British journal of anaesthesia
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Deciding the optimal time for surgery in patients with pre-existing comorbid disease is complex. A careful balance of risks is required to weigh up the therapeutic benefits of surgery against an increased risk of perioperative adverse outcomes, whereas the subsequent risk of adverse events and mortality is more dependent on pre-existing conditions. A study in a recent issue of BJA shows that people with a previous cardiovascular or cerebrovascular event within 10 yr of elective surgery were at a higher risk of major adverse cardiovascular events within 1 yr from surgery and that an at-risk period existed if surgery occurred within 37 months of the preoperative event. Before this observation can be used to inform clinical decision-making, caution is needed to interpret these findings because of biases introduced by the analytical approach and potential confounding.
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Surgery can induce severe neuroinflammation and negative emotional symptoms, such as anxiety-like behaviour. We studied whether reactive astrocytes in the zona incerta (ZI) mediate surgery-induced anxiety in mice. ⋯ Reactive astrocytes in the zona incerta mediate surgery-induced anxiety, possibly by regulating GAT-3-mediated GABA homeostasis and inactivating ZIGABA→median raphe nucleus projections in mice.