lung-protective ventilation. The primary outcome was the incidence and severity of PPCs within 5 postoperative days. Secondary outcomes included hospital length of stay, mortality, postoperative nausea and vomiting (PONV), and surgical site infection (SSI).

Results: The incidence of PPCs was 70.7% in the high FiO₂ group and 55.5% in the low FiO₂ group (p=0.08). Grade ≥ 3 PPCs occurred only in the high FiO₂ group (3.4%). The average PPC severity score was lower in the low FiO₂ group (0.9 ± 0.9 vs. 1.2 ± 0.9, p=0.08). No differences were observed in hospital stay, mortality, or SSI. PONV was more frequent in the low FiO₂ group (43.6% vs. 27.6%, p=0.08).

Conclusion: Although the difference was not statistically significant, the observed lower incidence of PPCs in the low FiO₂ group may indicate a potential clinical effect. Larger, multicenter trials are warranted to confirm these results and optimize oxygen management in obese surgical patients. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2300076656.

Background: Continuous adductor canal block (CACB) is a highly effective analgesic technique in total knee arthroplasty. The brachy axis approach (BA) is currently the common method used for CACB. Although CACB for BA offers advantages such as easy localization and operation due to clear anatomy, it has limitations such as short catheter placement and a high dislocation rate. These limitations can result in insufficient postoperative analgesia and impact patient rehabilitation. The perineural catheters placed parallel for CACB increases the difficulty of operation and the risk of puncture injury. In this study, the authors first applied the oblique approach (OA) to CACB and systematically compared the postoperative analgesic effects and adverse reactions of these two CACB methods with different puncture angles.

Methods: Ninety subjects who underwent TKA were randomly assigned to receive ultrasound-guided CACB using either the OA or BA. The main outcome measured was the exercise maximum visual analog scale (VAS) score at 72 h after surgery. The main safety indicator was the rate of catheter dislocation. The data were recorded and analyzed using analysis of variance, with adjustments made for baseline characteristics.

Results: There was no statistical difference in catheter placement time or postoperative resting VAS between the two groups. However, the postoperative exercise VAS and the incidence of postoperative adverse effects were lower in the OA group compared to the BA group.

Conclusions: The OA of CACB applied after TKA improved the analgesic effect during the postoperative motor state compared to the BA and reduced the incidence of adverse reactions, without increasing the catheterization procedure time.

Trial registration: Chinese Clinical Trial Registry: ChiCTR2200059889.

Background: Considering the importance of hemodynamic stability during tracheal tube removal in patients undergoing surgery with general anesthesia. This study was designed to evaluate and compare the impacts of intravenous dexmedetomidine and remifentanil on mitigating the cardiovascular responses associated with extubation in individuals receiving general anesthesia. Methods: In this clinical study, a cohort of 90 patients scheduled for surgical procedures under general anesthesia was evenly divided into three groups of 30, receiving dexmedetomidine (0.7 μg/kg), remifentanil (0.3 μg/kg), or a placebo of normal saline. Hemodynamic metrics, such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were assessed at baseline, prior to extubation, and at intervals of 1, 3, 5, and 10 min following extubation. Results: At 1-10 min postextubation, the control group (C) had a higher HR than the dexmedetomidine (D) and remifentanil (R) groups (p < 0.001), there was no difference in HR between the D and R groups (p=0.57). There was a significant difference in SBP between D and C groups (p=0.09) and between D and C groups (p=0.047). No significant differences in DBP were found among the groups (p > 0.0.5). There was a notable difference in MAP changes between Groups D and C (p=0.010), but there were no differences between Groups D and R (p=0.14) and R and C (p=0.84). In addition, the incidence of tachycardia in Group C was significantly higher than that in other groups (p < 0.001). In addition, the incidence of tachycardia in Group C was significantly higher than that in other groups (p < 0.001). Conclusion: Administering dexmedetomidine at a dosage of 0.7 μg/kg enhances hemodynamic stability during extubation and decreases the occurrence of hemodynamic disturbances and coughing when compared to remifentanil at 0.3 μg/kg and the control group. Therefore, it is regarded as the optimal option for alleviating cardiovascular responses during extubation. Trial Registration: Iranian Clinical Trials Registry: IRCT20200825048515N74.

Introduction: Emergence delirium, characterized by early postoperative behavioral changes in pediatric patients, poses potential risks to patient safety, resulting in extended hospital stays and increased medical costs. Remimazolam has a rapid onset, moderate half-life, and lower compression on respiratory and circulatory function. This double-blind randomized study aims to compare the incidence of emergence delirium in pediatric patients who received a single dose of remimazolam or dexmedetomidine before the end of sevoflurane anesthesia. Methods: A total of 110 pediatric patients aged 2-12 years, American Society of Anesthesiologists (ASA) Class I or II, undergoing elective tonsillectomy and adenoidectomy were included in this study and randomized into the dexmedetomidine group and remimazolam group (R group) (n = 55). Inhalation of sevoflurane was stopped 15 min before surgery after asking the surgeon's opinion, and either 0.2 mg/kg of remimazolam or 0.2 μg/kg of dexmedetomidine was administered. The main and secondary results of the research were both analyzed with the intention-to-treat analysis. The main outcome observed in this study was the incidence of emergence delirium in both groups. Secondary outcomes were vital signs at various time points after administration, Pediatric Anesthesia Emergence Delirium (PAED) scale score for delirium, extubation time, the length of time in the postanesthesia care unit (PACU), postoperative adverse events, and parental satisfaction. Results: The intention-to-treat analysis indicated that the mean age of patients was 5.7 ± 0.4 years, with 62 (56.4%) of them being male. The incidence of emergence delirium was 25.5% overall, with no significant difference seen between the two groups. Compared to the R group, dexmedetomidine decreased the heart rate significantly (p < 0.001). There were no differences in extubation time, PACU stay, postoperative adverse events, and parental satisfaction between the two groups. In addition, age is an independent risk factor contributing to the emergence delirium. Conclusions: Discontinuing the inhalation of sevoflurane 15 min before the end of the procedure and administering 0.2 mg/kg of remimazolam intravenously did not show superiority over 0.2 μg/kg of dexmedetomidine in preventing emergence delirium. Trial Registration: Chinese Registry of Clinical Trials: ChiCTR2300072526.

Nutritional screening is gaining recognition in perioperative medicine, as anesthesiologists need to assess patients' nutritional status to identify malnutrition risks. Poor nutritional status is associated with increased perioperative complications, including postoperative pain. Effective pain management is crucial to prevent acute pain from developing into chronic pain. However, the link between malnutrition and pain is not well established, prompting interest in whether nutritional assessment tools correlate with pain severity. The Mini Nutritional Assessment Short-Form (MNA-SF) is a validated screening tool for geriatric patients, recommended by European Society for Clinical Nutrition and Metabolism (ESPEN) for routine use. The modified Nutrition Risk in Critically Ill (mNUTRIC) score evaluates critically ill patients' nutritional risk, guiding interventions to improve outcomes. This study aimed to explore the relationship between nutritional status, inflammatory markers, and postoperative pain in elderly surgical patients to optimize care. A prospective study involving 108 elderly patients (≥ 70 years) assessed the preoperative nutritional status using MNA-SF, mNUTRIC, Acute Physiology and Chronic Health Evaluation (APACHE), Sequential Organ Failure Assessment (SOFA), and inflammatory biomarkers (C-reactive protein (CRP) and albumin (Alb)). Postoperative pain was measured at surgery, 30 days, and 6 months. Statistical analysis found significant links between the nutritional status and pain outcomes. Higher mNUTRIC and APACHE scores correlated with increased pain, while higher Alb and MNA-SF scores were associated with lower pain levels. Chronic pain at 6 months was strongly linked to poor preoperative nutritional and inflammatory status. Findings suggest that nutritional deficiencies and inflammation are associated with postoperative pain and recovery. Integrating nutritional screening into preoperative assessments could improve outcomes by guiding interventions. Future research should refine predictive models to better understand the complex interplay between nutrition, inflammation, and pain in perioperative care. Trial Registration: ClinicalTrials.gov identifier: NCT06802575.