Articles: anesthetics.
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J Neurosurg Anesthesiol · Jan 2025
Anesthesia for the Pregnant Patient Undergoing Intracranial Procedures.
This focused review explores the current literature on anesthetic care of pregnant patients requiring intracranial intervention. Neuropathology in pregnancy is rare, and existing evidence for management remains limited by the ethical complexities surrounding maternal and fetal research-related risks; pregnant women are typically excluded from randomized controlled trials. Physiological changes during pregnancy, combined with additional fetal considerations, alter pharmacodynamics and complicate the safety profile of maternal interventions. ⋯ Emphasis is placed on the importance of multidisciplinary collaboration to ensure safe, patient-centered care tailored to neuropathology, gestational age, and clinical status. Despite recent advances, significant gaps in evidence persist. Further research from large retrospective or observational data sets is recommended to improve evidence-based approaches for managing this complex and uncommon patient population.
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Multi-compartment computer models of heterogeneity in alveolar ventilation-perfusion ratios (VA/Q scatter) across the lung explain the significant alveolar-arterial (A-a) partial pressure gradients and associated alveolar dead-space fractions (VDA/VA) seen in anesthetized patients for both carbon dioxide and for anesthetic gases of different blood solubilities. However, the accuracy of a simpler two-compartment model of VA/Q scatter to do this has not been tested or compared to calculations from the traditional Riley model with "ideal", unventilated (shunt) and unperfused (deadspace) compartments. ⋯ Satisfactory prediction of the A-a partial pressure gradients and alveolar dead-space for the modern volatile anesthetic gases measured in vivo requires a model with more than one gas-exchanging lung compartments, which the traditional Riley model lacks. A simple "reciprocal" two-compartment model achieves this.
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Randomized Controlled Trial
Pharmacokinetics and pharmacodynamics of ciprofol after continuous infusion in elderly patients.
Ciprofol, a novel intravenous anesthetic, which has primarily been used for the induction and maintenance of general anesthesia in adults, is characterized by rapid onset, short duration of action, and quick and smooth recovery. However, the pharmacokinetic characteristics of continuous infusions and the correlation between the plasma concentration and the bispectral index (BIS) in elderly patients are still unknown. ⋯ Ciprofol, a novel intravenous anesthetic, can be safely and effectively used in elderly patient continuous infusion with minimal injection pain. Plasma concentrations of ciprofol correlate well with BIS values, helping control sedation depth. For elderly patients undergoing gastrointestinal tumor surgery, an optimal maintenance dose of 0.8 mg/kg/h is recommended.
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Complexity of neuronal firing patterns may serve as an indicator of sensory information processing across different states of consciousness. Recent studies have shown that spontaneous changes in brain states can occur during general anesthesia, which may influence neuronal complexity and the state of consciousness. In this study, we investigated how the firing patterns of cortical neurons, both at rest and during visual stimulation, are affected by spontaneously changing brain states under varying levels of anesthesia. ⋯ However, this was contradicted by the observation of low neuronal complexity in both spontaneous and stimulus-related spike activity, which more closely aligns with unconsciousness. Our findings reveal that transient neuronal states with distinct spiking patterns can emerge in visual cortex at constant anesthetic concentrations. The reduced complexity in states associated with deep anesthesia likely indicates a disruption of conscious sensory information processing.