British journal of anaesthesia
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Peripheral surgical trauma can trigger neuroinflammation and ensuing neurological complications, such as delirium. The mechanisms whereby surgery contributes to postoperative neuroinflammation remain unclear and without effective therapies. Here, we developed a microfluidic-assisted blood-brain barrier (BBB) device and tested the effects of omega-3 fatty acids on neuroimmune interactions after orthopaedic surgery. ⋯ We present a new approach to study neuroimmune interactions relevant to perioperative recovery using a microphysiological BBB platform. Changes in barrier function, including dysregulation of pericytes and perivascular macrophages, provide new targets to reduce postoperative delirium.
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Acquired factor XIII (FXIII) deficiency after major surgery can increase postoperative bleeding. We evaluated FXIII contribution to clot strength and the effect of fibrinogen concentrate administration on FXIII activity in infants undergoing cardiac surgery using cardiopulmonary bypass. ⋯ ISRCTN: 50553029.
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Previous studies indicated an association between impaired cerebral perfusion and post-procedural neurological disorders. We investigated whether intra-procedural hypoxaemia or hypocapnia are associated with delirium after surgery. ⋯ Intra-procedural hypoxaemia and hypocapnia were dose-dependently associated with a higher risk of postoperative delirium. These findings support maintaining normal gas exchange to avoid postoperative neurological disorders.
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The novel synthetic neuroactive steroid (3β,5β,17β)-3-hydroxyandrostane-17-carbonitrile (3β-OH) blocks T-type calcium channels but does not directly modulate neuronal γ-aminobutyric acid type A (GABAA) currents like other anaesthetic neurosteroids. As 3β-OH has sex-specific hypnotic effects in adult rats, we studied the mechanism contributing to sex differences in its effects. ⋯ The sex-specific differences in the hypnotic effect of 3β-OH in mice are attributable to differences in its peripheral metabolism into the more potent hypnotic metabolite 3α-OH.
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Editorial Comment
Assessment of haemostatic function in paediatric surgical patients: 'if you prick us, do we not bleed?'.
Healthy babies have ∼50% of adult procoagulant factor levels, but without an increased risk of bruising or bleeding. The preoperative clotting tests, prothrombin time and partial thromboplastin time, are frequently performed in infants and children. However, the clinical usefulness of screening coagulation tests remains controversial. ⋯ Enhanced coagulability was previously demonstrated on some viscoelastic testing devices using blood from younger infants. This editorial focuses on several key findings from the paediatric reference range study using a new whole blood viscoelastic coagulation test system, ClotPro® (Haemonetics, Boston, MA, USA). Altered clotting patterns in younger infants, underlying mechanisms of coagulation, and potential clinical implications are discussed.