Browse
Recent Submissions
Item Comparing general and regional anesthesia in patients undergoing primary total hip arthroplasty: analysis of national health insurance data in Korea(Frontiers Media, 2025-03-17) Lee, Seungyoung; Ahn, Eunjin; Kim, Min Kyoung; White, Fletcher A.; Chung, Euiheon; Chung, YongHun; Anesthesia, School of MedicineObjectives: To compare the effects of general and regional anesthesia on clinical outcomes following primary total hip arthroplasty (THA). Methods: This retrospective study using data from the Korean National Health Insurance Research Database included 1,522 patients who underwent THA under general anesthesia (n = 640) or regional anesthesia (n = 882) between 2002 and 2015. We compared the mortality and complication rates within 30 days after surgery. Results: Prosthesis failure (1.56% vs. 0.45%, p = 0.025), admission to the intensive care unit (9.53 vs. 5.44%, p = 0.0023), and total cost (₩7,332,515 vs. ₩6,833,295, p < 0.0001) were higher in the general anesthesia group than in the regional anesthesia group. No significant differences were observed in mortality (0.94% vs. 0.57%, p = 0.54), transfusion rate (81.1% vs. 80.9%, p = 0.94), length of hospital stay (45 vs. 45 days, p = 0.23), or other complications between the groups. Similar results were observed in propensity-score matched analysis (n = 640 patients per group). Conclusion: Our study showed that both anesthesia types resulted in comparable mortality and complication rates in patients who underwent THA, but the costs differed.Item Cardiovascular outcomes of a positive nuclear stress test but negative coronary angiography in a multiethnic male predominant cohort(Nigerian Medical Association, 2014) Addison, Daniel; Singh, Vinita; Okyere-Asante, K.; Okafor, Henry; Anesthesia, School of MedicineBackground: Patients presenting with chest pain and evidence of functional ischemia by myocardial perfusion imaging (MPI), but lacking commensurate angiographic disease pose a diagnostic and therapeutic dilemma. They are often dismissed as having 'false-positive MPI'. Moreover, a majority of the available long-term outcome data for it has been derived from homogenous female populations. In this study, we sought to evaluate the long-term outcomes of this presentation in a multiethnic male-predominant cohort. Materials and methods: We retrospectively identified 47 patients who presented to our institution between 2002 and 2005 with chest pain and evidence of ischemia on MPI, but with no significant angiographic disease on subsequent cardiac catheterization (cases). The occurrence of adverse cardiovascular outcomes (chest pain, congestive heart failure, acute myocardial infarction and stroke) post-index coronary angiogram was tracked. Similar data was collected for 37 patients who also presented with chest pain, but normal MPI over the same period (controls). Overall average follow-up was over 22 months. Results: Fifty-three percent (26/47) of the cases had one or more of the adverse outcomes as compared with 22% (8/37) of controls (P < 0.01). Of these, 13 (50.0%) and 3 (37.5%) were males, respectively. Conclusions: Ischemia on MPI is predictive of long-term adverse cardiovascular outcomes despite normal ('false-negative') coronary angiography. This appears to be gender-neutral.Item Carbamazepine Potentiates the Effectiveness of Morphine in a Rodent Model of Neuropathic Pain(Public Library of Science, 2014-09-15) Due, Michael R.; Yang, Xiao-Fang; Allette, Yohance M.; Randolph, Aaron L.; Ripsch, Matthew S.; Wilson, Sarah M.; Dustrude, Erik T.; Khanna, Rajesh; White, Fletcher A.; Anesthesia, School of MedicineApproximately 60% of morphine is glucuronidated to morphine-3-glucuronide (M3G) which may aggravate preexisting pain conditions. Accumulating evidence indicates that M3G signaling through neuronal Toll-like receptor 4 (TLR4) may be central to this proalgesic signaling event. These events are known to include elevated neuronal excitability, increased voltage-gated sodium (NaV) current, tactile allodynia and decreased opioid analgesic efficacy. Using an in vitro ratiometric-based calcium influx analysis of acutely dissociated small and medium-diameter neurons derived from lumbar dorsal root ganglion (DRG), we observed that M3G-sensitive neurons responded to lipopolysaccharide (LPS) and over 35% of these M3G/LPS-responsive cells exhibited sensitivity to capsaicin. In addition, M3G-exposed sensory neurons significantly increased excitatory activity and potentiated NaV current as measured by current and voltage clamp, when compared to baseline level measurements. The M3G-dependent excitability and potentiation of NaV current in these sensory neurons could be reversed by the addition of carbamazepine (CBZ), a known inhibitor of several NaV currents. We then compared the efficacy between CBZ and morphine as independent agents, to the combined treatment of both drugs simultaneously, in the tibial nerve injury (TNI) model of neuropathic pain. The potent anti-nociceptive effects of morphine (5 mg/kg, i.p.) were observed in TNI rodents at post-injury day (PID) 7-14 and absent at PID21-28, while administration of CBZ (10 mg/kg, i.p.) alone failed to produce anti-nociceptive effects at any time following TNI (PID 7-28). In contrast to either drug alone at PID28, the combination of morphine and CBZ completely attenuated tactile hyperalgesia in the rodent TNI model. The basis for the potentiation of morphine in combination with CBZ may be due to the effects of a latent upregulation of NaV1.7 in the DRG following TNI. Taken together, our observations demonstrate a potential therapeutic use of morphine and CBZ as a combinational treatment for neuropathic pain.Item Impact of intravenous antihypertensive therapy on cerebral blood flow and neurocognition: a systematic review and meta-analysis(Elsevier, 2025) Meacham, Kylie S.; Schmidt, Jacob D.; Sun, Yanhua; Rasmussen, Mads; Liu, Ziyue; Adams, David C.; Backfish-White, Kevin M.; Meng, Lingzhong; Anesthesia, School of MedicineBackground: Intravenous antihypertensivedrugs are commonly used in acute care settings, yet their impact on cerebral blood flow (CBF) remains uncertain. Methods: A systematic review and meta-analysis of 50 studies evaluated the effects of commonly used i.v. antihypertensive agents on CBF in normotensive, hypertensive, and intracranial pathology populations. Meta-analyses used standardised mean differences (SMD), stratified by population type, consciousness state, antihypertensive agent, and CBF measurement method. Results: Intravenous antihypertensivedrug therapy significantly reduced CBF in normotensive individuals without intracranial pathology (SMD -0.31, 95% confidence interval -0.51 to -0.11), primarily driven by nitroprusside and nitroglycerin in awake subjects (SMD -0.80, 95% confidence interval -1.15 to -0.46), with a median CBF decrease of 14% (interquartile range 13-16%) and a median mean arterial pressure reduction of 17% (interquartile range 9-22%). Other antihypertensives showed no significant effects on CBF in normotensive individuals, nor were changes observed in hypertensive patients or those with intracranial pathology when the median mean arterial pressure reduction was ∼20%. No correlation was found between mean arterial pressure reduction and CBF change, supporting intact cerebral autoregulation. Historical data revealed neurocognitive changes when CBF fell to ∼30 ml 100 g-1 min-1, associated with a 58% mean arterial pressure reduction and a 38% CBF reduction. Conclusions: Most i.v. antihypertensive agents do not significantly affect CBF in clinical dose ranges; however, nitroprusside and nitroglycerin can reduce CBF under specific clinical conditions. The certainty of evidence remains low. Neurocognitive changes appear to depend on the magnitude of blood pressure and CBF reductions.Item A Few Extra Needles Can Make an Impact on Mental Health(Mary Ann Liebert, 2024) Stone, Jennifer A. M.; Anesthesia, School of MedicineItem Prognostic models for predicting insomnia treatment outcomes: A systematic review(Elsevier, 2024) Holler, Emma; Du, Yu; Barboi, Cristina; Owora, Arthur; Anesthesia, School of MedicineObjective: To identify and critically evaluate models predicting insomnia treatment response in adult populations. Methods: Pubmed, EMBASE, and PsychInfo databases were searched from January 2000 to January 2023 to identify studies reporting the development or validation of multivariable models predicting insomnia treatment outcomes in adults. Data were extracted according to CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) guidelines and study quality was assessed using the Prediction model study Risk Of Bias Assessment Tool (PROBAST). Results: Eleven studies describing 53 prediction models were included and appraised. Treatment response was most frequently assessed using wake after sleep onset (n = 10; 18.9%), insomnia severity index (n = 10; 18.9%), and sleep onset latency (n = 9, 17%). Dysfunctional Beliefs About Sleep (DBAS) score was the most common predictor in final models (n = 33). R2 values ranged from 0.06 to 0.80 for models predicting continuous response and area under the curve (AUC) ranged from 0.73 to 0.87 for classification models. Only two models were internally validated, and none were externally validated. All models were rated as having a high risk of bias according to PROBAST, which was largely driven by the analysis domain. Conclusion: Prediction models may be a useful tool to assist clinicians in selecting the optimal treatment strategy for patients with insomnia. However, no externally validated models currently exist. These results highlight an important gap in the literature and underscore the need for the development and validation of modern, methodologically rigorous models.Item Intraosseous basivertebral nerve ablation: A 5-year pooled analysis from three prospective clinical trials(Elsevier, 2024-12-13) Khalil, Jad G.; Truumees, Eeric; Macadaeg, Kevin; Nguyen, Daniel T. D.; Moore, Gregory A.; Lukes, Dylan; Fischgrund, Jeffrey; Anesthesia, School of MedicineBackground: Vertebrogenic pain is a documented source of anterior column chronic low back pain (CLBP) that stems from damaged vertebral endplates. Nociceptive signals are transmitted by the basivertebral nerve (BVN) and endplate damage is observed as Type 1 or Type 2 Modic changes (MC) on magnetic resonance imaging (MRI). The clinical impact and safety of intraosseous radiofrequency ablation of the BVN (BVNA) for the treatment of vertebrogenic pain has been demonstrated in three prospective clinical trials (two randomized and one single-arm study). Objective: Report aggregate long-term BVNA outcomes at five years from three studies. Methods: Pooled results at 5-years post-BVNA are reported for three clinical trials with similar inclusion/exclusion criteria and outcomes measurements: 1) a prospective, open label, single-arm follow-up of the treatment arm of a randomized controlled trial (RCT) comparing BVNA to sham ablation (SMART); 2) a prospective, open label, single-arm follow-up of the treatment arm of an RCT comparing BVNA to standard care (INTRACEPT); and 3) a prospective, open label, single-arm long-term follow-up study of BVNA-treated participants (CLBP Single-Arm). Paired datasets (baseline and 5-years) for mean changes in Oswestry disability index (ODI) and numeric pain scores (NPS) were analyzed using a two-sided paired t-test with a 0.05 level of significance. Secondary outcomes included responder rates, patient satisfaction, adverse events, and healthcare utilization. Results: Two hundred forty-nine (249) of 320 BVNA-treated participants (78 % participation rate) completed a five-year visit (mean of 5.6 years follow-up). At baseline, 71.9 % of these participants reported back pain for ≥5 years, 27.7 % were taking opioids, and 61.8 % had prior therapeutic lumbar spinal injections. Pain and functional improvements were significant at 5-years with a mean improvement in NPS of 4.32 ± 2.45 points (95 % CI 4.01, 4.63; p < 0.0001) from 6.79 ± 1.32 at baseline and a mean improvement in ODI of 28.0 ± 17.5 (95 % CI 25.8, 30.2; p < 0.0001) from 44.5 ± 11.0 at baseline. Nearly one-third (32.1 %) of patients reported being pain-free (NPS = 0) at five years, 72.7 % of patients indicated their condition improved and 68.7 % had resumed activity levels they had prior to onset of CLBP. In the sixty-nine participants taking opioids at baseline, 65.2 % were no longer taking them at 5-years, and spinal injections decreased by 58.1 %. The rate of lumbosacral treatment (therapeutic spinal injection, radiofrequency ablation, or surgery) for the same index pain source and vertebral level was 33/249 (13.2 %) at 5 years post BVNA; including a 6.0 % rate of lumbar fusion. There were no serious device or device-procedure related adverse events reported during the long-term follow-up. Conclusion: In this 5-year aggregate analysis, BVNA significantly improved pain and function scores compared to baseline. Similarly, there were significant reductions in opioid consumption and spinal injections post BVNA. Data demonstrate a strong safety profile with no serious device or device-related events and low healthcare utilization rate for the same index pain source through a mean of 5.6 years. Results demonstrate that intraosseous BVNA treatment for patients with vertebrogenic pain is safe, effective, and durable through five years.Item Esketamine vs. placebo combined with erector spinae plane block vs. intercostal nerve block on quality of recovery following thoracoscopic lung resection: a randomized controlled factorial trial(Wolters Kluwer, 2024-08-22) Hu, Jing-hui; Zhong, Zhang-zhen; Shi, Hai-jing; Wang, Jie; Chen, Shaomu; Shan, Xi-sheng; Liu, Hua-yue; Liu, Hong; Meng, Lingzhong; Ji, Fu-hai; Peng, Ke; Anesthesia, School of MedicineBackground: Multimodal analgesic strategy is pivotal for enhanced recovery after surgery. The objective of this trial was to assess the effect of subanesthetic esketamine vs. placebo combined with erector spinae plane block (ESPB) vs. intercostal nerve block (ICNB) on postoperative recovery following thoracoscopic lung resection. Materials and methods: This randomized, controlled, 2×2 factorial trial was conducted at a university hospital in Suzhou, China. One hundred adult patients undergoing thoracoscopic lung surgery were randomized to one of four groups (esketamine-ESPB, esketamine-ICNB, placebo-ESPB, and placebo-ICNB) to receive i.v. esketamine 0.3 mg/kg or normal saline placebo combined with ESPB or ICNB using 0.375% ropivacaine 20 mL. All patients received flurbiprofen axetil and patient-controlled fentanyl. The primary outcome was quality of recovery (QoR) at 24 h postoperatively, assessed using the QoR-15 scale, with a minimal clinically important difference of 6.0. Results: The median age was 57 years and 52% were female. No significant interaction effect was found between esketamine and regional blocks on QoR (P=0.215). The QoR-15 score at 24 h was 111.5±5.8 in the esketamine group vs. 105.4±4.5 in the placebo group (difference=6.1, 95% CI, 4.0-8.1; P<0.001); 109.7±6.2 in the ESPB group vs. 107.2±5.6 in the ICNB group (difference=2.5, 95% CI, 0.2-4.9; P=0.033; not statistically significant after Bonferroni correction). Additionally, esketamine resulted in higher QoR-15 scores at 48 h (difference=4.6) and hospital discharge (difference=1.6), while ESPB led to a higher QoR-15 score at 48 h (difference=3.0). Conclusions: For patients undergoing thoracoscopic lung resection, subanesthetic esketamine improved QoR after surgery, while ICNB can be used interchangeably with ESPB as a component of multimodal analgesia.Item Integrated Feedforward and Feedback Mechanisms in Neurovascular Coupling(Wolters Kluwer, 2024-12) Meng, Lingzhong; Rasmussen, Mads; Meng, Deyi M.; White, Fletcher A.; Wu, Long-Jun; Anesthesia, School of MedicineNeurovascular coupling (NVC) is the mechanism that drives the neurovascular response to neural activation, and NVC dysfunction has been implicated in various neurologic diseases. NVC is driven by (1) nonmetabolic feedforward mechanisms that are mediated by various signaling pathways and (2) metabolic feedback mechanisms that involve metabolic factors. However, the interplay between these feedback and feedforward mechanisms remains unresolved. We propose that feedforward mechanisms normally drive a swift, neural activation–induced regional cerebral blood flow (rCBF) overshoot, which floods the tissue beds, leading to local hypocapnia and hyperoxia. The feedback mechanisms are triggered by the resultant hypocapnia (not hyperoxia), which causes cerebral vasoconstriction in the neurovascular unit that counterbalances the rCBF overshoot and returns rCBF to a level that matches the metabolic activity. If feedforward mechanisms function improperly (eg, in a disease state), the rCBF overshoot, tissue-bed flooding, and local hypocapnia fail to occur or occur on a smaller scale. Consequently, the neural activation–related increase in metabolic activity results in local hypercapnia and hypoxia, both of which drive cerebral vasodilation and increase rCBF. Thus, feedback mechanisms ensure the brain milieu’s stability when feedforward mechanisms are impaired. Our proposal integrates the feedforward and feedback mechanisms underlying NVC and suggests that these 2 mechanisms work like a fail-safe system, to a certain degree. We also discussed the difference between NVC and cerebral metabolic rate-CBF coupling and the clinical implications of our proposed framework.Item Impact of high spinal anesthesia in pediatric congenital heart surgery on postoperative recovery: a retrospective propensity score-matched study(AME, 2024) Sivamurugan, Aravinthasamy; Sondekoppam, Rakesh; Rier, Alex; Sadek, Nada; Subramani, Sudhakar; Rajagopal, Srinivasan; Ranganath, Yatish; Singhal, Arun K.; Hanada, Satoshi; Anesthesia, School of MedicineBackground: High spinal anesthesia (HSA) has been utilized in cardiac surgery; however, there is limited evidence on its impact on facilitating postoperative recovery. This study aimed to evaluate the impact of HSA in pediatric congenital heart surgery on postoperative recovery. Methods: A single center, propensity score-matched retrospective cohort study was designed using data from pediatric patients under 18 years old, who underwent congenital heart surgeries classified as Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) score 3 or less. The comparison was made between the HSA group, who received HSA in addition to general anesthesia (GA), and the GA group, who received GA alone. The primary outcome was the odds of patients being extubated in the operating room. Secondary outcomes included the odds of patients being extubated within 6 hours after intensive care unit (ICU) admission, as well as the length of stay (LOS) in the ICU and the hospital. Results: A total of 566 cases were eligible for this study, with 224 cases in the HSA group and 342 cases in the GA group. Propensity score-matching yielded a total of 197 pairs of patients. The rates of extubation in the operating room and within 6 hours after ICU admission were significantly higher in the HSA group compared to the GA group [65.5% vs. 33.5%, odds ratio 3.82, 95% confidence interval (CI): 2.5 to 5.8, P<0.001; 82.7% vs. 61.9%, odds ratio 2.95, 95% CI: 1.9 to 4.7, P<0.001, respectively]. The LOS in the ICU was significantly shorter in the HSA group while there was no significant difference in the LOS in the hospital between groups (5.1 vs. 8.0 days, P<0.001; 8.7 vs. 9.5 days, P<0.60, respectively). Conclusions: The addition of HSA to GA in fast-track pediatric congenital heart surgery was associated with increased odds of extubation in the operating room, within 6 hours of ICU admission, and with a shorter LOS in the ICU. Future randomized controlled trials are needed to confirm these results.