Anesthesiology

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Exposure to environmental stressors and endocrine disruptors can induce multigenerational effects resulting in neurobehavioral and other abnormalities in the offspringEarly-life anesthesia exposure in rodents alters neurocognitive function in their offspring, but whether exposure of adult animals affects offspring has not been previously reported WHAT THIS ARTICLE TELLS US THAT IS NEW: Repeated exposures of adult rats to sevoflurane (2.1%, three times, 3 h on every second day) induce neurobehavioral abnormalities in the exposed males and in male but not female progenyThe neurobehavioral abnormalities in male offspring are accompanied by increased methylation and decreased expression of the potassium ion-chloride ion cotransporter Kcc2 gene that regulates neuronal chloride homeostasis, and, thereby, the functional modalities of γ-aminobutyric acid type A receptor-mediated neurotransmissionSevoflurane exposure also induces hypermethylation of the Kcc2 gene in both male and female parental germ cellsThese observations suggest that epigenetic reprograming of parental germ cells is involved in transmitting the adverse effects of sevoflurane exposure of adult rats to their male progeny BACKGROUND:: Sevoflurane administered to neonatal rats induces neurobehavioral abnormalities and epigenetic reprogramming of their germ cells; the latter can pass adverse effects of sevoflurane to future offspring...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: The optimal fluid for resuscitation of hemorrhagic shock (crystalloid, colloid, or hemoglobin-containing) and mitigation of acute kidney injury is unknown WHAT THIS ARTICLE TELLS US THAT IS NEW: In a rat model of hemorrhagic shock comparing fluid resuscitation with blood, diluted blood, hydroxyethyl starch, or polyethylene-glycolated carboxyhemoglobin, all fluids restored urine output and creatinine clearance, but only blood and diluted blood improved renal PO2Postresuscitation histologic renal tubular damage was increased compared with nonresuscitated rats but slightly less with blood, diluted blood, and polyethylene-glycolated carboxyhemoglobin compared with hydroxyethyl starchRestoration of circulatory hemodynamics and kidney microcirculatory PO2 was comparable with polyethylene-glycolated carboxyhemoglobin and balanced hydroxyethyl starch solution BACKGROUND:: Primary resuscitation fluid to treat hemorrhagic shock remains controversial...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Nitrous oxide exposure can induce spinal cord neurodegeneration and related neuropathy in humans rendered susceptible by genetic or acquired risk factorsThe effects of nitrous oxide on the regeneration of nervous system following trauma has not been previously reported WHAT THIS ARTICLE TELLS US THAT IS NEW: In in vitro and in vivo experimental models of male rats, nitrous oxide exposure impairs folic acid-induced axonal regeneration of dorsal root and retinal ganglion neuronsThe beneficial effects of folic acid on functional recovery following spinal cord contusion in male rats are hindered by co-administration of nitrous oxideThese experiments suggest that nitrous oxide can interfere with axonal regeneration and functional recovery following central nervous system injury BACKGROUND:: Nitrous oxide can induce neurotoxicity...

WHAT WE KNOW ABOUT THIS TOPIC: Functional capacity is thought to be an important part of preoperative assessment, but it is hard to assess without formal testingStandardized physical function questions might identify patients with adequate capacity (greater than or equal to 4 metabolic equivalents) WHAT THIS ARTICLE TELLS US THAT IS NEW: Results from standardized physical function questions and hip accelerometers were compared in 522 participantsPhysical function questions were sensitive but nonspecificOther approaches to assessing physical functional status should be considered BACKGROUND:: Functional capacity assessment is a core component of current perioperative cardiovascular evaluation and management guidelines for noncardiac surgery...

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Interscalene nerve block is commonly used for shoulder surgery for anesthesia and postoperative analgesiaUnfortunately, interscalene blocks commonly result in hemidiaphragmatic paralysis WHAT THIS ARTICLE TELLS US THAT IS NEW: When interscalene block was compared with superior trunk block, less frequent hemidiaphragmatic paralysis was seen in the superior trunk block groupSuperior trunk block was noninferior to interscalene block in terms of pain scores for up to 24 h postoperatively, and superior trunk block patients were no less satisfied BACKGROUND:: Interscalene brachial plexus block of the C5-C6 roots provides highly effective postoperative analgesia after shoulder surgery but usually results in hemidiaphragmatic paresis...

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Intestinal ischemia-reperfusion causes multiple-organ dysfunction syndromeNeutrophil extracellular traps and histone activation may be important in the development of multiple-organ dysfunctionRecombinant thrombomodulin binds to circulating histones and may modulate their activation WHAT THIS ARTICLE TELLS US THAT IS NEW: In male mice, recombinant thrombomodulin administration after intestinal ischemia-reperfusion increased survival rateHistones and neutrophil extracellular traps were found in the livers and intestines after ischemia-reperfusion, and recombinant thrombomodulin reduced these accumulations only in the liverRecombinant thrombomodulin may attenuate liver injury by suppressing hepatic histone and neutrophil extracellular trap accumulation BACKGROUND:: In multiple-organ dysfunction, an injury affecting one organ remotely impacts others, and the injured organs synergistically worsen outcomes...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Oligodendrocyte proliferation and maturation are prerequisites for myelination in the central nervous system. Disruption of these processes can lead to long-term impairment of neural function.Laboratory models demonstrate a variety of effects of anesthetics on the immature brain, but the consequences of early life anesthesia exposure on oligodendrocyte development have not been previously reported. WHAT THIS ARTICLE TELLS US THAT IS NEW: Exposure of 7-day-old mouse pups to isoflurane (1...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Patients sedated with standard clinical doses of dexmedetomidine can be readily arousedDexmedetomidine doses producing mild to deep sedation lack significant analgesic effectRemifentanil is an opioid analgesic with only modest sedative propertiesAddition of remifentanil to propofol sedation reduces the propofol concentration required to reach tolerance of shaking the patient while shouting their name and tolerance of laryngoscopy WHAT THIS ARTICLE TELLS US THAT IS NEW: This three-phase crossover trial to study the pharmacodynamic interaction between remifentanil and dexmedetomidine in 30 age- and sex-stratified healthy volunteers found that, despite falling asleep, most subjects remained arousable by calling their name, shaking the subject while shouting their name, or a trapezius squeeze, even after reaching supraclinical concentrationsAdding remifentanil to dexmedetomidine sedation did not affect the likelihood of response to graded stimuliDexmedetomidine potency increased with increasing age BACKGROUND:: Dexmedetomidine is a sedative with modest analgesic efficacy, whereas remifentanil is an opioid analgesic with modest sedative potency...

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