Pub Date : 2026-03-23DOI: 10.1097/aln.0000000000006059
Brian M Ilfeld,Baharin Abdullah,Jessica P Pham,Rhea Gandhi,John J Finneran
BACKGROUNDCryoneurolysis provides analgesia by reversibly ablating peripheral nerves using gas-induced exceptionally low temperature. The desired therapeutic temperature is between approximately -20°C and -100°C. Warmer temperatures can induce a neuropraxia that may itself induce pain; and colder temperatures can result in permanent nerve injury. Therefore, it is imperative that the target nerve reach but not exceed the therapeutic window.METHODSA convenience sample of participants undergoing mastectomy (n=3) received a high-thoracic paravertebral nerve block, while subjects being treated for traumatic rib fractures (n=3) did not. All participants had ultrasound-guided cryoneurolysis of multiple intercostal nerves with a percutaneous thermocouple inserted approximately 3 mm adjacent to the cryoprobe shaft. The returning argon gas and tissue temperatures were correlated. Due to the limited sample size, the data are presented and not statistically analyzed.RESULTSAlthough in all cases (31 nerves) the returning gas was ultimately colder than -80°C, the tissue adjacent to the probe did not reach -20°C after 3 and 5 min in 71% (n=5) and 42% (n=10) of treatments, respectively. The coldest mean temperature in adjacent tissue was 60 degrees warmer than the returning gas without a nerve block, and 95 degrees warmer with a concurrent nerve block. When treating adjacent intercostal nerves, the gas temperature remained unchanged while the tissue became colder with each consecutive treatment.CONCLUSIONSDuring percutaneous cryoneurolysis, the temperature of tissue is frequently deceptively warm relative to the returning gas and tissue frequently does not reach an adequately cold temperature; prolonging gas treatment from 3 to 5 min improves the success of reaching therapeutic temperatures; the presence of a peripheral nerve block appears to lessen the chance of reaching therapeutic temperatures; and caution is warranted when treating consecutive intercostal nerves as tissue temperature may decrease with each level.
{"title":"Cryoneurolysis Thermal Graphs: In Vivo Descriptive Data from Ultrasound-Guided Percutaneous Thermocouples.","authors":"Brian M Ilfeld,Baharin Abdullah,Jessica P Pham,Rhea Gandhi,John J Finneran","doi":"10.1097/aln.0000000000006059","DOIUrl":"https://doi.org/10.1097/aln.0000000000006059","url":null,"abstract":"BACKGROUNDCryoneurolysis provides analgesia by reversibly ablating peripheral nerves using gas-induced exceptionally low temperature. The desired therapeutic temperature is between approximately -20°C and -100°C. Warmer temperatures can induce a neuropraxia that may itself induce pain; and colder temperatures can result in permanent nerve injury. Therefore, it is imperative that the target nerve reach but not exceed the therapeutic window.METHODSA convenience sample of participants undergoing mastectomy (n=3) received a high-thoracic paravertebral nerve block, while subjects being treated for traumatic rib fractures (n=3) did not. All participants had ultrasound-guided cryoneurolysis of multiple intercostal nerves with a percutaneous thermocouple inserted approximately 3 mm adjacent to the cryoprobe shaft. The returning argon gas and tissue temperatures were correlated. Due to the limited sample size, the data are presented and not statistically analyzed.RESULTSAlthough in all cases (31 nerves) the returning gas was ultimately colder than -80°C, the tissue adjacent to the probe did not reach -20°C after 3 and 5 min in 71% (n=5) and 42% (n=10) of treatments, respectively. The coldest mean temperature in adjacent tissue was 60 degrees warmer than the returning gas without a nerve block, and 95 degrees warmer with a concurrent nerve block. When treating adjacent intercostal nerves, the gas temperature remained unchanged while the tissue became colder with each consecutive treatment.CONCLUSIONSDuring percutaneous cryoneurolysis, the temperature of tissue is frequently deceptively warm relative to the returning gas and tissue frequently does not reach an adequately cold temperature; prolonging gas treatment from 3 to 5 min improves the success of reaching therapeutic temperatures; the presence of a peripheral nerve block appears to lessen the chance of reaching therapeutic temperatures; and caution is warranted when treating consecutive intercostal nerves as tissue temperature may decrease with each level.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"3 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-20DOI: 10.1097/aln.0000000000005955
Jordan A Francke
{"title":"A Lesson in Two Clinical Vignettes: Laughter Remains a Potent Medicine.","authors":"Jordan A Francke","doi":"10.1097/aln.0000000000005955","DOIUrl":"https://doi.org/10.1097/aln.0000000000005955","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"34 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDRemimazolam tosylate, a novel short-acting benzodiazepine, has shown effective and safe sedation in mechanically ventilated patients in intensive care units (ICU) in a phase 2 trial. We conducted a multicenter, randomized, single-blind, actively controlled, phase 3 trial (NCT06222294) for further evaluation.METHODSMechanically ventilated patients, requiring sedation for ≥6 h with a target Richmond Agitation-Sedation Scale (RASS) of -2 to 1, were randomized (1:1) to receive intravenous remimazolam tosylate (loading dose, 0.08 mg/kg; maintenance, 0-2.0 mg/kg/h) or propofol (loading dose, 0.3-0.5 mg/kg; maintenance, 0.3-4.0 mg/kg/h). Both allowed for adjusted infusion rates or additional doses to maintain target RASS. Maximum treatment duration was 24 h. Primary endpoint was proportion of patients achieving sedation success, defined as maintaining target sedation range for ≥70% of drug administration time without rescue sedation. Non-inferiority margin was -8%.RESULTSBetween Mar. 12, 2024 and Sep. 24, 2024, 211 patients (mean age, 61.1 years; 63.5% male; 99.1% postoperative) received remimazolam tosylate (n=106) or propofol (n=105). Mean (SD) treatment duration was 11.5±3.6 h for remimazolam tosylate and 11.1±3.1 h for propofol; mean (SD) total dose was 187.1±134.4 mg and 593.7±530.9 mg, respectively. Sedation success rate was 98.1% with remimazolam tosylate and 96.2% with propofol (difference 1.9%, 95% CI -3.3% to 7.8%); mean (SD) percentage of time in RASS target range was 95.1±13.8% vs 95.0±12.9%, and proportion of patients receiving rescue sedation was 0.0% (0/106) vs 1.0% (1/105). Mean (SD) additional doses required was 0.03±0.17 for remimazolam tosylate and 0.18±0.77 for propofol. Adverse event occurred in 81 (76.4%) patients with remimazolam tosylate and 77 (73.3%) with propofol; all were mild-moderate, except one severe with propofol. Mean terminal half-life (SD) of remimazolam tosylate was 1.97±1.62 h.CONCLUSIONSRemimazolam tosylate demonstrated non-inferior efficacy and good tolerability compared with propofol for short-term sedation in postoperative mechanically ventilated ICU patients.
{"title":"Efficacy and Safety of Remimazolam Tosylate versus Propofol for Sedation of Postoperative Mechanically Ventilated Patients in Intensive Care Units: a Multicenter, Randomized, Single-blind, Non-inferiority, Phase 3 trial.","authors":"Xiangdong Guan,Ning Liu,Fenghui Lin,Jianbo Yu,Mei Yang,Qianyun Zhou,Kun Chen,Xiangyou Yu,Xiaobo Huang,Jianjun Zhu,Jie Lyu,Chunmei Gui,Zhenjie Hu,Shaopeng Zheng,Bin He,Maojuan Wang,Zhanbiao Yu,Xinglong Ma,Ailian Lv,Jiaqiang Zhang,Jingyuan Xu,Jilu Ye,Jianguo Gong,Xin Tian,Jing Zhou,Fachun Zhou,Li Yu,Wenlong He,Xi Li,Tengrui Yin,Huixin Zhao,Yan Ding,Minying Chen","doi":"10.1097/aln.0000000000006047","DOIUrl":"https://doi.org/10.1097/aln.0000000000006047","url":null,"abstract":"BACKGROUNDRemimazolam tosylate, a novel short-acting benzodiazepine, has shown effective and safe sedation in mechanically ventilated patients in intensive care units (ICU) in a phase 2 trial. We conducted a multicenter, randomized, single-blind, actively controlled, phase 3 trial (NCT06222294) for further evaluation.METHODSMechanically ventilated patients, requiring sedation for ≥6 h with a target Richmond Agitation-Sedation Scale (RASS) of -2 to 1, were randomized (1:1) to receive intravenous remimazolam tosylate (loading dose, 0.08 mg/kg; maintenance, 0-2.0 mg/kg/h) or propofol (loading dose, 0.3-0.5 mg/kg; maintenance, 0.3-4.0 mg/kg/h). Both allowed for adjusted infusion rates or additional doses to maintain target RASS. Maximum treatment duration was 24 h. Primary endpoint was proportion of patients achieving sedation success, defined as maintaining target sedation range for ≥70% of drug administration time without rescue sedation. Non-inferiority margin was -8%.RESULTSBetween Mar. 12, 2024 and Sep. 24, 2024, 211 patients (mean age, 61.1 years; 63.5% male; 99.1% postoperative) received remimazolam tosylate (n=106) or propofol (n=105). Mean (SD) treatment duration was 11.5±3.6 h for remimazolam tosylate and 11.1±3.1 h for propofol; mean (SD) total dose was 187.1±134.4 mg and 593.7±530.9 mg, respectively. Sedation success rate was 98.1% with remimazolam tosylate and 96.2% with propofol (difference 1.9%, 95% CI -3.3% to 7.8%); mean (SD) percentage of time in RASS target range was 95.1±13.8% vs 95.0±12.9%, and proportion of patients receiving rescue sedation was 0.0% (0/106) vs 1.0% (1/105). Mean (SD) additional doses required was 0.03±0.17 for remimazolam tosylate and 0.18±0.77 for propofol. Adverse event occurred in 81 (76.4%) patients with remimazolam tosylate and 77 (73.3%) with propofol; all were mild-moderate, except one severe with propofol. Mean terminal half-life (SD) of remimazolam tosylate was 1.97±1.62 h.CONCLUSIONSRemimazolam tosylate demonstrated non-inferior efficacy and good tolerability compared with propofol for short-term sedation in postoperative mechanically ventilated ICU patients.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"13 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-18DOI: 10.1097/aln.0000000000006043
Jeffry Florian,Dro Keshishi,Victoria Gershuny,Pablo Salcedo,Rutger van der Schrier,Keith Burkhart,Aanchal Shah,Rebecca Racz,Vikram Patel,Ryan DePalma,Murali Matta,Giri Vegesna,Cheng-Hui Hsiao,Rodney Rouse,Melanie Fein,Marc Stone,Albert Dahan,David G Strauss
BACKGROUNDOpioid-induced respiratory depression remains a critical public safety concern. Prior clinical findings demonstrated decreased hypercapnic ventilation after 5 days when paroxetine, a Selective Serotonin Reuptake Inhibitor (SSRI), was administered alone or with oxycodone. However, uncertainty remained whether chronic use of SSRIs could cause similar respiratory effects. This study investigated whether chronic use of paroxetine and another SSRI, escitalopram, lead to a similar decrease in ventilatory response to hypercapnia.METHODIn this randomized, double-blind, 3-period crossover trial, healthy participants were administered one of the following: paroxetine 40 mg from days 1 to 6 and 60 mg from days 7 to 21, escitalopram 20 mg from days 1 to 6 and 30 mg from days 7 to 21, and placebo from days 1 to 21. Oxycodone 10 mg was co-administered on days 6, 12, and 21. Hyperoxic-hypercapnic ventilation was measured using Duffin's rebreathing.RESULTSOf the 27 participants, 22 (81%) completed the trial. Paroxetine and escitalopram both significantly decreased hyperoxic-hypercapnic ventilation when co-administered with oxycodone compared to oxycodone alone on day 21 (paroxetine mean difference, -6.5 L/min [1-sided 97.5% CI, -∞ to -3.1] P<0.001, escitalopram mean difference, -5.5 L/min [1-sided 97.5% CI, -∞ to -2.1] P=0.001) and when administered alone compared to placebo on day 20 (paroxetine mean difference, -6.5 L/min [1-sided 97.5% CI, -∞ to -2.1] P=0.003, escitalopram mean difference, -6.9 L/min [1-sided 97.5% CI, -∞ to -2.5] P=0.002).CONCLUSIONSBoth paroxetine and escitalopram, alone and co-administered with oxycodone, decrease hypercapnic ventilation after 21 days suggesting that selective serotonin reuptake inhibitors may have a class effect on hypercapnic ventilation that persists with chronic use.
{"title":"Effect of Paroxetine or Escitalopram Co-administered with Oxycodone vs Oxycodone Alone on Ventilation During Hypercapnia: A Randomized Clinical Trial.","authors":"Jeffry Florian,Dro Keshishi,Victoria Gershuny,Pablo Salcedo,Rutger van der Schrier,Keith Burkhart,Aanchal Shah,Rebecca Racz,Vikram Patel,Ryan DePalma,Murali Matta,Giri Vegesna,Cheng-Hui Hsiao,Rodney Rouse,Melanie Fein,Marc Stone,Albert Dahan,David G Strauss","doi":"10.1097/aln.0000000000006043","DOIUrl":"https://doi.org/10.1097/aln.0000000000006043","url":null,"abstract":"BACKGROUNDOpioid-induced respiratory depression remains a critical public safety concern. Prior clinical findings demonstrated decreased hypercapnic ventilation after 5 days when paroxetine, a Selective Serotonin Reuptake Inhibitor (SSRI), was administered alone or with oxycodone. However, uncertainty remained whether chronic use of SSRIs could cause similar respiratory effects. This study investigated whether chronic use of paroxetine and another SSRI, escitalopram, lead to a similar decrease in ventilatory response to hypercapnia.METHODIn this randomized, double-blind, 3-period crossover trial, healthy participants were administered one of the following: paroxetine 40 mg from days 1 to 6 and 60 mg from days 7 to 21, escitalopram 20 mg from days 1 to 6 and 30 mg from days 7 to 21, and placebo from days 1 to 21. Oxycodone 10 mg was co-administered on days 6, 12, and 21. Hyperoxic-hypercapnic ventilation was measured using Duffin's rebreathing.RESULTSOf the 27 participants, 22 (81%) completed the trial. Paroxetine and escitalopram both significantly decreased hyperoxic-hypercapnic ventilation when co-administered with oxycodone compared to oxycodone alone on day 21 (paroxetine mean difference, -6.5 L/min [1-sided 97.5% CI, -∞ to -3.1] P<0.001, escitalopram mean difference, -5.5 L/min [1-sided 97.5% CI, -∞ to -2.1] P=0.001) and when administered alone compared to placebo on day 20 (paroxetine mean difference, -6.5 L/min [1-sided 97.5% CI, -∞ to -2.1] P=0.003, escitalopram mean difference, -6.9 L/min [1-sided 97.5% CI, -∞ to -2.5] P=0.002).CONCLUSIONSBoth paroxetine and escitalopram, alone and co-administered with oxycodone, decrease hypercapnic ventilation after 21 days suggesting that selective serotonin reuptake inhibitors may have a class effect on hypercapnic ventilation that persists with chronic use.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"33 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-16DOI: 10.1097/ALN.0000000000005961
Evan G Pivalizza
{"title":"Gabapentin for Postsurgical Pain: Comment.","authors":"Evan G Pivalizza","doi":"10.1097/ALN.0000000000005961","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005961","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147466879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-16DOI: 10.1097/aln.0000000000005960
Nicholas R Cormier,Zili He,Hung Mo Lin,N David Yanez,Viji Kurup
{"title":"Sense of Belongingness among Anesthesiology Residents: Adapting a Validated Tool to Establish Benchmarks and Identify Outliers.","authors":"Nicholas R Cormier,Zili He,Hung Mo Lin,N David Yanez,Viji Kurup","doi":"10.1097/aln.0000000000005960","DOIUrl":"https://doi.org/10.1097/aln.0000000000005960","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"80 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-16DOI: 10.1097/aln.0000000000005971
Mark D Neuman,Sarah Langer,Grace Lim
{"title":"Cesarean Anesthesia Type and Neonatal Outcomes: Reply.","authors":"Mark D Neuman,Sarah Langer,Grace Lim","doi":"10.1097/aln.0000000000005971","DOIUrl":"https://doi.org/10.1097/aln.0000000000005971","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"268 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDPatient-Reported Outcome and Experience Measures are essential for advancing pediatric patient-centered care in the perioperative context. Combining complementary patient-centered instruments supports a broader, multidimensional evaluation of perioperative care.The Pediatric Scale for Quality of Recovery is a patient-reported outcome measure assessing quality of recovery after surgery and anesthesia in children and represents an important step in this field. This study aimed to develop and validate a self-reported instrument, the Evaluation du Vécu de l'Anesthésie Générale en Pédiatrie (EVANpedia), designed to assess experience in children and adolescents within 24 hours after surgery.METHODSThe study included a developmental phase to generate items and a psychometric validation phase. The multidimensional structure of EVANpedia was explored using factor analysis, item internal consistency, and discriminant analyses. The Rasch model assessed the unidimensionality of each dimension, and reliability was evaluated using McDonald's ω coefficient. Convergent and external validity were examined using concurrent self-report instruments and clinical data.RESULTSSix hundred patients (7-17 years) were included across four anesthesia departments. Following the development and validation phases, EVANpedia comprised 26 items grouped into six dimensions: Anxiety, Thirst and Hunger, Loss of Autonomy, Pain, Nausea and Vomiting, and Confusion. Internal construct validity was high, with excellent fit statistics across all dimensions (from 0.95 to 1.03). Correlations between EVANpedia scores and all concurrent measures supported convergent validity. Nine percent of children reported disappointment with their perioperative experience, showing significantly lower overall EVANpedia scores (50.1 ± 12.1 vs. 62.8 ± 15.1; P < 0.001). Overall and all dimensional EVANpedia scores demonstrated excellent sensitivity to clinical change, supporting the responsiveness of the instrument.CONCLUSIONEVANpedia is a psychometrically robust self-reported instrument for assessing perioperative experience in children and adolescents.
{"title":"Development and Validation of EVANpedia for the assessment of Perioperative Experience in Pediatric Patients.","authors":"Sophie Bringuier,Christophe Dadure,Jean-Noel Evain,Delphine Kern,Daphné Michelet,Pascal Auquier,Safa Aouinti,Nicolas Molinari,Chrystelle Sola,Xavier Capdevila,Julien Pico, ","doi":"10.1097/aln.0000000000006038","DOIUrl":"https://doi.org/10.1097/aln.0000000000006038","url":null,"abstract":"BACKGROUNDPatient-Reported Outcome and Experience Measures are essential for advancing pediatric patient-centered care in the perioperative context. Combining complementary patient-centered instruments supports a broader, multidimensional evaluation of perioperative care.The Pediatric Scale for Quality of Recovery is a patient-reported outcome measure assessing quality of recovery after surgery and anesthesia in children and represents an important step in this field. This study aimed to develop and validate a self-reported instrument, the Evaluation du Vécu de l'Anesthésie Générale en Pédiatrie (EVANpedia), designed to assess experience in children and adolescents within 24 hours after surgery.METHODSThe study included a developmental phase to generate items and a psychometric validation phase. The multidimensional structure of EVANpedia was explored using factor analysis, item internal consistency, and discriminant analyses. The Rasch model assessed the unidimensionality of each dimension, and reliability was evaluated using McDonald's ω coefficient. Convergent and external validity were examined using concurrent self-report instruments and clinical data.RESULTSSix hundred patients (7-17 years) were included across four anesthesia departments. Following the development and validation phases, EVANpedia comprised 26 items grouped into six dimensions: Anxiety, Thirst and Hunger, Loss of Autonomy, Pain, Nausea and Vomiting, and Confusion. Internal construct validity was high, with excellent fit statistics across all dimensions (from 0.95 to 1.03). Correlations between EVANpedia scores and all concurrent measures supported convergent validity. Nine percent of children reported disappointment with their perioperative experience, showing significantly lower overall EVANpedia scores (50.1 ± 12.1 vs. 62.8 ± 15.1; P < 0.001). Overall and all dimensional EVANpedia scores demonstrated excellent sensitivity to clinical change, supporting the responsiveness of the instrument.CONCLUSIONEVANpedia is a psychometrically robust self-reported instrument for assessing perioperative experience in children and adolescents.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"31 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147465242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-16DOI: 10.1097/aln.0000000000006042
Jinfang Song,Xinmiao Piao,Wei Liu,Xu Han,Jingyun Su,Bingjin Li
BACKGROUNDDepression is a prevalent psychiatric disorder linked to excitatory/inhibitory (E/I) neurotransmission imbalance, particularly in the medial prefrontal cortex (mPFC). Propofol, a GABAA receptor agonist, induces rapid mood improvements clinically, yet its antidepressant-like effects and underlying mechanisms remain unclear.METHODSNetwork pharmacology was used to identify propofol-related targets linked to E/I balance. Male mice exposed to chronic unpredictable mild stress (CUMS) received a single intraperitoneal injection of propofol. Depressive-like behaviors were assessed using the open field, tail suspension, and forced swim tests. GABAergic and glutamatergic signaling in the mPFC was evaluated by Western blotting, immunofluorescence, and fiber photometry calcium imaging. Optogenetic manipulation of mPFC GABAergic interneurons was performed to test their causal involvement.RESULTSIn both male and female mice, compared with the control group, propofol (50 mg·kg⁻¹) significantly reduced CUMS-induced depression-like behaviors, showing optimal efficacy in the OFT, TST, FST and SPT. Propofol increased mPFC GABAergic neuron excitability while suppressing glutamatergic activity. It also restored CUMS-induced reductions in GABAergic (GAD65, GAD67, VGAT, GAT3, GABAAα1, GABAAγ2) and glutamatergic (GluA1, mGlu5, VGLUT1) protein expression. Pharmacologic inhibition of GABAA receptors with the antagonist bicuculline abolished propofol's antidepressant effects. Optogenetic activation of GABAergic interneurons at 10 Hz enhanced propofol's antidepressant effects, whereas inhibition attenuated them.CONCLUSIONSPropofol produces rapid antidepressant-like effects through activating the GABAA receptors and restoring the GABA/glutamate balance. These findings suggest that propofol could be a useful tool for investigating the mechanisms of fast-acting antidepressant.ETHICAL COMPLIANCEThe study was approved by the Ethics Committee of Jilin University.
{"title":"Effects of single bolus exposure to propofol on depression-like behavior in a chronic unpredictable mild stress model in mice.","authors":"Jinfang Song,Xinmiao Piao,Wei Liu,Xu Han,Jingyun Su,Bingjin Li","doi":"10.1097/aln.0000000000006042","DOIUrl":"https://doi.org/10.1097/aln.0000000000006042","url":null,"abstract":"BACKGROUNDDepression is a prevalent psychiatric disorder linked to excitatory/inhibitory (E/I) neurotransmission imbalance, particularly in the medial prefrontal cortex (mPFC). Propofol, a GABAA receptor agonist, induces rapid mood improvements clinically, yet its antidepressant-like effects and underlying mechanisms remain unclear.METHODSNetwork pharmacology was used to identify propofol-related targets linked to E/I balance. Male mice exposed to chronic unpredictable mild stress (CUMS) received a single intraperitoneal injection of propofol. Depressive-like behaviors were assessed using the open field, tail suspension, and forced swim tests. GABAergic and glutamatergic signaling in the mPFC was evaluated by Western blotting, immunofluorescence, and fiber photometry calcium imaging. Optogenetic manipulation of mPFC GABAergic interneurons was performed to test their causal involvement.RESULTSIn both male and female mice, compared with the control group, propofol (50 mg·kg⁻¹) significantly reduced CUMS-induced depression-like behaviors, showing optimal efficacy in the OFT, TST, FST and SPT. Propofol increased mPFC GABAergic neuron excitability while suppressing glutamatergic activity. It also restored CUMS-induced reductions in GABAergic (GAD65, GAD67, VGAT, GAT3, GABAAα1, GABAAγ2) and glutamatergic (GluA1, mGlu5, VGLUT1) protein expression. Pharmacologic inhibition of GABAA receptors with the antagonist bicuculline abolished propofol's antidepressant effects. Optogenetic activation of GABAergic interneurons at 10 Hz enhanced propofol's antidepressant effects, whereas inhibition attenuated them.CONCLUSIONSPropofol produces rapid antidepressant-like effects through activating the GABAA receptors and restoring the GABA/glutamate balance. These findings suggest that propofol could be a useful tool for investigating the mechanisms of fast-acting antidepressant.ETHICAL COMPLIANCEThe study was approved by the Ethics Committee of Jilin University.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"20 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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