British journal of anaesthesia
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Optimal postoperative pain management is a prerequisite for enhancing functional recovery after surgery. However, many studies assessing analgesic interventions have limitations. Consequently, further improvements in study design are urgently needed. ⋯ Novel clinical trial designs should improve efficiency and enhance the likelihood of detecting relevant treatment effects. Cohort and database studies using propensity score matching and directed acyclic graphs could provide real-world generalisable information. Procedure-specific and patient-specific trials should allow identification of subpopulations most likely to benefit from a particular intervention after a specific surgical procedure and thus ascertain optimal analgesic strategies in challenging populations.
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Anaesthesia has been shown to impair social functioning, but the underlying mechanisms remain largely unknown. The volatile anaesthetic isoflurane potentially disrupts the methionine cycle and trans-sulphuration pathway, contributing to social deficits. Cystathionine-β-synthase (CBS), a key enzyme in this pathway, might be targeted by isoflurane. We investigated the CBS-isoflurane interaction and its role in neuronal function and social behaviour. ⋯ These findings reveal a crucial role for CBS inhibition by isoflurane in anaesthesia-induced social impairment.