Articles: anesthesia.
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Substance P is a neuropeptide with a pivotal role in pain transmission and modulation. Preclinical studies suggest that targeting substance P and inhibiting its receptor, neurokinin 1 (NK-1), is a potential avenue for pain relief. When translated into clinical settings, these preliminary findings yielded mixed results. This meta-analysis of randomized controlled trials (RCTs) aims to investigate whether a preemptive administration of NK-1 antagonists may reduce postoperative pain. ⋯ Preoperative single-administration of NK-1 antagonists reduces postoperative pain. The observed pain reduction pattern is consistent with the pharmacokinetics (half-life 9-12 h) of these inhibitors and with data from preclinical studies.
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The traditional management of pregnant patients with Chiari I malformation (CM-I) heavily favors cesarean section and general anesthesia to limit the perceived risk of maternal neurological complications attributed to vaginal delivery and neuraxial anesthesia. The aim of this study was to compare reported neurological symptoms and radiographic presentations before and after childbirth performed by patients with CM-I, with and without associated syrinx. ⋯ Our findings suggest that patients with CM-I may deliver vaginally and receive neuraxial anesthesia with low risk of neurological complications or radiographic worsening. As these patients were not prospectively selected, limitations exist, and it remains important to consider the severity of the patient's clinical and radiographic presentation when selecting anesthetic and delivery modality.
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J Clin Monit Comput · Feb 2025
Personalized intraoperative arterial pressure management and mitochondrial oxygen tension in patients having major non-cardiac surgery: a pilot substudy of the IMPROVE trial.
The "Cellular Oxygen METabolism" (COMET) system (Photonics Healthcare, Utrecht, The Netherlands) non-invasively measures mitochondrial oxygen tension (mitoPO2) in the skin. The effects of general anesthesia and major non-cardiac surgery on mitoPO2 remain unknown. In this pre-planned pilot substudy of the "Intraoperative blood pressure Management based on the individual blood PRessure profile: impact on postOperatiVE organ function" (IMPROVE) trial, we measured mitoPO2 from induction of general anesthesia until the end of surgery in 19 major non-cardiac surgery patients (10 assigned to personalized and 9 to routine intraoperative arterial pressure management). ⋯ MitoPO2 under general anesthesia was about a quarter lower than preoperative awake mitoPO2, substantially fluctuated during major non-cardiac surgery, and transiently decreased below 20 mmHg in about two-thirds of the patients. Personalized - compared to routine - intraoperative arterial pressure management did not increase intraoperative mitoPO2. Whether intraoperative decreases in mitoPO2 are clinically meaningful warrants further investigation.
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Prehabilitation aims to enhance preoperative functional capacity through exercise, nutrition, and psychological programs. Home-based prehabilitation represents an alternative to hospital prehabilitation, with the advantage of not utilising hospital resources. This review aims to evaluate adherence and clinical effectiveness of home-based prehabilitation. ⋯ PROSPERO (CRD42024591208).