Anesthesiology
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During mechanical ventilation (MV), pulmonary shunt is cardiac output (CO) dependent; however, whether this relationship is valid during unsupported spontaneous breathing (SB) is unknown. The CO dependency of the calculated venous admixture was investigated, with both minor and major shunt, during unsupported SB, MV, and SB with continuous positive airway pressure (CPAP). ⋯ In contrast to MV and CPAP, venous admixture was independent of CO during unsupported SB, and was unaffected by mixed-venous oxygen tension, casting doubt on the role of hypoxic pulmonary vasoconstriction in pulmonary blood flow redistribution during unsupported SB.
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Ketamine is a commonly used anesthetic, but the mechanistic basis for its clinically relevant actions remains to be determined. The authors previously showed that HCN1 channels are inhibited by ketamine and demonstrated that global HCN1 knockout mice are twofold less sensitive to hypnotic actions of ketamine. Although that work identified HCN1 channels as a viable molecular target for ketamine, it did not determine the relevant neural substrate. ⋯ These data indicate that forebrain principal cells represent a relevant neural substrate for HCN1-mediated hypnotic actions of ketamine. The authors suggest that ketamine inhibition of HCN1 shifts cortical neuron electroresponsive properties to contribute to ketamine-induced hypnosis.
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Editorial Comment
Anesthesia for fetal surgery: miles to go before we sleep.