Background: Recent evidence indicates that general anesthesia and sleep-wake behavior share some overlapping neural substrates. GABAergic neurons in the central amygdala (CeA) have a high firing rate during wakefulness and play a role in regulating arousal-related behaviors. The objective of this study is to investigate whether CeA GABAergic neurons participate in the regulation of isoflurane general anesthesia and uncover the underlying neural circuitry.
Methods: Fiber photometry recording was used to determine the changes in calcium signals of CeA GABAergic neurons during isoflurane anesthesia in Vgat-Cre mice. Chemogenetic and optogenetic approaches were used to manipulate the activity of CeA GABAergic neurons, and a righting reflex test was used to determine the induction and emergence from isoflurane anesthesia. Cortical electroencephalogram (EEG) recording was used to assess the changes in EEG spectral power and burst-suppression ratio during 0.8% and 1.4% isoflurane anesthesia, respectively. Both male and female mice were used in this study.
Results: The calcium signals of CeA GABAergic neurons decreased during the induction of isoflurane anesthesia and was restored during the emergence. Chemogenetic activation of CeA GABAergic neurons delayed induction time (mean ± SD, vehicle vs. clozapine-N-oxide: 58.75±5.42 s vs. 67.63±5.01 s; n=8, P=0.0017) and shortened emergence time (385.50±66.26 s vs. 214.60±40.21 s; n=8, P=0.0017) from isoflurane anesthesia. Optogenetic activation of CeA GABAergic neurons produced a similar effect. Furthermore, optogenetic activation decreased EEG delta power (Pre-stim vs. Stim: 46.63%±4.40% vs. 34.16%±6.47%; n=8, P=0.0195) and burst-suppression ratio (83.39%±5.15% vs. 52.60%±12.98%; n=8, P=0.0002). Moreover, optogenetic stimulation of terminals of CeA GABAergic neurons in the basal forebrain (BF) also promoted cortical activation and accelerated behavioral emergence from isoflurane anesthesia.
Conclusions: Our results suggest that CeA GABAergic neurons play a role in general anesthesia regulation, which facilitates behavioral and cortical emergence from isoflurane anesthesia through the GABAergic CeA-BF pathway.
背景:最近的证据表明,全身麻醉和睡眠-觉醒行为有一些重叠的神经基底。中央杏仁核(CeA)中的GABA能神经元在清醒时具有较高的发射率,并在调节唤醒相关行为中发挥作用。本研究旨在探讨杏仁核中央 GABA 能神经元是否参与异氟醚全身麻醉的调控,并揭示其潜在的神经回路:方法:采用纤维光度记录法测定Vgat-Cre小鼠在异氟烷麻醉过程中CeA GABA能神经元钙信号的变化。化学遗传学和光遗传学方法被用来操纵CeA GABA能神经元的活动,右反射试验被用来确定异氟烷麻醉的诱导和唤醒。皮层脑电图(EEG)记录分别用于评估0.8%和1.4%异氟醚麻醉期间EEG频谱功率和猝发抑制比的变化。本研究使用了雄性和雌性小鼠:结果:CeA GABA能神经元的钙信号在异氟醚麻醉诱导过程中减少,并在苏醒过程中恢复。对CeA GABA能神经元的化学激活延迟了异氟烷麻醉的诱导时间(平均值±标度,载体 vs. 氯氮平-氧化物:58.75±5.42 s vs. 67.63±5.01 s;n=8,P=0.0017),缩短了异氟烷麻醉的苏醒时间(385.50±66.26 s vs. 214.60±40.21 s;n=8,P=0.0017)。光遗传激活 CeA GABA 能神经元也产生了类似的效果。此外,光遗传激活降低了脑电图的δ功率(刺激前 vs. 刺激:46.63%±4.40% vs. 34.16%±6.47%;n=8,P=0.0195)和猝发抑制比(83.39%±5.15% vs. 52.60%±12.98%;n=8,P=0.0002)。此外,对基底前脑(BF)中的CeA GABA能神经元末端进行光遗传刺激也促进了大脑皮层的激活,并加速了异氟烷麻醉后的行为唤醒:我们的研究结果表明,CeA GABA能神经元在全身麻醉调节中发挥作用,通过GABA能CeA-BF通路促进行为和大脑皮层从异氟醚麻醉中苏醒。
{"title":"GABAergic neurons in the central amygdala promote emergence from isoflurane anesthesia in mice.","authors":"Jin-Sheng Zhang, Wei Yao, Lei Zhang, Zhang-Shu Li, Xia-Ting Gong, Li-Li Duan, Zhi-Xian Huang, Tong Chen, Jin-Chuang Huang, Shu-Xiang Yang, Changxi Yu, Ping Cai, Li Chen","doi":"10.1097/ALN.0000000000005279","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005279","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence indicates that general anesthesia and sleep-wake behavior share some overlapping neural substrates. GABAergic neurons in the central amygdala (CeA) have a high firing rate during wakefulness and play a role in regulating arousal-related behaviors. The objective of this study is to investigate whether CeA GABAergic neurons participate in the regulation of isoflurane general anesthesia and uncover the underlying neural circuitry.</p><p><strong>Methods: </strong>Fiber photometry recording was used to determine the changes in calcium signals of CeA GABAergic neurons during isoflurane anesthesia in Vgat-Cre mice. Chemogenetic and optogenetic approaches were used to manipulate the activity of CeA GABAergic neurons, and a righting reflex test was used to determine the induction and emergence from isoflurane anesthesia. Cortical electroencephalogram (EEG) recording was used to assess the changes in EEG spectral power and burst-suppression ratio during 0.8% and 1.4% isoflurane anesthesia, respectively. Both male and female mice were used in this study.</p><p><strong>Results: </strong>The calcium signals of CeA GABAergic neurons decreased during the induction of isoflurane anesthesia and was restored during the emergence. Chemogenetic activation of CeA GABAergic neurons delayed induction time (mean ± SD, vehicle vs. clozapine-N-oxide: 58.75±5.42 s vs. 67.63±5.01 s; n=8, P=0.0017) and shortened emergence time (385.50±66.26 s vs. 214.60±40.21 s; n=8, P=0.0017) from isoflurane anesthesia. Optogenetic activation of CeA GABAergic neurons produced a similar effect. Furthermore, optogenetic activation decreased EEG delta power (Pre-stim vs. Stim: 46.63%±4.40% vs. 34.16%±6.47%; n=8, P=0.0195) and burst-suppression ratio (83.39%±5.15% vs. 52.60%±12.98%; n=8, P=0.0002). Moreover, optogenetic stimulation of terminals of CeA GABAergic neurons in the basal forebrain (BF) also promoted cortical activation and accelerated behavioral emergence from isoflurane anesthesia.</p><p><strong>Conclusions: </strong>Our results suggest that CeA GABAergic neurons play a role in general anesthesia regulation, which facilitates behavioral and cortical emergence from isoflurane anesthesia through the GABAergic CeA-BF pathway.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520796","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 : 2024-10-21DOI: 10.1097/ALN.0000000000005267
Mathieu Capdevila, Audrey De Jong, Fouad Belafia, Aurelie Vonarb, Julie Carr, Nicolas Molinari, Olivier Choquet, Xavier Capdevila, Samir Jaber
Background: Diaphragm dysfunction is common in intensive care unit and associated with weaning failure and mortality. Diagnosis gold standard is the transdiaphragmatic or tracheal pressure induced by magnetic phrenic nerve stimulation. However, the equipment is not commonly available and requires specific technical skills. We aimed to evaluate ultrasound guided transcutaneous phrenic nerve stimulation for daily bedside assessment of diaphragm function by targeted electrical phrenic nerve stimulation.
Methods: In this randomized cross-over study we compared a new method of ultrasound guided transcutaneous electrical phrenic nerve stimulation (SONOTEPS method) using a peripheral nerve stimulator, with the magnetic phrenic nerve stimulation. Intensive care unit adult patients under mechanical ventilation with a Richmond-Agitation-Sedation-Scale score of -4 or -5 were included. Each patient received the two methods of stimulation, in a randomized order. The primary outcome was the tracheal pressure (Ptrach) induced by stimulation.
Results: We analyzed 232 measures of Ptrach from 116 patients of whom 77 presented a diaphragm dysfunction (Ptrach < 11 cmH2O) and 50 a severe diaphragm dysfunction (Ptrach < 8 cmH2O). The Passing-Bablok regression showed no significant differences (intercept A of -0.03 [CI95:-0.83-0.52] and slope B of 0.98 [CI95:0.90-1.05]) between SONOTEPS method and magnetic stimulation which were positively correlated (R²=0.639). The mean bias was -1.08 (CI95 5.02, -7.18) cmH2O. The receiver operating curves showed an excellent performance for the diagnosis of diaphragm dysfunction and severe diaphragm dysfunction with respectively an area under curve of 0.90 (CI95 0.83-0.97) and 0.88 (CI95 0.82-0.95). This performance was not significantly affected by the body mass index or the presence of a neck catheter.
Conclusions: The SONOTEPS method is a simple and accurate tool for bedside assessment of diaphragm function with ultrasound guided transcutaneous phrenic nerve stimulation in sedated patients with no or minimal spontaneous respiratory activity.
{"title":"Ultrasound guided transcutaneous phrenic nerve stimulation in critically ill patients: a new method to evaluate diaphragmatic function.","authors":"Mathieu Capdevila, Audrey De Jong, Fouad Belafia, Aurelie Vonarb, Julie Carr, Nicolas Molinari, Olivier Choquet, Xavier Capdevila, Samir Jaber","doi":"10.1097/ALN.0000000000005267","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005267","url":null,"abstract":"<p><strong>Background: </strong>Diaphragm dysfunction is common in intensive care unit and associated with weaning failure and mortality. Diagnosis gold standard is the transdiaphragmatic or tracheal pressure induced by magnetic phrenic nerve stimulation. However, the equipment is not commonly available and requires specific technical skills. We aimed to evaluate ultrasound guided transcutaneous phrenic nerve stimulation for daily bedside assessment of diaphragm function by targeted electrical phrenic nerve stimulation.</p><p><strong>Methods: </strong>In this randomized cross-over study we compared a new method of ultrasound guided transcutaneous electrical phrenic nerve stimulation (SONOTEPS method) using a peripheral nerve stimulator, with the magnetic phrenic nerve stimulation. Intensive care unit adult patients under mechanical ventilation with a Richmond-Agitation-Sedation-Scale score of -4 or -5 were included. Each patient received the two methods of stimulation, in a randomized order. The primary outcome was the tracheal pressure (Ptrach) induced by stimulation.</p><p><strong>Results: </strong>We analyzed 232 measures of Ptrach from 116 patients of whom 77 presented a diaphragm dysfunction (Ptrach < 11 cmH2O) and 50 a severe diaphragm dysfunction (Ptrach < 8 cmH2O). The Passing-Bablok regression showed no significant differences (intercept A of -0.03 [CI95:-0.83-0.52] and slope B of 0.98 [CI95:0.90-1.05]) between SONOTEPS method and magnetic stimulation which were positively correlated (R²=0.639). The mean bias was -1.08 (CI95 5.02, -7.18) cmH2O. The receiver operating curves showed an excellent performance for the diagnosis of diaphragm dysfunction and severe diaphragm dysfunction with respectively an area under curve of 0.90 (CI95 0.83-0.97) and 0.88 (CI95 0.82-0.95). This performance was not significantly affected by the body mass index or the presence of a neck catheter.</p><p><strong>Conclusions: </strong>The SONOTEPS method is a simple and accurate tool for bedside assessment of diaphragm function with ultrasound guided transcutaneous phrenic nerve stimulation in sedated patients with no or minimal spontaneous respiratory activity.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456488","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 : 2024-10-17DOI: 10.1097/aln.0000000000005169
Mariam Tsikvadze,John C Haney,Melissa A Lyle,Anna Bovill Shapiro
{"title":"ECPELLA Mixing Cloud on Computed Tomography Angiogram.","authors":"Mariam Tsikvadze,John C Haney,Melissa A Lyle,Anna Bovill Shapiro","doi":"10.1097/aln.0000000000005169","DOIUrl":"https://doi.org/10.1097/aln.0000000000005169","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":8.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448056","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 : 2024-10-14DOI: 10.1097/aln.0000000000005178
Maxwell B Baker,Jamel Ortoleva,Yan Wang,Ala Nozari,William E Baker
{"title":"Damage Control Resuscitation in Traumatic Hemorrhage: Comment.","authors":"Maxwell B Baker,Jamel Ortoleva,Yan Wang,Ala Nozari,William E Baker","doi":"10.1097/aln.0000000000005178","DOIUrl":"https://doi.org/10.1097/aln.0000000000005178","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":8.8,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439486","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 : 2024-10-11DOI: 10.1097/ALN.0000000000005156
Haobo Ma, Elena Ahrens, Luca J Wachtendorf, Guanqing Chen, James Rhee, Maximilian S Schaefer
{"title":"Intraoperative Vasopressors and Delirium: Reply.","authors":"Haobo Ma, Elena Ahrens, Luca J Wachtendorf, Guanqing Chen, James Rhee, Maximilian S Schaefer","doi":"10.1097/ALN.0000000000005156","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005156","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405942","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 : 2024-10-11DOI: 10.1097/ALN.0000000000005155
Ashish Kumar, Amit Jain
{"title":"Intraoperative Vasopressors and Delirium: Comment.","authors":"Ashish Kumar, Amit Jain","doi":"10.1097/ALN.0000000000005155","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005155","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405941","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 : 2024-10-11DOI: 10.1097/ALN.0000000000005148
Michael Mazzeffi, Kenichi A Tanaka, Paul A Gurbel, Udaya S Tantry, Jerrold H Levy
{"title":"Platelet P2Y12 Receptor Inhibition and Perioperative Patient Management.","authors":"Michael Mazzeffi, Kenichi A Tanaka, Paul A Gurbel, Udaya S Tantry, Jerrold H Levy","doi":"10.1097/ALN.0000000000005148","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005148","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":null,"pages":null},"PeriodicalIF":9.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405943","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}