Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2019
ReviewAssessing Long-term Neurodevelopmental Outcome Following General Anesthesia in Early Childhood: Challenges and Opportunities.
Neurodegeneration has been reported in young animals after exposure to all commonly used general anesthetic agents. The brain may be particularly vulnerable to anesthetic toxicity during peak synaptogenesis (in gestation and infancy). Human studies of long-term neurodevelopmental outcome following general anesthesia in early childhood report contradictory findings. ⋯ We discuss potential solutions to these challenges. Further adequately powered, multicenter, prospective randomized controlled trials of anesthetic-induced neurotoxicity in children are required. However, we believe that the inherent methodological challenges of studying anesthetic-induced neurotoxicity necessitate the parallel use of well-designed observational cohort studies.
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Anesthesia and analgesia · Apr 2019
Progressive Increase in Scholarly Productivity of New American Board of Anesthesiology Diplomates From 2006 to 2016: A Bibliometric Analysis.
Improving research productivity is a common goal in academic anesthesiology. Initiatives to enhance scholarly productivity in anesthesiology were proposed more than a decade ago as a result of emphasis on clinical work. We hypothesized that American Board of Anesthesiology diplomates certified from 2006 to 2016 would be progressively more likely to have published at least once during this time period. ⋯ Publications by new diplomates of the American Board of Anesthesiology have increased between 2006 and 2016. Whether the observed increase in publications could reflect efforts to stimulate interest in academic objectives during training remains to be proven.
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Anesthesia and analgesia · Apr 2019
ReviewGlymphatic System Function in Relation to Anesthesia and Sleep States.
The brain is one of the most metabolically active organs in the body. The brain's high energy demand associated with wakefulness persists during rapid eye movement sleep, and even during non-rapid eye movement sleep, cerebral oxygen consumption is only reduced by 20%. The active bioenergetic state parallels metabolic waste production at a higher rate than in other organs, and the lack of lymphatic vasculature in brain parenchyma is therefore a conundrum. ⋯ Over the past 5 years, emerging data have begun to shed new light on these processes in the form of the "glymphatic system," a novel brain-wide perivascular transit passageway dedicated to CSF transport and metabolic waste drainage from the brain. Here, we review the key anatomical components and operational drivers of the brain's glymphatic system, with a focus on its unique functional dependence on the state of arousal and anesthetic regimens. We also discuss evidence for why clinical exploration of this novel system may in the future provide valuable insight into new strategies for preventing delirium and cognitive dysfunction in perioperative and critical care settings.