Anesthesiology
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The gut microbiome plays critical roles in human health and disease. Recent studies suggest it may also be associated with chronic pain and postoperative pain outcomes. In animal models, the composition of the gut microbiome changes after general anesthesia and affects the host response to medications, including anesthetics and opioids. ⋯ Additionally, the composition of the gut microbiome has been associated with pain conditions including visceral pain, nociplastic pain, complex regional pain syndrome, and headaches, partly through altered concentration of circulating bacterial-derived metabolites. Furthermore, animal studies demonstrate the critical role of the gut microbiome in neuropathic pain via immunomodulatory mechanisms. This article reviews basic concepts of the human gut microbiome and its interactions with the host and provide a comprehensive overview of the evidence linking the gut microbiome to anesthesiology, critical care, and pain medicine.
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Accurate estimation of surgical transfusion risk is essential for efficient allocation of blood bank resources and for other aspects of anesthetic planning. This study hypothesized that a machine learning model incorporating both surgery- and patient-specific variables would outperform the traditional approach that uses only procedure-specific information, allowing for more efficient allocation of preoperative type and screen orders. ⋯ A personalized transfusion risk prediction model was created using both surgery- and patient-specific variables to guide preoperative type and screen orders and showed better performance compared to the traditional procedure-centric approach.
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Editorial Comment
Mechanical Power: Correlate or Cause of Ventilator-induced Lung Injury?
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The first quantification of neural discharge from the carotid body of cats in response to hypoxia, hypercapnic acidosis, and their combination discovered a strong potentiating effect of hypoxia and hypercapnic acidosis combined as compared to either alone. This paper was the start of a research journey that eventually examined the regulation of blood and cerebrospinal pH by peripheral and central chemoreceptors in the setting of systemic acid-base alterations. This research focus was the result of the author's personal fascination with mountains and human adaptation to high altitude-an interest that led to his own ascent of Mount Everest in 1963. The inherent uncertainty and challenge involved with climbing high mountains has served as a metaphor and inspiration for his life, including his career in academic medicine.