Pub Date : 2026-01-09DOI: 10.1097/ALN.0000000000005867
R Ross Kennedy, Andrew McCombie, Richard A French
{"title":"Maintaining Lower Fresh Gas Flows When Using Sevoflurane: An Observational Exploration of Data from a Single Center.","authors":"R Ross Kennedy, Andrew McCombie, Richard A French","doi":"10.1097/ALN.0000000000005867","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005867","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931898","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 : 2026-01-07DOI: 10.1097/ALN.0000000000005862
Sidney T Le, Brian Lawson, Yun Lu, Andrea M Gochi, Patricia Kipnis, Bradley R Cohn, Vincent X Liu
{"title":"Predicting Preoperative Consultation Clinician Time Using Machine Learning and Electronic Health Record Audit Log Data.","authors":"Sidney T Le, Brian Lawson, Yun Lu, Andrea M Gochi, Patricia Kipnis, Bradley R Cohn, Vincent X Liu","doi":"10.1097/ALN.0000000000005862","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005862","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145916732","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 : 2026-01-01Epub Date: 2025-11-06DOI: 10.1097/ALN.0000000000005773
Kayla Gaye, Emily Newton, Janet Zhang, Alexander S Doyal
{"title":"Severe Esophageal Food Impaction: A Silent Threat to the Airway.","authors":"Kayla Gaye, Emily Newton, Janet Zhang, Alexander S Doyal","doi":"10.1097/ALN.0000000000005773","DOIUrl":"10.1097/ALN.0000000000005773","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"154-155"},"PeriodicalIF":9.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450198","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 : 2026-01-01Epub Date: 2025-11-10DOI: 10.1097/ALN.0000000000005782
Elena Ahrens, Nikolai Ratajczak, Maximilian S Schaefer
{"title":"Acetaminophen 5-HT 3 Antagonist Interaction: Reply.","authors":"Elena Ahrens, Nikolai Ratajczak, Maximilian S Schaefer","doi":"10.1097/ALN.0000000000005782","DOIUrl":"10.1097/ALN.0000000000005782","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"246-247"},"PeriodicalIF":9.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145480655","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 : 2026-01-01Epub Date: 2025-12-09DOI: 10.1097/ALN.0000000000005772
Annie Xin, Christopher Brasher, Martin W Dünser, Tobias Gauss
The practice of anesthesiology is both an art and a science. Despite the increasing emphasis on using scientific evidence to inform clinical decisions, the "art" of considering the contextual intricacies surrounding those decisions is equally important. This article borrows concepts from quantum mechanics and discuss how anesthesiology, too, is practiced and researched in complex systems with intrinsic uncertainty and unpredictability. The authors encourage the reader to reflect on the influence of contextual factors when appraising and applying scientific evidence to their own practice.
{"title":"Insights from Modern Physics.","authors":"Annie Xin, Christopher Brasher, Martin W Dünser, Tobias Gauss","doi":"10.1097/ALN.0000000000005772","DOIUrl":"10.1097/ALN.0000000000005772","url":null,"abstract":"<p><p>The practice of anesthesiology is both an art and a science. Despite the increasing emphasis on using scientific evidence to inform clinical decisions, the \"art\" of considering the contextual intricacies surrounding those decisions is equally important. This article borrows concepts from quantum mechanics and discuss how anesthesiology, too, is practiced and researched in complex systems with intrinsic uncertainty and unpredictability. The authors encourage the reader to reflect on the influence of contextual factors when appraising and applying scientific evidence to their own practice.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"144 1","pages":"17-18"},"PeriodicalIF":9.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145706956","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}
Background: General anesthesia induces both unconsciousness and respiratory depression, but whether these effects share a common neural substrate remains unclear. The parafacial zone, a γ-aminobutyric acid-mediated (GABAergic) sleep-promoting region, has been proposed to modulate respiration. This study investigates whether parafacial zone GABAergic neurons function as a common neural node coordinating anesthetic-induced unconsciousness and respiratory suppression.
Methods: A total of 95 male mice (10 to 12 weeks old) were used. Chemogenetic and optogenetic methods targeted parafacial zone GABAergic neurons to assess anesthetic efficacy and respiratory changes. Immunostaining evaluated neuronal activation, and awake-state stimulation tested for anesthesia-like effects.
Results: Chemogenetic activation of parafacial zone GABAergic neurons enhanced anesthetic sensitivity, shifting the sevoflurane dose-response curve leftward (50% effective dose, 0.662%; 95% confidence interval, 0.624 to 0.699% vs . 1.569%; 95% confidence interval, 1.502 to 1.637%) and lowering the concentration required for loss of righting reflex (0.735 ± 0.027% vs . 1.601 ± 0.048%; P < 0.0001; n = 10). Induction was faster (48 ± 4 s vs . 112 ± 3 s; P < 0.0001; n = 8), and emergence was delayed (435 ± 12 s vs . 89 ± 12 s; P < 0.0001; n = 8). Electroencephalogram showed increased delta and decreased theta power. Respiratory rate declined significantly (183 ± 24 breaths/min vs . 471 ± 3 breaths/min; P < 0.0001; n = 8). During anesthesia, brief optogenetic activation of parafacial zone GABAergic neurons immediately elevated the burst suppression ratio (69.5 ± 5.1% vs . 32.5 ± 7.7%; P < 0.0001; n = 9) and reduced the respiratory rate (38 ± 13 breaths/min vs . 120 ± 21 breaths/min; P = 0.0016; n = 7), indicating concurrent modulation of cortical and respiratory function. Chemogenetic inhibition weakened anesthetic potency. Increased c-Fos expression in parafacial zone GABAergic neurons during sevoflurane anesthesia confirmed their recruitment. In awake mice, optogenetic activation alone induced a low-arousal state with several features of anesthesia, including hypoactivity, analgesia, respiratory depression, and cortical suppression without abolishing righting reflex.
Conclusions: The GABAergic parafacial zone is a shared critical node regulating both respiration and consciousness during sevoflurane anesthesia. Its activation suppresses both, helping explain anesthesia-related respiratory depression.
背景：全身麻醉诱导无意识和呼吸抑制，但这些作用是否有共同的神经基质尚不清楚。旁面区（PZ）是一个gaba能促进睡眠的区域，已被提出调节呼吸。本研究探讨PZ gaba能神经元是否作为一个共同的神经节点协调麻醉诱导的无意识和呼吸抑制。方法：选取10 ~ 12周龄雄性小鼠95只。化学遗传学和光遗传学方法针对PZ gaba能神经元评估麻醉效果和呼吸变化。免疫染色评估神经元激活，清醒状态刺激测试麻醉样效果。结果：化学发生激活PZ gaba能神经元增强麻醉敏感性，使七氟烷剂量反应曲线左移（ED50: 0.662%, 95% CI: 0.624-0.699% vs. 1.569%, 95% CI: 1.502-1.637%），降低翻正反射丧失所需的浓度（0.735±0.027% vs. 1.601±0.048%,P < 0.0001, n = 10）。诱导更快（48±4 s比112±3 s， P < 0.0001, n = 8），出现延迟（435±12 s比89±12 s， P < 0.0001, n = 8）。脑电图显示波能量增加，波能量减少。呼吸频率明显下降（183±24 bpm比471±3 bpm， P < 0.0001, n = 8）。在麻醉过程中，PZ gaba能神经元的短暂光遗传激活立即提高了爆发抑制率（69.5±5.1% vs. 32.5±7.7%,P < 0.0001, n = 9），降低了呼吸速率（38±13 bpm vs. 120±21 bpm, P = 0.0016, n = 7），表明皮质和呼吸功能同时调节。化学发生抑制减弱了麻醉效力。七氟醚麻醉时PZ gaba能神经元c-Fos表达增加证实了它们的募集。在清醒的小鼠中，光遗传激活单独诱导低觉醒状态，具有麻醉的几个特征，包括低活动、镇痛、呼吸抑制和皮层抑制，但不消除翻正反射。结论：七氟醚麻醉时，gaba能PZ是调节呼吸和意识的共享关键节点；它的激活抑制了两者，有助于解释麻醉相关的呼吸抑制。
{"title":"γ-Aminobutyric Acid-mediated Parafacial Zone: Integrating Consciousness and Respiratory Control in Sevoflurane Anesthesia.","authors":"Linlin Luo, Zaixun Qin, Mei Chen, Yuanli Pi, Ying Wang, Zongcheng Jiang, Zhimin Deng, Jia Li, Xuejiao Dou, Junli Jiang, Haiying Wang, Shouyang Yu, Tian Yu, Tianyuan Luo","doi":"10.1097/ALN.0000000000005735","DOIUrl":"10.1097/ALN.0000000000005735","url":null,"abstract":"<p><strong>Background: </strong>General anesthesia induces both unconsciousness and respiratory depression, but whether these effects share a common neural substrate remains unclear. The parafacial zone, a γ-aminobutyric acid-mediated (GABAergic) sleep-promoting region, has been proposed to modulate respiration. This study investigates whether parafacial zone GABAergic neurons function as a common neural node coordinating anesthetic-induced unconsciousness and respiratory suppression.</p><p><strong>Methods: </strong>A total of 95 male mice (10 to 12 weeks old) were used. Chemogenetic and optogenetic methods targeted parafacial zone GABAergic neurons to assess anesthetic efficacy and respiratory changes. Immunostaining evaluated neuronal activation, and awake-state stimulation tested for anesthesia-like effects.</p><p><strong>Results: </strong>Chemogenetic activation of parafacial zone GABAergic neurons enhanced anesthetic sensitivity, shifting the sevoflurane dose-response curve leftward (50% effective dose, 0.662%; 95% confidence interval, 0.624 to 0.699% vs . 1.569%; 95% confidence interval, 1.502 to 1.637%) and lowering the concentration required for loss of righting reflex (0.735 ± 0.027% vs . 1.601 ± 0.048%; P < 0.0001; n = 10). Induction was faster (48 ± 4 s vs . 112 ± 3 s; P < 0.0001; n = 8), and emergence was delayed (435 ± 12 s vs . 89 ± 12 s; P < 0.0001; n = 8). Electroencephalogram showed increased delta and decreased theta power. Respiratory rate declined significantly (183 ± 24 breaths/min vs . 471 ± 3 breaths/min; P < 0.0001; n = 8). During anesthesia, brief optogenetic activation of parafacial zone GABAergic neurons immediately elevated the burst suppression ratio (69.5 ± 5.1% vs . 32.5 ± 7.7%; P < 0.0001; n = 9) and reduced the respiratory rate (38 ± 13 breaths/min vs . 120 ± 21 breaths/min; P = 0.0016; n = 7), indicating concurrent modulation of cortical and respiratory function. Chemogenetic inhibition weakened anesthetic potency. Increased c-Fos expression in parafacial zone GABAergic neurons during sevoflurane anesthesia confirmed their recruitment. In awake mice, optogenetic activation alone induced a low-arousal state with several features of anesthesia, including hypoactivity, analgesia, respiratory depression, and cortical suppression without abolishing righting reflex.</p><p><strong>Conclusions: </strong>The GABAergic parafacial zone is a shared critical node regulating both respiration and consciousness during sevoflurane anesthesia. Its activation suppresses both, helping explain anesthesia-related respiratory depression.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"116-133"},"PeriodicalIF":9.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12677344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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