Anesthesiology
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The current state of knowledge suggests that disruption of neuronal information integration may be a common mechanism of anesthetic-induced unconsciousness. A neural system critical for information integration is the thalamocortical system whose specific and nonspecific divisions may play the roles for representing and integrating information, respectively. How anesthetics affect the function of these systems individually is not completely understood. The authors studied the effect of propofol on thalamocortical functional connectivity in the specific and nonspecific systems, using functional magnetic resonance imaging. ⋯ Propofol conferred differential changes in functional connectivity of the specific and nonspecific thalamocortical systems, particularly in left hemisphere, consistent with the verbal nature of stimuli and task. The changes in nonspecific thalamocortical connectivity may correlate with the loss and return of consciousness.
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In animal models, several anesthetics induce widespread increases in neuronal apoptosis in the developing brain with subsequent neurologic deficits. Although the mechanisms are largely unknown, the neurotoxicity may, at least in part, be due to elevated oxidative stress caused by mitochondrial dysfunction. In an investigation of potential therapies that could protect against this type of damage, we studied the effects of molecular hydrogen on anesthetic-induced neurotoxicity in the developing mouse brain. ⋯ Inhalation of hydrogen gas robustly decreased neuronal apoptosis and subsequent cognitive impairments caused by neonatal exposure to sevoflurane.
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Evaluating patient-reported outcomes is complex. These difficulties may explain weaknesses with some existing tools: mainly, they rely on expert instead of patient views or are not metrically sound. The purpose of this study was to develop and validate a multidimensional self-reported questionnaire, specifically assessing the satisfaction of patients undergoing regional anesthesia, Evaluation du Vécu de l'Anesthésie LocoRégionale (EVAN-LR). ⋯ The authors have validated a new measuring tool assessing patient satisfaction within the perioperative period surrounding regional anesthesia. The multidimensional structure of EVAN-LR allows it to be used as a clinical tool for improving anesthesia management.