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Tethered Spinal Cord Syndrome Discovered during Ultrasound-guided Caudal Block. 超声引导下尾椎阻滞时发现脊髓拴系综合征。
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 DOI: 10.1097/ALN.0000000000004899
Ramón Eizaga Rebollar, Ana Isabel Carnota Martín, Elena Borreiros Rodríguez, Raquel Rojo Díez
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引用次数: 0
Reversal of Propofol-induced Depression of the Hypoxic Ventilatory Response by BK-channel Blocker ENA-001: A Randomized Controlled Trial. BK-通道阻滞剂ENA-001逆转异丙酚引起的缺氧通气反应抑制:随机对照试验。
IF 8.8 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 DOI: 10.1097/ALN.0000000000004915
Simone C Jansen, Maarten van Lemmen, Erik Olofsen, Laurence Moss, Joseph V Pergolizzi, Thomas Miller, Robert D Colucci, Monique van Velzen, Philip Kremer, Albert Dahan, Rutger van der Schrier, Marieke Niesters

Background: The use of anesthetics may result in depression of the hypoxic ventilatory response. Since there are no receptor-specific antagonists for most anesthetics, there is the need for agnostic respiratory stimulants that increase respiratory drive irrespective of its cause. The authors tested whether ENA-001, an agnostic respiratory stimulant that blocks carotid body BK-channels, could restore the hypoxic ventilatory response during propofol infusion. They hypothesize that ENA-001 is able to fully restore the hypoxic ventilatory response.

Methods: In this randomized, double-blind crossover trial, 14 male and female healthy volunteers were randomized to receive placebo and low- and high-dose ENA-001 on three separate occasions. On each occasion, isohypercapnic hypoxic ventilatory responses were measured during a fixed sequence of placebo, followed by low- and high-dose propofol infusion. The authors conducted a population pharmacokinetic/pharmacodynamic analysis that included oxygen and carbon dioxide kinetics.

Results: Twelve subjects completed the three sessions; no serious adverse events occurred. The propofol concentrations were 0.6 and 2.0 µg/ml at low and high dose, respectively. The ENA-001 concentrations were 0.6 and 1.0 µg/ml at low and high dose, respectively. The propofol concentration that reduced the hypoxic ventilatory response by 50% was 1.47 ± 0.20 µg/ml. The steady state ENA-001 concentration to increase the depressed ventilatory response by 50% was 0.51 ± 0.04 µg/ml. A concentration of 1 µg/ml ENA-001 was required for full reversal of the propofol effect at the propofol concentration that reduced the hypoxic ventilatory response by 50%.

Conclusions: In this pilot study, the authors demonstrated that ENA-001 restored the hypoxic ventilatory response impaired by propofol. This finding is not only of clinical importance but also provides mechanistic insights into the peripheral stimulation of breathing with ENA-001 overcoming central depression by propofol.

Editor’s perspective:

背景:使用麻醉剂可能会抑制缺氧通气反应。由于大多数麻醉剂没有受体特异性拮抗剂,因此需要不可知的呼吸兴奋剂,这种兴奋剂能增加呼吸动力,而不管其原因如何。我们测试了阻断颈动脉体 BK 通道的不可知呼吸兴奋剂ENA-001 是否能恢复异丙酚输注过程中的缺氧通气反应。我们假设ENA-001能够完全恢复缺氧通气反应:在这项随机双盲交叉试验中,14 名男性和女性健康志愿者被随机分为三次分别接受安慰剂、低剂量和高剂量的ENA-001。在每次输注安慰剂、低剂量异丙酚和高剂量异丙酚的固定顺序过程中,都测量了异丙酚缺氧通气反应。我们进行了包括氧气和二氧化碳动力学在内的群体药代动力学/药效学分析:结果:12 名受试者完成了三个疗程,无严重不良事件发生。低剂量和高剂量的异丙酚浓度分别为 0.6 和 2.0 µg/mL。ENA-001的低剂量和高剂量浓度分别为0.6和1.0微克/毫升。使缺氧通气反应降低50%的异丙酚浓度为1.47±0.20 µg/mL。使缺氧通气反应增加 50%的ENA-001 稳态浓度为 0.51±0.04 µg/mL。需要1 µg/mL ENA-001浓度才能完全逆转丙泊酚的C50效应:在这项试验研究中,我们证明了ENA-001能恢复异丙酚所损害的缺氧通气反应。这一发现不仅具有重要的临床意义,还从机理上揭示了ENA-001对呼吸的外周刺激可克服异丙酚对呼吸的中枢抑制。
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引用次数: 0
Reversal for Respiratory Depression: Let's Take a Breath! 呼吸抑制的逆转:让我们深呼吸
IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-06-01 DOI: 10.1097/ALN.0000000000004984
Thomas K Henthorn
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引用次数: 0
Evaluation of Malignant Hyperthermia Features in Patients with Pathogenic or Likely Pathogenic RYR1 Variants Disclosed through a Population Genomic Screening Program: Erratum. 评估通过人群基因组筛查计划发现的致病性或可能致病性 RYR1 基因变异患者的恶性高热症状特征勘误。
IF 8.8 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-05-01 DOI: 10.1097/ALN.0000000000004928
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引用次数: 0
Addressing Patient Concerns with Blood Transfusion from Donors Vaccinated Against COVID-19: A Clinician Primer. 从接种了 COVID-19 疫苗的献血者处输血,消除患者疑虑:临床医生入门指南。
IF 8.8 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-05-01 DOI: 10.1097/ALN.0000000000004913
Katherine T Forkin, Nicole R Guinn, Matthew A Warner, Anil K Panigrahi
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引用次数: 0
Stability of Epinephrine, Norepinephrine, and Phenylephrine for Intravenous Infusions Stored in Three Commercial Plastic Syringe Brands. 三种商用塑料注射器中储存的静脉输液用肾上腺素、去甲肾上腺素和苯肾上腺素的稳定性。
IF 8.8 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-05-01 DOI: 10.1097/ALN.0000000000004944
Victor M Neira, Ahmed AlFaraj, Luke Wiseman, Rince John, Pantelis Andreou, Alejandro Cohen
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引用次数: 0
Unmasking the Pain: Preserving Humanity in Medicine. 揭开痛苦的面纱:在医学中保护人性。
IF 8.8 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-05-01 DOI: 10.1097/ALN.0000000000004907
Amber K Brooks
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引用次数: 0
State-related Electroencephalography Microstate Complexity during Propofol- and Esketamine-induced Unconsciousness. 丙泊酚和爱斯基胺诱导昏迷过程中与状态相关的脑电图微状态复杂性。
IF 8.8 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-05-01 DOI: 10.1097/ALN.0000000000004896
Zhenhu Liang, Bo Tang, Yu Chang, Jing Wang, Duan Li, Xiaoli Li, Changwei Wei

Background: Identifying the state-related "neural correlates of consciousness" for anesthetics-induced unconsciousness is challenging. Spatiotemporal complexity is a promising tool for investigating consciousness. The authors hypothesized that spatiotemporal complexity may serve as a state-related but not drug-related electroencephalography (EEG) indicator during an unconscious state induced by different anesthetic drugs (e.g., propofol and esketamine).

Methods: The authors recorded EEG from patients with unconsciousness induced by propofol (n = 10) and esketamine (n = 10). Both conventional microstate parameters and microstate complexity were analyzed. Spatiotemporal complexity was constructed by microstate sequences and complexity measures. Two different EEG microstate complexities were proposed to quantify the randomness (type I) and complexity (type II) of the EEG microstate series during the time course of the general anesthesia.

Results: The coverage and occurrence of microstate E (prefrontal pattern) and the duration of microstate B (right frontal pattern) could distinguish the states of preinduction wakefulness, unconsciousness, and recovery under both anesthetics. Type I EEG microstate complexity based on mean information gain significantly increased from awake to unconsciousness state (propofol: from mean ± SD, 1.562 ± 0.059 to 1.672 ± 0.023, P < 0.001; esketamine: 1.599 ± 0.051 to 1.687 ± 0.013, P < 0.001), and significantly decreased from unconsciousness to recovery state (propofol: 1.672 ± 0.023 to 1.537 ± 0.058, P < 0.001; esketamine: 1.687 ± 0.013 to 1.608 ± 0.028, P < 0.001) under both anesthetics. In contrast, type II EEG microstate fluctuation complexity significantly decreased in the unconscious state under both drugs (propofol: from 2.291 ± 0.771 to 0.782 ± 0.163, P < 0.001; esketamine: from 1.645 ± 0.417 to 0.647 ± 0.252, P < 0.001), and then increased in the recovery state (propofol: 0.782 ± 0.163 to 2.446 ± 0.723, P < 0.001; esketamine: 0.647 ± 0.252 to 1.459 ± 0.264, P < 0.001).

Conclusions: Both type I and type II EEG microstate complexities are drug independent. Thus, the EEG microstate complexity measures that the authors proposed are promising tools for building state-related neural correlates of consciousness to quantify anesthetic-induced unconsciousness.

Editor’s perspective:

背景:对于麻醉剂诱导的无意识状态,确定与状态相关的 "意识神经相关性 "具有挑战性。时空复杂性是一种很有前景的意识研究工具。我们假设,在不同麻醉药物(如异丙酚和艾司卡胺)诱导的昏迷状态下,时空复杂性可作为与状态相关但与药物无关的脑电图指标:我们记录了由异丙酚(10 人)和艾司卡胺(10 人)诱导的昏迷患者的脑电图。对常规微状态参数和微状态复杂性进行了分析。时空复杂性由微态序列和复杂性测量值构建。提出了两种不同的脑电图微状态复杂性,以量化全身麻醉时间过程中脑电图微状态序列的随机性(I型)和复杂性(II型):结果:微状态E(前额叶模式)的覆盖范围和发生率以及微状态B(右额叶模式)的持续时间可以区分两种麻醉剂下的诱导前清醒、无意识和恢复状态。从清醒状态到昏迷状态,基于平均信息增益的 I 型脑电图微状态复杂度显著增加(丙泊酚:从平均值(±SD)1.562±0.059 增加到 1.672±0.023,p < 0.001;艾司卡胺:从平均值(±SD)1.599±0.059 增加到 1.672±0.023,p < 0.001):异丙酚:1.672±0.023 到 1.537±0.058,p < 0.001;艾司卡胺:1.687±0.013 到 1.687±0.013,p < 0.001:1.687±0.013 至 1.608±0.028,p < 0.001)。与此相反,在两种药物作用下,昏迷状态下II型脑电图微状态波动复杂性显著下降(丙泊酚:从2.291±0.771到0.782±0.163,p<0.001;艾司卡胺:从1.645±0.417到0.647±0.252,p<0.001),然后在恢复状态下上升(丙泊酚:从0.782±0.163到0.647±0.252,p<0.001):0.782±0.163 到 2.446±0.723,p <0.001;esketamine:0.647±0.252到1.459±0.264,p 结论:I型和II型脑电图微状态复杂性均与药物无关。因此,我们提出的脑电图微状态复杂性测量方法是一种很有前途的工具,可用于建立与意识状态相关的神经相关性,以量化麻醉剂诱导的无意识状态。
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引用次数: 0
Perioperative Extracorporeal Cardiopulmonary Resuscitation in Adult Patients: A Review for the Perioperative Physician. 成人患者围手术期体外心肺复苏:围手术期医生综述》。
IF 8.8 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-05-01 DOI: 10.1097/ALN.0000000000004916
Kunal Panda, Laurent G Glance, Michael Mazzeffi, Yang Gu, Katherine L Wood, Vivek K Moitra, Isaac Y Wu
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引用次数: 0
Chest Wall Hematoma after Continuous Serratus Anterior Plane Block. 连续锯齿状前平面阻滞后的胸壁血肿
IF 8.8 1区 医学 Q1 ANESTHESIOLOGY Pub Date : 2024-05-01 DOI: 10.1097/ALN.0000000000004890
Anthony Tucker-Bartley, Heitor Medeiros, A Sassan Sabouri
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Anesthesiology
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