Anesthesiology

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Perioperative organ injury is among the leading causes of morbidity and mortality of surgical patients. Among different types of perioperative organ injury, acute kidney injury occurs particularly frequently and has an exceptionally detrimental effect on surgical outcomes. Currently, acute kidney injury is most commonly diagnosed by assessing increases in serum creatinine concentration or decreased urine output. Recently, novel biomarkers have become a focus of translational research for improving timely detection and prognosis for acute kidney injury...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Sevoflurane has antiinflammatory properties, but less is known about effects on infectious inflammationSevoflurane effects on macrophage function in inflammation are not well understood WHAT THIS ARTICLE TELLS US THAT IS NEW: In a lipopolysaccharide model of inflammation, sevoflurane increased mouse macrophage nitric oxide synthase activity and bacteria phagocytosis in vitro and in vivoThese effects were abolished by pharmacologically inhibiting nitric oxide synthase expressionIn endotoxemia in mice, sevoflurane had bactericidal effects BACKGROUND:: Sevoflurane with its antiinflammatory properties has shown to decrease mortality in animal models of sepsis...

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Fresh frozen plasma is often used to prime the cardiopulmonary bypass circuit for pediatric cardiac surgical patients to help offset dilutional coagulopathy that might result in increased perioperative bleeding and allogeneic blood transfusionPrior randomized trials of crystalloid versus fresh frozen plasma prime have reported conflicting results, but the vast majority of these studies were not blinded WHAT THIS ARTICLE TELLS US THAT IS NEW: In this double-blind randomized controlled trial of patients undergoing pediatric cardiac surgery with cardiopulomonary bypass, postoperative bleeding and the need for allogeneic blood products does not differ significantly between patients for whom the cardiopulmonary bypass circuit was primed with crystalloid versus fresh frozen plasma BACKGROUND:: In congenital cardiac surgery, priming cardiopulmonary bypass (CPB) with fresh frozen plasma (FFP) is performed to prevent coagulation abnormalities...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Opioid agonists acting at the nociception/orphanin FQ, δ-opioid, and κ-opioid receptors may counteract respiratory depression induced by activation of the µ-opioid receptorR-dihydroetorphine is an opioid with full agonism and high affinity for the µ-opioid, κ-opioid, and δ-opioid receptors and low affinity for the nociception/orphanin FQ receptor WHAT THIS ARTICLE TELLS US THAT IS NEW: The effects of four R-dihydroetorphine doses (12.5, 75, 125, and 150 ng/kg) on isohypercapnic ventilation and antinociception were studied in 40 healthy male volunteersOver the dose range tested, an apparent maximum in respiratory depression to 33% of baseline ventilation was identified, but a maximum in antinociception was not reachedAt an R-dihydroetorphine effect-site concentration of 20 pg/ml, the probability of analgesia was 60%, while the probability analgesia without respiratory depression was 45%The probability of analgesia increased to 95% at 100 pg/ml, but the probability of analgesia without respiratory depression was reduced to 20% BACKGROUND:: There is an ongoing need for potent opioids with less adverse effects than commonly used opioids...

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Low vitamin D is common in the general populationIn nonsurgical populations, low 25-hydroxyvitamin D is associated with hypertension, left ventricular hypertrophy, heart failure, and coronary artery diseaseIn nonsurgical populations, low vitamin D concentrations are also associated with increased risk of some infections and renal injury WHAT THIS ARTICLE TELLS US THAT IS NEW: Vitamin D deficiency was common in this surgical populationPreoperative vitamin D was not associated with a composite of postoperative 30-day cardiac outcomesThere was an association between low vitamin D and a composite of infectious complications, and also evidence for an association with decreased kidney function BACKGROUND:: Low 25-hydroxyvitamin D is associated with cardiovascular, renal, and infectious risks...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Both saline and hydroxyethyl starch can be used for fluid resuscitation of hemorrhagic shockHemodynamic coherence is the concordant performance of macro- and microcirculationIt is not known whether saline or hydroxyethyl starch resuscitation achieves better hemodynamic coherence WHAT THIS ARTICLE TELLS US THAT IS NEW: In a sheep model of hemorrhagic shock, resuscitation with both saline and hydroxyethyl starch restored mean arterial pressure (macrocirculation)After fluid resuscitation with hydroxyethyl starch, microcirculatory perfused vessel density and microvascular flow index (microcirculation) both improved, whereas saline only marginally improved microvascular flow index and perfused vessel density decreased furtherResuscitation with hydroxyethyl starch but not saline maintained hemodynamic coherence after hemorrhagic shock BACKGROUND:: Fluid resuscitation in hemorrhagic shock aims to restore hemodynamics and repair altered microcirculation...

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Definitions and management strategies for septic shock continue to be updated as defined in Sepsis-2, Sepsis-3, and other guidelinesRecent randomized controlled trials of corticosteroids in septic shock report different treatment effects on 90-day mortality but use different inclusion criteria WHAT THIS ARTICLE TELLS US THAT IS NEW: In a post hoc analysis of the Adjunctive Glucocorticoid Therapy in Patients with Septic Shock (ADRENAL) trial, in participants who fulfilled either the Sepsis-3 or -2 inclusion criteria or those with severe septic shock, a continuous infusion of hydrocortisone did not result in a lower 90-day mortality than placebo BACKGROUND:: Two recent randomized controlled trials (Adjunctive Glucocorticoid Therapy in Patients with Septic Shock [ADRENAL] and Activated Protein C and Corticosteroids for Human Septic Shock [APROCCHSS]) of corticosteroids in patients with septic shock reported different treatment effects on 90-day mortality...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: While total intravenous anesthesia in combination with local-regional anesthesia during cancer resection may result in improved outcomes, potent volatile anesthetics may enhance tumor cell growth and metastasisSera taken from patients receiving propofol, but not from those receiving sevoflurane, induced a reduction in invasiveness, proliferation, and metastatic potential of cancer cells in addition to enhancing their apoptosisExtracellular vesicles are nanosized, membrane-encapsulated information carriers secreted by all living cells that play crucial roles in intercellular communication WHAT THIS ARTICLE TELLS US THAT IS NEW: This proof-of-concept study in colorectal cancer patients receiving either propofol (n = 8) or sevoflurane (n = 9) found 64 extracellular vesicle-associated microRNAs to be significantly regulated by total intravenous anesthesia and 33 to be significantly regulated by sevoflurane anesthesiaAll microRNAs downregulated in response to anesthesia were anesthetic agent specific, while most upregulated microRNAs were notTotal intravenous anesthesia-regulated microRNAs might mediate inhibitory effects on signaling pathways involving cell proliferation, migration, and epithelial-mesenchymal transition of tumor cell line and enhance effects on apoptosis of carcinoma cell lines BACKGROUND:: Extracellular vesicles and their microRNA cargo are crucial facilitators of malignant cell communication and could mediate effects of anesthetics on tumor biology during cancer resection...

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WHAT WE ALREADY KNOW ABOUT THIS TOPIC: β3 subunits of the γ-aminobutyric acid type A (GABAA) receptor play a central role in mediating hypnotic and sedative effects of etomidate, propofol, and pentobarbital in miceZebrafish are a vertebrate animal model amenable to high-throughput pharmacologic studiesThe role of GABAA receptor β3 subunits in mediating the effects of anesthetic drugs in zebrafish has not been previously reported WHAT THIS ARTICLE TELLS US THAT IS NEW: Zebrafish larvae lacking functional β3 subunits of the γ-aminobutyric acid type A (GABAA) receptor displayed selective insensitivity to the same anesthetic drugs (etomidate, propofol, and pentobarbital) as transgenic mice with mutated GABAA receptor β3 subunitsThese experiments indicate phylogenetic conservation of β3 subunit-containing GABAA receptors between zebrafish and mice in mediating hypnotic and sedative components of general anesthesiaThese observations also suggest that zebrafish can be a valuable experimental model for mechanisms of anesthesia research BACKGROUND:: Transgenic mouse studies suggest that γ-aminobutyric acid type A (GABAA) receptors containing β3 subunits mediate important effects of etomidate, propofol, and pentobarbital...