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Novel Challenges and Advances in Anesthesiology and Pain Management
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Novel Challenges and Advances in Anesthesiology and Pain Management

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Clinical Medicine, Cell, and Organism Physiology".

Deadline for manuscript submissions: closed (5 September 2023) | Viewed by 11784

Special Issue Editor

Dr. Diansan Su

E-Mail Website
Guest Editor
Department of Anaesthesiology, Renji Hospital, School of Medicine Shanghai Jiaotong University, Shanghai, China
Interests: anesthesiology; perioperative management; postoperative cognitive dysfunction

Special Issue Information

Dear Colleagues,

Anesthesiology is an essential part of surgery and crucial in ensuring patient safety and promoting high-quality recovery after surgery. In recent years, the concept of anesthesiology has evolved into perioperative medicine, which encompasses preoperative evaluation, intraoperative anesthesia management, and enhanced recovery after surgery. Despite advancements in the field of surgery and anesthesia, the perioperative mortality rate remains high at 1.4% in the United States and 4% in Europe. Chronic pain affects 30% of patients, and perioperative stroke affects 10%.

The aim of this Special Issue is to bring together researchers in the field of anesthesiology and perioperative medicine to address the novel challenges and advances in the field. The scope of the Special Issue includes but is not limited to:

  1. Overview of recent research trends and hotspots in anesthesiology and pain management.
  2. Preclinical research focused on neuroscience to understand the mechanisms of anesthesia and pain-related topics, including general anesthesia, pain development, postoperative cognitive decline, stroke, and sepsis.
  3. Clinical research, including new methods and concepts for perioperative management and prevention of anesthesia-related topics.
  4. Other works discussing novel challenges and advancements in anesthesiology and pain management.

We encourage researchers to submit cutting-edge research on advancements in anesthesiology and pain management and to provide their own thoughts and insights. We especially welcome preclinical research that offers innovative ideas and potential targets for individual therapy.

Dr. Diansan Su
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • anesthesia
  • pain
  • perioperative management
  • mechanism

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Further information on MDPI's Special Issue polices can be found here.

Published Papers (6 papers)

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Research

12 pages, 2119 KiB  
Article
Myocardial Priority Promotes Cardiovascular Recovery for Acute Type A Aortic Dissection Combined with Coronary Artery Disease Undergoing Aortic Arch Surgery
by Lian Duan, Chengliang Zhang, Xuliang Chen, E Wang, Zhi Ye, Yanying Duan and Lingjin Huang
J. Pers. Med. 2023, 13(9), 1296; https://doi.org/10.3390/jpm13091296 - 25 Aug 2023
Viewed by 1205
Abstract
The optimal surgical strategy for acute type A aortic dissection (ATAAD) with coronary artery disease (CAD) remains unclear. The goal of this study was to investigate the cardiovascular protective effects of the myocardial priority (MP) strategy or traditional selective cerebral perfusion (SCP) in [...] Read more.
The optimal surgical strategy for acute type A aortic dissection (ATAAD) with coronary artery disease (CAD) remains unclear. The goal of this study was to investigate the cardiovascular protective effects of the myocardial priority (MP) strategy or traditional selective cerebral perfusion (SCP) in ATAAD with CAD. A total of 214 adults were analyzed retrospectively, of which 80 underwent the MP strategy intraoperatively. Seventy-nine pairs were propensity-score-matched and divided into SCP and MP groups. The follow-up period ranged from 6 to 36 months. The MP group had a significantly shorter myocardial ischemic time, higher perfusion flow, higher radial artery pressure, and lower incidence of NIRS decrease >20% of the base value, but a longer lower limb circulatory arrest and bypass time than the SCP group. Although similar adverse cardiac and cerebrovascular events were observed in both groups, a shorter posthospital stay, less blood loss and transfusion, higher postoperative hemoglobin, lower creatinine, and higher PaO2/FiO2 were observed in the MP group. Subgroup analysis showed that when the TIMI Risk Score was <4, the MP group had a lower incidence of low cardiac output and lower postoperative cTnI level. The follow-up patients had similar morbidities between the two groups. The novel MP strategy is associated with a shortened myocardial ischemic time, better maintained perfusion of vital organs, and postoperative recovery after surgery for ATAAD combined with non-severe CAD. Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Anesthesiology and Pain Management)
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12 pages, 835 KiB  
Article
Total Intravenous Anesthesia Protocol for Decreasing Unacceptable Movements during Cerebral Aneurysm Clipping with Motor-Evoked Potential Monitoring: A Historical Control Study and Meta-Analysis
by Yong-Seok Park, Yong-Seo Koo, Seungil Ha, Sangho Lee, Ji-Hoon Sim and Joung Uk Kim
J. Pers. Med. 2023, 13(8), 1266; https://doi.org/10.3390/jpm13081266 - 16 Aug 2023
Viewed by 1584
Abstract
Injury can occur during intraoperative transcranial motor-evoked potential (MEP) monitoring caused by patient movement related to insufficient neuromuscular blocking agent use. Here, we evaluated the incidence of unacceptable movements in patients undergoing intraoperative MEP monitoring following our anesthetic protocol. We reviewed the anesthesia [...] Read more.
Injury can occur during intraoperative transcranial motor-evoked potential (MEP) monitoring caused by patient movement related to insufficient neuromuscular blocking agent use. Here, we evaluated the incidence of unacceptable movements in patients undergoing intraoperative MEP monitoring following our anesthetic protocol. We reviewed the anesthesia records of 419 patients who underwent unruptured cerebral aneurysm clipping with intraoperative MEP monitoring. The anesthetic protocol included target-controlled infusion with a fixed effect-site propofol concentration of 3 μg/mL and an adjustable effect-site remifentanil concentration of 10–12 ng/mL. We compared our findings of the intraoperative parameters and incidence of spontaneous movement and respiration with those of published meta-analysis studies. Spontaneous movement and respiration occurred in one (0.2%) patient each. The meta-analysis included six studies. The pooled proportions of spontaneous movement and respiration were 6.9% (95% confidence interval [CI], 1.3–16.5%) and 4.1% (95% CI, 0.5–14.1%), respectively. The proportion of spontaneous movement in our study was significantly lower than that in previous studies (p = 0.013), with no significant difference in spontaneous respiration (p = 0.097). Following our center’s anesthesia protocol during cerebral aneurysm clipping resulted in a low incidence of spontaneous respiration and movement, indicating its safety for patients undergoing intraoperative MEP monitoring. Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Anesthesiology and Pain Management)
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20 pages, 9546 KiB  
Article
The Role of LincRNA-EPS/Sirt1/Autophagy Pathway in the Neuroprotection Process by Hydrogen against OGD/R-Induced Hippocampal HT22 Cells Injury
by Ya-Hong Li, Shun Zhang, Lu Tang, Jianguo Feng, Jing Jia, Ye Chen, Li Liu and Jun Zhou
J. Pers. Med. 2023, 13(4), 631; https://doi.org/10.3390/jpm13040631 - 3 Apr 2023
Viewed by 1892
Abstract
Cerebral ischemia/reperfusion (CI/R) injury causes high disability and mortality. Hydrogen (H2) enhances tolerance to an announced ischemic event; however, the therapeutic targets for the effective treatment of CI/R injury remain uncertain. Long non-coding RNA lincRNA-erythroid prosurvival (EPS) (lincRNA-EPS) regulate various biological [...] Read more.
Cerebral ischemia/reperfusion (CI/R) injury causes high disability and mortality. Hydrogen (H2) enhances tolerance to an announced ischemic event; however, the therapeutic targets for the effective treatment of CI/R injury remain uncertain. Long non-coding RNA lincRNA-erythroid prosurvival (EPS) (lincRNA-EPS) regulate various biological processes, but their involvement in the effects of H2 and their associated underlying mechanisms still needs clarification. Herein, we examine the function of the lincRNA-EPS/Sirt1/autophagy pathway in the neuroprotection of H2 against CI/R injury. HT22 cells and an oxygen-glucose deprivation/reoxygenation (OGD/R) model were used to mimic CI/R injury in vitro. H2, 3-MA (an autophagy inhibitor), and RAPA (an autophagy agonist) were then administered, respectively. Autophagy, neuro-proinflammation, and apoptosis were evaluated by Western blot, enzyme-linked immunosorbent assay, immunofluorescence staining, real-time PCR, and flow cytometry. The results demonstrated that H2 attenuated HT22 cell injury, which would be confirmed by the improved cell survival rate and decreased levels of lactate dehydrogenase. Furthermore, H2 remarkably improved cell injury after OGD/R insult via decreasing pro-inflammatory factors, as well as suppressing apoptosis. Intriguingly, the protection of H2 against neuronal OGD/R injury was abolished by rapamycin. Importantly, the ability of H2 to promote lincRNA-EPS and Sirt1 expression and inhibit autophagy were abrogated by the siRNA-lincRNA-EPS. Taken together, the findings proved that neuronal cell injury caused by OGD/R is efficiently prevented by H2 via modulating lincRNA-EPS/Sirt1/autophagy-dependent pathway. It was hinted that lincRNA-EPS might be a potential target for the H2 treatment of CI/R injury. Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Anesthesiology and Pain Management)
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12 pages, 998 KiB  
Article
Effects of Dezocine on the Reduction of Emergence Delirium after Laparoscopic Surgery: A Retrospective Propensity Score-Matched Cohort Study
by Lu Wang, Qiong Yi, Chunyan Ye, Ning Luo and E Wang
J. Pers. Med. 2023, 13(4), 590; https://doi.org/10.3390/jpm13040590 - 28 Mar 2023
Cited by 3 | Viewed by 1393
Abstract
In China, dezocine is commonly employed as a partial agonist of mu/kappa opioid receptors during anesthesia induction for surgical patients, yet evidence supporting its causal association with emergence delirium is limited. The objective of this investigation was to evaluate the impact of intravenous [...] Read more.
In China, dezocine is commonly employed as a partial agonist of mu/kappa opioid receptors during anesthesia induction for surgical patients, yet evidence supporting its causal association with emergence delirium is limited. The objective of this investigation was to evaluate the impact of intravenous dezocine administered during anesthesia induction on emergence delirium. The retrospective studied existing data containing medical records of patients undergoing an elective laparoscopy procedure and the study was conducted with ethics-board approval. The primary outcome was the incidence of emergence delirium. Secondary outcomes included the VAS in the PACU and 24 h after surgery, the RASS score in the PACU, postoperative MMSE, hospital stay, and ICU stay. A total of 681 patients were analyzed, after being propensity score-matched, the dezocine and non-dezocine group each had 245 patients. Emergence delirium occurred in 26/245 (10.6%) of patients who received dezocine and 41/245 (16.7%) of patients did not receive dezocine. Patients on whom dezocine was used were associated with a significantly lower incidence of emergence delirium (absolute risk difference, −6.1%, 95% CI, −12% to −0.2%; relative risk [RR], 0.63; 95% CI, 0.18–0.74). All secondary outcome measures and adverse outcomes were not significantly different. The use of dezocine during anesthesia induction was associated with a decreased incidence of emergence delirium after elective laparoscopic surgeries. Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Anesthesiology and Pain Management)
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14 pages, 1796 KiB  
Article
Intraoperative Hypertension Is Associated with Postoperative Acute Kidney Injury after Laparoscopic Surgery
by Yongzhong Tang, Bo Li, Wen Ouyang, Guiping Jiang, Hongjia Tang and Xing Liu
J. Pers. Med. 2023, 13(3), 541; https://doi.org/10.3390/jpm13030541 - 17 Mar 2023
Cited by 4 | Viewed by 2180
Abstract
Background: It is well demonstrated that intraoperative blood pressure is associated with postoperative acute kidney injury (AKI); however, the association between severity and duration of abnormal intraoperative blood pressure (BP) with AKI in patients undergoing laparoscopic surgery remains unknown. Methods: This retrospective cohort [...] Read more.
Background: It is well demonstrated that intraoperative blood pressure is associated with postoperative acute kidney injury (AKI); however, the association between severity and duration of abnormal intraoperative blood pressure (BP) with AKI in patients undergoing laparoscopic surgery remains unknown. Methods: This retrospective cohort study included 12,414 patients aged ≥ 18 years who underwent a single elective laparoscopic abdominal surgery during hospitalization between October 2011 and April 2017. Multivariate stepwise logistic regressions were applied to determine the correlation between the severity and duration of intraoperative mean arterial pressure (MAP, (systolic BP + 2 × diastolic BP)/3), acute intraoperative hypertension (IOTH) and postoperative AKI, in different periods of surgery. Results: A total of 482 hospitalized patients (3.9%) developed surgery-related AKI. Compared with those without IOTH or with preoperative mean MAP (80–85 mmHg), acute elevated IOTH (odds ratio, OR, 1.4, 95% CI, 1.1 to 1.7), mean MAP 95–100 mmHg (OR, 1.8; 95% CI, 1.3 to 2.7), MAP 100–105 mmHg (OR, 2.4; 95% CI, 1.6 to 3.8), and more than 105 mmHg (OR, 1.9; 95% CI, 1.1 to 3.3) were independent of other risk factors in a diverse cohort undergoing laparoscopic surgery. In addition, the risk of postoperative AKI appeared to result from long exposure (≥20 min) to IOTH (OR, 1.9; 95% CI, 1.5 to 2.5) and MAP ≥ 115 mmHg (OR, 2.2; 95% CI, 1.6 to 3.0). Intraoperative hypotension was not found to be associated with AKI in laparoscopic surgery patients. Conclusions: Postoperative AKI correlates positively with intraoperative hypertension in patients undergoing laparoscopic surgery. These findings provide an intraoperative evaluation criterion to predict the occurrence of postoperative AKI. Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Anesthesiology and Pain Management)
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11 pages, 1346 KiB  
Article
Pain Trajectory after Short-Stay Anorectal Surgery: A Prospective Observational Study
by Yujiao Zhang, Yangyang Xia, Yue Yong, Yalan Zhou, Zhiyu Yin, Jing Wang, Ling Mei, Wei Song, Jian Wang and Jiangang Song
J. Pers. Med. 2023, 13(3), 528; https://doi.org/10.3390/jpm13030528 - 15 Mar 2023
Cited by 3 | Viewed by 2595
Abstract
The evolution of pain after anorectal surgery has not been well characterized. The main objective of this study is to evaluate patterns in acute postoperative pain in patients undergoing short-stay anorectal surgery. A total of 217 patients were included in the study, which [...] Read more.
The evolution of pain after anorectal surgery has not been well characterized. The main objective of this study is to evaluate patterns in acute postoperative pain in patients undergoing short-stay anorectal surgery. A total of 217 patients were included in the study, which used group-based trajectory modeling to estimate postoperative pain and then examined the relationships between sociodemographic or surgical factors and pain trajectories. Three distinct postoperative pain trajectories were determined: hemorrhoidectomy (OR, 0.15), higher anxiety (OR, 3.26), and a higher preoperative pain behavior score (OR, 3.15). In multivariate analysis, they were associated with an increased likelihood of being on the high pain trajectory. The pain trajectory group was related to postoperative analgesic use (p < 0.001), with the high-low group needing more nonsteroidal analgesics. The study showed that there were three obvious pain trajectories after anorectal surgery, including an unreported low-moderate-low type. More than 60% of patients maintained moderate to severe pain within 7 days after the operation. These postoperative pain trajectories were predominantly defined by surgery factors and patient factors. Full article
(This article belongs to the Special Issue Novel Challenges and Advances in Anesthesiology and Pain Management)
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