Anesthesiology
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The objective was to investigate if cryoneurolysis were superior to sham in reducing pain intensity in patients with chronic knee osteoarthritis. We hypothesized that cryoneurolysis was an effective and safe therapy to reduce chronic pain in patients with knee osteoarthritis. ⋯ This study did not show a clinically relevant reduction in pain after intervention comparing cryoneurolysis and sham. Further studies are needed.
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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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Tranexamic acid is an anti-fibrinolytic agent routinely used during hip and knee joint replacement surgery to minimize bleeding. Chronic kidney disease is a common chronic health problem seen among adults requiring major arthroplasty surgery. Tranexamic acid is renally cleared and may accumulate in chronic kidney disease. Optimal tranexamic acid dosing and dose adjustment for chronic kidney disease patients needing major arthroplasty is unknown. The objective of this study was to serially measure plasma tranexamic acid concentrations in patients with varied kidney function undergoing hip or knee replacement surgery for population pharmacokinetic modelling and to guide new dosing recommendations. ⋯ Using population pharmacokinetic modelling and simulation, we recommend a new dosing regimen to optimize the anti-fibrinolytic effect of tranexamic acid and avoid excessive dosing.
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The medial prefrontal cortex plays a crucial role in regulating consciousness. However, the specific functions of its excitatory and inhibitory networks during anesthesia remain uncertain. Here we explored the hypothesis that somatostatin interneurons in the medial prefrontal cortex enhance the effects of sevoflurane anesthesia by increasing GABA transmission to pyramidal neurons. ⋯ Cortical somatostatin neurons may inhibit local pyramidal neurons by enhancing GABA transmission, which increases the effectiveness of sevoflurane anesthesia.
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Longitudinal Milestones data reported to the Accreditation Council for Graduate Medical Education (ACGME) provide a structured framework for assessing the developmental progression of residents in key competencies and subcompetencies. This study aims to investigate the previously underexplored longitudinal reliability of Milestones data, with the goal of identifying patterns in learning trajectories that can inform targeted interventions for residents and programs. ⋯ Our study indicated that the anesthesiology Milestones provides moderately reliable information for tracking individual progress over time. The findings underscore the importance of using a multi-faceted approach to assessment and providing individualized learning plans to support resident development.