Pub Date : 2026-01-13DOI: 10.1097/aln.0000000000005850
Lynn R Kohan,Eugene R Viscusi
{"title":"Rising Treatment for Substance Use Disorder Presents New Challenges for Anesthesiologists as Perioperative Medicine Specialists.","authors":"Lynn R Kohan,Eugene R Viscusi","doi":"10.1097/aln.0000000000005850","DOIUrl":"https://doi.org/10.1097/aln.0000000000005850","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"42 1","pages":"266-269"},"PeriodicalIF":8.8,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994941","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}
BACKGROUNDPost-operative bleeding is frequent in cardiac surgery, but its incidence, risk factors and consequences remain largely unknown after heart transplantation. The main objective of this study was to describe the incidence of severe bleeding complications after adult heart transplantation.METHODSWe conducted an observational study including all adult patients who received a heart transplant between 2015 and 2022, in two French referral centers. The primary endpoint was the incidence of severe bleeding complications defined by a UDPB score ≥ 3 (Universal Definition of Perioperative Bleeding). Multivariable logistic regression was used to identify variables associated with the incidence of severe post-operative bleeding. The impact of severe post-operative bleeding on one-year mortality was evaluated using a multivariable Cox regression model.RESULTSAmong the 446 patients included, 112 (25%) developed severe bleeding. In multivariable analysis, long-term mechanical cardiac support (adjOR 2.21 [1.01-4.88]), preoperative hemoglobin (adjOR 0.85 [0.76-0.95]) and the duration of CPB (per 10min increase, adjOR=1.08 [1.03-1.15]) were associated with severe bleeding. Severe postoperative bleeding was associated with an increased mortality at one-year (35% vs 13%, p<0.001), with an adjusted HR of 1.91 (95% CI, 1.18-3.09, p=0.008).CONCLUSIONSThis study reports a high incidence of severe hemorrhagic complications following heart transplantation, particularly in patients with mechanical circulatory support. Bleeding complications were associated with a significant increase in morbidity and mortality. Larger-scale studies are needed to identify and evaluated potential prevention strategies.
{"title":"Severe post-operative bleeding after heart transplantation.","authors":"Alexandre Mansour,Adrien Bougle,Marion Turpin,Adel Zaouini,Nicolas Patou Parvedy,Céline Chabanne,Geoffroy Hariri,Guillaume Coutance,Erwan Flecher,Pascal Leprince,Nicolas Nesseler","doi":"10.1097/aln.0000000000005930","DOIUrl":"https://doi.org/10.1097/aln.0000000000005930","url":null,"abstract":"BACKGROUNDPost-operative bleeding is frequent in cardiac surgery, but its incidence, risk factors and consequences remain largely unknown after heart transplantation. The main objective of this study was to describe the incidence of severe bleeding complications after adult heart transplantation.METHODSWe conducted an observational study including all adult patients who received a heart transplant between 2015 and 2022, in two French referral centers. The primary endpoint was the incidence of severe bleeding complications defined by a UDPB score ≥ 3 (Universal Definition of Perioperative Bleeding). Multivariable logistic regression was used to identify variables associated with the incidence of severe post-operative bleeding. The impact of severe post-operative bleeding on one-year mortality was evaluated using a multivariable Cox regression model.RESULTSAmong the 446 patients included, 112 (25%) developed severe bleeding. In multivariable analysis, long-term mechanical cardiac support (adjOR 2.21 [1.01-4.88]), preoperative hemoglobin (adjOR 0.85 [0.76-0.95]) and the duration of CPB (per 10min increase, adjOR=1.08 [1.03-1.15]) were associated with severe bleeding. Severe postoperative bleeding was associated with an increased mortality at one-year (35% vs 13%, p<0.001), with an adjusted HR of 1.91 (95% CI, 1.18-3.09, p=0.008).CONCLUSIONSThis study reports a high incidence of severe hemorrhagic complications following heart transplantation, particularly in patients with mechanical circulatory support. Bleeding complications were associated with a significant increase in morbidity and mortality. Larger-scale studies are needed to identify and evaluated potential prevention strategies.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"46 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961585","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 : 2026-01-13DOI: 10.1097/ALN.0000000000005864
Nathaniel J Brown
{"title":"Ocean of the In-Between.","authors":"Nathaniel J Brown","doi":"10.1097/ALN.0000000000005864","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005864","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146058844","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 : 2026-01-13DOI: 10.1097/aln.0000000000005860
Mariusz Ligocki,Nikolaos J Skubas
{"title":"Turning Down the Surge: Preemptive Magnesium during Pheochromocytoma and Paraganglioma Resection.","authors":"Mariusz Ligocki,Nikolaos J Skubas","doi":"10.1097/aln.0000000000005860","DOIUrl":"https://doi.org/10.1097/aln.0000000000005860","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"22 1","pages":"260-262"},"PeriodicalIF":8.8,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994932","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}
BACKGROUNDThe majority of dorsal root ganglion neurons are excitatory glutamatergic neurons. Recent studies suggest that a subset of dorsal root ganglion neurons are able to synthesize γ-aminobutyric acid (GABA) and are immunoreactive to vesicular GABA transporter (Vgat) that packages GABA into the synaptic vesicles critical for inhibitory neurotransmission. The current study aimed to investigate the spinal circuits innervated by these Vgat+ primary sensory neurons and interrogate the role of Vgat+ primary sensory neurons in nociceptive modification.METHODSThe authors used viral tracings, immunohistochemistry, patch clamp electrophysiologic recordings, optogenetics, chemogenetics, and behavioral assays in male Vgat-Cre mice to dissect the anatomical connectivity and function of Vgat+ primary sensory neurons.RESULTSThe data showed that the central terminals of Vgat+ primary sensory neurons made inhibitory connections with spinal cord somatostatin-positive excitatory interneurons and meanwhile formed glutamatergic connections with local GABAergic interneurons driving feedforward inhibition. The functional dichotomy of Vgat+ primary sensory neurons constituted an inhibitory spinal circuit that prevented aversive and pain-like responses of mice to innocuous or noxious mechanical stimuli. After peripheral nerve injury, the reduction of inhibitory drive from Vgat+ primary sensory neurons to spinal somatostatin-positive interneurons correlated with mechanical nociceptive sensitization. Optogenetic or chemogenetic stimulation of Vgat+ primary sensory neurons effectively alleviated the nerve injury-induced hypersensitivity to mechanical stimulation.CONCLUSIONSThe data suggested that the Vgat+ primary sensory neurons innervating a discrete spinal microcircuit were ideally suited to suppress the mechanical pain transmission.
{"title":"Effects of γ-Aminobutyric Acid and Glutamate Signalings from Primary Sensory Neurons to Gate the Spinal Transmission of Mechanical Pain in Mice.","authors":"Shu-Jin Wu,Hu-Hu Bai,Yan-Ni Liu,Qi Zhang,Yu-Bo Gao,Juan Li,Xu Yang,Jia-Ning Dang,Xiao-Xue Liu,Xue Bai,Xian Yang,Zhan-Wei Suo,Xiao-Dong Hu","doi":"10.1097/aln.0000000000005854","DOIUrl":"https://doi.org/10.1097/aln.0000000000005854","url":null,"abstract":"BACKGROUNDThe majority of dorsal root ganglion neurons are excitatory glutamatergic neurons. Recent studies suggest that a subset of dorsal root ganglion neurons are able to synthesize γ-aminobutyric acid (GABA) and are immunoreactive to vesicular GABA transporter (Vgat) that packages GABA into the synaptic vesicles critical for inhibitory neurotransmission. The current study aimed to investigate the spinal circuits innervated by these Vgat+ primary sensory neurons and interrogate the role of Vgat+ primary sensory neurons in nociceptive modification.METHODSThe authors used viral tracings, immunohistochemistry, patch clamp electrophysiologic recordings, optogenetics, chemogenetics, and behavioral assays in male Vgat-Cre mice to dissect the anatomical connectivity and function of Vgat+ primary sensory neurons.RESULTSThe data showed that the central terminals of Vgat+ primary sensory neurons made inhibitory connections with spinal cord somatostatin-positive excitatory interneurons and meanwhile formed glutamatergic connections with local GABAergic interneurons driving feedforward inhibition. The functional dichotomy of Vgat+ primary sensory neurons constituted an inhibitory spinal circuit that prevented aversive and pain-like responses of mice to innocuous or noxious mechanical stimuli. After peripheral nerve injury, the reduction of inhibitory drive from Vgat+ primary sensory neurons to spinal somatostatin-positive interneurons correlated with mechanical nociceptive sensitization. Optogenetic or chemogenetic stimulation of Vgat+ primary sensory neurons effectively alleviated the nerve injury-induced hypersensitivity to mechanical stimulation.CONCLUSIONSThe data suggested that the Vgat+ primary sensory neurons innervating a discrete spinal microcircuit were ideally suited to suppress the mechanical pain transmission.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"14 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949573","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 : 2026-01-09DOI: 10.1097/ALN.0000000000005858
Kathryn E McGoldrick
{"title":"The Stitch-Up: How Medical Misogyny Harms Us All.","authors":"Kathryn E McGoldrick","doi":"10.1097/ALN.0000000000005858","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005858","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":"145931919","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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