Anesthesiology (original) (raw)

This Month in Anesthesiology

Effect of Intraoperative Midazolam on Postoperative Delirium in Older Surgical Patients: A Prospective, Multicenter Cohort Study

Li, Hao; Liu, Chang; Yang, Yu; Wu, Qing-Ping; Xu, Jun-Mei; Wang, Di-Fen; Sun, Jing-Jia; Mao, Meng-Meng; Lou, Jing-Sheng; Liu, Yan-Hong; Cao, Jiang-Bei; Duan, Chong-Yang; Mi, Wei-Dong Less

Anesthesiology. 142(2):268-277, February 2025.

In Brief:

This cohort study was designed to study whether intraoperative administration of midazolam versus no midazolam was associated with the development of postoperative delirium in the first 7 days after surgery in patients 65 yr of age and older. Despite the inclusion of more than 5,000 older patients in this study, the authors found no significant association between intraoperative administration of midazolam and the development of postoperative delirium in the first 7 days after surgery in older patients.

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Xiong, Ling; Tan, Yanzhe; Yang, Xue; More

Xiong, Ling; Tan, Yanzhe; Yang, Xue; Wang, Hezhi; Ding, Mengwei; Sessler, Daniel I.; Zhong, John; Zhu, Lirong; Tang, Linlin; Xu, Ying Less

Anesthesiology. 142(2):298-307, February 2025.

In Brief:

In a cohort of neonates scheduled for major intestinal or cardiac surgery, asymptomatic central venous thrombosis was common (68%) early after catheter removal. Thrombi spontaneously resolved by 6 months in 73% of those with early thrombi. Weight, central venous catheter to vein diameter ratio, duration of catheterization, and catheter dysfunction were independent risk factors for vessel thrombus.

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Neurodevelopmental Outcomes after Multiple General Anesthetic Exposures before 5 Years of Age: A Cohort Study

Xin, Annie; Grobler, Anneke; Bell, Graham; More

Xin, Annie; Grobler, Anneke; Bell, Graham; de Graaff, Jurgen C.; Dorris, Liam; Disma, Nicola; McCann, Mary Ellen; Withington, Davinia E.; Davidson, Andrew J. Less

Anesthesiology. 142(2):308-319, February 2025.

In Brief:

Approximately 20% of patients enrolled in the study of general anesthesia or awake-regional anesthesia in infancy had one or more additional procedures requiring general anesthesia. This preplanned retrospective analysis utilized the study database to determine whether multiple anesthetic exposures were associated with reduced neurocognitive outcomes at the age of 5 yr. Although the findings are positive, caution is warranted. This small study, like other observational studies, may have suffered from confounding by variables that were not measured.

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Continuation versus Interruption of Buprenorphine/Naloxone in Adult Veterans Undergoing Surgery: Examination of Postoperative Pain and Opioid Utilization in a National Retrospective Cohort Study

Hitt, James M.; Elkin, Peter L.; de Leon-Casasola, Oscar A.

Hitt, James M.; Elkin, Peter L.; de Leon-Casasola, Oscar A. Less

Anesthesiology. 142(2):320-331, February 2025.

In Brief:

Veterans Affairs patients with opioid use disorder between 2010 and 2020 undergoing surgery with preoperative buprenorphine therapy were analyzed. A total of 1,881 surgical procedures in 1,673 patients taking buprenorphine for opioid use disorder were identified; these procedures were matched to 5,748 control patients (5,775 procedures) without a buprenorphine prescription. Among the 1,881 procedures, 1,186 (63%) continued buprenorphine through the perioperative period, while 695 (37%) interrupted buprenorphine. Pain scores were clinically similar for all three groups (4.1 ± 1.9 control, 4.9 ± 2.0 continued buprenorphine, and 5.5 ± 1.7 interrupted buprenorphine). Patients who continued buprenorphine did not require significantly more supplemental opioids as compared to controls (39.7 ± 1.9 mg morphine equivalents/day vs. 36.5 ± 0.7 mg morphine equivalents/day). Patients who interrupted buprenorphine received more supplemental opioids than those who continued it (74.2 ± 4.5 mg morphine equivalents/day vs. 39.7 ± 1.9 mg morphine equivalents/day, respectively).

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GABAergic Neurons in the Central Amygdala Promote Emergence from Isoflurane Anesthesia in Mice

Zhang, Jin-Sheng; Yao, Wei; Zhang, Lei; More

Zhang, Jin-Sheng; Yao, Wei; Zhang, Lei; Li, Zhang-Shu; Gong, Xia-Ting; Duan, Li-Li; Huang, Zhi-Xian; Chen, Tong; Huang, Jin-Chuang; Yang, Shu-Xiang; Yu, Changxi; Cai, Ping; Chen, Li Less

Anesthesiology. 142(2):278-297, February 2025.

In Brief:

In mice, activity of γ-aminobutyric acid–mediated (GABAergic) neurons in the central nucleus of the amygdala decreased during the induction of isoflurane anesthesia and was restored during emergence. Both chemogenetic and optogenetic activation of GABAergic neurons in the central nucleus of the amygdala delayed induction time and shortened recovery from isoflurane anesthesia. Optogenetic stimulation of GABAergic terminal projections from the central nucleus of the amygdala to the basal forebrain also promotes recovery, suggesting that this pathway plays a role in mediating the effects of isoflurane anesthesia.

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Four-factor Prothrombin Complex Concentrate Use for Bleeding Management in Adult Trauma

Mora, Lidia; Maegele, Marc; Grottke, Oliver; More

Mora, Lidia; Maegele, Marc; Grottke, Oliver; Koster, Andreas; Stein, Philipp; Levy, Jerrold H.; Erdoes, Gabor Less

Anesthesiology. 142(2):351-363, February 2025.

In Brief:

The clinical use of four-factor prothrombin complex concentrate in adult trauma patients at risk of bleeding is supported by evidence for urgent reversal of oral anticoagulants but is controversial in acquired traumatic coagulopathy.

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Pulsatile versus Nonpulsatile Cardiopulmonary Bypass

Chaney, Mark A.; Onorati, Francesco; Dhawan, Richa

Chaney, Mark A.; Onorati, Francesco; Dhawan, Richa Less

Anesthesiology. 142(2):364-377, February 2025.

In Brief:

This review addresses investigations involving pulsatile versus nonpulsatile flow cardiopulmonary bypass, a reinvigorated topic from developments in microcirculation physiology, increased use of extracorporeal life support, and discovery of physiologic aberrations from continuous flow ventricular assist devices.

Perioperative Management of Patients with Preeclampsia: A Comprehensive Review

Dennis, Alicia T.; Xin, Annie; Farber, Michaela K.

Dennis, Alicia T.; Xin, Annie; Farber, Michaela K. Less

Anesthesiology. 142(2):378-402, February 2025.

In Brief:

Patients with preeclampsia represent a high-risk perioperative cohort. This article discusses management of hypertension and cerebral, cardiac, hepatic, renal, hematologic and placental dysfunction; monitoring; anesthesia; and postoperative care for these patients, within a perioperative medicine framework.

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